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Nursing Home Planning

Wednesday, August 7, 2013

Continuing Care Retirement Communities

Continuing-care retirement communities (CCRCs) are communities that are part independent living, part assisted living and part skilled nursing home, offering a tiered approach to the aging process and accommodating the changing needs of their residents.  And due to the recession, many CCRCs are becoming more efficient, making now a good time to consider a move to a community.  Eager to draw in new residents, many are offering different services and bargains that can be quite nice if you are ready to move.
Before you get up and go, make sure you find a community that appeals to you.  It’s important to check many different components, including:
  • The Caregiving Component.  Check if care is on-campus or off-campus.  Also, if your family has a history of a medical problem, like Alzheimer’s, make sure your CCRC has good care for that.
  • The Costs.  CCRCs normally have an entrance fee depending on the apartment size and a monthly fee to cover needs.  They are also dependent on other factors, including health, the number of residents living in the facility and the type of service contract (fee-for-service or all included).  Remember that many current expenses, like groceries and home maintenance, will be covered at the CCRC.  A general suggestion is to have your monthly income be one and a half times the monthly fee.
  • The CCRCs Finances.  If the occupancy rate is below average (90%), the number could reflect poor management.  Also, look at the sponsoring companies and the CCRC’s track record.  Have a lawyer or geriatric care manager check the community’s status, too.  Make sure your CCRC can keep any promises they make.

Thursday, January 24, 2013

Adult Day Services

The role of caregiving can be both rewarding and exhausting.  To handle those exhausting times, it is important to incorporate some down time in your schedule to take care of yourself.  A study from Penn State and Virginia Tech showed that adult day services (ADS), which can provide services to allow for down time, significantly lowered stress levels of the caregiving family members.  Adult day services can give caregivers respite by providing a center where elderly parents can be taken for a couple of hours or the entire day and picked back up later. The day programs include social activities, meals and general elderly supervision.  Older adults who cannot be home alone can go into a safe supervised setting that can administer medications, provide hot meals and fun activities, and give caregivers a break.  In Lancaster County there are six facilities and all give tours to caregivers to determine whether ADS is a good fit.  To find out more about the adult care centers, contact one of the six in Lancaster.

Thursday, January 10, 2013

For Profit Nursing Homes: Higher Bills and Lower Care

A November report by federal health care inspectors said that the U.S. nursing home industry overbills Medicare $1.5 billiion a year for unnecessary treatments or treatments the patients never received.  What is worse is the providers who have a profit motive - the for-profit homes.  Research shows that for-profits are more likely to pursue money in all kinds of ways, even by pushing the legal envelope.  This profit motive is having an outsize affect on the quality of care, resulting in a spike in waste, fraud and abuse charges brought by federal authorities.  Federal prosecutors brought 120 civil and criminal cases against nursing homes and related individuals from 2008 to 2012.  This is twice the amount for the prior 5 years, compared with a 60 percent rise in all department cases.  All 120 cases are now resolved.

To read more about these cases and the fraud in for-profit nursing homes, visit the Bloomberg News investigation.

Monday, August 13, 2012

Drugs, Dementia and Nursing Homes

Did you know that one of the most common and longstanding, but preventable practices causing harm to residents in nursing homes is the overuse of antipsychotic drugs?  Last year, the Department of Health and Human Services found that 14 percent of nursing home residents were prescribed anti-psychotics.  Of these people, 8 out of 10 were prescribed off-label (that is: for purposes other than the ones for which they are FDA approved).  This overuse costs Medicare hundreds of millions of dollars and harms patients.

Still, this issue is not as simple as it seems.  Usually the meds are used because aides cannot provide basic hygiene for dementia patients without them.  Patients might be too agitated or violent for the aide to change their diaper or give them a shower.  Alternatives to these antipsychotic drugs can be time consuming and may require special skills, but are less harmful to the patients.

Alternatives, like giving a bed bath rather than a shower or changing the aide who is working with the patient, are focused on first learning why the patient acts a certain way and what triggers his or her agitation.  Once this is determined, a nursing home can make adjustments.  However, this takes both time and training, and for many facilities it is easier to give the patient a pill.  Alternative therapies, like music therapy and other non-pharmacologic solutions, may also work, but need further testing.

Thursday, June 28, 2012

Moving to a Nursing Home

Whether you have hours, weeks, or months to find a nursing home for an elderly loved one, the task is going to be daunting.  But this will be the task for a majority of the population, as two-thirds of people over 65 will need the care given by a nursing home, according to AARP.  Just as you wouldn't move into a new house without visiting and inspecting it, you should do research on nursing facilities ahead of time if possible.  And when researching, there are several key considerations you should take.

First, look at the official stats.  Medicare rates and compares nursing homes on their website (medicare.gov/nhcompare).  Some facilities are even certified by Medicare, meaning they are inspected every year and all complaints are investigated.  Read these ratings and recent inspection reports, but don't just take them at face value.  Check out the ratings for health inspections and for staffing and see if you can find why they rank as they do.  What are the citations for and how often do they occur?  One patient accident isn't a big deal, but frequent falls could be a red flag.  If you want more opinions on the nursing home, your local Area Agency on Aging (the Lancaster County Office of Aging) or a hospital discharge planner can give you referrals on nursing homes.  Furthermore, the state's ombudsman and licensing agency should be able to tell you about consumer complaints.

Check to see how staffing is at the nursing home.  How much time are residents receiving with the nurses?  The Centers for Medicare and Medicaid Services (CMS) recommends at least 2.8 hours a day of nursing aide time and 1.3 hours with an RN or licensed practical nurse.  Ask specific questions of the staff and about care, ask how personal preferences are accommodated.  Also see whether staff work with the same patients each day because when staffers know the patients better, the quality of care is higher.  Finally, make sure to ask how the staff will deal with an unexpected event, like a power loss or a situation which requires evacuation.

Visit the nursing homes you are considering, and visit more than once.  Observe lifestyle details, like do the nurses greet patients in the hall?  Are meal eaten in the dining room and are residents enjoying the meal?  Does it smell pleasant and homey and are residents smiling?  Check rooms for cheerfulness and safety, use the bathroom to check for hot water, and inspect the kitchen for cleanliness.   Ask about anything that could affect the well being and happiness of your loved one, like are there organized outings and visits?  What activities are listed on the bulletin board?  Are there stimulating offerings like exercise classes and a library?  Snoop around (and be wary of any place that objects) and try visiting unannounced on a weekend when staffing is likely to be tighter.

Another important consideration is how close the nursing home is to you.  The biggest influence on care quality is the frequency of visits by friends and family.  Make sure you're allowed to visit when you want to fit your schedule, and to monitor care at different times.  Drop by often and sometimes without notice.  Stay late sometimes after your loved one has fallen asleep.  By coming at different times, you can see how quickly a staff member respondes to a ring for assistance, whether residents are enjoying interesting activities together in the afternoon or staying cooped up in their rooms and how much your mom or dad eats at meals.

One of the biggest factors in your decision will be cost.  The median annual rate for a semi-private room in Pennsylvania last year was $89,425.  If the move is years away, consider getting long-term care insurance.  If your loved one already has long term care insurance, find out the daily rate it covers.  This could be far less than your preferred homes and most policies don't kick in until after a 60 or 90 day "elimination period."  To keep costs down, determine if it's possible to keep your loved one at home a bit longer through a combination of health aides, adult day care, and family help.  You can also consult an elder law attorney for help with nursing home planning.  The Law Office of Shawn Pierson can help with the planning and can help get you qualified for Medicaid, known as Medical Assistance in Pennsylvania.  However, not all facilities accept Medical Assistance, so make sure your preferred facilities accept payment or else you might have to move when payments switch.

If you find that your loved one is not receiving the care he or she deserves, don't hesitate to move him or her.

For more ideas on what to look for in a nursing home or long term care facility, use the checklist found here by AARP.

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