nursing homes

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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Evil undercover: Alzheimer’s, Abuse, and the Elderly

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Alzheimer’s and the Elderly.

I’m attaching the above article from a fellow blogger.  He, like so many of us, find it difficult to fathom how anyone would take advantage of a vulnerable human being.  The very unsettling fact, however, is that incidents of abuse of the elderly occur and are far too common.

Whether the abuse is instigated by family members upon the elderly in the privacy of their home, or by “professionals” in long-term care settings such as assisted living facilities, nursing homes, or group homes – it happens.  Oftentimes such incidents go unchecked for months, or years, and are discovered only when a death occurs, or when someone with a conscience steps forward and complains to the authorities.  Those being abused either don’t have the ability to complain or they fear that doing so will make matters even worse for them.

Worse?  Residents fear that if they complain, they’ll be thrown out of the place in which they live – the place in which they receive the abuse.  I know that you and I are quick to say, “Fantastic!  What a great relief that would be if the person no longer lived with his or her abusers!”  We say that because we have not experienced what they have experienced; we have not heard the threats and vicious statements directed towards these vulnerable human beings.  These violated human beings don’t understand that abhorrent behavior is not normal because it’s all they’ve known.

These are older human beings who at one time were innocent children showing up on their first day of school; worried teenagers fretting over what to wear to the prom; young adults heading off to college and/or a career; husbands and wives, moms and dads … people just like you and me.  Now they’re nothing but broken, barely alive bodies who have been treated worse than a junk yard dog.

That makes me mad.

Long Term Care Insurance scares me.

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insurance, n. A thing providing protection against a possible eventuality.  Concise Oxford English Dictionary, 11th Edition; 2004.

Result of a serious automobile accident
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Auto insurance, home or renters insurance, and health insurance – we understand these policies and know that more likely than not the need for the aforementioned insurance policies will rear its ugly head in the near or distant future so we pay the premium for said policies, hoping we won’t need it, but sleeping better at night because we have it.

Why is purchasing long-term care insurance such a difficult step to take for me and my husband?

  1. Unquestionably, it’s expensive;
  2. Fearfully, companies who offer this product are going out of business left and right and may leave us holding an empty bag;
  3. Definitely, it’s a real difficult type of policy to understand; but
  4. Undeniably, the financial need for it can outweigh the cost of purchasing it.
New Orleans, 1942. Doctor at Marine Hospital p...
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My husband and I have still not made an effort to look into it further.  Here are my two reasons based on family experience – both of which tend to contradict each other:

My father’s long-term care insurance policy.  My father had a long-term care insurance policy for which he paid premiums for at least 20 years – no small amount of money to be sure.  He was diagnosed with Alzheimer’s at the age of 84 and died five years later.  His care needs at the retirement facility in which he had lived for 13 years didn’t meet the insurance reimbursement threshold until his final month of life.  As with most policies, the insurance holder’s care needs must meet a defined level of care before the insurance company kicks in their assisted living care reimbursement payments.  When that happens, the insurance holder no longer pays any more premiums.  Twenty years of paying premiums for one month of reimbursement benefit.

My sister-in-law’s long-term care policy.  My brother and sister-in-law purchased their long-term care insurance policies when they were in their late fifties.  Less than a year later my sister-in-law was diagnosed with early-onset dementia and approximately two years later drew benefits from her policy.  A couple of years of paying premiums for what will be years of reimbursement benefit.  If that isn’t the good news/bad news of long-term care insurance I don’t know what is!

I have no excuse. I know the devastating costs of long-term care because in my past professional life I worked for a senior housing provider and they represented the Champagne & Chandelier variety of assisted living.  But even the generic assisted living providers charge high rental rates and as ones’ care needs increase, so do the care fees.  This isn’t avoidance behavior on my part and I’m not squeamish about the subject of health and ones’ eventual death.  I’m just finding it hard to take this leap into signing up for insurance, even though it holds the assurance of fending off the potential of total personal financial collapse without it.

How are you Baby Boomers dealing with this subject?  If you finally bit the bullet and purchased a policy – how did you finally take that leap of faith?

I AM NOT LOOKING TO BE BOMBARDED BY SELLERS OF INSURANCE AS A RESULT OF THIS BLOG ARTICLE SO PLEASE DON’T GO THERE.  But I welcome other constructive feedback for those of us on the brink of making this difficult decision.

Navigating the maze of long-term care housing choices.

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The most comfortable decisions you can make in life are well-informed ones.  Whether you are choosing a vehicle, the vacation of a lifetime, or a potential residence, doing so is made easier when you’re armed with essential information.  Oftentimes when inundated with too many choices, we exclaim that we would rather have fewer options from which to choose.  “Give me two choices and I’ll be able to decide – six or more? Forgetaboutit!”  There is one time, however, when you will welcome a diversity of options: selecting appropriate care in your Senior years.

Identifying the person in need of care.

Gazebo at dementia unit where my father lived.

This quest upon which you are embarking may be your own personal quest.  You know staying in your current home might prove dangerous to you – and therefore inadvisable – in the years to come.  Or perhaps you just want to retire from doing house repairs and weekend yard work –and who doesn’t?  Whatever the reason, you’re considering your options for when you might be less able to take care of your daily needs.

Another scenario is that your spouse, parent or sibling is in need of some sort of long-term care resultant from a debilitating condition such as cognitive decline, mobility restrictions and/or advancing age, so you’re trying to discern how best to address the care needs associated with their condition.

There are two primary care options from which to choose:

  • Aging in Place – This blog posting addresses the option of staying put and making adjustments that modify a residence to suit your needs or that of your loved one.  Also included in this option is the potential for hiring in-home care.  Both of these options allow a person to remain in their home for as long as possible.
  • Long-term care (LTC) housing options.  In a future posting I will address the available categories of long-term care (LTC) housing and will provide resources that should be helpful towards choosing a replacement for your current residential situation.

Both options have Pros and Cons involved with them.  But only you know what best fits your personal situation.

Aging in Place: I don’t even want to think about moving!

Aging in Place refers to living where you have lived for many years using products, services and conveniences to enable you to remain where you are.  To successfully age in place without moving you will most likely need to accommodate the physical and cognitive changes that may accompany aging.

Structural changes.  Both the inside and outside of the home could eventually require some structural adjustments to accommodate a person’s current – and future – needs.

  • If you live in a two-story house and your primary bedroom and bathroom are upstairs, does your bottom floor afford a bedroom/bathroom alternative?
  • Are you financially prepared for the costs of making the inside of your home more accessible, e.g. wider doors for wheelchairs or walkers; lowered counters to accommodate same; showers that can accommodate someone confined to a mobility aid?
  • Does the outside of your home allow for the addition of ramps and railings for easier access to the residence?
  • If one of you has cognitive decline and is prone to wandering outside of the house – what measures, if any, will assure this resident’s safety?
  • If you need care assistance during the day, are you comfortable having a health care provider in the home?  The costs and logistics of hiring and scheduling staff to come into your home can prove to be overwhelming and oftentimes more expensive than if a person moved into a residential community that readily offers the needed care.

How expensive is in-home care these days?  Caveat: I will not be addressing financing sources such as long-term care insurance, Medicare, Medicaid and the like.  My intent in these articles is simply to provide an overview of care options and potential costs.

The U.S. Department of Health and Human Services gives a 2009 run-down on costs for care options both in the home and in a long-term care residential setting.  I know that in Washington State, where I reside, the average Home Health Aide hourly rate is $22; the average monthly cost of an Assisted Living (AL) facility is $2870; and the average daily cost of a semi-private room in a nursing home is $225 which is approximately $6700/month.

Focusing on Home Health Aide/In-home care: based on the average hourly rate of $22, one could expect to pay close to $528 per day if based on an hourly rate.  Keep in mind, however, that most staffing agencies offer a monthly rate which will be less than the hourly rate.  But even with that “discounted” rate, in-home care can be very cost prohibitive.  A great many of us may not have access to that amount of cash and if the need extends out to several years – now it’s really adding up.

So why even think of remaining in one’s own home if it’s so %#^%($ expensive?

All of the above is not to suggest that Aging in Place is not doable.  Many people around the nation are successfully aging in place so why shouldn’t you have a crack at it?  Consider this alternative: some people start out Aging in Place and then transition into a long-term care housing situation when finances, or circumstances, warrant such a move.

The articles, Avoiding the pitfalls of selecting senior housing, and Selecting a senior housing community – easy for some, not for the rest of us, provide some tips for your selection process.

Some links of interest: Alzheimer’s Association Carefinder service; Leading Age; Federal Govt Senior Topics.