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.”

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

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

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!

Charlene Harrington, RN, PhD, FAAN

Results of a new study suggest that the nation’s largest for-profit nursing homes deliver significantly lower quality of care, compared with smaller and not-for-profit nursing homes. Why? Fewer staff nurses (despite profits).

The study looked at quality in the 10 largest for-profit chains, which control about 13% of all nursing home beds in the country. They were choses because of their influence and expansiveness. The researchers from University of California, San Francisco (UCSF) found that when nursing homes put profits ahead of people, they cut costs by reducing the number of staff… especially trained and experienced (but more expensive) staff.

“Poor quality of care is endemic in many nursing homes, but we found that the most serious problems occur in the largest for-profit chains,” said first author Charlene Harrington, RN, PhD, professor emeritus of sociology and nursing at the UCSF School of Nursing. Harrington also is director of the UCSF National Center for Personal Assistance Services.

“The top 10 chains have a strategy of keeping labor costs low to increase profits,” Harrington said. “They are not making quality a priority.”

The correlation is so strong that many experts believe that the best predictor of nursing home care is the number of nurses working at the facility.

Something to remember if you should find yourself looking for a good nursing home.

Of the hundreds of blogs we write each year, the most heartbreaking are those we write about nursing home abuse and neglect. The stories are tragic, and they happen to people who are vulnerable and defenseless. Here is a round-up of the most important nursing home stories of the year. (To read any of the blogs, click on the title and you’ll be taken directly to the story.)

Nursing Home Horror Stories

I am constantly amazed and disturbed by the level of abuse and neglect happening in nursing homes across the country. I talk to people everyday who say they can’t believe that any care facility could actually put residents at risk of harm or death. To give credence to my pessimism, here are some very frightening stories gathered from news articles across the country.

• Nursing Home Tragedies
• Nursing Home Abuse Caught on Hidden Camera
• More Nursing Home Tragedies
• Riverdale’s Nursing Home “Hell”
• More Tragic Nursing Home Stories
• Even More Nursing Home Tragedies
• More Scary Stories About Nursing Home Care

How to Spot Signs of Elder Abuse

Many older people who are abused are at the mercy of their caregivers, and therefore may be afraid to speak about their pain or fear. If you have a loved one in a nursing home, it’s important to remain alert to the signs that something may be wrong.

• Signs of Nursing Home Abuse or Neglect
• “Granny Cam” Captures Images of Abuse

How to Choose a Good Nursing Home

Want to prevent abuse altogether? Start by choosing a quality nursing home.

• Nursing Home Ratings Available

VIDEOS

Early this month we wrote a blog called “Visiting a Loved One in a Nursing Home,” which talked about the nuts and bolts of holiday visits—what gifts to bring, what to check in advance, and when a visit should be delayed.

Today’s blog deals with the more personal side of visiting a loved one in a nursing home or hospital. This advice, from Carol Abaya of The Sandwich Generation, holds true all the time, not just during the holidays.

Advice for a Successful Visit

• For someone who is confined to a nursing home or hospital, time is the best gift you can give. As Carol Abaya says, “Time is the essence of caring. And the physical presence of a close relative can have positive effects on the emotional health of the person being visited.
• Enter the room quietly and talk softly to the patient. While spreading cheer in the rest of the world might mean loud greetings and shouts, people in a nursing home respond better to quiet energy.
• People who are elderly or sick may have a difficult time following complicated sentences or multiple speakers. Let one person talk at a time, and speak in short sentences.
• Don’t interrupt or rush the patient to finish a thought. This can take practice and patience, but it will make the patient feel like an important part of the conversation.
• Talk about positive events in your life…leave complaints, anger, or fear outside. And don’t talk about anyone else’s illness.
• On the other hand, if the patient wants to talk about important but potentially sad topics, join that conversation at the same emotional level. And don’t try to impose false happiness on a difficult situation. For example, people who are dealing with a terminal illness know that they are very sick and they don’t like for visitors to press false optimism.
• If the patient wants to talk about happier memories, encourage it and chime in with memories of your own.
• Don’t feel the need to fill in every moment with chatter. Sometimes just sitting quietly and watching a TV show together can be more valuable to the patient than hours of talk.
• Don’t overstay your visit. For a very sick person, 15 minutes may be enough time. Unless you know the person well and just want to sit quietly in the room, don’t ever plan to stay longer than about 45 minutes. Any longer than that may tire the person too much for the visit to be enjoyable.

To read more information about caring for elderly loved ones, visit The Sandwich Generation.

During the holiday season, nursing homes see an increase in the number of people visiting their loved ones—some estimates say that more people visit in the month of December than in all the other months of the year combined. In order to have the visit go as smoothly and successfully as possible, the Iowa Press-Citizen offers these tips:

• Keep in mind the limitations of the person you are visiting. What are the person’s physical or cognitive limitations? Do they have a limited attention span, or do they tire quickly? If so, plan a shorter visit. If they have trouble recognizing people, it might be too overwhelming if you arrive with a large number of visitors.
• Call ahead. Talk with the resident and the nursing staff to see if some days or times are better or worse than others. Some people with dementia need consistency, and breaking a routine by arriving during mealtime or other activity could be disruptive. Also, some people might have better energy or mood earlier in the day or after an afternoon nap. Better to know what is best for the resident than to have your visit cause problems.
• Consider visiting during mealtime. If your loved one agrees, and if the facility allows, you may want to visit during lunch or dinner. Call the facility in advance to find out the process, how much they charge, and other details. Some residents like being able to introduce family to their nursing home friends while sharing a meal. Alternatively, offer to take your loved one out for a meal.
• Don’t visit if you are sick. While having a cold might not stop you from doing your other daily activities, the elderly have weak immune systems. Something as simple as the common cold could turn into pneumonia, and could actually be fatal for some elderly people. Instead, make the visit by phone, and visit in person when you are totally healthy.
• Even if you are healthy, wash your hands before you enter the facility, and after you leave.
• Bring comfort food. Again, call in advance and speak with both the resident and the nursing staff. The staff can tell you if there are certain foods that are restricted for your loved one’s diet (for example, you wouldn’t want to bring salty foods to a person with high blood pressure), and the resident can tell you which foods he or she particularly likes or dislikes.
• Ask if there are other items you can bring. Nursing home residents can’t just hop in the car and go get anything they want. Your visit could be a lifeline to favorite items, such as lotions, clothing, videos, music, soft blankets, etc. If you bring an item, consider putting the resident’s name on it.
• Ask the resident how he or she would like to spend the time. Consider a hand massage, reviewing a photo album, listening to music, watching a video or TV show together, or making crafts. Some residents will be happy to see the gadgets you have in your pocket (cell phone, ipod, etc.). If you run out of ideas, ask the activities director.
• Connect family members digitally. Call the facility to ask if wireless service is available. If so, you can bring a laptop or iPad to arrange for distant family members to say hello via Skype, FaceTime, or similar services.
• Thank the nursing staff—many are working extra shifts or giving up holiday time with their own families to care for residents.

To read the full article in the Press-Citizen, click here:  Things to Consider When Visiting