Thursday, November 27, 2014

Postcards From The Edge: Create The Golden Years Now

I think I know why I spent so much time in the library when I was growing up -- to prepare me for my focus in life which has been finding information most people have no idea exists or where it can be found.


At least that's what I tell myself when I go exploring and want to find more substantial information about subjects like Senior Care -- so important because we're all headed there.


Just like those Tropical Destinations or Great Vacations we've all dreamed about and many have taken, we want to enjoy the trip and the destination.


Without the "postcards" and the "brochures" meaning the pieces of information and the connection to specific insights, our "Golden Years" may weigh on us like a lead anchor we can’t shake off and gets heavier and more burdensome as time passes.


As I’ve mentioned before, I like the factual information I can find on AARP but getting to that point sometimes means wading through volumes of ads, pop up videos and other distractions.

Found on line by clicking through to:
http://www.ahcancal.org/ncal/resources/Documents/residential-care-insight-on-the-issues-july-2012-AARP-ppi-ltc.pdf


"Assisted living and residential care residents are overwhelmingly female (70 percent). More than half (54 percent) are age 85 or older, and just 10 percent are younger than 65. Approximately one-third of residents (33 percent) have been living in the facility for less than a year; 36 percent for one to three years, and 31 percent for more than three years."


"About 74 percent of residents receive assistance with ADLs. (inserted note: Activities of Daily Living)  Thirty-seven percent have three or more ADL limitations, and 42 percent have Alzheimer’s or other dementia. Approximately one in five residents (19 percent) receive Medicaid assistance, and 43 percent of facilities have at least one resident who receives Medicaid." 

LET’S SUMMARIZE AARP STATS FOR SENIORS IN LONG TERM CARE


More than half are age 85 or older. We’re gaining years of life; do we really want to spend those years in facilities that shelve us rather than provide quality of life?


About 3/4 of the amount of residents NEED assistance with Activities of Daily Living. This means a range of possibilities requiring at least one person or possibly two for some type of assistance.  MY CONCERNS:  We’re not accurately assessing how much assistance and what type to adequately and safely provide this assistance. I’ll discuss more about the types of assistance in another blog entry and how critical it is for some functions to be done by more than one person at a time – Gait Belts can endanger people.


…and 42 percent have Alzheimer’s or other dementia. It’s not stated if the Dementia is diagnosed or observed or both; general info available elsewhere would up this figure considerably esp since the above statistic of more than half of the residents are aged 85 or older and one form of Dementia, Lewy Body Dementia, is more difficult to recognize and is just beginning to be counted as a MAJOR contributor to the Dementia population.

Approximately one in five residents (19 percent) receive Medicaid assistance.  With costs skyrocketing in all areas of living, we’ll soon see this figure, in my opinion, double or triple. Hard economic times, inability to set aside funds needed for daily living, larger families requiring more maintenance (the baby boomer family size of 2, 3 or maybe 4 is today 3, 4, 5 or maybe more). Higher cost of living; higher expectations of living; constant changing needs to update, upgrade and built in obsolescence causing need and not just want in replacement – thrown out/not repairable and obsolete/not outdated.

43% of facilities have at least one resident who receives Medicaid.  Many facilities are trying to move away from accepting Medicaid. Long Term Care Insurance, when medical costs are a part of the distribution, are as challenging for the policy holder as they are for the facility and we all know how difficult Private Insurance offerings are as they change from year to year and seem to eliminate more and more. So, Government provided Insurance or Private Company provided, there will still be many challenges in these arenas.

SENIOR CARE CONCERNS NEEDING CONSTANT INQUIRY 
  • Technology is advancing. There are far better and easier, less time consuming ways to record and ensure accuracy than ever before.  
  • Systems and procedures are being developed and need to be put in place through mandatory conformance.  
  • Standards of care provision for our growing Senior population need to be ensured through mandated reports that are transparent and readily available.
  •         HIPPA can be adhered to, information can be made available                   it’s not either or, it’s both in tandem.
  • REMEMBER:  If you’re one of the “lucky” ones to live well into those Golden Years…..You, too, can be one of the statistics listed above or on many websites.
              OR, You can work now to change the statistics
                    RAISE THE BAR     SET THE STANDARDS HIGHER  
                                       CREATE REAL GOLDEN YEARS
                            THROUGHOUT THE SENIOR CARE SYSTEM

Wednesday, November 26, 2014

Peace of Mind: Stop Ongoing Abusive Behaviour

It’s almost December. January and another new year with two anniversaries of death will soon return; my husband’s on Jan 5 and my mother’s on Jan 10, on the third anniversary of my husband’s burial.
 
You don’t forget or set aside these times, these dates, when the people who passed are intricate and daily parts of your life who you loved, cared for and about.  
 
Visiting Mom’s gravesite is a little difficult but I know other relatives visit when they go to see their own loved ones. We’ve found remnants of flowers, a potted Pansy (for remembrance), on Mom’s grave when we visited several weeks ago. It’s an hour’s drive to the site and a gravel road, not great travelling in this cold and uncertain Winter weather.
 

Visiting my husband’s grave is far more difficult even though he’s buried much closer. Although I’m still comforted by surrounding gravestones with memorable sayings that gave me solace when we looked for a different gravesite for him, for me and for our daughter and her future husband, it’s disturbing.
 

I can’t go as frequently as I’d like because I won’t be buried with him. My oldest son has made that impossible. I will not allow myself or my daughter, and she is of the same opinion, to be controlled and manipulated by him or by the cemetery who calls our situation “a family matter” and refuses to stop the abuse we’re enduring.
 

We won’t continue to be abused now and we won’t be afraid of a future where my oldest son or his heir(s) might refuse or make the whole process of burial and saying goodbye full of hostility and regrets.
 

When I agreed to inter my husband’s body in a cemetery different from the one we had planned, actually just across the street, it was openly discussed within the presence of a representative of the Cemetery
    • (1) we had available burial space, free and clear, titled to me, within the other cemetery
    • (2) both sons had shown through their reactions and our talking they would prefer not to have their father buried in that cemetery due to its lack of care and maintenance
    • (3) I was not able at the time to cover the amount required to inter my husband but would take over payments
    • (4) I negotiated the lowest possible payments over the longest span of time believing as times passed we’d both (daughter and I) get jobs and be able to make minimal payments,
    • (5) daughter suggested burial with us and her taking responsibility for 1/2 of the cost and myself 1/4 and we would purchase 2 graves with possibility of four internments, 2 in each, and  
    • (6) it was agreed by all I would be on the contractual agreement
My oldest son was given a copy of the contract on the first day we visited the “new” cemetery – the day before we actually made the decision and the commitment to inter my husband. It was a significant additional expense and I was basically asking both my sons for help with burial assistance due to the debilitating expenses of both my husbands long term medical challenges and the costs incurred with my Mom’s growing care needs and our having used all resources we’d accumulated.



On the second day, when we decided as a family to have the burial at the “new” cemetery, I recall asking my oldest son when he went outside the conference room “to check on the contract’s being ready” if I should go with him and his telling me it wasn’t necessary as he was just checking. Then, when he came back, asking him if there was anything I should do and his answer that nothing was needed at that time and he’d signed the contract. I asked if they needed me to sign and he said it wasn’t necessary.
 

He lied. Plain and simple. Nothing new. Same problems we experienced when he was younger; same problems we experienced in our relationship with him and also with his wife. You don’t think straight when you’re mourning; when challenges are coming right and left as life throws curve ball after curve ball.
 

I cannot chose to live with the emotional abuse his ownership of the gravesite provides both me and my daughter. We don’t know which of us might need that site first, daughter or myself; God alone knows.



The law provides no rights to our daughter.. Oldest son and his heirs hold all the rights of internment and monument erection as everything currently stands.


He knew it. He received a copy of the contract and I did not. Again, over a year of medical caregiving and emotional distress with husband’s more than 100 days hospitalized almost all in intensive care/critical intensive care and the ongoing challenges faced by the woman who abused Mom – neither of us were thinking, considering or believing this son, this brother, would abuse us – again.
 

The Cemetery is owned by the same religious denomination who turned their backs on the abusive situation caused by one of their members; who told us we had to forgive the woman who abused Mom and our family.



What to do? How to regain my rights my oldest son took away and this religious denomination turns their back on remedying? Walk away? Be buried elsewhere? Cremated? The choice is not just for me; the choice also involves my daughter.

 
We’re deciding.  We’re focused on ending the abuse we’ve endured for almost four years. If we decide to move my husband, the cost will be extensive and there are legal procedures with high costs.



On our forty second anniversary, my husband lay in a hospital bed in critical intensive care. I couldn’t find a card in the hospital gift shop. I saw a child’s “Magic Slate” and wrote a special message I placed it where he could see it:  “Happy 42nd, Darling!  In Sickness and in Health, To Love and To Cherish”.

 
Now, our oldest son, violates our vows as he changes the words: “Let no man put asunder” the joining together of husband and wife, of my husband and myself, and instead makes even more meaningful the words, “Til Death Do Us Part” as it appears I will be forced to do by my oldest son.





Wednesday, November 19, 2014

A Double Edged Sword: Gericare Chairs & Facility Accidents


This is an entry I started in November, 2014. 

Sometimes I move on to write other topics. Sometimes the topic is too "recent" to post; too hard to share at the time.

November 19, 2014

Just a couple of weeks ago leaves were changing and dropping on the ground. Some dried and were soon to be removed with rakes and bags. Others were still clinging with all their remaining strength to stay on the tree as long as possible, especially the Oaks.


Many of our aging are Oaks; standing strong against the challenges life presents, surviving, providing. 


They moved forward believing what they’re told about the “Golden Years” that seemed so far ahead that when they arrived, they still thought those years were far into the future.

And when their time was near, when their days were far less than before, how are they seen, how are they treated, how are they honored for what they have provided, given and endured?

Now, outside it's unseasonable, unexpected cold, snow and ice -- weather reflecting similarities between nature and changes in life for many of our aging population -- sudden, at levels not experienced before and with side effects not expected. 


Like the lives of our aging population and those with medical conditions that do not necessarily improve or “get better”, a bitter time of suffering, enduring and coping are everyday challenges for many who are “cared for” at levels we wouldn’t approve of for children or animals.

Gerichair -- interesting word, Gerichair, "geri" being short for Geriatric meaning "of or related to old people"  "especially for their care" according to an internet search.

A special chair used for many purposes in hospitals and medical facilities. It can be used during dialysis, blood collection and respiratory and cardiac care as well as in Long Term Care Facilities.

In general, medical facilities like hospitals and out patient centers, individuals would scream if they had to endure equipment that caused physical harm to their bodies. 


In Skilled Nursing Centers they scream, too, but who’s listening?

People in SNC's often must be moved, lifted, placed in these chairs. Use of a special lift, a Hoyer can be involved. 


In SNC's people often spend hours in these chairs with little or no adjustment (although this is medically incorrect) or only simple adjustments to change the angle of recline and not the positioning or adjustment of the body leading to sores, abrasions and other medical conditions.

It's a positive asset for eldercare when used correctly. It is a negative and an endangerment when used incorrectly. 


Unfortunately, few who place residents, oversee residents or tend to residents in Gerichairs check to make certain there are no rough edges or places that can cut, bruise or harm the elderly. Few facilities ensure their attendants and especially their RN's and LPN's are required to regularly check and notate their observations regarding the use of these "medical devices".


It’s up to the “Nursing Staff” and Administrators to determine when and if adjustments are to be made, on what basis and when. 


A few "caring" CNA's will attempt to provide caring service but they're always mindful of being found at fault for doing "more" or "less" than "directed" and so many provide services strictly as directed with no variance even when it's in the best interest of the resident.

What are the Mandated Requirements for monitoring or recording when any changes in positioning, checking with communicable individuals for their wants/needs, overseeing individuals who cannot communicate and providing caring adjustments to clothing and to the equipment to ensure comfort and physical protection?


NOTE: It's now January, 2017 and I still haven't been able to find the answer to the above question. If anyone has, would appreciate the reference taken by copying from the website so we can share with the hundreds of people now regularly reading this blog.

Are there any? Who's responsible for making them -- the individual facility, the Doctor assigned to the case, the resident RN, the Department of Health and Senior Services (no, don't think so, all they do is "uphold" what's written, they don't get involved (strange, right?) in making the guidelines/laws -- WHO IS RESPONSIBLE?


Guidelines and suggestions are common in the Long Term Care industry but generally both Medicare and Medicaid do not oversee or ensure Residents are provided with any specific care. 

IT'S UP TO THE RESIDENT AND TO THE RESIDENT'S ADVOCATES TO ENSURE SAFETY AND WELL BEING. 


In my opinion, too many residents are alone, without family or friends able to oversee and ensure their safety and well being. IT TAKES A VILLAGE used to be a popular saying about children; IT'S A GREAT SAYING TO APPLY TO OUR AGING POPULATION, TOO.

The chair used for Mom was an endangerment. Mom was physically mobile with her legs and arms. The chair had rough, raw edges and Mom would get her leg caught in between the side rail and the raised leg support. The metal raw edges cut into her leg. The facility never told us this was happening.


Always Look Beneath and Beyond When Visiting A Loved One In Long Term Care

We arrived for a visit and Mom had some gauze wrapping on an area of her leg. We asked Mom what happened but her ability to relate an incident became less and less as the Lewy Body Dementia progressed in her body and the end drew near. And, sadly, some will recite what’s been told to them by Staff as what happened when it’s not the truth. Mom said she didn’t know. Another common response from individuals with Dementia

Seeking out Staff, the Nurses (LPN’s by the way; only one RN is required to be on duty at a Long Term Care Facility in Missouri and he's/she’s busy “administering” and not on the floor --- safely tucked away somewhere and always seeming to be busy, in a meeting or somehow “unavailable”) we were told Mom’s “medical condition” was “deterioration” and the LPN claim the bandage was to cover a “sore” produced by those factors.

UNTRUTH. Mom had thrown her leg, she had thrown it against the raw metal edge and a cut had occurred. Only when we unwrapped the leg for ourselves did we see a cut, a gash and not a “sore” as we were told.

We watched her, also, and we saw this natural behaviour from a human being used to walking, used to rising from a chair, used to being active and a brain that still sent these messages and they were received and acted upon by the body. Mom's body "remembered" and acted even when parts of it were not capable of following through.

This wasn’t the first misreporting or coverup; that was standard operating procedure at the facility and I believe happens more often than not in almost all facilities.

 A Skilled Nursing Facility is designed and licensed to provide medical care. That is their focus, their reason for being; that is why in the State of Missouri they receive Federal and State Funds in the form of Medicare and Medicaid to provide specific services not available except in a hospital on a 24/7 basis.

The facility withheld a lot of information about "accidents" or grossly understated the effects of the occurrences.

No amount of contacting the Elder Abuse Hotline or the Office of the Ombudsman for the State of Missouri brought forth any real assurances these practices would cease and desist and would continue to be monitored.

No fine. No removal of abilities. Just a written report CITING the observance of a team that would on occasion visit the facility and a review to ensure it wasn't continuing when they rechecked. And for some reason, the “infraction” always seemed to “be corrected” when the facility was reviewed and then the “violations” were cited as “corrected”.

That was it. The End. Actually it was always “To Be Continued” because another incident, another accident, another negligence and another abuse was always just around the corner and we never knew when, where or how but we knew it would happen to Mom and to others and does every day in more facilities than we know.

Long Term Care Facilities are very adept at covering up and of smoothing over violations, even major infractions that take lives, as are many medical facilities, unfortunately.

To our knowledge, the facility started all over again with a "clean slate" and these infractions didn't seem to be tallied, recorded and actually seen for what they were -- human injustice on the highest level to those least capable of speaking out and most in fear of reprisal if they did.

Mom’s story isn’t unique. This is happening every day in all fifty states due to ineffective legislation with statutes, rules and regulations that are vague, open to interpretation and quite frankly, written many times to favor the Senior Facilities. Think it doesn’t happen “in your backyard”??? Think again.

Anyone who truly cared would have ensured Mom was immediately moved into another chair that did not have exposed and open sharp metal pieces. 


No one in the Administration, No Nurse responsible for the facility, no LPN who oversaw her section of the floor, no Aide, made a move to ensure Mom's safety and well being. Negligence leading to more challenges; Negligence that is really Abuse because Medical Professionals or Psuedo Medical Professionals have enough training and experience to realize what overlooking endangerment can do physically, mentally and emotionally to our aging population.

We couldn't be there 24/7 and the facility ignored our pleas they provide another chair. More sores, more cuts bandaged and more skin abrasions. We were not silent but we were only one voice. Unity and many voices raised are needed for any action to be taken.

Actually, the chair should have been repaired or eliminated from service by the facility but that would have meant spending money they preferred to allocated to paying for Country Club memberships for some of their higher level staff people. Yes, that's correct, the facility annually pays for certain organization Administrators various expenses including membership in local private clubs. Check it out, we did, if yours is a Not For Profit facility you can go online to Charity Navigator and find their tax filings and itemized reports.

Perhaps their reasoning for this allocation is  they have to prospect for future donations being a Not For Profit?  My opinion as a volunteer fund raiser for many years: There are many other ways to network and prospect that cost very little and produce the same results.

We, those of us who live outside of the walls of the Skilled Nursing/Long Term Care Facilities, who must survive, work, care for ourselves and others, continue to build a life as those within the walls of facilities did for so long, should not have to constantly stand guard, be ultra vigilant, spend hours upon hours ensuring those we love, those we care about, are safe, secure and treated with respect and dignity.

Care now. Make a difference. Raise your voice. Share the information we present. Be as effective providing protection for our aging population as we are as a society to children and animals.

Our aging population is vulnerable and easily taken advantage of and our laws are vague, weak and inconsequential in providing and ensuring protection, self determination and individual rights.

Tuesday, November 11, 2014

Your Life May Depend On Knowing Facilities DO NOT Control & Interpret Individual Rights

The previous two entries started my focus on encouraging more people of all ages to be aware of the National guidelines for State's Senior Living Facilities to ensure the INDIVIDUAL and PERSONAL health and well being of Seniors.


On the surface, just visiting, many people believe the facility where their loved one lives provides a "good" environment and "cares" about each resident. 


Maybe you're lucky. Maybe you can afford a facility that has higher standards and practices. But, for how long? If you don't enter "near the end" of life (and who actually knows when that is?) chances are, according to latest statistics, you'll spend at least three years in a facility.


Perhaps, like a friend of mine in Mom's facility whom we visit as often as we can, you'll encounter a very limiting life medical condition at a very "young" age and spend years inside the walls of a facility.


We've watched over the past two years as her abilities have decreased in ways we believe were due to lack of care and neglect. It seems to us that once a resident becomes "costly" in care or in wants and needs the facility starts decreasing the level and amount of service and oversight and the resident's health and well being declines considerably.


WE WANT A HIGHER MARGIN OF SAFETY FOR SENIORS IN FACILITIES


TRANSPARENCY.  MORE INFORMATION READILY AVAILABLE. STATISTICS FOR STATES AND CURRENT STATISTICS ON INDIVIDUAL FACILITIES SERVICES AND INVESTIGATIONS.


The more you're there, the more you see and hear and if you vary your days and times of visit, not just going when there are special events or activities, you may witness many nightmares others and your own loved one experience.


This site is determined to be a guide beneath the surface, into the real world where Seniors live and try to survive daily often struggling to adjust and endure ever changing reductions in service and daily needs.


DISCUSSION:  Rights of the Individual.


The Medicare/Medicaid State Guide DOES NOT focus on the rights of the facility to make decisions based on what is best for them financially including making decisions to provide or not provide a level of service or provision because they made a poor buying decision or supply purchase.


EXAMPLE FROM RECENT EXPERIENCE that's actually a constant repetition of systems and procedures at the Skilled Nursing Center where Mom lived.


Son of a resident visits his father. Dad is becoming more and more incontinent. Son constantly finds his father sitting in paper pants (with a liner, supposedly) that is soaked with urine and possibly with feces.


FACILITY'S RESPONSE:  They've changed suppliers and cannot change the man's type of pants until they "run out" of what they purchased for him and some "staff" tell the Son they can't be changed until "the supply purchased for the entire facility" runs out.


WRONG!  This decision and action are a financial decision made to benefit the facility, not the individual's health and well being.


The Senior faces possible infection, sores, and other health issues plus mental deterioration, potential challenges with behavior -- AND JUSTIFIABLY SO.


How would you like to sit in your urine and/or excrement only to be told and/or shown through lack of necessary changes and attendance this is going to continue indefinitely?


IT HAPPENED TO MY MOM.  The facility refused to provide liners for her paper pants when the pants they chose to provide would not hold the amount of urine she passed.


In the beginning, Mom was more cognizant and could get the pants changed; in the beginning, the facility was a little more responsive -- but then when a "new" resident comes in, they're very responsive for the first thirty days or so and then it becomes a descent into a living nightmare a living H---.


INDIVIDUAL RIGHTS.  That father, husband, human being HAS RIGHTS.


He does NOT have to wait until the facility "uses up" whatever supply of improperly requested, fitted incontinence pants.


THINK ABOUT THIS.  Come into the outside world and apply the same "reasoning".


You receive a prescription for a medication, a physical brace for a sports injury or special shoes or a wheelchair.


Immediately or within a period of time, you realize you're having reactions to the medication, sores produced from the brace or shoes, the wheelchair is fitted incorrectly and causing you to only be able to move forward or back but won't turn.


You go to your Doctor or the medical provider and they tell you you have to "live with it" because your insurance paid for what you received or it's wasteful to provide another type or you'll have to wait until they "get it right" with the vendor understanding how to measure or order.


REALLY?  I don't think any "outsider" which is how I'm referring to people who are privileged to live outside of the walls of a Senior facility that violates individual rights -- would stand still for this treatment. They'd be calling the local news channel, newspaper, out on Facebook, Twitter and using any and all Social Media to correct this violation of medical and personal needs.


SO, WHY AREN'T YOU?  If you have someone inside a facility and you're experiencing this type of treatment, how long are you going to sit by, stand by and believe it will work itself out?  If you have no "ties" to a facility consider "volunteering" your time to spend online researching what can be done to enlighten the public that rights are only rights when they're respected and when those capable of ensuring they're respected, ARE!


Chances are, based on statistics, the facility will outlast your loved ones and you'll walk away (or most probably run) until another time when you're "forced" to face another incarceration -- yes, that's what it can be like and was like for Mom and for us -- in facilities that, day to day, are the cause or instrumental in pain and suffering for Seniors entrusted to their care.


Will you continue to read these entries, feel sad or sorry for us and then turn away and go on with your life?


Perhaps someone should put pictures of "caged" Seniors who've been "neglected" or "abused" in facilities on the TV like current ads for Dogs and Cats needing to be rescued from this treatment.


Or will we just keep moving forward and keep praying it won't happen to us, we won't be unfortunate enough to be subjected to "that kind" of treatment.


Please add a note and tell me what humane actions in the United States or anywhere have simply been a matter of chance and not a matter of choice and action. I can't think of any.



Sunday, November 9, 2014

Rights Protected In All States Through Medicare/Medicaid

Second Subject Area: Resident Rights

Read the entire section using this link:

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf

Rights protected in all States through Medicare/Medicaid

“F153
(Rev. 107, Issued: 04-04-14, Effective: 04-04-14, Implementation: 04-04-14)

§483.10 Resident Rights

The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility. A facility must protect and promote the rights of each resident, including each of the following rights


All residents in long term care facilities have rights guaranteed to them under Federal and State law. Requirements concerning resident rights are specified in §§483.10, 483.12, 483.13, and 483.15. Section 483.10 is intended to lay the foundation for the remaining resident’s rights requirements which cover more specific areas. These rights include the resident’s right to:


Exercise his or her rights (§483.10(a));


Be informed about what rights and responsibilities he or she has (§483.10(b));


If he or she wishes, have the facility manage his personal funds (§483.10(c));


Choose a physician and treatment and participate in decisions and care planning (§483.10(d));


Privacy and confidentiality (§483.10(e));


Voice grievances and have the facility respond to those grievances (§483.10(f));


Examine survey results (§483.10(g));

Work or not work (§483.10(h));

Privacy in sending and receiving mail (§483.10(i));

Visit and be visited by others from outside the facility (§483.10(j));

Use a telephone in privacy (§483.10(k));

Retain and use personal possessions (§483.10(1)) to the maximum extent that space and safety permit;

Share a room with a spouse, if that is mutually agreeable (§483.10(m));

Self-administer medication, if the interdisciplinary care planning team determines it is safe (§483.10(n)); and

Refuse a transfer from a distinct part, within the institution (§483.10(o)).




A facility must promote the exercise of rights for each resident, including any who face barriers (such as communication problems, hearing problems and cognition limits) in the exercise of these rights. A resident, even though determined to be incompetent, should be able to assert these rights based on his or her degree of capability."

IMPORTANT:  This last statement is often a "gateway" for facilities to freely interpret the content and intent cutting corners in services and provisions for the individual and for the entire community they supervise: "A resident, even though determined to be incompetent, should be able to assert these rights based on his or her degree of capability."

FREE TO CHOOSE.  Yes, we all want and deserve that freedom. However, we must be vigilent and listen, observe and communicate with residents and families as to what is done, how it is done and where challenges exist in the daily care and offerings in a facility.


Those with cognitive challenges, who are dependent 24/7 on where they live and who cares for them are vulnerable. Sometimes their fears are unsubstantiated but sometimes they're very real. WE MUST BE VIGILENT. WE MUST LOOK, LISTEN AND SPEAK UP, SPEAK UP. For the day is coming and we do not know how close it is when we may be walking the same road, the same way.

FOR OUR FAMILY:  The facilities excuses regarding following an outside Dr's "suggestions" Mom would benefit from having more movement in her arms and legs but didn't see Physical or Occupational Therapy as needed was a "financial block" for the facility.,

There were/are no programs of individualized "motion, movement, retention of physical abilities" at many facilities. This involves staff, takes time and also costs money.


Facilities often put the $ before the human factor. Decisions are made and staff who want to retain their positions are told to follow directives.


Stretching, passing a balloon, kicking a balloon, having fun, socializing -- some facilities use these methods while others are more "clinical" and determine if it's not billable, it's not doable.

So, they OFFER with language both verbal and physical through their staff the "activity" in a way that the individual will not accept, not want and therefore not participate. VIOLA!  No need. No expense. THE RESIDENT REFUSED becomes a common entry into the individual record and the facility has maneuvered its actions safely inside the above mandates.

Is this best for our aging population? To "trick" them into submission to what the people who are responsible for providing shelter, food and care want to provide, choose to provide?

That's unfortunately more true than it is false. There are exceptions. There are great facilities. What we need to ensure is all facilities, all sizes, private businesses and not for profits, adhere to humane standards with REAL CONSEQUENCES and not just a "report", a "slap on the wrist".



Our society members advocate for the prevention of cruelty to animals. It's time we had active advocacy highly visible, easily accessible, well known and NOT connected to any agency or division of government, independent and directly focused on Senior Advocacy throughout the United States.


Friday, November 7, 2014

CRITICAL INFO: Entry 1: Medicare/Medicaid State Operations Manual

Attending a meeting of a group I started at Mom's facility, a Family Council, family members expressed many of the same concerns, problems and issues we faced during Mom's two year stay.

New Administration in now for almost two years; new food service just put in place. What's changed? From visiting, observing and now listening to family members, very little. In fact, in some areas it's getting more challenging for residents and their families.

With this in mind, decided to go back through my dozens of files on information concerning Rights of Individuals living in facilities and putting them here, on this blog, hoping more people in the United States will be drawn to reading small sections and passing this blogsite and its information along to friends and families.

SUGGESTION:  Make a list of these Rights by exact entry, number and quote the verbage as it is written. Your voice has more meaning when you use this approach. Copy it down, don't depend on memory; carry this one and the others I'll write about with you. When needed, you'll have them with you.

APPRECIATE GREATLY THOSE WHO "LIKE" THE BLOG AND "FOLLOW" US.

As we age we all face a time when we will be "taken care of" by someone other than ourselves. We may need to live in a facility. That place should be safe, welcoming, and provide safety, security and compassion.

This entry begins an overview of areas I've found highly important for those who walk the road of responsibility working with or managing the care of a loved one living in a facility.

You can access the manual  Transmittals PP by going to the following site location:
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf

It's 667 pages long and a great reference. The one I'm using for these entries latest update is currently Rev. 107 dated 04-14-14. As time passes, these entries may contain additions or deletions, there may be more sections. Please check for the latest information if this is blog is being read far past the posting date of 11-07-14.

CHALLENGE:  In facilities, it's mostly verbal communication. Even though they are required by law to keep written documentation, during visits and at Resident Care Planning meetings, we did not receive any written report, everything was verbal.

What about you who are reading this entry? What's your experience? Reminds me to find a way to put a Poll on this site. Learning as I go.

Here's the exact citation from the Medicare/Medicaid State Operations Manual governing all the United States as linked above:

#1  Resident and/or Legal Representative has/have the right to access by verbal request all records. FACILITY CANNOT MANDATE A WRITTEN REQUEST

Why do you think this is important, verbal being enough to obtain records? Possible physical challenges limiting ability to write; eyesight challenges or other limitations often come with aging.      
                Limited abilities should not limit accessibility.

"F153


§483.10(b)(2) -- The resident or his or her legal representative has the right--
  1. Upon an oral or written request, to access all records pertaining to himself or herself including current clinical records within 24 hours (excluding weekends and holidays); and (ii) After receipt of his or her records for inspection, to purchase at a cost not to exceed the community standard photocopies of the records or any portions of them upon request and 2 working days advance notice to the facility.
Interpretive Guidelines §483.10(b)(2)
An oral request is sufficient to produce the current record for review."

********IMPORTANT TO REMEMBER FROM ABOVE************
(1) oral OR written request for access to records
(2) access MUST BE granted within 24 hours --
                        (excluding weekends and holidays)
(3) AFTER receipt of records for inspection, to purchase at a reasonable
      community standards (think library copying or Office Supply Store)
      standard photocopies of the records OR ANY PORTION of them
(2) 2 working days advance notice

PLEASE NOTICE:  There is no time of day/night specified allolwance for your completion of your examination. UNLESS THERE ARE OTHER FEDERALLY  OR STATE MANDATED LIMITATIONS, you have the right to review these documents (1) more than once (2) on a basis of multiple days at a time esp in the beginning

#####THE CHALLENGE######## Unless you request "all records" and include any "historical records on file obtained from outside sources" or specify exact types of files, reports, papers, you may be given whatever the facility "wants you to have" and claim those are the "records".

In another entry we'll examine the specific types of records kept by long term care facilities which you can use as a reference.

RESIDENTS AND LEGAL REPRESENTATIVES:  You have the right to request a formal, written copy of the resident's Care Plan and any and all reports that directly affect decisions made by the facility on that Care Plan.

TO PROTECT OUR SENIORS, to judiciously manage their care, to ensure effective use of funds through systems we all pay for -- Medicare and Medicaid -- more effective record keeping and sharing should be a top priority.

Question: Did you know you, the resident, or the appointed representative and/or both, can review and determine and consult outside of the facility or get another opinion (probably at your own expense, but you have that choice; check your medical coverage) concerning the Care Plan.

KEEP THOSE COPIES. They're valuable papers in understanding treatment and progressions or regressions.

MY GOAL:  WORKING TOGETHER.
My writing, your reading and for those of you who choose, your submissions of additional information, will protect our loved ones when we cannot be with them and ourselves, as we age and move through various life challenges and stages of life.