The Lives of Elders

Happy New Year

Myself and everyone at Fox Learning Systems and askdebrafox.com would like to wish everyone of our readers a safe and happy new year.

Exciting News...

I am proud to announce that I will be working as a contributing writer on another blog! www.insideassistedliving.com by Ryan Malone is doing some great things for the long term care industry, especially for the consumers.

Las Vegas Elder Care Abuse

 

How can this be possible? Another eldercare home shut down because of lack of care and horrible conditions for its elders! This time we go to the city of Las Vegas where Skyview Group Home 2 is the latest facility to be caught providing substandard care. Of the many violations that have been found are:

-      Illegal Narcotics on Premises

-      Residents going without medication for up to 3 Day

-      Insufficient amounts of food

-      Heat was off for a period of 2 days

Doing a quick search on the web about this facility I came across a posting on www.ripoffreport.com where a woman complains that she had to take her grandmother out of this facility because her health was deteriorating quickly. When this woman placed her loved one in their care she was able to walk when she left the facility just a few months later she was unable to walk, was malnourished and discharged with more than one stage 4 pressure ulcers. This woman died 1 month after being in their care.

Reading one of their advertisements I find this statement “we have the personal care that gives clients and families the peace of mind they deserve”. How many nursing home facilities out there make identical statements? This is why you must do your homework. In the white paper we wrote last month we lay out the questions that need to be asked when placing a loved one in a long term care facility.

It is so sad to me that our elders continue to be treated so poorly. Why do we allow this? Why is it that prisoners in our jail system are treated better than loved ones that are placed in facilities like this?

For more information on Elder Abuse my company is posting a free course on Elder Abuse and Prevention.  If your loved one is in long term care let the facility know about this course. http://www.foxlearningsystems.com/elder_abuse.html

Amazing Lives

A story that often crosses the newswire came again today, “Oldest man in US dies”. This weekend George Francis of Sacramento, California died of congestive heart failure in a Sacramento long term care facility.

When I read these stories I am astounded at how much one person can see over a lifetime. Here is a man that tried to enlist for the First World War. This man has lived through three centuries and countless historical events. He was most recently excited to see Barrack Obama elected President. 44 Years ago his wife died to put that in some form of context he was 68 years old when she died in 1964! He has children in their 80’s and great-great grandchildren in their teens.

It is always important to keep in mind that as caregivers the people we are caring for, however helpless they may seem at times, have lived amazing lives. They deserve an amazing amount of respect for what they have seen and done in their lives. Take a minute today and talk with an elderly person you are working with. Listen to a story about something they remember as a child, be thankful that you are able to be helping someone so experienced and someone who has witnessed history first hand.

Holiday Depression

We are right in the middle of the height of the holiday season, for many it is a great time of year. This is the time of year to spend with family and friends. But for elders suffering from mobility or mental illness these can be extremely trying times. Depression in the elderly can peak during these times especially those living in long term care facilities or those living away from family.

According to the NIH almost 20% of elders suffer from some form of depression. This percentage includes a significant amount of elders suffering severe depression.

So what are the causes of depression in elders? Just like with people of any age elders can feel despair for daily life. Bills, Family and Health can be major factors in contributing to depression. Other more serious issues like mental illness and Alzheimer’s can also be contributing to a depressed elder.

If you notice an elder or loved one becoming depressed around the holiday time it is important to get them into a social situation. If you are able get them to the Mall and let them see all the activity, take them for a walk if the weather is nice, even a long conversation on the phone can do wonders getting your elder out of the holiday blues. It is important to let them know they are not forgotten! Most importantly make sure they recover from the holiday blues. If an elder continues to show signs of depression after the holiday season make sure they get to a doctor to get help. Depression is to some degree controllable with medicine and activity. Make sure your elder and loved ones have a happy and healthy life both physically and mentally.

Senator Casey's Quest for Nursing Home Reform

     Senator Bob Casey  (D-PA) is on the right track in proposing introducing the “Promoting Small House Nursing Homes” bill to the United States Senate. Senator Casey is absolutely right in trying to promote a culture change in the Long Term Care industry.

     Nursing homes have become complacent with providing “quality care”, a definition that is used very loosely, in a hospital-like setting. Imagine making the shift from a cozy household to a facility with florescent lights. Instead of waking up and having breakfast at your leisure, you are awakened at 5:45 am in order to eat at 6:30. This sudden loss of freedom is absolutely debilitating and can cause serious depression, a fact of life for about 20% of the elderly. Change however is approaching. A very innovative idea to integrate quality care with freedom as well as a cozy home-like atmosphere is called the “Green House Movement”.

    An average of ten residents would live in one structure, each with their own private bedroom and bathroom. This would be connected to a common area as well as a kitchen. Instead of florescent lighting, the common area would have incandescent bulbs, just like those found in our homes. The smells from the kitchen would permeate into the living room, making the act of eating much more enjoyable and expanding a sometimes meager appetite. Board games and casual conversation would become commonplace in the living room, bringing residents out of their isolated rooms and into a community of peers.

    The staffing would be done by two or three committed individuals for every home who are trained in cooking, washing of clothes, and daily care. This allows the staff to get to know the residents on a very personal level, and the residents can form their own routine with the staff. For example, if someone likes to sleep late, it wouldn’t be any extra burden for the staff member to wake someone up at 10 am rather than 6 am. If a resident doesn’t like pancakes, fine, she can eat eggs. Doctors and Registered Nurses would make the same type of rounds they do in conventional homes.

    What I thought when I first heard this idea was that it would be insanely expensive to change nursing homes into “Green Houses”. Yes, building new structures would be very expensive. The costs would remain the same in almost every other category. Staffing levels would not increase and staff turnover would likely decline when CNAs would build stronger relationships with the residents.     

    There is anecdotal evidence to suggest that Green Houses would save nursing homes costs from illness’s that stem from immobility. Residents would be able to walk around more and integrate themselves in a community which would reduce pressure ulcers and depression. So why hasn’t the industry taken this step? It takes a tremendous amount of capital to build these new, smaller structures.

    And that is where the honorable Senator from Pennsylvania comes in. He has proposed that the Department of Health and Human Services gives a low interest loan to nursing homes who want to build these structures. They would need to fulfill the criterion that ensures they are creating person centered care, of which the Green Houses is just one strategy. With a little nudge from the federal government, nursing homes would be able to take a step in the right direction that would not only improve the quality of care but also save taxpayers money in the future by reducing needless ailment brought on by the current institutionalized conditions. Contact your senator today and tell him/her that you support the “Promoting Small House Nursing Homes” bill.

Nursing Home Ratings

 

It is such a breath of fresh air to learn that Medicare has offered their Nursing Home Compare service. Just like at restaurants or hotels, nursing homes will now be rated on a one to five star scale. Consumers can simply log on to www.medicare.gov and go to the NH compare section. The folks at Medicare chose three criteria in rating nursing homes; health inspections, nursing home staffing and quality measures. The health inspections section is pretty straight forward. It calculates how many times the nursing home has been found in violation of the health code, the severity of the transgressions, and translates it into a scale from 1 to 5. Quality measures look at the percentage of many different factors such as pressure ulcers, use of restraints and pain.

          

      Since I am in the business of staff education, I have some trouble with how Medicare is rating the staffing category. They have sections for total RN hours per resident, total LPN hours per resident and total CNA hours per resident. It simply takes the average total hours of staff per day and divides it by the number of residents. Using this metric, consumers can figure out how WELL staffed a nursing home is, but not the QUALITY of staff. There are homes where the staff to resident ratio is one to one but because the staff is not well trained they can’t provide quality care.

   

     I film directly in Long Term Care facilities and I have come across some of my favorite facilities that received a 1 or a 2.  Perhaps their resident to staff ratio is on not great but the quality of their staff is superb. One home I have in mind received a 2 simply because of their ratio, but their staff is extremely well trained and stay with this home because of promotion opportunities for dedicated workers. On the flip side, I filmed in another home that received a 4 due to an awesome resident to staff ration but their workers frequently turnover and are not well trained. Thus they do not have a high quality of care.

       

     I understand it is hard for Medicare to rate the quality of staff. Inside the rating system, they have buried some statistics that are telling as to the quality of staff. In the "Quality Measures" section one can find the rate of pressure ulcers and the management of pain. Only through direct observation however can the consumer fully determine the quality of the staff. My suggestion to the consumers remains the same: visit the nursing home and see how the staff interacts with the residents. For my White Paper on this topic, click here.

How is the Weather?

It’s that time of year again! Winter weather is starting to settle in! As I watch the news I see snow storms in Las Vegas, Ice Storms in New England and I look out my window and see snow starting to accumulate on the ground. Snow and winter weather can be very beautiful but very dangerous for a variety of reasons.

The biggest threat to long term care facilities during cold weather times are power outages. Some residents use electricity to help them maintain a quality life, some residents will have issues with sudden change like the lights going out, some facilities have inadequate back up power to sustain operations. The recent ice storm in New England shows that many long term care facilities understand that maintaining the status quo will help their residents continue their routines. In an article published in McKnight Long Term Care News they mentioned that some of the long term care facilities even acted as shelters for the general public because they were so prepared. These New England facilities need to be applauded for taking proactive steps to ensuring a quality of life for their residents.

I only hope that we hear less of the bad stories about how long term care facilities all but abandoned their residents during crisis and start hearing more of the good stories about how these facilities are stepping up in the time of crisis.

Elder Abuse

                Although the pictures give off a vibe of teenage innocence, these two girls have been charged with one of the most grotesque crimes imaginable. For a full story on their actions, click here. I however would like to speak about how to prevent these incidents from happening in the future. Nursing homes go through the casual steps of doing criminal background checks before hiring employees. Otherwise, the hiring process for CNA’s is very lax due to the tremendous turnover that plagues the industry.

I believe it is impossible to prevent some bad apples into entering the workforce. These two teen girls would have never raised a red flag. What is preventable is the way the other staff reacted to the criminal actions. In this particular incident, 6 others are charged with failing to report the incidents. It would be a statistical anomaly to have 8 different bad apples in one nursing home.  It seems like these other staff members were improperly trained on the severity of the crimes and how to detect and report elder abuse.  For a free course on elder abuse, click here.

A CONSUMER HANDBOOK

This paper was recently created as a consumer's guide to LTC facility staff training. It includes a questionnaire that every consumer should take with them to their next visit. Click on the link below to download the PDF.

White Paper on Staff Training