Look for the Resident Experience When Choosing a Long-Term Care Home

I had the opportunity to write an article for Health Leaders entitled The Chief Experience Officer that looked at having someone in a hospital or long term care facility responsible for how the health care experience is delivered, spiritually, physically, clinically. As a marketer, I wrote it simply to support the notion that if you provide a great experience for people, they will talk about it. Simple, no brainer, word of mouth marketing is the cheapest and best marketing of all. As a result of that article the Cleveland Clinic created just such a position.

I contend that not all nursing homes can afford to be or will be one of The Eden Alternative’s Green Houses where residents are truly residents in a home and the care is a secondary but vital part of that environment. But I do believe that nursing homes need (and some are) to change their approach to residents so that it is about their needs, on their time, at their convenience.

Sunny Hill Nursing Home in Joliet, IL is one example of a facility that is changing and was written about in The Chicago Tribune January 28.

Schedules once rigid are now flexible. Residents decide when to wake, eat, bathe and exercise. Residents have one assigned nurse and residents and their families can have input about who they want as caretakers. Residents also can have a say as to who is hired.

“No duh” you might say, isn’t that the way things are supposed to be? Well sorta. Nursing homes are perceived as too much like being a hospital for the long term and not a place to live another chapter in your life in quality.

The Commonwealth Fund reported last year that a third of the country's roughly 16,000 nursing homes have adopted cultural-change practices and that another quarter are moving in that direction. The federal government has now included a segment on cultural change in Guide to Choosing a Nursing Home.

The physical additions are all contributing to the experience as well, creating a soothing environment and one that encourages socialization. And because of these additions the facility has actually reduced their capacity to 238 beds from 300.

So when you are evaluating nursing and assisted living facilities, consider the experience.

· Are specific care-givers assigned to residents?

· Can residents and families choose their care-givers?

· Can residents do things on their schedule?

· Do residents have a say in hiring, even interviewing or meeting candidates?

· Does the physical environment support the resident experience?

Make Your End of Life Decisions While Your Life is in Full Bloom

There is a great article in the NYT in which they interview a now retired physician Robert L. Martensen about the state of health care. He observes that "most Americans die in hospitals or nursing homes, and neither is configured to take care of dying patients." So you end up with situations where extra-ordinary measures are taken so that the patient or nursing home resident “doesn’t die on my watch.” There is a fine line between hope and reality as he points out. And that means acknowledging when all that has been done is done. He furthers points out the enduring pain we cause those by trying to keep them alive for a quality of life that is questionable. For example, if you resuscitate an older person, you may break their ribs during C.P.R. If you put them on a ventilator, you may end up sedating them so heavily they are barely conscious.

We all want to live as long as possible and I think I speak for most when saying we want to live that life with quality. So having a living will and a durable medical power of attorney is absolutely imperative.

Simply stating that you do not want extra-ordinary means taken for your care will not stop caregivers from trying especially if they are concerned with lawsuits and quality metrics like mortality rates. And as the good doctor points out even with written directives in place he has seen hospitals still try to revive patients who have clearly specified otherwise.

A quick to-do list:

· Put together a living will

· Put together a durable medical power of attorney

· For a great book on this, see my friend Jo Kline Cebuhar, J.D., author of
Last things first, just in case…The practical guide to Living Wills and Durable
Powers of Attorney for Health Care

Of course this has some underlying issues and 800 pound gorillas in the room. The simple fact is we don’t talk about what it means to grow older in this country let alone what it means to die with dignity. We need too.

Elder Abuse - Families Often Responsible

We often think of abuse of our elders in terms of physical abuse and often associate that with nursing homes. But abuse can also be verbal, financial exploitation. And most abuse comes from family caregivers themselves. The latest study in the British Medical Journal reports that more than half of family members looking after people with dementia admit they have behaved abusively toward their relative.

Actual physical abuse was rare among the 220 caretakers in the study. But 115 of those surveyed acknowledged some abusive behavior toward the relative under care, with "significant" abusive behavior described by 33.6 percent of caregivers.

The most common form of abuse was screaming or yelling at the person with dementia. Insults or swearing accounted for 18 percent of reports, with threats of sending the person to a nursing home happening in 4.4 percent of cases.

Comparable studies in the U.S. have not been done.

So a few suggestions:

· Create a plan for you and your loved one well before any signs of disease or sickness appear.
· Work a plan with family members near and distant.
· Research care options and costs. Unless medically necessary many home health options will
not be covered by insurance.
· Draft a living will and durable medical power of attorney.
· Plan for how you will pay for care. Consider long-term care insurance.
· Reach out to your church and research support options.
· Once care is actually needed; don’t be afraid to ask for help!
· Acknowledge your own feelings and behaviors and seek out a friend or pastor to talk.
· Understand the motivations for your caregiving. Doing it for the wrong reasons can lead to
resentment, being overwhelmed, and feeling you have no options.
· If a loved one needs physician or hospital care, seek out a board certified geriatrician and a
hospital that has geriatric physicians on staff.
· Consider a geriatric care manager. Find one in your area at: http://www.caremanager.org/ They
can help you find available resources, paid and non-paid, and help coordinate care.
· Consider your path as a caregiver as an opportunity to know your loved one and yourself in a
new and different way.

Consider some resources:

Take this stress test from the Alzheimer’s Association: www.alz.org/stresscheck

Use your local area agency on aging as a resource. Find one here.

Use the Medicare's online Nursing Home Compare tool if you need a skilled care facility.
They just introduced a new rating system for nursing homes to help you find the best one.

Grandma Is Getting More Exercise Than You

I got a Wii. Woo-hoo. A Christmas present. And guess what, instead of watching television all night and sitting on my a__ I burn at least some calories. And as I have observed in my nursing home travels and speaking engagements, Wii is all the rage with seniors. Califormia, no surprise, has taken it to new heights.

Last year, the Department of Aging and Adult Services in an Bernardino County, CA used a one-time grant from the state to purchase 36 Wii systems, one for every senior center in the county. It was classified as a disease prevention grant.

The county’s Health Department has also developed “Wii Can” classes for seniors, using a curriculum provided by an outside company. It includes doing some “regular” exercises and also incorporates Wii exercises. On the first day of the class, the participants have some basic information evaluated, i.e. waist circumference, blood pressure, etc. At the end of the class the participants are again evaluated to see if the class has had an impact.

Just today in the Charlotte Observer there was an article describing a self-defense class that was being done at a senior center teaching folks how to use their canes to ward off people. Much of the point though was that by simply moving their arms and legs they were getting some exercise and learning new skills. Oh yes and having fun.

I'm not here to advocate Wii though the Wii Fit stresses one thing in particular - balance. And that is a skill if mastered as you grow older will help prevent falls, fractures, hospitalizations and nursing home care.

So get off you keister and start exercising because Grandma and Grandpa are putting you to shame.

Don't Sweat the Small Stuff

In my keynote The Meaning of Life (so presumptuous huh!) we cover eight basic points that we have learned from older folks about living a quality life. Among them we talk about lifelong learning, having a great attitude and having a broad social network. We have cited studies in the past that support this of course so here is another.

Hui-Xin Wang of Karolinska Institute in Stockholm, Sweden published a study in Jan. 20 issue of Neurology that adds to a growing body of evidence suggesting a link between personality traits, lifestyle and Alzheimer's disease.

Researchers questioned 506 older people about their personality traits and lifestyle, to measure their sociability and disposition to stress. After six years, 144 people had developed some sort of dementia, but researchers discovered that calm, more relaxed people, whether they had active social lives or not, were 50 percent less likely to develop dementia.

People who were both calm and outgoing, with active social lives, were also 50 percent less likely to develop dementia.

The study suggests that changes to lifestyle, such as having an active lifestyle, engagement in different leisure activities, i.e. mental, social and physical activities, or having a rich social network, may protect against dementia.

"The main limitation of the current study is that personality was assessed only at one occasion," said Wang. " And that is true. Some older adults do become depressed and stressed as they age and face more physical and emotional struggles. That said, people going into that stage of their lives who exhibit the eight traits we talk about handle aging much better than their counterparts.

Want all eight? Ah heck, you need to have me come and speak to you!

Elder Abuse Support

It's said that it has to come to this. We have blogged before about the Good Samaritan Society Nursing Home in MN and the abuse suffered by residents at the hands of seemingly wholesome teenagers. Now the 15 families of the alleged abuse victims have formed an official support group called Families Against Nursing Home Abuse. It is is giving them a chance to talk of their experiences with others who could have potentially gone through the same experiences.

I hope that the nursing home involved is supporting this and doing everything in their power to be transparent during this tough time.

But there is more to this and it really comes down to some basics that I harp on all the time. Basic respect and dignity for our elders. It needs to start at home and society needs to enable it by embracing inter-generational programs that bring people together. We don't want to talk about getting old in this society and we need to. I fully embrace the concept of youth and vitality and clearly see the sands shifting with a new president to a youth oriented culture. But folks we have some very youthful older folks that need our love and attention. Seems as soon as they retire from a profession we write them off as retired from life.

Adult Medical Day Care an Alternative Worth Considering

One of the first things you may consider for a loved one who needs extra assistance is adult day care or adult medical day care. It is a great resource particularly for those isolated in their homes who are capable of going out but choose not to socialize.

Here is an interesting article on adult day care and particularly why it is being threatened in the current economic crisis and within the context of health care reform.

Even Hollywood Can't Take Care of Our Elders

The Motion Picture & Television Fund -- a charity started by Charlie Chaplin, Mary Pickford and other Hollywood luminaries to care for entertainers - - said Wednesday that it was closing a hospital and nursing home by year's end.

The facilities have been a $10-million annual drain on the fund's budget for the last four years according to the administrators.

Residents have included DeForest Kelley, who played Dr. Leonard "Bones" McCoy on "Star Trek"; Dick Wilson, of Mr. Whipple fame; and producer-director Stanley Kramer.

A annual pre-Oscar fundraiser bash at the Beverly Hills Hotel contributes six to seven million dollars a year, almost half the motion picture fund's budget. But fundraising was not enough to cover the hospital and home shortfall, plus millions more the fund spends annually on direct financial assistance to needy entertainers.

Does this sound familiar. The primary sources of funding for the home and hospital are Medicare and Medi-Cal, the government healthcare programs for elderly and poor patients. The home and hospital cost $30 million a year to operate but received only $20 million in reimbursements. However, not for nothing, but Hollywood stars could easily make up the shortfall and not feel any pain. That is a little bit different then what typical facilities could do.

So, even though I continue to sound like a broken record, here are your lessons. Take care of yourself physically and mentally. Many of the residents I see in nursing facilities got there not because age caught up with them but because they did not take care of themselves. Yes some illnesses and diseases can not be avoided so there will still be a need for facilities. And that gets to lesson number two - expect no one but yourself to pay for the care in a nursing facility. Buy a long term care insurance policy.

Hey this isn't glamorous but even Hollywood glamor loses its sheen when they can no longer take care of their own.

Falls Associated with Certain Drugs

In a study published in the Archives of Internal Medicine falls among elderly people are significantly associated with several classes of drugs, including sedatives often prescribed as sleep aids and medications used to treat mood disorders.

Antidepressants showed the strongest statistical association with falling. Anti-psychotics often used to treat schizophrenia and other psychoses and drugs such as valium were also significantly associated with falls.

The study notes that "Safer alternatives, such as counseling, shorter-term or less-sedating therapies, may be more appropriate for certain conditions." Painkillers were found not to be statistically associated with falling.

"Elderly people may be more sensitive to drugs' effects and less efficient at metabolizing medications, leading to adverse events, which in turn lead to falls," researchers added.

Prescribing medications to seniors has increased substantially over the past decade. In addition, determining which medication classes are associated with falls remains a challenge since seniors are often on multiple medications for multiple health conditions, with new drugs entering the market on a regular basis.

You may want to check your elders' medicine inventory when visiting and be on the lookout for any unsteadiness and tendency to fall. If you are particularly concerned call their doctor and initiate a conversation.