The Lives of Elders

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.

Great Expectations

Why is eldercare a forgotten topic when it comes to the political battles? This is a multi-billion dollar industry that has an ever growing need for reform. I know I have my own ideas on how to change the industry that I will be sharing with you in future postings, but I’m curious of what you think. How can we get eldercare to be an important topic on the political scene? Email me at debra@foxlearningsystems.com. Here is an email I received recently from a long time friend, a 25 year veteran in the Long Term Care Industry.

Hi Debra,
I love this! I hear all my friends and colleagues say, "we (the
boomers) will never tolerate substandard care in our old age...we will demand
more". I can only laugh and tell them that when we are in that position,
we will be toothless and powerless. We will have to depend on our children
to change the system for us. As they think about the self-absorbed
children they have raised, their mood turns glum.
If we do not take action
now, for our parents or grandparents, we cannot count on our offspring taking
action for us.
I cannot identify any lawmaker on a national level (or
even local) who has identified eldercare as their "mission". Yet,
virtually every family in the U.S. experiences the failures of this system with
their own family members at one time or another.
There are some wonderful
organizations who are addressing this, such as the Pioneer Movement. But
can anyone identify a legislator who could join us in our quest to change this
system?

A Fountain of Youth

Ponce De Leon’s claim to fame is sailing across the Atlantic in search of the ‘Fountain of Youth’. Unfortunately, his quest was deemed a failure when he, like everyone else, grew frail with age. Ponce was by no means the first historical figure to strive for immortality, but perhaps his discovery (or lack thereof) made people accept the fact that, one day, everyone will grow old.
Hence; eldercare. It is the basic idea that we have a duty to care for those who at one time cared for us. It is by no means easy. Lisa Nerenberg, a long time eldercare abuse consultant, put it this way; “Among our greatest challenges as a nation today is making America a safe place to grow old.”
For a nation with the highest GDP in the world, and one that has jumped through all types of other seemingly impossible hurdles, it might seem like a mystery why eldercare is such a challenge. Take this example. An 80 year old with Alzheimer’s might have functionality similar to that of a 3 year old. The hard part is that a 3 year old will grow out of that stage, quickly learning the ways of the world and how to be more independent. The Alzheimer’s patient will do exactly the opposite- keep degenerating.
It is also a challenge for these elderly patients, many of whom at one point in their lives were running the show. They were at once the masters of their destiny but now are imprisoned by the myriad of mental and physical health challenges that come with age.
To no surprise, it is extremely stressful for a family to care for their elderly loved ones. This is why many of us chose to send our loved ones to Long Term Care facilities. Our goal should be to make sure every elderly person is comfortable and cared for in their later years.

Baby Boomers Beware

There's good and bad news if you are among the 75 million babies born between 1945-1964. The good news first. We are living longer.  In 1900, just 3 million people reached their 65th birthday.   100  years later, that number increased by 11 percent with 35 million people living to age 65.  In the next 30 years, the population 65 and above will grow by a huge 76 percent to 71.5 million people.  We owe living longer to incredible advances in medicine, but the bad news is our long term care system is  burdened with the demands of keeping up with those advances?  With the growth of the senior population, comes the growth of the eldercare workforce. Do we have enough skilled personnel to handle this upcoming senior tsunami?  Will long term care facilities continue to go off shore to supply this exploding workforce.  Will the new eldercare workforce speak English?  If not, how will these  "caregivers" be trained in the medical needs of babyboomers that will soon become the new frail elderly?     Babyboomers are proactive whether it be politics, righting wrongs, or fighting for their beliefs.  Will we start fighting for better quality of care for our parents and for "us"?  Will we start fighting for a better trained eldercare work force and will we start demanding effective staff training from our healthcare providers?  The Senior Tsunami has begun to hit. But are we ready for it?

Debra Fox