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Can A Caregiver Be Too Devoted?

May 10, 2019

How to know when caregiving crosses the line to self-neglect
By Randi Mazzella

Stacey G.’s (she asked that we use her last name initial only due to the personal details in the story) parents had a storybook romance. Married for over 60 years, her father still called her mother “sweetheart.”

Stacey’s mother developed dementia. As it progressed, her father tried for several months to take care of his wife at home with the help of health care aides. But then her behavior become explosive and irrational. Stacey, who lives in Voorhees, N.J., was faced with the painful decision of placing her mother in a nursing home.

“It was an extremely difficult decision and I still struggle with it, even though I am certain it was the right decision for everyone — especially my dad,” she says.

Her father’s devotion did not waver. He visited his wife twice daily, with just brief midday respites. “He would call at the same time every day to give me an update me on how my mother was doing,” Stacey says. “He rarely deviated from his routine.”

It didn’t matter that his wife’s dementia made it impossible for her to know if he was there or not. He continued to visit his sweetheart daily for more than three years, until she passed away.

While Stacey found her father’s devotion to her mother admirable, it was also concerning. Her father was in his mid-80s and had given up doing any of his traditional leisure activities, including playing poker and twice-per-week trips to Atlantic City with friends.

“He worried about my mother constantly,” Stacey says. “I was sad for my mother, but I didn’t worry because I knew she was being well cared for by the staff and by him. But I worried about my father. He wasn’t taking care of himself, he was driving exhausted and he didn’t spend time with anyone but my mother.”

Is it possible to be too devoted as a caregiver? And if so, how can a loved one’s help caregivers understand that they need to think about themselves?

The Physical Demands of Caregiving

“Can a vehicle continue to run without regular fill-ups and service? No!” says Rick Lauber, and author of the book, The Successful Caregiver’s Guide. Lauber, who lives in Alberta, Canada, helped care for his parents until they passed away. “Caregivers are no different. Caregivers helping and supporting aging loved ones routinely give too much of themselves while overlooking their own health and wellness.”

Clinical gerontologist David J. Demko adds, “Caregivers tend to get reduced sleep, including much-needed REM sleep. They have muscular aches from the physical demands of caregiving and neglect their personal nutritional needs.”

Stacey’s father eventually wound up hospitalized for five days with pneumonia. “The thing that really troubled me was that he still went to the care facility disregarding the fact that he was starting to feel pretty sick,” she says. “But his needs were unimportant to him.”

Some care partners actually become ill and die before the person they are caring for, says Rachael Wonderlin, a gerontologist and founder of a consulting business called Dementia By Day in Pittsburgh. “And it’s no wonder — they are highly stressed and consumed in their newfound role,” she says.

Strain On Relationships

Caregivers have decreased time for social outings and become emotionally drained. Even when they do take a break, they experience guilt. “When my father came to my house for holidays, he tried to enjoy himself, but I could tell he felt guilty that my mother was alone,” Stacey says. “He seemed lost and sad. He was much happier when I would bring my kids to him at the nursing home, but this was a hard environment for my young son. It was stressful for me to balance my father’s needs with my son’s.”

What Stacey’s father experienced is common, says Katie Ziskind, a family therapist at Wisdom Within Counseling in Niantic, Conn. “The (caregiver) often can develop codependency and depression as a result of caring so much for their loved one, even with the best intentions,” she says.

Stacey says her father is a very warm and kind man, but when he was away from the nursing home, he was usually distracted and anxious due to worrying so much about her mother.

“When we spoke, he would tell the same stories over and over again and was not really focusing on what was going on with me, my kids,” she says. It wasn’t until after her mother died that her father said, “I just realized, you lost your mother.”

How to Help a Caregiver

“Self-care is absolutely essential to be a good (caregiver) because you can’t give from an empty bucket,” Ziskind says. Explaining this to devoted caregivers can be difficult, but try stressing that if they don’t care for themselves, they won’t be as helpful to their loved one or to the other people in their lives who love and worry about them.

Yoga, meditation, writing in a journal or going for a daily walk can all help to replenish a caregiver’s energy and mental well-being.

Socialization for caregivers is also crucial. Encourage them to spend time with friends, connect with family or attend support groups with other caregivers.

Looking back, Stacey says her one regret is that she didn’t insist her mother be placed in a facility closer to her home, instead of over an hour away. It was difficult for her to visit her mother more than once a week while balancing work and childcare responsibilities.

“My father didn’t have a lot of support in the area. If she were closer to me, I could have visited her more often and I could have tag-teamed with my dad instead of him going twice a day,” Stacey says. “He also could have spent more time with his grandchildren and me without feeling guilty that my mother was alone.”

During her mother’s illness, Stacey feared that her father would die from the pace and intensity of his devotion to her mother. She says her father was a beautiful role model to her and to her kids. She is thankful that he now appears to be doing more things for himself.

“He has no regrets about the time he spent taking care of my mother. Even though he is sad that she is gone, he is also calmer and less anxious knowing she is at peace. He is taking better care of himself and is back to his twice a week Atlantic City trips. We still talk daily about my mother, but about other things too,” she says.

By Randi Mazzella

Randi Mazzella is a freelance writer specializing in a wide range of topics from parenting to pop culture to life after 50. She is a mother of three and lives in New Jersey with her husband and teenage son.  Read more of her work on randimazzella.com. 

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Take a Break

May 10, 2019

Are you a full-time caregiver for someone with Alzheimer’s or dementia? A little breather may be just what you need.

Alzheimer's disease is life-changing for both those who are diagnosed and those close to them. Having a helping hand when you need it is key to keeping yourself, and your loved one living with dementia, healthy and happy.

When you need a break, consider adult day services.Not only is it good for you, but it’s good for your loved one. Adult Day Services offer people living with Alzheimer's and other dementias the opportunity to be social and to participate in activities in a safe environment.

Adult Day Services may be for you if:

  • You are a full-time caregiver: Adult Day Services can provide a much needed break. While your loved one is at adult day, you'll have time to rest, run errands or finish other tasks.
  • You work during the day: Adult Day Services can help you to balance a job with caregiving duties.
  • You want a safe, caring environment for your loved one:  Adult Day Service is a chance for your loved one to share time with their peers. It provides a chance for them to be social and to participate in engaging activities such as music and exercise programs, as well as fun outings. 

Did you know that Woodside Place of Presbyterian SeniorCare Network offers Adult Day Services at its campuses in Oakmont (412-828-5600) and Manchester Commons (814-838-9191)? We are here to help!

HELP WANTED: Must Have a Passion for Serving Seniors

May 9, 2019

Long-term care is a clinically rich career for nurses

Long-term care, isn’t that boring?” Well, imagine this. It is 3 am, and the usually quiet night shift suddenly springs an emergency on you. As the nurse, you may be challenged to make decisions that provide the best possible outcome for all of those involved. If that sounds more like the ER than long-term care, you’d be wrong.

What makes nursing in long-term care so clinically rich? We sat down with Kristin Henderson, senior director of clinical services for Presbyterian SeniorCare Network, to ask the important questions about a nursing career in long-term care.

Q: Is long-term care different than say a hospital environment?

A: If you are expecting the overhead paging system directing you to a “code” or sirens and medical professionals running down the hall with a crash cart, then yes. But in terms of the care provided, we are pretty competitive. The landscape of hospital care has changed. Before, a patient would stay in the hospital for a week or more and get most of the care they needed while in the hospital. But now, that is totally different. A patient is in the hospital for one to three days and then they discharge to a skilled nursing community like ours for short-term care. So the care that was once provided at the hospital is now provided in a long-term care setting, specifically in a rehabilitation setting. The majority of the time, nurses in long-term care are utilizing the same skills as those in the hospital. The bottom line is the skill set required to be a successful long-term care nurse is very specialized and utilizes a hands-on approach.

I think one of the most obvious differences in a long-term care environment is the relationship that our nurses build with their residents and their families. That relationship is key to their care plan, not only for the medical needs, but for the care of the whole person. My nursing teams tell me that this is a rewarding environment because they are able to see the resident through their entire plan of care.

Q: What types of nursing jobs are available in long-term care?

A: We hire at a variety of levels. Entry level team members are Certified Nurse's Aides (CNA) and they provide the direct day-to-day care. At mid-level, we hire Licensed Practical Nurses (LPN) and Registered Nurses (RN). We also hire experienced nurses directly into manager and supervisor roles. But even RNs and LPNs without manager or supervisor experience have room for career growth. We have had great success training and growing our nurses into team lead positions, supervisor positions, as well as nurse educator and nurse navigator positions. We really can accommodate a variety of skill sets and experience levels!

Q: You’ve been with us for 15 years. What characteristics do you see amongst the nurses across our Network?

A: All nurses get into the field because they want to care for others. Our nursing teams are passionate about caring for others, it is ingrained in their DNA. And they do this every day, even when the day is emotionally or physically demanding, the caring never stops.

Our nurses are critical thinkers. They spend a lot of time with our physician groups and absorb a great deal of knowledge that they can use when a doctor is not onsite. They are comfortable offering recommendations to the doctors since they know their residents so well. They do this because they have a strong desire to quickly and accurately have proper diagnoses and treatments developed for our residents; after all, that’s what our residents deserve.

Q: What’s your favorite memory of your 15 year tenure?

A: Let me take you back to my first day at Presbyterian SeniorCare Network working as a staff nurse. I was given a stack of lab results to interpret and then report any abnormal results back to my supervisor. I had previously worked in a hospital setting where a doctor was always there and someone else read the lab results, I had not used those skills in years! What I quickly learned is that nurses in long-term care are challenged in new ways each day to pull all of those skills they learned in nursing school from the backs of their brains. It’s a really exciting environment if you like using critical thinking skills and nursing judgment. To meet these needs, we are committed to providing relevant training to refresh skills.

Q: Is a career in long-term care for anyone?

A: No, just like a career in a hospital setting or doctor’s office is not for everyone. It’s all about knowing your career aspirations and finding the right fit for you.

Q: What do we do to ensure that those we are recruiting are a good fit?

A: We want consistency of care for our residents and want to avoid as much team member turnover as possible because that impedes on that continuity of care, so we work hard in the interview process to ensure that our candidates understand the environment, and also feel that we fit into their own unique career goals. We offer tours of our campuses to prospective team members, as well as, when possible, the opportunity to shadow a current nurse and interact with our current team members.

Our recruitment team has a great motto: Happy caregivers = happy residents/patients = positive outcomes. I believe in that motto.

Q: The unemployment rate is low right now, making the job market very competitive and nursing jobs are always in demand. What are we doing to reach out to prospective nurses at every level?

A: We know that recruiting nurses is not a one-stop-shop and that there are multiple things we need to do to engage prospective team members. Our clinical recruiters are out and about, visiting nursing schools and participating in community events to share our open positions, as well as answering any questions about working in long-term care. We also know that there is a benefit to talking with our current high school- and college-aged employees. They may already know our organization through an entry level position in housekeeping or dining services, so it’s important for us to educate them about other career paths that are available in our nursing departments. We know that not everyone wants to go to college, so we offer guidance on the positions available within our organization that do not require a degree, such as a CNA. In 2018, our recruiters Network-wide made more than 300 touchpoints with the public, so we are out there!

Q: Anything you’d like to say to a prospective nurse looking to work in long-term care?

A: I could go on for hours about long-term care nursing careers! For prospective nurses, I’d say that each day you come to work, you get to use not only your clinical judgment, but what’s in your heart. We have a culture of caring, not only for our residents, but for our coworkers. It is truly a privilege to care for our residents, and if you are looking for a place to work where you can make a profound difference, we’re the place for you.

Explore Careers: CareersAtSrCare.org

We love our nurses!

May 8, 2019

Nursing at Presbyterian SeniorCare Network

Your Path. Your Expertise. Your Impact.

In honor of National Nurses Week, we are proud to feature one of our many superstar nurses! Check out why Stefany loves her work!


“I have worked at Presbyterian SeniorCare Network for 14 years and I love my position as an RN. I have a flexible schedule that allows for a healthy work/life balance with good pay and benefits. 

I love being a part of a nonprofit organization that has strong faith-based values and truly places the residents first. I value the personal relationships I have been able to form with our residents and their families over the years. My residents and coworkers have become my second family. 

I honestly could not see myself working in any other field or community. I am truly blessed.”

Stefany Renner, RN
Presbyterian SeniorCare Network, Washington Campus


Nursing at Presbyterian SeniorCare Network: A job isn’t one size fits all—it should be unique to the person filling the role! Here, our person-centered approach rings true for our residents, patients and team members alike. Find more than just a job. Build lasting relationships while doing meaningful work in a home-like setting. It’s your path. Be Uniquely YOU at Presbyterian SeniorCare Network.

Apply now! Click here to browse the RN and LPN open positions around our Network.

When’s the best time to start thinking about long-term care?

May 1, 2019

You may or may not need long-term care. But an unexpected illness or injury can change your needs—sometimes suddenly. The best time to think about long-term care is before you need it.

Long-term care is a range of services and supports older adults may need to meet their personal care requirements. Most long-term care is not medical care but rather assistance with activities of daily living (ADLs), such as bathing, dressing, eating and bathroom tasks and supportive services, such as taking medication, doing housework, shopping and preparing and cleaning up after meals. 

The best time to start planning for the possibility of long-term care is before you need it, and no time is better than the present. Consider this: According to the U.S. Department of Health and Human Services, almost 10 million people currently need some form of long-term care in our country. Of this population, 63 percent are over the age of 65 and 37 percent are under 65. Although one-third of today’s 65-year-olds may never need long-term care, one-fifth of them will need it for longer than five years—and women, on average, need care longer than men.

But although most seniors will need long-term care, many have not yet thought about what they may need and fewer still have a good understanding of how they’ll pay for it.  Consumer surveys show misconceptions on what Medicare will pay for. Fully 25 percent of people said they’d let Medicare pay for their long-term care—a major problem since, in the vast majority of cases, Medicare does not pay for long-term care costs.

The website longtermcare.gov explains that Medicare only pays for long-term care if you need skilled nursing or rehabilitation in a nursing home, for a maximum of 100 days (although the average Medicare-covered stay is 22 days) or at home if you are also receiving skilled home health or other skilled in-home services, and usually only for a short period of time.

Medicare does not pay for non-skilled assistance with ADLs, which make up the majority of long-term care services; so if you do not have a private insurance program in addition to Medicare, you will have bear the expense of these services yourself.

Medicaid, the nation’s health program for the low-income and disabled, will pay for long-term care but it requires seniors to spend nearly all of their assets beforehand. These days, nearly half of all long-term care in the United States is paid for by Medicaid—a huge burden that is only going to grow as millions of baby boomers reach their 80s.

Clearly, thinking ahead about the type of long-term care you might need and putting a plan in place early on is important for both you and your family members. And people with Alzheimer’s disease or other cognitive impairment should begin their planning as soon as possible.

Planning for the possibility of long-term care gives you time to learn about the services available in your community and what they cost. And it helps you to consider all your options so you can make informed decisions on such things as housing, medical care, legal documentation and finances while you are still able.

One innovative long-term care planning option offered by Presbyterian SeniorCare is called Longwood at Home.™  Licensed by the PA Department of Insurance, Longwood at Home offers services for healthy older adults that help them stay in their own homes and age in place.   

Longwood at Home provides adults ages 60 and up the opportunity for a lifetime of continuing care without giving up the comfort of—or investment in—their homes. Members are offered care coordination, wellness programs, medical transportation, social events and asset protection, as well as the assurance that a total package of long-term care services—from private duty to nursing facility care—will be available to them if needed, at a fraction of the cost of paying for the services privately.

With Longwood at Home, seniors get the peace-of-mind of knowing that the services and care they may need will be there when they need it, while remaining at home for as long as possible.

For more information, visit www.longwoodathome.org.

How to Job Hunt if You Haven’t in Years

April 30, 2019

The keys, according to this expert, are people skills and patience
By Kerry Hannon

People looking for jobs in their 50s or 60s who haven’t been job hunters in years — maybe decades — often tell me they find the process frustrating. They apply for posted jobs and never hear back — the “black hole” syndrome. Steve Dalton, program director for daytime career services at Duke University’s Fuqua School of Business and author of The 2-Hour Job Search: Using Technology to Get The Right Job Faster sympathizes, but also has important advice: You need to know how to look for work in this age of virtual job search.

“Sadly, every year I see dozens of very smart people voluntarily subject themselves to situations with high competition and low odds of success (online job postings, most commonly),” Dalton writes. “Submitting resumés online lets job seekers feel like they’re looking for a job, but it’s like watching someone beating up a vending machine completely unwilling to accept that it just ate his or her money.”

The 2-Hour Job Search

After reading The 2-Hour Job Search, I interviewed Dalton to hear more; below you’ll see my eight favorite tips he offered.

Now about that “2-hour” notion: In reality, the two hours are not how long it will actually take you to get hired, but the time it will take to winnow down your list of 40 potential employers and finding networking connections who can be your insider booster or advocate. That’s a person who can bring your resumé to the right person, make an introduction and help you get an interview.

“In practice, you start with forty employers that you rank in terms of priority, but no job seeker I have worked with who has followed the two-hour search has ever gotten past fifteen without getting hired,” Dalton says.

The Power of Boosters for a Job Hunt

Boosters are the people who love their current job and take an interest in helping others advance their careers, according to Dalton. “It essentially boils down to purposeful relationship building,” he says. “Even if you are not the perfect fit for the job, but you can get someone to advocate for you, you can jump ahead of people who might have that fit, but don’t have a champion.”

Dalton’s people-centric approach hits me as particularly wise with the news this week that the Federal Trade Commission (FTC) charged two companies with bilking hundreds of thousands of dollars annually from consumers for sham job placement and resumé repair services. To get an interview, job seekers had to pay upfront fees of $1,200 to $2,500. In many instances, the defendants pocketed consumers’ money knowing the job opportunities were fake, according to the FTC. A federal court halted the scheme and froze the defendants’ assets at the FTC’s request.

8 Tips for a Job Hunt After 50

Now, as promised, here are my favorite eight job-seeking tips from Dalton. They can be summarized in three words: people skills and patience:

  1. Don’t be embarrassed. “There’s a lot of needless embarrassment and shame associated with job searching mid- or late-career, when nobody at that age has been rigorously taught how to job search, particularly in the online job posting era. Don’t be ashamed. Embrace this as a new skill set — turning strangers into advocates on demand,” says Dalton.
  2. Get contacts at your prospective employers to talk about why they are so good at their work. “Set up an informational interview. This can take some persistence. Find people whose work you admire, preferably at companies where you want to work, and reach out by phone or in person to learn about their jobs,” says Dalton.
  3. During these conversations, resist the temptation to sell yourself. “It is the sell-yourself mentality that sends the conversations off the rails. Focus on really learning. When you embrace the humbling process of no longer selling yourself and instead dedicate yourself to listening, you will get so far, so quickly,” says Dalton.
  4. Hone your listening skills. “When I give my talks, I show the audience a GIF of dog cuddling up to its owner because dogs are experts at this. When they look at their owner, there is not another person in that dog’s world. They block everyone out. They are singularly focused. We don’t love dogs because they are good conversationalists. We love them because we are the only person in their world when they look at us. That is the key to listening well,” says Dalton.
  5. Be likeable. “The point is not to tell them why you are so great. The point is to let them know that they have been heard. That you are open to learning and are passionate about learning about their employer or the work they do. You are perceived to be likeable if you are listening. It’s how you build a booster relationship. It is counterintuitive concept,” says Dalton.
  6. Take advantage of LinkedIn. “I don’t endorse a lot of career -related websites, but I do consider LinkedIn a must. Even better, it’s free [if you don’t sign up for the premium version]. A LinkedIn People Search helps find contacts at a target employer. It’s six degrees of separation. You supply the name of employer and it shows the closest connection you have to someone who works there. If it’s someone who shares an alumni connection with you, even better. LinkedIn Groups are also helpful to find connections, or people to reach out to with a short, fewer than one-hundred words, email that has no mention of a job, just your connection to him or her and expressing an interest in learning about a topic,” says Dalton.
  7. Use job boards for research. “Online job postings aren’t good for getting you a job, but they’re great information about what sorts of jobs are available in a particular city. I recommend using Indeed for meta information; what employers are looking for in your city, even different jobs than what you’re looking for. I always figure the specific jobs listed are already spoken for. The chance of a random applicant online going through and getting that job is a longshot. Remember, you are looking for people. I have never heard of a job seeker finding a job online who didn’t have a booster,” says Dalton.
  8. Don’t fear technology. “The good news there is really no intimidating technology anyone has to learn to pull this off. Use a simple spreadsheet to create your list of employers; LinkedIn and Google searches to learn about trends in the industry that interests you and to discover smaller companies in the field doing interesting things that you may not  have known. You may also tap into databases such as an alumni one or Dun & Bradstreet’s Hoovers to learn about competitors of companies you’re interested in that may tip you off to less obvious employers. Back in the old days it was accidental networking; you meet or know somebody who knows somebody. Now the game is about having those accidental meetings, but on purpose. That is terrifying, but not a lot of new technology to learn,” says Dalton.

By Kerry Hannon

Kerry Hannon has covered personal finance, retirement and careers for The New York Times, Forbes, Money, U.S. News & World Report and USA Today, among other publications. She is the author of a dozen books including Money Confidence: Really Smart Financial Moves for Newly Single WomenGreat Jobs for Everyone 50+: Finding Work That Keeps You Happy and Healthy...and Pays the Bills, Getting the Job You Want After 50, Love Your Job: The New Rules for Career Happiness and What's Next? Finding Your Passion and Your Dream Job in Your Forties, Fifties and Beyond. Her website is kerryhannon.com. Follow her on Twitter @kerryhannon.

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Making a Safe Transition From Hospital to Rehab

April 25, 2019

How to ensure your loved one will receive good care after the move
By Cari Shane

If you have a parent or other loved one who will soon be released from the hospital after an injury or surgery, he or she might not yet be well enough to return home, even with the assistance of in-home care. That likely will mean a transition to a short-term rehabilitation facility or nursing home.

If you’ve never had this experience, you may not know what to expect. The following are some important tips, and a few cautionary tales, from caregivers and a patient who have been through the hospital-to-rehab transition.

Before You Leave the Hospital

Don’t let your loved one leave the hospital without being “admitted.” Without the word “admitted” stamped on hospital papers, the stay at the rehab facility is not covered by Medicare. It’s this semantics loophole that left Cat Stone’s mother in severe debt after a 2012 hip fracture.

“Medicare didn’t just abandon my mother — she went to her grave ashamed and afraid knowing they’d stolen her life savings, her security and her dignity with an undisclosed loophole,” says Stone, of New Jersey, whose mother was living in a Florida nursing home. Stone wrote about what happened to her mother and family for The CoveyClub.

Medicare covers nursing home care if a person over 65 has been admitted and remained in a hospital for three days, counting admission day but not the day of discharge. Since Medicare only picks up the rehab tab for the first 20 days, a secondary insurance may cover the $170.50/day co-pay for days 21 through 100.

Know you can request a private room. The hospital’s social worker will place your loved one in the facility of your choosing as long as there’s a bed available. Since a private room doesn’t cost extra, you might want to request one to ensure a restful stay. While many temporary roommates can get along just fine, sometimes it doesn’t work out.

“My grandmother[’s] roommate was not a good match,” says Amie Clark, whose grandmother was in a nursing home near Portland, Ore. “Had we not spoken up, she would have had to continue to tolerate a situation that was not healthy for an 88-year-old.” If your loved one ends up in a double room and it’s not a good situation, you can add his or her name to the private-room waiting list.

Plan for a Sunday, Monday or Tuesday discharge time. Since patients do not receive physical therapy from either the hospital or the nursing home on discharge or arrival days, the prime day to transition is a Sunday. At most facilities, Sunday is a typical off day for therapy, so your loved one won’t miss what he or she won’t get anyway.

By that same calculation, being discharged on a Saturday can ratchet up three missed therapy days: no therapy on Saturday (transition day), no therapy on Sunday (off day) and no therapy on Monday because this is the day department heads assess your loved one’s therapy needs. If the rehab facility doesn’t do assessments on Saturdays, a Friday departure would mean four days of therapy missed.

When You Arrive at the Care Facility

Disinfect the room. Studies show that the rails on the bed, over-bed table, bed control wand, nurse’s button and the room’s door handles can be ripe with germs. Get wipes and disinfect.

Get direct phone numbers. It may prove difficult to get a human to answer any of the phone numbers provided in the welcome pamphlet. Since most department heads carry company cell phones, ask for these numbers. Key ones to get: the nursing supervisor, social worker and the doctor assigned to your loved one’s care.

Schedule advocates. Schedule at least one person — a family member, friend or perhaps a paid aide — per day to advocate for your loved one, at least until you feel like everything is going well. An advocate helps draw attention to the person’s needs, especially in an environment where nurses and other care staff often are over worked and in charge of a large number of patients. If you hire someone to be an aide for this, just know the service is not covered by Medicare.

Make sure the staff understands your loved one’s mental condition. When transitioning from a hospital to a care facility, many older adults suffer from some level of hospital delirium. The rehab staff may assume that this is who your loved one is and create a misinformed treatment plan. Some of this is inherent ageism, says Catherine Callahan, 68, who says she tackled head-on the assumptions about her abilities when she arrived at a nursing home in Santa Barbara, Calif., after major surgery. They “may think you are hard of hearing, confused and limited in your determination … I stated up front that I have a keen sense of hearing … and was very committed to doing my program,” she says.

Check with your loved one’s doctor. The facility may require an immediate influenza and/or tuberculosis shot. Since your loved one may already be up to date on these, insist that the facility wait for you to get medical records. And, while you’re on the phone with the doctor, discuss medication changes and contraindications.

Look and ask before your loved one takes medicine. Each time your loved one is given medication, make sure you, your advocate or the patient asks the nurse to state the names of the pills. Lana Wolfe’s 81-year old mother was prescribed oxycodone despite an allergy, which was noted on her chart. “She was given this for two days before I found out,” says Wolfe, of Fort Colins, Colo., whose mother was in a rehab facility near Denver. Also, a few times “the medication was just left with my mom [even though] the nurse is supposed to wait until the patient actually takes the medication,” she says.

Don’t ever accept “we can’t do that” or “you have to do that” as gospel. Patients have the right to turn down treatment. “Many people assume that they have to follow the doctor’s orders and don’t have a choice, but they do,” says Clark, who is also a former long-term care social worker. Also, a family member or other individual who is legally designated can refuse treatment and make other decisions for a person in the hospital or rehab.

While Medicare’s Bill of Resident’s Rights states that patients have the right to be treated with dignity and respect, sometimes it can be a battle. “Nurses aides insisted that my mother wear a diaper even though she could go to the bathroom on her own,” says Dr. Carole Lieberman, whose 101-year old mother spent time in two Los Angeles-area rehab facilities. “Diapers are easier for the staff … but they infantilize the patients.”

Patients also have the right to ask for treatment. “My speech was unclear … [but] my program did not include speech therapy,” says Callahan. “I never gave up asking for it.” She gave doctors specific reasons for why she needed it, “such as therapists not being able to understand me.” By the second week, Callahan was assigned a speech therapist.

You have the right to read all paperwork before signing. Remind your loved ones that they do not need to sign something they don’t understand, haven’t read or for which they do not agree.

If you don’t like how your loved one is being treated, go straight to the top. It may be difficult to get the facility administrator on the phone, but keep trying. If the person remains elusive, demand an internal investigation about your loved one’s treatment from the director of nursing or social work.

By Cari Shane

Cari Shane is a freelance journalist and corporate writer specializing in public relations and social media strategy. She is based in Washington, D.C.@cariinthecity

Helping to Shape Our Culture

April 23, 2019

We love when our team members share their stories, especially when it shows their 31 year journey with Presbyterian SeniorCare Network!

Read about Dawn Kauffman, a CNA at The Willows, the skilled nursing community at our Oakmont campus, and how resident care has evolved throughout her career as a CNA.

“I have worked at Presbyterian SeniorCare Network for 31 years and have seen so many positive changes. When I first started, I worked in the "Presbyterian Medical Center," which is now "The Willows." Just the name change shows how we have changed to a person-centered culture, caring not only for the medical needs, but the whole person. Back in the 1980s, we cared for everyone exactly the same way, so when we first started talking about changing our culture, I was very doubtful as to how it would turn out. But it really has changed for the better for all of the residents in our care, and I'm proud to have been a part of that change!”

Like Dawn, do you have a story about Presbyterian SeniorCare Network that you would like to share? We would love to hear it! Click here to visit our web page. Once there, please click on the button, Share My Story.

Once you have submitted your story, you will automatically be entered into a random drawing to win a $50 Visa gift card! Winners will be pulled the first Monday of every month.

Meet me at the Sim Lab

April 19, 2019

“Maxine” enhances quality of clinical training

I am an advocate of blended learning. Learning in the classroom setting is certainly important, but learning extends way beyond sitting in a classroom. The classroom does not offer real life condition changes, so it is important to utilize training that includes real scenarios in order to enhance and refresh the confidence and skills of our caregiving teams,” says Ginny Burke, director of clinical quality and education. Ginny continues, “There is an increase in acuity of our skilled nursing residents. Hospitals are under pressure to discharge patients and long-term care communities are caring for individuals requiring higher levels of care. Our clinical teams are expected to have the skill and confidence to care for residents that are more complex, and be able to identify subtle changes that may indicate a significant change in condition.”

How do we ensure that our teams are up for the challenge? With Maxine.

Scenario-based training with Maxine “We have access to a simulation mannequin, or Maxine as we fondly refer to her, through our partners at Health Ventures Alliance in Erie. The simulator allows our nurse educators to set-up scenarios for our teams so that they can comfortably work through assessing a resident,” says Kristen Moore, care transition educator for our Erie campuses. While the team member is assessing Maxine, the mannequin has the capability to respond to what the team member is doing for treatment. So the “patient” changes as the scenario moves forward.

Photo caption: Megan Smith, LPN, practices recognizing lung sounds. 

“Maxine helps our clinical team members learn how to identify changes and seek interventions earlier in the treatment process. They also learn how to stabilize a patient, which in a real-life scenario, could ultimately avoid transfer to the hospital,” says Kristen. The simulation mannequin provides training on a variety of topics, including how to recognize normal and abnormal breath sounds and heart sounds, IV placement, blood draws, urinary catheterization, wound identification and care, injections, tracheotomy care, blood pressure checks and more. Another benefit of the simulator is that it offers special programming for common illnesses such as pneumonia and heart failure. “What’s great about Maxine is that she was built to have all of the common diagnoses that we see in our communities. If we find that at any given time, there are a number of residents in our care that have congestive heart failure (CHF), we are able to hold a special education session with our teams to discuss CHF, and then we program Maxine so that they can practice the proper treatments,” says Ginny.

The simulation lab was created at Manchester Commons, one of our campuses in Erie, after Ginny attended a presentation where the labs were discussed. At the end of the conference, she was so inspired, she drew the Simulation Lab on a piece of paper while waiting to catch her plane home. Her dream turned into reality shortly after, and the simulation lab was set-up like a typical resident room. When Maxine isn’t on campus for training, team members are still able to practice on the variety of simulated body parts that have been purchased for training purposes; they are able to practice clinical techniques on a foot, an arm, a leg and more.

How often do we train?

As part of orientation, newly hired Certified Nurses Aides (CNAs) and nurses participate in the Simulation Lab training to show that they are able to complete basic competency skills. Current nursing team members complete the training once a year as a refresher.

Photo caption: Team members practice proper wound dressing. 

“I have to admit, when we first started training with Maxine, it felt a little silly and awkward because she’s a mannequin. But those feelings quickly disappeared after a number of team members went through the training and thanked me for a refresher that they felt was needed. I cannot believe how many team members have told me ‘Wow, I learned how to do that procedure more efficiently,’ and ‘the lab was wonderful, can you believe I forgot how to take a manual blood pressure!’ But what gets me the most is when a team member tells me thank you and that they appreciated the time I took to show them how to do a particular procedure. That is what it’s all about – we are all in this together,” says Kristen.


“The Simulation Lab was a good refresher on a lot of different topics such as lung sounds, and I learned a lot about orthopedics as part of the simulation. Kristen was a great teacher and always willing to help, and when we didn’t know something, she just encouraged us to learn it and add something new to our skill sets. It is important to train on the simulation mannequin because it is the closest thing to a real person, which helps us in our everyday work.” ~ Jessica Bush, LPN at Manchester Commons, one of our Erie Campuses


Expanding the reach of the Simulation Lab

“We are so lucky to have access to the simulator through Health Ventures Alliance, but we could really benefit from having our own simulators so that team members from across our Network have consistent access to the tool,” says Ginny. Currently, the use of Maxine is limited to our Erie and Oil City communities, and while some team members have made special arrangements to travel to Erie to participate in the training, many are unable to make the trip. Ginny is working with Presbyterian SeniorCare Foundation, our fundraising arm, to raise money to purchase two of the simulators for use around our Network. David Dix, major gifts director explains that “the cost of one of the simulators is $42,000. So we are looking to raise $84,000 to purchase two simulators for educational purposes. Being able to purchase these is crucial to our success in providing well-rounded clinical training.”

If you are interested in learning more about donating towards the purchase of a simulator, please contact the Foundation office at 412-826-6195 or email foundation@srcare.org.

CNA Profile: Brianna Larrow

April 15, 2019

Meet Brianna Larrow, a team member who benefited from the CNA Training Classes at our Oakmont campus. Learn more about her journey to becoming a CNA.

Q: How long have you worked at Presbyterian SeniorCare Network?
A: I’ve worked at the Oakmont campus for about three years, working first in dining services as a hospitality aide, and now as a CNA.

Q: You decided to transition from the dining department to working as a CNA. Why?
A: While I worked in dining, I often received encouragement from residents and coworkers to take the CNA classes. I took their kind words to heart and  eventually enrolled! I did not have caregiving experience, so I saw the CNA training classes as more than just a way to advance my career and increase my knowledge, I saw it as an opportunity to do what I love – care for others.

Q: Did you find the class helpful in learning how to do the daily work of a CNA?
A: Yes. The CNA training classes taught me and my classmates the skills required to work in long-term care. I really feel that the classes taught me everything I needed to know so that I could perform my daily duties and responsibilities. I learned that I would be the eyes and ears in the skilled nursing neighborhood which made me feel like what I was training for was both needed and meaningful.

Q: In order to become a CNA, you need to pass a State test. Were you prepared?
A: I felt extremely prepared for the test after taking the class. Mindy (instructor) teaches us everything we need to know, going over all the material multiple times not only before the exam, but before we even step out on the floor with the residents. The clinical portion just reinforces everything we learn with Mindy in the classroom. By the time we took the test, the material is second nature.

Q: What did you enjoy most about the class?
A: I loved the clinical portion and gaining firsthand experience with the residents. I loved seeing how things worked as part of the clinical team and helping out, especially because I’m a hands-on learner. Because of my previous work in dining services, I already knew the residents well, and now I was able to work more closely with them, which was and still is so rewarding.

Q: As a CNA, what are some of your main responsibilities?
A: I take care of our residents, make sure they are comfortable and without pain. I help them with daily activities and observe any changes in condition, which I report to the nurse manager. I also keep them motivated and hope to make them smile!

Q: What would you say to anyone thinking about pursuing certification to become a CNA?
A: There is always a need for CNAs. If you love taking care of people and seeing them smile, consider becoming a CNA! Sometimes the job is hard, but in the end, it’s not about difficult duties, it’s about helping to make our residents feel important and cared for at this stage in their lives.

Interested in becoming a CNA like Brianna? Visit CareersAtSrCare.org to explore your options around our Network! 

 

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