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.)

Today’s featured senior living facility is Pinebrook Rehabilitation and Nursing Center in Venice, FL. Pinebrook is a 120-bed facility that offers a wide range of post-acute care, short-term rehabilitation, long-term care, and other specialty medical services. They also have a special Alzheimer’s care unit called the Avalon Wing, and they provide hospice-related services (in partnership with a licensed hospice organization) and respite-care services (for elderly people whose primary, at-home caregiver is temporarily unavailable).

Pinebrook has been part of the Venice, Florida, community for more than 17 years. Last year the facility received the Excellence in Action Award from the Florida Health Care Association, in recognition of outstanding customer service.
One of the facility’s unique features is an outdoor therapy garden. This functional therapy garden provides real-life activities where elderly residents can regain balance, strength, mobility-and confidence. For example, instead of using parallel bars indoors, patients can cross a bridge with parallel railings that spans a man-made koi pond.

Other therapeutic areas include:

• A beach-like area to practice walking in sand
• A gravel walkway similar to many home driveways
• An uneven pavement area

Pinebrook also offers:

• On-site beauty/barber shop
• Common room
• Several dining rooms
• Family lounge
• Well-equipped therapy gym
• Koi pond
• Picnic areas
• Assistance with scheduling transportation to medical appointments and nearby shops

To learn more about Pinebrook Rehabilitation and Nursing Center, visit www.pinebrookrnc.com. For a searchable database of senior living facilities in Florida, visit Florida Senior Living Advisor.

I am trying to vary the topics for my Florida Senior Living Advisor blog, from the lighthearted to the more serious, but all with a focus on topics of interest or importance to senior citizens, their caregivers and family members. One topic I will always address is any instance of elder abuse that I hear about at a Florida senior living facility. And unfortunately, there seems to be plenty of material on this topic.

In the less than three months since I launched Florida Senior Living Advisor, this is now the fourth incidence of abuse that I am reporting. In this most recent case, a Broward County woman faces charges of abuse of an elderly person after she allegedly attacked a 65-year-old patient at the Manor Pines Nursing and Rehabilitation Center in Fort Lauderdale. To make matters worse, the patient suffers from Parkinson’s disease.

Eronie Deverlus, 50, was arrested a few days ago by law enforcement officers with the Attorney General’s Medicaid Fraud Control Unit. According to Sandi Copes, a spokeswoman for Florida Attorney General Bill McCollum, Deverlus was a nursing assistant at Manor Pines and While working at the center, she allegedly struck the female patient in the face after becoming angry with the woman.

Deverlus, who was fired shortly after the incident, is charged with one count of abuse of an elderly person, a third-degree felony. If convicted, she faces up to five years in prison and a $5,000 fine.

I’m starting a new segment on the Florida Senior Living Advisor blog today called “Friday’s Featured Facility.” Every Friday I’ll tell you about one of the more than 3700 senior living facilities in Florida, everything from assisted living facilities, to nursing homes, continuing care retirement communities, hospice, skilled nursing units and adult day care centers. If you’d like to recommend a facility for me to feature, send it to me at mitra@flseniorlivingadvisor.com.

The inaugural “Friday’s Featured Facility” is Guardian Home Health in Spring Hill, Florida, about 60 miles north of Tampa. This is actually an assisted living facility, but the name “home health” refers to the fact that it is located in a single-family home. The facility is licensed to care for six residents. Of the nearly 3,000 assisted living facilities in Florida, about half have a capacity of less than 10.

Owner Elaine DeCiutiis runs Guardian Home Health, along with her husband Frank and daughter, Paulamarie Aurigemma. DeCiutiis and Aurigemma are both certified nursing assistants and have backgrounds in health care administration. They opened the home last October, with the goal of providing very personalized care to each elderly resident.

“When I’ve gone to big nursing homes, I see people just sitting there and doing nothing,” says DeCiutiis. “We try to keep them active. We play cards.  We discuss current events. We go to the movies or out to lunch.”

DeCiutiis also tailors each meal to the residents’ taste as much as possible.

“You could say we spoil them,” she says with a laugh. “But at their age, they deserve to be spoiled.” Residents are also offered a shower every day, a service that is often not possible in larger facilities where there may not be enough staff to accommodate residents in this way.

For more information on Guardian Home Health, you can visit their website at www.guardianhomehealth.org. You can also call 352-688-8832 or send an email to edecuitiis@tampabay.rr.com.    

Lately, whenever I put on a pair of shoes, I think about my elderly father. As I stare at my choices – high heel, low heel, sandal, sneaker, black, white, pink or blue – I think about him putting on the same pair of brown fisherman sandals day after day, month after month. He only has one pair; not because he’s particularly picky, but because we have not been able to find another pair that meets his needs for comfort and function. Like a lot of senior citizens, his feet appear slightly swollen most of the time. Not enough to cause concern but enough to make it difficult to find suitable shoes. He needs them to be wide; he needs them to have a high rise (the opening from the sole to the top of the shoe); he needs them to be easy to put on; and most importantly, he need them to be safe. When he first moved to Florida about a year ago to move into a continuing care retirement community, he primary footwear was a pair of slip-on sandals. They met all the criteria except the most important one – safety. Without any support around his heel, the shoes forced him to walk in a shuffle, not really picking his feet up and often snagging on carpet.
 
Last September, he took a fall (unrelated to his choice of shoes), that forced him to spend several weeks in the nursing home section of his ccrc. Upon his release back to his independent living apartment, I decided it was time to get him new and better shoes. The pair we selected is a leather fishermen’s sandal with one very helpful feature- a velcro closure strap. At 84 years old and having had double hip replacement surgery several years ago, my father’s mobility is limited. There’s no way he could bend down long enough – and steady enough – to tie shoelaces. But he also can’t wear slip-on shoes that can’t be opened and then closed; they are just too tight for him to get on. So these fishermen sandals have been the perfect solution. He can sit in his chair, position the shoes just in front of his feet, and with some patient wiggling, get his feet in. Then he slowly reaches down and closes the velcro. The holes in the sides of the shoe also offer much-needed ventilation.

I tell you all this because it has only recently hit me how something that I take largely for granted – the ability to wear whatever shoes I want – can become a huge issue for senior citizens. Shoes that seem sturdy may actually contribute to falls for the elderly, according to a study by Dr. Carol Frey, an orthopedic surgeon. Dr. Frey studied 185 men and women. Among those who fell and were injured during the year of the study, 28% said that the shoes they were wearing had caused the fall. Sixty percent of those wearing sneakers said they fell because their shoes caught or dragged on the floor.

Here are some safety tips from orthopedic experts:

• Never wear shoes with slippery or worn outer soles. Also avoid shoes with smooth leather or plastic soles, which can be slippery on carpets, wood and tile floors, and wet surfaces. Some athletic shoes made with synthetic soles, which may be ideal for exercising in a gym, can be extremely slippery on a damp or wet surface.
   
• Avoid wearing shoes and slippers that are loose or ill-fitting.
   
• When walking on carpets, avoid wearing shoes with heavy rubber lugs that can catch on carpets, especially when they are worn by people who barely pick up their feet when they walk (exactly my father’s problem). The rubber tips on the toes of running shoes can also cause a stumble on a carpeted surface.
   
• For an all-around shoe, consider walking shoes, which provide good traction and support but do not have heavy soles or rubber over the toes.
   
• Although shoes with a lot of cushioning can make you feel as if you are walking on air, they can also make an older person unstable and are best avoided.
   
• Shoes that tie are safer than shoes that slip on the feet. Laced shoes can be adjusted to accommodate orthotics, braces and swelling of the feet. For those who lack dexterity, consider replacing cloth laces with elastic ones that hold the shoe firmly on the foot, but stretch enough to allow shoes to be slipped on and off without tying or untying the laces. (I am planning to have my father try out this type of laces on his next pair of shoes.)
   

I am currently talking to some companies that sell shoes specifically for the elderly about advertising on my Florida Senior Living Advisor website. Stay tuned for more on that.

This made me smile. I just heard about a wonderful exhibit at the Museum of Florida History in Tallahassee. “Art from the Heart” is a display of artwork from 35 nursing home and assisted living residents from throughout Florida. The elderly residents created the artwork as entries for the Florida Health Care Association’s “Art from the Heart” 2009 calendar competition. According to a news release from the FHCA, some of the artists have been creating art their entire lives, while others have recently discovered their talent. Some of the individuals who submitted pieces for this year’s calendar include:

• 82-year old Helene Kereluk’s passion is painting, as demonstrated by her “St. John’s River” artwork featured on the 2009 calendar cover. She studied art in Chicago and continued her studies after moving to DeLand, Florida, where today she resides at The Cloisters independent and assisted living facility (ALF) and teaches a monthly class for her fellow residents.
• 84-year old Sally Darcangelo never realized her natural talent for painting, ceramics and crafts until entering Palm Garden of Pinellas in Largo, where she has lived for over a year. Her “Starry Night” painting is the featured artwork for May.
• 56-year old Bruce Landers is a C5, 6, 7 quadriplegic who is paralyzed from the chest down and has no hand or finger function. He used a hand adaptation to create his “Lighthouse Keepers Home” painted jigsaw puzzle that is the featured artwork for September. Bruce resides at Park Meadows Health and Rehabilitation Center in Gainesville.

The artwork will be on display in the Museum’s Heritage Gallery through September 7. The 2009 Art from the Heart calendars sold for $7 each, with proceeds used toward FHCA’s Quality Credentialing Foundation. The Foundation focuses on improving services and quality care for those living in Florida’s nursing homes by offering long term care providers mentoring, information and resource sharing and advocacy. The Foundation also promotes increased customer satisfaction and employee retention in long term care facilities and offers continuing education and scholarships for long term care nurses, nursing assistants (CNAs) and other professional staff.

For a comprehensive searchable database of senior living facilities in Florida, visit Florida Senior Living Advisor.

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.

Last week, my father fell while alone in the apartment of his continuing care retirement community. I am so thankful that he was wearing his “alert” necklace. He was able to push the button, which sent an emergency signal to the security staff in his senior living building. In a matter of minutes, they were in his apartment, helping him up off the floor. Thankfully, he was not seriously injured. A continuing care retirement facility means that while my father lives in a fully independent apartment, there is a nursing home on the same property. So in a situation such as this, one of the registered nurses from the nursing home was called to his apartment to evaluate him after the fall. This gives me great peace of mind, to know that he has access to a full medical staff 24/7. Otherwise, in this case, the security officer would have had to call an ambulance to transport him to a nearby hospital.

When you are evaluating a senior living facility, be sure to ask specific questions about the safety and security measures the facility offers. In my father’s case, each apartment comes equipped with an emergency pull-cord in the bathroom. But the “alert” necklace that he wears was an optional feature that we had to order through his maintenance department.

Have you or a loved one been helped by an “alert” necklace or other safety feature in a senior living facility? Share you comments below.