Tragedy in Pennsylvania

I read the saddest story over the weekend about an 85-year-old woman who had been taken from her Pennsylvania nursing home by her 50-someting son. He dumped her from his car and ran over her several times, killing her. How sickening and tragic.

As someone who has lived in nursing homes over the last four years, I can't grasp there is any way, rationally-speaking, that a home could not have seen something in the son's behavior toward their patient to prevent them from letting him take her. In fact, in this case, a guardian had been appointed by the court to care for her -- someone saw red flags, but that didn't keep the facility from letting her go out with her diabolical son.

He sits in jail, charged under Pennsylvania law with 1st, 2nd and 3rd degree murder.

But that won't do his Mom any good.

IF IT SMELLS, TURN AROUND AND WALK OUT

Sunday is a popular day to visit nursing homes or assisted living facilities. Caveat: The institutions are on their best beahavior, they know you'll be coming.

Stop in during the week, when you're least expected. When you visit any assisted living or nursing facility for yourself, or even if you’re helping a friend, if it smells the minute you walk through the lobby, don’t waste your time. LEAVE. There is no excuse for foul smells. It means the staff is not adequately caring for the patients, changing briefs, cleaning messes, preventing bedsores. Don’t waste your time, and in my opinion, share your experience with all your friends. Places like that don’t deserve to have patients.

New Publications on American Chronicle

Newly Published by Jane Allison Austin on American Chronicle: "Long-Term Health Care Insurance" You've got it, now what will it do for you? And if you're considering buying long-term care insurance, different rates for different daily rates in nursing homes apply.Click Here to Learn What You Need to Know for Yourself and Your Parents.

Popular Article by Jane Allison also published on American Chronicle: "An RN Speaks Out on Nursing Homes" Click Here!

My Parent Has Long-Term Care Insurance-Now What?-Part 2

In "My Mom Has Long-Term Care Insurance-How do I Interview Nursing Homes-Part 1," we looked at the importance of first determining the per diem rate your parent's long-term care insurance policy provides. You will want to check with your health care insurance company to find out exactly how much the policy your parent purchased will pay to a nursing home for your parent's daily care.

This question is very important because different health care insurance companies provide different long-term care insurance policies purchased at different rates.

One daughter told me that her health care insurance company told her that she could pick any nursing home for her mother, so she immediately wanted to know what to look for in nursing homes.

Great question, but the first question to ask is how much will you have to spend under the terms of your parent's long-term care insurance company policy -- how much in additional funds will you or your parent have to pay if you pick a nursing home of better quality than the per diem allowable cost of Mom or Dad's long-term care plan.

As you're looking at nursing homes, ask what is the nursing homes' daily cost? Will there be extra charges for diapers, gloves, wipes, laundry, medicine? If you have to purchase these, they CAN be brought in from the outside. Don't pay the rates the nursing home charges--that's usually where they make extra money. Save your money for the important expenses. Go to Costco or Sam's Club or order on line.

There are also outside mail-order pharmacies for any medications covered or not by Medicare or secondary insurance. A good nursing home facility will help you arrange for that. If not, you can also do it on your own.

If you're looking for an inexpensive tool to discover free resources and giveaways for seniors Click Here!

Many facilities have trouble finding quality nurses to work in their facilities. Often you will see that they don't even have every shift covered by one registered nurse.

This is a bad sign.

You should also look at the most recent state health board report on the nursing home facility. Check out how many negative notices have been made against the nursing homes your are looking at. Often times, nursing homes will be cited for not giving medications at the proper time (very important) or skipping them altogether. Ask also what is the turnover rate of staff?

Stop in some time during the week when the nursing homes are not typically expecting family visitors and ask to take a tour -- look through the entire facility. Is there a cup with a straw and filled water pitcher by each person's bed? Is there a television, telephone?

How will you reach your parent by phone? Will your Mom or Dad have to use a cell phone to talk to you? Will you have to rely on the nurse's desk to take a phone to your parent's when you call (good luck with that!). Communication between the elder and family members is crucial to the elder's mental health. Make sure you and your family members can communicate easily with Mom or Dad.

Also ask to look into the shower areas and see how clean they are.

And, of course, as I recommended in Part 1, talk to other family members of other patients. But still make sure you make a surprise visit during the week to really see what happens when the nursing home is not typically expecting visitors.

Also, find out about doctors. Does the facility have a Medical Director who visits or is on call? Typically, only the highest-end facilities do. So, you need to make sure that your parent's physician will come to the nursing home you choose or that it's easy for you to arrange for transportation to the doctor's office.

I've written before and will mention again that elder and disability transportation services are one of the highest growth areas of necessary services as boomers and our parents age. Many available services are run very poorly.

If you are looking for a growth business, I recommend strongly that you check out elder/disability transportation service opportunities. This resource I'm recommending may look a little intimidating at first but it's a great investment in learning how to build a transportation service company--Click Here!

I can tell you from first-hand experience that a well-organized, caring, service-oriented transportation company for the aging and disabled will attract many clients, both private individuals and families as well as nursing home facilities that have to arrange for transportation of their patients to and from hospitals and doctors' appointments.

Finally, meals. Some facilities do not want to serve individuals in bed because they want them up and out, they say, it's more social for the seniors, but it's also more work for the staff. You should find a nursing home facility that will allow meals to be served in the room, at the patient's discretion. There may be days or come a time when your parent will want/need meals to be served in bed.

Keep in mind, you are not alone through all of this. We offer telephone consultations to guide you through your health care planning, both pre-planning and emergency situations. To contact us, Click Here!

Blessings and encouragement, Jane Allison

My New Article On Nursing Homes Published Today On American Chronicle!

Please click here to read!

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.

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

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's Homecoming

Coming Home

Bringing a family member home after a stay in a skilled nursing facility (SNF) or rehabilitation center, or directly from the hospital, can be an overwhelming challenge emotionally and physically. If you are going to be a caregiver either in your own home or your parent's, to minimize emotional overload you need a plan. I'm going to give you one. First, let me share my story, and then I'll recommend what to do.

My Mother's coming home tomorrow at 2 p.m. "Home" I've learned over the last three years is wherever your loved ones are. I have been traveling from my "grown-up" home in Virginia to my "childhood" home in California, looking after my 86-year-old Mother (only child of only children). It's been a joy, but whenever I leave one place, I say "I'm going home." This last trip I decided both are home -- so I now refer to them as "the ocean" and "the farm."
My mother's coming home tomorrow at 2 p.m. is real for her. This has been her main residence or second home in California for over 30 years. I've been a nomad in it as I have come and gone to look over her care and be with her in a beautiful (we have been blessed) skilled nursing facility close by. But it struck me one night as I lay in my nomad state watching TV that she was doing the same thing several miles away, so why shouldn't we be doing it together? She has been in the facility for three years. They had taken great care of her. When I left to go to the farm after her first hospitalization, I worked hard to get caregivers for her at home who would care for her in my absence. She wasn't really sick, just immobile and afraid to be touched. She graciously growled at every lovely lady who came in, and I again knew in that moment, if I left, she'd kick them all out, so it was back to the facility, which kindly took us in.

Fast forward three years and she's been well cared for. Her mind is still sharp. Yet, she had come to the point where all she wanted was to lie in bed, be left alone, not eat (except for the chocolate I brought ever day) and said repeatedly she was living too long. In our care plan discussion, the lovely hospice social services lady, Paula, told me to be prepared, that it was not unusual for women to just start shutting down until they pass away.
Then a funny thing happened on the way to "home." My mother rallied. Three days before the scheduled departure I get a call from wonderful, Kit, the Head of Nursing. "I've got the greatest news. Mom has been up in her wheelchair, sitting in the Activities Room, taking all three meals in the dining room" -- which she had always called the "old people's room" and refused to go into, preferring meals in her room. I'm told the staff in amazement is calling this the "Awakening of Mrs. Lee."

Her front room with the ocean view is all ready to go, new bed (not a hospital bed, you need a special bed~more later), a lovely sofa bed to sit in by day and hang out with her all night if necessary, all my "little girl" furniture of which I was most proud has been taken away to make room for this new era in our lives.

My mother's coming home tomorrow at 2 p.m. -- from now on that's where I'll be hanging with one-half of my family at "the ocean." What joy.

I want you to have the same experience -- with or without the ocean. Here's what you need to do:

1. If your loved one is in a SNF, hospital, or rehabilitation facility, sit down about a week before you are planning to bring your parent home, listen and ask lots of questions!

2. If your parent is on hospice, hospice will offer a hospital bed at no charge. The standard in the industry says they are unbearably uncomfortable. If finances are an issue, you may have to take the bed. It is a blessing hospice even provides all that they do. If you are able to spend some money, I recommend checking into a nursing home bed distributor. Some of those beds are better than others. I worked directly with my "team" at the nursing facility (they have connections, you just have to ask and push) to arrange for a top-of-the-line bed to rent for $150 per month. The bed can also be purchased. The IMPORTANCE of this type of bed is that it moves the body in all different positions, crucial to prevent bedsores, and allows the bed to go all the way to the floor if your parent has a tendency to fall. Hospital beds don't go to the floor.

3. Hospice will also provide an eating table that goes over the bed for meals and holds drinks during the day, a wheelchair, oxygen, and a hoyer lift, which takes us to #4.

4. There are different sizes and kinds of hoyer lifts. You will want to talk to hospice about what they can provide, or check on your own -- Google "hoyer lifts" -- to find the right one for you. They will aid you in lifting Mom or Dad out of the bed and putting them in an armchair or wheel chair. You need practice, so ask the facility to show you how it works and practice with your Mom or Dad before they come home.

5. Finally, but equally important, finding caregivers to support YOU! You cannot take care of your parent 24 hours a day -- it is a physical and emotional impossibility. Watch out or the bed your Mom or Dad vacated might soon be yours! Reputable, trustworthy, bonded caregivers are the key. Ask your facility for whom they know to be the most trustworthy caregiving agencies. You will want to interview the caregivers and introduce them to Mom or Dad. If one doesn't work out, don't hesitate to ask for another. This is the most important step--you are entrusting your parent's life to another so that you can get out and have some recreation time, etc., AND you want someone in your house you can trust while you're gone. Put any valuables away. No matter how great we believe someone to be, we never truly, truly know them, especially in this setting.

You can do it. Loving your parent through this difficult time is a challenge, but will give you those special moments you will treasure forever. Corny to say, but love is a powerful thing, and serving your Mom or Dad at this time in your life is healing to them and a gift to you.

Help! My Parent's in the Hospital! Five Things You Must Do IMMEDIATELY!

Have you gotten that call in the middle of the night telling you that your mother who is 2,000 miles away has fallen and is in the hospital? Has your father come for a visit and had a slight stroke? These circumstances can interrupt your everyday life and send you into a state of panic and fear. THE MOST IMPORTANT THING TO DO WHEN YOUR PARENT IS HOSPITALIZED IS TO PUT YOUR PANIC AND WORRY ASIDE AND SHIFT INTO WARRIOR MODE. Here's what you need to do.

1. Don't panic. It is natural to be fearful and overwhelmed when your mother or dad is rushed to the hospital. Accept your feelings as natural, but put them aside right away. YOU ARE YOUR PARENT'S BEST ADVOCATE. If you live far away, immediately call a friend who can go to the hospital and be your liaison on the ground until you get there. You will quickly get frustrated and angry trying to get information about what's happening with Mom or Dad unless you have someone on the scene looking out for YOU and letting you know what's going on. If you can't get to the hospital, there are also elder care advocates like myself who can be your eyes and ears and fight through the system so your parent gets the best care.

2. Contact your mother or dad's physician immediately. As a side note here, it is very important that your parent have a general internist physician (preferably a gerontologist if you can find one) WHO IS WILLING TO FOLLOW YOUR PARENT TO THE HOSPITAL IF NECESSARY. This is obviously something to arrange now, before any unforeseen hospitalization occurs.

Many hospitals now promote to patients a new system of "hospitalists" -- these are physicians who only work at the hospital and don't have a private practice. The problem with this is that your parent will be a new patient to the hospitalist and you might not have the same hospitalist every day. WHAT YOU WANT IS YOUR PARENT'S PHYSICIAN WHO KNOWS YOUR PARENT'S HISTORY TO VISIT THE HOSPITAL EVERY DAY AND DIRECT YOUR PARENT'S CARE! This is very important for the continuity of care for your mom or dad and for your comfort. A hospitalist might not pick up on something about your parent that his or her own physician would because of their history together.

3. Don't be intimidated by the hospital system. The reality is that hospitals have their own protocols and systems which may work for them, but may not necessarily work for you! You land in a place that's all new to you -- and they've got the advantage. Do not be afraid to ask questions of the nurses, other staff or the physicians. Hospitals tell us that their mission is to take the best care of their patients, but the reality is the only person who will be looking out for the best interests of your parent is YOU or YOUR ADVOCATE.

When my mother was in the hospital, I walked up to the nurses' station behind which about 10 people were chatting away, and the one who was sitting at the desk right in front of me refused to look up. I finally called out, Hello, anybody home? And they all turned in disbelief, but I got what I needed.

4. If possible, keep your parent in the hospital for THREE OVERNIGHTS. True, you do not have complete control over this, that's why the presence of your parent's own physician can be so important, but if your parent will have to go to a rehab facility or go home for therapy, and he or she is on Medicare, Medicare will only pay for follow-up treatment if your parent has spent three full overnights in the hospital. Not days, but overnights.

Don't let them try to push Mom or Dad out too early. If it's legitimate for them to stay in the hospital, make sure they stay. I had a friend who unfortunately did not know the three-day rule at the time, and her mother wanted to leave the hospital early. She needed therapy at home as the doctor prescribed but had to pay for it herself because she did not meet the three-overnight rule.

5. Manage the hospital's discharge planner. Within a day or two of your parent's admission, you will meet the discharge planner, whose job it is to arrange for where Mom or Dad goes and what help they need after the hospital. THIS IS VERY KEY -- if your parent is going to have to go to a rehab facility, a skilled nursing facility, and the three-day rule is met, Medicare will pay for the best or worst facility. IT IS YOUR JOB AS ADVOCATE TO FIND OUT THE BEST FACILITY AND GET MOM OR DAD IN THERE! This will make a world of difference in their aftercare.

The discharge planner will give you a list of facilities in the area. They are not ethically allowed to tell you what the best ones are. Typically, they will ask you to pick three, and then whichever of those three facilities has a bed on the day Mom or Dad is discharged from the hospital, that's where they'll go.

BUT HERE'S THE CATCH -- THERE MAY ONLY BE ONE GREAT FACILITY IN THE AREA. SO HOW TO GET THERE? First, you have to find it. Ask friends, families, colleagues. If you've hired an advocate, they'll be able to guide you. If you're on the ground, go visit the facilities. Ask for a tour of the skilled nursing facility. Talk to the admissions officer at the facilities you like. If one stands out above the rest, keep talking to the Admissions officer at that facility (you won't know exactly what day your parent will be discharged) and tell the hospital's discharge planner that you want your parent to go there.

This is so important and the trickiest part. When you find out (usually the day before) when Mom or Dad is to be discharged, call the facility (or facilities if you're blessed to have several you like) and ask if they will have a bed open the next day. Some hospital discharge planners are wonderful, others are annoying and territorial. They may see you as interfering with "their" job. But put any concerns about that aside, and recognize that they are treading on YOUR territory, where Mom or Dad goes will make no difference to them, it will make all the difference to you. If there's a bed open where you want to go, tell the discharge planner that day -- tell them you've talked to the admissions representative at the facility, there's a bed available, and you want Mom or Dad to go there. DO NOT GIVE IN AT ANY POINT AT THIS STAGE. YOU'VE DONE THE HARD WORK, IT'S TIME FOR MOM OR DAD (AND YOU) TO REAP THE BENEFITS OF YOUR INVESTIGATIONS AND ADVOCACY!

Remember, regardless of your past history, fighting for your parent at this time in his or her life when they may need you most, can become the most rewarding time of togetherness for both of you and lead to great healing, if needed, and joy. It won't be easy, but it will be worth it. Hopefully, with these tips in mind, you can focus on loving your parent to the best of your ability and not on the frustrations that come from navigating unknown waters.

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