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Certain truths are anything but self-evident. This is the case when trying to discern truth from fiction and marketing from reality in “Assisted Living” facilities. Assisted Living (AL) and Board and Care Facilities are a popular and rapidly growing elder care option somewhere between home sweet home and the dreaded “nursing home.”

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Elderly couple, woman holding her head with hand and man sitting with his hand on her shoulder consoling her.According to the American Geriatrics Society 40% of nursing home residents are affected by depression, yet depression often goes undiagnosed or un-treated in elders living in long term care facilities.

Depression is the No. 1 under-treated illness in the geriatric population. Unlike the profile of other diseases that cluster with aging, depression does not show up on lab tests, or EKGs. It is often masked by other chronic illnesses and can mimic dementia. These and many other reasons make depression in the elderly a difficult challenge.

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family-advocacyThis past week I met with a distraught mother and father at a long term acute care facility in San Diego. Their 36yr old only son had been hit by a car 5 weeks earlier and suffered severe brain injury. To add insult to injury, he’s suffered a severe stroke after that.

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maintenence-therapyIn 2014 in the landmark case of Jimmo v. Sebilius, the practice of denying Medicare coverage for skilled care solely because someone is not “improving” was ruled unlawful. “Jimmo” holds that upon proper showing of need, skilled maintenance therapy is covered by medi­care.

Unfortunately, in a post Jimmo world, elders with chronic conditions and medical complexities continue to have difficulty getting medicare coverage for skilled maintenance therapy.

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long_winding_roadThis battle is not for the faint of heart. The battle I speak of does not roar but whimpers on in homes and skilled nursing facilities across our nation. It is the battle for getting extended therapy for those rehabilitating from acute injury as well as those suffering from chronic degenerative diseases.

The former need therapy to get back to normal function, and the latter need ongoing therapy to simply maintain what they have and prevent further deterioration. In both cases, getting as much therapy as possible is critical to quality of life.

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nursing home, discharge from nursing homeIt is important to educate yourself about skilled nursing facility (aka “nursing home”) discharges before you receive the notice that your loved one is going home. Know the ropes so you can make sure your loved one’s rights are being honored and the discharge will be optimum.

The following is an excerpt from CANHR’s Long Term Care Justice and Advocacy site.

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Assisted-Living-2016As a Geriatric Care Manager, I have been involved in placing elders in long term care facilities over the years. I am often asked to continue on managing their care.

Many people may think that it’s unnecessary to have a nurse or a professional advocate overseeing your loved once they move into a “nursing home” or assisted living. The truth is that your loved one’s health care still needs management and advocacy.

It’s especially necessary in “Assisted Living” facilities and here’s why.

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chronic-painAccording to the CDC, from 1999 to 2014 opioid prescriptions have quadrupled and over 165,000 people have died from prescription opioids.

Some of those 165,000 people are the elderly who have been over-medicated with opioids. The elderly have a very different and diminished ability to metabolize pharmaceuticals and this is not always taken  in to proper account.

Improper pain management, whether over medication or under medication is the genesis of much suffering for the elderly with chronic pain.

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Four PillarsHome sweet home. Most of us want to stay home when we are sick and even more as we get older and need care.

Unless there are extenuating circumstances, we certainly want Mom and Dad to stay home and be well cared for instead of seeing them have to go into a nursing home, assisted living or board and care facility.  However, as our loved ones age most of them have some combination of chronic illnesses that present constant challenges. Sometimes they need some help in managing their health issues.

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16d37c0a78849c0818cf9d4e038ef6ccQuality patient care: It’s the holy grail of health care … and just as hard to find.

Millions of management hours are spent trying to meet and document quality improvement benchmarks. Marketing material is effusive and glowing with promises of quality care for your loved ones in long term care settings, such as skilled nursing and assisted living facilities.

Yet, quality care remains elusive.

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