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In an article in today's New York Times, reporter John Leland, describes the cuts states are making to close budget gaps and the effect those changes are having on the elderly. Some of the cuts described by Mr. Leland include meal deliveries, housekeeping assistance and aid for family caregivers. 

As Mr. Leland correctly points out at the beginning of his article, such cuts are "penny wise and pound foolish" (my words not Mr. Leland's) because the programs being cut have demonstrated they actually save states money by keeping the elderly at home and not in expensive nursing home and assisted living facilities. Interestingly, Bruce Goldberg, the director of the Oregon Department of Human Services, inadvertently demonstrated the very problem with attempting to balance Oregon's budget on the backs of its elderly and infirm population. According to the article, Mr. Goldberg said: "[T] he agency did not have an estimate for how many of the people losing home care would end up in assisted living facilities or in nursing homes -- or, if they did, how the state would pay for them."

Is it right for Oregon and other states to balance their budgets in such an irresponsible manner? I will leave that for you to decide (although, perhaps, the way I phrased the question reveals my answer). More importantly, to the extent those loosing the financial assistance for home care need to take adequate steps ahead of time to properly research nursing home and assisted living facilities in order to ensure when the time comes, they are placed in a safe, nurturing and caring facility. A facility that is able to adequately care for their needs. 

A new wave of nursing home and assisted living facility residents are being created by state budget cuts. The question remains, will the facilities be able to handle the deluge of new residents? Only time will tell. 

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Although this post is a little off the topic usually addressed in this blog, I found an an interesting article by Anne Barnard in yesterday's New York Times. The article reported on the practice of Queens, New York, prosecutors using New York's "hate crime" law to prosecute those who target the elderly. According to Ms. Barnard, Queens' prosecutors are using the hate crime law against those "singling out elderly victims for nonviolent crimes like mortgage fraud, because they believed older people would be easy to deceive and might have substantial savings or home equity." The use of New York's hate crime law results in stiffer sentences for those convicted of taking advantage of the elderly precisely because they are elderly. This is, indeed, a novel approach.

Will such prosecutions work in Idaho? Likely not because, unlike the New York statute, Idaho's "hate crime" or, more properly, "malicious harassment" statute does not include the elderly, in its definition of a class of people under its protection. The New York statute includes "age" and "disability" in its definition of protected groups. In Idaho, the statute does not. Perhaps this apparent oversight can be addressed by the legislature. 

If you feel strongly that Idaho's "malicious harassment" or "hate crime" law should include the elderly under its umbrella of protection, contact your state legislator today. 

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In a recent Los Angeles Times' "Booster Shots" article, Shari Roan writes briefly about a study of nursing home resident's sleep patterns and habits. The study, published in the Journal of American Geriatrics Society, and conducted by UCLA and the VA Greater Los Angeles Healthcare System, looked at 121 "older adults," 65 and older, living in assisted living facilities. According to the Ms. Roan, the study found: "the residents slept about six hours per night and about 1.5 hours during the day. The most common sleep problems included walking in the middle of the night or early morning or the inability to fall asleep within 30 minutes. Not surprisingly, the study also found "declining function status and quality of life and greater depression over 6 months of follow-up." That meant those residents who slept poorly required more help with their "activities of daily living," such as bathing, dressing and grooming. Unfortunately, the study does not get to the cause of the sleeplessness. Obviously, this is an important issue. What can be done?

Two of the causes of sleeplessness in older adults in general and, likely, residents of assisted living facilities in particular, may be chronic pain and medications. Both of these causes can be addressed and, in all likelihood, fixed. The first step is, of course, recognizing the "problem" exists. The next step is to get the "team" -- that is, the doctor, staff and family -- involved in finding the solution. If chronic pain is the culprit, your doctor and, and should, be able to help. In terms of current medications causing sleeplessness, perhaps the dosage of medication can be adjusted or or the medicine changed all together.

No matter what the cause, the problem of sleeplessness of assisted living facility residents must be recognized, properly diagnosed and addressed. If not, the effects are long-lasting and serious.

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As a resident of a nursing home or assisted living facility, there are many things you rely upon the facility to help you with. One of the most important, perhaps, is the administration of prescription or over-the-counter medications. If the facility gives you the wrong medication, the consequences can be dire, even fatal.

In an article posted today, KSAX, an ABC affiliate in Minnesota, reports on such a medication error. According to reporter Megan Matthews, the facility gave another's medication to a resident. The result was death. According to the CEO of Fair Oaks Lodge, Mr. Joel Beiswenger, the medication error and resulting death was "just one of those things that happened. Nobody intended to do anything, and it was the human making the tragic error."  a 

Mr. Beiswenger appears to either honestly miss, or simply ignore, an important point: Similar medication errors have occurred no fewer than two other times at the facility. This facts leads me to question whether Mr. Beiswenger or Fair Oaks Lodge have taken adequate steps to find the root cause of such errors. Was the facility adequately staffed for the number and acquity of the residents? Was the staff adequately trained to ensure medications were given only to the proper resident? Were there safeguards in place to prevent a medication error which led to a resident's death?

If you are a resident of a nursing home or assisted living facility, make sure the medications you receive are, in fact, your own. Make sure you receive them in the correct dosages at the proper times. The life you save may be your own. If you are the family member of a nursing home or assisted living facility resident, make sure the facility takes adequate precautions to prevent medication errors. Such medication errors can and do occur and, as demonstrated by the incident at Fair Oaks Lodge, the results can be catastrophic.

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In a recent New York Times blog entitled "Easing Tensions In The Nursing Home," author Paula Span addresses the important issue of tension between family members and nursing home staff. As you can imagine, most, if not all, of the issues contributing to this tension is a family's belief their loved one is not being cared for in an appropriate manner against the staff's belief to the contrary.

According to Ms. Span, the tension between family and staff leaves the family concerned that, if they voice their concerns, their family member will suffer because unhappy staff will, in some way, retaliate against the resident for the complaints of the family. To avoid, or at least lessen, the chance for tension between family and staff, Ms. Span provides the suggestions of Karl Pillemer, a gerontologist at Cornell University, and the sociologist J. Jill Suitor of Purdue University:

• Take complaints and requests to the right place. While aides do most of the hands-on care in nursing homes: “They’re almost never the ones who are making decisions about it. You’ve got to go high enough up the chain to make sure the person you talk to has the ability to influence what goes on.” The staff social worker is a starting point.
• When a problem involves an aide’s duties, practice “clear and respectful communication.” “Avoid blaming the other person. As people get angry, there’s a tendency to insult the other party, and it escalates.” A demand or reproach — “How come nobody’s shaved my father?” — puts overworked staffers on the defensive. Try phrasing it this way: “I noticed my father isn’t shaved. This is very important to him. How can we make sure he’s shaved every day?” After the conversation, summarize to clarify the agreement you have reached: “I understand that you were short-staffed today. But he will be shaved every morning — is that what you’re saying?”
• Keep visiting, and monitoring. “The amount of visiting people receive is directly related to the quality of care. Families do need to advocate for their relatives, but they need to do it in the right way.”
• Give positive feedback as often as possible.

In a previous blog post, entitled "The Ombudsman for the Idaho Commission on Aging is on the Side of Idaho Nursing Home Residents," I addressed the role of the Idaho Ombudsman for long term care in addressing concerns regarding teh care of nursing home and assisted living facility residents. Regardless of the involvement of the Ombudsman, it is important you, as a loving and caring family member, are able to effectively communicate your concerns with the proper individual at the facility so your family member does receive the proper care. As Ms. Span and Mr. Pillemer suggest, perhaps the most important contact at any nursing home or assisted living facility is the social worker or, if none is available, the director of the facility.

I suggest not only approaching the appropriate individual with your comment or concern, but also following up with that person in writing. A written summary of your concerns, the discussion which you had with the appropriate upper-level employee and the outcome or change in care you expect are all good things to write down. This way, if the concern is not addressed, you can again voice it or contact the Ombudsman. If the concern is addressed, you will be able to follow up with a "thank you" to the staff of the facility caring for your family member or loved one.

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The decision to place someone you love into a nursing home or assisted living facility is not easy. You and your loved one have decided it is “best” because they can no longer live safely on their own. You have struggled with the decision. You have spoken to everyone you know about it, but do you know the important questions to ask when making this most important decision?

In Tammy Worth's Los Angeles Times article, How to Decide Whether a Nursing Home is the Right Fit, she shares excellent questions you and your loved one should ask before deciding on a facility. Those questions are:

• Does the care meet the needs of your family member? Does the facility have proper medical services? Can residents personalize their rooms with photographs and other items? Are staff members interacting one-on-one with residents? Is the staff smiling and welcoming?
• Does the facility have adequate fire and safety systems? The most recent state inspection report will show if it had deficiencies related to fire drills, up-to-date manuals and policies, or expired fire extinguishers. A fire marshal report should also be posted at each facility.
• Does it have a wanderer alert? These devices are used to make sure a disoriented resident doesn't leave the residence.
• Does it have a pastoral care program of any kind? Such programs suggest the homes are connected to the community and that they value all dimensions of the residents' lives.
• Does it have a volunteer program and, if so, what do those volunteers do? These programs indicate “fresh air in the place.”
• What is the policy on chemical and physical restraints? Obviously, the fewer the better.
• How frequently do patients get pressure ulcers? Such injuries occur when an individual stays in one position for too long and the skin in contact with the bed or other surface begins to break down. Again, the fewer the better. This is listed under a home's quality report on Medicare's Nursing Home Compare.
• What is the medical direction model? This explains what kind of care the facility specializes in providing, i.e. subacute, Alzheimer's, for the developmentally disabled. Ideally, many of the patients at a facility would need similar kinds of care.
• What are the weight loss numbers like? All homes will have some, but they should not be substantial. This is listed under the quality report on Nursing Home Compare.
• Does the facility have a resident or family satisfaction survey, and if so, will they show you the results? Good facilities will be transparent?

Of course, the most important question to ask regarding any facility is whether it has the ability to meet the needs of you or your family member. If a facility does not have the experience or expertise to meet the medical and other needs of your family member, it really does not matter that it "looks nice," or "the food is good." If the facility is unable to meet a potential resident's needs, it should say so. Unfortunately, that may no always happen. That is why it is important for you to be knowledgeable and ask the right questions. Questions, like those Ms. Worth suggests are a good place to start.

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