Nursing Home Abuse Advocate : Idaho Nursing Home Abuse Lawyers & Attorneys : Kormanik Hallam & Sneed Law Firm : ID Assisted Living Neglect, Nursing Home Injuries : Boise, Nampa, Caldwell

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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With all the news about H1N1 "Swine Flu," focus has turned to methods to protect ourselves from becoming infected. The Swine Flu is serious, no doubt, but the methods for protecting yourself from becoming infected with the Swine Flu apply to ensuring you are not infected by just about any similar contagious disease.

RISKS OF BECOMING INFECTED WITH THE FLU VIRUS

According to the Centers for Disease Control and Prevention (CDC), although people 65 years old and older are least likely to become infected with the H1N1 Swine Flu virus, if such a person does get infected, they are at "high risk" to develop serious complications from the virus. Additionally, the CDC believes those 65 years and older are at "increased risk" for serious complications from the seasonal flu as well. As a nursing home or assisted living facility resident, how can you protect yourself? Simple, wash your hands and make sure all those who come in contact with you do the same.

PROPER HANDWASHING IS A SIMPLE AND EFFECTIVE PREVENTATIVE MEASURE

The CDC believes: "Handwashing is a simple thing and it is the best way to prevent infection and illness." Although handwashing seems like a simple process, which all of us have seemingly been doing since we were 2 years old, the CDC provides the following guidelines for effective and proper handwashing:

When washing hands with soap and water:

• Wet your hands with clean running water and apply soap. Use warm water if it is available.
• Rub hands together to make a lather and scrub all surfaces.
• Continue rubbing hands for 15-20 seconds. Need a timer? Imagine singing "Happy Birthday" twice through to a friend.
• Rinse hands well under running water.
• Dry your hands using a paper towel or air dryer. If possible, use your paper towel to turn off the faucet.
• Always use soap and water if your hands are visibly dirty.
• If soap and clean water are not available, use an alcohol-based hand rub to clean your hands. Alcohol-based hand rubs significantly reduce the number of germs on skin and are fast-acting.

When using an alcohol-based hand sanitizer:

• Apply product to the palm of one hand.
• Rub hands together.
• Rub the product over all surfaces of hands and fingers until hands are dry. 

A simple and effective method of ensuring people wash their hands is to purchase a container of alcohol-based hand sanitizer and put it on a table in your room. Do not be shy about asking people to use it! It is up to you to make sure people who come into your room wash their hands.

Protect yourself from infection by making sure those who come in contact with you, whether they be staff caring for you or friends and family visiting you, wash their hands. The alternative, becoming infected with a contagious disease to save a few minutes of time just is not worth the risk. 

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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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Are you choosing a nursing home for yourself or a loved one? You need to be comfortable and knowledgeable. There are numerous websites to assist you.

The United States Department of Health and Human Services' Medicare nursing home website is an excellent place to start your quest for knowledge. There, you will find a link called “Nursing Home Compare.” You can use this website to compare nursing home facilities in your area. You can also compare the quality of nursing homes you are considering. A “Nursing Home Checklist” is available if you are going to be visiting a facility.

In Idaho, you have additional choices for researching potential nursing homes. You can contact the Idaho Commission on Aging to help you in this most important decision. There you will find information about the Ombudsman program as well as a link to the Bureau of Facility Standards, where you can review results of surveys of long term care facilities in Idaho. A copy of the most recent survey results lists 84 facilities throughout Idaho. The survey includes complaints, violations discovered during inspections and a facility’s response to these things.

The "Nursing Home Checklist" is an excellent resource for when you go to various facilities to investigate which facility is the right one for you. For example, the beginning of the Checklist focuses you on whether the facility actually has the appropriate level of care you or your loved one requires. Remember, no matter how nice a facility or its staff is or appear to be, if the appropriate level of care (skilled nursing vs. custodial care) that facility is simply not the right one for you or your loved one. Choosing an inappropriate facility can lead to numerous problems, not the least of which is injury to you or your family member.

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According to a 2005 factsheet by the National Center on Elder Abuse, the incidence of abuse of the elderly is between 2% and 10% nationwide. Remarkably, the NCEA believes that, for every incident of elder abuse in America, five additional incidents are not reported. It seems like there is a story about a nursing home resident being abused in the newspaper every day.

 In Idaho, if you are a resident of a nursing home or assisted living facility and believe a loved one is being abused or neglected, you have someplace to turn. The Idaho Commission on Aging  has an “Ombudsman” program to help you.

An Ombusman is a person appointed by the Idaho Commission on Aging to investigate complaints concerning your care in either a Nursing Home or an Assisted Living Facility. The Ombudsman will insure your health, safety, welfare and rights are protected. You can contact the Ombudsman free of charge 24 hours a day, seven days a week.

The Ombudsman is an excellent resource for residents of Idaho's nursing homes and assisted living facilities. In fact, the Ombudsman's primary job is to "advocate for resident's rights and quality care." Because the Ombusdman is familiar with the duties a nursing home or assisted living facility owes to its residents, he or she can answer a variety of questions or accept ensure the investigation of resident complaints. If you have a question about the care you or a family member is receiving in an Idaho nursing home or assisted living facility, the Ombudsman should be your first call.

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