long-term care housing

Long-term care: squeaky wheels and raging forest fires

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Although now retired, over a twelve-year period I worked in long-term care (LTC) wearing three different hats:

  • My first job in this industry was in the corporate office of a very fine assisted living and memory care company. In time, I decided to work in one of the company’s facilities so I could spend more time with the residents and families who chose our company for their LTC needs;
  • When I left the company, I took several years off to care for my father who had Alzheimer’s disease. A few years after his death, I became a certified long-term care ombudsman for the State of Washington – an advocate for vulnerable adults living in LTC settings;
  • Concurrent with my ombudsman work I became a trained Alzheimer’s Association caregiver support group facilitator, providing a listening ear to those on the caregiving path.

Given all that experience, I’ve seen and heard of many unfortunate and nasty occurrences where residents and patients were denied the basic rights each living person should expect to receive, especially those dependent on others for their well-being and quality of life.

I’m sorry to say that some nursing homes, assisted living/memory care communities, and adult group homes do not employ sufficient staffing to meet the needs of their residents. I can confidently say that the government agencies that oversee the LTC industry are also understaffed. When complaints are called in, those government employees have to apply grease to the squeakiest wheels and must turn their fire hoses on the most out of control fires in their case files.

That’s where you and I come in.

We must be the squeakiest darn wheels we can be so our complaint(s) are attended to.

We also need to be the hottest, most devastating fire imaginable so that our vulnerable loved one’s rights are respected.

One grievous example. This is just one example of common issues that arise in LTC settings. The complaint process I mention later in this post provides a good starting point when issues arise.

Nursing home call lights are being ignored so that residents/patients are left to defecate and urinate in their adult sanitary garments on a routine basis. Not only is such an act demeaning to the poor soul with no option but to let go of his/her bodily wastes, but said wastes are sure to cause skin breakdown and a urinary tract infection that is not only extraordinarily painful but can also be life-threatening.

What does the family member/good friend do about this indignity? They need to complain vehemently to the administrator of said facility and when she/he does nothing or very little, family and friends contact the local area’s LTC ombudsman program. This website will direct you to ombudsman resources right where you live: National Long-Term Care Ombudsman Resource Center.

Your local ombudsman program will investigate, work with the facility’s staff, and if need be, get the full force of the law to come to the defense of those in need. State ombudsman programs are staffed by paid and volunteer employees, therefore their staffing levels are usually higher than many government agencies. These ombudsmen all receive the same extensive training required for such a vital role. Once you’ve reached a dead end at the facility, ombudsmen are your most active line of defense. They are passionate about what they do and they will ceaselessly advocate for you and your loved ones. Their proximity to appropriate resources and their intimate knowledge of residents’ rights laws makes them an approachable and viable alternative for the common man’s (yours and my) needs. Caveat: if you suspect criminal activities such as physical or sexual assault law enforcement needs to be immediately involved in the matter. Additionally, severe lack of care that endangers the lives and well-being of adults more likely than not will also require law enforcement involvement.

Adults in long-term care settings are a reflection of you and me. By that I mean they were once active and self-reliant adults, just like many of you reading this piece, but they now find themselves unable to fend for themselves and need you and me to step in for them. Imagine, if you will, being in their shoes, unable to speak up for yourself. If you or I ever find ourselves in a similarly vulnerable situation, wouldn’t you want an advocate to step in on your behalf?

Advocacy for vulnerable adults falls on all of our shoulders. You can make a difference in the life of your loved one. Won’t you please step up to become their most important advocate?

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Welcome to the year 2015!

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2015 New Years

If you’re like me, you’re wondering how another year has slipped by so quickly.  I’m sure there were a few of the 52 weeks that seemed to slog by, but all in all we can now look back and marvel at what we accomplished, or what others accomplished in our stead, during the past 365 days.

An accomplishment with which I’m happy is having authored this blog for the past three and a half years.  I’ve provided this blog for you, but I’ve also provided it for me because I truly enjoy having the opportunity to share my experiences and my viewpoints; I hope in the process that I have encouraged, helped, and entertained you.  From the start of Baby Boomers and More in 2011 to the end of 2014, I posted 520 articles.  I’d be a very happy blogger if the quality of those articles surpassed the quantity because if I’m just talking into thin air without benefit to others, its hardly worth the space my blog occupies.

Here are links to the five most visited articles in the year 2014 based on WordPress statistics:
Read the rest of this entry »

The Journey of Grief: A Personal Snapshot

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The Journey of Grief: A Personal Snapshot.

Grief
Grief (Photo credit: Wikipedia)

Grief – when one experiences a loss, there is no way around this emotion.  It has no clearly defined end.  It manifests itself differently for every individual.  The writer of the above article shares the personal side of how this emotion presented itself in his own life in this continuation of his series of articles on grief.

This “personal snapshot” is a follow up to his first article in the series that addressed an event in ones life for which everyone’s grieving experience takes on a slightly different character.  I  hope you’ll read the article attached above, and his previous article – also available on his website.

Moving Mom and Dad – or your spouse.

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Moving Mom and Dad – Leaving Home is an article from the June/July 2012 AARP Magazine.  Statistics on aging are astounding, and scary.  “By 2020 some 6.6 million Americans will be age 85 or older.”  That’s an increase of 4.3 million from the year 2000.  Time to celebrate – right?  We’re living longer – and in some cases – thriving in our older age.  The reality of the situation, however, is that eventually we’ll need some sort of assistance with our activities of daily living (ADLs) that might require a move to a care facility of some sort.

The stories presented in the attached article describe family instances where emergent circumstances warranted an emergent decision to move a parent into some sort of care facility.  The best case scenario, as this AARP article suggests is that you, “dig the well before you’re thirsty.”  Nice sentiment – but not always possible.

I have written numerous articles for my blog that address the difficulties the caregiver, and the one needing care, go through when making the decision to choose a long-term care (LTC) facility for a loved one.  Below are links to each of those articles.  I hope they prove beneficial to you.

Deathbed promises and how to fulfill them.

Caregiving: The Ultimate Team Sport.

Selecting a Senior housing community – easy for some, not for the rest of us.

Avoiding the pitfalls of selecting Senior Housing.

Adjustment disorder: a long-term care facility side- effect.

Be an advocate for your aging loved one.

Visiting a loved one at a long-term care facility.

Caregiver guilt.

Adjustment disorder: a long-term care facility side-effect.

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Duct-tape Moving Van

Think of a moving/relocating experience you’ve had with all of its inherent tasks of purging of items, packing what remains, and leaving all that is familiar as you move into uncharted territory.  In your new neighborhood you’re starting all over again to find: new friends;  a new supermarket with the best deals; perhaps the best school(s) for your children; a new church; and new ties to the community.  Not exactly an enjoyable experience.  It took you some time to adjust to your new community and feel that you fit in, didn’t it?

Now imagine doing the same thing as someone who is at least 70 years old with failing health, no family nearby, and perhaps with a compromised cognition level.  Vulnerable adults move into a long-term care (LTC) housing environment because of a condition, or combination of conditions, that make living independently no longer an optionBecause of this disruptive move, another disorder – adjustment disorder – makes their move a perilous one.

A loss of context in a new environment.  In my work as an advocate for vulnerable adults, I had the privilege of hearing a wonderful speaker, George Dicks.  At the time, Mr. Dicks supervised the Geriatric Psychiatry Service clinic at Harborview Medical Center in Seattle, WA.  He was also a contracted instructor for the University of Washington, teaching courses on Gerontology, Psychiatric Consultation, and Mental Health.  He emphasized that residents living in nursing homes and assisted living facilities struggle to look for context within their new environment.  For example, context is hard to come by when your daily bath occurs at 2:00 in the afternoon instead of in the morning or evening as was the case prior to the move.  And forget about finding comfort in routine because the demands on LTC staff are such that caring for numerous residents on their shift can’t possibly assure a routine on which the residents can rely.

Just providing care doesn’t mean that a staff person is caring.  Everyone who moves into a long-term care facility will have difficulties, but those who are cognitively impaired face an especially arduous adjustment.  As I previously mentioned, staff are hard pressed to provide individual care to their residents, and oftentimes are poorly prepared to handle the disorders that walk through the door.  Just getting through their daily shift is troublesome so trying to learn the habits and routines that are so vital for quality of life of the resident with dementia is a very time-consuming task.

a hand holding unidentified white pills
(Photo credit: Wikipedia)

Quite frequently, the only contact a staff person has with a resident is when they are making demands of that resident: “time to take your medicines Mrs. Jones;” “let’s get that soiled clothing changed Mr. Smith;” “open your mouth Mrs. Clark so I can feed you.”  Providing for  basic needs is not providing care.  Why?   Because the staff are requiring something of the resident.  There is no connection.  When a staff person interacts with a resident, absent a provision of care, that’s a better definition of care.

How to lessen the effects of adjustment disorder.  Those living in a long-term care housing situation oftentimes feel as though they left all their power, and all of their basic human rights, at the door.  They are constantly surrounded with reminders of their condition – all those other residents who look as lost and helpless as they do – and it seems that the only time anyone pays attention to them is when someone is demanding something of them in the form of providing some sort of assistance with their care needs.  If every staff person spent just five minutes of non-task-oriented time with each resident during their shift, those residents just might start feeling better about themselves.

  • Walk with a resident for a few minutes by simply accompanying them in the hallway and reassuring them along the way.
  • Play music the residents like in the common areas and in their rooms – and don’t assume that you know what they like to hear.  Take the time to find out what gets their feet tapping.
  • When you walk past a resident, greet them, smile at them, just as you would if you were in a social environment instead of a clinical environment.  Again, do so even when you’re not providing a care service.  Your friendly, heart-felt greeting may just make their day.
  • Start a dialogue with residents that allows them to open up to you about who they are; what their lives were like prior to arriving at the facility.  If you need to jot down some of their stories so you’ll remember them later, do so and continue the dialogue the next time you see them.  Wouldn’t it be a pleasant surprise to a resident when you asked them, “Tell me more about your grandson Charlie.  He seems like a real character!”  Wow – you were actually listening, and it shows.  Now you’re connecting with the resident.

If you are a staff person in a long-term care facility, can you put your grandma or grandpa’s face on your patients/residents faces thereby having a greater incentive to connect with those receiving your care?  Or if that doesn’t work for you, do what you must in order to add an element of care to those you serve.  Just because you’re helping the resident perform a task, doesn’t mean that you’re providing the care that they really need.

Avoiding the pitfalls of selecting Senior Housing.

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You’re patting yourself on the back, congratulating yourself for:

  • finally deciding that it’s time to move into Senior Housing; and
  • deciding which type of long-term care (LTC) option suits your needs.

Now what?  You’re scared to death because of the abhorrent negative press you’ve read regarding certain types of Senior Housing.  Good for you – you should be!  There are ways to make your selection a more trustworthy one.  What follows will hopefully weed out the bad eggs, but there is absolutely NO guarantee the decision you make is 100% sure.

WORD OF MOUTH

Chances are that those similar to you in age – your friends, work associates, neighbors – have looked into or are currently looking into Senior housing options and they can be a very worthwhile resource.  Don’t be afraid to ask them to share their experiences with you and you’ll certainly do the same with others as their needs become known to you.  Better yet – if you know of someone who already lives in a LTC facility, visit them to discern what they think about their own choice.

HOUSING SEARCH RESOURCES 

Where will your path take you?
  • Check out your state’s Aging & Disability Services Administration department (linked here is Washington State’s ADSA.)  You really can’t go wrong checking out your State’s services for the Senior population.  These resources usually have links to long-term care facility research tools, such as the Assisted Living section of my local state’s ADSA.  No doubt your State’s Aging & Disability department will have similar links.  If you’re looking for retirement communities that involve totally independent living, or a Continuing Care Retirement Community (CCRC), an all-care type of residential model mentioned in my previous blog “Selecting a Senior Housing Community”, your search will be less informational because most States do not license retirement communities.
  • STATE INSPECTION SURVEY.  All licensed facilities in the United States are inspected/surveyed every 12 – 18 months.  This survey is quite thorough and covers absolutely EVERY aspect of a facility’s operations.  When you tour a facility, always ask to look at a copy of that building’s latest State Survey.  By law they must make it available to anyone who asks.  I don’t think I would ever consider a Senior housing option without reading the building’s State Survey.  You’ll find minor or major citations which will be very telling as to how the building is run and how the Administration or Owner of the building responds to such citations.

LONG-TERM CARE OMBUDSMAN PROGRAM (LTCOP)

Every state must have a long-term care ombudsman program in place.  These programs are mandated by the Federal Older Americans Act and are intended to improve the quality of life for people who live in long-term care facilities.  A call to the LTCOP intake line in your state is a call worth making.  Let’s say you’ve narrowed down your housing search to a few options.  You ask the LTC Ombudsman’s office about the types of complaints that have been filed against those facilities and this office will provide worthwhile information to help you make your housing decisions.  The National Long-Term Care Ombudsman Center  will help you locate your local LTC Ombudsman program.

SENIOR HOUSING LOCATORS

You’ll notice that I’ve placed this type of resource at the bottom of my list.  There are numerous housing “finders” out there and they can certainly be helpful.  You tell them what you’re looking for; what area of town you prefer; what type of care you need; and what you’re willing to pay; and they’ll come up with some options for you.  Please keep in mind, however, that these senior housing finders have an inventory of housing clients that may or may not be representative of all that is out there.  They may come up with some very good options for you but their list will most likely not be an exhaustive one.

Regardless of what/who you use to locate a LTC facility, I hope you’ll go through the previous options I’ve listed above to discern the appropriateness of any facility you’re considering.  Perhaps a Senior Housing Locator has provided what appear to be some great options for you and you’ve even toured them and feel comfortable with what is offered.  Prior to making your final selection, at the very least go through your State’s Long Term Care Ombudsman to discern whether or not any recent actions or citations have been placed against that facility.  And when touring any housing location, be certain to ask for the facility’s latest State Inspection Survey so you can see what the State thinks about that facility.

My father & I on a picnic a year before he died.