Seniors and Bullying

It’s an irony of life that, in many ways, we end as we begin — dependent, spoonfed pureed foods (is Ensure the geriatric Enfamil?), wearing diapers. If it’s true that at a certain point we our lives begin to Benjamin Button, then maybe it’s true that retirement communities are like high school, replete with the ubiquitous resident mean girls.

In a New York Times Op-ed piece this weekend, Jennifer Weiner writes about the bullying behavior her 99-year-old “Nanna” experienced when she first arrived at her new retirement home. In Mean Girls in the Retirement Home, Ms. Weiner describes that Nanna wasn’t allowed to sit at certain dining tables. Nanna wasn’t invited to play bridge. It sounded to Ms. Weiner (and to me) like classic school bullying.

I thought, is senior bullying really a thing? It is.

With more elderly entering senior care centers, retirement communities, assisted living facilities, and nursing homes, the instances of senior bullying is on the rise. It’s estimated that 10-20% of seniors in these types of communities find themselves objects of bullying by the members of the “controlling group.” Sometimes, residents with dementia will act in a bullying manor out of frustration, anger, and confusion.

Senior-to-senior aggression can be overt or passive-aggressive. Studies show that, much like the bullying found in high school, men tend to be openly abusive, challenging other residents both verbally and physically. Women tend to take part in stereotypical behavior, spreading rumors and ostracizing victims.

Why do seniors engage in bullying? The same reason kids bully. A bully, no matter what age, seeks to control and dominate. Perhaps because they lack power in their own situation, they seek to make themselves feel stronger by making others feel weak and fearful. They also have a lack of empathy.

How do you know if a senior is experiencing bullying? Here are some telltale signs:

  • Isolation
  • Depression
  • Avoidance of certain communal areas
  • Taking circuitous, out-of-the-way routes to get to and from areas
  • Complaints that they are not liked and are not included in activities

Bullying is a form of elder abuse and should not be tolerated. In these instances, a third-party has to get involved. Alert the staff  or on-site social worker if you suspect bullying. If they don’t intervene, contact your state’s long-term care ombudsman to report the abuse. Everyone deserves to live their life with respect in a caring community.

Have you ever experienced senior bullying? What did you do about it? Tell us in the comments.

Go Do Good: Volunteering Senior Care

We know there is a great shortage of senior caregivers. That looming need for qualified home health aide caregivers is a topic I’ll address in depth in a New Year blogpost, but for now I’ll address some of the abundant opportunities to help the elderly within your community.

Meal Delivery
I have a friend who works with a food pantry delivering meals monthly to homebound seniors in senior housing not far from her house. This month, she included in her deliveries a small three-dollar poinsettia. She said that the gratitude for not only the meal but the extra gift was immeasurable. She also said that the deliveries would have gone much quicker and easier with more hands. If you’d like to volunteer to prepare and/or deliver a meal to a senior, the Meals on Wheels program caters (pun intended) to seniors around the country through their local communities.

Relieve Isolation and Loneliness
According to the Census Bureau (2010), in Chicago, 1 in 3 householders over 65 years of age lives alone. Little Brothers, Friends of the Elderly has made it their mission to make sure no senior lives in isolation if they don’t want to be alone. It’s a national network of non-profit volunteer-based organizations committed to relieving isolation and loneliness among the elderly. (They) offer to people of goodwill the opportunity to join the elderly in friendship and celebration of life. Contact your local chapter to investigate opportunities to visit an elder in person or by phone.

Share Your Skills
Many nursing homes and assisted living communities are always interested in hearing from potential volunteers to help with activities and programs. Usually after passing a background check, a TB test, and signing a confidentiality agreement, volunteers are welcome to help with social activities, lead arts, crafts, music, drama, and educational programs. While you won't be able to help withe Activities of Daily Living (that's reserved for trained professional caregivers,) you can share your expertise to help better lives. Technology can help bring long-distance family together, so sharing your computer knowledge can assist a senior in keeping connected. If you have video skills, help a senior center go viral! You have so much to offer share where it will be appreciated most.

As my meal-delivering friend said, “It’s amazing how much a little interaction brightens the day of the senior crowd.” Keep the great holiday feeling going all year long. Perhaps make it a New Year’s resolution to bring a little light to a senior’s life by volunteering just a little bit of your time.

And from me and Caregiverlist, Happy Holidays!

Nursing Homes, Assisted Living Out of Middle Class Reach

It's all excitement around here as we await the release of the movie, The Hunger Games: Mockingjay - Part 1, in which our heroine, Katniss Everdeen (Jennifer Lawrence), leads the have-nots of Panem’s districts in a rebellion against the haves of The Capitol.

Dystopian views of a future society, in books and in movies, often feature a missing element of the population — the middle class. In these communities, only the very rich and very poor have access to services, the former is afforded private (superior) services, the latter, inferior, government-provided resources. Like it or not, America is beginning to look a lot like those futuristic civilizations where you are either very rich (and in the ruling minority) or very poor (the rest of us.)

The Harvard Joint Center for Housing Studies’ recent report, Housing America's Older Adults—Meeting the Needs of An Aging Population, shows that affordable elder housing will be one of the single biggest challenges we face in the near future.

Housing is the largest expense in many household budgets. Even though the majority of seniors prefer to age in place, many older Americans find that the high cost of housing expenses make it necessary to cut spending in other areas such as groceries and healthcare. In fact, over 37 percent of Americans aged 80 or older put more than 30 percent of their income toward housing expenses. And those are the property owners — the lucky ones.

In Joel Kotkin’s book The New Class Conflict, the author points out a “doomed” middle class.  In the wake of the housing bust, U.S. homeownership, which peaked in 2002 at nearly 70 percent, has since dropped to 65 percent in 2013, the lowest in almost two decades, according to the U.S. Census.

How does that affect senior housing? Even if you have the financial wherewithal to age in place, the Department of Health and Human Services estimates that 37 percent of those aged 65 and over will receive care in some sort of institutional setting at some point, with an average stay of one year.

Nursing home and assisted living costs are always increasing. The recent (Nov. 2014) Caregiverlist® Index reported the average annual cost for an Illinois nursing home is $72,631.35. Of course, quality of care usually decreases at lower cost points. The national average for assisted living base rates was $3,550 per month in 2012.
    
The typical homeowner aged 65 and over has enough wealth to cover nursing home costs for 42 months and enough non-housing wealth to last 15 months. The median older renter will not be able to afford even one month in a nursing home or in assisted living.

As a society, we will be facing these challenges together to make sure that the aging population, whether they be the Jeffersonian ideal “small landholders” or increasingly-numbered  “lower middle-class” have access to the similar quality housing and services in order to age with security and dignity.    

INFOGRAPHIC: Housing America
 

Glen Campbell Says Farewell in Documentary

When Glen Campbell, 78, received the news about his Alzheimer’s disease in 2011, he was told to “hang up his guitar and prepare for the inevitable.” The singer/songwriter instead decided to embark on a “Goodbye Tour” that was to last 5 weeks. Instead, the tour lasted a year and a half, and Glen Campbell played to sold-out audiences in 151 performances around the country.

That tour, along with the chronicle of Mr. Campbell’s advancing disease, has been captured by the documentary, Glen Campbell . . . I’ll Be Me, which opened this past week across the U.S. Documentarian James Keach captures not only the amazing performances, but also the struggles with his advancing Alzheimer’s disease. However, not only do we see the anger, frustration, and moments of lucidity that are the hallmarks of memory loss disease, we also get to see the triumph of Mr. Campbell’s spirit on stage. Of his film’s subject, Keach has said, “It became not so much the story of Glen Campbell, but the story of the gift that is being taken away from him. And us."

Even if he sometimes forgot the words, the music is so ingrained in this man’s mind, body, and soul, that he could still do this:

For those too young to remember, Glen Campbell is a 6-time Grammy winner, including an Album of the Year in 1967 and is a recipient of a Lifetime Achievement Award (2012). He was a session guitarist with the Beach Boys and Elvis Presley and in 1975, his hit “Rhinestone Cowboy” was No. 1 on Billboard’s Hot 100 list. He is back on the list at No. 90 with the film’s "I'm Not Gonna Miss You." It’s his first chart appearance since Sept. 5, 1981—marking a 33-year hiatus.

Since the tour ended, Mr. Campbell’s family, including his wife, Kim Woolen and the couple’s daughter Ashley, 27, were caring for the singer at home until this past April. It was then that the 24-hour care Campbell needed became too much for the family to provide themselves. They decided to place Mr. Campbell in a memory care facility near their home in Nashville, TN. Ms. Woolen told People magazine about the decision. "No one was getting any sleep and we were just struggling every second to keep him safe – we felt like it wasn't safe anymore."

An estimated 5.2 million Americans have Alzheimer’s disease in 2014. Most of us know someone or love someone with some form of dementia. We know how difficult it is to watch that person slowly slip away. It used to be that we wouldn’t acknowledge memory loss disease. What was referred to as “old-timer’s disease” was rarely spoken of and it’s sufferers stigmatized. It takes a lot of courage for someone like Glen Campbell, along with his family, to open their lives and share publicly what so many families are experiencing privately.

Veterans Benefits for Senior Care

Veteran’s Day is the day we set aside to appreciate those who have served in America’s wars. No matter what your political ideology, both sides of the aisle can agree that elderly veterans are entitled to our support, especially as they age.There are many benefits available to elderly veterans, but bureaucracy can make getting those benefits challenging. It helps to know to which benefits you’re entitled and how to apply for the assistance you need.

Elderly Veterans
According to the U.S. Census Bureau, there were 9.3 million veterans 65 years and older in 2013 (including America's oldest living veteran, 108-year-old Richard Overton.) The Department of Veterans Affairs (VA) is committed to providing benefits and services that help address the needs of the aging veteran population.

VA Benefits for Elderly Veterans
Elderly Veterans may be eligible for a multitude of benefits including:

A relatively unknown but extremely helpful benefit is available for senior veterans. The Aid and Attendance and Housebound Improved Pension benefit, known as A&A, can cover the costs of caregivers in the home. Our family found out too late that this can include sons and daughters who are paid to be caregivers, (but not spouses) or be used in assisted living or a nursing home. 

According to the VA, Aid and Attendance (A&A) is paid if you meet one of the conditions below:

  • You require help performing daily functions, which may include bathing, eating or dressing.
  • You are bedridden.
  • You are a patient in a nursing home.
  • Your eyesight is limited to a corrected 5/200 visual acuity or less in both eyes; or concentric contraction of the visual field to 5 degrees or less.

Learn more about these benefits on the Aid & Attendance Housebound benefits page.

How to Apply
Caregiverlist has provided a comprehensive webpage that discusses the Veteran's Aid and Attendance Benefit for Senior Care. In it, we discuss what it is, who qualifies, the dollar amount of financial requirements and benefits, and links to all necessary paperwork.

Unfortunately, LGBT veterans and their spouses do not receive the same full and equal benefits if they live in a state that doesn’t recognize same sex marriage, even though the benefits are on a federal, not state, level. At present, a petition is pending in the United States Court of Appeals for the Federal Circuit [AMPA v. MacDonald, No. 14-7121 (Fed. Cir. 2014)].

Family Caregivers
The VA also provides a website specifically designed to support VA family caregivers. It’s mission is to:

  • inform you about assistance from the VA
  • assist you in accessing all available services and benefits.
  • put you in touch with your local VA medical center family Caregiver Support Coordinator
  • lend you a sympathetic ear

The VA's Caregiver Support Line is toll-free at 1-855-260-3274

As always, Caregiverlist thanks all veteran’s for their service and a special thanks to all the caregivers who aid and assist them.

Will Maine Senior Voters Say "Keep ME Home"?

Maine is a state with many unique distinctions. In 1641, the city of York became America's first chartered town. Eastport, the most eastern city in the United States, is the first city in the country to receive the morning sun. And the lobster! You can’t think of Maine without thinking about lobster. Maine provides almost 90% of the nation’s lobster supply.

Maine is the oldest state in the nation. According to projections, one in four Mainers will be over the age of 65 by 2030. It also has some of the oldest housing stock in the nation. Expensive to heat and difficult to maintain, seniors in the state of Maine find themselves on waitlists (typically 140 names long) for affordable housing.

Maine's Democratic House speaker Mark Eves has outlined a series of policy proposals to help the state's rapidly aging population live independently longer.

The "KeepME Home" initiative is a package of bills intended to create affordable, energy-efficient senior housing communities, increase property tax credits, and provide higher pay for in-home direct care workers.

In-home care, in addition to being the more prefered type of eldercare, can be more economical than institutional care. According to Muskie School of Public Service, MaineCare (Medicaid) spent an average of $558 per month for each client who received in-home care in 2010, compared to $4,150 per month for each nursing home resident during the same year.

According to Caregiverlist’s® Nursing Home Ratings and Costs, the average daily price of a single-bed in a Maine nursing home is $266.45 per day.

The proposed $65 million bond issue would help address senior housing concerns, home care, long-term care, transportation, and a myriad of other senior service shortages.

House speaker Eves may just be courting the substantial silver-haired voter demographic in his bid for a November re-election (he can’t submit the legislation unless wins.) However, committing yourself to fight for your state’s elderly to live in their homes longer, or move to an aging-friendly community, or not having to choose between paying the heat or buying groceries is an honorable quest for someone who can affect public policy change. 

Having Medicaid supplement home care agency wages for direct in-home workers — professional caregivers and C.N.A.s —  helps draw and retain quality caregivers since they may finally eke out a living wage. With the work they do, they certainly deserve a raise, their first in a decade. A politician championing that fight is worthy of consideration.

Improving quality of life for all citizens, creating jobs, spending money more efficiently — that’s a politician’s job. As the population ages, I expect more senior issues come to the forefront, with more proactive initiatives to benefit an aging population. That’s smart politics.

Nursing Home Staff Turnover Rate Affects Care

Aging-in-Place: there’s no doubt about it—when given a choice of where to spend their waning years, the majority of Americans, nearly 90 percent, want to stay in their own homes as they grow old. However, that’s sometimes not possible. Although the Census Bureau reports the number of American nursing home residents decreased by 20% from 2000 to 2010, falling from 1.6 million to 1.3 million, the fact is that many elderly need care they cannot receive at home.

Nursing homes used to (and perhaps still do) have an attached stigma. I grew up on horror stories about neglect, theft, and all sorts of senior abuse running rampant in facilities. Grainy “hidden camera” news reports showed the horrific institutions where the elderly were left to die alone. While I am sure that those situations still unfortunately remain, I also know from first hand experience that top-notch, quality nursing homes do exist.

Modern skilled nursing homes provide safe and comprehensive care that might be difficult to receive at home. As our Elder Law Expert, Ben Neiberger asserts in Tip Nine of his 10 Elder Care Tips to Make Senior Care Easier, nursing home placement isn't death sentence.

There are many factors that go into determining what makes for a great (or even good) nursing home. Caregiverlist's® Nursing Home Star Ratings are calculated utilizing the nursing home’s overall Medicare Star Rating, percent of short-stay residents with bed sores, Certified Nursing Aide hours per resident per day, and percentage of long-term residents whose need for help with ADLs has increased.

Nursing home staff turnover is another factor that determines quality nursing home care. Direct care staff, registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (C.N.A.s) have an immediate affect on the quality of life for nursing home residents. The longer a caregiver stays on the job, the more they know their patients and are better equipped to provide the continuity of care they need. If a nursing home’s staff turnover is high, the caliber of care may suffer.

The American Health Care Association (AHCA) conducts an annual survey to collect data on staff turnover, retention, and vacancy rates in nursing homes nationwide. The 2012 survey shows the median turnover rate in skilled nursing centers for RNs was 50.0%, LPNs was 36.4%, and C.N.A.s was a whopping 51.5%. High C.N.A. turnover increases the odds of a nursing home being cited for deficiencies by 54 percent, according to a 2014 study published in February by the Journal of American Medical Directors Association.

States are beginning to take notice of nursing home staffing concerns and are putting systems in place to help retain quality workers. In Iowa, the Public Health Department has developed an online Prepare to Care course for direct care workers and is collaborating with the Caregivers Association to help nursing home workers sign up for health benefits. Ohio has instituted a Long-Term Care Quality Initiative to help raise the bar for long-term care staff.

One (of four) of AHCA’s Quality Initiative goals, whose deadline is March 2015, is to reduce turnover of long-term direct care staff by 15 percent.

Here’s hoping they achieve those lofty goals, for the sake of nursing home staff and residents alike.

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Alzheimer's Caregivers Cannot Sue, Rules California Court

Seniors who suffer Alzheimer’s can be a challenge to their professional caregivers, especially those who are able to age at home, outside of an institutional setting like a nursing home. Especially in later stages, Alzheimer’s patients and those with other dementia’s can be aggressive, angry, and violent. That can be a very difficult environment, especially for the in-home professional caregiver.

But if a senior caregiver suffers an injury at the hands of their Alzheimer’s client, they cannot sue the patient nor their family or estate for damages, according to a ruling by the California Supreme Court. Monday’s ruling came as a result of a case of a home health aide who was cut with a knife by her elderly client.

Prior to hiring her as to aid his ailing wife, a Los Angeles man informed the agency and the home health aide that his wife was prone to violent outbursts, including biting and scratching. Because of this prior knowledge, the court ruled 5-2 that it would not be appropriate to allow workers to sue their employers. 

California law already states that caregivers in nursing homes and other institutional facilities cannot sue Alzheimer’s patients who hurt them because those risks are inherent in their duties, especially since it’s well known that , although it’s not common for Alzheimer’s patients to become violent, discomfort and confusion can cause a violent flare-up.

The ruling is intended to help families keep their loved ones as home longer. If home healthcare workers were allowed to sue, families might decide it more financial sense to put seniors with memory issues into a nursing home.

Senior caregivers who are not warned of their client’s potential violent nature are precluded from future lawsuits, the court added. 

The best way a professional caregiver can learn how to deal with Alzheimer’s and dementia sufferers and help prevent latent violent outbursts is to partake in professional caregiver training. Caregiverlist® Basic Training, powered by Caregiver Training University provides the elemental training for every in-home caregiver. In addition, Caregiverlist® offers training videos especially for care techniques for those giving care to those with Alzheimer’s and other memory loss diseases.

Minnesota Leads the Way in Senior Care

Minnesota’s comprehensive senior care programs may well become the nation’s standard. In addition to scoring a first-place position in AARP’s 2014 State Long-Term Services and Supports (LTSS) Scorecard (also in 2011), Minnesota’s Department of Human Services announced in a July 1 press release a plan to award $3.5 million to providers of services to older Minnesotans, as well as for people with disabilities. The money is specifically earmarked for innovative projects designed to improve quality for home and community-based services.

The program comes on the heels of the state’s successful 2006 Performance-based Incentive Payment Program (PIPP) that provides nursing homes with additional funds for proven quality improvement projects. In 2013, an article published in the journal Health Affairs determined that PIPP facilities showed significantly increased quality after PIPP funding and continued to have higher overall quality scores than nursing homes not in the program.

In fact, Good Samaritan Society - Albert Lea (Private), which rates over 4 stars in Caregiverlist's® Nursing Home Star Ratings, used its PIPP money to implement a nursing assistant mentorship program to increase its C.N.A. retention rate with great success.
 
The Minnesota Department of Health and Human Services is hoping to see a similar outcome by funding 27 projects in 39 Minnesota counties. Recipients must put policies in place to improve quality of life or deliver better service more efficiently.

For example, Knute Nelson Home Care will receive funding to implement GrandCare technology, an interactive touchscreen used as a communication portal between the older person and family caregivers. The Lutheran Home Association will use funds to decrease staff turnover in its in-home services, and the grant will help Tealwood Senior Living to develop and apply dementia care culture change in its assisted living facilities.

“Home and community-based service providers are key to helping people with disabilities and olderadults live independently, which is what most people prefer,” Human Services Commissioner Lucinda Jesson said in a written statement. “We have found that initiatives like this promote greater, lasting quality and efficiency and a better overall experience for people being served.”

Caregiverlist salutes Minnesota for taking a proactive approach to improving the quality of care for its elderly citizens. Minnesota’s initiatives are proving to set the bar for the best senior care in the U.S.  Now if they could just do something about those winters!

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Hospital Readmission: Revolving Door for Some Seniors

Part 1: Hospital-to-Nursing Home-to-Hospital

My mother always believed that if she ever found herself in a skilled nursing facility, she would never go home again. That’s a scary prospect for a senior, especially since nursing homes have become an extension of a hospital stay, with Medicare footing the bill for the first 100 days. That stay includes rehabilitation services. Lucky for my mom, she breezed through her post-hip replacement surgery nursing home rehab and made it back home with plenty days to spare. But her fear is not unfounded; here are some startling facts:

  • 1 in 5 (20%) Medicare patients are transferred from hospital to skilled nursing facility to complete their treatment and/or rehabilitation.
  • 1 in 4 (25%)  Medicare patients will be readmitted to the hospital within the first 30 days of their nursing home stay.

Hospital readmissions from a skilled nursing facility (SNF) can be disastrous for elderly and frail individuals. Complications can arise due to hospital infections. Constant hospital readmission can be distressing for the resident and family, causing patient delirium. Some patients even find it stressful to assimilate back to the nursing home after being released from hospital yet again.

Medicare could also begin cutting reimbursements to nursing homes they deem to have high rates of “avoidable”, “preventable”, and “unnecessary” hospital readmissions.

The American Health Care Association, has introduced an initiative to reduce hospital readmisssions. There are a few programs within their Quality Initiative that are assessing and attempting to correct the phenomenon of rampant hospital readmissions.

INTERACT (Interventions to Reduce Acute Care Transfers) is a program designed to improve the early identification, assessment, documentation, and communication about changes in the status of residents in skilled nursing facilities. By implementing strategies on a daily basis, the goal of the program is to reduce transfers of nursing home residents back to hospitals.

CHATS (Communicating Health Assessments by Telephone) is a program designed to help nurses and physicians communicate the status of a patient. Good communication can lead to prevention and treatment within the SNF.

LTC Trend Tracker is a free web-based tool that enables long term care providers to access key information to benchmark and examine their ongoing quality improvement efforts.

While some hospital readmissions are inevitable, some are preventable. Indicators show that progress has been made. According to the AHCA website, as of the end of third quarter 2013,

  • AHCA members have reduced 30-day readmissions by 3.3%.
  • Over 2,000 member centers achieved a 15% reduction in their hospital readmission rates since the launch of the AHCA Quality Initiative
  • About 26,400 readmissions in AHCA member centers were prevented, saving the health care system roughly $270 million.

We at Caregiverlist® recommend the book Ending Hospital Readmissions: A Blueprint for SNFs for Skilled Nursing Facility administrators. This book shows the financial consequences of the “revolving door” and provides strategies and tools to help minimize unnecessary transfers. With education and staff involvement, not only can costs be reduced, but residents’ quality of life can be enhanced. It’s a win-win for everyone.   

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