There are two things I know my 84-year-old father will always have in his pocket: a toothpick and a wad of bills. Like many elderly people who grew up in a different era, his preferred form of payment is cold hard cash. Over his lifetime, he has used credit only sparingly and I don’t think he has ever had a debit card (no matter how hard I try to explain that it is like using cash, he doesn’t buy it). Since he moved into a Florida continuing care retirement community about a year ago, I have been a little concerned about him keeping too much cash on hand. Thankfully his building has a Bank of America branch right in the basement. Not only does it give him peace of mind to know that he has easy access to his money, but I think it also helps preserve his sense of independence and dignity, especially since he no longer drives. 

I got to thinking about this after reading last week that an employee of a West Palm Beach nursing home has been arrested for stealing more than $2300 from an elderly resident. The employee, Natasha Petit-Homme was an admissions clerk at Woodlake Nursing and Rehabilitation Center in West Palm Beach.  According to Florida Attorney General Bill McCollum, Petit-Homme gained access to the victim’s checkbook, wrote herself a check for $2,341 and deposited the funds into her personal checking account. Petit-Homme is charged with one count of exploitation of an elderly person, a third-degree felony. She faces up to five years in prison and a $5,000 fine if convicted.

I don’t know anything about this victim’s capabilities or her situation, but I have to wonder why a nursing home resident is keeping a checkbook. These are sensitive issues, I know. As I have seen with my father, control of one’s finances is an important part of maintaining dignity and holding on to some independence. And as I have also seen with him, things can change rapidly for the elderly. Someone who is sharp-minded and on top of things today can go downhill in a matter of weeks or even days. Maybe the best we can do for our loved ones who are in senior living facilities is to be aware of these issues, discuss personal security with them and look out for changes in their mental abilities that may warrant a change in their responsibilities.

The arrest in this case resulted from an investigation by the Attorney General’s Medicaid Fraud Control Unit’s Patient Abuse, Neglect and Exploitation (PANE) team. According to their website, the AG’s Medicaid Fraud Control Unit investigates fraud committed by health care providers, and it also investigates the abuse, neglect and exploitation of the elderly, ill and disabled residents of long term care facilities such as nursing homes and assisted living facilities. If you want to report fraud or abuse, you can call the statewide hotline number or contact the Medicaid Fraud Control Unit nearest you:
The statewide hotline number is 1-866-966-7226

Tallahassee (850) 414-3300

Orlando (407) 999-5588

Tampa (813) 287-7940

Ft. Lauderdale (954) 712-4600

Miami (305) 377-5441

Jacksonville (904)-858-6919

Ft. Myers (239) 338-2442

West Palm Beach (561) 837-5000

Pensacola (850) 595-6057

While I was on the AG’s website, I noticed that they also provide a link to a new brochure, “Smart Consumers Can Stop Fraud: A Guide for Seniors.” The information in the brochure provides valuable guidelines and steps for consumers to take to protect their interests, as well as information on tools designed to save money, especially in the important area of prescription medication.

I’ve been a fan of online shopping for years. I was what you’d call an “early adopter” – back when friends and family were still too scared to think about submitting a credit card number online, I jumped right in with enthusiasm. I love the convenience of being able to shop when I want (often late at night) and where I want(comparing several different stores and products without spending a dime on gas). So I was thrilled to learn about a new shopping website that is unlike any other I know of – Alice.com.

Alice carries all the common household items we all need – things like laundry detergent, shampoo, toilet paper and deodorant – that we buy again and again. Once you set up your free account, the site walks you through the process of selecting your favorite items and brands. You can search by product name, price or even find out which items have coupons available. Here’s the best part: shipping is free. And you can set up your account so Alice will remind you when to re-order; for example, toilet paper once a month, band-aids every three months, etc. The website says that it offers savings comparable to the big-box stores, because it allows manufacturers to sell directly to consumers, eliminating the middleman. I need to spend some more time comparing prices on my favorite items, but I have to say that from what I’ve seen so far, I’m impressed. (And remember  – no gas money spent.)

I’m telling you about Alice.com not just because I like the service for myself, but because I think it could turn out to be a great resource for the elderly and all users of Florida Senior Living Advisor. For example, my father lives in a continuing care retirement community. The facility provides weekly van trips to a local grocery store, but the residents are responsible for carrying their own items up to their apartments. I know it would make it easier for my dad if he didn’t have to worry about hauling things like toilet paper and laundry detergent, and he could focus on buying his favorite food items. I think Alice.com could also be a helpful service for folks living in assisted living, although maybe not as much for people in nursing homes, where most of these types of products are provided. My father is not what you would call computer savvy, so I’ll manage his online account and do his ordering for him. This would be a great way for family members who live far away to be able to help their loved ones in senior living facilities with a necessary task.

So check out Alice.com and let me know what you think. You can also enter to win a $250 gift certificate to Alice.com by visiting Five Minutes for Mom.

Well this is encouraging. On Friday the Centers for Medicare and Medicaid Services - the federal agency that sets quality standards for nursing homes – issued new guidelines for nursing home surveyors that emphasize the importance of “resident quality of life” and “homelike environments.” CMS says the goal is to get nursing homes to focus on resident-centered care. It’s about time, don’t you think? And just what have they been focusing on prior to this decision? Profit margins?

Last fall my father had to spend several weeks in the nursing home that is part of his Florida continuing care retirement community. He had fallen in his apartment, received treatment at a local hospital and then was discharged to the nursing home for rehabilitation and physical therapy. To be blunt, initially it was a terrible experience. When we arrived at the nursing home, they assigned my father to a room and then left us to fend for ourselves for what felt like an eternity. How wonderful it would have been to have someone – a nurse, an administrator, anyone -  take a few minutes to welcome him, explain his daily schedule, meal options, etc. Yes, I understand that he was just one of many patients they had to deal with. But a little warmth and time spent in his admission would have gone so far in starting things off on the right track. Instead I left the nursing home that afternoon with a knot in my stomach, with no confidence in the care he would receive. It certainly did not feel like a “homelike environment.”

One of the other points in Friday’s CMS report is that nursing homes should start to pay “close attention to resident’s preference for his or her own daily schedule.” I know this will be a difficult task, but how wonderful it will be for the residents in nursing homes that can fulfill this suggestion. My father prefers to eat his dinner later in the evening, 6:30 at the earliest. While he was in the nursing home, he had to eat at 5pm. That may seem like a minor issue, but to anyone who has dealt with a family member in this situation, you know that it has a big impact on their attitude and sense of dignity. One of the things that upset my father the most while he was in the nursing home was that he was dependent on the nurses and CNAs just to use the bathroom. He would have to ring the call bell and then wait, and wait, and wait, for someone to come into his room to help him up to the bathroom. As you can imagine, at 84-years-old, this was often an urgent issue for him.  But most of the nursing staff seemed to exhibit total disregard for this.

I believe that part of the problem initially was that my father was placed on a floor where most of the other residents were much more incapacitated that he was. So I think the staff was a bit slack – it is tempting to not be “resident-centered” if the resident doesn’t know the difference, and can’t even articulate any frustration. He was also placed in a corner room at the end of the hall, a bit of the “out of site, out of mind” phenomena. After my sister and I raised a fuss, he was transferred to a different floor and that’s when things turned around. He was surrounded  by more active residents, and more engaged staff members. I recall the dining supervisor found out that he had been asking for honey to go with his hot tea (which was usually served lukewarm, by the way). Just when he had given up on ever getting honey, she arrived with several small packets  delivered personally to his room. A small gesture that made a big impression.

I’m sure there are nursing homes in Florida and the rest of the country that already focus on “resident-centered care” and “homelike environments.” But there are far too many that don’t. This won’t happen overnight. But I have hope that these new survey guidelines will at least get these important issues on the table and create greater accountability for nursing homes. If you’d like to learn more about the CMS guidelines, visit http://www.cms.hhs.gov/transmittals/downloads/R48SOMA.pdf

For a searchable database of nursing home in Florida, visit Florida Senior Living Advisor.

I’m starting to think that the next hit reality TV show should be shot in a senior living facility. Judging from what I have seen at my father’s Florida continuing care retirement community, there is plenty of material. Who sat with with whom at dinner? Who said they’d call, but didn’t. Who is most likely to flirt with the new – and rare – single men who move in? The drama is endless. And I have to believe that it is not just amusing to those of us on the outside, but it is actually mentally stiumulating to those involved.

Prior to moving into his senior living facility more than a year ago, my father had spent about four years living all alone in a traditional apartment building, filled primarily with people much younger than him who were busy with their own lives. I suspect he would go days without interacting with anyone else, especially in the cold winter months when he would not venture out. Imagine eating every meal alone? It took me a while to realize that this social isolation was having a very negative effect on his mental and physical health. He, of course, denied it, trying to take pride in his belief that he didn’t “need” to be around people as much as most. How wrong he was.

Within a week or so of moving into his Florida continuing care retirement community, I could sense renewed energy in his voice. He started making friends and I could tell he was amused by the “soap opera-like” drama among residents. Within the first month, he met a female resident that he really clicked with. Here we are nearly a year later and they are still going strong, sharing meals, long walks and participating in the facility’s organized activities together. His attitude and energy are far better than when he first moved in. At times he does sound a bit disgusted by some of the gossip and nosy-ness that he thinks some of the residents exhibit. But while he may never be able to admit it, I think he does realize it is better than the alternative – living all alone.

I just learned that a nursing home in West Palm Beach has been fined $16,000 after a patient was found on the floor with maggots crawling out of his leg cast. An August 2008 report by state regulators determined that Azalea Court Nursing Home failed to provide necessary care to the resident, who had a cast on his lower leg, leading to the infestation of maggots. The patient’s broken leg was supposed to be treated every three days, but the facility could only document weekly treatment.

In April 2008, just four months before the above-mentioned incident report, inspectors cited the 120-bed facility for a series of isolated events that it said “put the health or safety of residents in immediate jeopardy.” The nursing home was put on a “watch list” and given just one out of a possible five stars as its overall inspection grade, including just one star for quality of care and quality of life measurements, according to the Florida Agency for Health Care Administration. State regulators gave Azalea Court a “J” grade for protecting residents from mistreatment and having policies to prevent abuse. That grade means there was “immediate jeopardy” to resident’s health or safety for isolated violations. You can find Florida’s watch list and get other state ratings of nursing homes here. Azalea Court has appealed the penalty.
 
I can’t help but wonder if the resident in this case has any family members nearby who oversee his care. I know that when my father fell last fall while living in his continuing care retirement facility, I was there every day afterward to check on his care and rehabilitation at the on-site nursing home. This shouldn’t be necessary – a resident in a senior living facility should get quality care whether there is a relative or friend watching or not; but I can’t help but think that in reality – at least in some senior living facility – it does matter.

What is particularly appalling about this story is the paltry size of the fine – $16,000??!! I’d like to know how state regulators came up with that amount. And more importantly, when the appeals process is complete, will the facility face any fine??

The nationally renowned advocacy group, Americas Watchdog, has created the Nursing Home Complaint Center to draw attention to senior citizens suffering wrongful death, abuse and neglect. America’s Watchdog describes itself as a “National Advocacy Group for Consumer Protection and Corporate Fair Play.” It’s the same group that has been helping to lead the charge against allegedly toxic Chinese drywall. They have also received attention for their Mortgage Inspection Service, intended to keep consumers from being cheated or overcharged when they finance or refinance their home.

According to America’s Watchdog,”once our legal team is in place, the Nursing Home Complaint Center will focus weekly press releases on elder abuse, Medicare or Medicaid fraud, Class Actions, or Wage and Hour investigations.”

They are interested in the following issues:

• Nursing homes not providing patients with minimum time per day.
• Nursing homes over billing Medicare for testing that was never done.
• Nursing homes not changing patients for a 24 hour period of time. (the patient then gets septic infections and then they often die)
• Nursing-home care firms that, instead of sending an actual nurse, send a undocumented worker to spend the day with the patient.
• Nursing homes not paying overtime to their employees, or abiding by fair labor laws.
• Possible class issues related to standard of care, drug costs, testing schemes, etc.

I will be interested to see what develops from this group. Unfortunately, I suspect they won’t have any trouble finding complaints against nursing homes to try to splash all over the evening news. Certainly there are many wonderful nursing homes throughout Florida and the entire country that are providing quality care and service to patients. But I also think that in many of these facilities, employees are overworked, underpaid and not monitored closely enough. Maybe just the creation of this complaint center will be enough to get some nursing homes to pay closer attention to safety, quality and customer service.

We’ll see. I’ll report back as I learn of updates from America’s Watchdog.