While the ability of many Ohio seniors to reside in their homes may be a source of comfort to their children and loved ones, it can also be a cause for concern.

This is especially true if the aging parent or relation lives far away from family and friends where a daily “check-in” is difficult, if not impossible. For example, an aging mother might live in the vicinity of Cleveland, Ohio, while her daughter may live closer to Columbus, Ohio. The daughter may make regular weekend trips to Cleveland in order to visit her mother, take her shopping, and make sure that all her medication is being taken; however, she will not be able to visit her mother every evening. Also, in case of inclement weather (e.g., heavy snowfall) the daughter may not be able to visit her mother for several weeks at a time.  

Most elderly individuals understand the impracticality of their children or loved ones traversing long distances in order to take care of their basic needs. Additionally, even children and loved ones who live closer to their parents or other relations often have a difficult time juggling between work and family responsibilities and eldercare. In such cases, there are businesses in the state of Ohio that provide basic eldercare services such as housekeeping, cooking, shopping, bill paying, transportation, and even much needed companionship. Such eldercare services are priced at much more affordable rates compared to those at assisted living facilities or nursing homes. These services are available on a 24-hour and 7-day/week basis, including evenings, weekends, and holidays. Most importantly, professional eldercare services provide the peace of mind that parents and other loved ones are being looked after and taken care of by qualified caretakers.

Nursing homes that are equipped to handle Alzheimer’s and dementia patients are more likely to have the following specialized equipment and policies in order to prevent residents from hurting themselves or others:

Strict entrance/exit privileges for residents: Alzheimer’s or dementia patients are likely to wander and become lost, and this tendency can lead to their injury or death. For example, there is a case of a 90-year-old man who suffered from dementia and wandered away from the Sierra Oaks Assisted Living facility in Pennsylvania. After 10 days, authorities located the man’s body.

Visitor sign-in registry: Mentally challenged residents are more likely to be physically or sexually abused. A required sign-in registry keeps track of patient visitors and holds them accountable for the well-being of the patient.

Surveillance bracelets and alarms: Residents who have a tendency to wander may be outfitted and tracked with surveillance bracelets. Alarms on doors and windows can also help resolve problems with wandering residents.

Clearly marked walkways: Walkways both inside and outside the nursing home should be clearly marked, well lit, and should have directional signage and diagrams instead of written diagrams.

Circular configuration: Ideally, the nursing home should have a circular layout so that residents do not encounter dead-ends or right angles and become confused or agitated.

Patient/staff ratio: Residents who suffer from Alzheimer’s require more care and attention than other residents. Therefore, nursing homes that tend to Alzheimer’s residents should have a daytime patient/staff ratio no greater than 6:1. If the nursing home has a higher patient/staff ratio, it is unlikely to provide the skilled nursing that such residents require.

The above mentioned equipment and policies, as well as patient/staff ratio, are usually not in place at assisted living facilities. Can a nursing home also be negligent when it comes to Alzheimer’s resident care? Of course it can be. In 2008, a 72-year old man wandered away from Robbins Supportive Living, a nursing home that is located in Illinois. Two weeks later, authorities discovered the man’s body, lying facedown in the marshland, just 20 feet away from the facility.

Because particular care and attention must be exercised whenever Alzheimer’s or dementia patient care is concerned, it is advisable to first visit and inspect the candidate nursing home. This first visit should be announced to the staff at the nursing home so that they can show all the features of the facility. Following this initial and announced visit, a second and unannounced visit should be made to the facility. In this way, the day-to-day conditions of the nursing home can be observed firsthand. Staff will be less on-guard, and their job satisfaction (or dissatisfaction) will be more easily noted. Keep in mind that unhappy staff members usually translate to unhappy residents. By making such announced, and then unannounced, visits, the quality of skilled nursing for a loved one can be more accurately judged.

The U.S. News & World Report derives its rankings from Nursing Home Compare, which is a program that is run by the federal Centers for Medicare and Medicaid Services (CMS). The CMS regularly analyzes all nursing homes that receive Medicare and/or Medicaid funds and assigns ratings ranging from one to five stars, with one star being the lowest rating and five stars being the highest rating. The facilities also receive one to five star ratings in three specific categories: nurse staffing, measures of care, and health inspections. Facilities found to be deficient in specific areas of care, and which continue to be deficient in those areas, are placed into a separate category and termed SFFs. The CMS regularly compiles a survey of SFFs, which it publishes on the CMS Certification & Compliance page.

There are probably more than 131 SFFs in the country. However, the approximate $1 million sum that is allocated for investigating nursing homes only allows for about 135 homes to be analyzed and monitored. Based on its total nursing home count, each state is allowed a certain number of SFF submissions per year; for example, California is allowed six, while Vermont, only one.

Some states which have had nursing homes just added to the SFF list include: Arizona (1), California (2), Florida (2), Illinois (2), Oregon (1), New York (1), Pennsylvania (1), Texas (4), and Virginia (1). Some of these states have additional SFFs, while others have past SFFs that have shown improvement and/or have graduated (are in the process of being taken off the list). When researching a potential nursing home in a specific state, it pays to look through the latest CMS Certification & Compliance Report carefully.

If a long term care facility does not remedy the problems that are noted by the CMS, it can lose its Medicare and Medicaid credentials, leading to it being shut down or having to rely entirely on private resident funds.

Homemaker Service. This service does not involve any medical or skilled nursing, but rather the completion of basic household tasks such as cleaning, cooking, and running errands. The individuals who perform homemaker services are often called companions or personal care assistants.

Home Health Aid. This service involves more hands-on help with personal hygiene and care such as bathing, dressing, and grooming. Home health aid can be administered to individuals who are elderly, disabled, or ill, and who live either in their own homes or in assisted living facilities (also called residential care facilities in California).

Adult Day Health Care. This service offers a much needed respite for full-time caregivers, allowing them to attend to personal business or maintain their day jobs. Adult day health care provides a supervised and protected community-based environment where participants can receive personal care, health and therapeutic services, transportation services, and partake in social activities. There are three different types of adult day health care models:

Social. This model provides recreational and social activities for individuals. Meals, transportation, and basic care are also provided.

Medical. This model offers medical assistance and monitoring for individuals who are frail or have health issues. Skilled nursing care is provided via a Registered Nurse (RN) or a Licensed Practical Nurse (LPN) and may include occupational, physical, and speech therapy.

Combination. This model offers both social and medical services to participants by employing an RN or LPN and by providing activities that are designed to improve cognitive and motor skills.

Assisted Living Facility. This living arrangement provides some personal and medical care, but is actually intended to keep residents as independent as possible. Therefore, an assisted living facility is not intended to be an alternative to a nursing home, but rather an intermediate form of long term care.

Nursing Home. A nursing home is intended for individuals who require constant supervision and skilled nursing care. These could be individuals suffering from dementia, Alzheimer’s Disease, or physical paralysis. In addition to personal care, a nursing home offers residents medication, physical and speech therapy, and room and board.

For a listing of long term care facility prices by state, please click on the following Long Term Care Tool.

The Illinois Department on Public Health, as well as the Illinois Department on Aging, offer valuable tools and advice on how to select a long term care facility in the state of Illinois. To begin with, consider the needs of the aging parent or relative. Does this person require basic assistance with paying bills, shopping, and so on? Alternately, is the person in the hospital with an injury and will he or she require 24-hour care and rehabilitation? Next, find out if this person has Medicare or Medicaid insurance coverage. Both of these insurance programs pay the bills for long term care facility residents, with Medicare covering the costs for residents over the age of 65, and Medicaid covering the costs for low-income residents.

Once this information is in hand, it is time to start making some phone calls. When calling nursing homes, be sure to find out if they are self-described as “intermediate care” or “skilled nursing” facilities. These terms are important because the Medicare and Medicaid programs cover each type of facility differently. An intermediate care facility provides basic assistance with personal care as well as some health and nursing services. Medicaid, but not Medicare, may cover the costs incurred at such a facility. A skilled nursing facility provides around-the-clock nursing care and is usually covered by Medicaid if the person’s physician recommends such care. Medicare may also cover the costs incurred at a skilled nursing facility, but only if the person was first hospitalized for at least three days and his or her physician recommended skilled nursing care. Upon release from the hospital, that person is covered by Medicare for up to 100 days, after which Medicaid coverage begins if the person still requires such care.

Certification and licensing should also be considered when selecting a nursing home or assisted living facility. The Illinois Department of Public Health inspects and certifies facilities that are covered under the Medicare and Medicaid programs. Two important documents include the long term care facility license and the nursing home administrator license. Make sure that the nursing home being considered has both such licenses. Additionally, it may be helpful to check the facility’s state survey (inspection) report and find out how it met the state standards for licensing.

Click on Skilled Nursing Facilities in Illinois for a listing of long term care facilities, assisted living, and nursing homes in the state of Illinois.

One way in which these high costs can be covered is through long term care insurance. Many insurance companies offer long term care insurance policies; however, there are stipulations included as well. To begin with, the individual considering long term care insurance must take out the policy before he or she needs assisted living or skilled nursing and long term care. Second, the person taking out the policy must be reasonably healthy.

Oftentimes, people assume that their Medicare insurance program will cover the costs of a nursing home. Unfortunately, Medicare does not cover nursing home care, except in the case where a person is hospitalized for at least three days and that person’s physician recommends skilled nursing home care. At that point, Medicare does pick up the cost of nursing home care for the first 100 days. After those 100 days are up, Medicare coverage ceases and the patient is on his or her own.

Some people try to obtain coverage under the Medi-Cal program in order to pay for assisted living and long term care costs. Medi-Cal is California’s Medicaid program and covers needed health services for low-income individuals and families. To obtain Medi-Cal coverage, applicants must go through a series of complex legal qualifications and determine what assets they must divest themselves of and what assets they can keep. Many quasi-legal “firms” exist and claim that they can obtain Medi-Cal coverage for their clients; however, it is best to seek out the services of a qualified lawyer who has an in-depth understanding of long term care laws and regulations. This is especially important because the rules for Medi-Cal qualification change year-to-year.

Individuals can also call organizations that deal specifically with Medi-Cal and know its rules intimately. One such organization is the Seniors Advisors Network, which can be reached at (800) 640-5626 (California only).

]]> http://longtermcarecorner.com/caregivers-corner/long-term-care-coverage-options-in-california/feed/ http://longtermcarecorner.com/caregivers-corner/staying-healthy-during-ontarios-winter-months/ http://longtermcarecorner.com/caregivers-corner/staying-healthy-during-ontarios-winter-months/#comments Wed, 13 Jan 2010 04:44:46 +0000 adam http://longtermcarecorner.com/caregivers-corner/?p=137 Staying Healthy During Ontario’s Winter Months

The number of seniors in Ontario is growing at a rapid rate as baby boomers reach their golden years. All the extra seniors couldn’t come at a worse time for Ontario’s public health system, which is faced with a record deficit in 2010. The government has already warned hospitals to expect no increase in funding, a 1% increase in funding, or a 2% increase in funding. This is bad news for hospitals, who expect to see their expenses go up by at least 3 – 3.5%, leaving a significant funding gap that would affect the services that they can provide. Where might a reduction in hospital services leave Ontario’s seniors, who in general require more health care than the average younger Canadian?

Seniors and their caretakers should take preventative measures to keep themselves from landing in the hospital in the first place. Especially as winter weather sets in, seniors should be especially vigilant to stay healthy.

Stay Warm

Seniors need to stay plenty warm. Although “catching a chill” is technically not a cause of illness and is supposed to be an old wives’ tale, as it turns out the old wives knew what they were talking about. A drafty or cold home can lead to a drop in the body’s natural temperature, and for people with a compromised immune system – which includes the elderly – a lower temperature translates into a lower resistance against germs.

Keep in mind that older homes, which seniors inhabit disproportionately, are notorious for being drafty and cold. If you yourself or an elderly relative lives in a cool, drafty home, but are unwilling or unable to pay for higher heating costs, it might be time to consider weatherizing your home. A few upgrades to windows and additional insulation can make a world of difference in a home’s ability to hold heat in the winter.

By staying warm, staying active by walking or engaging in other non-strenuous exercise, and keeping a healthy diet filled with as many fresh, vitamin-rich foods as possible, seniors in Ontario can stay healthy this winter, and stay away from an Ontario hospital system in crisis

Not all strokes are catastrophic and immediately obvious. Many minor strokes hit without seniors or their caretakers immediately noticing. The longer it takes to recognize that a stroke has occurred, the more damage will be done to the brain, making recovery time longer and certain stroke side-effects potentially permanent.

Here are six signs to look for that indicate a stroke has occurred:

1. Confusion: When a stroke hits an elder, they may show signs of dementia or confusion where previously they were quite lucid.
2. Balance Problems: Strokes can leave their victims feeling dizzy, experiencing a loss of balance, or a loss of coordination.
3. Speech Problems: Strokes frequently slur speech or cause other speech problems, such as not being able to remember a certain word.
4. Loss of Eyesight: Strokes can cause a partial or a complete loss of sight in one or both eyes.
5. Numbness or Weakness: One of the most common signs of stroke is a sudden numbness or weakness, usually affecting just one side of the body. This numbness will often manifest in the face, leaving stroke victims unable to move one side of the face.
6. Headaches: Stroke victims often experience sudden and severe headaches for no obvious reason.

Testing to See if a Stroke Has Occurred

If you think an elder might have had a stroke but you want to be sure before you rush them to the hospital, here’s a quick scanning technique recommended by the US National Stroke Association:

1. Ask the potential stroke victim to smile. If one side of the face droops, this is a sign that a stroke has occurred.
2. Ask the potential stroke victim to raise both arms. If one arm drifts downward, this is a sign that a stroke has occurred.
3.Ask the potential stroke victim to repeat after you a simple sentence. If the words are slurred, or if the person cannot repeat the sentence without making an error, there’s a good chance that a stroke has occurred.
4. If one or more of these symptoms is present, it’s crucial to get the individual to the hospital as quickly as possible.

To remember this scanning technique, use the acronym “F. A. S. T.” “F” stands for scanning the face; “A” stands for scanning the arms; “S” stands for scanning speech; and “T” stands for time, which is of the essence.

Emotionally, caring for an elderly parent who always cared for you can be a disconcerting role reversal, and without addressing these new emotions, caregivers eventually feel frazzled, overwhelmed, and unable to deal with all the new changes. But with proper preparation, a lot of the stress that comes from taking on the role of primary caregiver for an elderly relative can be avoided.

One of the hardest things for caregivers is making decisions about their loved ones’ health in times of crisis. Without much time to act, and without being able to ask an elder what his or her wish might be, caregivers are thrust into making snap decisions. These major, life-altering decisions leave the caregiver often feeling guilty or anxious because they aren’t sure if the decision they arrived at was the best one or the one their elder would have chosen. Meanwhile, certain decisions – such as putting a relative into a nursing home – may lead to a family feud between siblings, in-laws, and other family members, which only increases the caregiver’s stress level.

This is one stress that can be avoided. Although having a discussion about future health care choices with an elder might be a difficult one, it’s better to work through a few awkward conversations when your elder is still cognitively competent than it is to have to make a health care decision for your relative that might lead to conflict within your family.

Another conversation you should have with your elderly relative sooner rather than later is the money conversation. Money is a sensitive topic, and children of aging parents (and the parents themselves) often feel unwilling to broach the topic. However, if an aging parent is showing signs that they soon may be unable to care for themselves, it’s important to have an open, honest, non-confrontational conversation about money early on. Things like adding your name to their checking account or double-checking home insurance plans (some home insurance plans become void if they are left empty for a period of time) might be uncomfortable, but they are absolutely necessary and can help prevent conflict and misunderstandings later on.

As the old saying goes, “an ounce of prevention is worth a pound of cure.” Understanding this, make sure you do what you can to prevent the potential pitfalls of caring for an aging loved one.

]]> http://longtermcarecorner.com/caregivers-corner/tips-for-caregivers/feed/ http://longtermcarecorner.com/caregivers-corner/eldercare-and-the-workplace-how-to-strike-a-balance/ http://longtermcarecorner.com/caregivers-corner/eldercare-and-the-workplace-how-to-strike-a-balance/#comments Tue, 12 Jan 2010 02:46:42 +0000 adam http://longtermcarecorner.com/caregivers-corner/?p=122 Eldercare and the Workplace: How to Strike a Balance

Canadian employers are understandably concerned about the effects that elder care has on the workforce. In Canada, over 70% of caregivers to the elderly also hold down a job. Many of these caregivers also have a family of their own, with children still living at home.

The stress is too much for some to handle; more than a fifth of Canadians caring for an elderly relative have reported that the dual demands of work and care giving may force them to retire earlier than they had wanted. Other caregivers report elevated levels of stress, sickness, absenteeism from work, and depression compared to their non-caregiver peers.

Here are a few ideas for caregivers to help strike a balance between work and their role as a caregiver:

1. Talk to your employer. First of all, you should communicate with your employer to let them know what’s going on with your family situation. You may be concerned that your employer will “punish” you for needing to take care of your family, but the majority of employers are increasingly sympathetic and understanding. As the percentage of elderly Canadians is rapidly increasing, so is employer sensitivity to the issue of caregiver responsibilities.
2. Use an adult day care facility. Adult day care facilities are springing up throughout Canada. These are ideal facilities for caregivers who want their elderly relatives to stay out of a nursing home but can’t leave them by themselves during the work day.
3. Find a caregiver support group. Caregivers suffer in part because they feel very isolated in their responsibilities. If the feeling of isolation and stress is beginning to wear on you, find a support group before it’s too late. Otherwise, the stress will affect your health and your work.

Striking a balance between your role as caregiver and your role as employee is crucial if you wish to remain effective at both.

]]> http://longtermcarecorner.com/caregivers-corner/eldercare-and-the-workplace-how-to-strike-a-balance/feed/