Should Seniors Choose Adult Day Care?

Senior citizens fear moving into a nursing home and the loss of their independence far more than death.

A recent study commissioned by Clarity and the EAR Foundation found that 89 percent of American seniors want to age-in-place, that is, continue to live in their homes as long as possible, and are willing to use adaptive technology that will allow them to maintain their independence.

The study found that their children—Baby Boomers born between 1946 and 1964, now faced with the responsibility of dealing with the housing care and other needs of their aging parents—share the same concerns and are willing to support their parents’ efforts. This means, of course that many of the more than 76 million Boomers have assumed the caregiving role for their aging parents. Most are unprepared for the cost, emotional toll, and health issues they face as caregivers.

Seniors rated loss of independence (26 percent) and moving from their home into a nursing home (13 percent) as their greatest fears. Death was listed as a fear by only three percent of the respondents questioned for the research study. “These findings tell us that, above all else, older Americans value their ability to live independently,” notes Peter Bell, president of the National Aging in Place Council.

Adult Day Care is a particularly attractive solution that can provide comfort to aging seniors, as well as their Baby Boomer caregivers. It’s true that these caregivers may be somewhat reluctant to use adult day care services because these services are unfamiliar to them, or because the elder is hesitant to try something new. The benefits of adult day careadult day care are these:

• Participants benefit from socializing with others and receiving the kinds of care services they need.

• Equally important, the caregiver benefits by getting a break from caregiving duties while knowing that their loved one is in good hands.

The fact is, of course, is that because life expectancy is continuing to rise, many, if not all of us may need assistance as we age. Help of all kinds is becoming increasingly available, and an especially valuable option is adult day care. It’s specifically designed for older adults who can no longer manage independently, or who are isolated and lonely.

What is an adult day care center? Adult day care is a planned program of activities designed to promote aging seniors’ well-being by means of social and health-related services. Adult day care centers typically operate during weekday daytime hours, offering a safe, supportive, cheerful environment. Nutritious meals that can accommodate special diets are typically included, along with an afternoon snack.

The centers can be public or private, non-profit or for-profit. The intent of an adult day center is primarily two-fold:

• To provide the elderly an opportunity to get out of the house during the day, and to receive mental and social stimulation; and

• To give the elder’s caregiver with a much-need break, which can be used to attend to other responsibilities or to rest and relax.

The National Adult Day Services Association (NASDA) estimates that there are approximately 4,000 adult day care centers operating nationwide. The proliferation of centers over the past two decades corresponds to what NASDA believes is the "mushrooming demand for home and community based services" to meet the needs of a rapidly-escalating elder population.
Good candidates for adult day care are seniors who:

• Can benefit from the friendship and functional assistance a day care center offers,

• May be physically or cognitively challenged but do not require 24-hour supervision,

• Are in the early stages of Alzheimer's disease.

Adult day dare center participants need to be mobile, with the possible assistance of a cane, walker or wheelchair; in most cases, they must also be continent.

Adult day care is different than “adult day health care.” The latter usually requires a physician-performed health assessment as a precondition to admission into the program. Adult day health centers, which typically use the term "Adult Day Health Care" (ADHC) in their names, often provide physical, occupational, and speech therapy. ADHCs are usually staffed with a registered nurse, as well as other health professionals. There is a third type of day care that provides social and health services specifically for seniors with Alzheimer's or a related type of dementia.

Services provided by adult day care centers. The mission of these centers is to maintain and build upon seniors’ skills, knowledge, and their particular abilities and strengths. Typical activities are these:

• Arts and crafts;
• Musical entertainment;
• Mental stimulation games;
• Stretching or other gentle exercise;
• Discussion groups;
• Holiday and birthday celebrations; and
• Local outings.

Some centers offer programs that include children and animals. Indeed, recent research has found that the availability of animals in these environments provide the following benefits:

• Improved sense of purpose and fulfillment.
• Reduced feelings of loneliness and isolation.
• Lowered blood pressure and cholesterol levels.
• Increased survival among heart-attack victims who own dogs.
• Improved blood circulation.
• Slowed loss of bone tissue.

One Australian study revealed that pet owners typically visit the doctor fewer times and use less medication; recover more quickly from surgery and illness; and deal better with stressful situations. Pets also have been found to relax us, entertain us and open up opportunities for socializing.

Besides recreational activities, some adult day care centers provide transportation to and from the center, social services including counseling and support groups for caregivers, and health support services such as blood pressure monitoring and vision screening.

Benefits of adult day care. The benefits of adult day care can be substantial and significant. Here are some examples.

• A safe, secure environment to spend the day;
• Enjoyable and educational activities;
• Improvement in mental and physical health;
• Enhanced level of independence;
• Socialization and peer support; and
• Nutritious meals and snacks.

When to opt for an adult day care center. According to ElderCare Online, you should seriously consider using adult day care when a senior:

• Can no longer structure his or her own daily activities;
• Is isolated and wants companionship;
• Can't be safely left alone at home; or
• Lives with someone who works outside the home or who is frequently away from home for other reasons.

Finding the right adult day center for your family's needs. The National Adult Day Services Association (NADSA) recommends you start by asking yourself what specific services both elder adult and caregiver most need.

• Are social activities the primary need?
• Is there a need for assistance with walking, eating or medications?
• Is mental stimulation required? Exercise?
• As a caregiver, do you need support? Some free time? Help with transportation?

The answers to these questions will help you determine which of the three main types of adult day care centers (social, health-focused, and Alzheimer's/dementia oriented) will best serve you.

There are numerous references and resources that can help locate adult day care centers in your area, including http://www.greatplacesinc.com. In addition, you can also try:

• Your family doctor
• Local social services or health department
• Mental health centers
• Local senior center
• Area Agency on Aging (Call 1-800-677-1116 for the AAA in your area)
• Yellow Pages listings under Adult Day Care, Aging Services, Senior Citizens' Services, and similar categories.

When you phone the center(s) you've decided to consider, ask the following questions:

• Who owns or sponsors the agency?
• How long has it been operating?
• Is it licensed or certified? (If required in your state)
• What are the days and hours of operation?
• Is transportation to and from the center provided?
• Which conditions are accepted (e.g., memory loss, limited mobility, incontinence)?
• What are the staff's credentials, and what is the ratio of staff to participants?
• What activities are offered? Are there a variety of individual and group programs?
• Are meals and snacks included? Are special diets accommodated?

Next, spend a day at the center that sounds best to you, so that you can get a "feel" for the people and environment. Be sure to bring a site checklist with you. You may wish to go back a few times to see whether your experience on different days confirms your initial impressions.

Costs and financial assistance for adult day care. The cost for an adult day care center ranges from $25 to $70 or more per day, depending on where you live and the services provided (e.g., meals, transportation, nursing supervision). Professional health care services will mean higher fees. Many facilities offer services on a sliding fee scale, meaning that what you pay is based on your income and ability to pay.

Although Medicare does not cover adult day care, Medicaid will pay most or all of the costs in licensed adult day health care settings and in Alzheimer's focused centers for participants with very low income and few assets. Be sure to ask about financial assistance and possible scholarships.

Private medical insurance policies sometimes cover a portion of adult day care costs when licensed medical professionals are involved in the care. Long-term care insurance may also pay for adult day services, depending on the policy. Additionally, dependent-care tax credits may be available to you as caregiver.

Author : Laurence Harmon

http://www.isnare.com/?aid=325892&ca=Family+Concerns

Are Florida Nursing Homes Really Jails?

You’ve probably never heard of Charls Todd “Bud” Lee, although he was an award-winning photojournalist whose work has been published in “Life” magazine, “Esquire,” “The New York Times Magazine” and even “Rolling Stone.” His photo of a bleeding 12-year old boy in Newark, New Jersey, who’d been caught in the crossfire of a police shooting, graced the cover of “Life” magazine in July, 1967. Almost exactly 16 years later, however, Bud suffered a stroke that left him semi-paralyzed and landed him in a Florida nursing home.

It turns out that Florida law requires nursing home care for Medicaid recipients, rather than allowing them to live wherever they choose. Bud is still there, in the Community Care Center in Plant City, Florida, an involuntary resident, more than five years later--and he’s really angry.

Last September, Bud’s plight caught the attention of Matt Sedentsky, a writer for the Associated Press. Sedentsky’s subsequent September 21st article, arguing that Florida nursing homes, fearful of losing money, have successfully pressured politicians to make such alternatives as in-home health care difficult for Medicaid recipients to obtain.

He reported that Bud Lee has filed a lawsuit in federal court on behalf of the approximately 8,500 Floridians who are similarly institutionalized. As Bud succintly described his situation, "Most of the people come here to die, so you want to die. It is a prison. I can't escape it."

A recent study found that seniors fear moving into a nursing home and the loss of their independence far more than death. Indeed, according to the study commissioned by Clarity and the EAR Foundation, fully 89 percent of America’s elderly want to age in place, and will use adaptive technology to stay independent. Their Baby Boomer children, the study noted, are equally concerned about nursing home care for their parents, and they’re eager to support their parents in this quest.

More than one-quarter of the study’s respondents cited as a fear a loss of independence, which is closely aligned with the fear of nursing homes and assited living facilities. Moving from their home into a nursing facility is a fear of 13 percent of seniors, while a mere three percent of research study participants identified the fear of death.

These fears appear to be justified. A recent report by the Department of Health and Human Services found that about 17 percent of nursing homes had deficiencies that caused “actual harm or immediate jeopardy” to patients, including infected bedsores, medication mix-ups, poor nutrition, and patient abuse and neglect. In fact, approximately 20 percent of the complaints verified by federal and state inspectors involved abuse or neglect of nursing home patients.

Last May, the 18,000 residents of Albert Lea, Minnesota were shocked to learn that 15 residents of the Good Samaritan nursing home, all suffering with Alzheimer’s or dementia, had been verbally, emotionally and sexually abused by local high school girls who were working at the facility. The subsequent report by the Minnesota Department of Health quoted one employee as saying that “When (the students) would do these things, they would pull the curtain enough, so when they heard a door open, they could stop. They were quite sneaky about what they were doing. The ones they were targeting were those that have Alzheimer’s so bad, that they wouldn’t be able to say it or remember.”

The report found that the abuse involved spitting and putting fingers in mouths, poking breasts and nipples, touching and tapping genitals, sticking buttocks in faces, rubbing buttocks and penises, anal insertion, and restraining residents and teasing them.

Following investigation by state and local authorities, a 19-year old and an 18-year old were charged with gross misdemeanors, carrying a maximum penalty of one year in jail and a $3,000 fine for each count. One of the teens faces 11 charges; the other, 10, including abuse of a vulnerable adult by a caregiver, abuse of a vulnerable adult with sexual contact, disorderly conduct, and failing to report suspected maltreatment. Four of the others, all 17 at the time of the alleged abuse, were charged in juvenile court with failure to report maltreatment.

More than 1.5 million people live in the nation’s 15,000 nursing homes, which are typically inspected annually. They are required to meet federal standards as a condition of participating in Medicaid and Medicare, which cover more than two-thirds of their residents, at a cost of more than $75 billion a year.

Although there are obvious acts of nursing home abuse—long-term over-medication, for example--others are more subtle, or as in the Albert Lea situation described above, difficult to detect because of the dementia of the patient. Consequently, these cases can easily be overlooked by family members. Following are some indicators of abuse:

Bedsores or open wounds are common instances of neglect or abuse. Nursing home personnel often claim that bedsores are normal among frail or immobile seniors. Unfortunately, concerned family members are duped by these explanations, and their parents and loved ones suffer pain and sometimes die from these sores. Experts say that almost all bedsore cases are caused by abuse or neglect. Guidelines require nursing homes to move patients regularly and ensure that sheets and clothing are kept dry. Should a family member find a bedsore, insist that the victim is moved to a medical facility for treatment.

Unexplained bruises, cuts, burns or fractures are often evidence that residents are being dropped or abused by staff personnel. This often occurs when the senior is in a medicated condition. Family members are urged to ask questions to get clarification about these situations, and vague or questionable responses often indicate abuse.

Torn, bloody or stained garments are the best evidence of sexual abuse, which, as described above in the Albert Lea story, frequently occurs in nursing homes, where victims are often medicated or suffer from Alzheimer’s or dementia.

Refusal to allow contact with a resident, or unexplained delays in making the resident available for a visit, indicate underlying abuse, that is, the nursing home staff is attempting to intimidate or prevent the victim’s reporting of the abuse or neglect.

Modifications to the resident’s financial documents, including wills and trusts, are cause for suspicion, particularly if these changes occur abruptly or if the resident cannot adequately explain why they occurred. Such changes suggest that the resident may have been coerced or threatened.

Each of these warning signs should spur action among family and friends, including reports to police. Suspicions of sexual or physical abuse require changing nursing facilities, as well as police involvement. Nursing home residents, who are frequent targets of abuse, nonetheless have civil rights that need to be protected, most often, unfortunately, by concerned family members and friends.

Author : Laurence Harmon

http://www.isnare.com/?aid=335585&ca=Family+Concerns

Assisted Living, The Top Choice Of Infirm Seniors

A recent study conducted by the Coalition to Protect Choice in Senior Living found that an astounding 84 percent of Americans over 50 expect that, within the next 10 years, at least one member of their immediate family will move into a senior living community, and that nearly one-quarter of those over 65 anticipate that they will do so as well.

There's more. More than one-half of younger Americans--Baby Boomers, 76 million in number, the largest generation in our history--believe that their own parents will be relocating from their single-family homes into a senior housing project within the decade.

As might be expected, the study found that cost and quality of care will be the most important factors as these Boomers and seniors evaluate the various long-term housing options.

Prospects will be very budget-conscious as they consider assisted living or nursing home care. They intend to keeps costs at a minimum. Fully 78 percent of the study's respondents agreed with the statement, "It is difficult to find the quality you desire at the price you can afford.”

Here's how prospective assisted living residents and their family members ranked the most important attributes for a facility:

76%: Personal care quality;
76%: Residents' personal safety;
74%: Cleanliness; and
68%: Staff and management (57%) quality

Assisted living facilities are a relatively new housing phenomenon. Although they were extremely rare even ten or fifteen years ago, they've become the fastest-growing and most popular elderly residential product type. Although actual numbers are sketchy, an estimated one million seniors currently reside in approximately 40,000 assisted living facilities, as compared with only 600,000 who did so only ten years ago, when there were about one-quarter of these projects nationwide. And looking ahead, experts estimate that by the year 2020, 14 million of us will require this kind of housing, double the number who do so today.

Perhaps not surprisingly, as their popularity has grown, assisted living facilities have been subject to criticism because of the health and healthcare issues that some residents have experienced. The typical assisted living project provides private or semi-private rooms, meals and housekeeping services. Many of these facilities also provide some social activities.

What may be surprising to some, however, is the fact that, unlike nursing homes, only approximately one-half of assisted living facilities are staffed by registered nurses. A recent study in the Elder Law Journal, published by the Illinois College of Law, summarized the differences between assisted living and nursing home facilities:

"In contrast to assisted living facilities, nursing homes are subject to federal guidelines because they rely on Medicaid and Medicare funds. A second major difference between assisted living facilities and nursing homes is their respective costs. Assisted living facilities typically cost less than nursing homes. However, this cost (differential) is misleading because assisted living residents use private funds to pay for their expenses while eligible persons can use Medicaid to cover nursing home costs."

The study surveyed the type and extent of state-level assisted living regulation. Unfortunately, many of these facilities had shortcomings in rules enforcement and routine inspections. The most glaring deficiency, however, was the lack of on-site training, which the study found was the case in many states.

Indeed, Maryland, one of the states critiqued in the study requires a mere three hours of training as a prerequisite to working in one of its assisted living projects. Perhaps as a consequence, patients in these facilities were found to have significant signs of neglect, including untreated bedsores and hypothermia.

As states increasingly wrestle to balance their budgets, it is likely that annual inspection of assisted living facilities will be a target for cost-cutting. In California, for example, as state that previously required annual inspections, now requires inspections only every five years. Alabama lawmakers recently slashed the budget for these inspections, reducing funding from $5.5 million to inspect 244 facilities in 2002 to $500,000 for 330 of these projects last year.

The purpose of the federal Nursing Home Reform Act in 1987 was to require some minimal level of service. In addition, it established a bill of rights for nursing home residents.

The Illinois study found that the law has favorably impacted the quality of nursing home life, including reduction in the use of physical and chemical restraints, as well as reducing hospitalization rates. The study concluded that extending federal regulation to assisted living facilities, and particularly, requiring improved personnel training, would be desirable.

On the other hand, Daniel R. Levinson, inspector general of the Department of Health and Human Services reports that, just last year, and despite the Nursing Home Reform Act cited above, more than 90 percent of nursing homes were cited for federal health and safety violations.

Indeed, nearly 20 percent of these facilities had deficiencies that, in the words of the inspector general, caused “actual harm or immediate jeopardy” to patients. These problems included infected bedsores, medication mix-ups, poor nutrition, and abuse and neglect of patients.

In fact, about 20 percent of the 37,150 complaints that were inspected, 39 percent were found to be valid and approximately 20 percent of them involved patient abuse or neglect.

There are approximately 15,000 nursing homes in the U. S., housing more than 1.5 million seniors. They're typically inspected annually, and, to qualify for Medicaid and Medicare participation, they must meet federal standards. These federal programs, which cost more than $75 billion a year, cover the expenses for more than two-thirds of nursing home residents.

The inspector general's report found deficiency rates varied widely, ranging from a high of 76 percent in Rhode Island to 100 percent in the District of Columbia, Alaska, Wyoming and Idaho.

Author : Laurence Harmon

http://www.isnare.com/?aid=334467&ca=Family+Concerns

Assisted Living Is Seniors' Top Long-term Housing Choice

Assisted living facilities are a good option for seniors who need ongoing help with personal care and typical daily activities, yet who wish to retain their independence to the maximum extent. Here's more:

As Baby Boomers enter their retirement years, it's inevitable that some might start to need assistance with day-to-day activities. But they're understandably reluctant to forfeit their independence. If they have been accustomed to managing a business--or a family--they could have a difficult time acknowledging that they occasionally forget to take their medications, or even need help getting bathed and dressed. Because they don't need daily medical care at this point, assisted living might be a good housing option.

What is an assisted living facility? These facilities provide care for seniors who need some help with activities of daily living yet wish to remain as independent as possible. They essentially serve as a middle ground between independent living and nursing homes.

Assisted living facilities aim to foster as much autonomy as the resident is capable of. Most of them offer 24-hour supervision and an array of support services, with more privacy, space, and dignity than many nursing homes—at a lower cost.

There are approximately 33,000 of these facilities operating in the U.S. today. The number of residents living in a facility can range from several to 300, with the most common size being between 25 and 120 individuals.

An assisted living facility helps seniors with personal care, such as:

• Bathing
• Dressing
• Toileting
• Eating
• Grooming
• Getting around

Daily contact with supervisory staff is the defining characteristic of an assisted living facility. Medical care is limited, but it is often possible to contract for some medical needs.

Here are the key characteristics of assisted living facilities:

Activities of daily living (dressing, personal care): Comprehensive assistance provided.

Community activities (social events, outings, golf, etc.): Some activities offered.

Community services (laundry, cleaning, etc.): Many / most services provided.

Health dervices (medications, nursing care): Some services provided; not skilled nursing, however.

Environment (personal freedom):Residents are somewhat independent.

Overall health (physical, emotional): Residents have average health problems.

A recent Prudential Insurance report found that the average daily cost for an assisted living facility is now more than $100, or $3,241/month.

Although the report examined both assisted living and nursing home costs, it found the largest increase in cost of care in assisted living, spiking about 13 percent since 2006.

By the year 2030, the number of Americans aged 65 and older is expected to reach more than 71 million, or almost 20 percent of the entire U.S. population.

As the population ages, of course, the need for care is projected to grow correspondingly. Not surprisingly, recent studies continue to show increases in the cost of long-term care throughout the country.

The Prudential findings are similar to those from this year’s Genworth Financial Cost of Care Survey, which can be found at http://www.communityed.com/blog/administrative-concerns/do-you-measure-up_05-12-2008.

The Genworth survey found that the national average monthly rate for assisted living housing is $3,008/month.

You can find more information about these studies and their findings at
www.communityed.com/blog/administrative-concerns/prudential-cost-of-care-report-assisted-living-rates-continue-climb_08-19-2008

Author : Laurence Harmon

http://www.isnare.com/?aid=325816&ca=Family+Concerns