This week—May 13 to 19—is National Nursing Home Week. The theme for 2012 is “Celebrating the Journey,” which reminds us all to recognize and honor the lives and milestones of the older adults in our lives. According to the American Health Care Association (AHCA):

Celebrating the Journey reminds us that every life should be honored, every life’s story needs to be told and that every day we have the chance to begin writing a new chapter. Whether the day is filled with comedy or drama, nursing home residents and caregivers are co-authors and leading characters in each other’s life story.

Today is about living life to the fullest, irrespective of age, infirmity or disability. There is no fixed formula to follow or guide the process, just the quiet routines of daily caregiving, meals, activities and, let’s hope, visits from family and friends. They bring the joy that comes from the heart of a loved one.

Nursing Home Week is the perfect time to remember to spend a little extra time with loved ones who are no longer able to live independently, and to make sure that the quality of the care they are receiving is what you hoped and expected.

At HensonFuerst, we advocate for nursing home residents throughout the year. We work with residents and their loved ones to make sure that cases of abuse or neglect are addressed, and that the rights of nursing home residents are protected. That’s our own contribution to “Celebrating the Journey.”

For older adults, falls are a major health problem:  Falls are the leading cause of brain injury among seniors, and are linked to a risk of death due to complications from hip fractures. If we could find a way to prevent falls, it would prevent a lot of pain, suffering, early death, and medical costs. Now, researchers have made a discovery that could lead to fewer falls among the elderly.

Dr. Frank Lin from Johns Hopkins and Dr. Luigi Ferrucci of the National Institute on Aging reviewed five years of information from more than 2,000 people ages 40 to 69. They looked at demographic information, balance, falls, cardiovascular function, vision and hearing. It turns out that the greater the hearing loss, the greater the chance of falling.

According to a Johns Hopkins press release, people with mild hearing loss (25 decibels) were three times more likely to have a history of falling. And every additional 10 decibels of hearing loss increased the chances of falling by an additional 40%.

Why might this be so? One reason is that people who can’t hear well might not have good awareness of their overall environment, making tripping and falling more likely. Another reason might be that hearing loss could overwhelm the brain by making additional demands, or “cognitive load.”

“Gait and balance are things most people take for granted, but they are actually very cognitively demanding,” Dr. Lin says. “If hearing loss imposes a cognitive load, there may be fewer cognitive resources to help with maintaining balance and gait.”

No matter why hearing loss is linked to falls, it stands to reason that correcting hearing loss could help prevent falls. Many people with hearing loss resist seeking treatment–they don’t want to end up with a hearing aid. That’s more frustrating for the people around them than for the person with hearing loss. Maybe knowing that they could prevent winding up in the hospital after a fall could spur more folks to give in and get a hearing aid. This is one time when vanity could be both expensive an painful.

Do you have an emergency preparedness plan for your home and family? Do you have an evacuation plan in the event you have to leave the area? Do you keep extra batteries for flashlights… a well-stocked first-aid kit… a supply of bottled water?  Well, the federal government requires that nursing homes have specific plans in place for how they plan to protect their sick, frail residents from natural disasters, such as tornados, hurricanes, floods, and fires. Sadly, inspectors have found that the plans are weak or nonexistent.

According to an article in the News & Observer, the department of Health and Human Services has been investigating emergency plans of of nursing homes ever since Hurricane Katrina seven years ago. Now, their report says that current plans lack relevant information, such as how to coordinate with local authorities, how to notify relatives, and how to keep track of residents’ medications. They recommend that Medicare and Medicaid add mandated specific planning and training steps to the current disaster plan requirements.

While nursing homes can easily pull out written disaster plans, the proof of true preparedness lies in how well the staff respond in an actual emergency. So inspectors dug a little deeper into the records of 24 selected nursing homes in California, Louisiana, Minnesota, North Carolina, North Dakota, Tennessee, and Texas. All 24 facilities had been affected by a disaster, and 14 had evacuated. According to the N&O article:

Of the 24 emergency plans, 23 did not describe how to handle a resident’s illness or death during an evacuation. Also, 15 had no information about specific medical needs of patients, such as feeding tubes and breathing equipment. Seven plans were silent on how to identify residents in an evacuation, such as by attaching wristbands or name tags. Inspectors said 15 made no provision for including medication lists.

None of the nursing homes met a government recommendation for a seven-day supply of drinking water if residents had to shelter in place and their regular source of water was unsafe or unavailable.

Twenty-two had no backup plans to replace staff members unable to report for work during a disaster.

Transportation was an Achilles’ heel. None of the nursing homes had planned to ensure transportation of adequate food and water for evacuated residents, while 19 had no specific plan for transporting wheelchairs and similar equipment. Twenty-two of the plans did not describe how the nursing home would transport medications.

Let’s hope that the results of this investigation lead to some real changes with actual benefits to residents. We’re not going to hold our breath: Medicare chief Marilyn Tavenner agreed that training steps should be added to the current regulations, she offered no timetable for doing so. Will it take another disaster on the level of Hurricane Katrina to have them heed the call to action?

To read the full article in the N&O, click here:  Big gaps found in nursing homes’ disaster plans

North Carolina is notorious for its wild daily temperature swings. You might start the day needing long sleeves and long pants, change to shorts by lunchtime, then put on a jacket after sunset. For most of us, this is nothing more than a minor sartorial inconvenience; but for people over age 65, temperature swings can be dangerous to their health.

According to research published in the Proceedings of the National Academy of Sciences, even seemingly small changes in summer temperature swings–changes as tiny as 2° F–may shorten life expectancy for people with chronic medical conditions. According to the lead scientist for the study, Antonella Zonobetti of the Department of Environmental Health at Harvard School of Public Health (HSPH):

“The effect of temperature patterns on long-term mortality has not been clear to this point. We found that, independent of heat waves, high day to day variability in summer temperatures shortens life expectancy. This variability can be harmful for susceptible people.”

Previous studies have confirmed the association between heat waves and higher death rates. But this new research goes a step further. Although heat waves can kill in the short term, the authors say, even minor temperature variations caused by climate change may also increase death rates over time among elderly people with diabetes, heart failure, chronic lung disease, or those who have survived a previous heart attack.

The research showed that for each 2° F increase in summer temperature change, there was a 2.8% to 4% increase in death rate for susceptible seniors. Calculations suggest that summer temperature swings could account for more than 10,000 additional deaths per year.

Why? What could that tiny temperature fluctuation do that is so dangerous?

Researchers say that older people and those with chronic health conditions have a hard time adjusting to extreme heat. As their bodies struggle to adjust, the elderly experience physiological stress, which can cause frail or sick bodies to become sicker.

Although there is not much to be done about this, Dr. Robert Glatter, interviewed for WebMD, says that friends, relatives, and neighbors should try to keep a closer eye on people with chronic health problems, not just on days with blazing heat, but also during sudden weather snaps.

“Watch for any changes in their daily vital signs and complaints,” says Glatter, [an emergency medicine specialist at Lenox Hill Hospital in New York] who was not involved in the study. “Make sure you’re listening very carefully to their complaints.”

Make sure the elderly have appropriate temperature controls in their living environments, and provide them with air conditioning and fans, if possible. And if your loved one lives in a nursing home, spend a full day there in the summer to see how well the facility controls temperature.

To read the full story on WebMD, click here:  Summer Temperature Swings

In keeping with our on-going series, today’s blog is about nursing home tragedy. We collect stories from around the world to remind everyone that the elderly are vulnerable to abusers and unscrupulous care facilities. If there is a lesson to be taken from these stories, it is that friends and family of nursing home residents need to visit often, stay involved, and speak up if anything seems unusual.

Here’s today’s nursing home story round-up:

Whose Meth Lab Was It?

Investigation of a deadly fire at Park Haven Home in Ashtabula, Ohio, revealed that the blaze began in a resident’s room…where someone had created a shake-and-bake meth lab. The man who died, 31-year-old Shaun Warrens, was not a patient or an employee of the facility. As of this writing, it’s not clear what connections he had to the nursing home. Three residents and one non-resident were hospitalized with injuries caused by the fire.

According to an article by the Associated Press:

Police Chief Robert Stell told the Star Beacon of Ashtabula that police believe two visitors and one Park Haven resident knew about the meth lab. Police expect to charge two men who also were burned in the fire.

Methamphetamine, or “meth,” is a highly addictive stimulant. Mobile meth labs, also called one-pot or shake-and-bake labs, usually consist of a 2-liter bottle and the drug’s ingredients. According to Bob Frey, of the health department:

“Basically, you can take all of the components and equipment and put it in a backpack and use it to brew a small quantity of methamphetamine,” he said. “It’s a highly dangerous but very self-contained method of making methamphetamine.”

Shaking the mixture agitates the chemicals and produces the heat needed to cook the drug. But it can also cause a violent reaction that could melt or rupture the container. The explosion or fire usually is confined to the person making the drug and the surrounding area, Frey said.

Meth is a problem nationwide, but it’s highly uncommon in a nursing home setting. I’m not sure whether this speaks more to the expansion of meth’s addictive reach, or to the changing demographics of nursing homes. As addiction spreads, it eventually reaches all segments of society.

To read the full story, click here:  http://www.ajc.com/news/nation-world/nursing-home-with-meth-1374675.html

Jailed for Facebook Photos

According to the Daily Reporter, 26-year-old Oregon nursing assistant Nai Mai Chao served eight days in jail after a jury found her guilty of invasion of personal privacy. Some believe that her crime should have brought a much higher punishment.

“Invasion of personal privacy” sounds so innocuous, doesn’t it?  What Ms. Chao did was awful:  She took disturbing photos of elderly and disabled patients using bedpans, then posted them on Facebook. Ms. Chao surrendered her nursing certificate, and was fired from the Regency Pacific Nursing and Rehab Center where she worked.

To read the full story, click here: http://www.greenfieldreporter.com/view/story/5365bdb7f2544ef9a21be69e5d6f1d4f/US–Nursing-Home-Photos/

British Elderly Denied Basic Care

According to an article in The Telegraph, more than half of nursing home residents are denied even basic health services. Some have to wait up to three months for formal checks of painful conditions, such as bed sores… some face significant delays in getting their medication… and many are not given a choice of male or female staff to help them use the bathroom, raising issues of dignity and respect.

The Geriatrics Society issued results of a study that showed that about half of primary care facilities don’t even provide key services, such as continence assessments, physiotherapy, bed sore checks, and mental health services. According to the president of the society:

“What it shows is that there is a massive disconnect between what the NHS aspires to and what it actually delivers to people in care homes and they are the most vulnerable group of people.

To read the full story, click here:  http://www.telegraph.co.uk/health/elderhealth/9126976/More-than-half-care-home-residents-denied-basic-care-unpublished-data-shows.html

Vulnerable, Inside and Out

When you have to rely on other people for your daily care, you have to trust that you won’t be taken advantage of. Unfortunately, the elderly are often more vulnerable to scammers, cheats, and liars. Case in point:  64-year-old Surjeet Chana, a British “grandmother” who worked in the Land Registry office. She used her position to supply documents to a white-collar gang that stole houses from elderly people who had moved into nursing facilities.

According to an article in The Telegraph:

Using information she gathered, including title deeds and ownership signatures, the group targeted empty homes, pretending to be the owners and selling them on to third parties.

Over the past two years, the gang sold at least nine properties across London, worth a combined value of about $8 million. The judge who sentenced Chana to more than 3 years in prison called her “greedy” and “corrupted.”

You have brought great shame on yourself and your family, you have ruined your career and no doubt prejudiced your pension rights.

Judge Grieve added the gang preyed on “highly vulnerable” victims whose family homes which had a “lifetime of memories” were sold from beneath their noses. “It takes little imagination to realise the shattering trauma that this experience would bring,” he said.

Indeed.

To read the full story, click here:  http://www.telegraph.co.uk/news/9126384/Grandmother-jailed-after-plot-to-steal-homes-from-elderly.html

One Final Insult

Even after a resident died, one nursing home went the final, abusive step. In Great Britain, the Highcliffe Nursing Home sent a bill for the equivalent of about $4,740.00 because the dead man didn’t give 4 weeks notice of his death. Got that? The nursing home claims that unless they receive advance notice of a resident’s death, the resident (or his family) can be charged for an extra month’s stay at the facility. They claim that the charge is valid…similar to not giving a month’s notice before moving out of an apartment.

According to an article in the British newspaper The Daily Mail, the resident’s daughter felt that her father had been well cared-for while he lived at the facility, but she questions the crazy charge.

“I wouldn’t mind paying for a week,” she said. “But to pay for a month – which covers his food, laundry and nursing care – is daylight robbery.”

As if this wasn’t bad enough, the billing department was overly efficient. The bereaved daughter received the notice the day after her father’s funeral. The nursing home administrators claim they are reviewing this policy.

To read the full story, click here: http://www.dailymail.co.uk/news/article-2104184/Care-home-bills-grieving-daughter-3k-didnt-notice-fathers-DEATH.html#ixzz1oY2dZafV

As the saying goes, you cannot fully understand what another person’s life is like until you “walk a mile in their shoes.” That’s the point behind an innovative training program designed to help caregivers truly appreciate what life is like for their loved ones with dementia. According to an article on GoErie.com, a division of the Pennsylvania newspaper the Erie Times-News:

“You don’t know what they go through until you do this test yourself,” said [Patty Gregory, a certified nursing assistant at Saint Mary's Home of Erie]. “I took care of my father for 12 years, and now I truly know what he went through.”

In order to give caregivers a taste of what what an elderly person with dementia experiences, this is what they go through:

• Kernels of uncooked popcorn are put in their shoes to make walking more difficult;
• Kernels of popcorn are dropped into rubber gloves before sliding them onto the caregivers’ hands;
• Some fingers of the gloves were taped together to make it more difficult to grab and hold objects;
• They wore goggles with dark circles taped to the middle of each lens to approximate what macular degeneration does to vision;
• A CD played loud static and other distracting sounds through headphones;
• Strobe lights flickered.

The caregivers were then escorted to an empty patient room and told to perform five simple tasks—such as pouring half a glass of water and folding towels—but they had to listen to instructions through the static and noise, or read a list in which the words were scrambled. It was a difficult chore. According to the article:

“Where’s the water, where’s the water, where’s the water?” nursing assistant Alice Flemings said after entering the training room. “Oh my, oh my. Where am I going?”

“Take your time and calm down,” said DeAndra Jackson, a Saint Mary’s Home employee whose job during training was to ensure the nursing assistant did not walk into a door or otherwise hurt themselves.

Some nursing assistants were able to complete most of their tasks, while others struggled to finish even one.

One nursing assistant, who asked not to be identified, was so visibly aggravated when she walked out of the simulation room that Jackson jokingly called her a “noncompliant patient.”

The exercise helped caregivers to understand that it takes more patience to work with people with dementia and physical impairments, and that hurrying them along may only serve to make them agitated.

“My love for people has never changed and never will change,” Gregory said. “But until you walk in that room, you will never know the deep impact a disease like dementia can have.”

Such a fascinating program. It seems that this type of training should be required for anyone who works in a nursing home.

To read the full article, click here:  Erie nursing home shows aides what dementia is like

If your loved one has become bedridden due to illness or infirmity, it is important to take steps to prevent bedsores, also known as “pressure ulcers,” which are areas of broken skin caused by the pressure of lying in one spot too long without moving. Bedsores themselves cause pain, but worse than that, if left untreated bedsores are prone to becoming infected. In severe cases, the infection spreads from the skin to the blood, and even the bone.

In extreme circumstances, bedsores can be deadly. According to an article on the British news site The Daily Mail, bedsores kill almost as many hospital patients as the “super bug” called MRSA (methicillin-resistant Staphylococcus aureus).

According to the Mayo Clinic, bedsores can move through four stages of development very quickly:

• Stage 1:  Closed wound. The skin appears red (on fair skin), or ashen, bluish, or purple in people with darker skin. The site may be painful, and may be either warmer or cooler than the surrounding skin.
• Stage 2: Open wound. The outer layer of skin is damaged, making the ulcer look like a shallow divot, or like a large intact or ruptured blister.
• Stage 3: Deep wound. The ulcer starts looking like a crater, possibly with some yellowish dead tissue.
• Stage 4: Large-scale loss of tissue. The would exposes muscle, bone, and/or tendons. The bottom of the wound may look dark with crusty dead tissue.

Treating bedsores can be difficult, which is why prevention is so important. Whether your loved one is at home, or in a nursing home or hospital, here are some steps you can take to prevent problems before they start, from Dr. Anthony Komaroff (AskDrK.com) and the Lake County News-Sun:

• Relieve pressure on vulnerable areas. Move your loved one every 2 to 4 hours—from lying on the back, to one side, then the other side, then the back again. According to Dr. Komaroff: “When she is on her side, she should be only partly on her side (about a 30-degree tilt); if she is completely on her side, her hip bone will push down hard on her skin.”
• Use pillows to keep vulnerable areas from pressing into the mattress.
• Reduce irritation. You know how a tiny pebble in your shoe can feel like a jagged piece of glass after walking on it for awhile? To the skin of a bedridden person, tiny irritations can cause big pain. Keep sheets smooth and not bunched… don’t allow books or other objects to remain in the bed when not in use… make sure crumbs are caught or cleaned after eating.
• Inspect sore-prone areas at least once a day.
• Get prompt medical care if you see suspicious areas of skin irritation.
• Encourage good nutrition. If you have any doubts or questions, talk with a nutritionist to make sure your loved one gets enough calories, protein, fats, vitamins and minerals.
• Encourage movement or exercise. Even stretches or simple arm or leg lifts can help the blood circulate, which can keep the skin healthy.
• Keep skin clean and dry. Wash with plain water and very gentle soap (when in doubt, ask a nurse for recommendations). If sweating is a problem, use absorbent pads to keep moisture off the skin.
• Communicate with nursing home staff about your bedsore observations. If your loved one lives in a nursing facility, ask what steps they take to prevent bedsores. Let them know if you discover early signs of problems. Ask if they have any recommendations about items you could purchase that might make your loved one more comfortable. If you work as a team, your loved one has a better chance of staying healthy!

To read the full article from the News-Sun, click here: Measures to prevent sores in the bedridden elderly

To read more about bedsores from the Mayo Clinic, click here:  Mayo Clinic Bedsores

The U.S. government’s 5-Star ratings of the nations nursing homes are in!

While these results are not as glamorous as the Oscars or the Grammys… okay, they are not glamorous at all, but they are significantly more meaningful than entertainment awards, and they affect more of us much more directly. Currently, about 7.5% of Americans currently live in nursing homes. With the current trends in costs of care, health concerns, and the number of aging Baby Boomers, it has been estimated that about 11 million people will be likely to require assistance in old age within the next 10 to 20 years. That makes it essential that we understand what makes a “good” nursing home or a “bad” nursing home, and how to find the good ones.

Every year the Centers for Medicare and Medicaid Services (CMS) publish the results of their 5-Star Quality Ratings of nursing homes. The Five-Star Quality Rating System was created to help consumers, their families, and caregivers compare nursing homes more easily, and help identify areas about which you may want to ask questions. Nursing home ratings are taken from three sources of data:

• Health Inspections. Onsite visits by a team of trained inspectors who check on the quality of care, inspect medical records, and talk with residents about their care. Inspectors also make sure that the nursing home meets federal quality processes.
• Staffing. This rating looks at the overall number of staff compared to the number of residents…as well as how many of the staff are trained nurses.
• Quality Measures. This measure rates how well a nursing home performs on 10 important aspects of care, such as how well the nursing home prevents and treats skin ulcers, and how well residents are helped in eating and dressing. While this sounds like a valuable measure, the data for Quality Measures are self-reported by the nursing home staff. This makes it the least objective measure, and the most likely to be inappropriately high.

Each of these areas is individually rated, and then these three ratings are combined to calculate an Overall Rating.

The lowest overall rating is awarded to homes “much below average” compared with others in their state, according to CMS. Among problems that can drop a rating: consistently dirty equipment and linens, mistreatment and unlicensed caregivers or specialists.

How to Choose a Good Nursing Home

USA TODAY Analyzes Ratings

The CMS Nursing Home Compare data only list the most recent star ratings, but it doesn’t provide a history for consumers. Now, USA TODAY prices an analysis of the ratings for more than 15,000 nursing homes over the past 3 years. Among their findings:

• Quality improved. There was a 5% decrease in the number of nursing homes with 1- or 2-star ratings; and there was a 5% increase in the number of 4- and 5-star rated facilities.
• Some of the worst stay bad. 564 nursing homes received 1-star ratings in each of the rating periods during the past three years.
• Two-thirds of these low-performing facilities are for-profit organizations.

Here’s how to see specific nursing home ratings from the past three years:

• Go to the USA TODAY ratings page here:  USA TODAY Nursing Home Ratings
• On the upper right corner of the chart at the top of the page, enter the state you would like to search.
• On the lower right side of the chart, you can narrow your search by entering a specific term, which can include a city name, part of the name of the nursing home, a street name, etc.
• To see a comparison of all three years’ ratings, click the “+” sign to the left of the nursing home name and address.

ADDITIONAL RESOURCES

USA TODAY article: Fewer seniors live in nursing homes

To see the full reports AND to search for specific nursing homes by name or location, see the Nursing Home Compare page here: Nursing Home Compare

To see the HensonFuerst video about how to choose a good nursing home, click here: How to Choose a Good Nursing Home (and Avoid the Bad Ones)

BINGO is a fun activity for many people, but especially those in nursing homes and assisted living facilities.  Now, researchers have discovered that BINGO has benefits that go way beyond passing the time: Bingo seems to boost thinking and playing skills, especially among people with Alzheimer’s disease and Parkinson’s disease.

According to an article on ScienceDaily, as people age, they begin to lose sensitivity to perceive contrasts…and this problem is worse in people with dementia. The researchers tested different types of specially-made bingo cards, and discovered that improving contrast and increasing the size of the cards improved the players’ skills. In fact, increasing contrast in the environment made living easier for the seniors, too.

For example, putting a black sofa in a white room would improve the contrast of the room and make it easier for individuals to move about. Additionally, they found that individuals with dementia actually eat more if they use a white plate and tableware on a dark tablecloth or are served food that contrasts the color of the plate.

These types of simple interventions could help people with dementia remain independent longer, and give them greater enjoyment of life overall.

To read the full article on ScienceDaily, click here:  BINGO!

Alzheimer’s disease makes just about everyone’s short list of aging fears. The disorder robs individuals of their memories…their sense of self…their connection to friends and family. It’s hard on everyone who has to watch their loved one disappear before their eyes.

Now, scientific research published in The Archives of Neurology offers a small—but statistically significant—ray of hope for anyone hoping to prevent Alzheimer’s disease. The answer:  Walking!

The scientists studied 201 healthy adults (ages 45 to 88). The participants were tested for genetic predisposition to Alzheimer’s disease, and were given a brain scan to look for signs of amyloid plaques, the abnormal protein deposits that are a characteristic of the brains of Alzheimer’s patients. Fifty-six participants tested positive for the APOE-e4 gene, a marker that increases the risk of developing Alzheimer’s disease by a factor of 15. None of the participants had signs of Alzheimer’s disease at the beginning of the study. Finally, everyone completed detailed questionnaires about their exercise habits.

According to an article in The New York Times:

The volunteers who reported walking or jogging often — meeting (or, in rare instances, exceeding) the American Heart Association’s exercise recommendation of 30 minutes of moderate or vigorous activity five times a week — had fewer amyloid plaques than the volunteers who reported almost never exercising….

The carriers of the gene who reported walking or jogging for at least 30 minutes five times a week had plaque accumulation similar to that of volunteers who were e4-negative. In essence, the APOE-e4 gene carriers mitigated their inherited risk for developing Alzheimer’s by working out.

So moderate exercise was protective against Alzheimer’s disease…even for people who have an extremely high genetic risk of developing the disease. The scientists have a lot more work to do to figure out why exercise is protective, but for the average person, the take-home lesson is that exercise should become a part of daily health habits for everyone—but especially for those with a family history of Alzheimer’s disease.

“There are so many benefits to exercise,” [Denise Head, an associate professor of psychology at Washington University who led the study] says, “and one may be that it helps the brain” to defend itself against the slow leaking away of memory.

Now that’s science we can get behind!