Nursing Home Conundrum

                This is a decision I do not want to make, but I know, at some point, my parents may need the services of a nursing home.  My parents divorced when I was six years old and live in different states.  I am the primary caregiver for my father and my brother is supporting our mother.  Both are in their 80’s and struggle with a myriad of ailments.  They both fear nursing homes and distrust the level of care they would receive.  They both consider these places simply as a place to die.

                It is estimated by the Centers for Disease Control (CDC) that there were 1.2 million nursing home residents in 2016.  This number will continue to grow as the “Baby Boomer” generation ages.  Nursing homes serve a vital role within the healthcare system yet are feared by the elderly and their families.  In a survey taken by Clarity and The EarFoundation, 89% of want to age within their current living conditions.  82% of family members fear that their loved ones will be mistreated in nursing homes.  There have been a lot of news worthy stories of elder abuse in nursing homes.

                The decision to place a loved on in a skilled nursing facility is huge for families.  It involves a recognition that the loved one has deteriorated to a point where the person and their family cannot adequately care for the needs of the patient.  There’s a sense of defeat and as previously stated, fear for everyone involved.  Once this realization had settled, the next choice is to choose an appropriate and affordable home.

                I will not get into the details, but the financial end of choosing a nursing home can be a unique struggle in its own right.  Navigating Medicare and Medicaid can be daunting.  According to A Place for Mom, engaging an Elder Care attorney may be the best course of action.  These advocates can help a family navigate the uncertain waters for their loved ones and create the best possible outcome.  This person can also help when abuse or error is suspected.

                When choosing a nursing home, it is important to do your homework.  It is best to seek quality ratings for nursing homes in your area.  One useful website is https://www.medicare.gov/nursinghomecompare/search.html? Which provides a ranking of facilities by zipcode or address.  A simple search here can quickly help rule out facilities that do not measure up.  Once you have a list of potential choices, make appointments with the facilities and tour them noting the cleanliness and condition of the patients that you might encounter.  Talk with the administrator about your concerns and your loved one.  See if the activities offered by the nursing home match up well with your needs.  Talk about the conflict resolution process they have in place and discuss any special requirements like food allergies or preferences.

                The staff must be well trained and vetted.  Accidents, falls, and any process that causes bruising or marks must have appropriate records and follow up by the administration.  There should be a notification process in place when an incident occurs.  All in all there should be a clear line of communication between the staff and the family about the care of the loved one.

                Once a facility is chosen, be engaged in the care of your loved one.  Every nursing home must create a customized plan for each patient.  According to Strom & Associates, it is important to not only be involved in the creation of the plan, but to be part of its enforcement.  There is no doubt that an engaged family advocate will ensure the best possible care. 

                Personally, as I see this day coming for my 86 year old father, I have a number of concerns that I want to be sure to address.  Beyond his ongoing medical conditions, these include medications, avoiding bed sores, engagement with others in the facility and his diet.

                My father takes a variety of medications at different parts of the day.  We have developed a routine for which he is quite comfortable and can manage.  When my mother-in-law experienced a short stay in a rehabilitation wing of a nursing home, this was a real struggle.  Medications were given at the wrong times or not given at all.  We were in constant conflict with the nursing staff over this topic and it challenged our wellbeing everyday.

                Recently my father had an extended hospital stay and he developed a bed sore.  This was very painful for him. For sedentary seniors, this is a huge problem that can be avoided with proper care and attention.  Unfortunately limited staff and lower quality bedding often create a situation where bed sores are prevalent.

                I would want my father to have some social contact that was meaningful and enriching.  The facility I would choose for him would have activities to engage the residents and stimulate physical and emotional wellbeing.

                Finally, my father has a number of food allergies that would need to be addressed by the staff.  The skilled nursing facility would need to be prepared to ensure that my father was receiving a proper diet while at the same time avoiding foods that cause him difficulty.

                It is a difficult decision for families to put an elderly loved one in a nursing home.  Having a plan, conducting research and staying involved in the day to day care of your loved one can make all the difference. 

Robert E. Lee (no, not that one)

When I entered the church as a young, fresh out of basic training, United States Air Force Airman Basic (E-1) at the ripe old age of 18, I was met by an older man who nearly immediately became my mentor.  His name was Robert E. Lee.  No, he wasn't that famous Confederate general of the Civil War.  He was a gentle old man with such love and compassion for younger people.

The kids new him as the "candy man" because he gave each child at church one piece of hard candy after services.  He new every child's name, their candy preferences, and their parent's restrictions.  Every one else called him simply "Brother Lee."

Having never been away from home for such a long time, Brother Lee recognized the homesickness and struggle I was going through.  He would tell me that things would pass and that I would do great things in the future after my training.  He was just always there and able to give advice on any subject.

After nine months in technical training, I got orders to another base and left.  I thought often about Brother Lee, but as a young person with lots of life ahead of me, I soon forgot my old friend and was married and started a family.  Four years later, I found myself back at the same base, this time as a technical instructor.  This time when I entered the church building, I had a wife and two small children.  Brother Lee was the first to meet me at the door and hug me.  He remembered me and he still seemed robust and on his game.

His role shifted a bit for me because now I was a father and husband.  He would tell me stories about his children and working with the church.  He saw how people engaged with me and wanted me to take on responsibility at church.  One day in a quiet tone which was his typical way, he asked to speak with me for a few minutes.  We sat down on some chairs near the door and he discussed priorities with me.  He cautioned me to remember to put my family first in all things.  He said he was concerned that if I got too busy, I would potentially lose my family, maybe not physically, but more from a family tightness point of view. Through this conversation I could see pain in his eyes.  I think perhaps he was speaking from experience, though I did not ask.

Brother Lee eventually got sick and it was clear to me that he would not live much longer.  He was always a skinny older man and being sick was quickly sapping all his strength.  One day I was talking with his wife and she told me that she couldn't get him to eat much any more.  That day I was going on a fishing trip as part of a festival for the coastal community we lived in.  We were going shrimping on a real shrimp boat!  Many hours of dragging a net yielded a ton of shrimp, but also all kinds of fish.  Knowing that my friend, Brother Lee, liked mullet, I quickly grabbed a few for my friend as we divided the left over fish.

I called the house and let them know that I was coming with the fish and Brother Lee's wife was so happy because she thought he might eat some.  I brought the fish and visited with my friend for quite some time.  I don''t remember much about the conversation, but I do remember the pain he was in and how frail he was.  I don't know if he ate the fish or not.  I never asked.  Just a few days later, my friend, Brother Robert E. Lee passed away.

Since that day, I often think about his guidance and the way he loved me.  I think about his advice which lives on inside me.  I find myself giving others the same kind of advice now.  I really miss my friend.

Brother Lee had the family support to stay at home and not enter a nursing facility.  He had many friends and a strong church family.  Unfortunately, this is not true of many older people.  Often, because of extenuating circumstances, the elderly are placed in nursing homes and exposed to all kinds of difficulties.  It is estimated by nursinghomeabuse.com that upward to 5 million elderly are abused each year.  This is incredible.  The same article goes on to say that only 1 in 14 cases of abuse are actually reported.

According to Steinburg, Goldman & Kalish Law Firm, there are indications to look for in elderly people that may indicate active abuse.  Those indicators are bruising, changes in mood or personality, and open sores.  Often however, especially in older people, there's blood thinners, dementia, and bed sores that occur even in the best facilities.  It is hard to really know what is going on when you leave your loved one behind.

What can you do? First and foremost, before placing a loved one in a skilled nursing facility, do your homework.  Research all you can about previous cases brought on the nursing home and staff.  Physically visit the facility and talk with the staff and patients.  Look for signs of abuse or neglect in the patients.  Talk with friends that have loved ones in facilities and find the best rated.  Second, once you place your loved one, be vigilant and be present and involved in their care.  Being involved is a human shield of protection you provide to your loved one.  Third, know the regulations and rights of a nursing home patient and have a clear legal understanding of how to report concerns to the staff of the facility.  Along with this, be sure to have powers of attorney, wills and living wills in place.  Finally, if you suspect abuse, be prepared to engage an attorney and to register a complaint on the facility.

Nursing facilities can be a great blessing or a terrible tragedy to our families.  Vigilance and knowledge are your super power when dealing with them.  I am happy my friend didn't have to endure a nursing facility, but I know many others that do need them.  Having a plan, possessing knowledge of rights, and being an advocate for your loved one can make the difference in how your experience will be viewed.  Older people who once counseled us and cared for us are now in a position of vulnerability.  We owe them so much for who we are.

Distracted Driving Family Plan

As I rode my bicycle down a familiar road near my house, having nearly completed a fifteen-mile ride, I found myself suddenly spinning through space with no air.  I instantly knew I had been hit by a car, but how could this be happening?  As I moved in slow motion, I wondered how much it would hurt to finally let gravity push me onto the ground.  As I landed, first with the elbow, then with my left hip, pain jolted me.  I rolled and remember seeing a red SUV emergency braking.  Finally, I came to a stop. Pain!  I immediately rolled off of my left side and found myself rolling the opposite way down into a ditch.

Assessing my situation, my pain and my happiness to be alive, I ached in pain unsure of what to do.  The driver was braking so I was sure I had help coming.  I kept trying to move, but any movement hurt.  I tried deep breathing, but I was panting in pain.  Suddenly I hear a male voice say “Man!” and I asked for an ambulance.  I would be okay.  The driver stopped and I would be okay.  I didn’t hear anything and I couldn’t see anyone.  There’s no call being made and I don’t hear anything.  I asked for help again… no answer.  No answer!  I rolled on to my side and I see a while male enter his red SUV and drive away.

That day, I was hit by what I assume is a distracted driver.  It obviously changed my life in many ways.  I was lucky.  I had only a few broken bones and road rash, but a few inches to the right and I would be dead.  As I touch those scars and remember that day, it has forever changed the way I drive.

These days, people think they can multitask – do two things at once and have concentration on both tasks enough to operate safely and accomplish tasks more quickly.  This is a ruse.  The human mind can only really operate successfully on one task at a time with complete concentration.  Yet, we still eat hamburgers while we drive or dial our phones.  We drive with our knees while our hands are busy searching for the sunglasses we just dropped.  Somehow, we feel invincible behind the wheel.

It is interesting however to me that we really know that we are not really that good at driving and eating French fries.  When I clean up my car, I’m astounded at the fries on the floor.  Clearly my concentration is not as good as I perceive it to be.  We know, yet, nearly everyday we still do it?  We feel safe, but are those around us safe?  I register a hardy “No” here.

When we look at the statistics, we find that ten people die every day in the U.S. and thousands are injured.  How we know it is wrong, yet do it anyway is a testament to our own feelings of invincibility.  According to psychologists, young people tend to have an idea that bad things will not happen to them which brings on riskier behavior.  As we age this wears off to some degree because life teaches lessons, some of them very harsh lessons.

So, you might be asking at this point, how to avoid being distracted.  The real and time-tested method to avoid it is to plan the trip and set your own guidelines for driving behavior.  Simple things like leaving a few minutes early can give you time to actually eat at a table at the drive through restaurant instead of trying to eat that Whopper while driving.  Properly setting up your phone to operate with your hands-free car system or Bluetooth headset can keep your hands on the wheel and your concentration clear.  Keep your phone calls short on and on the topic.  Planning your trip so that you your music already selected and your coffee already mixed can allow your concentration to be on the task at hand, driving.

The Copilot Club from the Automobile Safety Foundation has a series of recommendations that seems well thought out and clear for passengers.  This effort allows those travelling as passengers to help the driver focus on driving and removes distractions.

Having been hit by a distracted driver might have been a good thing for me because it has given me focus in my own driving habits.  I could have been this driver myself with my eyes on my phone instead of on the road.  I could have been the one standing on the side of the road looking at a torn cyclist in the ditch contemplating my own well-being and legal difficulties.  While I would have called for help and stayed at the scene to care for that cyclist, I have been that guy allowing everything but driving safely distract me from the task at hand.  Make a plan, leave a little early, keep focus on driving.  Three easy ways to avoid driving distracted.