Tuesday, May 24, 2016

Resource: Individual State Assisted Living Regulations and Licensing

With more building of "multi level" care facilities for Seniors, we need to be aware of the Regulations and Licensing of Independent Living, Assisted Living and Long Term Care.

Bear in mind, as you read the State guidelines, they are very general and allow these "businesses" to operate with minimal standards and minimal supervision.

This entry is a resource for anyone who wants to access a link to the regulations and licensing of Assisted Living in various states within the United States.

ADVISORY:  This site has sections only accessible through membership to the organization and has some connecting links that were not functioning when checked.

CONCLUSION: Site allows for discovery of connections through specific agencies responsible for rules and regulations in States and transference of this information through further internet search.


Copied from the site is some basic introductory information to provide an overview of information available through accessing the various State sites on rules and regulations for State Assisted Living Regulations.

"The following resources are available to help you learn more about assisted living in your state. Explore information related to:  
  • State Regulations A list of each state's assisted living regulations including contact information for each state's agency responsible for regulating assisted living (scroll down to see below). 
  • Voter ID Requirements For Seniors A list of state requirements relating to voter identification.
  • Argentum's State Partners Links to each Argentum state affiliate and chapter.
  • Argentum In The States (Member Only Resource) A state by state look at laws and regulations, important legislation and proposed regulations, and other state specific resources such as: elder abuse reporting contacts, important news in your state, and information on the local government.
  • Argentum's State Regulatory & Legislative Snapshot (Member Only Resource) An executive summary of Argentum's comprehensive quarterly report about pending and enacted regulation and legislation impacting assisted living."

If anyone finds a site that covers the last two areas in the above listing that's for general public access, I'd appreciate your sharing the site(s) to inform those who choose to access this blog.

BLOGGER COMMENT:  Knowledge is power and understanding the "systems" and their functioning is as important in Senior Care Management as it is in buying a home, a car or making an investment. 


Monday, May 16, 2016

The Taste of Bitter Fruit Served Continuously Through Undue Influence Lasts A Long Time

My Mother made me promise I would never place her in a facility until she had no idea where she was. 

I kept that promise.  I never put her in the Nursing Home/LTC/Old Folk's Home.

Julia H, her Undue Influencer, planned and executed every detail to ensure Mom's move from our home to a Long Term Care Facility including falsely reporting to the State of Missouri Elder Abuse Hotline preceded by her action in regaining her RN registration with the State of Missouri just months before she made her report.

Julia H took Mom to the bank, opened a safety deposit box and kept both keys. Julia H convinced Mom to remove my Power of Attorney, an appointment Mom had made decades before and I'd given her one over our daughter when Mom traveled with her. 

We believed each could be trusted and built our life together, our multi generational life, on that trust.

We lived together, Mom and I all but a few years of my life until Julia H entered our lives and saw the opportunity to take advantage of Mom, saw the advancing Dementia, probably knew it was Lewy Body Dementia, and took advantage of her and of our entire immediate family unit.

Julia had Mom take money out of our home, the little that still remained, tucked away for Mom's burial and what we'd allowed her to believe was "hers" but knew she couldn't have that amount and be on Medicaid. 

It gave Mom peace of mind to be able to count the money and know it was in her room, in our home, and we didn't care how she looked at it but we'd made that money possible over the years and had no intent, no matter how difficult the life and death journey was with my husband or with her, to use it for any other purpose.

Care giving 24/7 I'd not even thought about Mom's Social Security accumulating.  Dutifully I went to the bank for her, cashed her check except for a few dollars she deposited and gave it to Mom every month. 

Julia would use that "failure" to take Mom to the bank as a weapon in her arsenal of "proof" of abuse.  

Julia was really good at conversations with me that elicited information I had no idea were for a specific purpose.

Julia would ask me how Mom was doing in her visits and in her emails; was she able to get out, could I take her places like to the store and to the bank?

Stupidity or innocence -- a combination of the two looking at the situation from many angles -- I shared, I confided and I believed Julia H cared about Mom, cared about us and our best interests. WRONG. Julia H was focused on her goal, on her WIN, on seizing opportunity and taking advantage.

As I've mentioned in this blog previously, Julia H was an award winning tennis player and entered the Tennis Hall of Fame at her University. She plays still. She's a trained Registered Nurse complete with many hours in how to handle patients and families -- meant for good but used for the opposite.

Julia H, I believe, practiced and continues to practice Elder Abuse and is so adept at it that family members, ours included, do not see what she's doing and do not realize it's all about Undue Influence, gaining the trust of the Elderly and family members, and then helping herself to whatever she feels she can "get away with".

It was months after Mom's "entry" into LTC and my husband's death before I realized Mom couldn't possibly have spent money from at least nine months or more of receiving Social Security checks.

The last time I ever thought about Mom's having any money that might help us through the challenges we were experiencing with my husband's MRSA and complications of surgery and 100 consecutive days in the hospital, most in critical intensive care, was when we were behind on payments on our van, the only transportation we had, by $250. and were threatened with repossession.

Mom told me "NO", she wouldn't let me have the money. Looking back, I should have realized this wasn't the Mom I knew. But I respected her rights, "her" money and had told this story to Julia H. Looking back, I'm sure she felt Mom had that money and that's why she took her to the bank and secured the lock box in her name and Mom's.

In Mom's defense, a few days after Mom refused to help, she said she'd loan me the money, that was after the van was repossessed. By that time the amount was over $1,000 and when I told Mom the costs due to all the charges the company who took it added, she refused to help and we were suddenly without transportation.

A note of hope: a relative of our second son's wife had a car sitting in his driveway he didn't use; he drove it from across the country and gave it to us. He gave us a lifeline in a time when we were losing all hope and to this day I remain grateful for his help in our great time of need. 

Logical thinking, a function of processing information that disappears with Lewy Body Dementia, is now clear to us but back then we were told by everyone, including the Dr she was visiting, how capable Mom was "for her age".

A friend recently described her Mom, in her nineties, as "just plain mean" these days. 

No matter how I tried to counsel her, she would not accept her Mom might have Dementia, in particular, Lewy Body Dementia. 

The friend insists her Mom has a good Doctor who her mom sees regularly and the Doctor doesn't see anything and tells her "Mom" will probably pass from a fall but otherwise is "very healthy". 

Falls and LBD go together because the signals within the brain become less and less able to provide accuracy and that's why a higher level of assistance is necessary esp in the later stages.

Sad. So sad. My friend doesn't understand most Doctors don't recognized Dementia, especially Lewy Body Dementia.

Those who are fortunate to have a Dr who knows this silent and stealthy robber of lives, Lewy Body Dementia, have been given a great gift. 

We received that gift finally late into Mom's Lewy Body Dementia, but Mom's LTC Facility would not accept it -- diagnosis cannot be conclusive before death and an autopsy at this time. 

Diagnosis uses the terms "possible" and "probable" and the facility's "lead Doctor" refused to accept this "shoddy, inconclusive and improbable" diagnosis.

It was during those really challenging economic times when financial institutions were highly aggressive when we lost our van.

It was January, 2010. My husband was going to be getting out of the 100 day stay in the hospital and going into rehab. Our savings were gone. I couldn't possibly work. Daughter was in college and I was trying to keep her there so she could graduate knowing without that college degree, her ability to find anything, especially in the really depressed economy, would be limited to entry level, minimum wage jobs. She was and is bright, highly capable and was given amazing opportunities and had great academic promise.

I used to take Mom to the bank but caring for my husband 24/7 and trying to ensure Mom got out to Adult Day Care, both went to a myriad of Dr's appointments and other needs, I was functioning on little sleep and extensive physical challenges.

Anyone who's assisted someone needing a wheelchair from a car to a chair, rolling them through buildings and assisting them in getting MRI's and other necessary treatments knows it takes a great deal of physical strength, mental endurance and often leaves the care giver without strength and ability to do other things and even to think clearly and accurately.  

When you have TWO people needing to be moved by wheelchair, and you're not a certified weight lifter, the strain physically and emotionally is overpowering. 

Then there's the other challenges of toileting when you're out somewhere or just moving them through doors that have no automatic openers -- like at the bank.

And when Mom went to the bank, she didn't want to go to the drive through and insisted we go inside. 

I didn't need another challenge in life and decided, and she agreed, at the time, I could do the banking for her when I needed to go to the grocery store or out for something made more sense. 

I tried taking her with me but pushing a wheelchair and trying to get groceries is not an easy task.

I could not afford "private duty care" and there was no organization, no church, no community of volunteers to help.

Our daughter, seeing the toll it was taking, quit college to help and then also became a victim of long term care giving being unrecognized, unassisted and often chastised because she "wasn't doing enough" in other people's eyes or because she "left college" when she should have finished -- should have taken care of "her needs first".

It's easy to criticize and find fault from hundreds of miles away as my oldest son did.

It's far easier to believe Mom/Dad/Grandma can "handle" their lives because that's how you've always seen them. 

It's easy to make excuses for not providing help even in the simplest form of listening and hearing the truth and not turning it into a web of deceit being spun by an Undue Influencer for their own personal profit and gain.

Mom told us she was "happy" in a Long Term Care Facility when we found out she'd "moved out" through a notification of change of address from the postal service, wasn't coming home, as we thought and were told would happen by the Missouri Department of Health and Senior Services representative when they pushed her and us INTO GIVING MOM RESPITE.

Yes, there are family abusers but we weren't, aren't and will never be.

Lewy Body Dementia is an abuser to the person who suffers from it and to the families who are caught up in the web it weaves in the lives of all who experience it first hand.

The facility was smart; they placed Mom in an empty room, as a single occupant, a large, spacious and quiet room. 

Of course she would be moved from that location; it was a way to ensure she stayed, to get her to sign a formal letter of "self committment" which anyone who knows Lewy Body Dementia realizes the person with the disease really doesn't have the mental processing ability especially in the mid to late stages of the disease, to legally sign.

False, misleading and destruction of a family unit based on unsubstantiated and uninvestigated Elder Abuse.

Coconspiracy on the part of the Long Term Care Facility who saw a "capable" person at an advanced age who they could work into entering "their" facility. 

Why would the facility want to disprove Elder Abuse by the family? Families are a facility's worst nightmare as they visit and especially if they're vocal and become involved in insuring good care and quality of life. 

Facilities welcome Medicaid recipients who are mostly self reliant. It's a win-win for them because they require less care giving and reduce the ratio of needed employees to give care.

Permanent Residency in a place where, according to State Law, Mom had "rights" and one of these would be to Julia H's unsupervised, private visits with Mom. 

Yes,Julia knew exactly what she was doing and she knew the law, the system and knew very well she had a short amount of time to take action.

The State of Missouri incarcerated my mother, split apart our family, caused significant financial loss emotionally and financially, all on the report of a woman who had much to gain and nothing to lose because she knew and understood the system through "caring for" many other elderly people who had the challenge of Dementia.

Are we the only ones? As I write and talk I find others like ourselves. We are not alone.

What's upsetting is I've never been formally "released" from this accusation. No letter. No phone call. Everything has "disappeared". I understand. I do not accept. 

We were in her way; I was especially in her way. 

I had the same name as Julia's mother, who she'd told me once when we were Eucharistic Ministers together she really didn't get along with her mother very well. 

Imagine it was far more than just not getting along with but deeper and more challenging a relationship if not shown, certainly retained inside Julia.

Why was it necessary, Julia, to separate Mom from the only family she knew, the home she lived in for decades and the life with people who truly gave her daily care 24/7?  

Guess you needed to ensure you gained access to Mom's correspondence.

Trying to see if she had a charge account, perhaps, that you could use?

Possibly believing she may have had some "investments" or perhaps money tucked away some place and it was getting on the end of the year when these reports would be sent out.


Dementia exists before the starting of possible behaviors like staring into space blankly, continual body rocking, conversations with no one visible and other behaviors we know and can easily see mean the person is no longer really cognizant or capable. 

Lewy Body Dementia wears many masks.

Dementia is not to be ignored, dismissed or underestimated.

It is and will continue to be more devastating to entire generations until we recognize Dementia is a medical challenge the same as Cancer, Heart Disease, Kidney Disease and Lung Disease.

Dementia is the brain, the heart and the circulatory system combined reducing and eventually eliminating functioning.

Dementia is not inevitable.

Dementia is a group of medical problems with individual names but each is significant and must be spoken about, learned about and most importantly, understood.

It's not due to aging. It can happen in the young and the old. It's medical. It's possibly totally curable and potentially reversible

We hold the future of Dementia study in all its forms in our hands by joining the various Dementia communities -- Lewy Body, Alheimer's, Parkinsons and others -- together in a collaboration to promote understanding and to seek ways to reduce, eliminate and possibly cure


Sunday, May 8, 2016

Ashes To Ashes; Dust To Dust

Like the Phoenix, a visit by my second son and two of his children "resurrected" many memories.

Wish he was closer and around more as his recollections helped to put the challenges of each day coping with the memories and the constant pain experienced by actions of his brother (and wife) aside for a short time.

So different....yet we don't always agree, we've had differences of opinion...the major difference is he and my daughter take responsibility for their actions, words, and yes, deeds. 

They don't strike out verbally when they have a disagreement, when they do not want anyone to dare to "restate" something that was so wrong, so against teachings that respect others and do not "throw mud in their faces" and then deny it's there.

We survive as a species with positive experiences; negative experiences have the opposite affect -- from wars to everyday negative treatment of one person to another, we create harsh and destructive environments when we could choose to communicate, step back, reconsider and respect.

It had been a somewhat trying day as I returned after "staying away" from one of the scenes of the "crime" perpetrated by Julia against my mother, my husband, me and my daughter.

Arriving at the 11 AM services of our Church, I saw very few cars on the parking lot. I'd been told there was a "family service" in another part of the facility where everyone was welcomed and more "participation" was usual.

SEPARATION. SEGREGATION. All because one "segment" could not, would not, find a way to compromise, to come together.

SO LIKE OUR FAMILY.  I'd tried over many years to "resolve" situations and we usually succeeded after far less time than has been now (I'd mentioned in a previous entry my son had dictated I could no longer have contact with or speak with "his/their" children -- that was over five years ago). 

THAT WAS BEFORE their latest family addition.

My husband, my mother, for whom there was an "obligation" to try resolution in the past are no longer with us. 

Difficult and challenging for me? Absolutely. 

But riding the merry-go-round of my oldest son's constantly placing me in the position of being verbally abused I knew I had to cut this cord and pray I live long enough to see at least one of them not just grown but out of their parent's home.

He, of course, tells me and everyone that "I" am the abuser.

He's also told me how incompetent I have always been, how many "life mistakes" I made (he lumps my husband, his father, into this, also but it's always "insinuatted and never really directed specifically at him).

He used the word "you" and criticized everything we did and told me how "incompetent" I was in "not planning better" and how I "wasted time and money".

I'd restate how he has what he has because of what we did and gave to him, his brother and sister, and didn't ask for anything in return but he insists he's "self made" down to "paying for his complete college education".

I'm somewhat of a "keeper" and so when I go through records, yes, that many years ago, I find the "aid" program for each of his years and the obvious difference in the total of the awards and the loans and the "missing piece" is the amount we had to pay to the school. 

Not to mention we bought him a computer, two actually, paid for all his books every year and he was a double major in Engineering with books reflecting the national debt (or so it seemed), gave him the opportunity to attend a school on the East Coast and we live in the Midwest; let him keep ALL his earnings from work when he was asked to "leave" for a year the University we worked so hard to help him achieve entry; provided storage for his "things" over the Summer; paid him for work in our business which meant incurring the "employer" costs of matching taxes as well and diminishing what we could have had; paid for that "extra" undergraduate time he messed up on; drove him out to school and picked him up when it ended; gave him a car to use (reducing us to one vehicle instead of two); bought him a bike one year and he "forgot" to lock it so it was stolen -- brand new; paid for gas and repairs on the car and found him running it in an annual "race" without telling us; paid for all repairs, tires, oil changes, etc; get the picture? And more ... he wanted a "loft" in his on campus room so we bought the materials and then had to store them locally along with all his "living off campus" things because he decided he no longer wanted to live "on campus"

By the way, did I mention he was one of three children and for a year we took in a relative's daughter when she had no parents and gave her what we gave our daughter?

Or that "first born" had a brother at the same University also in double major engineering program who didn't "take off" a year? Or his sister also deserved to go to college.

Well, I guess we were just incompetent -- or so I've been told I was/am.

It's obvious to me, it's because he made major mistakes and had to leave school for over a year; when he returned he had an additional year and was given more loans than awards -- to be expected-- but we still had "our share" to pay.

And, we also now had his brother's "share" to pay as he was now in college AND we'd taken on caregiving for my husband's son's child who lost her parents and that side of the family wanted to try to give the child a home -- with a daughter, just days in age older than this child, we became the obvious choice.

Then husband became very sick, 100 days critical intensive care, home to need my providing 24/7 extensive care changing three and sometimes four bags on openings that kept happening in his abdomen while also providing care to my mother, then in her late nineties, who had been and continued to be a part of our immediate family living with us.

You know what? It's deminimus, his "rants" and his "beliefs". The records reflect the truth and we know what we did and how we did it.

The bottom line is:  "Yes, my son, we gave too much and provided too much putting ourselves at the back of the line and not anticipating severe life crises or changes in each of us there was no way to anticipate.

Believe what you want. Live how you choose. As for me and "my house", we know truth and follow its lead.