Tuesday, July 28, 2015

Reporting Neglect or Abuse

Standards in Long Term Care Facilities. What are they? Who makes them? Who administers them and most of all, who do you go to if you suspect neglect and/or abuse?

Where to research Long Term Care requirements, standards, systems and procedures, some suggestions:

Federal Regulations
State Regulations
Health Codes -- Federal, State, Local
Building and Maintenance Codes -- Local 
Professional Accreditation Agencies for medical and service providers of Seniors

What is neglect? How far should you let a situation go before you take action outside of a facility? Where should you go?

Neglect is a failure to provide a service or ensure the safety and well being of an individual that falls outside of or below established standards or affects the individual's personal level of service expectations and may endanger their health or well being -- my definition gathered from various laws and writings on the subject.

The challenge for all of us is raising the bar on these standards as some are so vague or so low as to allow neglect and abuse to not only happen but to escalate and cause increasing incidents of accidents and even death.

What is abuse? What's the difference between neglect and abuse? 

Abuse is legally defined as well as socially defined. It involves taking advantage of another human being for personal or other benefit.

Abuse is usually covered by Federal and State Statues. 

Unfortunately, the Statutes are also general, broad and leave a great deal open to interpretation.

Sadly, it takes money and time to pursue litigation and residents of Long Term Care generally have neither.

Who can report neglect or abuse?  ANYONE.

Where can you report neglect or abuse?  There are not for profit agencies and government agencies. 

The effectiveness of each one depends on the individuals administering agencies, departments and even those who are assigned to a "case" or to follow up on a request or concern.

Can you "see" neglect and abuse?  SOMETIMES it's right in front of your eyes or you see something you believe might be abuse or neglect. SOMETIMES it's hidden in actions and words that appear to be "helpful" but are actually demeaning, demoralizing and destructive to the individual. 

Look carefully, listen closely and remember, above all, these are adult human beings who may have challenges physically, emotionally or mentally but still have feelings and retain individual rights to respect, dignity and consideration.

Neglect is often due to poor or lack of training and information, lack of time or amount of staff, burned out or uncaring individuals or a facility that does not effectively monitor, evaluate and completely inform staff through access to accurate and current information on physical, emotional and mental conditions of residents. 

Another cause is based on finances -- either the need or desire to "save money" spent on care for residents to increase the bottom line or to stay in business -- both cause more problems for society.

Abuse is continual disregard for the individual and actions, words or deeds that cause the perpetrator to supercede the individual rights of the person for their own wants and needs.

What can we do?  Share our concerns publicly.  

We're concerned about who comes into our home to do repairs, where the best buys for travel and even for household cleaning items are located but we do not establish a rating system, a reference point for Long Term Care Facilties.

An unbiased, open forum type gathering of information where real people voice concerns and concerns are grouped into categories for easy reference. Anyone want to start one?

I do not see the "Star Rating System" now used by the Government as valid, valuable or even useful as it relies on information gathered from State Inspections. 

Society has a basis of needing these institutions to continue to provide care, stay open because closing them would add costs of relocation and alerting the general public to the real challenges inside these closed doors but we don't get real, accurate and measureable information.

What are you willing to do to ensure the safety and well being of the men and women who rely on us, you and me, to protect and defend them as they did as parents, citizens and serving in Wars for our well being and safety.

What will you do today for those in need and possibly for your future self?

Wednesday, July 15, 2015

Perception versus Reality

Did my eyes deceive me?  Was Mom receiving good quality medical care in her facility?

What exactly is "good quality" medical care?  

What are the standards, who creates them, who oversees them and who enforces the standards?

Standards are set by individual States. They must adhere to Federal Standards and Regulations. These are broad and open to interpretation and if you read them, you'll see what I mean.

Why are they so broad?  Good question.  Could it be money for the programs flows (some would say trickles) down from the Federal Level to the States and as it moves through channels there's a "loss" due to Administrative and other costs generated through this passage.

How many people are employed within the Senior Services Sector administering programs through Federal and State departments?

How many of these actually have any contact directly with the people they are supposed to be "serving"?

What are their job requirements for their positions?

Usually minimal. Some not requiring a college degree much less one in a specialized area.

What authority do any of them have directly to take or cause action to be made when violations are suspected?

Very little. READ YOUR STATE'S STATUTES and their Rules and Regulations for the actual content. 

Look closely and you'll see a very wide berth of "interpretation" is given and when violations are found -- well, try to find out what the consequences are. If you can find this "hidden" information, let me know -- I'm still looking.

THE DHSS IS THE BOTTOM LINE.  That's each State's Department of Health and (according to where you are) Social Services or Senior Services.

In Missouri, there are one/two mandated yearly "inspections". They're supposed to be "unknown" but it's guaranteed someone at the facility is usually aware of the upcoming "visit" and many coincide with the anniversary of their yearly recertification so within a month a facility is aware of this visit.

What about the general public, you and me?  Do we receive any notice of this visit so that we can meet with a representative and voice our concerns?

NO.  Only once at three facilities have I ever seen a posting of the DHSS being "on site" and available for friends and family of residents and even the general public to meet with them.

WHY NOT?  Are these "inspections" similar to the health inspections at many restaurants where it's "in and out" and "who you know" that gets a rating?

WHAT ARE THE RULES? THE REGULATIONS? What are the questions asked, the specific details of the requirements in the areas the DHSS investigates?

We can't see clearly because information is not transparent and readily available.  Why not?  Well, if we truly saw and understood the conditions that are tolerated, overlooked and set aside in Long Term Care Facilities due most probably out of a fear that closing one means fewer places for those who need them, we would be picketing in the streets.

ALAS, we continue to "park" our parents and grandparents, aunts and uncles and tell them "we'll see you again soon" and "have a nice day".  

What if they don't? 

Who really cares enough to do something -- night or day, weekday or weeknight? 

In Missouri, and possibly your state, no one. 

Perception -- seeing their world through rose colored glasses-- the way you want it to be.

Reality -- clear lenses magnifying the view to show the reality of neglect that grows in many cases to be abuse; unrecognized and untended because there isn't enough vigilance and transparency to ensure safety and well being. 

Sunday, July 12, 2015

Seniors Suffer Isolation In Many Long Term Care Facilities

Where would you be without your cell phone? Who would you be without the ability to communicate with whomever you chose at whatever time you wanted?

How would you know what was going on in the world without the ability to click and search on a TV for the news, weather, entertainment and general information on daily life and living?

Magazines. Newspapers. Computers.


What would your life be like, what would your world be like without the freedom to access information?

It would be like living in many long term care facilities.

Do you really believe everyone in Long Term Care Facilities are "so far gone" they have no ability to think, to reason, to care?  THINK AGAIN.

Yes. Residents can have a TV in the room. Provided they can afford it or it's allowed as part of their "property allowance" under the rules of Medicaid, if they're recipients; usually a maximum of $999 in cash and assets.

Maybe there's a "common area", possibly more than one, where a TV is placed, usually on the wall. 

Who controls the TV?  The Staff on duty, of course.

What's on?  Often it's whatever someone thinks they'd personally like to watch and sometimes not appropriate for individuals with mental challenges. 

No one talks about "screening" TV programs in facilities and so programs that can often depress or even frighten minds that no longer can sort through reality and "make believe" are "entertained" with murder and gore. 

Some facilities "park" residents in front of a TV much like parents parking children -- as a "sitter", something to do, a way to relieve the need to watch, care for and find something constructive or stimulating for the mind or body.

ISOLATION COMES IN MANY FORMS.  In Mom's previous facility, there are books on a shelf in the "living room" just off the main entrance to the facility. It looks good. As it's meant to do. I've only seen one woman reading books in all the time we've visited. 

Magazines? We've started taking some to a resident but haven't seen any and certainly not on the residential floors in any "gathering place" for residents.

Inside the lower level Activities Room there are some Videos and DVD's. Not on the floors where residents live and where they would have their TV's/entertainment centers.

Locating the Activity Room "in the basement" of the facility -- where there's also the laundry, the very small "gift shop" for residents and some facility offices -- is not convenient to the majority of residents who are physically incapable of making their way to the location. Then, too, it's closed "after hours" and so residents must plan to visit to pick up a movie; a major feat for those with physical and/or mental limitations.

Interesting Point to Consider:  Walking around the facility when we were trying to find a better place for Mom to live, we were "impressed" by these "features".  

We didn't fully analyze or consider the limitations but accepted the claims made and what we saw as being "inclusions" when they were really exclusions for many in the aging population.

Physical challenges and growing medical problems isolate residents and so do actions on the part of facilities to limit provisions of services and availability of choices.

You may not have the choices you believe you'll have when you grow into the very late, later years of life so many are achieving.  

Are you ready to give in and give up as they learn to do?

Or, will you begin now to raise your voice, open your eyes and see more clearly how we continue to accept, tolerate and even propagate these conditions by not recognizing, actively working to change and ensuring full transparency within Long Term Care Facilities nationwide.

Sunday, July 5, 2015

Senior Workforce: A Valuable Asset for Society

Age equates to incapacitation and incapability in many minds.

In fact, it's a News Story when someone who's in their 80's or 90's appears to be physically fit and capable and/or mentally fit and capable. 

This morning a young man in his mid 20's was featured on a news story because he'd had a stroke. Interesting because society generally doesn't see physical challenges as belonging in that age sector.

Actually, if you do a little research, you'll find there are many serious diseases that can and do affect individuals at very young ages including cancer, heart disease, liver and kidney ailments, Multiple Sclerosis, Lupus and others.

The reality is health issues can strike any age, any time in life.

The picture painted of growing old is loss and incapacity. 

The challenge is why, where and when in the "aging cycle" (which we all grow through from birth onwards) society begins to paint this picture and with what amount of emphasis society puts on those specific challenges.

Then, there's the Language Factor.  

In a rapidly changing world we've also reinvented or redesigned language. 

Terms that were once limited to a Doctoral Thesis on Business and Economics are becoming common everyday terms used in all types of businesses.

Those who are moving ahead on the ladder of time past the forty and even the fifty something mark are running as fast as the twenty somethings to assimilate the language and apply it correctly.  

Unlearning, relearning and erasing non applicable, non "now" phrases and expressions along with assimilating as quickly as possible the new professional acronyms and explanations.

So why don't companies value the input of the older generation?  Why do they often see 54 or 64 as a "cut off"?

Do they fear their ability to analyze and discern? 

Millennials I've met rate high on the scale of using this same level of consideration. Just ask them where they want to work and where they don't, you'll be surprised how many opt out of the large corporate sector seeing it as demoralizing and demeaning of humanity in general. 

Shouldn't be news to anyone. Read the websites and see how corporations work to generate a picture of consideration, compassion and concern. Some deserve it while others are simply giving "lip service" to attract the employees they want.

Are Seniors only prospects as consumers for hearing aids and walking aids?  Or maybe Term Life Insurance?

Time to look around and see the realities. 

Seniors are concerned and rightfully so about their income lasting through a lifetime that may stretch into the 80's and 90's but if we value their contributions and keep them gainfully employed those worries would not be so great for the individual or society.

There are positions they could do including work from home.
It can be a  lack of tools and abilities due to not being considered "teachable" or "worth the investment" -- as I see it -- that holds them back and keeps them out.

The age groups of 18-25 and those of 55+ are truly in the same employment "boat" -- the younger ones are trying to board the vessel and the older ones are trying to stay onboard.

Seniors can be very dedicated, could work hours others don't want (due to their internal clocks waking them earlier and earlier --see studies on this fact) and have a sense of dedication to a job not seen in younger generations who are looking for the next, the better, the more important position.

What a waste. Believing the years past 60 are just for retirement.

Or, believing the value of an older woman is to be a babysitter for the grandchildren and an older man to be someone who shows the grandchildren how to "do things".

Maybe for generations past where skillsets were not as varied and lives of women weren't in the workplace. 

These were the continuations of a lifestyle where women were in the home and men in the workplace -- many in jobs involving using their hands and creating or repairing.

Oh, and of course, Volunteering and Charity work are acceptable but not necessarily the paid positions in organizations.

We've passed legislation extending tolerance legally in many areas including most recently marriage. 

Time to work on Ageism and remove it from the list of "ism's".

The value of a person doesn't being or end according to a calendar. 

IF we value human life, we value all ages and we respect individual rights.

Wednesday, July 1, 2015

So Sorry For Your Loss

Later today, I'll attend a celebration of life, a retirement party for a friend I made along the way after my husband's passing.

She, too, experienced this loss. Younger and without the secondary care giving for a parent, I saw her continue her busy life and move forward knowing the piece that was missing was being a wife as well as a mother athough she still had a son living at home as I had a daughter.

How long has it been since we've sat and talked like we did before she joined the "widow's club"?  

As she started her journey, that solo time of working through life as it is becoming while staying the same through so many changes and adjustments, we moved apart.

Time passes differently now. Measured by other ways and means. 

Trying to remember one of the last times I saw her. We've emailed a few times but haven't "come together" -- ships passing in the night, as the old saying goes.

Daughter and I went to the funeral. Funerals become more prominent in your memory when you have them close in your life even when they're not of your own family members.

We went to the cemetery. I was a little reluctant to go. It was the same cemetery where my husband was buried. 

Memories of that day, of the procession from the hearse to his final resting place. 

I'd chosen men from among his friends and people who walked with him in life: our two sons to represent our family and his continuation, his sister's youngest son to represent the family of his beginnings.

One man who went to college with him (and me) and we'd remet in a local service organization many years later. 

I'd asked a much older man we'd known through our Church and who my husband worked alongside. 

Sadly, he passed within a day or two of my husband -- unexpected but understandable as he'd lost his wife, whom we also knew, just a few months before. 

He was to be an honorary pall bearer because of his age -- in his mid nineties. I'm sure he was there in spirit.

As a second honorary pall bearer, I'd chosen a neighbor who moved into their house just months before we moved into ours and ironically his birthday was the same month and day as my husband's. 

I remember going out to dinner with him and his wife (something we did very seldom) to celebrate their mutual birthday and to ask him to be our pediatrician for the daughter we were expecting -- our late in life blessing.

One was another friend from high school -- we'd become Godparents for their youngest son. And one was a friend he'd made in high school and kept through many moves around the country both on his part and on ours.

I remember being concerned about the last man because he'd just mentioned during the time we were together he'd had recent heart problems. I walked close to him at the cemetery and asked the funeral director to please walk nearby for help if it was needed. 

Yes, many of those carrying my husband were close in age; some had health issues; he had seemed to be the healthiest of the group, actually.

I remember stopping by to visit my husband's grave so many times in the beginning. Then, I couldn't bear to visit because there was no headstone, no marker, no identity. I visit more infrequently now. 

There are changes that must be made so we both can truly rest in peace. 

Death can do more than take someone; it can cause others to act in ways that are less than honorable.

I remember going back and watching as the site went from being a "new grave" to one that began to look the same as all the rest with grass growing, leaves blowing in the wind around the headstones, snow on the ground and the flowers, real and artificial, left to mark visits of those who loved and were loved.

We bury our dead but not our memories.

Death takes a mighty toll. Even when you believe you're in control, thinking and acting reasonably and responsibly, there is a form of  "shock and awe" that surrounds you and envelopes your entire being.

Death changes so many things. Plans of people, their hopes and dreams and their wants. 

So sorry for your loss is heard so many times in the beginning and then fades away.

We who remain are within a different time and place and we learn to adjust, to see the beauty again and to live the life we have looking forward while continuing to look back.