Articles Posted in Skilled Nursing Homes

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Assisted living communities that have a memory care unit are supposed to be adequately staffed with assistants and aides who are educated to deal with the behaviors of dementia residents. The habits of these residents can often be repetitive and endanger the resident if they are not closely watched. Many residents “sundown” in the evening, meaning they may often become more confused and agitated at this time. In my opinion, the caregiver ratio in these sorts of units at night should be no less than 1 aide to 8 residents, when residents with dementia, whether ambulatory or not, can become very agitated and even combative. The “powers that be” at some senior living communities will dispute my ratio, contending that they only need to staff according to long-term care regulations. This month’s real life story will outline the consequences of understaffing.

Real-Life Story

I was recently hired by a client who was forced to place her memory-impaired relative in an assisted living community’s memory unit. The relative had been living in another retirement community that was not equipped to care for residents with memory issues. When the staff at the original community witnessed the relative dragging a bag of laundry up the hallway in the wee hours of the morning, the staff arranged to have her taken to the local hospital’s behavioral unit for evaluation. Apparently, this had not been the first incident of questionable behavior. When the evaluation of the relative was complete, my client was informed that the retirement community could not handle the relative’s behaviors. Therefore, my client had to place the relative in an assisted living community that had a bed available in its specialized memory unit.

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One of my current clients is a former medical professional who has decided to donate her body to science upon her death. She therefore enrolled as a member of a local anatomical gift association. As her Power of Attorney for Health Care, I was assigned the task of pre-arranging for the disposition of her body. My client’s enrollment card stated that arrangements needed to be made in advance with a funeral director to transport the body to the location of the anatomical gift association when the time comes.

Upon making a telephone call to a local funeral home to get a price for transportation of the body, I was shocked to be quoted a price for more than $1,600, along with a $350 cremation fee. Since the quote sounded high, I called the anatomical gift association to be certain that I understood all of the stipulations. When I had a discussion with the association’s representative, I was informed that every funeral home has the right to charge differently for its services. I was also informed that if the anatomical association accepts the body, then cremation of the remains is free. If the body is not accepted, i.e., is diseased or in unacceptable condition, the association would charge $370 for the cremation of the remains. The association’s representative gave me the name of two other funeral homes and recommended that I get quotes from them.

When I called the second funeral home, I was informed that the cost to transport the remains would be $1,150, with a $350 cremation fee. Although the price was better, the funeral director’s demeanor was so unfeeling that I wrote him off immediately. The second funeral director quoted me a fee of $850, and there was no cremation fee whether the anatomical society accepted the body or not. The deal sounded a little too good, so it made me wary. Last, I contacted the funeral director who handled by late husband’s services, because he was a very easy going man who made my life easier during a very difficult time. His price was $650, plus a $350 fee for cremation if the body was rejected. While his transportation quote was even lower than $850, I knew that I need not be wary based on my firsthand knowldege of his services and demeanor.

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The recent CBS investigative report regarding the cases of alleged neglect at a national assisted living chain held no surprises for me. I began my career in the elder care industry fifteen years ago when assisted living provided only “stand by,” assistance with activities of daily living (ADLS = bathing, dressing, toileting, transferring, walking, and eating). Several years ago, I made the observation that many of the assisted living communities were offering more “hands on” care to their residents. At the same time, I also observed that they were accepting residents who really belonged in intermediate nursing care or a skilled nursing community*. Being a former Admissions Director and with my current position as a senior living advisor, I thoroughly understand the current long term care market conditions.

The Admissions Director is the most important contact at a long-term care community. He or she is responsible for attracting and residents, while maintaining a high census. Many Admissions Directors also act as marketing liaisons. They provide your first impression of a long-term care community, and often are a direct reflection of the care your loved one is going to receive. They are also responsible for the initial assessment of the type of care that is appropriate for the senior. It is important to bear in mind that Admissions Directors are often commissioned salespeople. They are accountable to, “the powers that be,” for maintaining a high census. I can remember the terrible pressure that was exerted upon me by the management in order to keep filled the continuing care retirement community where I was working. Scarcely was a bed emptied before pressure came to fill it. The passing consolation that the seniors, “were called home by God,” just didn’t cut it in terms of lightening the pressure for quick turnarounds. I know that with a bad economy, the pressure is even worse.

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I was sad to read that the search for victims who perished in a Quebec retirement community fire had ended. At least twenty eight seniors were killed when the wood-framed building caught fire and was destroyed in less than an hour.

In the fifteen years that I have been involved in the elder care industry, I have never been asked how a senior would be evacuated from a building during a fire or other disaster. In light of current tragedy in Quebec, it is a question that should be addressed when assessing senior living communities.

Before I opened Andrea Donovan Senior Living Advisors, I was the Admissions Director of a retirement community that offered Intermediate nursing care (as well as independent living and assisted living) to its residents as part of the continuum of care. We were bound to act according to the Illinois Administrative Code for Skilled Nursing and Intermediate Care Facilities, Section 300.670 on Disaster Preparedness. This meant the staff had to adhere to extremely rigorous guidelines in case of a “disaster.” A disaster meant, “an occurrence as a result of natural force or mechanical failure such as water, wind or fire, or a lack of essential resources such as electric power, that poses a threat to the safety and welfare of residents, personnel, and others present in the facility.” The requirements were as follows:

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My client whom I will call “Marie” for the purposes of this story, was a 71 year old woman who had serious respiratory issues. Until recently, Marie lived at home with her mother. They had spent their entire lives together. A sudden illness caused Marie’s mother to be hospitalized and subsequently sent to a nursing home for rehabilitation. When it became apparent that my client’s mother was not going to recover, Marie brought her home and arranged for hospice services. There, my client Marie, a 70-something senior, continued to help tend to her mom, who eventually passed away.

As I had been hired by Marie previously, I was recently contacted by her trust officer, and was informed that Marie had been ill. It was requested that I act as her geriatric care manager. I went to the hospital in order to assess her situation. At that point in time, the trust officer knew very little about Marie’s physical condition.

When I arrived at the hospital, I was very surprised at how much Marie had deteriorated. She had been a feisty, quick witted woman. Despite her breathing issues, she had always been a fighter as evidenced by her devotion to her mother. At first, Marie didn’t recognize me because she was taking medications. Then in a matter of a few minutes, she confessed to me that the combination of taking care of her mother and the breathing issues landed her in the hospital, then in a rehab. community for respiratory therapy, then back in the hospital again. She said, “Andrea, I am convinced that taking care of my mother worsened my health. But, I loved her, and I would never change what I did. But, now that she is gone, I really have nothing to live for.” The hospital’s plan was to send Marie home with hospice care. She told me she was impressed with the hospice team that had taken care of her mom, and wanted the same people to take care of her.

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And old saying observes that “Beauty is only skin deep,” but I believe both beauty and better health begin inside and out. Here’s one example why.

I serve as a Geriatric Care Manager for a woman in her late 80s who has no family. Although I regret to take her outside during the cold weather, her medical appointments are a necessity that cannot be avoided. I’ve thought about how tough the frigid Chicago weather can be on anybody’s skin. Since I know my client’s medical history, I keep the following things in mind as part of her elder care planning:

Since she is over 85 years old, her skin is very fragile and rather thin. Therefore, she is subject to two skin conditions:

1. Seborrheic Dermatitis, a skin inflammation that is characterized by areas of dry, itchy flakes that are normally found in oily areas such as the scalp. The condition becomes worse during the cold weather. The condition is caused by yeast that activates skin irritation in cold weather.

2. Psoriasis, another skin condition that appears like a red outbreak with a dry patch on the top. It can appear just about anywhere on the body, but emerges mostly on the elbows, knees, and scalp. I have often seen the psoriasis flare on my client’s legs, and during the dark winter weather, it is much harder to clear up. It is much easier to get the outbreak to diminish when the skin is exposed to some light. The dermatologist treats the outbreak with a combination of topical steroids and an ointment called Calcitrol.

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I have never had a circumstance arise where the wishes outlined in my client’s Power Of Attorney For Healthcare were not carried out by a community where s/he was residing. I am sharing the facts regarding a recent incident that occurred lest it happen to you and your loved one.

I was hired by the child of an elderly loved one who was living in a rehabilitation community (religious affiliated) under Medicare benefits. The child lived out of state and told me that I was to identify the best long term care communities of the same religious affiliation for the loved one. The current community typically did not have a lot of long term care beds available. Placement was to occur once the loved one’s rehabilitation was completed. Spirituality was exceedingly important to this particular senior. The ability to attend religious services was a mandatory prerequisite.

After preparing the necessary research on the communities that fit the family’s criteria, I was instructed to arrange transportation to accompany the senior on the tours of the various communities.

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Happy Holidays to you and your loved ones!

While the holidays can be a time of joy, they are also a time when extended family gatherings may provide us with occasion to notice that an older loved one’s health is deteriorating. As families reunite, celebrate the season, and take stock of the year gone by, they sometimes reflect on the passage of time – and begin to recognize how it might be affecting a senior member.

A sense of fear or worry — exacerbated, perhaps, by the darker winter weather – can then lead families to make rushed and hasty decisions about senior care or senior living options. Later, they hire me when they realize they have made an error.

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According to the National Institute on Aging (NIA), Alzheimer’s Disease is now the most common form of dementia among older persons. Dementia is marked by serious decline of one’s cognitive abilities — that is, the ability to think clearly, remember information, and engage in critical reasoning. More than the occasional “slip of the brain” that all of us experience from time to time (like forgetting where we placed our house keys or when a friend’s anniversary is coming up), Alzheimer’s Disease involves significant damage to the brain itself.

As the NIA explains, the brains of persons with Alzheimer’s Disease will exhibit abnormal tissue clumps (known as amyloid plaques) and/or tangled bundles of fibers (known as neurofibrillary tangles). A third main characteristic of the disease is the loss of connection between neurons, or nerve cells, in the brain.

The US Centers for Disease Control and Prevention report that as many as 5 million Americans suffer from Alzheimer’s Disease. More than half of all Americans know, or know of, someone with Alzheimer’s. The disease is believed to affect some 35 million people worldwide. According to the Global Burden of Disease Study, worldwide deaths from Alzheimer’s disease and other dementias more than tripled between 1990 and 2010. This may not be altogether surprising, as nations advance and more and more people live longer lives.

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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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