Category / Skilled Nursing

2020 Best of the Best

July 17, 2020

We are once again participating in a People’s Choice awards contest sponsored by the Observer-Reporter newspaper in Washington County – and we need your help to be nominated as the Best of the Best!

 

Please take a moment and visit www.O-Rbest.com and nominate Presbyterian SeniorCare Network in the categories of “Best Assisted Living Facility/Nursing Home,” “Best Place to Work,” and “Best Retirement Community.”

 

Voting begins TODAY -- July 16! Get YOUR NOMINATION in before the July 25th deadline.

 

Here’s how:

Visit the nomination site by clicking here (or copy and paste this link: http://o-rbest.com/contest#//). This link cannot be opened in Internet Explorer, you will need to use another browser such as Chrome or Microsoft Edge.

  1. Scroll down and click on “Health
    1. Select “Assisted Living* Facility/Nursing Home” and type in “Presbyterian SeniorCare Network” 
  2. Next, in the left hand column, select “People and Places
    1. Select “Place to Work” and type in “Presbyterian SeniorCare Network”
  3. Finally, in the left hand column, select “Home Services
    1. Select “Retirement Community” and type in “Presbyterian SeniorCare Network”

      Note – if you nominated us last year, the account you created will work for your nominations this year. Simply type in your email address. If you did not nominate us last year, you will be asked to enter your email address and to create a password.

      If there are any other categories you wish to nominate our organization in, please feel free! If Presbyterian SeniorCare Network makes it into the Top 5 nominated organizations in our categories, we’ll move on to the next round which is voting.

      Thank you for nominating – your nomination helps us to build awareness for all of the great work that happens around our Network each day!

      *Just like with our CARF accreditation in assisted living, this nomination applies to personal care; personal care communities are accepted as entries in the category.

Clever Ways Senior Housing Has Kept Residents Engaged During the Pandemic

May 26, 2020

Creative thinking from three execs in a recent webinar on the topic
By Richard Eisenberg

Part of the The Coronavirus Outbreak: What You Need to Know Special Report

When Senior Living Foresight, a website for senior living community developers and operators, asked if I’d volunteer to host its April 24 Virtual Summit panel: How Senior Housing Is Keeping Residents Engaged in the Pandemic, I agreed. But I was a little dubious about the premise.

After all, we’re well aware of the COVID-19 problems some long-term care communities, their residents and families have been dealing with the virus’ spread; the inability of adult children to see their parents and the temporary halt to congregate dining and activities. As Senior Living Foresight publisher Steve Moran wrote in a wrap-up of the summit:“COVID-19 is hell for senior living.”

But after hearing the session’s panelists describe creative ways their businesses have recalibrated for the pandemic to excite, entertain and energize residents  — sometimes, with real  challenges — I came away pleasantly surprised. Also, I’m hopeful that these new ways of engaging residents in their 60s, 70s, 80s and 90s will continue and expand when the coronavirus fades.

A quick caveat: My panelists (and many summit speakers and attendees) represented independent living and life care retirement communities. So their residents tend to be healthier than those in nursing homes.

“We decided to actually Zoom to our residents. And I’m not going to say that’s been an easy journey,”

My panelists were Sara Kyle, director of resident experience at Holiday Retirement Senior Living Communities, which house more than 30,000 people across the country; Kelly Stranburg, wellness director at Mather and Theresa Perry, corporate director of hospitality and wellness services at Acts Retirement-Life’s 26 communities (full disclosure: Acts Retirement-Life is a sponsor of Next Avenue).

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Here’s how they answered my three questions about how they’ve engaged residents during the pandemic and expect to in the future:

What forms of engagement have you implemented for your residents during COVID-19?

Kyle first talked about what she and her colleagues stopped doing. “The whole calendar activities that we typically go off of — you could basically just toss it in the trash because it wasn’t going to work anymore,” she said.

Offering virtual web chat and conferencing services, like Zoom, has become a key way to talk to, and with, residents as well as to offer them instruction and entertainment.

“We decided to actually Zoom to our residents. And I’m not going to say that’s been an easy journey,” said Stranburg. ‘You can’t force tech on people, right?”

Initially, she said, Zoom “seemed a little scary, because we were so curious how many of our residents would actually embrace this. Where were they with their comfort when it comes to technology? And what we discovered is: shame on us.”

In fact, Stranburg noted, “every single week, we see our [Zoom] adoption numbers by our residents tick up.” Now, she added, “we’re offering a variety of exercise programs, mindfulness opportunities, art lectures and poetry groups.”

Sometimes, Mather is reaching out to lecturers and performers who’d been part of its programming before COVID-19.  “We’re figuring out ways to embrace their skillsets and talents that our residents love and bringing them into this Zoom world, if you will,” said Stranburg.

Perry echoed this (Acts uses Microsoft Teams, not Zoom), adding that staffers are helping lead the way through YouTube.

“We are definitely leaping into the virtual world as well,” she said. “We have created different ways for our staff to do videos through YouTube… When you have twenty-six communities and thirty fitness staffers, the only way you’re going to connect is through videos, because of the small classes you can have.”

Perry noted that “we have reached more people through virtual fitness than we had in the past.” Some classes are live. “Now we’re taking it to the next level, using our resident portal, and we are making the fitness videos available to do anytime they want.”

One of the panel’s attendees messaged that their community’s Zoom Bingo had gone from 22 people to 100 in two weeks — 25 of the 100 were on screen, 75 played using their phones.

The Touchtown video community engagement platform came up frequently as a huge help. “Touchtown has done a fabulous job of providing us with videos that we can upload to the in-house television, which is the channel [residents] have in their homes, which is important to them,” said Perry.

Stranburg mentioned that, in certain cases, residents who’ve embraced the new technologies during the pandemic have persuaded others to join in. She called this “the power of influence.” A resident who was first resistant might say: “My friend down the hallway called me and they were like, ‘Oh you need to do this with us. It’s really fun,’” Stranburg said.

“We have to continue to explore both sides, technology as well as non-technology for our residents.”

And, she added, “I also think the influence of family has helped. ‘Cause most certainly a lot of the residents I’ve spoken with have shared that they have done FaceTime and Zoom with a family.”

For those refusing to try the technology, some communities have launched phone groups. “They’ve been having conversations, book clubs, basically anything you can think of,” said Perry.

At Mather, Stranburg said, they use “telephone topics,” where anyone can call into the general phone line at a scheduled time to talk about the prearranged topic. Coming up: “10 tips to live well.”

Also recommended: The Institute on Aging’s 24-hour, toll-free Friendship Line, for non-emergency emotional support calls (800-971-0116).

Then there are what Perry called “boredom busters” — puzzles and games her communities hand out every week that can be done in the residents’ homes. “We have to continue to explore both sides, technology as well as non-technology for our residents,” she said.

One problem, however, has been engaging residents with hearing or cognitive issues.

What are some of the best practices you’ve discovered during the pandemic?

“Well-being calls; we call it a concierge service,” said Perry. “We had not done this before. It’s all of our staff calling our independent residents on a daily basis, seven days a week. Basically, we’re just checking in to make sure they’re all right. We’re making sure they have groceries, that they have medications, that they’re communicating with their families and friends. And how we can connect them if they need any help.”

This service also helps draw residents closer to staffers. Sometimes, when a person gets the call, Perry said, “they’re actually answering the phone saying, ‘Hi, Teresa. How are you today? I’m excited that you called me again.” Added Perry: “We’d never anticipated this.”

Stranburg said: “What I’ve really taken away from [the pandemic] is the value in making sure we continue to reinforce communication expectations.”

Kyle reflected with this: “It’s interesting what you do in crisis that you think, goodness, why didn’t we do that earlier?” One of those things Holiday Retirement began is a Bridging Generations website, where volunteers across the country are matched with residents and sign up to be buddies, communicating by phone or email. The volunteers can be any age.

Also, Kyle said, “we’ve gone to hallway activities. The doors of the hallways are absolutely six feet apart, so it’s the perfect spacing. We’re finding that people who never would come down to group exercise love hallway exercise. I saw some broomball going on.”

The pandemic has also shown senior housing operators the hidden talents of some of their staff.

“I didn’t realize we had a classical opera singer,” said Perry. “She has been creating videos for us through YouTube. She explains the opera first and then she sings it. It’s gorgeous.”

When Acts delivers food to residents each night, they add notes from children to their dinner bags.

Some Acts communities have been creating a senior housing version of American Idol. “We call it Acts idol. I love that,” said Perry. After staffers compete for three weeks, residents pick the winner. Next up: “the residents will do this with their talent,” said Perry.

There have also been some successful ideas just to brighten residents’ moods — what Kyle calls “small moments of surprise and delight.”

When Acts delivers food to residents each night, Perry said, they add notes to their dinner bags. “The one thing you’ll hear from the residents is that they get excited about the dinner meal coming because there’s going to be something exciting inside,” said Perry.

Holiday Retirement puts a small flower on dinner trays, along with a note from a staffer. “We’ve had some really emotional connections between staff and residents that have come through pretty big,” said Kyle.

What do you think will be embraced and continued beyond COVID-19?

“The young lady that’s doing the opera? She says she can’t wait for the day that she can actually do it in person, in front of everybody,” said Perry. “I think that would be something we should be tapping into. And hopefully, one day, we can have an audience again and have everybody get back together.”

Detective Work Serves as Bridge to Care

December 3, 2019

by Pam Policz, nurse navigator, Washington campus

I am a detective. I get to dig deep to learn about each individual. I love learning about my patients and what they hope to get out of their stay with us.

This is my dream job. I get to spend time with our short-term rehabilitation patients to learn more about their healthcare needs and goals. It’s gratifying to become a consistent support and player in their overall care plan.

Helping individuals navigate their care options isn’t just about nursing, or the medical part of the journey. We have a whole team – everyone from dietitians to housekeepers – who play a role in the care experience. I am so honored to be part of the care team, and wouldn’t be able to do my work without my teammates, who make up the backbone of my work.

Together with my team, we build the bridge between healthcare and hospitality, ensuring that the needs of the whole person are met. And that can be anything from helping them to understand their medication to checking in with them to see when they want their room cleaned. It’s everything that we do as a team.

Building the “bridge” is the best part of my work. Once I receive a new patient, I start examining the newcomer’s history, lab results and what brought them to short-term rehab.

I live for the moments I get to spend with each patient. When someone is with us for a short stay, it is often because something has changed in their life. Maybe they’ve just had open heart surgery and need to recover, or maybe they are learning how to manage their COPD.

Regardless, it is my job to get to know them so that we can individualize their care and educate them on their condition so that they can go home feeling empowered.

It is my personal mission to help our patients recover. I help them understand what it takes to get better, show them that I am invested in their care. And when their eyes light up just knowing that they have a support system, I know I’ve done my job well and that I am a visible difference in their lives.

UPRITE Fall Prevention Education Program in our Care Communities

September 23, 2019

September 23 is Fall Prevention Awareness Day!

Learn more about our fall prevention efforts in our care communities.

Every community that serves the older population is looking for ways to reduce falls. There is no one concrete way to prevent falls. "Knowing this, we take special precaution to keep our residents as safe as possible while they are in our care, and one way we do that is through the UPRITE Fall Prevention Education Program,” says Ginny Burke, director of clinical education and quality.

The main focus on the UPRITE Fall Prevention Education is that everyone in the community, from nursing to housekeeping to maintenance, can help prevent falls. In fact, UPRITE stands for YoU help Prevent Resident Incidents with Team Effort!

“All team members who work in the neighborhoods in our skilled nursing and personal care communities know the residents just as well as a nurse does, so we have trained different disciplines to be looking, watching, and pointing out any potential fall risks,” says Ginny.

“UPRITE really focuses on the importance of being aware of what’s going on around you. If a team member is passing through a neighborhood and notices someone is trying to get up alone, they assist them or get a team member that can. If they notice a call light is on, they will pop their head in – a resident may need something that is just out of reach such as the television remote or a tissue. It’s the little things like this that can prevent bigger things from happening,” Ginny says.

In our care communities, we have a larger number of residents who are wheelchair bound, or who use walkers to get around. Because the mobility of some of our residents is limited, they often experience weakened legs and muscles due to inactivity. Ginny says, “In order to assist those residents who have limited mobility, we encourage our team members to frequently ask if there is anything the resident needs, even if they have just helped them or are just checking in. We have found that rounding consistently has improved resident satisfaction and safety.”

Interested in learning more about fall prevention? Check out this article for stats and other facts about fall prevention.

Doing your homework before joint replacement leads to a better recovery

May 30, 2019

Meeting with a physical therapist and educating yourself before you have joint replacement surgery can help you to have a quicker, less stressful recovery.

Patients who meet one-on-one with a physical therapist (PT) and educate themselves prior to knee or hip replacement surgery feel better prepared to leave the hospital and report less pain and joint stiffness during recovery compared to those who did not, according to a study by Hospital for Special Surgery (HSS). The study evaluated the effect of a face-to-face counseling session coupled with web-based education on patient satisfaction and functional outcomes.

The goal of the education session was to manage patient expectations of the surgery and recovery before undergoing the surgery—rather than after the surgery, when they might be dealing with fatigue, pain or anxiety—so they were able to better absorb and retain the information. Researchers followed 126 patients who underwent knee or hip replacement for osteoarthritis.

All patients attended a group education class before surgery—the standard of care for those scheduled for joint replacement at HSS. They were then randomized into two separate groups. In group one, 63 patients attended the one-on-one education session with a physical therapist in addition to the group class and were granted access to an informational web portal featuring videos. The control group of 63 patients attended the standard group class and received a booklet about what to expect after joint replacement—with no further education.

Using patient satisfaction and patient-reported scores to measure pain, joint stiffness and function both before and after surgery, researchers determined that the patients who attended the extra one-on-one PT counseling session indicated they were better prepared to leave the hospital after surgery and were overall more satisfied with the preoperative education they received. Almost 97 percent of these patients accessed the informational web portal, and all of them said they would recommend it for patients undergoing the same procedure.

Almost 70 percent of patients from the group that did not receive the supplemental educational session or web portal access believed they could have benefited from additional education before surgery. Patients who received one-on-one counseling also needed fewer physical therapy sessions in the hospital before discharge and met PT discharge measures sooner, including being able to get out of bed, walk with or without an assistive device and go up and down stairs independently.

The upshot of this research is that, if you are considering joint replacement surgery, ask to meet one-on-one with a physical therapist BEFORE your surgery if that is not your doctor’s standard approach. And take advantage of any and all learning materials your doctor may give you—specifically online videos and information.

The more you know, the better your recovery may be.

Should You Adopt an 80-Year-Old?

February 1, 2019

Five programs that provide assistance for struggling older adults
By Lisa Fields

Everyone of a certain age remembers Sally Struthers’ Save the Children TV commercials, encouraging viewers to improve the life of an impoverished child in a developing nation by sponsoring him or her for the price of a cup of coffee a day. Many organizations still let people sponsor underprivileged children. But if you’d rather sponsor a struggling older adult with limited resources, there are a number of programs available.

“Lots of older adults are barely making ends meet,” says Homa Rostami, board member of the California-based Adopt an Elder Foundation. “They fought in wars and are kind of forgotten. They might just need a [little] more a month.”

Programs for older adults in need can provide tangible results. If you’re hoping to make a difference in the lives of adults across the country or around the world, consider programs like these:

Unbound

This Kansas-based nonprofit can pair you with a 60-plus adult needing assistance who lives in a developing nation in Asia, Africa or Latin America, to help him or her age with dignity. Many older adults spent decades performing manual labor. Now, their health is declining, their mobility is limited and they may not have many social services available to them. Sponsors donate $36 per month, which provides older adults with food, medical care, support groups and recreational activities. Donors receive photos of, and letters from, their beneficiaries. More than half of donors are over 50.

“We often hear that our elders in the developing world and their sponsors are able to bond over similar challenges, such as illness, losing a spouse of other family member or children moving away,” says Andrew Kling, Unbound’s community outreach director. “Both the families we serve and our sponsors frequently tell us that the letters and photos they receive become cherished possessions.”

The program serves more than 31,000 elders from 18 countries and has allowed people to sponsor older adults since 1984.

Adopt an Elder

It isn’t safe for every older adult to continue living independently, but some can’t afford to move to assisted-living facilities. This nonprofit provides financial aid to older adults in Northern California, supplementing their incomes by $350 per month so they can live in facilities providing the appropriate level of care. This provides a needed financial boost since many people come up a few hundred dollars short of what they would need to stay in assisted living facilities.

Many are introduced to the program by their doctors or social workers if the professional is concerned that the older adult is no longer able to safely live alone. (The program itself isn’t involved with moving people directly into facilities.)

Donors typically provide $25 per month to the program. You won’t be paired with one individual, but you can interact with beneficiaries by distributing holiday gifts with volunteers in December. Beneficiaries appreciate the help they receive, which allows them to enter assisted-living communities for life.

“They always talk about the social engagement, having someone to talk to,” Rostami says. “They say, ‘It’s nice that I’m not alone anymore.’”

This year, the program has helped 72 older adults remain in assisted living facilities. The nonprofit has existed since 2001.

Adopt A Senior

Here, you can develop relationships with long-term-care facility residents, some of whom who have few or no visitors.

People donate $50 annually through this New Jersey-based nonprofit to provide every resident of five long-term-care facilities in New York and New Jersey with personalized birthday gifts, holiday gifts and two seasonal gifts. Volunteers visit the facilities monthly for birthday celebrations, games and conversations, which help ease residents’ loneliness. You can meet the person you’re paired with if you choose to hand-deliver gifts with volunteers during these events. Some people stay in touch by phone or letter.

“They consider us their ‘family,’ and we feel the same about them,” says Annye Cohen, Adopt A Senior’s president and co-founder. “Our motto is: Seniors should never be forgotten, and we strive to do that each and every day.”

The program serves 1,300 older adults. Since 2014, it has distributed more than 9,000 gifts.

Adopt a Native Elder

Many older adults in remote areas of the Navajo Reservation in Utah and Arizona live below the poverty line. This nonprofit provides assistance beyond what the reservation’s elder care programs can address.

Donors provide $200 annually, covering the cost of a year’s worth of food for an older adult. The program also provides Navajo elders with medicine, clothing, firewood and other essentials. Once you sign on through this Utah-based nonprofit, you’ll receive a photo of the elder you’re paired with, along with his or her contact information, and you’ll be encouraged to stay in touch.

“Friendships that last a lifetime may develop between the elders and people who adopt them,” says Linda Myers, founder and executive director of Adopt a Native Elder.

Since 1991, the program has helped more than 2,000 Navajo elders. Today, over 560 older adults are enrolled in the program.

Be a Santa To a Senior

With this program, you can deliver holiday gifts to older adults across the U.S. and Canada who are identified as at-risk for loneliness, which helps them feel like they’re a part of a meaningful community.

Those who are identified as potentially lonely by local organizations request simple necessities like blankets, gloves and personal care items. Once you receive someone’s wish list, you shop, then return with the requested gifts.

This Nebraska-based program extends to more than 200 Home Instead Senior Care franchises. Some locations organize delivery events, so if you want to meet the person whom you’ve shopped for, you may be able to connect face-to-face.

“One recipient last year said, ‘I haven’t received a gift in over 10 years, and it made me feel so good to open a gift and to just have something new,’” says Jeff Huber, president and CEO of Home Instead Senior Care. “We hope that these small moments help to alleviate feelings of loneliness, so seniors are not only happier, but healthier each holiday season.”

Since 2003, more than 700,000 older adults have received gifts, and more than 1.2 million gifts have been given through the program.

By Lisa Fields

Lisa Fields is a writer who covers psychology and health matters as they relate to the workplace. She publishes frequently in WebMD and Reader’s Digest.

Simple Steps to Keep the Deadly C. Diff Infection at Bay

January 22, 2019

The contagious bacterial infection can be more serious for older adults
By Mark Ray

When you were a child, did you worry about monsters hiding under your bed or lurking behind your closet door? It turns out one monster — clostridium difficile, or C. diff — may actually be closer at hand, at least in hospitals and nursing homes.

Transmitted via fecal matter, the C. diff bacterial infection can cause severe diarrhea, nausea, fever, dehydration, abdominal pain, kidney failure and even death. Older adults are more vulnerable to it because of naturally weaker immune systems, more likelihood of underlying health issues and more time spent in health care settings.

  1. diff is resistant to some antibiotics, but there are some shown to work against it. In serious and recurrent C. diff cases, patients may undergo a fecal transplant or surgery to remove a portion of the colon.
  2. diff spores adhere to every imaginable surface, including toilet seats, faucet handles, doorknobs, linens, bedrails, nurse call buttons, chair arms, ceiling vents and even floors. A 2017 study in the United Kingdom detected it in floor corners in 86 percent of hospital rooms that had undergone routine cleaning.

Since its spores resist standard cleaning methods and alcohol-based hand wipes, C. diff is tough to eradicate. “We know those spores can last nine months or more in a room,” says Dr. Kate Mullane, an infectious disease specialist at The University of Chicago Medicine. “It takes a high concentration of bleach to kill the spores: a cup of bleach in a gallon of water.”

And killing the spores is critically important because C. diff itself is a killer. The most common microbial cause of health care-associated infections in the United States today, it causes nearly half a million infections and 15,000 deaths annually — almost as many deaths as drunk driving and HIV/AIDS combined,  according to the U.S. Centers for Disease Control and Prevention (CDC). Eighty percent of C. diff deaths occur among people 65 and older, and one in 11 patients in that age group dies within 30 days of diagnosis.

A two-pronged approach can keep this microscopic, but deadly killer, at bay. Prong one is antibiotic stewardship; prong two is infection control.

Antibiotic Stewardship

You’ve doubtless heard the world uses far too many antibiotics, wasting money and contributing to the growing problem of antimicrobial resistance. The Pew Charitable Trusts reported that 30 percent of outpatient antibiotic prescriptions in the U.S. are unnecessary (antibiotics prescribed for a viral infection, for example).

Doctors are getting more judicious in their use of antibiotics, but Mullane says patients should still talk with their doctors about the drugs they’re prescribing. If you can avoid antibiotics, or at least broad-spectrum antibiotics, you will be less vulnerable to C. diff. This is because, along with the bad bacteria the drugs are after, antibiotics also kill much of the good bacteria in our intestines. This leaves C. diff an opportunity to overwhelm the gut and cause illness.

  1. Diff Infection Control

Given C. diff’s persistence in health care environments, it’s also important to prevent transmission between patients, health care workers and visitors — including people who aren’t symptomatic.

“We know at any one time, about 5 percent of the population is colonized with C. diff,” Mullane says. “They may not be sick with it, but they’re at least carrying it.”

The easiest way to stop transmission is with proper handwashing, according to Anna Barker., a researcher in the medical scientist training program at the University of Wisconsin-Madison. “Even with hospital-grade hand sanitizer, which in many cases is pretty similar to what you would buy out in the community, you do still need to use soap and water,” she says.

“It’s not only the soap and water (that gets rid of the germs), it’s the friction and having your hands under the tap water, which you just don’t get when you use (hand sanitizer) gel,” Barker says. A good rule of thumb to make sure you get rid of the germs: Wash your hands for as long as it takes to sing Happy Birthday to You.

But hand hygiene is just the beginning. In the April 2018 issue of the journal Clinical Infectious Diseases, Barker and two colleagues reported their research on the effectiveness of nine discrete C. diff hospital interventions, including everything from patient hand hygiene to terminal cleaning (deep cleaning of a room after a patient is discharged).

Using computer models, Barker and her colleagues found that daily room cleaning with a sporicidal cleaner plus screening for C. diff at the time of admission reduces hospital-associated infections by roughly 82 percent and asymptomatic colonization by about 91 percent.

“When hospitals try to combat their C. diff rates, they’ll end up doing lots of things at once,” Barker says. “This paper showed you can get a considerable reduction in C. diff with only those two interventions.”

What Patients Can Do

While patients don’t have much control over infection-control practices in a hospital or clinic, they can take two concrete actions.

The first is to ask health care providers if they’ve remembered to wash their hands.

“That’s easier said than done given everything we know about power dynamics and the patient-doctor relationship, but I think that really has a potential to make a big impact,” Barker says.

The other action, perhaps surprisingly, is to reduce the clutter in hospital patient rooms.

“One of the things we hear from the cleaning staff is that it’s very difficult to clean a patient’s room effectively if there are newspapers everywhere or books or food or other items throughout the room,” Barker says. “They can’t, at least at our institution, move the patient’s things for them.”

While decluttering your hospital room may not be quite as simple as switching on the lights to banish an under-bed monster, it can go a long way toward keeping you safe from C. diff.

Mark Ray is a freelance writer who has written for Scouting, Eagles’ Call, Presbyterians Today, Kentucky Homes & Gardens and other publications. He has also written, edited and/or contributed to a dozen books for the Boy Scouts and the Presbyterian and United Methodist churches.

18 Questions to Ask Any Nursing Home

January 14, 2019

How to find a place that wants to be a real home
By Denise Logeland

Part of the Transforming Life as We Age Special Report

What makes a nursing home a good place for you or your parents? While “good” can mean a lot of things, it should include qualities like dignity and self-determination for the people who live there. The Pioneer Network offers tips on how to check for those qualities.

Formed 20 years ago, the nonprofit Pioneer Network is made up of professionals who work in long-term care, people who live in long-term care and families who advocate for them. The network, active nationally and through coalitions in 36 states, belongs to a broad-based movement in long-term care that is sometimes called simply “culture change.” That is a movement away from generic, system-based care and toward more individual, person-directed care. With culture change, residents have a large voice in the care they get and have as many of the freedoms they had in their earlier homes as possible.

You can find out if a nursing home is guided by the principles of culture change by asking specific questions when you visit to take a tour. A few examples:

  • Can residents wake up when they want to in the morning?
  • How do you get to know the people who live here?
  • How do you build a sense of community and give those who live here a voice in how things are done?
  • What is the turnover rate for the direct care workers on your staff?

There are 18 questions in all to ask at nursing homes, and a similar set of 16 to ask when looking at assisted living facilities. You can see the questions and the answers to listen for on the Pioneer Network website, where they are also available as downloads.

Denise Logeland is a writer and editor in Minneapolis who has covered business, health and health care. She is the author of Next Avenue's ebook, 10 Things Every Family Should Know: Aging With Dignity and Independence.

One Doctor’s Plea: Consider Palliative Care

January 2, 2019

An oncologist grapples with letting patients suffer when there’s an alternative

By Grace Birnstengel

For some people facing a terminal illness or the end of life, transitioning to palliative care (care given to improve quality of life for patients with life-threatening diseases) can signify quitting. They see it as surrendering to what’s ailing them and giving up the fight. But Dr. Isaac Chan, a medical oncology fellow at Johns Hopkins Hospital, wishes people would look at palliative care differently. It just might provide the blessings of time and peace, he believes.

Chan understands that holding onto every ounce of life is an expected reaction, even if it means enduring more pain and suffering for little or no payoff. In an essay published in The Washington Post, he writes about the difficulty for patients in approaching the decision to continue with treatment or pursue palliative care. He sees that struggle all the time at the hospital.

“I am watching a 68-year-old man fall apart,” Chan writes. “He has been through five different types of chemotherapies, yet his kidney cancer continues to grow and metastasize, spreading to different organs. He now sits hunched in his wheelchair. With his worsening diarrhea, and sores in his mouth, he no longer eats with pleasure. Sleeping a few hours without pain has become a luxury.”

In the patient’s eyes, chemotherapy will help him live longer, and his goal is beating the cancer. When a doctor like Chan knows that’s not realistic, he’s put in a tough spot.

Palliative Care Can Grant Time and Peace

In his empathetic and thought-provoking essay, Chan grapples with balancing having frank conversations with patients, explaining the benefits of palliative care in their situations, with the top priority: respecting a patient’s wishes.

He explains to one patient that concentrating on reducing symptoms instead of treating his cancer would provide relief. And, he adds, studies show he could live longer with palliative care instead of having more chemotherapy.

As we’ve pointed out in previous Next Avenue reporting, palliative care has proven benefits of lowered stress and depression in patients and caregivers; reduced pain and better control of other symptoms and better clinical outcomes.

Though palliative care might seem like the obvious route to doctors like Chan, they have to meet patients where they’re at.

What This Doctor Has Learned About Palliative Care

“If the patients are not ready [for palliative care], instead of feeling relief, they may experience this advice as abandonment,” Chan writes.

Chan has learned that no matter what statistics or studies say about the clear benefits of palliative care in the cases of the terminal illnesses he treats every day, that’s not always going to be appealing or meaningful to patients. You can’t always apply logic or science to things as all-consuming or deep as the end of your life.

“Sometimes what our patients need most is just more time: time to accept the terminal diagnosis and time to grieve and hopefully find peace,” notes Chan.

Though the doctor’s perspective is not the one that truly matters at the end of someone’s life, it’s interesting to hear from Chan about how he views these challenging issues where doctors are assessing not only physical needs, but emotional and spiritual ones as well.

“The biggest lesson I have learned is that our role is to support our patients so that they can have they dignity to make these difficult choices and feel empowered to make their own paths, no matter how frightening the decision may be,” Chan says.

By Grace Birnstengel

Grace Birnstengel is an editor at Next Avenue. Her work has appeared in Minneapolis-St. Paul's alt-weekly City Pages, the St. Paul Pioneer Press, Stereogum.com, The Riveter Magazine, VICE's Live Nation TV, 89.3 The Current and more. She most recently worked as an editor for a B2B magazine in New York City. She holds a degree in journalism and gender, women and sexuality studies from the University of Minnesota–Twin Cities where she was the editor-in-chief of the student magazine, The Wake. Reach her by email at gbirnstengel@nextavenue.org.

What Hospice Does and Doesn’t Do

December 11, 2018

Know what's offered so you can make informed decisions ahead of time
By John F. Wasik

Part of the Living to the End of Life Special Report

(Editor’s note: This story is part of a special report for The John A. Hartford Foundation.)

More than once in my life, I wish I knew more about hospice care, which is a sustained focus on quality-of-life near the end of a journey. A deeper working knowledge would have made the closing days of several loved ones’ lives more comfortable.

Yet no doctor or adviser even suggested hospice care to my family as we grappled with the end stages of cancer. It was only later that I discovered how much hospice care has to offer — and how millions of families can benefit from its humane mode of care.

What Hospice Can Do

Generally, hospice is requested by a doctor who gives a prognosis of six months or less. It’s usually covered by health insurance plans and Medicare.  Some life insurance policies are even offering riders that provide “accelerated benefits” for the terminally ill. What surprised me, sadly after the fact, was how much hospice had to offer.

Keep in mind that hospice is a subset of palliative care, which can be provided to any patient, regardless of whether he or she is diagnosed with a terminal illness. This maximizes the patient’s overall comfort, reduces chronic pain and focuses on bolstering quality of life. Think dignity and humane decisions instead of dehumanizing technology and relentless treatment.

When a doctor “certifies” for hospice care, that triggers a range of services that will be covered by Medicare Part A. In addition to medical and nursing services, also provided are social work, grief counseling and even physical and occupational therapy. The emphasis is on accommodating the entire family and enhancing the patient’s comfort. Here’s how the Medicare hospice care benefit works if you need, and qualify for, it:

  • Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill; that is, you’re expected to live six months or fewer. Note: Only your hospice doctor and your regular doctor can certify that you’re terminally ill and have a life expectancy of six months or fewer.
  • You accept palliative care for comfort instead of conventional care to cure your illness.
  • You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.
  • After six months, you may continue to receive hospice care as long as the hospice medical director or hospice doctor re-certifies — at a face-to-face meeting — that you’re terminally ill.

Medicare is actually fairly generous on what it covers, paying for “any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness and related conditions, as recommended by your hospice team.”

What Hospice Doesn’t Do

Most hospice care can be offered at home or in a non-medical facility, which includes long-term care settings such as assisted living and memory care. Hospice, however, doesn’t cover room and board fees at senior communities.

Instead of providing endless surgeries and treatments, hospice focuses exclusively on the comfort of the patient. The palliative portion of the care may offer an array of pain medications while not treating the cause of the terminal illness.

If a patient is suffering from cancer, for example, he or she would be offered extensive pain-killing drugs, but not radiation or chemotherapy. Frequent trips to hospital emergency rooms are generally avoided.

Medicare also specifies what’s not covered by hospice care. Unless a facility is approved to provide this kind of care, you may not receive reimbursement. You can’t assume that every institution is qualified. Here are some additional requirements, according to the National Hospice and Palliative Care Organization:

  • In addition to federal rules, there are state licensing requirements that must be met by hospice programs for them to deliver care.
  • Hospices must periodically undergo inspection to be sure they are meeting regulatory standards to maintain their license to operate and the certification that permits Medicare reimbursement.
  • A growing number of hospice programs have their own hospice facilities or have arrangements with other facilities. Some patients may require a different place to live during this phase of their life when they need extra care. However, care in these settings is not covered under the Medicare or Medicaid Hospice Benefit. It is best to find out — well before hospice may be needed — if insurance or any other payer covers this type of care or if patients or families will be responsible for payment.

Plan for Hospice When You’re Healthy

One of the most granite-like barriers for families considering hospice care as an option is that they’ve seemingly admitted defeat in trying to battle terminal illnesses such as cancer.

“People think that end-of-life decisions are things that only doctors should deal with,” says Dr. Carolyn McClanahan of Jacksonville, Fla. “We need to change the conversation.”

Yet reframing the end-of-life decision, McClanahan says, should concentrate on life quality, which should be first defined by patients and families, not medical institutions.

What’s the best way to approach the hospice decision? Make it a family conversation. Consult with doctors and other trusted advisers such as financial planners and estate-planning lawyers. Have your loved one and family talk it through with hospice or palliative care professionals. You’ll also need to get wills, trusts, powers of attorney and beneficiary designations for assets and insurance in order.

While making the decision to enter into hospice care is perhaps one of the most agonizing decisions a family can make, many wait too long to seek this specialized care. The average length of stay in hospice care is less than 70 days, according to the National Hospice and Palliative Care Organization. Only 12 percent of people in hospice remain in hospice past 180 days.

“Plan when you’re healthy,” advises McClanahan.

At the very least, educate your family on the benefits of hospice and palliative care. Although it won’t make end-of-life decisions any easier, it may ease the anguish when the time comes.

By John F. Wasik

John Wasik is the author of Lightning Strikes: Timeless Lessons in Creativity from the Life and Work of Nikolas Tesla (Sterling, 2016) and 16 other books.

 
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