In the past two months three friends have spent time in a skilled nursing facility. Fortunately each was there for rehab and not a long-term stay. I have previously written about my fifteen years as a Long-Term Care Ombudsman. In this role I have visited many residents of care facilities, including RCFE’s (Residential Care Facility for the Elderly/Assisted Living) and SNF’s (Skilled Nursing Facility). The decision to move into or place a family member or friend in any long term care facility is a major, life-changing one.
It is by far better if this decision can be made with pre-planning and the involvement of the person moving. This helps to ensure a smooth transition and adjustment to a new life style. The lack of planning and buy-in from from the person being moved will most likely result in long lasting resentment and an unhappy resident. Occasionally a move is necessitated by a sudden crisis, such as a stroke or fall, which prevents the person from returning home. This can make the transition even more challenging.
California Advocates for Nursing Home Reform (CANHR) is a statewide nonprofit advocacy organization. Since 1983 it has been dedicated to improving the choices, care and quality of life for California’s long-term care consumers. It works through direct advocacy, community education, legislation and litigation to educate and support consumers and advocates regarding their rights and remedies under the law. Their goal is to create a united voice for long-term care reform. The information in this post comes from CANHR’s A Guide to Preventing Abuse in Long Term Care Facilities, which can be found on their website.
CANHR suggests that anyone moving into a care setting have a comprehensive assessment. It is important to work with the staff to get a transitional care plan and a more comprehensive one regarding future care. If the person is being moved from the hospital, a check on medications taken and condition of skin is warranted. The move to a skilled nursing or assisted living facility can affect the new resident’s appetite, sleeping patterns, motivation, and ability to participate in therapy or activities, so it is critical to closely monitor their needs, changes and care during the transition.
Frequent visits are very important but there are things that can make visits more meaningful. Visit at different times and shifts, on different days of the week, during meals and activities, and definitely at night and on weekends and holidays. The unpredictability of visits keeps the facility on its toes.
Visits can become routine and something you do out of duty. Make a plan for something you can bring to talk about or do together. Anticipate special occasions and plan something different and if possible plan occasional outings. It is so easy for people living away from their homes and loved ones to feel deserted, resentful and lonely. When you visit, try to put yourself in the resident’s place, think of what would make you feel happier, and always realize that your visit is probably the highlight of their day.
The plan of care describes the strategies that the facility and staff will use to enhance, restore or maintain a person’s optimal physcal, mental and psychological well being. SNF’s are required to review and update these quarterly and RCFE’s annually or whenever there is a significant change in the resident. The care plan should contain concrete, measurable plans, and timetables and should be used to monitor the overall care of the resident.
The importance of residents having an advocate can never be overstated. Effective advocacy is based on knowledge of the rights of residents and your rights as a representative of the resident. The Ombudsman Program can assist residents and advocates understand and exercise their rights. The Ombudsman is the resident’s advocate. A poster for the local Ombudsman Program must be prominently displayed in both RCFS’s and SNF’s. You have the right to confidentially make complaints to the Ombudsman Program and local licensing agencies.
Having an active advocate is the most important factor in preventing abuse. CANHR presents the following signs of abuse:
– Unexplained bruises, scratches or marks on face or body.
– Signs of over-medication like drowsiness, dry and cracked lips, drooling and vacant stares, and slumping in their wheelchair. Chemical abuse is rampart in CA nursing homes where 1 out of 4 residents are given anti-psychotic drugs, especially those with dementia.
– Poor personal hygiene, urine smell, residents left alone for long periods in bed or on the toilet, unexplained weight loss, frequent falling, skin breakdown and bed sores are indicators of neglect.
– Theft of personal property
If you suspect abuse of any kind, don’t wait and try to resolve this alone. Contact the Ombudsman Program, make a complaint to the local licensing agency, refer any physical or sexual abuse to local law enforcement, and seek the advice of an attorney through CANHR’s Lawyer Referral Service.
Hundreds of thousands of people are in skilled nursing and residential care facilities in California and throughout the country. Acting within a group can be more effective, provide protection from rear of retaliation, and produce positive change in care quality for all residents. Encourage a resident to join a Resident Council and encourage family to join or form a Family Council.
There are statistics available from many sources indicating not only that the population of the United States is collectively aging but also that the need for care facilities is going to increase rapidly over the next 20 – 30 years. These statistics should act as a warning to people who may be needing this care themselves or have family members who may need this care. It is way too easy to believe that neither you nor a family will ever need this care. The majority of people I have visited as an Ombudsman never thought that congregate care was in their futures. It is never too early to learn more about available care in your area, costs of this care, and what is needed to make a stay the most beneficial it can possibly be.