Aging: Let’s Clarify the Concept of Contiuum of Care

It came to my attention today, as I was presenting an educational program to a group of caregivers, that there may be some confusion out there regarding the term continuum of care. The phrase continuum of care refers to a continuous sequence of elder care services and programs designed to meet specific needs and changes  that occur throughout an older adult’s life. For example, an individual with Alzheimer’s disease may initially require minimal assistance by a non-medical home care agency to be cared for safely. As their disease progresses, adult day care may be a better option or assisted living. As that individual progresses even further on their journey, they may require a memory care unit or a nursing home. And the final stage of the disease process may require intervention with a hospice program. As they travel through their Alzheimer’s journey; they travel through a continuum designed to meet their needs at every stage.
The phrase continuum of care is also used to describe a specific type of housing for older adults and this is where the confusion comes in. I want you to think of this as a continuum within a continuum…. 
Continuing care retirement communities (CCRCs) provide a full range of housing options and care for older adults: independent living, assisted living, nursing home all under the same roof. They may also provide adult day care, rehabilitation, memory care units and hospice but the key is that the services are all provided under one roof.
It would take days for me to go in to the specifics of each program and service so I’m going to stop here for now. But the next time you hear the term continuum of care I want you to remember these 3 things… 
1) The term continuum refers to a sequencing of programs, services and elder care.
2) The need for a specific program/care is based on your loved one’s current needs.
3) Continuing care retirement communities are a housing option and are a continuum within the continuum.
I hope this helps in some small way and remember I’m always happy to answer your questions so please feel free to leave a comment!

Nursing Homes: 5 Secrets to Finding the Right One!



Five Secrets to Finding the Right Nursing Home

Are you starting to think it’s time for your aging parent to move to a nursing home? The decision to transition your aging parent to a nursing home is the toughest one of all along your elder care journey. The impossible promises made, the uncertainty of what you’ll find and the horror stories you’ve heard can create overwhelming anxiety and apprehension. I’ve been on both sides of this decision: admitting my dad for a short term stay in a nursing home and having worked in admissions and social service in nursing homes. There are good ones out there you just have to know the secret to finding them…

I can spot a good {or bad} nursing home a mile away: this is what I look for…

Reputation: The first question I ask clients that are considering locating a nursing home for mom or dad is this: have you or someone you know and trust had any experience with a local nursing home? The best way to start your search is to go on reputation. If a facility has a reputation of providing excellent care over the years, this is the facility I would look at first. On the other hand, reputations wax and wane so do your due diligence before you make that leap and sign the paperwork but reputation is the place to start your search from!

Odor: I don’t care what anyone says: all nursing homes have a bit of an odor but some worse than others. There’s no way to avoid this when residents are incontinent of urine and feces. However, the odor should be isolated, not masked by perfumes and should not be ignored. If you smell odor throughout the building on your tour, I would think twice. If you smell an odor that is isolated or acknowledged by the admissions coordinator, I would consider it “par for the course”. The admissions coordinator may say something like “excuse me I’m going to check to see if someone needs freshening up” and then discretely get help for someone.

State Surveys: Reviewing the latest state survey {which should be easily available} is one way to start narrowing down your search but take them with a grain of salt. True Story: years ago I worked in a nursing home that was inspected by a state surveyor that had been terminated by the company that owned the facility. How unbiased do you think that person was? The state survey process is not related to care as much as how care is documented. Some companies are really good at this documentation and some are not. Review the survey and look for patterns: medicine errors, skin care and family complaints. Try to read between the lines and ask the facility if you have concerns regarding specific citations. See how open they are to discussing or avoiding the questions!

Staff: All nursing homes have staff turnover especially with certified nursing assistants. Cleaning feces off of frail older adults at minimum wage isn’t exactly a long term situation for most. What I want to know is how long has the current Director of Nursing been at the facility and ask to meet with him or her. The Administrator is important as well but believe me it’s the Director of Nursing that runs the show and oversees the care your parent will be receiving. Get a feel for the type of person they are: eye contact, open door policy, warm, friendly, are they asking questions about your mom or dad? Is staff dressed appropriately? Do they have rings in their noses or eye brows (I can’t tolerate this one)?

Look and Listen: As you walk down the hall listen and learn. Is staff being loud and offensive using words like honey and baby? Are there a lot of call lights on that are being ignored? Are you acknowledged with a hello and eye contact? Are residents yelling and being ignored? Are people making eye contact and acknowledging you? You should hear people being treated with respect and dignity. You should not hear staff gossiping and complaining about their workload. You should hear calmness in the tone of the staff, cheerful conversation and positive reinforcements: “you’re doing a great job today Warren” or “Mary I love your outfit, you look awesome today”.

No doubt, the nursing home decision will be the toughest you have to make along your elder care  journey. It’s never an easy decision but there’s plenty you can do to find a decent facility that will provide competent loving care for your aging parent. Start here and if you have any questions leave them in a comment!

Aging Parents: Hospital Discharges

Hospital discharge planning is the process of developing a plan post hospitalization for an individual to receive appropriate services {think home health, rehab or nursing home}. The hospital by law must identify, at an early stage of hospitalization, all patients who are likely to suffer adverse health consequences upon discharge. For our purpose, this identification begins at the time of admission when your parent presents their Medicare card. The nuts and bolts list of what is required of the discharge plan process is very lengthy {dare I say boring} but what you need to know is this:

  •  The doctor following your parent in the hospital is the one driving the discharge time frame. If your primary care physician is not following in the hospital they cannot write orders regarding your treatment or hospital discharge.
  • That physician is very aware of the Medicare A guidelines in terms of billing and believe it or not their hands may be tied. This all relates to diagnostic related groups which you can read more about here…
  • If your hospital says to you: “I’m sorry but we’ve assessed your mother and believe she does not need a discharge plan” you can have your physician request one.
  • A discharge planner is responsible for arranging the services your parent will need at the time of discharge. Your discharge planner may be referred to as a care manager, social worker or registered nurse.
  • You have the right to appeal your discharge and there are very specific steps in place to do this. Speak with your physician, discharge planner or patient advocate for specifics.
  • The hospital indication that it’s time for discharge does not mean mom is ready to live at home independently but that the condition she was admitted for is stabilized and her time under Medicare A has come to an end.
  • Your hospital discharge planner will provide you with a list of available services i.e. home health agencies, skilled nursing facilities and can provide you with education but cannot give an opinion or recommend a specific organization.
  • Be open and honest with your discharge planner. If your dad was struggling at home before this hospital admission, he will probably need additional help {either at home, rehab or nursing home, companion care} at the time of discharge.
  • In order to receive skilled Medicare A services following the hospital admission, your mom or dad needs to be in the acute care setting for a minimum of 3 DAYS! This means that if discharge to skilled rehab happens on the 2nd day your parent will not receive inpatient Medicare A coverage for their rehab. Be aware, ask questions and advocate!

A discharge planner’s job is a pressure cooker type job with high expectations and huge case loads. I recommend that within 48 -72 hours of your parent being admitted to the hospital {depending on the situation: if it looks like a short term stay move quicker} YOU ask to speak with your discharge planner. The RN on the floor or someone at the nurses’ station should be able to provide you with the name of your discharge planner and how to get in contact with that person.

I’m happy to answer any questions you may have! Leave a comment…