Valery Hazanov, PdD is a clinical psychologist in Brooklyn. He is writing a book about his training to become a psychotherapist.  He wrote about the life lessons he learned while working at a nursing home for Vox.

The first thing I noticed when I began working in a nursing home was the smell. It’s everywhere. A mix of detergent and hospital smell and, well, people in nursing homes wear diapers. It’s one of those smells that takes over everything — if you’re not used to it, it’s hard to think about anything else.”

Being in the nursing home is tough. People weep and smell and drool. Sometimes you can go on the floor and hear a woman in her 90s scream, “I want Mommy.”

But it’s also ordinary — just people living together: gossiping, daydreaming, reading, watching TV, scratching their back when it itches.

People at the nursing home like to watch TV. It’s always on. How strange, then, that there are no old people on TV.

For the past eight months I have been working as a psychotherapist with dying patients in nursing homes in New York City. It’s an unusual job for a psychotherapist — and the first one I took after graduating with a PhD in clinical psychology. My colleagues were surprised. “Why not a hospital? Or an outpatient clinic? Do the patients even have a psychiatric diagnosis?”

The short answer is that I wanted to see what death looks and feels like — to learn from it. I hope that I can also help someone feel a little less lonely, a little more (is there a measure to it?) reconciled.

I haven’t gotten used to the smell yet. But I have been thinking a lot about the nursing home and the people who live and die there, and wanted to share what I learned.

1) At the end, only the important things remain

“This is all I have left,” a patient recently told me, pointing to a photograph of himself and his wife.

It made me notice the things people bring to the nursing home. The rooms are usually small, so what people bring is important to them. If they have a family, there will be photos of them (most popular are the photos of grandchildren). There might also be a few cherished books, a get-well-soon card, a painting by a grandchild or a nephew, some clothes, maybe flowers. And that’s about it. The world shrinks in the nursing home, and only a few things remain: things that feel important — like they’re worth fighting for, while we still can.

2) Having a routine is key to happiness

I’m a little lazy. My ideal vacation is doing nothing, maybe on a deserted beach somewhere. I look in terror upon very scheduled, very planned people. Yet I have been noticing that doing nothing rarely fills me with joy, while doing something sometimes does. Hence, the conflict: Should I push myself to do things, or should I go with the flow and do things only when I feel like doing them? Being in a nursing home changed my perspective somewhat: I noticed that all the patients who do well follow a routine. Their routines are different but always involve some structure and internal discipline.

I am working with a 94-year-old woman. She wakes up at 6:30 am every day, makes her bed, goes for a stroll with a walker, eats breakfast, exercises in the “rehabilitation room,” reads, eats lunch, naps, goes for another walk, drinks tea with a friend, eats dinner, and goes to bed. She has a well-defined routine. She pushes herself to do things, some of which are very difficult for her, without asking herself why it is important to do them. And, I think, this is what keeps her alive — her movement, her pushing, is her life.

Observing her, I have been coming to the conclusion that it might be true for all of us. And I often think about her when I am debating whether to go for a run or not, whether to write for a couple more hours or not, whether to finally get up from the couch and clean my apartment or not — she would do it, I know, so maybe I should, too.

3) Old people have the same range of emotions as everyone else

“You are so handsome. Are you married?” is something I hear only in extended-family gatherings and in nursing homes. People flirt with me there all the time. This has nothing to do with their age or health — but rather with whether they are shy. When we see someone who is in his 90s and is all bent and wrinkled and sits in a wheelchair, we might think he doesn’t feel anything except physical pain — especially not any sexual urges. That’s not true.

As long as people live, they feel everything. They feel lust and regret and sadness and joy. And denying that, because of our own discomfort, is one of the worst things we can do to old people.

Patients in nursing home gossip (“Did you know that this nurse is married to the social worker?”), flirt, make jokes, cry, feel helpless, complain of boredom. “What does someone in her 80s talk about?” a colleague asked me. “About the same things,” I replied, “only with more urgency.”

Some people don’t get that, and talk to old people as if they were children. “How are we today, Mr. Goldstein?” I heard someone ask in a high-pitched voice of a former history professor in his 80s, and then without waiting for a response added, “Did we poopie this morning?” Yes, we did poopie this morning. But we also remembered a funny story from last night and thought about death and about our grandchildren and about whether we could sleep with you because your neck looks nice.

4) Old people are invisible in American culture

People at the nursing home like to watch TV. It’s always on. How strange, then, that there are no old people on TV.

Here’s a picture I see every day: It’s the middle of the day and there is a cooking show or a talk show on, and the host is in her 50s, let’s say, but obviously looks much younger, and her guest is in his 30s or 50s and also looks younger, and they talk in this hyper-enthusiastic voice about how “great!” their dish or their new movie is, or how “sad!” the story they just heard was. Watching them is a room full of pensive people in their 80s and 90s who are not quite sure what all the fuss is about. They don’t see themselves there. They don’t belong there.

I live in Brooklyn, and I rarely see old people around. I rarely see them in Manhattan, either. When I entered the nursing home for the first time I remember thinking that it feels like a prison or a psychiatric institution: full of people who are outside of society, rarely seen on the street. In other cultures, old people are esteemed and valued, and you see them around. In this manic, death-denying culture we live in, there seems to be little place for a melancholic outlook from someone that doesn’t look “young!” and “great!” but might know something about life that we don’t.

There isn’t one Big Truth about life that the patients in the nursing home told me that I can report back; it’s a certain perspective, a combination of all the small things. Things like this, which a patient in her 80s told me while we were looking outside: “Valery, one day you will be my age, God willing, and you will sit here, where I sit now, and you will look out of the window, as I do now. And you want to do that without regret and envy; you want to just look out at the world outside and be okay with not being a part of it anymore.”

5) The only distraction from pain is spiritual

Some people in the nursing home talk about their physical pain all the time; others don’t. They talk about other things instead, and it’s rarely a sign of whether they are in pain or not.

Here’s my theory: If for most of your life you are concerned with the mundane (which, think about it, always involves personal comfort) then when you get old and feel a lot of pain, that’s going to be the only thing you’re going to think about. It’s like a muscle — you developed the mundane muscle and not the other one.

The saddest people I see in the nursing home are childless

And you can’t start developing the spiritual muscle when you’re old. If you didn’t really care about anything outside of yourself (like books, or sports, or your brother, or what is a moral life), you’re not going to start when you’re old and in terrible pain. Your terrible pain will be the only thing on your mind.

But if you have developed the spiritual muscle — not me, not my immediate comfort — you’ll be fine; it will work. I have a couple of patients in their 90s who really care about baseball — they worried whether the Mets were going to make the playoffs this year, so they rarely talked about anything else; or a patient who is concerned about the future of the Jewish diaspora and talks about it most of our sessions; or a patient who was worried that not going to a Thanksgiving dinner because of her anxieties about her “inappropriately old” appearance was actually a selfish act that was not fair to her sister. Concerns like these make physical pain more bearable, maybe because they make it less important.

6) If you don’t have kids, getting old is tough

The decision to have kids is personal, and consists of so many factors: financial, medical, moral, and so on. There are no rights or wrongs here, obviously. But when we are really old and drooling and wearing a diaper, and it’s physically unpleasant to look at our wounds or to smell us, the only people who might be there consistently, when we need them, are going to be either paid to do so (which is okay but not ideal) or our children. A dedicated nephew might come from time to time. An old friend will visit.

But chances are that our siblings will be very old by then, and our parents will be dead, which leaves only children to be there when we need it. Think about it when you are considering whether to have children. The saddest people I see in the nursing home are childless.

7) Think about how you want to die

José Arcadio Buendía in One Hundred Years of Solitude dies under a tree in his own backyard. That’s a pretty great death.

People die in different ways in the nursing home. Some with regrets; others in peace. Some cling to the last drops of life; others give way. Some planned their deaths and prepared for them — making their deaths meaningful, not random. A woman in her 90s recently told me, “Trees die standing tall.” This is how she wants to go: standing, not crawling.

I think of death as a tour guide to my life — “Look here; pay attention to this!” the guide tells me. Maybe not the most cheerful one, slightly overweight and irritated, but certainly one who knows a lot and can point to the important things while avoiding the popular, touristy stuff. He can tell me that if I want to die under a tree in my backyard, for example, it might make sense to live in a house with a backyard and a tree. To you, he will say that if you don’t want any extra procedures done to you at the end, it might make sense to talk about it with the people who will eventually make this decision. That if you want to die while hang-gliding over an ocean, then, who knows, maybe that’s also possible.

I think of death as a tour guide to my life — “Look here; pay attention to this!”

My father, who has spent the past 30 years working in an ICU as a cardiologist and has seen many deaths, once told me that if he had to choose, he would choose dying well over living well — the misery of a terrible, regretful death feels worse to him than a misery of a terrible life, but a peaceful death feels like the ultimate reward. I think I am beginning to see his point.

I am 33. Sometimes it feels like a lot — close to the end; sometimes, it doesn’t. Depends on the day, I guess. And like all of us, including the people in the nursing home, I am figuring things out, trying to do my best with the time I have. To not waste it.

Recently, I had a session with a woman in her 90s who has not been feeling well.

“It’s going in a very clear direction,” she told me. “Toward the end.”

“It’s true for all of us,” I replied.

No, sweetheart. There is a big difference: You have much more time.”

Public Citizen, along with 30 national and civil rights and citizen groups, issued the letter demanding the seven CEOs stop forced arbitration after The New York Times reported the experiences of customers and employees.

“CEOs of American Express, General Electric, JPMorgan Chase, Sears, Citigroup, Toyota and Discover Financial Services [should] stop putting forced arbitration clauses in their contracts because the practice is unfair and abusive,” Public Citizen stated.

The three-part report described how the seven companies have disabled consumer challenges to practices like predatory lending, wage theft and discrimination.

According to Public Citizen, the seven corporations played an early role in promoting what has become a “proliferation of forced arbitration clauses” in consumer and employment contracts.

“As public awareness of the abusive nature of forced arbitration grows, and as greater numbers of Americans encounter these forced arbitration clauses, the call to fix this problem will increasingly be recognized as a compelling call to justice,” the letter noted.

The letter is also being sent as US lawmakers who are debating legislation that could potentially block future laws from banning the use of forced arbitration clauses in contracts pertaining to loans, credit cards and other consumer financial services agreements, Public Citizen added.

Forced arbitration clauses deny American consumers and workers of the right to hold corporations accountable.

Instead of going to court, these clauses force consumer claims into private arbitration that favors the corporation.

Corporations write the arbitration rules, even choosing the arbitration firm and the location for the proceeding.

Forced arbitration is thus a parallel system of dispute resolution created by and for corporations and explicitly designed to protect their interests above all else.

Often, consumers are unaware that the contracts they sign subject them to arbitration. Even if they were aware, they would face the difficult choice of foregoing necessary products or services, and even potential employment, to preserve fundamental rights.

The corporations that were sent letters were named in a series of articles recently published by The New York Times.

The series highlighted the experiences of customers, small business owners, workers, students and ordinary American families with forced arbitration and showcased how the corporate practice severely impeded individuals’ access to justice.

The companies played an early role in promoting what has become a proliferation of forced arbitration clauses in consumer and employment contracts.

“As public awareness of the abusive nature of forced arbitration grows, and as greater numbers of Americans encounter these forced arbitration clauses, the call to fix this problem will increasingly be recognized as a compelling call to justice,” the letter said.

Particularly harmful are forced arbitration clauses that prevent individuals from joining their claims together to seek accountability for wrongful corporate actions that cause widespread or systemic harm.

“[A]rbitration, as an alternative way to resolve disputes outside the court system, can only be fair if meaningfully chosen by both parties after disputes arise,” the letter says.

The letter is being sent against the backdrop of an effort, spurred by Wall Street, to add a provision to the appropriations bill Congress is now finalizing, that would block the Consumer Financial Protection Bureau from moving forward with an announced rulemaking to curb the use of forced arbitration clauses in consumer loans, credit cards and other consumer financial services agreements.

 

David Wolfe had a great idea for providing independence and security to elderly family members.  MedCottages or “Granny Pods” are an excellent solution for taking care of elderly family members. Wolfe wanted to take care of his aunt and was excited about having his loved ones close, but still in their own space. Reverend Ken Dupin invented these 12 feet by 24 feet pods that sit conveniently in any backyard and plug right up one’s existing plumbing and electrical. They allow both caregiver and senior to have their own space while remaining connected.  Here is his website with pictures.

These “Granny Pods” are specially built with the safety of a senior in mind. They include a small kitchen, bedroom, and bathroom all designed to house safely a senior. The bathrooms are handicap accessible with railing and safety features built in.

The kitchen includes a microwave, small refrigerator, and a pill dispenser. The microwave could be unplugged and used as an electromagnetically-insulated safe container for supplements. A BerryBreeze refrigerator purifier could be put in the small refrigerator. The pill dispenser could be filled with capsules of supplements, superfoods, and superherbs. Everything is conveniently located and safe to reach.

The safety features for these little homes are fantastic. They include webcams for monitoring by family members and a padded floor! Padded floor is great on joints. Also, they protect older relatives from a fall. One can be comfortable having their family member spending time in these homes.

These pods utilize small robotic features that can monitor vital signs. In addition, they can filter the air for contaminants while sending alerts reminding when to take supplements, superfoods, and superherbs. Communication is a breeze with high-tech video and text cell technology incorporated. If anything were to go wrong, these pods have alert systems to notify caregivers as well.

The Hartford Courant had an article about the recent GAO Report.  The report questions whether self-reporting measures on staffing and incidents accurately reflect improvements in nursing home care, or are due to deficiencies in reporting and oversight. The GAO notes that the average number of consumer complaints per nursing home has climbed in 30 states since 2005, including a 20 percent increase in Connecticut.

The ability of the federal Centers for Medicare & Medicaid Services (CMS) to assess nursing home quality “is complicated by various issues with these data, which make it difficult to determine whether observed trends reflect actual changes in quality, data issues, or both,” the GAO said. The agency said that self-reporting of some of the data is among the problems that could undermine CMS’ much-touted Nursing Home Compare program, which rates nursing homes on a five-star scale and is intended to help guide consumers’ decisions.

In its response to the report, CMS pledged to continue to improve “data quality and oversight,” including more auditing of self-reported information.

In the report, GAO officials noted that the number of serious nursing home deficiencies cited by state inspectors decreased nationally from 0.35 per nursing home in 2005, to 0.21 per home in 2014, a 41 percent drop. At the state level, the number of serious deficiencies cited per home declined in 36 states, including Connecticut, where inspections are handled by the Department of Public Health.

The GAO questioned whether the decline was due to an “improvement in quality” in nursing homes or to inconsistencies in monitoring, including the use of multiple survey types. CMS officials told the GAO that state-level budget problems in recent years “had the significant and lasting effect of reducing some state survey agencies’ ability to complete high quality standard surveys.” CMS also has reduced federal monitoring of state agencies’ survey activities, and has scaled back a “special focus facilities” program that identifies homes with repeated problems, the report says.

“By reducing the scope of federal monitoring surveys, CMS may be decreasing its ability to monitor state survey agencies — which is essential,” the GAO said.

The report also raised concerns about the accuracy of nursing homes’ self-reported data on nurse staffing, saying CMS does not regularly audit the data (which are used in the Nursing Home Compare ratings). CMS has plans to begin collecting staffing data through a payroll-based system, but the GAO urged the agency to develop a plan to audit that data.

Similarly, nursing homes self-report data on certain “quality measures,” such as the percentage of residents with pressure sores or who are injured in falls. CMS has started to audit that data, the report says, but the GAO urged the agency to establish “a clear plan for ongoing auditing, to ensure reliability.

 

WBUR’s Common Health had the below article about “sundowning” by Dr. David Scales, M.D., Ph.D., a third year resident in internal medicine at Cambridge Health Alliance.

The elderly woman had been normal all day, my colleague told me, tolerating it well when a tube was placed in her bladder to measure her urine. But that evening, she was found wandering the hospital halls yelling in Italian, carrying her urine bag under her arm thinking it was her purse, traumatized that hospital staff were trying to take it away.

Another night in the hospital, a female Sri Lankan colleague saw an elderly man who was convinced she was a Nazi soldier. Reassurances and even a plea from the doctor — “How could I be a Nazi? I have brown skin!” — could not persuade him otherwise. The next day the patient was back to normal, incredulous when told about what transpired the night before.

An 80-year-old man — I’ll call him Bill — came to our emergency room after a fall. He seemed fine and his tests were negative, but his family wanted him admitted over night for observation. That evening, he began shouting out, repeatedly wanting to get up and walk to the bathroom (forgetting he had just gone). Our calming efforts only riled him up more.

This erratic nighttime behavior is called “sundowning.” Staff in hospitals and nursing homes always worry what will happen as twilight approaches. As the sun sets, many elderly patients can change drastically: They can become extremely confused, agitated, not know where they are, and even hallucinate. In other words, they exhibit signs of delirium, a confused state that can lead them to do things they otherwise wouldn’t.

Experts agree that confusion and agitation are more common in the evening and at night. But there is surprisingly little scientific consensus on what sundowning actually is.Thankfully, not every elderly patient sundowns, but when one does, it can be emotionally traumatizing for everyone. To be confused or hallucinate, or to see a relative acting out in irrational ways, is frightening and destabilizing. Yet, sundowning seems to be extremely common. So, what is it? Why do people sundown? And what can you do to minimize the risk of sundowning in yourself or a close friend or relative?

The debate is in how much sundowning and delirium are related. Some experts think they’re the same thing, others separate but related entities.

It’s hard to study sundowning without a clear definition and diagnostic criteria. Experts can’t even be sure how often it happens. A recent review found a rate of anywhere from 2.4 percent to 66 percent.

Dr. Eyal Kimchi, a neurologist at Massachusetts General Hospital who studies delirium (and a friend of mine from medical school), says we are still in the early stages of understanding sundowning. “There are probably many types of delirium — delirium after operations, delirium in the intensive care unit, delirium tremens associated with alcohol withdrawal — and some we haven’t separated out yet. Sundowning may be another one of them.”

We do know a few things, though. Elderly people with memory problems are the most likely to sundown, especially those with bad Alzheimer’s dementia. We know prevention works much better than treatment. Patients in hospitals and nursing homes are particularly prone to becoming agitated in the evening.

But being prone to sundowning isn’t enough — something has to tip the balance, like not being able to see or hear well. Other environmental factors can do it too, like being thrust into unfamiliar hospitals with bright fluorescent lights, having sticky heart monitors on your chest and alarm bells going off at all hours of the night.

Dr. Sharon Inouye, Harvard professor and director of the Aging Brain Center at Hebrew SeniorLife, also pointed to a dizzying array of barely pronounceable biological factors thought to contribute, including “disruptions in circadian rhythms, nadirs in cortisol, stress hormones, sympathomimetic neurotransmitters, melatonin or fluctuating cytokines.”

If syllable count is any measure, this is as complicated as it gets.

Which is why experts like Inouye and her colleagues developed a series of interventions to address the various factors that contribute to delirium, called Hospital Elder Life Program (HELP). (CommonHealth covered aspects of the program earlier this year.)

Many hospitals have similar friendly sounding protocols. Beth Israel here in Boston uses GRACE (Global Risk Assessment and Care plan for Elders). And there’s NICHE (Nurses Improving Care for Healthsystem Elders), a nursing protocol found in hospitals around the country. While they haven’t been studied specifically for sundowing, they are often used in hospitals to help prevent it.

All of these protocols are similar, and consist of various ways to keep patients oriented, for instance, keeping hearing aids and glasses within reach, getting patients out of bed, making sure they stay hydrated and well fed, avoiding medications that cause confusion, managing pain and reducing noise to allow patients to sleep.

It sounds simple and obvious, but these factors are so interrelated that changing one has only a tiny effect. Its power is in the package. HELP is now being used by more than 200 hospitals nationwide and abroad.

Still, it’s an uphill battle convincing hospitals to invest in more staff to implement these protocols. “It’s the best thing for the patient and for maintaining quality,” Dr. Hollis Day, currently at University of Pittsburgh Medical Center but incoming chief of geriatrics at Boston Medical Center, told me. “It’s hard to pay for something that doesn’t happen.”

But this is changing. Accountable care organizations are more common, so hospitals will get penalized if patients stay in the hospital too long.

“The financial implications of increased length of stay is one thing motivating hospitals to try to prevent delirium more systematically,” Kimchi, the MGH neurologist, said.

Implementing delirium precautions isn’t easy. It requires a change in mindset away from medications to behavioral interventions. “Doctors can’t always order therapeutic sleep protocols at night or reorientation activities three times a day,” Inouye said. “Giving a sleeping pill is so much quicker than a back rub, herbal tea and soothing music, but much more hazardous.”

While hospitals are changing, friends and families can get engaged in the effort as well. So what can you do to help prevent sundowning?

Prevention

Ask what protocols the hospital has in place to detect and minimize sundowning or delirium. There’s no data on which is the best, but the important thing is checking that a hospital or nursing home is working to prevent and detect sundowning and delirium.

A ‘Sense’ Of Security

Bring hearing aids, eyeglasses or dentures to the hospital. This helps keeps patients involved in what’s going on, not to mention able to eat. But keep track of them; these items can get lost in the hustle and bustle, and can be expensive to replace.

Establish Baselines

Make sure the doctors and nurses know what normal behavior is for you or your relative. Is your relative usually sharp as a tack? Or is it normal for them not to know what day it is? This helps the medical team recognize sudden changes.

Be Present

Help patients stay informed on world events or maintain hobbies like crosswords or knitting. Pictures of loved ones or other familiar objects can make the hospital seem less foreign. These steps help keep people oriented and calmer.

Stay Active

Work with doctors, nurses and physical therapists to understand how your family member can stay active. Encourage them to take care of themselves by showering or brushing their teeth, or walk with them around the room — if that is OK with the hospital staff.

Dr. Deborah Rosenbloom, assistant professor at UMass College of Nursing, researches family involvement in caring for patients with delirium. She acknowledges that many people cannot stay with their relatives all day — they might live hours away or need to work. In those cases, Rosenbloom suggests phoning the medical team at admission and then checking in daily.

In Bill’s case, we tried bed alarms, which made things worse. We tried dimming lights and minimizing noise so he could sleep. His bed was near the nurses’ station but we still worried he might jump out of bed and fall before someone could catch him.

At 11 p.m. one recent night, we called his family and discussed two options: Sedate him with medications to keep him from hurting himself — a last resort which might worsen the problem; or send him home. All the crucial tests were negative, so we agreed that the safest thing, despite the late hour, was for him to go back home to familiar people and a familiar environment. I never heard from him again, but I hoped the familiarity helped him feel settled.

The Tampa Bay Times reported the sleazy relationship between Florida Governor Rick Scott and the nursing home industry. The biggest nursing home company in Florida is one of the top donors to Florida Gov. Rick Scott’s political action committee, new campaign records show.

Consulate Health Care, a Tampa-based company, sent Scott’s Let’s Get to Work Committee a $100,000 check two weeks ago, becoming among an elite set of 11 donors who have given Scott at least at least $100,000 this year.  Consulate runs more than 200 centers in 21 states, including 80 in Florida, according to its website.

All told, Scott has now raised $3.8 million in his Let’s Get to Work Committee in 2015, even though he is term limited and cannot seek re-election.  Hmmm….I wonder why they are giving so much money to a lame duck politician?

 

 

The NY Times recently reported the difficulty nursing homes taking care of obese residents.  “Obesity is redrawing the common imagery of old age: The slight nursing home resident is giving way to the obese senior, hampered by diabetes, disability and other weight-related ailments. Facilities that have long cared for older adults are increasingly overwhelmed — and unprepared — to care for this new group of morbidly heavy patients.”

Cheryl Phillips, a senior vice president at LeadingAge, an association of nonprofit providers of services for older adults. “We don’t have adequate staff. We don’t have adequate equipment. We don’t have adequate knowledge.

The percentage of those entering American nursing homes who are moderate and severely obese — with a body mass index of 35 or greater — has risen sharply, to nearly 25 percent in 2010 from 14.7 percent in 2000,according to a recent study, and many signs suggest the upward trend is continuing.   The problem is especially acute in the South, where obesity rates first skyrocketed decades ago and extreme obesity — a 40 B.M.I. and above — continues to rise.

It’s really not a moneymaker,” said Aundrea Fuller, an owner of Generations of Red Bay, a private, for-profit facility.  “One or two places that have tried to do it recognize the economics just don’t work,” said Dr. David Gifford, the senior vice president of quality and regulatory affairs at the American Health Care Association, an industry trade group.

Weight loss can be dangerous for obese patients who, despite their size, lose muscle mass and can become frail, placing them at risk for fractures.

 

The Columbus Dispatch had a great article on the success of Ohio’s program to keep elderly citizens in their homes instead of being institutionalized in long term care facilities.  The strategy: care for more Medicaid beneficiaries at home at a lower cost and serve fewer in nursing homes and other institutions at a higher price.  Nursing-home care on average costs about $64,000 in Ohio, while home-based services are half that or even less.

With Ohio’s aging population increasing demand for long-term care, state officials have stretched Medicaid dollars by boosting the number of elderly, disabled and mentally ill cared for at home.  The shift has been dramatic.

Ohio now serves 60 percent of those receiving long-term-care services through home and community care and 40 percent in institutional care. Less than a decade ago, the opposite was true. About 58 percent were in nursing homes and similar facilities and 42 percent at home. State officials project nearly two-thirds of Medicaid beneficiaries will be cared for at home by 2017.

Ohio Medicaid Director John McCarthy said most people prefer to live in their own homes. To help them do that, the state eliminated wait lists for the popular PASSPORT home-care program and has invested in other home and community-based services.  A shortage of available housing and lack of awareness about the alternatives seem to be the biggest hurdles to moving people out of institutional settings.

The Home Choice Program has been one of Ohio’s most successful efforts, moving more than 7,000 people from institutions and back into the community since 2008. About 1,400 more are working with caseworkers to locate housing and set up needed services.

“It’s helped Ohio re-balance its long-term-care budget,” McCarthy said.

According to the most recent statistics available, Ohio now devotes 62 percent of its long-term-care spending to home care, up from 50 percent a year ago.

A recent report by the Kaiser Family Foundation found Ohio was leading the nation in transitioning individuals with mental illness, helping more than 1,900 return to the community. Overall, Ohio moved more people out of institutional care than any of the 43 participating states but Texas.

Through the Home Choice Program, citizens can get help finding an apartment, home services including regular visits from an aide, physical therapist and nurse, and transportation to doctor appointments and the grocery.

 

 

With more than 2 million people 60 or older, Ohio ranks sixth in the nation for the size of its aged population. By 2050, university researchers project, those 60 or older will make up 30 percent of the state’s population.

 

KSWO reported that the employees at Willow Park Health Care Center were blindsided when they didn’t receive their Dec. 16 paycheck.  The company changed ownership on Dec. 1, so it was the previous owners’ responsibility to deliver their final paycheck to workers on Dec. 16.  Instead of receiving their paycheck, they got a notice saying the IRS had frozen the payroll because of unpaid taxes by the nursing home’s previous owners.

One of those workers is simply upset because he’s dreading the impact on his family’s Christmas.

“When you have a 7-year-old child, it’s not about you having money to buy gifts because they don’t believe that we go out and we buy gifts. They believe Santa comes by and drops them off. How do you explain to your 7-year-old child that Santa didn’t come,” the employee asked?

The employee says how and if he will have to tell his three children Santa didn’t come is constantly on his mind since they found out they are going home without a check.

“It’s not just us, I’m sure a lot of families were depending on that final check to go do their final Christmas shopping. We didn’t have that opportunity simply because the first of the month you pay your bills, the next check you take care of your Christmas,” the employee said.

He says because there has been no communication, he is reluctant to believe anything will happen before Christmas.  Despite not getting their paycheck, many employees continue to go to work.

A company representative said they value their employees, and hope to have it resolved as soon as possible, possibly in time to save Christmas. The company issued the following statement:

“We are proud to be the new operators of this community, and are sorry that the previous owner has been having financial difficulties and was unable to meet payroll. As the new operators, we want to make things right and better for our employees, and are issuing employee bonus checks before Christmas.”

The employee said he hadn’t heard that was a possibility, but said even if he gets his check Christmas Eve, he will be happy to put something under the tree for his kids.

The American Civil Liberties Union says a North Carolina woman has reached a settlement with her employer who she claimed discriminated against her because she was pregnant. The Asheville Citizen-Times reports that Jamie Cole and Sava Senior Care reached an agreement through mediation.

According to the ACLU of North Carolina, the settlement includes payment for lost wages and emotional distress. Also, Sava will implement a new policy to make sure that pregnant workers get light duty and other accommodations on the same terms as other employees needing temporary job changes.

Her complaint said Cole provided personal care and services to residents at Sava Senior Care’s Brian Center in Weaverville for two years until a complicated pregnancy limited what she could do. She was taken off the work schedule. Cole never returned to work at Sava Senior Care.  She later secured employment as a certified nursing assistant at another local care facility.

At the time, according to the EEOC complaint, Cole requested “light duty” accommodations, filling out a Sava Senior Care’s Reasonable Accommodation Acknowledgment form. Representatives at Sava Senior Care denied Cole’s request, saying she could not perform the essential functions of the job, since she could no longer lift 35 pounds without assistance, as stipulated in the job description.

When Jamie Cole took out an Equal Employment Opportunity Commission complaint against SavaSeniorCare in October 2014, she wondered if anyone would listen.  The mother of three wanted to stand up for women everywhere when she alleged pregnancy discrimination in the workplace. Even if she didn’t win, she knew she had to do right by her now 3-year-old daughter.

Now, just over one year after the EEOC said it would investigate her charges against Sava Senior Care’s Brian Center Health and Rehabilitation in Weaverville, Cole received an answer.

“I almost want to cry,” said Cole of the news. “Since I won the case, their polices are going to be changed, and that right there is worth a million bucks.”  A lump sum will be paid to Cole to cover lost wages, legal fees and compensatory damages for emotional distress, she said. Sava Senior Care also has agreed to ensure it has policies in place that allow pregnant women accommodations the same way it would for people with other limitations.