Survey: Older Americans Puzzled About LTC Programs and Services

Published in Woonsocket Call on July 19, 2015

Planning for your golden years is key to aging gracefully.  But, according to a new national survey looking at experiences and attitudes, most Aging Boomers and seniors do not feel prepared for planning or financing their long-term care for themselves or even their loved ones.

This Associated Press (AP)-NORC (NORC) Center for Public Affairs Research study, funded by The SCAN Foundation, explores a myriad of aging issues, including person-centered care experiences and the special challenges faced by the sandwich generation.  These middle-aged adults juggle their time and stretching their dollars by providing care to their parents, even grandparents while also financially assisting their adult children and grandchildren.

Older American’s Understanding of LTC

This 21 page survey report, released on July 9th, is the third in an annual series of studies of Americans age 40 and older, examines older Americans understanding of long-term care, their perceptions and misperceptions regarding the cost and likelihood of requiring long-term care services, and their attitudes and behaviors regarding planning for possible future care needs.

The survey’s findings say that 12 percent of Americans age 40 to 54 provide both financial support for their children and ongoing living assistance to other loved ones.   Federal programs are often times confusing to these individuals, too.   More than 25 percent are unsure whether Medicare pays for ongoing living assistance services like nursing homes and home health aides. About 1 in 4 older Americans also overestimate private health insurance coverage of nursing home care.

Researchers noted that about half of the respondents believe that a family member or close friend will need ongoing living assistance within the next five years. Of those who anticipate this need, 7 out of 10 reports they do not feel very prepared to provide care, they note.

More than three-quarters of those surveyed age 40 or older who are either receiving or providing ongoing living assistance indicate that their care includes at least one component of “person-centered care.”  This approach allows individuals to take control of their own care by specifying preferences and outlining goals that will approve their quality of life.

The survey also finds that most of those reporting believe that features of “person-centered care” have improved the quality of care

Paying for Costly LTC Services

The 2015 survey findings are consistent with AP-NORC survey findings from previous years, that is older Americans continue to lack confidence in their ability to pay the costs of ongoing living assistance.  Medium annual costs for nursing homes are $91,260; the cost for at-home health is about half that amount, $45,760, says the report.

Finally, only a third of the survey respondents say that they have set aside money for their care. More than half report doing little or no planning at all for their own ongoing living assistance needs in their later years.

“The three surveys on long-term care [by AP-NORC] are helping us create a comprehensive picture of what Americans 40 and older understand about the potential need for these critically important services,” said Director Trevor Tompson, at the AP-NORC Center in a statement. “Experts estimate that 7 in 10 Americans who reach the age of 65 will need some form of long-term care, and our findings show that many Americans are unprepared for this reality,” he says.

Dr. Bruce Chernof, President and CEO of The SCAN Foundation, says that the 2015 study takes a look at public perception regarding long-term care and most importantly, how people can plan for future long-term care needs.  “The insight provided by this research is critical because it will help us promote affordable health care and support for daily living, which are essential to aging with dignity and independence.” he says.

AP-NORC’s 2015 study results are validated by other national research studies, says AARP Rhode Island State Director Kathleen Connell.    “AARP’s research, both nationally and state by state, reveals that people in the 50+ population are concerned about the cost of retirement and especially long-term care,” she says, observing that “very few people seem worry free on this question and rightfully so.”

 Beginning the Planning Process

Connell adds, “I would say our response to this survey is that it adds to the awareness that people need to start thinking about this at an earlier age. And that means not only focusing on saving but also getting serious about health and fitness.”

What can a person do to better prepare for paying for costly long-term care and community based services?   “AARP.org has an abundance of information on long-term care. There’s advice on long-term care insurance, a long-term care cost calculator and many other resources. We also need to remain strong as advocates for programs that support seniors. Social Security, Medicare and Medicaid need to remain strong in order to support Americans entering the most vulnerable chapters of their lives,” she says.

Amy Mendoza, spokesperson for the American Health Care Association (AHCA), a Washington, DC-based trade association that represents over 12,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and development disabilities, calls for increased conversations to help planning for potential future need.  “Given that the need for long-term or post-acute care is a life changing event, it demands some considerable thought, discussion and research,” says Mendoza.

“AHCA’s “Care Conversations” program helps individuals have the honest and productive discussions needed to plan and prepare for the future long-term care needs,” adds Mendoza.  Care Conversations has a Planning Tools page on its website which provides information on advance directives. Learn more at: http://careconversations.org/planning-tools.

Todd Whatley, a certified elder law attorney, notes that some of his best clients are middle age adults who after taking care of their parents want to avoid costly nursing home or community based care services.  “They are then suddenly very interested in some type of [insurance] coverage for the extraordinary expense of long term care when a year earlier, they had no interest whatsoever,” he says.

Whatley, President-Elect of the Tuscan, Arizona-based National Elder Law Foundation, suggests contacting a financial planner or Certified Elder Law Attorney when purchasing long term care insurance, “Get early advice from someone with their best interest at heart.  There are many times that a person simply doesn’t need this product financially, but most people do.

To locate a Certified Elder Law Attorney, contact Lori Barbee, Executive Director, National Elder Law Foundation.  She can be reached at 520-881-1076 or by email: Lori@nelf.org.

For a copy of the study, go to http://www.longtermcarepoll.org/Pages/Polls/long-term-care-2015.aspx.

Herb Weiss, LRI ’12 is a Pawtucket-based writer covering aging, health care and medical issues.  He can be reached at hweissri@aol.com.

 

 

Rethinking Rhode Island’s LTC Delivery System

Published in the Woonsocket Call on April 12, 2015

AARP Rhode Island releases a state-specific analysis, of the 2014 edition of “Raising Expectations: A State Scorecard on Long-Term Services and Supports (LTSS) for Older Adults, People with Physical Disabilities, and Family Caregivers” that just might give state officials cause for concern, a low rating on its long-term care delivery system, when compared to other states.

The 2011 Scorecard was the first multidimensional assessment of state performance of LTSS. Like this earlier version, the release of the 109 page 2014 report, referred to as the LTSS Scorecard, and its state-specific analysis (prepared by policy consultant Maureen Maigret), measuring how well the nation and each of the states is doing in providing long-term care services, does not bode well for the nation’s littlest state. It finds the Ocean State ranks 38th nationally on 26 performance indicators, with it achieving the lowest rank of all New England States.

“Our analysis provides a closer look at where Rhode Island is keeping pace and where we fall short,” said AARP State Director Kathleen Connell. “The report indicates that, as the state with the highest percentage of persons 85 and older, we face exceptional challenges. It is our hope that the General Assembly and state policymakers find the analysis to be a valuable tool,” she says.

Failing Grades

The 2014 LTTS Scorecard indicates that Rhode Island:

• Ranks 4th highest among states in nursing home residents per 1,000 persons age 65 and over

• Has a high percent of low-care nursing home residents and spends a far higher percent of its LTSS dollars than the national average on nursing home care as opposed to home and community-based services.

• Has some of the highest long-term care cost burdens in the country making private pay long-term services unaffordable for the vast majority of older households.
But, on a positive note, the state-specific analysis noted that Rhode Island’s best progress was made in the Legal and System Supports dimension largely due to the 2013 passage of the Temporary Caregiver Insurance program and Caregiver Assessment requirements for Medicaid Home and Community Based Services (HCBS).

In addition, to revisiting the 19 recommendations made following the release of AARP’s 2011 Scorecard, the more recent 2014 analysis recommends five new major policy initiates to improve the littlest state’s LTSS. Among the recommendations: funding of an Aging and Disability Resource Center; the developing an online benefits screening tool to allow access to income-assistance benefits and conducting outreach programs to increase participation; reviewing the Rhode Island’s Nurse Practice Act to allow nurse delegation of certain health maintenance and nursing tasks to direct care workers; requiring hospitals to provide education and instruction to family caregivers regarding nursing care needs when a patient is being discharged; and exploring emerging medical technologies to better serve home and community based clients.

The current analysis finds that only four recommendations out of the 2011 recommendations have been implemented, most notably those to promote coordination of primary, acute and long-term care and to strengthen family caregiver supports.

Meanwhile, only six recommendations were partially implemented, including the expansion of the home and community co-pay program and authority (but not implementation) under the 1115 Medicaid waiver renewal to provide expedited eligibility for Medicaid HCBS and for a limited increase in the monthly maintenance allowance for persons on Medicaid HCBS who transition out of nursing homes. Finally, nine recommendations, although still relevant, have not been implemented.

Response and Comments

Responding to the release of AARP’s 2014 Scorecard and state-wide analysis, Governor Gina Raimondo says, “we need to ensure that we have a strong system of nursing home care for those who truly need those services, but we must invest our Medicaid dollars more wisely to support better outcomes. We cannot continue to have the fourth highest costs for nursing home care (as a percent of median income of older households) and also rank near the bottom of all states in investments in home and community-based care.”

According to Raimondo, the state’s Working Group to Reinvent Medicaid is looking closely at AARP’s Scorecard and state-specific analysis and Rhode Island’s spending on nursing home and long-term care. Health & Human Services Secretary Elizabeth Roberts has directed her staff to look directly at the proposals recommended by AARP Rhode Island.

“I expect the Working Group will include specific proposals stemming from these findings in their April budget recommendations and their long-term strategic report they will complete in July,” says the Governor.

AARP Rhode Island Executive Director Connell, representing over 130,000 Rhode Island members, was not at all surprised by the findings of the recently released 2014 Scorecard. “Based on benchmarks set in the 2011 Scorecard, it was apparent that there was much work to do,” she says, recognizing that there are “limited quick fixes.”

“Some steps in the right direction will not lead to an immediate shift in the data. This is a big ship we’re trying to steer on a better course. We were encouraged, however, by ‘improving’ grades for lower home-care costs and the percentage of adults with disabilities ‘usually or always’ getting needed support rising from 64 percent to 73 percent,” adds Connell.

Connell says that the Rhode Island General Assembly is considering legislation to improve the delivery of care, which might just improve the state’s future AARP ‘report’ cards.” “In this session, there is an opportunity to improve long-term supports and services with passage of several bills, including one that would provide population-based funding for senior centers,” she says, stressing that it’s a “responsible investment that will help cities and towns provide better services.”

Connell adds, “The proposed CARE Act gives caregivers better instruction and guidance when patients are discharged and returned to their homes. This can be a cost saver because it can reduce the number of patients returned for treatment or care.”

The larger mission for state leaders is the so-called ‘re-balancing’ of costs from nursing care to home to community-based care. That’s where real savings can occur and home is where most people would prefer to be anyway.”

Finally, Virginia Burke, Executive Director of the Rhode Island Health Care Association, a nursing facility advocacy groups, supports the implementation of the policy initiatives recommended by AARP’s state-specific analysis. But, “The primary driver of our state’s nursing facility use is the extremely advanced age of our elders,” Burke says, noting that the need for nursing facility care is more than triple for those aged 85 and older than for seniors just a decade younger. Due to the state’s demographics you probably won’t see a change of use even if you put more funding into community based home services, she adds.

Governor Gina Raimondo and the General Assembly leadership will most certainly find it challenging to show more improvement by the time the next Scorecard ranks the states. Older Rhode Islanders deserve to have access to a seamless system, taking care of your specific needs. Creative thinking, cutting waste and beefing up programs to keeping people in their homes as long as can happen might just be the first steps to be taken. But, the state must not turn its back on nursing facility care, especially for those who need that level of service.

Herb Weiss, LRI ’12 is a Pawtucket writer who covers aging, health care and medical issues. He can be reached at hweissri@aol.com.

Study Shows Meal Deliveries Positively Benefit Seniors

Published in Woonsocket Call on March 22, 2015

In 2013, Dr. Kali Thomas, an assistant professor at Brown University’s Center for Gerontology and Healthcare Research, published a study that found home delivered meals can keep persons age 60 and older at home, allowing them to age in place.  The study’s data also indicated that some states would experience cost savings if they expanded meals on wheels because that could delay a Medicaid recipient’s entry into costly nursing home care.

The “More Than a Meal” pilot research study, conducted by Thomas, was released on March 2, 2015 the Alexandria, Virginia-based Meals on Wheels America, the oldest and largest national group representing over 5,000 community-based senior nutrition programs. The gerontologist found benefits far beyond basic nutrition identified by her earlier 2013 study — health and psychological benefits, too, particularly for those seniors who live alone.

Details of Groundbreaking Research Study

Thomas, contracted by Meals on Wheels America with funding provided by AARP Foundation, designed and executed the 15-week pilot study, involving over 600 older participants, in eight sites around the country, including the Ocean State.  Study participants either received personally delivered fresh meals daily, or weekly bulk deliveries of frozen meals, or just simply remained on a waiting list.

The Brown University researcher found those living alone who received meals showed statistically significant reductions in feelings of isolation, an effect that was greater if they received meals daily rather than weekly.  They also felt significantly less lonely, were less worried about staying in their homes, and said they felt safer. Those also receiving meals experienced fewer falls and hospitalizations.

Thomas said that based on her personal experience as a driver for Meals on Wheels of Rhode Island and as the family member of a meals recipient (her 98-year old grandmother), she was not at all surprised to see the positive benefits she observed anecdotally emerge as significant in a rigorous research study.

Elle Hollander, President and CEO on Wheels America, notes that her members have “faced tough choices forced by limited funding, rising costs, unprecedented demand and need, and increasingly for-profit competition.”  Hollander says, “We now have the research-backed evidence that confirms what we’ve all know for decades anecdotally through personal experience: that Meals on Wheels does in fact deliver so much more than just a meal.”

AARP State Director Kathleen Connell agrees.  “It really has been no secret that home-delivered meals are a critical for the older population, as well as the disabled. With  Kali Thomas’s earlier Brown data released in 2012 in our award-winning senior hunger documentary Hungry in the West End, the newest research reinforces what Thomas said in film: the nutritional benefits and relief from food preparation allows people to live in their homes longer and to stay healthier. And so, there are long term healthcare benefits as well as savings to the state if the investment in home-delivered meals delays someone’s transition from independence or home-based care into a Medicaid-supported nursing facility.”

A Call for More State Funding

Heather Amaral, Executive Director of Meals on Wheels of Rhode Island agrees with the benefits of visiting volunteers to the recipients, but stressing that the volunteer benefits, too, from the bond that develops. “There are many studies that show volunteering is good for your health and spirit, she says.

Amaral expresses pride that Rhode Island was selected as one of eight pilot sites in the study.  “This study proves what we’ve observed through the years—Meals on Wheels deliveries keeps people out of nursing homes and in their own homes longer,” she says.

According to Amaral, in 2014 Meals on Wheels of Rhode Island’s Home Delivered Meals program provided 316,524 meals to 2,298 individuals.  Over the years she has seen federal funding remain stagnant, while state funding has declined.  Last year’s budget allocated $200,000 to Meals on Wheels, down from $530,000 that was allocated by the General Assembly in 2006.   But, Governor Raimondo’s submitted budget does reinstate $ 330,000 more in funding, if approved by the Rhode Island General Assembly, she says.

Clearly, Governor Gina Raimondo recognizes the importance of Meals on Wheels as she begins to reshape Rhode Island’s long-term care continuum.  The Governor states, “Programs like Meals on Wheels are important investments. These programs are one of the strategies in our toolbox to keep people healthy and in their own homes. Particularly as we work to reinvent Medicaid to support better health outcomes and provide better value to taxpayers, we will continue to support programs like Meals on Wheels that help our most vulnerable seniors stay in their homes and in the community.”

The Rhode Island General Assembly must not be penny-wise and pound foolish.  Support the Governor’s budget to ratchet up funding for Meals on Wheels.  It is a sound policy move to put the breaks to spiraling Medicaid costs, by making the system more efficient and rooting out fraud and waste.   We must balance the State’s limited budget funds to keep older Rhode Islanders at home as long as possible.  But, if nursing home care is need, the Rhode Island General Assembly must allocate the necessary Medicaid funding to provide efficiently delivered quality of care.

Herb Weiss, LRI ’12 is a Pawtucket-based writer who covers aging, health care and medical issues.  He can be reached at hweissri@aol.com.

 

Senior Centers, Not Just a Place to Play Bingo

Published February 1, 2013, Pawtucket Times

Today’s senior centers are not the places our parents once visited to knit or play bingo. Established in the 1980s by the U.S. Administration on Aging, the centers programming has slowly evolved to encompass activities that encourage healthy aging and wellness, says Mary Lou Moran, who oversees Pawtucket’s Leon A. Mathieu Senior Center. Established in 1980, last year over 15,000 clients took advantage of programs and social services offered, or to eat a nutritious meal, she notes.

At Rhode Island’s 47 Senior Centers, “We are now looking at the whole person, the body, mind and spirit,” notes Moran, a former Program Coordinator who now serves as Director of Senior Services. “It is very important that we encourage individuals to live independently and safely in their communities.”

At the Leon Mathieu Senior Center, health screenings, specifically taking blood pressure readings, are performed by nursing students from Rhode Island College and URI Pharmacy students, notes Moran. “Proper nutritional counseling is a very big deal, too,” she adds, noting that a nutritionist is available to provide individual counseling.

Through the Eyes of Clients

Linda Slade discovered the Leon Mathieu Senior Center after retiring from working in retail for over 38 years. Initially, attending a few exercise activities in October 2010, she was forced to stop attending, taking care of her terminally ill husband. After his passing she came back four months later “to just be with people again.”

Slade, initially had misconceptions about Pawtucket’s Senior Center. “I was a young sixty-two and not really sure what to expect,” she said, expecting to be surrounded by very old people. That first visit totally changed her mind, seeing younger people. Besides knitting, playing cards or cribbage, the Pawtucket resident participates regularly in arthritis class, stretch exercises and Tai Chi.

Before attending the Senior Center’s exercise classes, Slade’s son had given her a gym membership. “Basically I was intimated to go because of the younger people,” she says. Now Slade is more comfortable working up a sweat with her Senior Center exercise companions.

According to Slade, the City’s Senior Center offers something [activities] for everyone, her involvement even gave her an opportunity to develop new social bonds. “I had a work family that I truly adored, but now I adore my Senior Center family, too” she said. Just like the fictional bar, Cheers, Slade knows everyone’s name in all her activity groups.

“Going bonkers” and feeling a need to get out of her home propelled Nancy Connor, 79, a former Secretary to the CEO of Citizens bank, to the doors of the Leon Mathieu Senior Center. Aortic valve surgery forced the Pawtucket resident into an early retirement in her early seventies from a job she loved and found intellectually challenging.

Once the Pawtucket widow, who lives with her companion, Mave, a 60 pound Royal Standard Poodle, found the Leon Mathieu Senior Center in the Yellow Page Directory, she went to see what it was all about. She’s been going daily ever since.

The Grand Dame of the Literary Circle

Like Slade, before attending, Connor had a misconception about Senior Centers, thinking that she would see “a bunch of old people doddering along.” Now the enthusiastic participant has found out that this was not the case.

According to Connor, not as many men come into the Center. “We really do outnumber them,” she quips, noting that they “usually appear out of thin air when there is a high-low jack game.

Walking with a cane keeps Connor from exercising but she hopes to some day explore the Chinese practice of Tai Chi. However, she gets activity involved in other pursuits. Never published, she took up writing, participating in the Book and Drama Clubs, and now considers herself the “Grandma Moses” of the Senior Center’s literary circle.

Meanwhile, Connor and a few other older participants meet monthly with third year Brown Medical students to teach them the art of speaking to the “geriatric crowd,” she says. At Friday coffee hours, invited guests come into the Senior Center’s large activity room to entertain, teach or educate, she says. If a cancellation happens, she’s drafted to play piano for the crowd in the activity room.

Like in Senior Centers across the Ocean State, every day Connor can eat lunch, only paying a minimal fee. “It is wonderful stuff, from soup to nuts,” she remarks.

A Medical Model

Jill Anderson, Executive Director of Senior Services Inc., a private nonprofit corporation established in 1975, manages the Woonsocket Senior Center. Each day over 100 clients (around 500 annually) participate in exercise activities and health and wellness programs at her site. A day care program in her building handles 35 people who have limitations in their daily living.

Reflecting its medical model philosophy, the Woonsocket Senior Center’s registered nurse, who also serves as the Wellness Director, counsels people on how to change behaviors to maintain better health. Health screening, including blood pressure checks, diabetic and bone density testing are also part of a Wellness program.

About 20 retired volunteers regularly help out each day serving lunch and assisting staff, notes Anderson. “These individuals create a friendly atmosphere for the new clients, making sure they don’t sit by themselves.”

Although many of Rhode Island’s Senior Centers have an annual membership fee or charge registration fees to participate in activities, Anderson’s nonprofit does not. “We just ask people to make a voluntary weekly contribution of one dollar to fill the gap that fundraising, grants and memorials don’t cover.”

Like in many other Senior Centers, computer courses in a computer lab is offered, says Anderson. “We would like to do more with computers, maybe we can some day offer both Intermediate and Advanced computer classes, too,” she adds, because the older clients are interested in embracing new technology, like I-pads, and smart phones.

“A Benefits Councilor also is on site to identify benefits and programs our clients are entitled to receive, states Anderson, this ultimately helping to lower the cost of supplemental Medicare plans, and make other economies.

Pumping Weights

Robert Rock, Director East Providence Senior Center, on Waterman Ave., provides all the typical exercise programs that Senior Centers offer. But through a $96,000 grant received from the U.S. Administration on Aging, his Senior Center now houses the only fitness center in the Ocean State.

“The [fitness] program promotes attitude change and development of appropriate exercise skills and reduces the risks of a sedentary lifestyle. It also improves the quality of life for our senior population,” Rock says.

According to Rock, a client can gain privileges to using the fitness room for a very minimal fee of $40 for single membership, $60 for couples. Equipment includes three treadmills, two recumbent bikes, an elliptical stepper, hand weights and six dual weight machines. Other features include a matted floor, mirrored walls, water, stereo, and cable TV.

Rock notes that 90 percent of the 258 people, mostly in their 60s, are taking advantage of this fitness center room, an attachment to the Senior Center. “They come to work out and then leave,” he says, noting that the oldest, a 91-year old man comes to work out three days a week.

Rock believes that once aging baby boomers come to us for the fitness room, they will choose to come back for other programs and services offered by his Senior Center.

Walking is also an important exercise, too, says Rock. Many clients take advantage of using the Senior Center’s half mile walking track.

Finally, Rock adds that the East Providence Senior Center is also a Rhode Island state-certified site for diabetes education. Both classes and individual counseling are offered.

In conclusion…

Starting in church basements, many as small social clubs, the passage of the Older Americans Act in 1965, propelled Senior Centers into a key provider in the nation’s long term care continuum of care.

Today, 11,000 senior centers serve one million older adults every day. In Rhode Island, 47 agencies, serving 208,000 persons, are geographically spread out from Westerly to Woonsocket and from Foster to Tiverton. Some are managed by municipalities, others by nonprofit groups. While catering to serving the state’s burgeoning elderly population, some have expanded their mission to offer programs for young and middle age adults.

While the average age is age 75, many of Rhode Island’s Senior Centers are adjusting their programming and services to attract the state’s aging baby boomers by focusing on health and wellness, recreation and life long learning.

According to Rhode Island’s Division of Elderly
Affairs (DEA), over 14 percent of Rhode Island’s population is age 65 and over. By 2030, its projected to grow to over 21 percent. Rhode Island’s senior centers are a key provider to keep the aging baby boomers, healthy, independent and at home.

Yes, today’s Senior Centers are not your parent’s bingo hall, as some mistakenly believe. Why not visit your local senior center you may even be surprised with what you find. Call DEA for a complete listing of the state’s senior centers at 401/462-3000.

Herb Weiss, LRI ’12, is a freelance writer covering aging, health care and medical issues. He can be contacted at hweissri@aol.com.

The Best Of…Day Services Help Seniors Stay at Home

           Published on May, 7, 2001, Pawtucket Times

            Like apples and oranges, senior centers and adult day care are quite different.  But when viewed as complementary community-based services, each can be instrumental in keeping elderly Rhode Islanders independent and at home.

           While senior centers serve the independent older population, programs and services provided by adult day care centers are specifically designed for functionally or cognitively impaired adults.

          Senior centers can serve as “brokers” between the elderly and the surrounding community, creating access to a wide variety of programs and services, states Rick Ryan, former chair of the Washington, DC-based National Institute for Senior Centers and director of senior services for South Kingstown.

        According to Ryan, some people today still believe the myth that senior centers are drop-in centers or “play pens for the frail aged where persons are spoon-fed programs and services.”  Not true, he says.

        “Indeed we have come a long way,” Ryan noted, stating that “senior centers are not developed through a cookie cutting process.”  Programs across the nation are as varied and diverse as the older population that they serve.  In fact, he says, senior centers evolved in response to their surrounding communities and reflect the interest and values of those older adults who not only participate in their programs, but also help shape them.

        For those participating, Ryan stated hat senior centers offer a menu of activities, with older participants being allowed to develop and design their own programs. Activities can range from computer labs offering Internet access, yoga, line dancing, aerobics, playing cards, art classes or even shooting pool.

         Since the early 1970s, adult day care centers have existed. According to the National Association of Adult Day Services in Washington, DC., here are more than 3,000 adult day care centers currently operating nationally.

         “There are 16 state-certified adult day care centers in Rhode Island,” noted Ryan, who also is a member of the Rhode Island Adult Day Services Association, a group representing programs in all of the state’s 39 cities and towns.

         Ryan stated that adult day centers provide a comprehensive planned program of health, social and support services in a protective setting during daytime hours.  “Activities include mental processing programs such as current affairs and word association games to stimulate thinking more physical activities like volleyball, dancing and range of motion exercises.”

         Services at adult day centers are specifically designed to meet the individual needs of the elderly and strongly focus on ways to help relieve the stress of the caregivers.  Such programs are critical in assisting caregivers to maintain their loved ones at home in the community.

       Adds Sharon Rice, director of the Comprehensive Day Care Center, a program of the Jewish Seniors Agency, “One of the most important factors of a day care program is that adult children taking care of elderly frail parents don’t have to worry about how they can take care of their parents, work a full-time demanding job while caring for their children.”  She noted that most adult children prefer to have their parents “age in place” at home rather than have to institutionalize them in a nursing home.

   According to Rice, today’s day care centers in Rhode Island have undergone vigorous licensing procedures through the state’s Department of Elderly Affairs to ensure quality.

          Ensuring quality through licensure can increase the adult children’s willingness to place his or her parents in an adult day care program, she said.

         Currently, Rice states there are 30 frail elderly persons enrolled in her day care program, attending each day.  Although located in Wayland Square on Providence’s East Side, Jewish Seniors Agency program, established in 1974, also serves East Providence and nearby Pawtucket.

         Keeping a person at home is not always the best option. Rice says, because the older person becomes isolated. “Day care can promote friendship, social interaction and therapeutic activities,” she added.

        “Person with Alzheimer or related-dementia, Parkinson’s disease or  who have suffered strokes receive supportive services at the day care center from a registered nurse, a professional social worker, and a certified nursing assistant,” Rice added, noting that participants also are served kosher meals.

      When adult children are faced with care giving responsibilities for their loved ones they do have a choice – to keep the person at home and not in a nursing home, Rice quipped.  “Adult children should feel comfortable in knowing that they can keep a frail elderly family member at home and in the surrounding community.

         Herb Weiss is a freelance Pawtucket-based writer who covers aging, health care and medical issues.   He can be reached at hweissri@aol.com.

The Best of…Research Confronts Nursing Homes’ Pain-Management Problems

           Published December 10, 2001, Pawtucket Times

         Nobody says that old age is easy, especially for those who ultimately end up being admitted into a nursing  facility.  And for those residing in facilities, there is a very high probability of being in pain, Brown University researchers say.  One of the first nationwide research studies reported in the Journal of the American Medical Association last April that pain is “prevalent, persistent and poorly treated in nursing facilities.”    

         According to the JAMA study, nursing facilities across the country provided “woe-fully inadequate pain management” with a large majority of the residents ultimately experiencing excruciating severe pain just months after admission.  Furthermore, the researchers acknowledged that the study results may even “underestimate the actual pain burden.

        The study noted that for those able to report on their pain, the rate of persistent pain in Rhode Island facilities was 46.4 percent. Nationally, the rate is 46.7 percent.  For those in pain, persistent pain left untreated experience impaired mobility, depression, and a reduced quality of life, the researchers say. 
 
        The Rhode Island Quality Partners, Inc., Brown University Researchers and 18 Rhode  Island nursing facilities came together last year to confront this issue by improving  how nursing facility residents are assessed for pain and how pain is managed.   At a press conference held last month, it was reported that all facilities participating had put into place pain policies and procedures, which included both the use of medication management and non-drug interventions like massage, music and aroma therapies and heating packs.

        During the 15 month study, the participating nursing facilities attended two-hour educational seminars each month.   The seminars were conducted by the project partners and, with the assistance of nurse facilitators, each facility began to develop pain policies and procedures, and worked with the project partners to implement the treatment protocols.

       Preliminary findings show a nearly 10-fold increase in the rate of comprehensive assessment of pain among the 18 nursing facilities, as well as a five-fold increase in the use of pain intensity scales to monitor the resident’s pain.  Translation.  Nursing facility residents benefited from the facility’s efforts to confront this care issue.

       “Some Rhode Island facilities watch previously inactive residents begin to participate in a variety of activities.  Others found that residents could cut back on some of their medications once their pain was well controlled,” stated Dr. David R. Gifford, principal clinical coordinator with Rhode Island Quality Partners.

       “Nursing facilities were able to get together, share and work closely with each other to try to improve pain management, despite the staffing shortages, inadequate Medicaid reimbursement despite all the other regulations they are trying to comply,” Gifford told All About Seniors.  “The participating facilities deserve credit for putting the time and resources into the project to improve an area of care that every one is concerned about, that is inadequate pain management.”

       “Both scientific and professional literature clearly tell us that pain management has been an area that can be controlled but it has not been,” states Wayne Farrington, Chief, Facilities Regulation, at the State’s Health Department.  “Sadly nursing facility residents have been living with unnecessary pain and implementing the best practices that were determined by this research project will greatly enhance the quality of life in 103 Rhode Island facilities.” 

        Hopefully, the states nursing home industry will disseminate the methods and practices identified as being successful by this research project to every facility in the state.  At least in Rhode Island, nursing facility residents should not be suffering from unnecessary pain.

        Herb Weiss is a Pawtucket, Rhode Island-based writer covering aging, health care and medical issues.  This article appeared in December 10, 2001 in the Pawtucket Times. He can be reached at hweissri@aol.com.

The Best of…Little Things Count When Deciding on a Nursing Home

            Published April 23, 2001, Pawtucket Times          

           It isn’t easy operating a nursing facility these days.

           The high turn over rate of certified nursing assistants has drastically impacted the quality of care provided in facilities.  And this direct care staffing shortage is also financially hurting facilities too, reducing their financial stability, even pushing many towards bankruptcy.

          According to the Rhode Island Health Care Association, eight out of the state’s 105 nursing homes have filed for Chapter 11 Bankruptcy, two are currently in state receivership and two more were recently ordered closed by the Department of Health.

         In these difficult financial times for nursing facilities, especially with a state-wide shortage of certified nursing assistants, youmusts become a better shopper when seeking the most appropriate nursing facility to place your loved one.

       “Until there is a health crisis, families don’t often think about nursing facility care until it’s too late,” states Roberta Hawkins, executive director of the Alliance for Better Long Term Care who serves as the state’s ombudsman on the behalf of 10,000 Rhode Island nursing home residents.  “If  it’s possibly, just plan ahead,” Hawkins recommends.

      “Your state health department provides a comprehensive list of nursing homes and their survey results to help you determine if the facility is reputable,” states Hawkins.

       According to Hawkins, word of mouth or personal recommendations from family, friends, neighbors, hospital discharge planners, and her nonprofit advocacy group about a nursing home’s care are key bits of information to determine if the facility is well managed.

        “The Alliance also offers a free phone help line to assist matching the particular needs of a person with a specific facility,”  Hawkins adds.

       With more than 20 years of experience under her belt in assisting families find the right nursing facility for the loved ones, Hawkins gives simple tips on selecting a facility.

        Hawkins suggested that a need for upgraded services for residents requiring intensive medical care, special rehabilitation therapies and dietary requirements, along with religious and cultural needs should also be taken into account before selecting a facility.

       Location should not always be a deciding factor in selecting a nursing facility.  Carefully choose a facility that meets your loved ones medical, personality and social needs.

       In many cases, this critical decision is made only for convenience of family members or visitors.  If an elderly spouse can not drive, make sure that the selected facility is on a bus line.  Keeping a married couple close together is very important for their psychological well-being.

       Always have the older person in need of skilled nursing care, actively participate in choosing a facility even if they can’t physically visit the site.  Family members can also provide this person with brochures and admission materials.

      Don’t choose a facility on the basis of a beautiful physical exterior, fancy rugs, or glittering chandeliers, Hawkins says.  When visiting a nursing facility, always observe how staff members interact with residents and each other — look for laughter, a pleasant environment, and a strong activity program.

       For those frail residents who are bed bound, look for a stable nursing staff.

       Ask yourself, is the facility’s environment cheerful in appearance and clean?

        Are the bedrooms warm looking and do they reflect the residents individuality?  Or do they all look the same, like hotel rooms.

        Find out if residents are allowed to bring in personal belongings such as chairs, tables, lamps or even a television set into their rooms.

        For those persons who always loved nature and being outdoors, find out if the nursing facility has an outside area for sitting or walking.  Determine if this area is accessible to a wheelchair bound person who might want to roll outside to listen to the birds.  This simple amenity is very important.

        When touring a facility determine if a dining room is available for eating meals and space to allow residents to socialize with each other and participate in activities.

         Is there a real working activities room?  A resident who has always been involved in crafts and enjoys participating in group activities will want to select a facility with a well-run activities program.

         Also, be aware of how the nursing facility smells.  Sometimes you may smell strong odors of deodorants.  This might be covering up unpleasant odors.

        Listen for sounds of buzzers, rung by residents in need of help, and observe how quickly staff responds.

         When walking the halls, say “hello” to the staff you meet.  Do the staff pleasantly respond to you?  IF not, consider that they may not respond           well to your loved one.

         Walk in and talk with residents gathered in a community room.  In conversation, find out how long they have lived at the facility.  Ask if they like the facility and are they respected as individuals by staff.

         If you see residents in restraints lying or sleeping in a chair or wheelchair, this may be a red flag for poor care.  The facility may not have enough staff to allow the residents to lay down in bed for a nap in the afternoon.

         After you locate your facility, “put your name on the waiting list,” Hawkins recommends, even if the nursing facility admissions will occur months later.

         For those afflicted with Alzheimer’s and related dementia, it is wise for these individuals to be admitted earlier in the disease process to get them acclimated to the facility and for the staff to learn more about the resident’s habits, likes and dislikes.

        Herb Weiss is a Pawtucket-based freelance writer covering aging, health care and medical issues.  This Column appeared in the Pawtucket Times on April 23, 2001.