When Care for You, Inc. started back in 1996, our primary goal was to fill a gap in the spectrum of services to seniors and others with special needs. To that end, we set out on a mission to help seniors age in place and live independently at home, by offering them an alternative to more expensive “traditional” care. Over the years we have come to realize that all of these care-models are a part of the eldercare continuum.

For those who don’t have family or financial resources to cover the cost of care, there ought to be a safety net of nursing and assisted living resources for seniors who fall through the cracks.

From the White House Website:

The Middle Class Task Force unveiled a series of initiatives in the President’s FY 11 budget that are aimed at helping families with soaring child care costs, balancing work with caring for elderly relatives or people with disabilities and saving for retirement.  These are costs that have risen dramatically for families at a time when their incomes haven’t.  This is particularly true for the so-called “sandwich generation” – people who are caring for children and their parents.  Almost all of us know someone who has juggled caring for a parent or relative who can’t get along completely on their own.  Millions of Americans provide unpaid care to aging relatives.
These caregivers play a vital role in helping seniors stay in their communities or at home.  But too often they don’t have the support they need to balance caregiving with work and family responsibilities.  As Elinor Ginzler of AARP put it:
“AARP is grateful that the Middle Class Task Force has drawn attention  to an issue that is deeply important to our members—the critical role of family caregivers and what we should be doing to help them.
It adds funding to programs that provide transportation help, adult day care, and in-home services including aides to help bathe and cook.
The caregiver initiative won’t magically alleviate all the strain on caregivers and their families – but it is an important first step toward providing more support for families and caregivers and the vital services they are performing.
Terrell McSweeny is Domestic Policy Advisor to the Vice President

Hopefully Congress and the White House will realize the medical benefits of non-medical care

In order for a community to support its citizens as they age in place, the physical environment is paramount. Is it walkable? Communities that are successful in caring for their elders will answer this question, “Yes!” Are there supportive businesses nearby like a dry cleaner, cafe, grocery store, restaurant, or exercise gym with programs for seniors? What about a library, post office, church or community center? In many places the resources are there, but there are physical obstacles like roads. In Bethesda, Maryland this barrier was overcome with a variety of tools. There is underground passage near the metro station that allows pedestrians to cross the six lane, divided Route 355, and an overpass on the similarly busy Old Georgetown Road. The Bethesda 8 Trolley offers free rides all week long and circulates through much of the city. Even in places where it is too costly or unrealistic to build an overpass, municipalities can easily increase length of time of walk signals to allow senior citizens, a parent with two kids in a stroller, or someone on crutches to safely cross the street. That’s the beauty of universal design. It helps everybody.

As heard on the Kojo Nnamdi Show last week, Aging in Place Villages or communities like The Palisades in Washington, DC and the Bannockburn Community’s ‘Neighbors Assisting Neighbors’ nearby in Maryland, have taken a little more grassroots approach. In the Palisades when you join as a paying member you can call one phone number to request a variety of services performed by volunteers for free. Things such as major home repairs, home inspections and home health care for seniors provided by third party companies may be charged at a reduced rate. In Bannockburn they address the needs of their residents with volunteers too, emphasizing an intergenerational approach. Services can be arranged through the website Lotsahelpinghands.com.

The importance of the social aspect cannot be understated. From our own experience at Care for You over the past 14 years, we have seen a number of our clients with Alzheimer’s disease and dementia who enter nursing homes quickly deteriorate and die. When your memory is already impaired and you are suddenly taken out of your familiar surroundings, it deals a death blow to your soul. The value of being recognized at local businesses and feeling like a part or your community and neighborhood is truly something we all need. To quote Louis Tenenbaum, a leading authority on Aging in Place, “It requires a custom model of care that is about YOU. Aging in Place is based in the sanctity of dignity, respect and control- independence, your home is your castle. These important human and American values are almost impossible to maintain in the dehumanizing, medical model of ‘senior housing’.”

We take our personal rights for granted. However, when a family member or a friend moves into a long term care nursing facility the question is often asked whether the family member or friend has any rights as a resident of such facility.  Federal law, Section 483.10 of the Code of Federal Regulations http://cfr.vlex.com/vid/10-resident-rights-19811580 requires that long term care nursing facilities must protect and promote the rights of each resident by providing specific, enumerated rights.

For example, in the State of Maryland, mandated rights of residents residing in long term nursing facilities are extensive and include:

• The right to choose one’s own physician if the physician agrees to abide by the facility’s policies and procedures.
• The right to be fully informed in advance about care and treatment; the right to participate in planning care and treatment; and the right to consent to or refuse treatment.
• The right to be free from physical or chemical restraints unless required to treat medical symptoms or provide for the safety of the resident.
• The right to be free from physical, verbal, mental or sexual abuse.
• The right to be free from involuntary seclusion.
• The right to reside and receive services with reasonable accommodations of individual needs and preferences.
• The right to receive treatment, care and services that enhance the resident’s quality of life.
• The right to be free of interference, coercion, discrimination or reprisal when exercising such rights.
• The right to privacy in the resident’s accommodations, medical treatment and personal care.
• The right to receive or refuse to receive visitors, subject to reasonable nursing facility restrictions concerning visiting hours and places where the visitation can occur.
• The right to meet privately with representatives of State agencies including the Department of Health and Mental Hygiene and the State Long-Term Care Ombudsman Program.
• The right to voice grievances without being subjected to nursing facility reprisals.
• The right to access and purchase copies of the resident’s records. Such records would include medical records, social work records, etc.
• Rights concerning resident transfers and discharges. Generally, the facility shall provide notification of the transfer or discharge at least 30 days before the proposed transfer or discharge. The notification shall provide (1) the reason for the proposed transfer or discharge, (2) a statement that the resident has a right to request a hearing and how to request a hearing, (3) contact information for relevant State and local officials and (4) the right to seek legal counsel.¹

Residents in states other than Maryland should consult the applicable state laws and regulations governing resident rights in long term care nursing facilities and assisted living facilities. An excellent source of information would be the state long-term care and/or assisted living Ombudsman.

Arthur L. Lappen, Attorney

Maryland and DC

¹ Various sections  of the Code of Maryland Regulations including sections 10.07.09.08, 10.07.09.10 and 10.07.09.11 http://www.takingcareofmomanddad.net/NursingHomes/Regulations/

A primer by Joan Van De Moortel, Executive Director of Care for You.

Care for You Companions meet the needs of residents in assisted living facilities as well as in clients’ homes.

Most people want to remain in their homes. It terrifies and depresses them to leave. They end up taking more medications, which can lead to more side effects and accelerate mental and physical decline.

At Care for You, therefore, we believe it is usually best for people to remain in their homes as long as possible. Yet the time may come to search for an assisted living facility for a loved one. If so, here are questions you should consider—they most likely will not be considered by others.

• Does my loved one want to go into this facility?
• What will be the total cost? Compute the basic rate plus each additional service, such as extra meals, help with medications, assistance with bathing and dressing, personal laundry, transportation, etc.
• What services EXACTLY does the facility offer? Commonly, assistance consists only of three meals a day and laundering of bed linens (for which you pay).
• What is the resident-to-staff ratio? A ratio of 6 to 1 is considered outstanding, but very few facilities have this ratio. Twelve to 1 is more common. For a person with dementia or Alzheimer’s, even a 6 to 1 ratio does not provide enough care. That resident really should receive one-on-one attention.
• What is the schedule for providing services? In most facilities care is provided by CNAs (Certified Nursing Assistants), who operate on a medical model and address physical needs on a time clock: get up at this time, bathe at this time, eat at this time, etc. Mental and emotional needs aren’t addressed. This usually doesn’t work with dementia, as time and space are very relative. The fact that it’s time for a certain activity not only doesn’t register for a person with dementia, it can cause anxiety, resistance, acting out. This often leads to increased medication to control the acting out. It doesn’t matter when a person with dementia bathes—7:00, 8:00, 9:00, or 10:00 a.m.—nor does it matter on which days he or she bathes. What’s important is that the person bathes two to three times per week, without being traumatized.

Make visits to any facility you consider, both announced and—even better—unannounced, and scrutinize the following:

• How many workers there are.
• What the residents are doing. Are they in activities? Sitting in front of a TV in a day room? Sitting alone in their rooms? If they have hearing, vision, or stability issues, is someone helping them?
• The physical condition of the residents. Is there any bruising, particularly on the left hand or arm? This is often a result of being pulled up too quickly and too hard.
• The food served. Is it nutritious? Tasty? Attractive? Often, two things happen: First, on the day you’re invited to the facility, the food is great. On other days, not so swell. Second, nutrition can be seriously lacking. Breakfasts of doughnuts and sweet rolls are common. Lunches and dinners can be tasteless and unappealing, with little nutrition.
• The building itself. Is it clean? Well-lit? How does it smell? What do you hear?