Staying Aware Regarding Long Term Care

In Long-Term Care every residents has the following rights:

• Quarterly Care Plan
• Medical information on their condition
• Visitors of choice
• Nurse 24 hour service in Nursing Homes
• Service Plan
• Financial billing information
• Level of function maintained or better

I think we often think that residents of Long-Term Care do not have rights. We place them in a Residential Care Facility because they are not safe living at home or we can't give them the care they need at home. We sometimes think we can keep Aunt Alice from visiting because she may upset the resident only to realize that Aunt Alice is very important for the resident to visit with. She was part of their normal life before being placed in Long-Term Care. It is the resident's right to choose who they visit with not ours.

We make decisions about medical information not considering that the patient has the right to know what is going on. We sell their home, pack up their treasures to pay for the cost of Long-Term Care without consulting with the loved one. We don't want to bother them with such tedious details, but they have a right to know how much the facility is billing them and where the money is coming from to pay the bills.

We can't assume that lying prone in bed is the future for our loved one. They may require physical therapy to be able to sit up again. It is important that everything is done to help them regain their health to the best of our ability. Sure, people don't always get better and they may even die, but just sitting there waiting for death is not an option in most cases.

I am amazed how little we expect from Long-Term Care facilities just because we are ignorant of the rules and regulations that govern these facilities. We assume because it is much easier than learning these regulations so that we can be an advocate for our loved one that is placed in such a facility.

I learned the hard way when I ignorantly placed my mother in a Long-Term Facility. I assumed they had her best interest in their hearts. The heart ended up being translated into the financial gain they could realize from my mother if they kept her at the lowest of all expectations. If one needs full assist on anything, it means the institution makes more money than partial assist or no assist. I found her being drugged into "full assist" as it is hard to do much when you are made into being unable to do the easiest of task, because you simply cannot wrap your mind around much when you are drugged.

I was frustrated feeling in my gut that all was not as I wished. I started asking questions and learning more. Needless to say, my mother now lives with me in our home. I took all her mind altering drugs from her and she came back to mostly only partial assist or no assist on her latest evaluation.

We can't assume. Be active in the lives of those we have in Long-Term Care. Like our children in grade school, you will find more satisfaction the more you are involved. You will know what is going on. You may be pleased at what you find out as there are many very fine facilities, but for every good facility, there is one that is in it simply to make money taking shortcuts to realize the highest profit. One of the facilities I am aware of spends $1.14 per resident per day on food. Can you imagine what these meals must consist of or do not consist of!

If you ask for the State Survey from a Long-Term Care facility, they are obligated to show it to you. It will show you what the latest state survey team found when they investigated the business. Take a look. You might find an infraction of a nurse not being on duty for 24 hours in a Nursing Home; which is against the rules. You might find feeding tubes not being implemented as to the regulations. Most often is the fact that call lights are not responded to forcing someone to wet their beds. How humiliating this has to be! Be an advocate for your loved one placed in Long-Term Care. They need your love and your support. Look on the bulletin board to see a flyer giving the name and the number for the State Certified Ombudsman assigned to the facility. Call her/him. Get to know just how they can help you be the advocate you must be.

Long Term Care Ombudsman Musings

June started off with presenting my information on Culture Change in Long Term Care at our local Care Connection Meeting headed up by Liz Cohen. I was surprised to see how many showed up and the way they seemed to eat up the information! It was a lively meeting with many comments by the audience. I love it when I can see sparks flying through a group knowing that they won't soon forget some of what I find worth sharing.

I have been energized by that Ombudsman weekend in Portland. My next step is to share my workshop on abuse in long term care. Abuse is such a gray issue. Sometimes I find myself not sure whether something should be reported or not. When in question, report. That gives the question to those much more qualified to decide whether abuse has taken place. I will share this next presentation once I get it typed up here on my blog.

We have a new Long Term Care facility here in Brookings, Oregon community. Sea View is like entering a fine hotel with a huge gathering place immediately upon crossing the front door. There are always groups of people at the many tables. Some are investigating whether or not to take up residency and some are residents enjoying getting together over lunch or listening to a talk or performance that has been brought in.

My friend Elmo Williams told me yesterday that he had given a talk there. Elmo is someone who recognizes good food and his report on the food was heartening. I find that I often do not even recognize what residents are being served in some facilities and here the food is presented as if it were a nice restaurant. I hope in a year or two I won't witness the food becoming much the same as anywhere else. I would love the cooks in all Long Term Care facilities to go to Sea View for lunch to see what is possible.

As an Ombudsman I need to stay objective. I will stay alert and not assume that all is perfect just because the food and facility is pretty!

Chetco Inn, a Residential Care Facility, is having a pot luck today. I've been invited to bring my mother. I think we will swing by as I hear it is always a good time. I like to see my residents having a good time.

The least favorite thing about being a Certified Ombudsman is writing up the reports. I find if I keep a running commentary on my computer with dates and times, I can assess whether a report should be written up along with notes about my residents helps me remember them and special information to help me serve them better. I feel good getting to know everyone better the more experience I have.

While I was at Sea View the other day, I sat in Memory Care with a resident sharing a cup of coffee and just chatting mostly about what she wanted to talk about. I feel I know her in a personal way. If I saw her at the grocery store, I would now feel she was like a neighbor eager to greet her and even give her a sincere hug. I'd like to have relationships like that with each and every resident I represent.

I have a male resident at one of my facilities that initially pretty well told me where I could go in no uncertain terms. Through meeting with him several times now, I feel he now even likes me and I have learned to like him. I think I might be a bit testy if I had lost my ability to communicate effectively and was stuck in a wheel chair somewhere I didn't really want to be. It is always good to put myself in their shoes before I go off thinking they don't deserve my attention.

I am sharing this stuff on my blog in a casual manner using no names or private information so that you out there bothering to read this might just spend some of your time being a friend for someone in long term care. Everyone deserves a best friend to off load on or just share with. Wouldn't it be special if each long term care resident had a "best friend"? The sad truth is many of them have no family, no friends and find themselves staring at the walls wondering why life ended up like it has. Now, some are still very much involved with life making the best of their situation and maybe even choosing to be where they are. Not all are suffering, but many are. I see dull eyes, lack of interest in much while hating the food, resenting sitting for way too many hours with nothing to do that interest them and missing their former lives. As human beings I feel we have a mission to make life better for those in need. I hope you find yourself motivated to stop by your local "old age home" to volunteer. Thanks for doing this! We never know if we will be one of them any day now.

Culture Change Movement in Long Term Care

I recently attended a meeting in Portland, OR, regarding long term care as an Oregon State Certified Ombudsman for Long Term Care. There is a movement in long term care to make long term care change from just caring for a resident into having the resident experience life much like they did before being forced into having others care for them. Residents haven't changed from who they were all their lives just because they are now living in an "institution". This movement addresses residents as individuals instead of the usual group getting all the same food, activities, care and environment. Here are some of the ideas I heard as suggestions for making this change for residents of long term care.


Life story questionnaire is a way to get to know each resident about their lives before long term care. How did they spend their day? What was their joy?

* Favorite music
* Favorite meals
* What did they see all day at home?
* did they have house cats?
* Were there live plants in their homes?
* did they enjoy a fish tank?

Some of the best practices to make a day better for long-term-care residents is to remember:

* Patience is needed
* Make repetitive - repeating is really O.K.
* Answer as first time you have been asked the question. Keep it fresh
* Jokes in morning set mood for the day
* Agitation spreads so defuse it before it goes further
* Validate even senseless. Everyone needs to be validated no matter what else is going on.
* Coloring outside the lines just fine as perfection is not really that important

Games:

* O’ho
* Roll dice to spots
* Trivia
* Songs
* Life style stories
* Grab bag poetry
* Good news stories

Activities:

* Garden time
* Walks
* Bible study
* Pet therapy
* Interact with music
* Laughing Yoga

Restorative Activities

* Blend home in the institution.
* Therapeutic needs
* Entertaining
* Meaningful fun that suits residents
* Geared for options and abilities
* Create what they want
* Know what builds their soul
* Life enrichment Dept.: Laughter, fun and interacting with purpose


Other things that can make life like it was before someone had to be a resident of a facility

* Choice as to when residents get up i.e.: 7:30-9:30
* Buffet style meals instead of trays
* Consistent staffing with staff meetings sharing ideas in a learning circle
* I also read that having a staff member be assigned to a resident as a "best friend" can make life have more meaning. We all need a best friend even when old and sick.

Small group activities that:

* Engage
* Innovative
* Inspire

Here are some fun activities that bring smiles and a sense of what life was before being in long-term-care

* Pie eating contest
* Dog shows
* Brewing beer
* Wine tasting
* Pajama day for staff
* Make dog biscuits
* Have car washes
* Husk corn
* Make salads
* Make pies

* Have evening activities. Not everyone wants to just sit in front of the TV or go to bed. Older adults do have social lives and activities after dark when they are home. They should also have this pleasure in long term care.

Volunteers need purpose to keep them, so don't give them silly meaningless activities. I have volunteered often where I know if I were to stop tomorrow, no one would even miss me. Make the volunteer an important member of the team and they will stay.

Have more moments

* On the day of each resident's birthday have the resident have their own gift and their own cake. In "real" life we don't have a group birthday cake at the beginning of the month. We wake up to the joy of our own special day. Residents of long term care deserve the same.

We all need something to:

* To do
* To care for
* Care about
* To love
* To hope for

In Foster Homes some of the activities could be:

* Real life activities like polishing the silver, combing the dog etc
* Scrabble
* Cooking fun where "usual" life returns
* Copy what we do at our homes like making a bed, feeding the bird and more
* Ask residents what they like and incorporate those likes into their lives

Pacific Antique Mall Brookings, Oregon

I bought some racks from Mory's stationary/art store; which is going out of business. They are the perfect racks for displaying Elmo's many pieces of art and movie memorabilia. They were originally made to display water color paper, so now they display completed art. I hung some of our throws on the side. They are 30 per cent off; which is a real bargain! That orange one would make a perfect wrap to wear over a swim suit as it is light, soft and washable!
Elmo is blessed to have spent years in other countries collecting beautiful items along his travels. This carving can be dated anywhere between 1500-1700's. It is the Muse of Music; which hung in a series of panels across the walls of Oxford University.


My husband was good enough to hang some trim to hold enough of Elmo's storyboards to show how interesting they are. We have many for sale all signed by Elmo. The storyboards were drawn by Hubner Mentor, who also drew the storyboards for Ben Hur. They were created for the movie, The Longest Day.
Elmo gave me this lovely shelf from France. Someday it will find a special place in my home, but I still need it to display many of Elmo's china pieces. You can see the majolica along with other fine collectibles.

This is what the booth #141 looks like that hold mostly Elmo's inventory. I also have some of my inventory mixed in with his and vice versa.

You will find this at the far right side of the area before Elmo's area. I have his menus here on the wall that are very collectible and wonderful kitchen or restaurant wall art. Remember to get a letter from Elmo if you purchase anything of his. I often have the letters with product, but that isn't always possible. Ask Dick of Dee at the Mall, if you don't have a letter with anything you purchase. It will add value and collectible value. They know where I keep those letters.
Looking to the far left across the middle of the larger booth. You can see there is rustic decor, floral items, home accessories and even some handcrafted items. I am selling Forest Angels made by a local Yurok Indian, Lena Hurd. They are just to the left of that large cabinet hanging on a little fir tree.
This is a close up of the far left corner. I see pillows, antique frame, a fine antique cast iron light, Elmo's cast iron dog candle holders from the 1700's and much more! That statue in the corner was purchased by Elmo while in the South Pacific making a movie. It won first place at an art show. Elmo had to wait an extra day for the art show to close so he could pick up his purchase.

I've been at PAC for just about a month and am very pleased at the sales Elmo and I have made! I am looking forward to summer-time business when the tourist descend on Brookings for cooler weather and excellent fishing just off shore!

We had over 4 inches of rain up the Winchuck River, where I live, yesterday, so I bet those women visiting headed for the stores helping to boost my effort to finally retire! I need to clear out my inventory. I took these pictures to show you how our booths look at Pacific Coast Antique Mall.



I found the following report showing not quite the 4 inches my neighbor reported measuring, but we made a national record for rain! I almost wore a snorkle going into town yesterday to take the grandchildren to the movies! I actually hydroplaned on wet road heading down river...the kids did a collective gasp, but old grandma gained control and continued safely into town. We sure enjoyed watching the action-packed, Prince of Persia!

WEATHER EXTREMES:

HIGHEST TEMPERATURE (DEGREES F)..........................102 Pecos, TX

HIGHEST HEAT INDEX (DEGREES F)..................108 Brownsville, TX

LOWEST TEMPERATURE (DEGREES F)................30 Leadville, CO

LOWEST WIND CHILL (DEGREES F)...................-7 Santa Rosa, CA

HIGHEST WIND GUST (MPH)..........................62 Macomb, IL

HIGHEST PRECIPITATION (INCHES)....................2.34 Brookings, OR