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Nursing Homes Discussion


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2009 Feb 5, 1:07am   3,858 views  19 comments

by Patrick   ➕follow (55)   💰tip   ignore  

This is the general forum for nursing home questions and comments, especially for suggestions on how to make the nursing home blog easier to use.

The main nursing home page is http://patrick.net/nursing/homes.html

You can search for specific nursing homes by zip code, name, area code, etc with this box:

Patrick

Comments 1 - 19 of 19        Search these comments

1   diplomanurse   2009 Feb 5, 3:23am  

Thanks for starting this blog. I'm a nurse and have been employed in nursing homes over the past 3 years. I'm beginning to see many younger and middle-aged people end up in nursing homes, and the majority thought it would never happen to them.

With the 77 million Baby Boomers who are about to become elderly in phases, the issue is only going to become profound. Many people will become broke and destitute because they did not plan for old age during their younger years. Most people don't want to end up in nursing homes, but don't think it will never happen to you. One major stroke or surprise heart attack can be the straw that breaks the camel's back.

I've got to go to work soon, but I definitely will be back.

2   Patrick   2009 Feb 5, 4:48am  

Posted for reader Catherine:

FYI, here are some things I discovered that might help others:

*Every state nursing home has to have the results of their annual inspections posted and available to be read, usually in a notebook near front desk.
*The employee moral will tell you volumes.
*You can buy one of the meals there and see if it is edible, eat it in the dining rm and see how the residents are treated and if they seem to like it there.
*Find out what they allocate for food per resident, in terms of dollars, it is appalling at some places.
*Find out if they hire help from an "agency" when they are short handed, they are supposed to, but many are cutting that out and skimping by with too few aids.
*Find out why they have such a high turnover rates for their CNAs and aids, it is NOT just the work, the people leave when the facility is non responsive to the residents's needs as well as the employees, the dedicated ones finally give up if the management is all about making more $$ for corp so they get their bonuses, etc.
*Find out the ratio of care, aids to residents, it has to be posted daily, look at it and ask some aids if it is accurate, often not, if so, report it to the state caseworker.
*Keep an eye on the items you bring to the nursing home and inventory them occasionally, they need to reimburse for stolen items, if provable.
*Find out if any doctors or dentists will come to the facility to treat residents, some do.
*Find out if nursing students will do hands-on training there, if so, you might want to opt out of that, my mom was a "guinea pig" for a student that dropped her, she did not read her care plan posted in the closet, did not know she was recovering from a broken leg and required 2 aids to assist her to the bathroom. We had no idea students would be attending to her unsupervised, reported that to the state as well and they were fined for that incident.
*Make sure the resident's care plan is updated regularly and see that the employees read it, many do not so they have no idea what their current medical needs are.
*Find out what transportation is available to the residents, the social worker should know several companies and if they charge for the service.
*Find out what bathing facilities are avail, usually a shower room, 2 x week.
*Find out how many residents to a room and how many share a bathrm.
*Find out if women share a bathrm with men, happened to us and it was/ is not a good experience.
*Find out if the dementia patients are housed with other dementia folks or if they are mixed in with the" long term care" residents, that can be a big problem as they can be very vocal and disruptive, stressing out the other folks and keeping them awake all night, happened to us, the woman next door screamed incoherently day & night, the staff just ignored it but the other residents could not get away from it, it was awful, we had to get the state involved to move her to another wing.
*Ask how many Medicaid beds are available in the residence, most have just a few and most of them have a waiting list, very short supply. Get on the list early.
*Be sure to use the link above to see how the state has RECENTLY rated the facility, don't go by word of mouth, it is usually not accurate & out of date.
*Look for blogs from people that might have worked at the various facilities you are considering, that can be very eye opening!

Incidentally, if it becomes necessary to move a resident to another state, some states have reciprocal arrangements with the other states around them to take in nursing home patients on Medicaid, but they will have to wait until a Medicaid bed is open. We ran into that trying to move my mom to another state, I was trying to move her to MN where my sister lives so I could move for another job. The new admin in MN told us they could take her, we went through so much to orchestrate the move, several months of planning on many levels, all for nothing since we found out at the last minute that MN only has agreements with a few states right next to it. Oregon was out of the question… what a nightmare.

Also, every state has it's own rules for qualifying for a Medicaid bed in nursing home, and most nursing homes only have a few beds set aside for folks that have gone through all their $ before being accepted as a Medicaid patient. Remember, there is probably a waiting list for most of those Medicaid beds.

Knowing each state's terminology would be helpful to folks, most states know nothing of any rules in other states than their own, so hard to get that info.

For example, Arizona refers to it Medicaid as "Access" and they have their own policy on accepting Medicaid patients from other states. I tried to move my mom there as well so I could look for work. Found out she would have to physically travel to AZ for a face to face evaluation by the state to see if she was indeed so debilitated that they would agree she qualified for a Medicaid bed there. That would have meant getting her to AZ and leaving her bed here in OR which meant she would have lost her bed here in OR due to rules about leaving more than a day or some such nonsense. (AZ folks were very decent to speak with but they are broke like all the other states and have had many elderly "dumped" in their state over the past yrs, so now have to be very strict, can't afford it)

My experience is that once your loved one is in a nursing home, it is tough to move them, so research for yourself which homes are rated best before hand so you will be prepared. Also, do not go by word of mouth as the ownership changes. If possible, select a non-profit, the less corporate greed involved, the better. Many nursing homes have been bought up by lge corporations over the last several yrs as they saw them as major profit centers, some of those lge corporations are now going under, it's happening here in Oregon and elsewhere, so make sure you know what the overall financial picture is.

Feel free to post this, hope it is helpful. I would also appreciate reading feedback you receive from others!

Take care,
Catherine

3   Patrick   2009 Feb 5, 6:21am  

Hello Patrick,

I don’t have suggestions on how to make you site better however I have
a number of ideas on how to take care of your loved ones that are in a
nursing home.

First, get a letter addressed to the Social Security Administration
giving you authority to have the bills and information regarding the
premiums for Medicare sent to you. If this is not done you will lose
Medicare parts B and D, and any drug benefit will be lost. I was not
aware of this when my mom went in to a nursing home and wound up
paying for all of her drugs out of pocket. I could not get her to
sign the letter before dementia set in and any legal recourse was more
expensive than her meds.

Two, work with the nursing staff and doctors to get the proper
medications. Since my mom had both dementia and COPD she needed
several different changes in medication over the course of 2 years.
The biggest issue is they would try out a new drug order a large
supply and it would turn out to be ineffective. Get an initial 2 week
supply and if works have them order the regular amounts. You wind up
paying for drugs that don’t work and have to start the process over
again.

Three, have a standing appointment with the doctor in charge of the
patient on a monthly or semi-monthly basis. You can talk over care
and improvements/declines in health. It also keeps the staff aware
that there is someone keeping an eye on the quality of treatment being
received.

Four, visit often, not only is it good for your loved one but also
makes you visible to staff. They will make sure that good care is
taken and you can see any changes to the patient. Also it makes the
patient feel better knowing that someone still cares enough to make
time out their schedule to come and see them. You can bring some of
their favorite treats, even bring a meal from outside, after all it’s
still hospital food.

Five, mark all personal items brought in, this includes clothes,
blankets, pictures and electronics. Try as they might things
disappear, not by the staff but other patients and just general
institutional busyness. It’s hard work trying to take care of all
possessions of a hundred different people.

Six, treat the staff with respect. They are not the highest paid
people however most go into that type of care because they genuienely
like their work and they do care about people.

I know that I have several more, but at this time it’s just a brief
list.

Thanks,

Avis

4   Patrick   2009 Feb 5, 6:23am  

Patrick, I see in this morning's email that you've launched a nursing home blog by state.

I think your California readers might find useful information in this link: http://canhr.org/ especially articles about nursing home deficiencies (cited), how MediCal works (Ca's version of Medicaid); there is also info related to assisted living/residential facilities.

Best regards,

Bob

5   Patrick   2009 Feb 5, 8:07am  

Posted for reader Ash:

The thing that confused me was that hospice isn't necessarily a place. It can be a facility but it's good to think of it as a service that sometimes has a facility with beds. The one we used, Hospice By The Bay, has facilities but did home care for us that included bathing, delivery of meds, setting up of IV's and other things. Also, something we didn't know was that our insurance paid for everything that hospice brought including medical bed, meds, sheets, gown, and a bunch of other stuff. Of course this could be different depending on insurance, location, whatever. Also, staff is trained to deal with what's going on mentally with patient and their family. Hospice is one bright spot in an otherwise horrible situation.

6   joerg1   2009 Feb 5, 9:20am  

This forum is a great idea. My Company is a subcontractor for a large corporate chain of nursing homes. Recently we have been updating their TV systems. I have great respect for this private company because of their genuine compassion for their patients. Recently because of the budget crisis in Ca., insurance payments are not being made to the nursing homes. They are carrying patients at their own expense! If this problem continues they will be forced to close or go bankrupt.

7   elliemae   2009 Feb 7, 4:57am  

This is a response to the following comment:
"First, get a letter addressed to the Social Security Administration
giving you authority to have the bills and information regarding the
premiums for Medicare sent to you. If this is not done you will lose
Medicare parts B and D, and any drug benefit will be lost. I was not
aware of this when my mom went in to a nursing home and wound up
paying for all of her drugs out of pocket. I could not get her to
sign the letter before dementia set in and any legal recourse was more
expensive than her meds."

There is no letter that the SSA will honor - a Durable Power of Attorney for Healthcare from the patient, completed while they are competent, will suffice. If the patient is not competent, a family member can intercede on the patient's behalf. The nursing home has a Social Worker whose job it is to help with such an issue - but Parts D (drug plan) and B (medical) shouldn't be jeopardized by the patient's inability to participate in his/her decisions.

8   birdie997   2009 Feb 7, 9:30am  

My mother has Alzheimer's and broke her hip and needed to spend time in a county nursing home before returning to assisted living (she lives in an assisted living home for Alzheimer's patients). What I saw at this county nursing home will leave me with nightmares until the end of my days. I saw the deliberate and systematic inhumane treatment of helpless people - and the staff and the state were in collusion, because I complained and they turned a blind eye. I got my mother out of there as soon as I could, arranging with the assisted living home to hire a round the clock nursing aide until she could walk on her own again. The others who remain in the nursing home are not so lucky as to have someone like me, who will pay any price, even sacrificing my own retirement savings to keep my mother out of a nursing home in the future. It horrifies me to know how much needless suffering is going on right there in our community - and no one seems to care.

I must respond to Catherine's comment above. I found the opposite to be true. Firstly, dementia patients for the most part are quite docile and not at all disruptive (particularly so if they receive proper care). Just as people are in the general population. In my mother's case, the nursing home put her in with the non-dementia patients, and it was several younger non-dementia patients who were disruptive and actually abusive toward my mother. The neglect and lack of proper care of all patients was truly disturbing, but Alzheimer's patients are in may ways like children, and to see them wandering about with no one to protect them or give them a kind word or a pat on the back was heartbreaking.

9   birdie997   2009 Feb 7, 2:10pm  

By the way, reading back what I wrote, I just want to make clear what I saw was quite serious. I tried to word things civilly in my post above, but perhaps I was too circumspect. Neglect doesn't say enough. Inadequate nutrition, improper medical care, horrifically neglected hygiene, subjecting patients to dangerous situations, filthy and infested environment (bugs were crawling all over the beds!), extremely poor behavior of staff (for instance, while a woman was choking as her breathing tube was caught on her wheelchair wheel, the aide sitting 3 feet away who was supposed to be feeding the patients who were losing 10 pounds a week was engrossed in watching TV, as usual), and as I said previously, total disregard of the most basic standards Alzheimer's patients REQUIRE. I'm sure I'm missing something. It was a nightmare in every respect. Sweet, kind old men and women quietly suffering until they die. The elderly deserve so much better than this. And that's not getting into the extremely expensive alternatives, assisted living homes. $6,000 a month - how long can we keep this up? And what will become of this generation when we are old and have no money? The dysfunctional health care system in this country is devastating our present and our future.

10   elliemae   2009 Feb 8, 1:00am  

Birdie:
Report, report, report. You can report any issues you found to the state bureau that investigates nursing home abuse, or can find the info listed under Adult Protective Services in your phone book. Your complaints are serious and if they can be substantiated during a surprise visit, the place will have to address them or can be closed down.

The system works; I personally witnessed abuse in a nursing home in which I worked and reported the abuse; it nearly ruined my career but it was the right, and only, thing to do. The state is obligated to respond. In my case, the abusers were removed and the abuse stopped. Don't stop with your complaints because your family member is gone from there - please.

You can search the information about the nursing home you refer to on the Medicare.gov website, search nursing home compare and follow the prompts to look at the healthcare deficiencies. Unfortunately, they don't have the same rules for Assisted Livings and there are some out there that need an overhaul to say the least. Family diligence is important for anyone who has a family member living in a NH or Assisted Living.

11   LK   2009 Feb 9, 6:30am  

Unfortunately, all of us with family members who are on Medicaid and are currently residing in nursing homes had better be forwarned that these residents are now being evicted as they are "unprofitable". Here is an article that explains how they can get away with this practice. Given the fact most states are in terrble financial shape, we had better plan ahead in the likelihood that this may become more pervasive as the economy worsens.
Here are a few quotes from the article dated 2-6-09

http://seattlepi.nwsource.com/local/399219_evicted07.html

Even elderly are facing eviction
Complaints on rise of nursing homes forcing out residents

As health care costs rise and Medicaid rates lag behind, nursing and boarding homes are forcing out sick, elderly and frail residents in what advocates say is a growing trend. No official data exist on eviction counts, but discharge complaints have climbed to record highs.

The Washington Long-Term Care Ombudsman program handled more than 700 such complaints last year, nearly a 50 percent increase over the year before. Nationally, discharge-related complaints have more than doubled in a decade -- to 12,000 in 2007, according to the U.S. Administration on Aging.

"The system is getting frayed around the edges," said Louise Ryan, the state's long-term care ombudsman, or chief resident advocate.

"People are getting harder to take care of," she said. "When (homes) can find an opportunity to discharge the person, they will. The problem is especially hard with nursing homes, because where else are they going to go? It's the end of the line."

In 2007, Seattle University forced out 115 residents when it decided to convert its nursing home into office and class space. Three months later, 14 of the residents had died.

Social workers have a name for such a swift decline after a move: "transfer trauma."

One of the most common types of eviction is when homes send a resident to the hospital and refuse to take him back, in a practice that resident advocates call "dumping."

"We have a lot of experiences with nursing homes who load somebody up in an ambulance on a Friday night. ... They do it on a Friday, I think, because advocates go home," said Vicki Elting, the regional ombudsman in King County. By Monday morning, hospitals are struggling with a discharged patient with nowhere to go.

With assisted living costing residents $3,000 to $6,000 a month, and nursing homes costing up to $10,000 a month, homes lose money daily on each Medicaid resident, Weeks said. On average the state pays out about $5,000 a month for a nursing home resident, and $2,000 for a boarding
home resident.

12   diplomanurse   2009 Feb 9, 2:46pm  

Since I have worked in different nursing homes that are corporate-owned, I can conform that administration deems Medicaid residents to be very unprofitable. Many nursing homes in my area are reducing the number of Medicaid beds and converting them to short-term skilled rehab (Medicare) beds, which are significantly more profitable.

In my state of residence, the nursing homes are reimbursed about $100 per day per resident for each Medicaid bed. However, they can make $300 to $400 per day per resident for every skilled Medicare bed that they can manage to fill.

I hate working in the skilled Medicare units due to the lack of staff. The residents tend to be very sick, recovering from recent surgeries, and/or had recent heart attacks or strokes. These types of residents need plenty of staff and supplies in order to receive proper care. Unfortunately, I have had up to 70 residents by myself during night shift.

13   LK   2009 Feb 12, 4:42am  

One of the loopholes they (nursing homes) have discovered in my state is that the language in the state law changed a bit the last time they modified the requirement for care ratios. It currently states that there must be "x" amount of caregivers per resident per shift, but they can spread the caregivers throughout the entire building. That is why some shifts are so short handed, they are floating them around to fill gaps in some units. Ultimately, the residents get less assistance and have to wait longer to receive it. Often times they get frustrated from waiting so long, try to do things on their own, and fall. Rarely is it provable that the nursing home is at fault, they generally just state the resident had been warned not to do things on their own without help, chose to ignore that advice and wound up injured. This is esp true at night when staffing is reduced.

Therefore, I can imagine that what Diplomanurse indicated , having cared for up to 70 residents herself during the night is completely feasible.

14   elliemae   2009 Feb 13, 1:06am  

“We have a lot of experiences with nursing homes who load somebody up in an ambulance on a Friday night. … They do it on a Friday, I think, because advocates go home,” said Vicki Elting, the regional ombudsman in King County. By Monday morning, hospitals are struggling with a discharged patient with nowhere to go."

Unfortunately there are nursing homes that dump patients out - if the patient is admitted to a hospital it's possible that the nursing home isn't legally required to take them back. Most hospitals won't admit patients unless they have a medical need, and the nursing home has to accept the patient back if he isn't admitted to the hospital.

Many nursing homes are ethically run; those that dump patients lose credibility in the community and often are the place of last resort for hospital discharge planners. Complaints are investigated by Nursing Home Ombudsmen - the federal government requires that each state have these workers to protect the rights of patients in nursing homes and assisted livings, but the states don't recieve federal funding for thse positions. This means a higher caseload, and less protection for the residents - with the economy tanking, they are needed now more than ever.

Write your congressional and senate representatives and ask for more protection for the elderly in these difficult times - ask them to fund Nursing Home Ombudsmen and set a reasonable caseload for them so that they can fully investigate complaints.

15   SHintheCiy   2009 Mar 11, 11:25pm  

Patrick,

I would ask that you expand this discussion to cover all of what I term the 'Care Continuum'.

The Care Continuum consists of 2 axes:

1) the healthy living axis - in the senior's own home, in senior assisted housing (such as a Sun City), living with family, in assisted living, in nursing homes

2) Medical care needed - prevention/safety, chronic care, acute care, hospice

It is important because the aging process and senior's lives are marked by different phases governed by their health, and behavior in one phase often affects the quality and duration of later phases.

For example: many seniors get to their advanced age because they are independent and active. But this independence and activity could sow the seeds for injury as physical capabilities diminish with extreme age (75+). Even with great health, there are still many prevention/safety considerations to take into account in order to continue to live independently - and this is a discussion which should take place before the need becomes acute.

Another example is dementia care: Alzheimer's, Dementia with Lewy bodies, Vascular dementia, Frontotemporal dementia, etc. The needs in each case are often different, the skills needed for care are also different, and the benefits and limitations of any single service provider pale compare to what a family+respite+professional partnership can accomplish.

As a non-medical in-home care provider, you'll note that what I do at Senior Helpers doesn't fall into any one particular part of the Care Continuum. Rather what I do is provide the personalized and/or respite care which can be of benefit in any part of the spectrum.

Part of what I hope to see in the field of geriatrics/gerontology is recognition of aging as a process, not an event. And as a process, to start a dialogue on how best to optimize healthy practices at each stage of the process.

16   elliemae   2009 Mar 15, 12:05pm  

Good point. I'd like to see funding for programs that help people stay in their homes, or with family, rather than having to go to nursing homes because Medicaid pays there. Waiver programs are woefully underfunded, and mismanaged in that they don't save money by the time the monies are spread amongst the different agencies administering and providing oversight for the programs.

17   SHintheCiy   2009 Mar 18, 6:50pm  

Ellie Mae,

If you are interested, here is a link to a public discussion on the subject of holistic senior care held by the Senate Committee on Aging:

http://aging.senate.gov/hearing_detail.cfm?id=309028&&tr=y&auid=4605669

It talks about how such programs in Wisconsin and Florida have resulted in significant improvements in senior well being without spending increases.

18   elliemae   2009 Apr 1, 11:26pm  

I was speaking with an Assisted Living Administrator, who told me that a board like this is dangerous because people can say anything that they want to. I pointed out that he loves Wikipedia, and that there's no difference in the theory. This forum, and each page, provides the rare & unique opportunity to give feedback - both good and bad - about nursing homes. It also allows people to ask all those questions and receive the answers from other "normal" people, not someone who works for a facility.

19   elliemae   2009 Apr 15, 1:47pm  

http://www.dailymail.co.uk/news/article-1170269/Whistleblower-nurse-filmed-elderly-patient-neglect-guilty-misconduct-Panorama-expos.html

Yet another example of abuse in a nursing home - not only on the part of the provider, but also the nurse who recorded the abuse. Unfortunately, with cuts in Adult Protective Services and Ombudsmen programs across the country, there will soon be no one to investigate these incidents.

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