holidays are a great time to talk to your elderly paraents about being "fine"

 Across the country during the holidays there will be thousands visiting their parents. The same parents who tell you weekly they are "FINE". The same parents who never complain, which makes your life easier doesn't it? The same parents who are driving but you're not sure if they should be. The same parents who go to the doctors' and tell you everything is just "FINE".Parents don't want to bother their children. They may know that things just aren't the same as they used to be but they don't want to ask. They are from a generation that families all lived together, took care of each other but we're not from that same group. We go to college out of state and stay there; we hae busy lives with children, work obligations and sometimes just don't have the time to ask those pesky questions. If we're being told by them they are FINE then we let it go. Face it, it's easier isn't it? If we don't dig deep into what is going on it means we don't have to burden ourselves on how to replace what they can't do anymore.TEN THINGS TO LOOK FOR BEFORE A CRISIS HAPPENS:1. THE CAR -Drive with your parents to see if they can. Ask them to drive to the store without giving them the directions there and back. Check and see if there are dents, dings, damage. Look for tickets they may have gotten in their glove compartment.2. THE MEDICATIONS-Look around, find their medications. Are they taking them? When were they renewed last? Are they organized. Ask them if they are managing their medications okay. Do they know what they are taking and why their taking them? Do they have a list of their medications readily available?3. THE HOUSE-Keep your eyes open as to how the house looks. Often times when people get older they tend to hoard things. Are there papers everywhere? Are there dirty clothes around, dishes in the sink, garbage not emptied? Disrepair of anything outdoors and indoors? Who mows the grass? plows the snow? Who do they call when there is a problem in the house with the plumbing?4. THE BILLS and MONEY- Do you see bills stacked up? Shut off notices? are they able to write their checks and pay their bills? Talk to them about who is in charge of them and if they know when to pay their bills, order oil, pay the electric bill, the cable bill their insurance bills. Life insurance bills? Who manages the money? Are they aware of the money they have and where it is? Do they have a lot of cash around the house?5. THE GROCERIES- Who is in charge of grocery shopping? The cooking? Are they on a special diet and do they know what that is? Food storage and outdated cans of food as well as outdated boxes of food? What are they eating? How often do they eat. Who cooks? can they use the stove safely? The microwave? do they eat three meals a day? Is that person in charge of all the meals or do they go out to eat once or twice a week or daily? Where do they go to eat? Who brings them there?6. COGNITION- Are you speaking to your parents and they don't seem to participate in the conversation? Do they make yes and no statements part of how they answer everything with you? Taking the time to have a conversation will be an opportunity for you to know if they have significant memory issues, confusion about what season it is or month it is. The last time you spoke to them on the phone, knowing your name and other family members names. It's difficult to assess but this will help you know the signs to look for. 7. MEDICAL MANAGEMENT-Who are their doctors? Do they have many different doctors and specialists? Do these doctors talk to each other so they are all aware of any changes made in medications or treatments? How often do they go to the doctor? Who manages the appointments? Transportation? Eye doctor, dentist, primary care physician, cardiologist, neurologist, whomever is involved with their care. Is there a list? Do you as a family member have access to information from their doctor's to have them call a family member when there is a change or an event?8. EMERGENCY MANAGEMENT- Do they know how to manage an emergency? If one falls do they have access to life line or something similar? Neighbors checking in? Phone numbers readily available? List of medications and physicians to access easily by emergency personnel? Contact information?9. FUNCTIONALITY- This is probably the most important of all. How do they function. Watch how they get out of a chair. Look for bruises from past falls. Ask them if they have fallen at all. Don't put a short time frame on it because they may have not fallen in the last month but fell last summer and laid there until a neighbor came to help. Are they touching the walls and furniture to keep themselves steady? Can they button their coat or shirt without help? How do they bath? Are they not showering because they are afraid of falling? Do they not take a bath because the tub is too high to get into? Be observant of how they move and how they dress.10. CONTINENCE- As we get older it is more difficult to hold our urine.  If your parents have an odor of urine, you see multiple items hand washed and hanging in the bathroom ask the question. If they are seriously incontinent of urine this needs to be addressed. They could have a urinary tract infection, which is a common condition often not identified until it's too late. Are there bags of depends around that weren't there before. Have the discussion.​

thousands of dollars a month in rent and $4.00/day budget for food in elderly communities- shameful

 What are the budgets for food in your very expensive elderly communities. Well it varies but it isn't much. $4.00 to $6.00 a day per person for those meals.  That's right three meals a day; even on the high end that is $2.00/meal. Is that a good diet for those who are paying thousands to live in these communities? And in long term care ? Assisted living? Independent Living?A post from 2013 from Ask -  from Joe Starr who has been in  eldercare healthcare for 20 years."Yes, most skilled facilities utilize a formula called PPD:  Per Person Daily.I believe my Dietary manager told me a few months ago he had $4.01 per person daily.  This means he has$ 284.00 to feed 71 (if that's how many people we have) each day.Now, you take that figure, and multiply it by 30- a month's worth of food, out of which he orders monthly items such as napkins, coffee, bowl covers and such, and from what is left, he divides that by 4.5 (the average number of weeks in a month) so he knows what he has to work with for his weekly menus.  There are trade-offs and switcheroos-  if he has a big can of pineapple and a yellow cake mix in dry storage already, he may scratch out the Devil's food with chocolate icing dessert on Wednesday's menu and substitute pineapple upside down cake, same type dessert.  Thanksgiving is coming up, which is a HUGE meal for our Facility, and so he's been buying things a bit at a time so he doesn't blow the whole budget on one meal in November.Very few Corporate-owned skilled facilities have a more generous budget.  Unless the majority of their clientele are private pay, $4-5 a day each is about average.  All foods possible are ordered through Sysco and a few other distributors, and we have a Safeway card for emergencies like we ran out of burger buns on sloppy joe night. He is also not allowed to order certain Sysco products, at all, such as shrimp cocktail or lambchops or sirloin steaks.  Our company doesn't do expensive."I recently came across an independent community that has a budget of $3.50/day per resident. The average rental there is $3200/month. Includes the meals. Most of the meals are repetitive with hot dogs and beans casserole as a main dish for dinner or peanut butter and jelly sandwich. Let's not forget the ham salad that perhaps can feed 10 people from a few slices of ham and mayonnaise whipped up in the blender a favorite in long term care.How about  a long term care facilities that charges hundreds of dollars a day  in our state.  Daily amounts of-$350.00 to $450.00 /day room and board. Do you think perhaps something other than ham salad sandwich or a small chicken leg once in a while is adequate for paying over $13,000 per month for room and board? It would seem to me that in a 5 star hotel you would get filet mignon daily along with a pleuthera of other great choices to eat. Oh let's see you do have nursing for 24 hours per day. But do those who don't meet the qualifier of having a "skill" in order to have medicare pay the bill need a nurse for 24 hours?? What are the nurses doing. Medication management. Yup that's it. Mostly LPN's in the community that deliver medications. (please I don't need a million responses from LPN's to tell me how great they are this isn't anything other than facts here)Alternatives to long term care are those communities that you privately pay for ranging from $2800 per month up to $10,000 per month.  There are 92 licensed communities in Connecticut some owning more than one community. Benchmark now the largest with 17 communities last count.Long term care facilities range from $350.00/$450.00/day which is $13,500/month for sometimes a shared room of three or four in a room and not very pretty facilities.  There are many more convalescent homes in Connecticut and all are competing to fill those beds and those units.  Who cares?? Well I think the residents care but little is said by them as most are from a generation of not complaining.  I have a resident in one of those private pay memory care units that cost over $10,000/month. She has gained over 22 lbs in a  year from the "junk" that is fed to her. Stale bread, peanut butter and jelly sandwiches, store bought cakes recycled from one meal to the next and sweet sugary cheap juices.  That's the diet you get for paying thousands a month for. I can't say the care is much better and have had to scramble with management that changes frequently to be sure she is attended to.Most of us don't know that the budgets for food are so low. I know I didn't until I heard one of the managers complain about the food. He said "they don't care, we mention it often and they say they have chef's when their actually cooks. People with little training who come in and have no idea how to make a meal. That's what you get when your paying someone $11.00/hr." He also said they are dictated what they make and are limited to a budget of two to three hundred dollars a month to feed all these people (70 last count) and they try to make it stretch. Often not having the items on the menu that have already been printed.So to all of those owners out there checking on your stats on a daily basis of how much money is coming in and how the sales are going. What exactly are you eating for dinner????​

an industry built on revenue and little integrity

AN INDUSTRY BUILT ON REVENUE AND LITTLE INTEGRITYEldercare housing, assisted living communities, independent communities and memory care units all in this industry are very competitive, not new news but not in a GOOD way; not only with other communities but with each other.  There are a few that know how to get along and work together then there is always that person who is TOXIC no matter where they go.That's what I witnessed this week. One community slandering another, getting people above who are friends to intervene. Playing games behind the scenes. Throwing others under that bus we all know so well. Shameful.Not only did they bully their way into the decision but they slandered the other community to get their way.  Everyone will deny it of course. But it happens often and the administrators above. Where are they? Do they know??  I think they are very aware but I also think that the ONLY let me repeat the ONLY thing the owners, administrators and micro managers above the community directors are interested is revenue. Period. They care about revenue. They care about how much money they are making. Period.As I watch the turnover in these communities; all the communities, independent, assisted living and memory care; with good people who try to do good things it only confirms one thing. Money. They don't care about the resident or the families or anything that happens to them they care about money. I've seen neglect, stupidity, failures, lack of compassion, uneducated staff throughout the industry. When your paying people minimum wage you get minimum wage staff. It's heart wrenching as I advise and consult with families where the best places are to go only to see there aren't any, there is no best anywhere.  Same issues, same problems in all of them. Interest in getting them in and then everything that is promised goes to the wayside even if someone is watching over them. They lie to you. Yes they lie.I refer many people to independent settings, assisted living communities and memory care. I am challenged to find one that actually provides what they say they provide and is without a very big problem with the resident. Many don't find out what is going on because they aren't in the communities and they trust. Like the healthcare system I say don't trust. Make sure you are actually getting what they said you would get  and that your loved one is being taken care of. They will tell you what you want to hear and that I will tell you it is NOT what is going on.It's sad that I even have to write this but I've become so disgusted with the care that I see and little accountability, only excuses. There is never an excuse when a resident is harmed, none.                                         ​

​home healthcare based on best not ownership

 HOME HEALTHCARE BASED ON BEST NOT ON OWNERSHIPthere are 100 medicare qualified home health agencies in Connecticut according to  Home health agencies are evaluated by outcomes designated by medicare.  They are broken down into categories, Quality of Patient Care and Patient Survey.Under Quality there are many categories that are requested by Medicare. Some of the important ones (in my view) are How Often patients wounds improved or healed after surgery?Some of the top agencies areInterim - 100% of their patientsHebrew Healthcare -97.3%Farmington VNA - 91.7% of their patientsHartford Health at Home - 89.9%                   Connecticut Average is 90.8%                   National Average is 89.4%Data collection on re-admissions to the hospital is a key issue that all are working towards.  How Often home health patients had to be admitted to the hospital (lower is better)   Farmington VNA- 12.4%   Interim-15.6%   Hartford Healthcare at Home-17.6%   Hebrew Healthcare-19.8%              Connecticut Average - 16.8%              National Average - 15.9% How often home health patients, who have had a recent hospital stay, had to be re-admitted to the hospital (there is no number connected to these yet) Hebrew Healthcare - Same as expectedFarmington VNA - Same as ExpectedInterim Healthcare – Same as expectedHartford Healthcare at Home-worse than expectedSo for me this begs the question as to why we don't refer patients to those agencies that have the best outcomes? It doesn't happen and even worse if someone goes to the hospital with an active agency it is probable that this patient will leave with a referral to the agency that the hospital owns. There is no  process of evaluating which agency is better with outcomes than the other and apparently no interest either.  If the goal is to improve the patient when they leave to go home then the agency involved should be one that has the best outcomes for that particular issue. There are other data that are also collected related to pulmonary issues, cardiac issues, diabetes, ambulation, emergency department visits and much more. So let's me be clear. There are only 100 agencies in Connecticut and plenty of patients to go around. Is it fair for the hospitals, short term care and physician practices to be directed to whom they refer to? Is it right for patients to not be aware that one agency may have better outcomes than other agencies? Perhaps there should be a list of preferred agencies that the providers give and review with patients and families so there is a better understanding on who is going to care for them when they go home and why the hospital is recommending them.   ​

LAck of communication still exist

I have a 50 year old gentleman with diabetes admitted to the hospital a week ago Friday.  He had a urinary tract infection and was septic so he landed in the ICU. I went to visit on Saturday, introduced myself and gave them our HIPAA release form and asked  "please keep us in the loop".  I went in again on Monday when he was transferred to the medical unit and had a discussion with the nurse. Very nice, information shared and spoke to my client and asked "please make sure his implanted catheter as he won't need it coming back and we have been trying to get it out for a few weeks now" she replied "we'll take care of it".  I then called the case manager and left her a message with my contact information explaining what I do and how I am involved.  I never heard from her until Thursday when she called tell me he was being discharged that day. She thought she was calling the VNA, (visiting nurses), I quickly told her no we were not the VNA and gave her the VNA that was involved.  I also reminded her about his catheter that needed to be removed. She didn't even know he had a hickman catheter.  When I also discussed that he will go back to have his wound vac placed by the VNA she continued to say that perhaps he needed assessed by the wound clinic. I advised her that he has been going to the wound clinic for quite some time. She did not know he went to the wound clinic.  I asked if she would please confirm his appointment with the wound clinic, make an appointment for the hickman catheter that should have already been taken out.  She said she needed to have the manager call me.  She did and the above things were done. Here's the problem NO ONE IS COMMUNICATING!!! simple you would think to just talk to each other but they don't.  Even after being told on a few occasions it was clear she knew nothing about this gentleman being discharged.Someone like this gentleman could have been back in the system in a heart beat without knowing his history or just talking to him. Imagine talking to the patient!! He is only 50 I didn't spend a lot of time with him because I knew he could talk for himself. BUT no one talked to him.​


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