An RN Speaks Out On Nursing Facilities-What To Ask and What to Look Out For!

We talk with a lot of clients about nursing homes. I have asked a licensed RN who visits multiple nursing homes to share with us her observations and thoughts on care in these facilities. Very inciteful.

I hope this is helpful to you as you care for your parents. As always, please share any comments you have below. Thanks to my friend for her great contribution.

This is in response to a request I've gotten to post my ad hoc observations about nursing homes and how they differ, and how to know if your loved one is getting the appropriate care.

First, I strongly recommend the Medicare website, which has a Nursing Home Compare section with a ton of information.

Next, keep in mind that I am still very new to working with nursing homes, so my observations have their limits. I welcome input/comments from anyone who can expand, elaborate, contradict, or otherwise enhance these comments. For example, I don't actually know what regulations nursing homes have to follow, and what information they are required to provide to the public. With all that said, here we go.

Here's what I like to see:

-- Nurses who know the patients well, and can easily talk about their eating habits, the "as needed" medications they've had to take, and their physical status without having to look something up.

-- Patients who need to be fed actually being fed, instead of having their tray sit in front of them untouched for 45 minutes without anything to keep the food warm, or any indication that they DO get fed -- at all. (TIP: schedule a stealth visit at mealtime.)

-- Patients with significant debilities nonetheless being encouraged and helped to get out of bed and into some sort of chair if at all possible.

-- Clear, detailed documentation of any wounds and their treatment (including measurements) that is (1) easy to access, and (2) updated AT LEAST weekly (you'll only be able to legally access records for your own family members).

-- Appropriate use of "as needed" medication for pain, agitation, or other distressing symptoms.

-- A clean, bright environment with no evidence of broken equipment.

-- A low pressure ulcer acquisition rate, and someone who can tell you what it is.

-- Activities for residents.

-- A wide variety of services provided by the facility (not contracted), including physical therapy, speech therapy, occupational therapy, behavioral therapy, dieticians, and so on.

-- Staff that clearly enjoys working together and at the facility

That's a start. I'm sure there are folks reading this who could add more.

Please add any thoughts or comments below. Especially if you are an RN, please share with us your insights. If you are looking for a nursing facility, keep these and other facts discussed below in other posts in mind as you search for a facility. Take great care of your parents in this area and the reward will be tremendous!

Blessings, Jane Allison

My Mom Has Long-Term Care Insurance -- How Do I Interview Nursing Homes? - Part 1

It is SO important at this juncture to research, research, research.

First find out what is the per diem on your mother or father's long-term care insurance. Different plans pay different amounts per day.

Every facility has a per diem, and any difference between what your insurance provides and what the actual cost of the nursing home facility is would come out of you or your parent's pocket.

A long-term policy might pay $114 a day, but the best nursing home facilities may charge $250 or more. (This is also important to think about in your 40s when you start looking at purchasing long-term care insurance.)

So, have your insurance paramaters straight before you journey out into the unknown nursing home world.

The first thing you want to notice as you walk into a nursing home facility, is does it smell? If it does, walk out. Bad smelling facilities are poorly run. It means that the patients are not being changed and cleaned routinely. It also means the staff and director are willing to tolerate that -- which raises concerns about what other poor care they are willing to tolerate.

I would ask to meet with the Director of Nursing (DON), not just the Admissions Director or Assistant, who are basically the sales people. If the DON is not willing to make an appointment to meet with you, I would go elsewhere. It is unusual for the request to be made, most people don't know to ask. But he or she is the person who runs the facility, if it is skilled nursing, so it is very important to interview them.

Ask the DON what the staff turnover rate is, what is their proportion of CNAs, LVNs (who give medicine) and RNs per patient. How many charge nurses are on duty (those who sit at the desk) during each shift. This should also be posted somewhere on a wall in the entry way by law in most states.

In Part 2 we'll focus on the difficulties many nursing home facilities have in training and keeping good staff, and how to give your Mom or Dad the best chance to get into the best nursing facility.

Exercise For Seniors -- The Happiest Way to Live!

I have to admit I hated golf. Tennis was always my thing growing up in L.A. Loved Breakfast at Wimbledon, the whole thing. Instant gratification (or not) every time you hit the ball, and the points went fast.

Then I married my husband. A golfer -- the most boring sport known to me. Slow, slow, slow...Then I watched him play. And man, did he think, and analyze, and think and analyze each shot. And walk and walk and walk. Me, too. Enlightened me: There's a lot of thinking involved with this game...It's very strategic...

So, now here's my pitch, to mix sports metaphors. One of the most important things for our aging parents to do is exercise. Here is a great place to answer your questions on the benefits of exercise for seniors.

Tennis for some may no longer be an option. (Tennis Elbow a problem? Click Here!)

But how about my new favorite? Golf? I'm even learning how to play. Putting's my best -- I think it was all that miniature golf as a kid. Here's a resource I also found for lots of great tips for senior golfers seeking exercise, a great game and fellowship.

Balance is also important as our parents get older. My mother is bedridden because over time she refused to get out of bed and now her internal equilibrium causes her to feel like she's falling even when she is lying in bed. That's why I press this point so hard: I don't want what happened to my mother to happen to yours. Here is a great resource for balance exercises for your Mom or Dad to work on now. Click for info here.

If Mom or Dad prefers swimming, Click Here!

Exercise works the brain, the soul and the body -- and it's one of the best social activities around. So get your folks out there, study how to improve your game together, if you're golfing, enjoy the links and remember the golfer's goal -- long and straight!

How to Talk with Your Parents About their Future!

Recommended by Mike Gamble @Mike_Gamble on Twitter -- An excellent Article! How to Talk About Caregiving with Your Aging Parents, written by Julie Davis, Managing Editor of ParentGiving.com http://bit.ly/ZC6fA

Elder Hallucinations Can Be Scary!

My mother hallucinated last night -- these are bits of the scary part of caring for an elder parent. From the living room, I heard her say, "I don't want any more orange juice." But as far as I knew, we were the only ones in the house.

I went it and asked about the juice. She said the nurse was making her drink more orange juice. "Which nurse," I asked, playing along. "The one right there." Okey-dokey. "How 'bout some water instead" Okay, she said.

My mother's on a mimumum amount of medication compared to many her age for which I am grateful. These hallucinations -- her mother, my Daddy, her old bosses, folks coming to a dinner party -- were more prevalent at the skilled facility, when she wasn't being talked to and engaged all day long like she is here at home.

So, I guess if I were alone, I'd make up friends, too. The first time it happened, I freaked out, but was told that it's typical with forms of even mild dementia.

Just as long as all she's looking at is a nurse wanting to give her orange juice. If the bad guys come, I might have to pull out my imaginary guns.

Just Published at American Chronicle

Powers of Attorney and Advance Medical Directives - What Every Adult Child Must Know - Part 1

Honored to have this publihsed today! Read article at American Chronicle and stay tuned for Part 2.

Cheers and thanks for your support!

Durable Powers of Attorney, Powers of Attorney for Healthcare, and Advanced Medical Directives--The Law

One of THE most important issues to talk to your parents about is their executing a Durable Power of Attorney -- (POA) or (DPOA) in some states, an Advanced Medical Directive and Power of Attorney for Healthcare.

If your parent has a stroke, heart attack, or is unconscious for a period of time, these documents must be in place to make your helping them as easy as possible so you can focus on loving them through it and not the attending medical legal issues. Any good attorney can prepare all of them for you. Please do it now before a sudden healthcare matter arises.

The Durable Power of Attorney will allow you or whomever your parent appoints to make decisions, pay their bills, handle conversations with Medicare and insurance while they are out of commission. I usually recommend a POA that does not require a physician's determination of the incapacity of the elder. But parents need to understand that the POA can be used even when they are fully conscious, so there are some safeguards I put around that, which we will discuss later.

Advanced Medical Directives tell your parents' physicians what they want done or not done for them if they're in a critical state: life support, a Do Not Resuscitate Order, etc.

A Medical Power of Attorney for Healthcare gives you or the person your parent appoints the ability to make health care decisions for them in their stead.

It's hard to face those decisions as a child, but much easier if you've had the conversation ahead of time about what your parent wants to do. Then you'll know you're carrying out their wishes, difficult as it may be.

Elder Care Transportation--A Much Needed Business

When my mother was in a skilled nursing facility (SNF), one aspect of her care that was very important was her transportation to and from doctors' appointments. Although we were blessed at her facility to have an on-staff medical director who came to her room, there were several referrals he made to specialists who would only see us in their offices.

Over the course of a year, we went to a neurosurgeon (and back and forth to the hospital for testing and eventual surgery to implant a shunt), to the endocrinologist, and to the radiologist.

None of this would have been possible in a regular car. My mother could only be transported in a wheelchair, and for that we need elder care transportation -- a large van with an elevator lift and safety belts to hold my mother (and me) in place.

Some services were great, others terrible. There is such a need for caring, professional transportation services for the elderly--it's a huge market, and not one necessarily well-served. In this economic age, many folks are looking for businesses to start. This could be a great one if you care for elders and run it well! If you're interested in some information that may be helpful, see Elder Care Transportation.

Some drivers went so fast my mother would scream; others treated her with tender loving care -- they were the best!

San Diego's Institute for Palliative Medicine Improving Acute Pain Treatments Worldwide

The Institute for Palliative Meidicine -- the research side of San Diego Hospice -- leads the world in acute care palliative research, treatment and training. Palliative care is no longer just for individuals who are passing. Palliative care specialists can be brought in to acute hospital situations to consult on pain management. Learn more about this shining research light and their work at The Institute for Palliative Medicine

Part 2 of Medicaid Nursing Home Article Published at American Chronicle

Stop before you encourage your loved ones to gift away their assets in order to qualify for Medicaid. Part 2 - What Nursing Home Will Your Seniors Live In? Medicaid Nursing Homes

My Mother Doesn't Like My Singing!

Happy Saturday! So, I'm cleaning house and playing John Denver -- You Fill Up My Senses again and again -- it just seems beautiful and worshipful on this gorgeous day -- so I go into my mother's room as I sing away. "No singing in here," she says. "How come?" I ask. "You have to have a good voice." Guess she preferred John to me.

Just Published on American Chronicle

Just published -- American Chronicle Gifting to Qualify for MediCal - Medicaid Eligibility - Unfair For Seniors? - Part 1 Medicaid Eligibility

Gifting to Qualify for MediCal--Unfair For Seniors?

As an attorney, I often see colleagues' promotional materials, advertising that there are lawful ways for elders to gift their estate to other family members in order to qualify for MediCal -- what we call "Medicaid" in California. Other states use the term "Medicaid" or have created their own term.

When I first read one of these elder attorney's pamphlets, I thought whom is he representing? Does the elder who is being advised or agreeing to do this know what a MediCal/Medicaid facility looks like? The quality of care they are going to receive compared to what they may be used to in what I call "real life" -- the time before they enter Assisted Living or a Skilled Nursing Facility (SNF) -- can be much less than their current standard of living.

MediCal and Medicaid facilities may do the best they can with their limited resources, but the resources ARE limited, and it is important that any elder understand what it means if they give away their estate in order to qualify for MediCal/Medicaid. THEY NEED TO VISIT THE TYPE OF FACILITY THEY MAY HAVE TO LIVE OUT THEIR LIFE IN BEFORE THEY AGREE TO GIVE THEIR ASSETS AWAY. That's what the legal community refers to as "informed consent", but I wonder how often that happens in these types of situations.

Many attorneys get around what appears to be a major ethical dilemma by representing the children and having a written waiver from the parent that the parent should seek their own counsel and that the attorney is not representing the parent. This waiver may or may not be effective depending on the specific circumstances and the state.

There may be those unselfish parents who are willing to give it all away for the sake of their children and risk living in a bad facility for the rest of their lives if necessary. My concern is most parents don't know exactly what they are doing when they seek to give away their assets to qualify for MediCal/Medicaid.

It sounds like a great come on, but go see the fine print! If you are an elder planning on working with an attorney and your family to qualify for MediCal/Medicaid, please educate yourself, seek your own personal legal counsel, and research the potential quality of life you will face if you have to rely solely on MediCal/Medicaid and not on your own personal funds.

Legally protecting your assets and saving tax dollars is your right, but please make sure it is what is best for YOU!

Jane Allison
http://yourelderlawadvocate.com/
http://twitter.com/janeallison

My Mother -- Hospice's Comedienne!

My mother is now home with me and comfortable, have the caregiving schedule worked out, and now lots of great time to write.

So, this is the best part, I've learned my mother is a lie-in-bed comic. As context, she has short-term memory issues, but that mind is still sharp even with its limitations.

As sad as last week was with all the tragic deaths in L.A., I was startled when after watching three days of coverage from morning to night, my mother turns to me and says, "I think Michael Jackson has died."

Yesterday, on the Fourth, I'm trying to get her to understand what day it is. She runs through the days of the week -- no, that didn't work. So, I say, "What day is the Fourth of July?" Her response, "On the Fourth of July."

Later I ask her again what day it is -- it's a beautiful, sunny day in Southern California, clear and gorgeous, unlike last year's Fourth of July Fog -- this time she says it's Christmas Eve. I say, "Look out the window, does it look like it could be Christmas Eve? It's the Fourth of July." She says, "Well, it can be both the Fourth of July and Christmas Eve." "Why do you want it to be Christmas Eve?" I ask. "So that I can get presents."

So then I am telling her today that before she came home I went out to shop, after checking with some Twitter friends about the best sofa bed to put in her room -- a plug for "American Leather" (but the sofas come in wonderful microfiber colors, too, and no springs!) so that I or a caregiver could spend the night with her. She tells me she loves the color. I explain how the first store we went to didn't have the right size or color. The second store, praise the Lord, had the twin size in exactly our color, but didn't want to sell it off the floor. It would take five weeks to order and deliver, but my Mother was coming home at the end of the week.

I told my Mom this morning I knew when I saw the sofa that the Lord had it there ready for us and they would sell it to us, which they did. She says she loves it and it looks beautiful in the room.

Then my mother asks for candy. I say, "You're always talking about candy!" "No, I'm not, I was just talking about sofas!"

Love your parents and bring them home if you can. You don't want to miss the magic moments.

Blessings, Jane Allison
http://yourelderlawadvocate.com
http://twitter.com/janeallison

P.S. As I am writing this on the sofa in her room, my mother calls out, "Throw me the flipper" -- our term for the TV remote. Then she quickly follows it up with, "But don't hit me." Fortunately, it was already by her side, no chance for that!