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Facility Living: Empowering Ideas For Better Care

Posted on August 20th, 2015 by karen

by Karen Keller Capuciati

“Feeling of defeat: When you realize the place where you have moved your loved one gives less than desirable care and there is no place better to go to. I had to accept that this was as good as it gets.”

This comment was written by Martha in a recent post to In Care of Dad. She had done her due diligence, checking all the memory-care facilities in a 50-mile radius surrounding her home, eventually locating the very best place for her father. But she is frustrated because the care her father is receiving doesn’t match up with her expectations for the facility.

Martha explained that all the personalized care details that she communicated at intake — her father’s food likes and dislikes, his special skin care needs, etc. — are not being communicated to the folks who are caring for him. Furthermore, the activities provided by the facility are not engaging.

So Martha’s question is, what can be done?

I asked some professionals in the field of geriatric care for ways to help a person in Martha’s situation. Here are some of their suggestions:

Joan Blumenfeld, a geriatric care manager:
I’d like to have some help with this myself. Even “good” places often fall short of our expectations and their promises. Sometimes our expectations do not jibe with reality and that’s frustrating. So we have to make some adjustments to our expectations.

Consider the following:

Pick your battles and set priorities. Not everything is worth a confrontation.
If there is an issue of health or safety, speak to nursing or administration, not to the aides. Facilities are hierarchical. Power to fix, change or adjust comes from the top.
Visit regularly and randomly, so you can see what is really going on.
If you can afford it, a part-time private duty aide might be of service, though it may create conflict between staff and the private aide.

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In Praise Of Nursing Homes

Posted on June 11th, 2014 by karen

by Joan Blumenfeld, MS, LPC

Anthony lived alone. He was 82 and suffered from multiple medical problems. He was diabetic, his balance and gait were dangerously off-kilter, and he was clinically depressed and sometimes a little confused. He had never fully recovered from hip-replacement surgery and consequently used a walker. He had an irregular heartbeat that occasionally caused him to pass out. All of which put him at very high risk for falls.

He could no longer drive and seldom went out. He mostly sat alone slouched in a chair, isolated in his dimly lit apartment looking at television. His dining table was cluttered with bottles of medications (some out of date) that he clearly was not taking with any consistency. For a man who had been meticulously neat about his appearance, he was now often unshaven and unkempt. His clothes were frequently stained, and his full head of white hair was left uncombed. Sometimes his refrigerator contained spoiled food, and he was losing weight because of poor nutrition.

Anthony was fiercely independent, a stoic member of the “Great Generation,” used to toughing it out by himself. He had a daughter who lived nearby, but he refused help from her and most other sources as well. He did allow an aide to come in for a few hours each week to assist with bathing and to take him on errands and to market, but that help was not nearly commensurate with his actual needs.

Anthony was rapidly declining. His present was dreary and his future was bleak. And then the accident that changed the course of his life occurred: he blacked out and fell down the stairs. He was shaken and bruised, but fortunately did not break any bones.

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Looking For A Nursing Home: The Essential Search Protocol

Posted on June 6th, 2013 by karen

Santo and his granddaughter Cece, June 2011

by Karen Keller Capuciati

I often seek out my friend, Elaine, when someone I know is looking for a nursing home in our area. Elaine has done a lot of research on the topic, and I know she will have detailed answers for all the important questions that come up. Elaine also has a lot of handy tips to enhance a loved one’s nursing-home experience. For example, when I spoke with her on the phone this week, Elaine told me how she had made a special effort to get to know everyone — administrators, aides, nurses, etc. — at the nursing home where her father-in-law became a resident.

“I introduced myself and told them that Santo was my father-in-law. I made a point to ask them their first and last names, and then repeated each one back to them in order to get it right and to remember it well.”

“I find you get better care that way,” she explained. “Santo definitely got VIP attention, and that was because they saw how important he was to his family.”

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Tis The Season: A Daughter’s Journal

Posted on December 11th, 2012 by karen

by Beth Whitman

So much can happen in a year. The pace of Mom’s decline with Alzheimer’s has been striking when I look back to last Christmas. Last Christmas, Mom put on her signature London Fog coat and walked to the front door, heading to church even though it wasn’t Sunday. So we went for a drive past the church instead and looked up at the steeple.

Last Christmas, Mom was walking, even though, when we went to church, she sat in the wheelchair because it was that much easier to leave when the crowds suddenly became too much for her.

Last Christmas, Mom sang all the verses of the old familiar Christmas carols with her beautiful soprano voice, even though it was only in song that she could say more than a very simple sentence.

Last Christmas, Mom was laughing and smiling and offering food, always offering food, to anyone around her.

And although the past year seemed slow, it was also very fast. And every couple of weeks I would notice some new subtle shift in Mom’s behavior. The first time she used her cane upside down. The first time she was entranced by the red lights across the field outside her window, without recognizing them as the taillights of passing cars. The first time she carefully ripped a page out of her favorite book.

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Time To Make The Move, Part II: A Daughter’s Journal

Posted on November 29th, 2012 by karen

Arthur and Beth Whitman visiting Marianne at the Alzheimer’s Care Facility.

by Beth Whitman

For three weeks I had not been out of the house except for very short periods to shop or take care of other necessities. I had canceled or backed out of all my obligations.

Mom was failing. She couldn’t stand up any more. This is Alzheimer’s, and the part of her brain that was going now was the part that tells the body how to stand.

A friend came over to visit, and while we talked, I kept one eye on the monitor. Mom was sitting on the side of the bed and would move her upper body forward to try to push up and off the bed. She would lift herself almost into standing position. Almost, almost . . . and then, kerplunk, she’d sit right back down. Over and over and over again.

“My God,” my friend said, after observing her for a while. “It’s exhausting just watching her.”

Exhausting and heartbreaking. We were all beginning to feel just a little bit desperate. It was a relief when we heard that Glenridge, the Alzhiemer’s care facility near us, had an opening.

But I had one last moment of doubt. Was it really time? I spoke with Dad. Yes, he agreed. It was time.

So the day had come. A friend of ours who has a wheelchair-accessible van picked us up and drove us over to the Glenridge facility 10 miles away. Dad rode in another car with a friend, while Amy and I rode with Mom in the van.

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Time To Make The Move, Part I: A Daughter’s Journal

Posted on November 27th, 2012 by karen

by Beth Whitman

The day had arrived. Mom was going into the Alzheimer’s Care Facility. The van was coming at 11 am, so at 9 I had dressed Mom and transferred her into her wheelchair. She was ready to go. Amy and I wheeled her out into the morning sun in the front yard. Dad joined us, and Peter came from down the road to help out as well. We brought out drinks and snacks and had a little party while we waited for the van.

I was nervous, as was everyone else. But Mom was excited. She was outdoors, happily absorbing the smell of freshly cut grass, waving at the cars going by. It was the first time she’d been outside in almost two months. She was all dressed up. And she was ready to go.

Fact is, Mom had been ready for the past three weeks. She hadn’t been able to stand up, her feet were swollen, she hadn’t been getting dressed any more, and it had become extremely difficult to change her because I’m simply not able to manage her weight by myself. She always wants to go somewhere, but the best she can do after hours of trying is just to slide herself onto the chair next to the bed. Then she won’t move back, so she sleeps all night in the chair or she wets the chair and I have to call someone to help hoist her back into the bed by maneuvering a sheet under her. And all the while she is protesting, “No, no, no, no, no…. NO, NO, NO, NO, NO!!!!” Her protests escalate loudly until we have her settled and all the wet clothes removed.

But then, suddenly calm, she looks up at me. “Thank you,” she smiles.

The day before we were moving her to the facility in Glenridge, I sat next to her on the bed after one of these sessions, and she leaned against me quietly, waving her hand in front of her. “You know . . . you know . . . I’m so . . . I’m so . . . sorry . . . for you . . . and . . . and . . . that other one . . . .” Her hand motioned toward the other room where my father was sitting.

She was apologizing to me for being such a burden! My heart was breaking.

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Save Your Pennies!

Posted on November 15th, 2012 by karen

by Joan Blumenfeld, MS, LPC

In Connecticut, if a person can pay for nursing home care out-of-pocket for several months, or in some cases show enough assets to pay privately for a year, they can select the facility they want and reduce waiting time. If they have spent down their assets and are subsequently accepted by Medicaid, then Medicaid will select the facility, depending on wherever there is a long-term bed available. Thus, setting aside money to privately pay for nursing-home care allows people to make crucial choices they cannot otherwise make.

My 72-year-old client, Sylvia, was outliving her money. And her worst nightmare was inexorably unfolding.

Sylvia was recovering from a stroke and was about to be discharged from rehab when I was hired by the court-appointed conservator to manage her care. Sylvia desperately wanted to return to her nine-room home in one of Connecticut’s lovely shoreline suburbs, but she was ill-equipped to do so.

As a result of the stroke, her walking was impaired, though she could ambulate unsteadily with a walker. One arm and hand were weakened. Sylvia had already been experiencing some dementia, which was exacerbated by her stroke, leaving her judgment and ability to manage her money, her meals, her medications — her life in general — severely diminished. She also struggled with an unrelated life-long mental illness that resulted in hallucinations and delusions, which impaired her relationships with others and required careful medicating.

From a Geriatric Care Manager’s point of view, Sylvia was a challenge!

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A Field Trip For Mary

Posted on October 30th, 2012 by karen

by Joan Blumenfeld, MS, LPC

Eighty-nine-year-old Mary had every reason to be sullen and depressed.

She’d had a stroke that left her unable to walk, swallow properly or take care of her personal needs. She was fed a nutritious solution through a tube permanently inserted into her stomach.

Mary was widowed from a husband whom she had treasured dearly. She had no children, and her relatives were few and lived far away. She’d been a biologist in her earlier years and was still quite sharp mentally, but spoke rarely because she was self-conscious about the swallowing problem which caused her to drool. Mary had been an avid reader but now had poor vision, and this prevented her from reading anything but very large print, and even that was dauntingly difficult.

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What To Consider When Considering A Nursing Home

Posted on March 28th, 2012 by kim

by Kim Keller

Take a deep breath. The first visit is the hardest. Here are some of the things we considered, and some of the questions we asked, and more importantly, some of the things we wished we had asked.

The Basics:

Where is the nursing home located? Is it close enough for family and friends to visit regularly? Is it close enough to your parent’s doctors to make it easy to get to appointments?
Make sure the home is certified by both Medicare and Medicaid. The federal government sets more than 150 different standards of care that a nursing home must meet, and inspections are conducted annually to ensure compliance. It will also make your parent eligible for short- and long-term payment assistance.
Check the latest state inspection, which should be posted near the entrance to the home. Make sure it’s there and current. It’s important to take the time to read it all the way through.
Are the facility’s licensing and certifications current?
Make sure to get a complete pricing list. You don’t want any surprises. Find out the basic rates and specifically what’s included and what’s not.
Ask about the security and safety measures that are in place at the home.
Does the home appear to be clean and in good condition?
Do the rooms look comfortable and clean?
Does it pass the smell test?

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The Crisis Is The Solution

Posted on January 17th, 2012 by karen

by Joan Blumenfeld, MS, LPC

Lily, 92, lived alone in a huge house in Greenwich, CT, with no family nearby. Her middle-aged daughter, Sue, lived in New Mexico, and her adult grandson, Charlie, lived in Georgia. Both had been very worried for some time about Lily, who was becoming increasingly frail, but they simply could not convince her to move nearer to one of them or to accept help at home. Lily had been widowed for many years and managed perfectly well for a long time, thank you very much. She saw no need for change even though she had recently given up driving and was using a walker to get around.

Although falling was constant danger, Lily would not consider a stair lift to help her get to her bedroom on the second floor because that would spoil the décor of her home. Nonetheless, the house was getting noticeably rundown — she could not attend to the considerable upkeep required to maintain it. But she did not share financial information with her loving family because she considered money a private matter. As a result, Sue and Charlie were in the dark as to whether there were sufficient assets to take care of Lily.

One day a shocked housekeeper found Lily lying on the floor in the kitchen and called 911. Lily was rushed to the hospital where she stayed for almost a week. No one knows exactly what had happened or how long Lily lay there waiting for assistance. After numerous tests, she was diagnosed with a urinary tract infection, pneumonia, dehydration and anemia.

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