Articles Posted in Skilled Nursing Homes

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Here are five easy steps to help convince your loved one who needs to move:

1. Enlist the child, sibling, or friend who is closest to the senior to initiate the conversation. The senior needs to hear the message from the right person.

2. ​Plant the seeds in very short, non-threatening messages. For example, “Gee, I noticed that you are having a little trouble getting yourself dressed. Don’t you think you would benefit from a little help?” Change the message at the right moment at the next attempt. “I noticed you have been eating a lot of cold cereal instead of a meal. Wouldn’t it be nice to have someone cook your meals for you?” Space out the messages and deliver them at the opportune times. It may take months for a senior to decide you are right.

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I want to share a story that may prove helpful to you my readers one day. I serve as the Power of Attorney for Health Care for one of my clients who has severe issues with her memory. She was recently transferred from the assisted living memory care unit of her current community to the skilled nursing section due to failing health. When I went to the nursing home to complete her admission papers, the social worker informed me that there was no completed DNR/POLST form in my client’s file, and I needed to complete one.

In order to accurately describe the form, I am quoting a description from POLST.ORG which reads, “The POLST Paradigm was developed to improve the quality of patient care and reduce medical errors by creating a system that identifies patients’ wishes regarding medical treatment and communicates and respects them by creating portable medical orders. While the POLST Paradigm supports the completion of advance directives, clinical experience and research demonstrate that these advance directives are not sufficient alone to assure that those who suffer from serious illnesses or frailty will have their preferences for treatment honored unless a POLST Form is also completed.”

Although I serve as Power of Attorney for several of my clients, most of them are not nearing the end of life at this point. When I looked at the form (http:www.idph.state.il.us/public/books/dnrform.pdf), and admittedly I had seen it before, I was a little overwhelmed. Seeing the form is one thing. Comprehending the reality associated with it is another. I told the social worker that my client’s POA for Health Care clearly stated that she did not want her life prolonged if the “burdens of treatment outweigh the benefits.” I was informed that without the completion of the POLST form, she would be a “CODE 3,” meaning that she would be resuscitated even if the POA form stated otherwise. Hence, the POA form was not sufficient in the absence of a POLST form on file.

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When you have completed the daunting task of choosing the right senior living community for your loved one, your next mission will be to prepare for his/her move. It is very likely that the senior will be moving to an apartment or room that will be much smaller than his/her current living arrangement. Decisions will need to be made as to which items the senior will discard, donate or keep. All of us tend to have difficulty parting with “keepsakes” to which we have emotional attachments; accordingly, it may be a wise decision to utilize the services of a professional organizer when your senior moves.

Sue Becker is a Certified Professional Organizer in Chronic Disorganization. She has worked side by side with my senior clients (including those with dementia) to help them with the highly emotional task of sorting through years’ worth of keepsakes and papers and deciding which items to keep.

Keepsakes: Turn Your Muddled Mess into Meaningful Memories

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Assisted living communities that have a memory care unit are supposed to be adequately staffed with assistants and aides who are educated to deal with the behaviors of dementia residents. The habits of these residents can often be repetitive and endanger the resident if they are not closely watched. Many residents “sundown” in the evening, meaning they may often become more confused and agitated at this time. In my opinion, the caregiver ratio in these sorts of units at night should be no less than 1 aide to 8 residents, when residents with dementia, whether ambulatory or not, can become very agitated and even combative. The “powers that be” at some senior living communities will dispute my ratio, contending that they only need to staff according to long-term care regulations. This month’s real life story will outline the consequences of understaffing.

Real-Life Story

I was recently hired by a client who was forced to place her memory-impaired relative in an assisted living community’s memory unit. The relative had been living in another retirement community that was not equipped to care for residents with memory issues. When the staff at the original community witnessed the relative dragging a bag of laundry up the hallway in the wee hours of the morning, the staff arranged to have her taken to the local hospital’s behavioral unit for evaluation. Apparently, this had not been the first incident of questionable behavior. When the evaluation of the relative was complete, my client was informed that the retirement community could not handle the relative’s behaviors. Therefore, my client had to place the relative in an assisted living community that had a bed available in its specialized memory unit.

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One of my current clients is a former medical professional who has decided to donate her body to science upon her death. She therefore enrolled as a member of a local anatomical gift association. As her Power of Attorney for Health Care, I was assigned the task of pre-arranging for the disposition of her body. My client’s enrollment card stated that arrangements needed to be made in advance with a funeral director to transport the body to the location of the anatomical gift association when the time comes.

Upon making a telephone call to a local funeral home to get a price for transportation of the body, I was shocked to be quoted a price for more than $1,600, along with a $350 cremation fee. Since the quote sounded high, I called the anatomical gift association to be certain that I understood all of the stipulations. When I had a discussion with the association’s representative, I was informed that every funeral home has the right to charge differently for its services. I was also informed that if the anatomical association accepts the body, then cremation of the remains is free. If the body is not accepted, i.e., is diseased or in unacceptable condition, the association would charge $370 for the cremation of the remains. The association’s representative gave me the name of two other funeral homes and recommended that I get quotes from them.

When I called the second funeral home, I was informed that the cost to transport the remains would be $1,150, with a $350 cremation fee. Although the price was better, the funeral director’s demeanor was so unfeeling that I wrote him off immediately. The second funeral director quoted me a fee of $850, and there was no cremation fee whether the anatomical society accepted the body or not. The deal sounded a little too good, so it made me wary. Last, I contacted the funeral director who handled by late husband’s services, because he was a very easy going man who made my life easier during a very difficult time. His price was $650, plus a $350 fee for cremation if the body was rejected. While his transportation quote was even lower than $850, I knew that I need not be wary based on my firsthand knowldege of his services and demeanor.

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The recent CBS investigative report regarding the cases of alleged neglect at a national assisted living chain held no surprises for me. I began my career in the elder care industry fifteen years ago when assisted living provided only “stand by,” assistance with activities of daily living (ADLS = bathing, dressing, toileting, transferring, walking, and eating). Several years ago, I made the observation that many of the assisted living communities were offering more “hands on” care to their residents. At the same time, I also observed that they were accepting residents who really belonged in intermediate nursing care or a skilled nursing community*. Being a former Admissions Director and with my current position as a senior living advisor, I thoroughly understand the current long term care market conditions.

The Admissions Director is the most important contact at a long-term care community. He or she is responsible for attracting and residents, while maintaining a high census. Many Admissions Directors also act as marketing liaisons. They provide your first impression of a long-term care community, and often are a direct reflection of the care your loved one is going to receive. They are also responsible for the initial assessment of the type of care that is appropriate for the senior. It is important to bear in mind that Admissions Directors are often commissioned salespeople. They are accountable to, “the powers that be,” for maintaining a high census. I can remember the terrible pressure that was exerted upon me by the management in order to keep filled the continuing care retirement community where I was working. Scarcely was a bed emptied before pressure came to fill it. The passing consolation that the seniors, “were called home by God,” just didn’t cut it in terms of lightening the pressure for quick turnarounds. I know that with a bad economy, the pressure is even worse.

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I was sad to read that the search for victims who perished in a Quebec retirement community fire had ended. At least twenty eight seniors were killed when the wood-framed building caught fire and was destroyed in less than an hour.

In the fifteen years that I have been involved in the elder care industry, I have never been asked how a senior would be evacuated from a building during a fire or other disaster. In light of current tragedy in Quebec, it is a question that should be addressed when assessing senior living communities.

Before I opened Andrea Donovan Senior Living Advisors, I was the Admissions Director of a retirement community that offered Intermediate nursing care (as well as independent living and assisted living) to its residents as part of the continuum of care. We were bound to act according to the Illinois Administrative Code for Skilled Nursing and Intermediate Care Facilities, Section 300.670 on Disaster Preparedness. This meant the staff had to adhere to extremely rigorous guidelines in case of a “disaster.” A disaster meant, “an occurrence as a result of natural force or mechanical failure such as water, wind or fire, or a lack of essential resources such as electric power, that poses a threat to the safety and welfare of residents, personnel, and others present in the facility.” The requirements were as follows:

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My client whom I will call “Marie” for the purposes of this story, was a 71 year old woman who had serious respiratory issues. Until recently, Marie lived at home with her mother. They had spent their entire lives together. A sudden illness caused Marie’s mother to be hospitalized and subsequently sent to a nursing home for rehabilitation. When it became apparent that my client’s mother was not going to recover, Marie brought her home and arranged for hospice services. There, my client Marie, a 70-something senior, continued to help tend to her mom, who eventually passed away.

As I had been hired by Marie previously, I was recently contacted by her trust officer, and was informed that Marie had been ill. It was requested that I act as her geriatric care manager. I went to the hospital in order to assess her situation. At that point in time, the trust officer knew very little about Marie’s physical condition.

When I arrived at the hospital, I was very surprised at how much Marie had deteriorated. She had been a feisty, quick witted woman. Despite her breathing issues, she had always been a fighter as evidenced by her devotion to her mother. At first, Marie didn’t recognize me because she was taking medications. Then in a matter of a few minutes, she confessed to me that the combination of taking care of her mother and the breathing issues landed her in the hospital, then in a rehab. community for respiratory therapy, then back in the hospital again. She said, “Andrea, I am convinced that taking care of my mother worsened my health. But, I loved her, and I would never change what I did. But, now that she is gone, I really have nothing to live for.” The hospital’s plan was to send Marie home with hospice care. She told me she was impressed with the hospice team that had taken care of her mom, and wanted the same people to take care of her.

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And old saying observes that “Beauty is only skin deep,” but I believe both beauty and better health begin inside and out. Here’s one example why.

I serve as a Geriatric Care Manager for a woman in her late 80s who has no family. Although I regret to take her outside during the cold weather, her medical appointments are a necessity that cannot be avoided. I’ve thought about how tough the frigid Chicago weather can be on anybody’s skin. Since I know my client’s medical history, I keep the following things in mind as part of her elder care planning:

Since she is over 85 years old, her skin is very fragile and rather thin. Therefore, she is subject to two skin conditions:

1. Seborrheic Dermatitis, a skin inflammation that is characterized by areas of dry, itchy flakes that are normally found in oily areas such as the scalp. The condition becomes worse during the cold weather. The condition is caused by yeast that activates skin irritation in cold weather.

2. Psoriasis, another skin condition that appears like a red outbreak with a dry patch on the top. It can appear just about anywhere on the body, but emerges mostly on the elbows, knees, and scalp. I have often seen the psoriasis flare on my client’s legs, and during the dark winter weather, it is much harder to clear up. It is much easier to get the outbreak to diminish when the skin is exposed to some light. The dermatologist treats the outbreak with a combination of topical steroids and an ointment called Calcitrol.

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I have never had a circumstance arise where the wishes outlined in my client’s Power Of Attorney For Healthcare were not carried out by a community where s/he was residing. I am sharing the facts regarding a recent incident that occurred lest it happen to you and your loved one.

I was hired by the child of an elderly loved one who was living in a rehabilitation community (religious affiliated) under Medicare benefits. The child lived out of state and told me that I was to identify the best long term care communities of the same religious affiliation for the loved one. The current community typically did not have a lot of long term care beds available. Placement was to occur once the loved one’s rehabilitation was completed. Spirituality was exceedingly important to this particular senior. The ability to attend religious services was a mandatory prerequisite.

After preparing the necessary research on the communities that fit the family’s criteria, I was instructed to arrange transportation to accompany the senior on the tours of the various communities.