PADWA LAW

It is crazy that RI has only required statewide criminal background checks for employees of nursing homes, home care agencies and others providing care to the elderly. Nursing homes have strenuously objected in the past to regulations requiring nationwide criminal background checks because of the cost. RI should move… as quickly as possible to get the program running and linked to the national database and then to pass regulations requiring nationwide checks.

Check out this ProJo article for more informaton: http://bit.ly/fg8BZx

We all know that death is inevitable. About 2.5 million people die each year in the U.S.  Eighty-three (83%) percent are receiving Medicare benefits and 25% die in nursing homes. 

Over the past decade, the use of hospice and palliative care has grown.  Hospice and palliative care are similar and different.  Hospice is a philosophy of care that accepts death as the final stage of life.  The focus is on quality of care, and not length of life. Palliative care relieves the pain, symptoms, and stress of serious illness. 

Hospice is triggered when a physician reports that patients have less than 6 months to live.  At that point, patients may receive hospice care, which usually includes a nurse to address physical needs, a social worker to help with emotional and other support as well as volunteers who help with basic needs that families cannot meet. 

The goal is to die “a good death.”  Advanced planning and advanced directives are essential in achieving “a good death.” 

The Patient Self Determination Act passed in 1990 requires health care facilities receiving Medicare or Medicaid funding to inform patients of their rights to refuse medical treatment and to sign advance directives.  Advance directives are like living wills and health care powers of attorney, but are different than DNRs.  DNRs are physician’s orders contained in a patient’s medical chart.    It is common for healthcare providers to not follow advance directives because people do not fill them out; they do not become part of patients’ medical records and oftentimes there are unresolved family disputes.  Advance directives should be documented.  However, good planning is NOT a document, but rather an ongoing discussion with loved ones. As death becomes more person centered, the questions we ask our dying family members are crucial to ensuring a “good” death.  The One Slide Project (www.engagewithgrace.org) is a great tool for asking questions.  The point is to engage death with the same purpose as life was engaged.  Ask the following questions using a scale of 1 to 5, where “Let me die in my own bed, without medical intervention” is a 1 on the scale, and “Don’t give up on me no matter what, try any proven and any unproven intervention possible” is a 5.  

1. Where do you fall on this continuum?
2. If there were a choice, would you prefer to die at home or in a hospital?
3. Could a loved one correctly describe how you’d like to be treated in the case of a terminal illness?
4. Is there someone you trust whom you’ve appointed to advocate on your behalf when the time is near?
5. Have you completed any of the following: written a living will, appointed a health care power of attorney, or completed an advance directive?

Check out this article in Provider Magazine for an excellent discussion of these issues.  http://bit.ly/gbSjUu

Here is the current list of the 50 largest nursing home chains. My experience leads me to strongly suggest that families avoid nursing homes owned by these chains. They tend to focus on making money rather than providing good care. As a general rule, families should look for non-profit independent facilities that are operated by a religious group.

The cost of nurses and nursing aides is the biggest expense for nursing homes.  Large chains tend to understaff their facilities in an effort to make as much money as possible.  Most states require nursing homes to disclose the number of hours of nursing care per patient per day.  It should be more than 4.1 hours per patient per day.  Good care is impossible with less time.  Get this information in order to make an informed decision about nursing home placement. 

Visiting loved ones in nursing homes is always important, but especially during the holidays.  Visits improve a resident’s health and quality of life.  It is well known that nursing home staff provide better care for residents who receive regular family visits.

The National Consumer Voice for Quality Long-Term Care offers the following suggestions to make visits the most enjoyable:

• Plan your visits around what makes you and your loved one comfortable.

• Ask/arrange to eat a meal with your loved one at his/her facility.

• Offer to accompany your loved one to a scheduled activity or program.

• Decorate your loved one’s room, do a craft or write cards together or bring his/her favorite holiday foods to help remember holiday traditions.

• Sing holiday songs, look at photo albums or watch family videos. Maintain and adapt family traditions to maintain family identity and feelings of belonging.

• Spend time together: take a walk, watch favorite TV shows or movies, read out loud or talk about family or current events.

• Describe your loved one’s condition and behavior to non-frequent visitors. Look at photos and talk with your loved one about who will be visiting.

• Monitor your loved one for agitation, frustration and difficulty communicating. Try not to overwhelm him a resident with memory loss to calm down.

• Take pleasure in your visits and the joy that you share. Though your loved one may not be able to converse a great deal, it is important to spend time together.

• If possible, tell your loved one when you will be returning for your next visit.

For more information about visiting loved ones in nursing homes, check out this report produced by the Consumer Voice. http://bit.ly/i0zaI7

Home health care for the elderly is one of the fastest-growing industries.  According to statistice cited by Inc. Magazine, by 2030, 71 million Americans will be over age 65.  Currently, thirty (30%) percent of elderly Americans who are not in assisted living live alone, and 90 percent say they want to remain living in their homes.

New businesses are targeting the homecare market.  Many are using technology to help seniors live independently. For example, GrandCare Systems, based in West Bend, Wisconsin, installs sensors around the home to monitor motion; check room temperature; and allow remote reporting of health indicators like blood pressure, pulse, and weight. A communications base, accessed through an ordinary television, delivers content that includes weather and spiritual offerings and enables communication with family, friends, and caregivers.

While these new businesses offer valuable and exciting new possibilities, families should proceed with caution.

Checkout this recent article in Inc. Magazine.  http://linkd.in/c2HPdq

Attorneys dealing with the elderly make judgments involving diminished capacity every day. Attorneys must determine whether the prospective client has sufficient legal capacity to enter into a contract for the attorney’s services, and must evaluate the client’s legal capacity to carry out the specific legal transaction(s) under consideration. In both cases, attorneys must conduct an analysis of the elderly client’s capacity considering the client’s cognitive and emotional abilities.

While there is no single indicator that provides a consistent, clear sign that an older person is functioning with diminished capacity, there are signs, which together may reflect diminished capacity.  When certain signs are present in sufficient number and/or severity, it may indicate a need for further evaluation by an independent professional.

Indicators of diminished capacity include: cognitive signs, emotional signs and behavioral signs.  In addition, mitigating factors should also be considered such as stress, grief, depression, recent events; normal fluctuations in mental ability and fatigue; hearing and vision loss as well as cultural traditions.

For more information, check out http://bit.ly/cBslZm.

A new report by the American Association for Justice (AAJ) illustrates how the civil justice system is the most effective force in uncovering abuses by corporate nursing homes and insurance companies that target elderly Americans.

There are 1.5 million elderly Americans currently residing in nursing homes – facilities that are now operated by mostly large corporate chains banking on the upcoming influx of baby boomers. Many of these vulnerable residents have suffered abuse by staff members and even died from dehydration or infection caused by inadequate care. The report explains how litigation has revealed this neglect and abuse and allowed residents and their families to hold offending corporations accountable.

The report, titled “Standing up For Seniors: How the Civil Justice System Protects Elderly Americans,” can be found at www.justice.org/seniors.

Last night’s meeting of our group, Passionate Participants for the Elderly, was terrific. We worked on our Nursing Home Report Card and also planned for several Advocacy Training Workshops. Notes from the meeting will be posted shortly. Thanks to all in attendance. We missed those who could not be with us and look forward to seeing everyone at our next meeting on November 16th.

For more information about our group, join our Facebook group at http://on.fb.me/ceJCBy or send me an email at jeffrey@padwalaw.com.

It’s Not Too Late to Register for  The Senior Agenda Coalition Conference & Expo.

Friday, October 22, 2010; 8:00 AM-2:45 PM

Crowne Plaza Hotel, Warwick, RI

There will be valuable workshops & great speakers, including:

1. Buddy, Can You Spare a Job: The seven common mistakes and the five keys to success for senior job-seekers. 

2. The Spirituality of Aging: (Rev. Marie Carpenter, ABCORI, and Rev. Ethan Adler). 

3. Difficult Conversations: Initiating and continuing conversations between seniors and family about the need for help. (Susan Graefe, MSW).

4. Supporting Caregivers (Elizabeth Morancy, former Executive Director, Alzheimer’s Association, and Kathy McKeon, Senior Services Director, Diocese of Providence).

5. Creative Opportunities for Senior Volunteering (Janice Pothier Pac, Serve Rhode Island and Deb Tanner,

   Southern RI Volunteers).

6. National Healthcare Reform: What it means for seniors. What RI is doing to take advantage of new opportunities. (Maureen Maigret, Long-Term Care Consultant, and Joan Crawley, former Executive Director,

   Leon
   Mathieu
   Center). 

7. Finding and Recognizing Quality Long-Term Care: Jenny Miller, MSW, of Senior Care Concepts and Jennaline. 

8. Mobilizing Seniors into Serve Corps: Bernie Beaudreau, Executive Director of Serve

   Rhode Island.

 3 Social Work Continuing Education Credits Applied For.   

The Keynote Speaker is PAUL NATHANSON, Director of the National Senior Citizens Law Center.  He will be discussing the “Latest Developments at the Federal Level Affecting Seniors.”

More details can be found at http://www.senioragendari.org  

Eating and drinking are not only essential for survival; they should also be totally enjoyable.  This article provides valuable insights and makes me ask myself, “How can we help? What can we do to make eating more pleasurable for our loved ones in nursing homes?” 

Radiation therapy for breast cancer many years ago caused me to have permanent bursitis in my left arm-the one arm that is partially functional. Since then I’ve had a very hard time moving my arm in certain directions, which affects my ability to feed myself. 

When I first moved to this nursing home, I ate in the “feed dining room.” Residents were escorted in about an hour before supper. Behind closed doors we sat with aides who were there to keep wanderers in check. I found it interesting that the aides talked only to each other, but they knew that few residents in this dining room could carry on a conversation. Despite this, I found there were some benefits to eating here: I got hotter food and had quicker access to the substitute meal. 

After my initial evaluation, therapy deemed I could feed myself. Instead of elevating my elbow to eat as I had done, they raised my food tray and my arms. It was true; I could feed myself this way. But I had to turn my tray around to be able to reach items on the far side. I looked like a marionette with my arms propped up so high. Since I felt conspicuous, I decided I would not use the same setup if I went out for dinner. 

The only available place in the “regular dining room” was facing the wall. This worked out as I did not have to worry about the other residents staring at my strange eating setup. Being positioned away from room traffic made it difficult for me to get an aide’s assistance, but we devised a system where staff checked up on me at regular intervals. 

Therapy exercised me to strengthen my arm but sometimes I only had enough strength to feed myself half a meal and there was not always an aide or nurse available to help me with the rest. About a year later another therapist said that my feeding motion was exhausting me, warning that it would not be good for my digestive system. She told me that the only way to avoid that was to be fed. 

As a “feed,” I chose to eat after the other residents. I decided being last could be better because more aides might be available then. However, waiting to be fed in the dining room frustrated me because I did not like sitting around doing nothing. 

When I finished eating in the dining room, it was hard to find an aide to assist me with toileting or setting me up at the computer. I’ve since been eating meals in my room, which allows me to at least stay busy on the computer until it’s time to eat. My meals are delivered on a fiberglass tray, usually served on bone or white dishes. Sometimes maroon, thermal bowls are used to keep items to temperature. 

My low-calorie diet causes many foods to be very dry so I need to drink frequently during a meal. There are also occasional delays when aides need to do go to dietary to get a substituted or missing item. 

Some aides say very little while I am eating, even though I face them. If the aide does talk, I try to make sure that we do not lose track of time. 

With all of that said, being fed by another person makes me feel quite helpless.

This article is found at: http://www.ltlmagazine.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=85E81568FCA64466A7085E9D57D4D9AF