I suppose I shouldn’t have been surprised by this sentence in a recent report by the Federal Government. The sentence reads, “In addition, the most poorly performing homes tended to be chain affiliated and for-profit and have more beds and residents.”  The report, by the General Accounting Office, is a lengthy document about the quality of our nation’s nursing homes. To see it in print – from the federal government – that “chain affiliated and for-profit” nursing homes tend to be the ones offering the poorest care to residents only reaffirms what I have long suspected, and what I have heard from many of you who write to share your personal experiences of loved ones in senior living facilities. Time and time again, I hear that the best care tends to come from a personal connection between caregiver and resident.

And here is another interesting finding – the most poorly performing homes are distributed UNEVENLY across the states, with eight states having no such homes and ten others have from 21 to 52 such homes. Where do you find the 52 worst nursing homes? According to the GAO, that’s in Indiana. Florida has 16 that make the list, a relatively low number considering there are 664 nursing homes in my Florida Senior Living Advisor database. But we don’t do as well as another popular retirement location – Arizona has just 4 homes on the list.

According to GAO’s estimate, of the 16,000 nursing homes in the US, four percent – or 580 – could be considered the most poorly performing. If you want to understand more about the GAO’s research and conclusions, you can read the summary and recommendations, or even review the entire report. But be patient – it is 57 pages long! (The map showing numbers of poorly performing homes in each state is on page 15.)

In the past year, I’ve seen first-hand how devastating a fall can be to an elderly person. My 84-year-old father has fallen twice in his independent living apartment. The first time, he was on the floor for about 36 hours before he was found; the second time, he was down for about five hours. He has been very lucky – he has recovered fully from both incidents, with no long-term effects. In fact, I think his two artificial hips have actually been a blessing in these  falls – his right hip did dislocate both times, but doctors were able to pop it back into place; had this been his natural hip, it likely would have broken, leading to a much more difficult recovery.

The sad reality is that falls are one of the most common causes of accidental death in the elderly. A series this week in the Minneapolis Star-Tribune aims to raise awareness of the prevalence of falls in Minnesota nursing homes; I have to believe this is a similar problem nationwide, and not just in nursing homes but in assisted living facilities, independent living communities and private homes. In her commentary on the series, Star-Tribune editor and senior vice-president Nancy Barnes writes, “I urge our readers not to look away, despite the distressing nature of these stories. Nothing is more certain in life than death; we can only hope that we will be allowed the gift of dignity. In many of these stories, that is simply not the case.”

The investigative article is long and, at times, difficult to read. But it is important. Worth sharing. As one doctor quoted in the  article states, “”I think if you asked a person on the street, not one of them would know that if you take the frequency of falling and the consequences of falling, it’s as big a problem as heart attacks and strokes.” My father was one of the lucky ones. For many elderly people, a single fall can trigger a rapid decline in health. I hope you will take a few minutes to read this article. And I hope you’ll share your thoughts by leaving a comment.

Today is the first annual World Pneumonia Day. Nearly 100 health organizations worldwide have come together to call on governments to take action to address this deadly disease. This awareness campaign is focused on pneumonia in children; and rightly so since pneumonia kills more than two million kids worldwide every year, making it the leading killer of young children.

Let’s not forget, however, that the elderly are the second most-affected segment of our population when it comes to pneumonia. Community Acquired Pneumonia (CAP) causes about 500,000 hospitalizations in those older than 65 yearly in the US and is the 5th leading cause of death in people over 65.  Nursing Home Acquired Pneumonia (NHAP) is one of the most common causes of infection in chronic care facilities and is one of the most significant infection-related causes of mortality in such facilities.

The Centers for Disease Control reports that last year 60% of adults 65 and over received a pneumococcal vaccination, sometimes called PPV. The good news is that if you get the pneumonia shot at age 65 or older, you should be protected from the most common type of bacterial pneumonia for the rest of your life, and Medicare will pay for it. According to the CDC, seniors age 65 and older should consider getting vaccinated against pneumonia as well as the seasonal flu, because they are at risk for developing the two infections at the same time.

So if you have an elderly family member, particularly one living in a senior living facility, find out if they have  received a pneumonia vaccine. Some, such as my somewhat stubborn elderly father, may refuse to get the shot. But it is an important issue to raise with the individual and his or her doctor.

If an elderly family member suffers from hearing loss, here is something you need to know: Florida Telecommunications Relay, Inc., (FTRI) will provide specialized phone equipment for them at no cost. FTRI is a statewide non-profit organization that provides this equipment as mandated by the Florida Legislature. The program is funded by an 11 cent surchage on all landlines in Florida. And these phones can be used in private residences, or in Florida nursing homes, Florida assisted living facilities, and Florida continuing care retirement communities.

And now FTRI has added a cordless amplified phone to its mix of available equipment. The Clarity W425 Pro amplifies incoming sounds up to 45 db.

Clarity W425 Pro cordless amplified phone

Permanent Florida residents who are certified as having a hearing loss can easily obtain the W425 Pro by completing an application and visiting one of FTRI’s 22 conveniently located distribution centers throughout the state.  For more information, call FTRI at 1-800-222-3448 or visit www.ftri.org. 

“FTRI aims to provide individuals with hearing loss a telephone solution like the Clarity W425 Pro,” said James Forstall, FTRI’s executive director.  “The majority of the people we serve are senior citizens and the Clarity W425 Pro is a device that may assist them with communicating with others on the telephone.”

 FTRI estimates that nearly three million Floridians experience some degree of hearing loss. Along with amplification technology, the W425 Pro contains large backlit numbers, a bright visual ringer, and is hearing aid compatible. 

 “FTRI is an outstanding program which helps so many people throughout Florida,” said Carsten Trads, president of Clarity.  “Hearing loss is a serious, yet often overlooked issue.  Many people are not aware that solutions like amplified telephones even exist.  Thanks to FTRI, hopefully more people in Florida will take the necessary steps to address their hearing loss and consider using amplified telephones.” 

FTRI also offers equipment for Florida residents who are deaf,  blind or speech impaired. Many other states have similar free programs.  Visit the Telecommunications Equipment Distribution Program  Association to learn more.

Sunday, October 18, life threw me a curve. My elderly father fell in his Florida senior living apartment and dislocated his hip. That triggered a series of events – a trip to the ER to have it put back in place, his release that same night to come stay with me, a second hip dislocation followed by a  second re-location. Then six nights in the hospital to run tests,etc.  He is now back in his Florida continuing care retirement community apartment and gradually re-gaining his strength. So I thought I would share the top ten things I learned in this last week of helping my father recover from this fall:

1 – At any age, life can change in an instant.
2 – Healthcare workers are just like the general population – some are nice, some are not so nice; some are highly skilled, some are mediocre; some genuinely care, some are just doing a job. We shouldn’t make them “God-like,” nor should we start with the mindset they are all incompetent (like my dad is prone to do).
3 – Communication is critical when in the hospital – both from the patient to staff and from the staff to patient. I find nothing puts me, and my father, more at ease then feeling like the medical staff is keeping us up-to-date on his situation; and nothing was more frustrating then having to walk around begging someone to tell us what is going on.
4 – Nothing happens fast in the hospital. Patience is key.
5 – You must be an advocate for yourself, or for your loved one if you are their caregiver. Ask questions, ask for clarification, ask to see test results, ask “What would you do if this was your father?” Don’t be afraid to push a little. I had to call my father’s nurse to say “He would really like to shave, can you help him do that?” and “He has been lying in bed all day, can someone please get him up to walk the halls?” The squeaky wheel gets the grease.
6 – The whole experience of being hospitalized can be confusing and frightening, particularly for the elderly. In my elderly father’s case, anything outside of his normal daily routine causes some confusion. So suddenly being in a hospital, with no familiar faces, a different schedule for meals, none of his personal effects, etc., left him confused and a bit angry. I had to remind myself that his anger was just an expression of his confusion and frustration at the situation and at having to rely on everyone else.
7 – When caring for an elderly family member, remember to care for yourself too. It has taken me a long time to embrace this concept. When my father had a similar fall last year, and was hospitalized for a couple of weeks, I was constantly wracked with guilt if I was not by his bedside 24/7. I have finally learned that is not necessary for him , and not healthy for me. And actually I have found that by taking breaks, I have helped him re-gain confidence that he can do things for himself.
8 – Health insurance & Medicare rules are confusing and can sometimes be an overriding factor in determining care.
9 – When dealing with a variety of care providers (physical therapists, home health, rehab facilities, etc), don’t lose sight of the fact that they are all in business and that factors in to their recommendations.
10 – Getting old is not for sissies (credit goes to my husband for that one).

Christopher Williams, Senior Solutions

The words “long term care” usually bring to mind images of nursing homes and elderly people living in them who can no longer care for themselves. In truth, long-term care (LTC) comes in many different forms, is provided in many different settings, and can refer to people of all ages.

In 2008, the average annual cost of a stay in a private room in a nursing home was more than $76,000. A stay in an assisted living facility was $35,628. Yet the majority of long-term care services aren’t paid for at all. They are provided by 52 million unpaid caregivers – primarily family members and friends of those needing the care.

According to the Alliance for Health Reform, two-thirds of Americans age 65 will need some type of long term care in their lifetimes. For those who do not have family members to provide it, or those who do not want to be a burden financially (or emotionally) on their relatives, the out-of-pocket cost can be substantial. These costs vary widely from region to region, ranging from $25 per day to $500 per day, with the highest rates in the Northeast, Texas, and Florida. The average cost of a nursing home here in Florida is near $140 per day.  With the average stay in a LTC facility being two and a half years, that adds up to $127,700.

The question that needs to be addressed is whether someone has enough income or assets to handle these costs over time.  Typically, a senior’s income will not cover the costs, but their savings may be enough to handle the expenses. Unfortunately, however, there is no way for anyone to estimate the total of their future LTC expenses.

In making these decisions, one should consider all of the options. Many elderly people who do not have the assets to sustain the high costs of LTC may eventually qualify for Medicaid assistance. In order to qualify, though, they will have to spend down their own assets first before Medicaid steps in. Medicaid accounts for 49% of the total spending towards LTC in America. Another option is to purchase a Long Term Care insurance policy. These policies can be expensive, with costs varying greatly depending on the age and medical history of the insured. But the cost of these polices pale in comparison to the out-of-pocket potential of using one’s own assets. Before making any decision, it is a good idea to sit with a state licensed insurance agent to estimate the cost of a policy. This may be the agent who sold you your life or auto policy, or you may need to find a specialist. Either way, be sure the person fully understands your needs and is active enough to be selling at least a dozen policies a year.

In 1987, the Robert Wood Johnson Foundation initiated the Program to Promote Long-Term Care Insurance for the Elderly. This program is available in eighteen states, including Florida. The program involves a partnership between Medicaid and private LTC insurance.  It allows nursing home patients with state-approved long-term care insurance policies to be eligible for Medicaid with substantially higher levels of assets than are normally allowed. This would permit them to receive nursing care but still have enough to live on and to bequeath to their children.

Whatever decision you make, you may want to make it sooner rather than waiting. The cost of an insurance policy is partly based on age, but you will also want to make arrangements with friends or family members should you choose to “self-insure” or to receive care from a relative. It’s never easy to discuss or think about, but definitely needs to be addressed before it’s too late.

I remember when I was helping my elderly father select a Florida senior living facility, one of the biggest issues for him was cost: What does it cost up front? What does it cost each month? And most importantly – will those costs increase every year? As someone living on a fixed income, he didn’t want to move into a senior community where he couldn’t afford to stay – forever.

The facility he selected guarantees only nominal increases each year, which gave him the peace of mind he was looking for. But I just learned about a Florida senior living provider that is going one better: Aston Gardens, which operates six senior communities in Florida, has enacted a three-year rent guarantee for new independent living residents.

“We know that times are uncertain and many seniors are faced with the worries associated with living on their own. Seniors who live on their own never know if the property taxes on their residence will skyrocket or when they’ll be hit with an unexpected, expensive home repair bill. Our three year Peace of Mind Rent Protection Guarantee means seniors will never have to stress about their monthly bills — everything remains the same month after month,” said Diana Ferrante Thies of Aston Gardens.

Aston Gardens has senior facilities in Parkland, Naples, Venice, Tampa and two in Sun City Center.

Maybe there are other senior living facilities around the state offering this type of rent-control program. If you know of any, please let me know.

Funny how life gets in the way. It’s been several days since I posted on this Florida Senior Living Advisor blog. There are two reasons: first, I was busy helping my elderly father address some issues he is having with his eyes. Looks like cataract surgery is in his future. First he has to see a retina specialist, to make sure there are no underlying issues with his retina. I don’t mind taking him back and forth to doctors, but the fact is it is very time-consuming.

In addition to those obligations, I was busy on Friday and Saturday attending an amazing conferenced about social media and blogging. It was called “Izeafest” – a reference to the company that organized it, Orlando’s Izea, Inc. I learned so much and met so many wonderful people. I’m still going through all of my notes, mapping out next steps for this blog and for the Florida Senior Living Advisor website. But I know one my priorities needs to be to find other websites and blogs to link to me. So this is my first shout-out: if you know of a useful blog that focuses on issues such as senior care, senior living facilities, nursing homes, assisted living facilities, Alzheimer’s disease, Medicare, really ANYTHING of interest to seniors, please tell me about the site in a comment below. I also want to know about these sites so I can add them to my “Helpful Links” section of Florida Senior Living Advisor.

Today’s “Friday’s Featured Facility” is The Veranda of Pensacola, a Florida continuing care retirement community. This means that The Veranda offers both independent living and assisted living options, which allows elderly residents to “age in place” – ie – transition from independent to assisted living as their needs increase.

According to their website, the apartments at The Veranda retirement community are spacious, modern and well-equipped one and two bedroom units with fully equipped kitchens.  Utilities and expanded cable TV are included. The amenities at The Veranda include common areas inside and out, an indoor heated pool, fitness center, and a own stadium seating movie theatre.

The Veranda provides housekeeping, linen and laundry service, scheduled transportation for independent residents and coordination of transportation for assisted living residents, a personal emergency response system and maintenance inside and out. The Veranda also has 24-hour camera surveillance.

The dining service provides a healthy breakfast, lunch (main meal of the day) and light meal in the evening. When it is time for community outings, shopping and personal appointments, the professional staff at The Veranda retirement community will schedule the necessary transportation.

The Veranda is just one of many Florida continuing care retirement communities. To see a complete list, searchable by region, visit Florida Senior Living Advisor. The database also includes assisted living facilities, nursing homes, adult day care centers, independent living communities, hospice and skilled nursing units.

My elderly father used to be quite the world traveler. Whether for his job with the U.S. Government, or for pleasure, he visited more corners of the earth than I will ever see. As I recall, his last overseas trip was to Paris about five years ago with my nephew. Now, at 84-years-old and a bit unsteady on his feet, he rarely leaves the grounds of his Florida senior living facility, much less travel out of the country, or even out of state. But I think with enough planning and accommodations, he could easily have some adventures in his future.

I recently came across this list of travel tips for wheelchair users and slow walkers. It is provided by Connie George Travel Associates, based in Pennsylvania. These tips are specifically tailored to a cruise vacation, but I think they can help to ensure a safe and enjoyable vacation of any kind.

• Be clear about what you need. Whether you are dealing with a travel consultant or directly with a cruise line, keep in mind that not everyone has exactly the same needs. A cabin feature that works well for most others may not meet your requirements. You are the best judge to know what works best and you need to relay that information rather than assume what you need is the norm.
• Think about all aspects of the trip. As well as an accessible cabin on an accessible ship, you may need accessible airport and pier transportation, an accessible hotel room before and/or after the cruise and accessible sightseeing options in the ports.
• Consider whether you need adaptive equipment in your cabin to be more comfortable. Some items may be offered by the cruise line while other equipment is available for rent from third party companies. If renting a transfer lift would make mornings and evenings easier for you and your traveling companion, consider adding it to your cruise plans.
• Check the itinerary for “tender” ports. Tendering means the ship will anchor in a bay and use a boat to shuttle guests into the port. Success in tendering depends on the cruise line’s policies on allowing and assisting guests who use wheelchairs to tender, the size and weight of your “wheels”, and sea conditions.
• Consider riding. If you are a “slow walker” with limitations on how long you can be on your feet in time or distance, consider renting a scooter. If it helps increase your stamina or gives you more flexibility to get around your large ship, it may make your vacation more enjoyable and relaxing.
• Consider downgrading your ride. If you use a scooter or power chair full-time and are able to use a manual wheelchair and perform transfers, you might want to consider bringing or renting a manual wheelchair for ports. Many ports don’t have accessible vehicles with ramps or lifts. In those cases, using a manual wheelchair and transferring onto the seat of a car can give you access to more sightseeing.
• Request a table location. Like banquet seating, tables can be a bit close. Request your dining table to be located near an entrance or pathway for ease in navigating to your table.
• Send a report. If your disability involves a chronic medical condition, consider obtaining a brief summary report from your physician. Request that the cruise line send a copy to the ship’s infirmary and carry an additional copy for you to have on hand. Ship physicians are hired from around the world so the report should use terms most used worldwide.
• Plug in. If you are traveling with a power chair, scooter, c-pap or other electric equipment, bring a power strip and an extension cord. Most cabins have only one outlet and it’s located at the vanity.
• Hire an advocate. That’s what you’re doing when you book through an agent who specializes in accessible travel. They have dedicated a lot of time and energy into learning about accessibility and have developed rapports with suppliers. They also devote a lot of resources to teaching suppliers about accessibility and in advocating for travelers who have disabilities. A specialist will go to bat for you, saving you time and concern so that you can look forward to your vacation with the same excitement that nondisabled travelers enjoy.