Articles Posted in Real Life Story

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I am usually hired by the child of a senior who engages my services and entrusts their loved one’s placement or geriatric care management to me. The child often lives out of state. I would like to share a, “Real LIfe Story,” that not only emphasizes the point in the title, but stirred a deep appreciation for how tirelessly the paid and family caregivers must work.

REAL LIFE STORY

My client is the child of an 86 year old senior. The child lived out of state and hired me to find permanent placement in a nursing home for the parent. The senior was currently completing some short-term rehabilitation under Medicare. The community normally had a waiting list for its long term care beds. The child asked me to find three communities that were within a certain location parameter so that the other sibling and family members. It was also to be of a certain religious affiliation.

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Many of my clients have asked me if they are making a mistake by “preparing too soon,” for a senior loved one’s life changes. My response is you can avoid an emotional and financial crisis by educating yourself with regard to the options for your loved one. Please read the following “Real Life Story” to learn what one of my clients experienced when they were forced into a “rush” decision.

Real Life Story

My clients are a woman and her elderly parents. There is a large age difference between the parents. One is in his/her mid-nineties, while the other is in his/her early eighties. The older of the two parents is totally independent and functioning very well. Unfortunately, the younger parent has dementia, can walk without any assistive devices, and recently began wandering. When a person with dementia wanders once, they will do it again. The parent had held a very prestigious job and was able to talk to me about past responsibilities.

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Sometimes you must face the fact that you are in denial about your senior loved one’s needs. I am sharing the following Real Life Story with you to emphasize that point.

My clients are a family of ten children who attended my, “Senior Living Myths Unmasked,” presentation over three years ago. Their elderly Mother was living alone in a large home. At that time, she had been diagnosed with early onset dementia. The children were divided in their opinions on whether to keep their Mother at home with a caregiver or seek placement in a long term care community. After countless conversations with them, they decided to hire a caregiver on a part-time basis.

The family contacted me recently to advise them on their Mother’s situation which had changed dramatically. The caregiver was helping their mother on a full-time basis. Her finances had changed drastically. Reportedly, she was down to her last $30,000. She owed no money on her home, but the house was not on the market to be sold.

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The popularity of reality TV shows has brought about an overwhelming interest in the disorder of hoarding. I delivered a presentation on the subject this week and was overwhelmed myself by the number of people in the audience who thought they had the disorder themselves. As a senior living advisor and certified care manager who works closely with hoarders, here is a summary of what I shared with my audience.

Hoarding is a disorder that is comprised of three components. First, a person accumulates too many possessions. Second, the person fails to get rid of them. Third, the individual fails to organize the “stuff.” The bottom line is that living spaces that are intended for other uses are so cluttered that they can’t be used for the purpose for which they were designed. The result is that the hoarder suffers distress due to the hoarding.

Here are some of the signs of a chronic hoarder:

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Yesterday I heard a report on Newsradio 780 in Chicago that Illinois was cited as one of the two worst states for nursing home care. The report was very brief and sketchy, so when I had an opportunity, I logged onto their website and read the article. It was only several paragraphs in length so I will just paraphrase what it said.

The report was produced by an advocacy group called Families For Better Care. Their executive director said , “his non-profit reviewed federal data from three groups and put much of the blame on the number of nursing home employees. The staffing in Illinois is nearly abysmal. They practically have skeleton crews working in nursing homes.”

My question is, federal data from what three groups? I am assuming he is talking about the three components that make up the Medicare five star rating system, meaning the annual survey from the Illinois Department Of Public Health (IDPH), the quality measures, and the staffing. As a senior living advisor, I always tell my clients that the five star system has its faults. The only component of that system that I trust somewhat is the survey from the IDPH. The other two components, quality measures and staffing are reported by the nursing home employees. I don’t trust anything that is self- reported.

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This week I was delivering my “Senior Living Myths Unmasked,” presentation to a group of business owners. The discussion on nursing home safety always stirs a lot of emotion and discussion. This week’s presentation wasn’t exempt from a lively discussion regarding the use of bed rails in long term care communities.

I shared a story with the group about a nursing home that had a reputation for terrible care. I had been hired by a client to move his wife from that particular nursing home to one of better quality. In the process of my research, I found that they had incurred 42 deficiencies during their inspection from the Illinois Department of Health (the average number of deficiencies in Illinois is 7), which is a feat that is next to impossible. Upon further investigation, I found that the home had a death in the records with regard to using a bed rail that was unsafe. The details of the death outlined the fact that a resident had a history of constantly climbing out of his bed. He required a bed rail that was waist high to assure his safe entry and departure from the bed. The nursing home maintenance department didn’t have the materials to install a railing at the right height. Some railings can cost as much as $200. Instead of a waist high railing, they installed an eye high railing. When the resident tried to climb out of the bed, he hit his forehead on the rail. His neck became compressed between the rail and the bed. He fell between the mattress, suffocated and died. Unfortunately, a resident may not be able to inhale or scream. At the end of my story, a member of the audience put his hand up and said, “Yes, but my parents were recently in a nursing home in Ohio, and there were no bed rails there. Instead, the home’s staff placed my parents’ mattresses close to the floor.”

Note that the story I shared with the audience occurred a number of years ago and I assured the individual that guidelines for bed rails had changed. The accident that I shared with them is one of the most common tragedies that occurred with the misuse of bed rails. Since the accident, some guidelines for the use of bed rails have been established. Hospitals and nursing homes do not allow the use of four bed rails at once, which is considered to be a restraint. Bed rails may be used with an order from a physician. What you may see are 2 rails used near the head of the bed that can assist the patient or resident with his/her mobility. The Center For Medicare and Medicaid Services does not allow the use of restraints and will no longer pay for treatment of falls if it was caused by an accident with a bed rail.

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The weather in Chicago has fooled us again! Last week, we suffered from the sweltering heat. For the past few days it has been like fall. Tomorrow, it will probably snow. Just as the weather can change on a dime, so can “Seasonal Affective Disorder (SAD) ,” cause depression in a senior at any time of the year.

What is Seasonal Affective Disorder? At is a form of depression that affects seniors (and other people) at the same time of the year every year. My Father started experiencing the symptoms at it at about the same time he was diagnosed with dementia. He had been a “sun worshipper” all of his life and spent hours outside during the summer months reading books. Once the winter months would set in and he was unable to spend time outside, he would experience depression, loss of interest in activities he enjoyed, sleepiness, anxiety, a heavy feeling in his arms and legs, weight gain, and social withdrawal. The symptoms would manifest themselves at the same time of the year. While most people suffer from SAD during the onslaught of fall and winter, some people actually exhibit symptoms in the spring and summer! People who have SAD during those months experience some of the reverse symptoms meaning weight loss, loss of appetite, insomnia along with anxiety, irritability, and agitation. As a Certified Care Manager, it makes sense that I observe so many seniors who (like my Father) experience the disease in the fall/winter. Inclement weather may inhibit a senior’s ability to drive, walk, and attend the activities that make him/her the most happy.

What causes SAD? As with other forms of depression, the causes are unknown. It is suspected that age is a factor along with the an individual’s genetics. Changes in the brain chemical or neurotransmitter, Seratonin, are also though to trigger SAD. This brain chemical affects mood. A reduction in sunlight may cause a drop in Seratonin which increases depression. When the seasons change, the levels of Melatonin may change as well. Melatonin is a hormone that helps with sleeping patterns. SAD is also diagnosed more often in women, but men often experience much more serious symptoms. People who have clinical depression or bipolar depression seem to be prone to SAD. If a person lives far north or south of the equator, the decrease in sunlight during fall or winter may increase the occurrence of the disease.

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I was an advocate for “person-centered care,” long before it became part of elder care terminology. “Person centered care” simply means that a community, or another entity, adapts and delivers care or amenities according to the habits of the senior. As the former Admissions Director of a community that catered to residents at the independent, assisted, and intermediate nursing home level, I knew that flexibility was the key to keeping the place full. Most importantly, it kept the residents happy.

The organization that I represented had not changed much aesthetically or administratively since it was built in the early 1950’s. Consequently, I broke just about every rule in the book (often to the dismay of the religious order that had once reigned there in the past) in order to keep the place filled. At one point, I admitted a cheerful, boisterous, resident who asked me if he could bring his extremely loud, talkative, Cockatiel to live with him when he moved in. I said, “of course,” even though the community had a strict no pets policy. The bird absolutely delighted the residents and I often saw a group of them congregating in the owner’s room before dinner. Another resident’s daughter told me that her Father was a sports fanatic and that he often watched as many as six different events at the same time. Bear in mind, we are talking about events that occurred 15 years ago, and the building was not yet cable friendly. I said, “That’s no problem, we’ll just install a satellite dish outside his window.” You can imagine how many eyebrows I raised when the satellite dish company pulled up and started to hammer away.There was also a long-term resident who confided to me that she had an illness that would eventually cause her to need a feeding tube. She said that above all, she wanted to live out her final days at the community rather than be moved to a nursing home where they could accommodate her needs. I was very touched by her request. I approached the Administrator and asked if there was something we could do for her. He was able to petition the State on a one time basis to allow the feeding tube, and her request was granted! Thankfully, times have changed since then. As a senior living advisor, I have learned that some but not all of the nursing homes are delivering “person-centered care.”

Real Life Story

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A recent article published in the Chicago Tribune entitled “Refund sought; ‘every little dime would help’ emphasizes two important points. First, the media has provided only the complainer’s side of the story. There are so many facts about this case we don’t know. Second, it points out the true pitfalls of having a neighbor of 47 years, and someone who is inexperienced at navigating the long term care health system calling the shots for an elderly person. As a senior living advisor who acts as Power Of Attorney for several of my clients, I cannot express the importance of having an experienced individual take on this serious task.

According to the article, the elderly person had fallen and spent over three months in a rehabilitation facility beginning in November. If the elderly person spent over 100 days in rehabilitation after a three night hospital stay, it is likely she had exhausted her Medicare benefit period. The costs to remain at the same rehabilitation community as a private pay client would have been prohibitive. I have in many cases, seen clients released to a lower level of care (before they are ready) in an effort to avoid paying higher costs. The Supportive Living community mentioned in this case provides only stand by assistance with bathing, dressing, transferring, toileting, walking and eating. There is no nurse present on a 24 hour basis. After living at the Supportive Living community for six weeks, the resident was sent back to a skilled nursing community after developing an infection in her heel. According to Doctors, the source of the infection was unknown and treated with an IV, which is a type of care Supportive Living communities are not licensed to deliver. After the diagnosis of infection, the resident was placed back in a skilled nursing home (which is the same level of care she was receiving during rehabilitation). I wouldn’t have allowed my client to make that sort of transition unless they were really ready.

The article also documents that the elderly woman’s Power Of Attorney tried to obtain a refund of a $2,500 move in fee. As a senior living advisor, I am unaware of very few move in fees that are refundable. Off hand, I can think of only one community that offers a refundable move in fee. But, that is one item that you need to be clear on before you move a loved one into a community. This Power Of Attorney insisted that the money be returned because the resident was only there six weeks. Needless to say, she still moved in.

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I recently had a situation occur that I’d like to share, lest the same circumstances arise for you.

My client’s were a family whose Mother was living in an independent living retirement community with a full-time caregiver. Her health issues had escalated to the point where she could no longer perform any activities of daily living on her own. She was approaching the point where she was a two-person assist. The cost of two full time caregivers plus the independent living rent was prohibitive. Therefore, the family retained me as a senior living advisor and certified care manager to find a nursing home for her.

I actually anticipated that the placement was going to be fairly easy. They wanted a private room for their Mom, with specific location parameters, and a certain religious affiliation if possible. Sounds easy, right?

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