Communication is Vital to Healthy Relationships

Learning new communication skills in any relationship is vitally important but when it comes to dealing with elder is often dismissed, overlooked or forgotten. For adult children it is natural to sink in to a parental role with their adult parents when they become needy. Not only is it natural it is easy. It takes a great deal of thought and care to change your way of communication and focus on dignity, choice and independence.

For example, in dealing with individuals who have dementia or Alzheimer it is important to not lie to them because it damages the relationship and trust. In their fragile state they are scared and frightened and need validation of their emotions. They may understand logically they need to sell their home or they can not live independently but emotionally they can't deal with the emotion and feelings. For their sake you need to forget the guilt and step back to figure out what they are trying to express emotionally but can not say due to the dementia or Alzheimer.

Naomi Feil has written a book on Validation which I suggest to understand the technique. Validation is for the old- old and when validation is done it bridges the gap, dementia or Alzheimer makes, and touches the effected ones humanity. It is a way of reaching through the maze of fear and terror the disease reeks and loving with compassion and unconditional love.

Redirection is another method of assisting with individuals who have memory impairment. Redirection requires that you enter the reality of the dementia. They may be back in 1950 feeding their baby or catching the bus to go downtown to work. Their actions seems unreal, lacking in judgment or reality and may present as immediately dangerous; but when you “enter their world” perfectly sane and real. Communicating in truth with your loved one changes when dementia and Alzheimer's attacks.

Even with elderly who are sound with no dementia or Alzheimer your communication must change and you need to think how you can help your loved one maintain dignity, choice and independence. It is challenging and a different way of communicating with your loved one. Even though you have been put in a position to be the parent rather than the child you can not use parental tone and sayings with your adult elder parent. You need to learn to use questions like who, what, where, how and leave off why, adult saying and statements. "Should's and should not's" smack of parental sayings.

Since the greatest fear of the elderly is losing control it is vital that caregivers and children become skillful in thinking through responses and request in such a way it promotes choice and promotes independence.

Thinking about how you would like to be treated when it is your turn is a good way to get started!

The Decision

All life is vanity.

When life changes and losses occur there can be grieving. Perhaps that is what I am currently experiencing and perhaps I am not the only one who has gone through grieving when placing their parent in an Assisted Living home. I am so fortunate because I am in the business and know many people and can feel confident in my mom’s placement. Others may not have those relationships, knowledge and comfort.

While staying with my mother this last week I awoke to her pleas of “help me, Belinda help me” I quickly ran into the kitchen and found her draped over her walker on the floor with her face into the tiled floor. I finally figured out how to gently lift and pull the walker out from under her and position her in such a way to lift her up, after checking to see if anything was broken, and putting her in her recliner. I called EMS who assessed and checked vitals and blood pressure. She did not want to go to ER. After they were gone I discovered a bruise at her hairline on the right lobe of her head. I prayed and we applied ice. She still did not want to go to ER. She had gotten up to get something to eat and had a sickening feeling and passed out.

I took her the next morning to her doctor for fasting blood work. She also had an appointment with her ear, nose, and throat doctor and in between the two appointments we sat in the parking lot and ate snacks I had packed and talked. At the last appointment she again while being examined expressed a lack of well being and passed out. EMS was called and transported an eight of a mile to the hospital ER. She then was admitted to stay for medication monitoring and observation. Goodness, she looked like a raccoon with her two black eyes as the bruising from her head injury progressed.

Of course, her stint in the hospital set her back physically as well her fall had damaged her confidence in ambulating.

I knew she was going to need 24 hour supervision when she went home but I saw the fear and tenseness when she was walked down the hall with the RN for the first time after being admitted to the hospital. All of a sudden I knew finding qualified sitters and coordinating those would be almost impossible at this juncture and it came to me

“respite care”.

She really thought she was going to die and seemed resigned and in a state of helplessness and I believe did not want to go back to her rigid routine taking care of home and yard and being lonely.

A 30 day respite placement in an Assisted Living home would give my mother, me and my brother a time out to recuperate, gain strength, clarity and knowledge to make important life changing decisions. I happen to know two wonderful women, who are RNs, who own a retirement community. I called and they had the prefect room available and after consultation with my brother and mother we accepted the placement. After that all the necessary requirements and needs fell into place to proceed and place her July 3, 2010.

While I know it is a 30 day placement, a time out, in my heart I think this is a permanent change and feels like a loss of what I have known of her over my 61 years.

It would thrill me if she would gain strength and decide to come back to her home of 56 years but it is not what I want that counts, it is what she needs. Maintaining that focus is how we have been able to move forward.

For others who have these life changes to make I would suggest with God’s help keep the focus on the needs of the parent who needs help and not on you and your emotions.

She has decided! She wants my brother to sell the house and her car. The change is permanent. May God continue to “direct our paths” as we place our trust in Him.

Words from a senior "I like it like I do it!"

My mother said these word to me tonight! She had cockscomb in both knees for the second week and her left knee and ankle swelled badly causing her to be at mortal risk for a fall. She is being extremely careful since she has already fallen about two weeks ago and burst her head while I sat in the den. She is constantly on a walker in the house.

I asked her tonight if she wanted me to come home to help her wash her hair and bathe. No! Can I arrange for someone to come and help? WHO? she says.

Every time I approach the issue of someone coming in to assist her the answer is "I like it like I do it!" When she is given options like my brothers house , my house, assisted living or someone to come in and help her it is " no thank you I'll do it my way". She is 87 going on 88 and very cognitively intact. WHAT DO YOU DO??? This is not a glib question! You would think with all my expertise I would know but .................................

Independence is most desired as one ages. Losing it and not having control is the elders greatest fear.

Who will take charge?

What will it take to improve care in North Carolina Assisted Living/Adult Care Homes? It will take someone with the authority who understands the complexity of the problems to take the lead to demand clear, understandable policy, facilitate attitude changes and embrace innovative approaches.
Historically, Adult Care Homes were residential social models with unlicensed personnel assisting persons with activities of daily living in a home like setting. Over time facilities were also required to arrange health services from outside professionals. In recent years policy dictated by the State attempts to duplicate the nursing home model of care turning Adult Care Homes into health care facilities expanding the cost and treating unlicensed personnel like licensed personnel. Does the public want Adult Care Home’s to become nursing homes or do they want the more cost effective option to continue to be available to North Carolina’s elderly and disabled population? This is the first policy question, which needs to be answered.
There seems to be sufficient evidence that the punitive, heavy-handed regulatory approach is not working to ensure that the quality and safety all agree is needed and desired is occurring. Setting up quality standards for providers to obtain rather than prescriptive laws and rules might better enable quality care and thus result in more safety for the elderly and disabled.
Would a more positive, educational, training, resourceful approach, with punitive as last resort, better enable the quality all desire?
In considering new and better approaches, studies prove better staffing ratios and more support for direct care workers equal quality and thus improves safety. The forty-five to fifty-five year old women; who make up the direct care worker in this system are "aging out". Due to lack of pay, benefits and job satisfaction, younger women are not choosing this role! Who is going to give care to our seniors unless these critical problems are addressed? The staff to resident ratio has not changed since 1977 except at night it went from 1/50 to 1/30. During the day it is 1/20.
Owner/operators of Adult Care are desperately trying to savage their investment and get out of the business! They are not reimbursed equal to the requirements. They are perceived as criminals and crooks rather than businesspersons and caregivers. The State does little to change these perceptions and assure the public trust.
Who will operate these businesses when longstanding North Carolina partners throw up their hands and quit?
We would all rather stay in our own homes and have the care we need, but this is not feasible for all persons. Long-term care policy for North Carolina must be appropriately balanced, designed and supported to be successful. If the adversarial relationship between advocates, regulators and providers/ owners continues, there will be no caregivers in the future to care for the elderly and disabled. The will for reform must come from the public, legislators, bureaucrats, advocates, direct care staff and owner/operators all working toward a common goal…A level of care that nurtures and protects the consumer, in which owners and the State alike can be proud.

In order for all of us to understand reimbursement for Assisted Living communities I offer this explanation. If you do not have $2,500 to $4,000.00 a month of private funds you will need to understand Special Assistance funds and Medicaid PCS funds.

In 1945 North Carolina developed the first licensure law in the nation in order to pay for the care of its elderly and disabled adults who had low incomes. The State/ County Special Assistance for Adults Program was established via a wavier from social security and state legislation. It established a level of care other states do not have. A level between being in the home and nursing home for adults without the financial resources to be in private Assisted Living communities.

North Carolina Special assistance is not a reimbursement system to facilities. The recipients who qualify or their guardian/ representative payees receive a supplemental payment. To be eligible their assets must be $2,000 or less. This supplemental payment bundled with certain personal private funds is then used to purchase room and board in a licensed adult care home.

The General Assembly sets the maximum rate an Adult Care Home can charge someone who receives special assistance for room and board. Currently the rate is $1,182.00 per resident per month. Special Assistance for Alzhemer's patients is a seperate rate of $1,515. But Special Assistance does not make up that entire rate; it supplements private income the person receives from places such as Social Security, Supplemental Security Income (SSI), Veteran’s benefits or other retirement benefits. The average special assistance monies, which supplements cost of care for the individual is approximately $450.00 a month, thus it is an average capitated monthly rate.

In addition to Special Assistance paid to the resident for cost of care to live in a licensed adult care home, the adult care home may receive additional assistance from Medicaid for personal care services. An ACH receives $16.62 per day per resident in an ACH with 30 beds or fewer and $ 18.21 daily in an ACH with 31 or more beds for 1.1 hour of Medicaid eligible reimbursement for personal care assistance with eating, dressing, ambulating, toileting and medications. This is not the same Medicaid program funded by county funds for nursing homes. It is a state optional program.

With these two sources of public money, a low-income elderly or disabled person who needs assistance with activities of daily living and supervision can receive care in a licensed Adult Care Home. So based on the size of the home it cost $57.00 to $58.00 a day to provide room, board, personal care and supervision.

Care in Adult Care Homes for low-income elderly and disabled has been an extremely compassionate and worthy program for over 60 years. Consider what your own daily rate for expenses are overall and you do not require a person to provide for you personal care assistance or supervision.

Governor Purdue released her new budget but this is only the beginning of the process and endeavor to infuse money into a sinking ship. The industry has been working with the Department of Health and Human Services to develop a wavier program on the federal level to satisfy the Centers for Medicaid and Medicare who have been upset over the inequity in the Adult Care provision of personal services and the Home Health provision of personal services to name one of their concerns.

They will propose to take the 9 million in state and county special assistance money found in the Governor's budget and pull down additional federal matching money in an attempt to infuse at least $200.00 more per resident per month a much needed boost in payment for care.

On my next posting I will explore current reimbursement and why it is so vital to put additional money into Adult Care Homes where a majority of our elderly and disabled who need 24 hour care find themselves.

Welcome to my blog where I would love to share with you thoughts regarding care for Seniors in North Carolina. These days one has to be very creative in finances and resources to be able to provide quality care in an Assisted Living home. Particularly, if that home predominately serves individuals who receive publicly assisted funding from the state and county along with medicaid funds for personal care. Hopefully as we explore these issues it will enlighten you as to ways of operating and managing that will make your business more viable and your residents more satisfied. I have been involved in the regulatory end of elder care since 1990 and the provider side since 1996. Starting out in 1990 I became qualified as a federal health-care surveyor as the new OBRA regulations were being implemented for nursing homes. I was trained as a complaint investigator for hospitals, home health and nursing homes. In 1996 I provided consultation for Assisted Living homes through my own company and later became a Certified Assisted Living Administrator for 28 homes in NC as part of my duties as Director of Operations for 32 Assisted Living properties in 4 states for an Assisted Living Corporation. I tell you these things to say I believe I have expertise to share. Look forward to an information exchange with you.