Convalescent homes

Parent Cafe
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<p>An elderly neighbor had an attack of vertigo and fell and broke her hip a couple of weeks ago. She had surgery and then was transferred last Monday to the convalescent home across the street from the hospital.</p>

<p>Objectively, the place is clean, provides the necessary re-hab, yada yada, so I can’t quite say that it’s out of Dante’s Inferno in an obvious way. But maybe Purgatory.</p>

<p>The amount of attention that the individuals get, as in just some human attention, is minimal. Some of the staff thought it an overextended imposition that they had to turn my friend, who is not petite, several times until she found a position where she was comfortable. When she moaned at one point, one nurse scolded, “I’m not even touching you.” Duh. The lady had a broken hip and it <em>hurt</em>, periodic doses of vicodin notwithstanding.</p>

<p>So many patients are just lying in bed, alone for hours at a time. The luckier ones play dueling TV’s (sound) in their rooms or are even wheeled into a common room where they slump in their wheelchairs and fall asleep while another TV drones. The amount of human-to-human interaction is minimal.</p>

<p>Is this the reality of convalescent homes or is something amiss here? It’s as if most of these patients are simply being warehoused while their biological functions progress, for better or for not.</p>

<p>I guess I’ve been lucky to not have to deal with stuff like this. I was in hospital twice for major surgery more than 20 years ago and was discharged home after a few days both times. My dad spent only 3-4 days in hospital when he died and my mom had a hospital bed in my brother’s home with palliative and then hospice care, so all of this is new to me. But the scene is one of existential despair and I think I’d rather have a quick fatal heart attack than to endure weeks or months of this.</p>

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<p>Is she in a short-term rehab unit or a long-stay unit?</p>

<p>With a broken hip, it might be a short-term rehab unit. In that type of unit (I was a patient in one once while recovering from an accident, although I am not elderly), the focus is on the rehab sessions, and pretty much nothing except for basic medical care takes place during the rest of the day. In the unit I was on, some people (elderly and otherwise) were just plain too exhausted from therapy and from their illness or injuries to want much interaction or activity during the rest of the day. Others were well enough and capable enough that they provided the interaction and activity for themselves – mostly through telephone calls, but also through reading and visits from family and friends, as well as watching television. Some also socialized with each other, forming friendships that were likely to continue after discharge. The staff was nice, but they had little time to just socialize with the patients. They had other work to do.</p>

<p>The same facility had a long-stay floor upstairs, where most of the patients were permanent residents – either very elderly or very disabled. Life up there was different, with a lot of organized activities and staff members to run them. The people on the short-stay floor were welcome to join in those activities (bingo and stuff like that) but few were up to it.</p>

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<p>My MOL is in a nursing home (86, is semi-mobile but senile but has severe athritis and is incontinent) where most interaction with staff takes place during the morning shift when the residents are bathed and dressed for the day). During this shift, we always see the most employees on duty. During the evening and night shifts, the number of employees drops drastically. My MOL’s medications make her very drousy so she ends up sleeping (in bed) for a good part of the day but in the morning she is required to sit in a chair (preferably not a wheelchair) and is visited by a physical therapist each weekday. My MOL basically treats her new home like a spa for the elderly. She loves the attention and the fact she is surrounded by those quite like herself. She seems to feel very comfortable</p>

<p>One of her roommates is there mostly because she is very elderly, forgetful (bordering on senility) and has no family, and while she is perfectly capable of mobility, she chooses to stay in bed all day and watch T.V.</p>

<p>Another roommate is mobile, and spends most of her time in the day room doing activities with her friends. We’re actually not quite sure why she’s there.</p>

<p>However, there are many residents who are so elderly (and perhaps medicated) that we do see them sleeping in their wheelchairs in the hallways and day rooms. While it seems very sad I keep reminding myself that if they were home with their families, their lot in life would be very much the same.</p>

<p>I don’t think the home is awful, my MOL seems semi-content there. We would be unable to care for her at home, since we are already caring for my H’s mentally disabled sister. My MOL realizes and accepts this. She is expected to be there for the rest of her life.</p>

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<p>

I think something’s amiss. Some of these places can be very nice. My mother was recently in one after having a knee replacement and it was almost luxurious and the attendants were excellent and caring. It was also all paid for by Medicare.</p>

<p>The thing to do is discuss options with a couple of doctors whose practices regularly require post-op care (such as joint replacement surgeries) or, talk to elderly groups where a number of them might have had experience with these types of facilities. It can come down to just a few places in a major metro area that seem to be recognized as the best. </p>

<p>Another thing to check - the facility my mother was in was a dual purpose place in that in addition to providing conalescent care they were also a retirement home (a bit of a luxo one) where they sell living units to retired people that might eventually need additional care. Living in the retirement home wasn’t a pre-req for using the convalescent care side (my mother didn’t live in their retirement home). I don’t know but maybe this drives them to ensure they have a good rep.</p>

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<p>Yes, The Dad, this is the norm. Hospitals are almost as bad. There is a severe nursing shortage. Because of this and to save costs, it is very common for those who need hospital care to be in a nursing home, with
inferior care.</p>

<p>Medicare has a limit on hospital stays. That will largely determine where you end up, UNLESS you have supplemental hospital insurance. I believe medicare only covers in hospital, so we are talking ADDITIONAL in hospital and
out of hospital insurance.</p>

<p>Now, if you are getting your first look at a nursing home, even the most expensive are dismal. In addition to a private room in the best
nursing home, I had to pay for a private duty nurse for an elderly relative, to keep her cleaned, etc.</p>

<p>As UCLA Dad mentions, if you are first in an assisted care facility, your conditions are nicer. To initially enter one of these, you have to be ambulatory and largely self-care. As you need more care, you are moved to the nursing
home facility. These are expensive operations, and function like a co-op. You are required to provide a large intital fee that is non-refundable, in addition to the monthly charge. If you die one day after arriving, you still are not entitled
to a refund of the lump sum. </p>

<p>Stock up on morphine.</p>

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<p>Earlier this year we moved my m-i-l into an assisted living facility near us. The initial fee is either 90% refundable (with a higher monthly charge) or 50% refundable, with a lower one. It was pretty much the same at all the facilities we looked at.</p>

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<p>TheDad, I agree with julietjane, this is the norm. In my experience, unless a person can afford the most top of the line home, the place is a holding tank. </p>

<p>I know this is only your neighbor, so I suspect you don’t know her financial situation, but if there were any way she could bring someone in to her own home (offer free rent?) to care for her, she would likely heal faster and in general get better care. </p>

<p>I do not envy her, and you are a wonderful neighbor to care enough to write about it.</p>

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<p>My neighbor’s mother is in a private nursing facility, at the cost of nearly $10K a month (until her pension runs out and she is declared indigent). Even with that cost, they often leave her “unchanged” for many hours.</p>

<p>Another friend’s parents are in an expensive assisted living facility. The dad has Alzheimer’s and the facility requires that they pay additional in overnight care, because they are afraid he will wander off. </p>

<p>I keep hearing more and more horror stories, as all of our parents age. It is my deepest hope that my own parents are spared any of this and die peacefully at home. We should be so lucky.</p>

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<p>Under the best of circumstances, home care would probably be better.</p>

<p>But many families don’t live under the best of circumstances.</p>

<p>My father, then in his early eighties and entirely independent, attempted to care for his deteriorating older sister (my aunt) in his home during the last months of her life. Despite home care help coming in several times a week (and eventually, for several hours every day), the situation was overwhelming for him. Among other things, my aunt would wake up disoriented and need care during the night. My dad didn’t get a full night’s sleep for months, which affected his own ability to function. And unfortunately, there were no other family members living in their part of the country who could help them. My aunt was isolated and lonely, and her physical condition repeatedly worsened. In part, I think, it was because my dad, who had no health care background, didn’t notice symptoms until they became extreme; a health care worker might have picked up on problems sooner.</p>

<p>Prior to this time period, my aunt had been in a nursing home for a while. Although she did not like the place, her physical condition was better because her problems were addressed more quickly. And for my father – who was her only caregiver – being her business manager and principal contact with the outside world was a do-able task – one that did not overwhelm him or place his own well-being at risk. He saw her every day, took care of her laundry, brought her things that she wanted, dealt with staff members, did her paperwork, and fought with her insurance company. He was a smart guy, although his stamina was limited because of his age. Helping her out while she was living in the nursing home was within his abilities. Being a full-time caregiver was not.</p>

<p>When my aunt was in the nursing home, she wanted to go home because she wanted to return the situation she had at home before her health deteriorated. But this was something that wasn’t going to happen because her health had permanently worsened. Instead of returning to the life she had before, she returned home unable to care for herself and having to impose too much on another elderly person to provide the care she needed. Both she and her brother were better off when she was in the nursing home. This is not a pleasant thing to have to say, but it was the reality of the situation.</p>

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<p>I’ve spent a lot of time visiting many, many nursing homes as part of my job. The first lesson I learned is don’t judge a book by its cover. I’ve seen some of the most posh places give minimal attention to the residents; and I’ve seen some of the dumpiest places treat their residents like they were family.</p>

<p>Also, regarding Medicare; yes they pay for the nursing home if it’s for rehab, but they don’t cover ‘custodial’ care - meaning the person lives there only because they don’t have anyone else who can offer 24/7 care in a home. Sometimes people will use up their Medicare benefit while recovering, but then have to start paying out of pocket when the recovery period is over, but they have no place to go or anyone who can take care of them. I will tell you that what Medicare reimburses for nursing home care is abysmal, which is why so many lack the staffing they need.</p>

<p>The problem with what you witnessed is that your friend was there for rehab, and has the goal of finally being discharged. Most of the people there, are there for a reason… their care becomes so overwhelming that even with the most supportive of family members, it really takes skilled workers to keep them alive. Many, many of those places have populations of residents with some form of dementia, and that’s the part you saw. Most places have requirements that they can’t leave patients in bed all day, so they place them out by the nurse’s station, where they fall asleep. Every place I’ve been into has some form of activities and recreation, but when 75% of your residents have varying degrees of dementia, it’s a challenge to find activities that everyone can participate in, even something as simple as Bingo. And frankly, there are just some people, who were never extroverted and will not become extroverted in a nursing home, and beg to be left in their rooms alone, no matter how much the staff encourages them to get involved. I think the important lesson is look at each person as a story, and accept we don’t know the history behind their life - do they have any family left, is that family capable of enriching their lives through visits or hiring someone, maybe the resident has a history of some prior behavior that estranged them from their family, maybe the family members who are alive have their own health problems they’re dealing with. </p>

<p>I’m reminded of a WW2 veteran I visited with yesterday. His daughter was also there on her lunch break from work, and definitely recognized her, but he was confused as to the time and place, saying he working on his discharge from the navy. It was difficult for her, but she stayed for a while, then returned to her work (her siblings don’t live in the area). I stayed with this gentleman another 30 minutes, barely getting a word in, while he talked of his time in the navy, and I’m sure every story he told me was accurate. I did this because I’m sure no one else at that facility had the 30 minutes to just sit there and listen to this man, and affirm his experience. I would take a guess that of the other residents on that floor that I saw yesterday, maybe there were three or four that he could have had a conversation with. The other 25-30 were just so totally out of it, and require so much attention to every task of daily living that, because this guy can still feed himself, he’s not given the same attention to care that the others are.</p>

<p>Most families that have any expendable resources, will hire a part-time caregiver for their loved one to make sure they are stimulated throughout the day. But for most people who don’t know how long that can go on, they have to come to terms with the reality that putting their loved on in a nursing home really is the best solution.</p>

<p>However, although it does on the surface seem like a ‘holding tank’, I truly believe all these residents have things they can still teach us, if we allow them, even those who have lost most abilities to verbally communicate. So with that belief, I don’t belief it is just a holding tank if we continue to affirm their lives by using those teachable moments.</p>

<p>Does this mean I’d not protest if I had to rely on a nursing home at some point in my life? Not at all, my attitude about them has changed, and I believe for the most part, those who are there, are there because in the majority of cases, it’s what’s safest for everyone.</p>

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<p>It has been several years since I have had to deal with elderly relatives, so my information may be outdated. However, with the escalating health costs, I am doubtful it is any better.</p>

<p>I agree home care is best. The problem with home care, is that the caregiver needs to be very closely supervised. This requires significant management skills.</p>

<p>There can be the intention and expectation to care for your elderly relatives and friends; however, you become sick and it isn’t possible.</p>

<p>Become familiar with the laws related to Medicaid eligibility, which change, exemptions related to home ownership, etc.</p>

<p>Stay healthy!</p>

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<p>Actually, my mother lives in an extremely well-run nursing home with also has an assisted living section as well. This is a very small, home-like environment that is very tightly supervised, and many staff members have been working there for a very long time, so it’s like one big happy family - the home has been in existence for many years, and people who live in my area and are "in the know’ are familiar with this particular place and also several others that are top-notch in care. I’m very familiar with “homes” in my area, since my mother initially was a short-tern resident at several of them, and they were all very nice and well-run, but they weren’t the right match for her for one reason or another. This website is an excellent resource for families who need to make choices for their loved ones in terms of placement in nursing/assisted living residences. Also, working with a geriatric care manager who is very familiar with homes/facilities in your own particular area can be extremely helpful. <a href=“http://www.retirement-living.com/[/url]”>http://www.retirement-living.com/&lt;/a&gt;&lt;/p&gt;

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<p>Please, for the sake of families who are/have been going through this with their loved ones, realize that there are wonderful assisted living/nursing homes with loving staff who treat their residents like family. As teriwtt said, “don’t judge a book by it’s cover” - in particular, to “julietjane” - make sure you do your complete research before you pass judgment, please, because from my experience, I am happy that my mom is being well-cared for - she needs to be there based on her particular situation, and she, along with all of the residents are being treated like royalty!</p>

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<p>Sounds painful to watch, Dad.</p>

<p>My next door neighbor, a GP, sends her elderly pneumonia patients to smaller nursing homes. She says they die if they go to hospital. The nursing homes give better care.</p>

<p>Two of my friends own nursing homes. They are both nurses. One of these homes has a wonderful reputation and it has long waiting list.</p>

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<p>Also, the “home” where my mother lives is so well-know and well-respected, thatlocal families bring their loved ones from out of state to live there.</p>

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<p>Thanks for the link nyumom and that is wonderful for all the people able to utilize that facility.</p>

<p>I was thinking more of The Dad’s friend and others who have accidents for which they aren’t prepared, as well as those who are unable to afford good care. Those are the one’s to whom I directed my thoughts.</p>

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<p>Also interesting, and related to nursing homes, is the case during Katrina, in which the nursing home owner’s, left the elderly to drown. The owners were recently acquitted.</p>

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<p>This just in from the NYT’s site: (probably in the Sunday edition)</p>

<p><a href=“http://www.nytimes.com/2007/09/23/business/23nursing.html?_r=1&hp=&adxnnl=1&oref=slogin&adxnnlx=1190491775-qDMOr+FtEl115SLBS2S6Dg:[/url]”>http://www.nytimes.com/2007/09/23/business/23nursing.html?_r=1&hp=&adxnnl=1&oref=slogin&adxnnlx=1190491775-qDMOr+FtEl115SLBS2S6Dg:&lt;/a&gt;&lt;/p&gt;

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<p>Actually, there are many “facilities” in my area which are exceptional, and even though there may be a case where someone needs a sudden placement due to an accident, etc., there are always wonderful and very helpful social workers, etc. who work for the benefit of the patient in securing the proper setting for rehab, etc.</p>

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<p>The key is to perform extensive research and stay away from the “mills”.</p>