Articles Posted in Skilled Nursing Homes

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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 blistering Chicago heat arrived last week. That means it is time to review some tips to keep your senior loved one safe. Our elderly loved ones are more sensitive to the effects of heat and are more prone to dehydration. Remember that they do not adjust well to rapid switches in temperature. If they have a medical condition, it may change the way his/her body reacts to the heat. Prescriptions s/he may be taking also affect the way his/her body adjusts.

I am fortunate enough to have a brother who is able to check on my 91 year old mother on a daily basis, and another brother who stays with her at night. I am blessed and I don’t know what I would have done without either of them. If you aren’t as lucky as I am, you will need to designate a trustworthy individual to check in on you elderly loved one. Whether your senior lives at home or in a senior living community at the independent, assisted living, or skilled nursing level, the following are tips that you can use to cope with the heat:

-Try not to take a senior outside during the hottest parts of the day. This sounds like common sense but when you are under the duress of taking care of a senior and your own family, common sense flies right out the window!

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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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One of the facts that I stress to my clients is that skilled nursing is not one-to-one care. Other facts that a lot of my clients don’t take into account are how the costs of a 24 hour caregiver (which can start at $200 per day if they agency is licensed) are going to affect their loved ones’ long term financial picture. This usually occurs when the child is in a rush and s/he doesn’t have the time to research all of the options. Or, the child feels guilty about the stigma associated with placement in a long-term care community. Everyone’s circumstances are different. As a Certified Care Manager, I assist my clients with looking at all of the options, including staying at home. But, you have to keep the senior’s long term financial picture in mind. If a senior can afford to stay at home, that is the best place for him/her if their medical conditions don’t require the presence of a nurse and if the socialization with the caregiver is adequate. People hire me for my senior living advisor services once they have already hired the full-time caregiver and discover after a period of time that the loved one is running out of money.

Last November, a family hired me because their Mother had three, unlicensed caregivers who were taking care of her in shifts for the past ten years. The son told me she had easily spent over one million dollars on caregivers. When he and his siblings realized that she was going to run out of liquid cash in the next year, they hired me to find a nursing home for her.

When I arrived at her home, the place was spotless. My client was impeccably clean and every single hair on her head was in place. She was sitting in a cheerful kitchen where the caregiver had fed her breakfast. Although my client was a total assist with all activities of daily living including toileting, and had latter stage dementia, I saw her smile and try to respond to the caregiver’s kind tone of voice. It was obvious that my client had received excellent care. That observation was verified by her son, who informed me that he often stopped in on all three ladies unannounced.

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I read the attached article, “Adult Children Ignoring Confucius Risk Lawsuits in China,” about the elderly having the option of suing their children if they don’t visit them enough while they are in a long term care community. I used to be the Marketing/Admissions Director of a large Continuing Care Retirement Community where I dealt with admitting seniors who were at the independent, assisted, or nursing home levels of care. The article made me reminisce about acting as, “manager of the weekend,” and some of the experiences I had with family members who were regular visitors. In other words, the families were the polar opposites of the “no shows” referred to in this article.

As manager of the weekend, each staff member at the community had to take a turn at watching over the place. This meant taking care of the needs of the residents, as well as meeting and greeting the family members who came to visit on the weekends. The manager was instructed to walk the hallways to observe cleanliness and anything that seemed out of the ordinary. Another assignment was to circulate in the dining rooms during meal times, ask the residents about the acceptability of the food, and to eat the food to make our own assessment. The best part of acting as the “manager of the weekend” was that I got to see all of the visiting family members that I had previously been involved with during the admissions process. However, I chuckled at the content of this article because some of the families didn’t deserve to be penalized because they didn’t visit enough. They deserved to be scolded for what they did while they were they visiting loved ones, particularly the seniors who were at the independent level. Let me share some of the events with you.

There was a woman who had lived at the community for a number of years and was practically a model resident. She never had a single hair out of place and was always dressed in the latest fashions with a hand bag to match. She had a son who lived in the neighborhood. He visited her each weekend without fail. One time I noticed a large bottle of liquor in her room. Residents at the independent level were allowed to keep liquor. Since independent living is just like an apartment building, there were no rules against it. I was told by another staff member that she kept it to offer her son a cocktail when he visited. The problem was that while I was walking the hallways after the son had left, I found her wandering the hallways half looped on several occasions. I had to escort her to the dining room to make sure that she ate. The same thing happened with another resident whose girlfriend picked him up on Saturdays to take him out for dinner.

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I am often confronted with some interesting family dynamics when a family hires me to consult with them. At times, the children are willing to accept my advice without reservation. Sometimes, there is often one child who wants to prove that s/he can “do this on her/his own.” While there is usually one child who emerges as the spokesperson for the family, the choice of the right care should be the result of a family consensus and not the persuasive skills of a ringleader. Consensus should be coupled with careful comparison of cost and methods of payment, level of care needed, staffing considerations, location, and quality of care involved with all the senior living options. Please read the following “Real Life Story,” that exemplifies my point

Real Life Story

One of my clients who did not follow my initial advice contacted me last week. She was unhappy with the care that her Mother was receiving at an assisted living community that specializes in memory support.

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When I am hired by a family whose loved one has Alzheimer’s or some other form of dementia, my thoughts immediately turn to my Father. My Mother, who is a registered nurse, insisted upon caring for him at home until his medical conditions forced his transfer to a nursing home. He had been one of the charter physicians who helped open a major hospital in the 1960’s. Because of this fact, my Mother felt obligated to place him a nursing home that was owned by the hospital. It was centrally located for most of my family members, except for my husband and me. We would travel 25 miles every night after work so that I could visit him. The commute exhausted both of us. The poor care resulted in my Mother making a decision to move him to a nursing home that was closer to her, but even further away from us. The care and compassion that he received at the new nursing home was the difference between night and day. I just had to resign myself that I was going to see him less. As a senior living advisor, I always tell my clients that location is important but it shouldn’t be the sole factor in choosing a long term care community.

REAL LIFE STORY

My clients were an 82 year old woman and her children. Their Father was at home with two caregivers who took care of him in 12 hour shifts. He was diagnosed with Alzheimer’s disease. His behavior was becoming very difficult to the point where he was a two person assist. The family was in favor of placing him in a long term care community. There was one child who volunteered to move him into her home. Her intent was hire a number of caregivers to accommodate the two person assist.

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