Long-Term Living Blogs

Coming to grips with old age

Tue, 10 Nov 2009 14:48:52 EST

Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} Garrison Keillor says he is in deep denial. The 67-year-old humorist and syndicated columnist confided to a max capacity audience of 5,000 at Tuesday’s AAHSA Annual Meeting & Exposition general session that he didn’t realize he was an elder until six weeks ago—when he had a stroke. Getting the somber discussion out of the way early, Keillor had his viewers in stitches for most of the hour-long monologue, which he ended with the type of dizzying, hilarious yarn that has earned him a loyal following. Speaking mainly of why people should invest in the health and wellbeing of their community’s elderly, Keillor offered these reasons: · helping those who have nothing to give in return is a moral exercise exemplified in religious traditions; · old people, through their behaviors and mannerisms, offer distractions from your all-too-serious lives; and · “It’s also a lot of fun to watch [elders] look for their glasses.” The importance of keeping the elderly around, Keillor said, is found in the “quiet moments” when they can impart their wisdom to young people. Keillor said the realization of his own status as an elder occurred during the physician assessment of his stroke. Inside the “great cyclotron”—or MRI—Keillor reflected on the liberation found in old age, namely being able to let go of the anxieties and self-consciousness that attributes to needless stress. Addressing the caregivers in attendance, he called this sense of liberation “a blessed state, and it comes at the end of your life. You [caregivers] help people reach that blessedness.”

AAHSA wants you to ‘change lives’

Mon, 09 Nov 2009 15:05:15 EST

Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} A man discusses a personal haiku left over from his wife with a young, attentive nurse. He tells her how appreciative he is that she would listen to his story. A senator tells a lobbyist that she will not change her stance on legislation that could adversely affect seniors. She then finds out the impact such a bill would have on her own mother, who calls straight from the nursing home and convinces her to reconsider. A resident in a wheelchair watches a young woman dance and then laments how she used to love ballet in her youth but can no longer participate. The woman grabs the resident’s hand, telling her, “Whenever you have a dancer’s spirit you can always dance,” and the two sway their arms in harmony. These scenes may remind you of something you as aging leaders have witnessed in facilities around the country. However, these did not take place in a nursing home—rather, they were acted out and presented on stage during Sunday’s opening general session of the 2009 AAHSA Annual Meeting & Exposition in Chicago. The purpose of these vignettes was to enforce the conference’s theme—“changing lives”—and served as an introduction to AAHSA President and CEO Larry Minnix’s brief address. “You’re here because you know so many people depend on you,” Minnix said to a large audience, which could surpass last year’s record attendance by the end of Wednesday. Throughout his speech, Minnix reminded everyone that tough financial times may bear some low-hanging fruit, such as the potential for leaders to gain insight from colleagues into problem solving. Minnix also stressed the importance of the CLASS Act, a piece of legislation added to the recently House-approved health reform bill, which promotes independence for retirees and seniors with an alternative financing option for long-term care. ( Click here to read more about the CLASS Act. ) Whether or not everyone agreed upon health reform and the CLASS Act, the audience was indeed unanimous in the declaration that aging leaders must continue to show up to their difficult jobs, learn how to improve resident quality of life, and advocate for industry solidarity.

Shower Aides Are Back

Sun, 08 Nov 2009 11:29:08 EST

This facility began to use shower aides again the beginning of November. We have two shower aides on our unit and each aide works three twelve hour shifts a week. That means shower aides give showers Monday through Saturday. If any showers are given on Sundays, the floor aides do them. Having shower aides changes some things. When floor aides did showers, they had to do them quickly because they have so many other things to do. Shower aides may have a bit more time, depending on how much they have to do for us before and after our showers. The shower aide does about 20 showers a day. One shower aide has been one here before. So she knows how to set up her schedule efficiently. The other one is new and has to learn how to organize the process herself. Shower aides are required to assist at meal times either by working in the dining room or passing treys on the hall. This week has been a bit confusing because my aide brushes my teeth and gets me ready for my shower. Then the shower aide takes me to the shower room, does my shower, and gets me dressed. If it all sounds a bit confusing, it is right now. But there is better continuity when the same two people give showers most of the time. They become used to the residents' routines, know where things are, and what to do. However, the other aides will sometimes do showers either to help out or just because they have the time. It definitely relieves some stress from the floor aides to know that one aide will be devoted to doing most showers. Then floor aides can concentrate on AM and HS resident care and possibly be able to spend a little bit more time with each resident. I am sure aides are still adapting to the new system. In order to be safe, shower aides need to wear nonslip shoes in the shower room. Waterproof shoes would be helpful as well. One shower aide told me her shoes are wet all day and it took most of the next day for them to dry out. Shower aides may need to bring another pair of shoes with them. In the past, shower aides tried wearing boots over their shoes; but some found them too cumbersome. I know from observing that being in constant water is very hard on the shower aides’ shoes. Despite the footwear and organizational issues, it seems like things are going pretty well. We residents requested that administration consider reinstating shower aides over a year ago. We had become accustomed to them under different ownership. So now we have shower aides again.

Common colonoscopy prep may cause kidney failure or death in elders

Thu, 05 Nov 2009 14:51:58 EST

We've all gone through the unpleasant task of preparing for a colonoscopy. Drinking unpleasant liquid or popping pills for the purpose of giving the doctor a better view of our colon's contents is … anything but pleasant. Now, news has surfaced that, depending on the product you used to prepare for the procedure, the experience may not have been merely unpleasant—but downright dangerous. On December 11, 2008, the FDA ordered the makers of Visicol and OsmoPrep to put a black box warning on their products alerting consumers to the fact that the drugs can cause kidney damage or death. The warning came after the FDA confirmed more than 20 reports of a severe kidney injury called acute phosphate nephropathy after people consumed the products. Acute phosphate nephropathy may progress resulting in: kidney failure, long-term dialysis, the need for a kidney transplant or death. On the heels of the FDA warnings regarding Visicol and OsmoPrep, C.B. Fleet Company, the manufacturer of Fleet Phoso-Soda and Fleet Phoso Soda EZ Prep Bowel Cleansing System, stopped selling the products over the counter without a prescription. Visicol, OsmoPrep, and the Fleet Phoso-Soda products all contain high doses of sodium phosphate that works to clean out peoples’ bowels before medical procedures such as colonoscopies. According to Dr. Joyce Korvick, deputy director of the FDA's Division of Gastroenterology Products at the Center for Drug Evaluation and Research, "Of the reported cases, three were biopsy-proven cases of acute phosphate nephropathy. The onset of the kidney injury in these cases varied, occurring in some within several hours of the use of the products and in other cases up to 21 days after use." The FDA's warnings applicable to Visicol, OsmoPrep, and Fleet Phoso-Soda products are particularly relevant to elderly people, because studies have repeatedly shown medical complications in the following demographics after they take oral sodium phosphate tablets: · people over 55-years-old · people suffering from dehydration · people suffering from kidney disease · people taking medications to control blood pressure (angiotensin-converting enzyme inhibitors to lower blood pressure or angiotensin-receptor blockers used to treat high blood pressure) · people taking anti-inflammatory medications (including many arthritis medications or ibuprofen) Symptoms of acute phosphate nephropathy People with acute phosphate nephropathy may or may not have physical symptoms of their illness. In the case of those with no physical symptoms, blood tests that measure kidney function can be used to confirm the diagnosis. The majority of people with acute phosphate nephropathy have some physical manifestation of the disease including one or more of the following symptoms: · reduced urine output · rapid energy loss · swelling in the legs and ankles Jonathan Rosenfeld is a lawyer who represents people injured in nursing homes and long-term care facilities. Jonathan has represented victims of nursing home abuse and neglect throughout Illinois and across the country. Visit his personal blog at www.nursinghomesabuseblog.com and his Web site BedsoreFAQ.com .

Can you be a Jekyll and Hyde leader?

Tue, 03 Nov 2009 11:03:44 EST

Warren Bennis asks, "Can a leader both act and be real?" Bill George, a professor at the Harvard Business School, in his book True North, contends that a journey to leadership cannot be made without “framing your life story, discerning your passions, finding your leadership purpose," and aligning it with that of your organization. In short, he is saying that you cannot fake leadership. I agree with George. Watch the video to see why. The more systemic issue is about how we hire and promote leaders in healthcare. We always look at past accomplishments and metrics that have been moved in previous jobs. But what about how leaders lead their lives? Should that be considered? And how do you measure that? Tell me what you think. Are some able to lead without being authentic to their organizations or to themselves? Anthony Cirillo, FACHE, ABC, is a marketing consultant, professional speaker, aging and senior health expert, and the owner of Fast Forward Consulting. Visit his personal blog at www.anthonyssong.blogspot.com .

When the administrator moves on

Mon, 02 Nov 2009 11:07:03 EST

Over the years I have seen many administrators come and go. The longest any has stayed has been about two years, so we residents can usually count on a new administrator about every 15 months. Our current administrator's last day was Friday, October 30. She moved on to another job in healthcare where she will work only weekdays. She knew all of us by name and many of our family members. She was very involved. During her year employed here we had last fall's 47-hour power outage and last winter's frozen water pipes above the kitchen. In other words, she had spent many extra hours here. Like other administrators she did not live very close. In fact, none have lived in the community. It has to be difficult to live away when you are responsible and can be called at any hour of the day or night. It also means a commute and less time for yourself and your family. Being a facility administrator demands dedication because the facility is open seven days a week and 365 days a year. So now the employees and the residents will have to get used to someone else in that administrator's spot. It will probably be someone temporary for a while. Then, over time, we will get another administrator. Things will be done pretty much the same. But individual administrators are not the same. We have experienced an administrator who was a 'people person' who had her own views of how residents should be treated. We could possibly disagree with her, but it was impossible not to like her. That is not always the case with administrators. All of us will miss her and we can only hope that we will get another administrator who cares as much about us as she did.

Nursing home loses 51 employees after customs inspection

Fri, 30 Oct 2009 08:45:33 EST

A probe by the U.S. Immigration and Customs Enforcement of the staff at Rosewood Care Center in Northbrook, Illinois, revealed many employees at the Chicagoland nursing home were working at the facility illegally—without proper paperwork the government requires for aliens to legally work. Over the course of a three month inspection of worker documents, Customs officials determined that many of the work documents were missing or expired. They also sent Rosewood a letter stating the fines for employing an “unauthorized alien” range from $375 to $3,200 per violation. Mike Brady, president of Bravo Care of Northbrook, the management company for Rosewood, says the nursing home is not at fault for hiring the workers. Rather, Brady says the nursing home was duped by workers who faked or forged documents to get jobs. The allegedly forged documents are called I-9 forms, which verify employment eligibility with the U.S. Citizenship and Immigration Services. After news of the illegal employment was formally disclosed, 51 of the 130 nursing home workers abandoned their positions at the facility. Consequently, many essential positions at the nursing home such as nursing assistant and dietary worker were left vacant. Brady said not to worry. "I would say our care being provided is excellent. We're still operating," he added. I certainly hope that the nursing home residents at Rosewood do not suffer any adverse effects with the huge turnover of staff. Read more about the story at this Illinois nursing home here . Has your facility ever discovered an illegal on staff? Please discuss in the comments below. Jonathan Rosenfeld is a lawyer who represents people injured in nursing homes and long-term care facilities. Jonathan has represented victims of nursing home abuse and neglect throughout Illinois and across the country. Visit his personal blog at www.nursinghomesabuseblog.com and his Web site BedsoreFAQ.com .

What about recycling in your facility?

Wed, 28 Oct 2009 13:21:10 EST

Ever since I came to a nursing home 13 years ago, I wondered why this facility did not recycle. I know there are recycling centers in the area. But I do not what the fees were to have recycled items picked up. I did know that it is expensive to have trash picked up and hauled to the landfill three times a week. It is still difficult for me to believe how much cardboard from here goes to the dumpster and then to the landfill. I used to recycle when I lived on my own. I worked in a community action agency building and they sold me on it. Of course, back in the 80s it was somewhat profitable to save your glass, aluminum, cardboard, and even newspapers. Recycling made me feel that I was doing my part to keep the Earth clean. My father always stressed respecting the Earth. He was into ecology ahead of his time. I have read a few articles here about helping facilities to become more green either by composting or by growing their own vegetables. But so far I have not read anything about facilities and their recycling policies. I can think of some reasons why recycling would be a good idea. It saves the Earth therefore it is good for business. Recycling trash could put less carbon into our environment which would be good for business. I know that some will say recycling is too expensive. They will say that we are wasting oil to remake old products. I know there is controversy around the issue. But when I pass a recycling pickup center in an adjacent county, I have to say that it is totally fascinating to me. That there could be business in our trash seems to be quite a revelation. It also reaffirms my parents’ Depression belief that everything is reusable. I would really like to see some input from those who run nursing facilities about recycling. Does your facility do it? Are you thinking about it for the future? If you do not think it is a good idea based on costs or other reasons please put those comments down. I hope you will participate.

Introducing the nursing home to 'family councils'

Tue, 27 Oct 2009 14:23:21 EST

Today, guest poster Karlin Mbah, of the New York-based organization Friends and Relatives of the Institutionalized Aged (FRIA), explains what “family councils” are and how they can work with nursing homes to improve care for the residents. In a later post, she'll discuss ways to create a successful family council. What is a family council? Background on FRIA and Karlin Mbah FRIA: The Voice and Resource for Quality Long Term Care is a not-for-profit organization dedicated to fostering the dignity and independence of seniors in long term care settings, with a special focus on nursing home residents, and to ensuring that they receive prompt, high quality compassionate care. Mbah is the Family Council Coordinator and Policy Advocate for FRIA . As the family council coordinator, Mbah provides technical support and assistance to family councils in the New York City greater metropolitan area. Currently FRIA conducts quarterly “Advocates of Nursing Home Reform” meetings at which family council members and leaders from all over the city meet to discuss issues and projects in their nursing homes. FRIA will also be assisting Advocates of Nursing Home Reform members in publishing a quarterly newsletter, by and for family councils, which will begin distribution in 2010. Mbah also works on FRIA ’s free telephone helpline (212.732.4455) which is open M-F 10AM-5PM to answer your questions about long term care. Parts of this blog contribution were taken from FRIA ’s Family Council Manual and Tool Kit by Jean Murphy and Jessica Herold . Family councils can play a very important role in helping residents of a nursing home have good quality of care and quality of life. A typical family council is a group of committed families and friends of nursing home residents who work together to improve the quality of life for all residents in a particular facility. For simplicity, I will refer to family councils and their members as families, but friends, partners, significant others, and all regular caregivers participate equally in family councils and are included when I refer to “families.” Family councils have the right to organize under the law. Under federal law, the 1987 Nursing Home Reform Act (OBRA ’87) recognizes that families are an important part of a nursing home community and serve as advocates for good care. The act guarantees families of nursing home residents the right to meet together in a facility and to be provided with space, privacy, and staff assistance if sought. Administrators are required to listen to, and act upon, the recommendations and grievances of family councils. Several states, including New York, have strengthened and empowered family councils by enacting laws that give additional rights and protections to councils, beyond those provided by federal law. What do family councils do? Family councils bring about positive change in nursing homes. The structure and activities of councils vary greatly, depending on their membership and the issues they decide to address. Some typical family council activities include: · welcoming new families and friends to the nursing home · offering support to each other · raising concerns and complaints and working to resolve them · providing education and information · improving communications with the home · arranging joint activities for families, friends, and residents · recognizing staff for good work · connecting to community resources · speaking out on public issues · taking the lead in bringing new models of long-term care to their communities, such as person-centered care, also known as culture change Family councils allow a venue for families to address their concerns in a safe setting and get support for the resolution of these concerns. Nursing home staff attends family council meetings by invitation only and must respond to recommendations and grievances presented by the council. These recommendations and concerns can be made in the name of the group, thus providing anonymity to individuals and a united front of families working for better care. Dr. Barbera is an author and a licensed psychologist consulting in long-term care facilities in the New York City area. She frequently lectures on subjects related to psychology, aging, and nursing homes. Dr. Barbera is available for private consulting with organizations, institutions, and individuals around eldercare issues. Visit her personal blog at www.mybetternursinghome.blogspot.com .

Therapeutic use of the Internet in nursing homes

Thu, 22 Oct 2009 14:57:56 EST

A recent study by the Phoenix Center looked at adults 55 and over, but not employed or in nursing homes, and found that Internet use decreased their level of depression by 20%. I'm not at all surprised by this, and I believe a similar decrease in depression levels would be observed in nursing home residents as well. While residents are living together rather than isolated in their own homes, and therefore have more opportunities for socialization, there are still many people who don't partake of the recreational activities offered for their enjoyment. Some residents never leave their rooms due to physical or psychological barriers, and some don't like crowds. Other residents feel uncomfortable socializing because of the physical changes of illness, wish to pursue activities other than those available in the nursing home, or miss connecting with those outside the home. The Internet offers the opportunity for nursing home residents to transcend their physical illnesses, leave the boundaries of the facility, and connect with the world. Here are ways in which I use the Internet for therapeutic purposes: 1. Psychoeducation regarding illness Oftentimes residents are given diagnoses, but little information about them, leaving them confused or upset, which can result in noncompliance with medication and care. I search for a resident’s illness with them on the computer, and discuss the symptoms and treatment, which enhances cooperation with medical staff. Some residents are more receptive to information coming from a “neutral” source than from their own caregivers, and most residents appreciate a print-out of information they can refer to over time. Posting a list of illnesses and the Web addresses of important sites near the computer would facilitate this process (eg; The American Diabetes Association, the Amputee Coalition of America, etc). 2. Support regarding illness Most of the residents deal with their illnesses in isolation, when there are many avenues of support available to them on the Internet. Having the opportunity to “discuss” their concerns anonymously with peers can often be more effective than trying to generate a conversation between two or more residents at the nursing home, due to discomfort at revealing personal information. At www.strokenetwork.org , for example, stroke survivors can “meet” other survivors on-line and get information and emotional support, as can their caregivers. To find the appropriate support groups, enter the name of a particular illness and “support” into the browser window and look around from there. Another option: Look for a Yahoo group about the illness and sign up the resident after establishing a free email account through resources such as Yahoo or Google. 3. Connection with family and friends Why should residents have to limit themselves to family visits or phone calls when most of the rest of the country is communicating via e-mail, Twitter, or a social networking site such as Facebook or MySpace? I’ve established e-mail accounts for octogenarians to help them keep up with the grandkids, and a free Facebook page would accomplish the same thing with a bit more zing. 4. Reminiscence I once worked with a terminally ill 88-year-old man who’d left Barbados in his thirties and had never realized his dream of seeing his country again. Imagine his expression as I entered “Barbados” into Google Images and up popped photos of the country he thought he’d never be able to see again. This intervention generated a flood of memories and a profound sense of relief and closure. Reminiscence could also be conducted in a group format, with connection to a large screen, so that residents should share with others information about their home countries or hometowns. 5. People search One of my favorite things to do with residents online is to find their long-lost friends and relatives. For example, through the Internet white pages, I helped one extremely lonely and depressed resident find a friend with whom he lost touch 60 years ago. They are now enjoying an exchange of letters and photos, and my patient has something else upon which to focus besides his poor health and lack of visitors. 6. Fun & miscellany Acting under the theory that doing something enjoyable will begin the upward spiral out of depression, I’ve occasionally brought a resident to the computer to listen to their kind of music (try www.shoutcast.com ), to check out the latest fashions, or to see photos of famous movie stars (Google Images). Once a 97-year-old Panamanian resident told me she’d felt unattractive all her life because she thought her lips were too big. “Oh, no,” I told her, “your lips are considered beautiful and the height of fashion.” She believed me after I clicked on Google Image photos of Angelina Jolie. Do you have more therapeutic uses of the Internet? Please add them to the comments section below. Dr. Barbera is an author and a licensed psychologist consulting in long-term care facilities in the New York City area. She frequently lectures on subjects related to psychology, aging, and nursing homes. Dr. Barbera is available for private consulting with organizations, institutions, and individuals around eldercare issues. Visit her personal blog at www.mybetternursinghome.blogspot.com .