Choosing a Long Term Care Facility

The elderly population enters into long term care facilities for a variety of reasons. There are many different situations that may occur prior to an elderly member of society entering this type of facility. Sometimes, age alone is not just the contributing factor. People may enter into a LTC facility due to chronic illnesses that can no longer be independently managed. They sometimes enter due to frailties and disabilities. Another common factor is the loss of a caregiver. It is not uncommon for family members to take on the responsibility of caring for their loved one, and often times this becomes too much to balance with life's everyday duties.

Before choosing a long term care facility there are many things to be considered. First, it is essential that the family and soon-to-be resident visit the facility in person. Second, it is very helpful to know how long the facility has been open and what the credentials are. Third, these types of facilities are not federally regulated, instead, they are state regulated, and it is the families right to inquire about these regulations. Finally, find out about the cleanliness of the facility, the other types of residents who live there, and the methods of socialization seen at the facility.

Whether your family member needs help with simple things like balancing a checkbook, or more complex things like activities of daily living, a long term care facility can serve as a multi-purpose place for all needs. Although long term care facilities may sound like the answer to many prayers, unfortunately, they can be extremely expensive. Luckily there are several forms of funding that may be available. These sources include: medicare, medicaid, and some private insurances. Other sources of funding may include certain social service agencies and non-profit providers.

Men, Women, Sex & Aging

A common misconception and stereotype placed on the elderly is that of their sex lives. Although it is true that many physical changes may occur within female and male sexuality, this does not always mean that sex must halt. It is very common for males over the age of 60 to be diagnosed with prostate cancer, this can commonly lead to removal of the prostate gland, having a negative effect on a males sexual abilities. Another common issue with aging males is erectile dysfunction, this too can have detrimental effects on a males sexual capabilities. Though both females and males may experience issues later in life dealing with sex, the issues females experience are entirely different. Males mostly experience systematic failures with their sexual and reproductive organs, while females primarily experience hormonal changes, such as menopause (leading to a reduced amount of estrogen). Females experiencing menopause may also experience many of the following symptoms: vaginal dryness, irritation, mood swings, depression, and even lowered libido. Unfortunately, all of these factors add to a less than ideal sexual environment. Aging men may become extremely self conscious of their inability to perform, adding anxiety and furthering their disability. Women also become self conscious of bodily changes as they age, creating an uncomfortable love-making environment. All of these conditions definitely create barriers for some elderly couples love making. However, there are many remedies, and routes around these issues, making it possible for couples to intervene. One common route is sexual psychotherapy. Some therapists are trained directly in intimacy issues. Another consideration is "spicing up" love making...creating a romantic environment, taking more time to make love, and trying new things may create a more harmonious environment for making love. Another thought is making some lifestyle changes. Healthy living choices can have an enormous effect on aging and sexuality. Enrolling into a yoga or dance class may do wonders for some couples sex lives. All else considered, there may be some challenges to having a sexual life and aging, but there are equally as many resolutions. Many resources are now available to assist the elderly and aging in this personal quest.

Mandatory Driving Tests

Motor vehicles are the leading cause of accidental death among elders aged 65 to 74 and the second leading cause for those over 75 years. Should Florida adopt mandatory testing of drivers over the age of 65?

I believe that Florida should adopt mandatory testing of drivers over age 65 for multiple reasons. First, the population of citizens retirement age and over is an ever increasing number in Florida. Second, enacting a law like this could help decrease the number of casualties the elderly population experiences due to this. Finally, this would help ensure that people who should not be on the road are not, providing safety for the other drivers on the road as well. As mentioned in our text, elderly drivers account for the smallest percentage of accidents, rarely drink and drive, and have the fewest miles driven of any age group. However, when compared on a per mile basis, drivers over the age of 75 have the worst driving record of all. Many problems are associated with the elders decreasing ability to drive as they age. The primary of these issues being vision impairments. As people age their vision was no where near as sharp as it once was, making it difficult for them to see, especially at night. Another important factor to consider when evaluating the safety of elderly drivers is their reaction time. Delayed reaction time accounts for many accidents. Driving is an activity that demands much of all of our senses at one time. This may be difficult for many elders who are experiencing one, if not more, issues with these systems. Florida (because of its higher population of the elderly) should definitely address the issues associated with the elderly and driving. Though some transportation services do exist for the elderly today, many more may need to be put in place as more people age and become less likely to drive. Other states may consider putting this law into effect as well. After all, it will not only protect the elderly, but it may save many other lives on the road.

Aging Stereotypes

A stereotype, as defined by dictionary.com is "a generalization usually exaggerated or oversimplified and often offensive, that is used to define or distinguish a group." Stereotypes exist for all types of people; from the overweight population to people of particular races. Stereotypes can be positive, but are more commonly remembered as having negative connotations.
I was walking through Wal-Mart recently in search of a bottle of club soda. While on my endeavor I'm stumbled upon a man who was also in search of a type of 'soda', he was in fact looking for baking soda. He appeared to be at least 70 and so I was eager to assist him with his search. After walking from aisle to aisle, we had no luck. The man looked at me, defeated, and said, "I heard that soda and vinegar is a great for unclogging your pipes." Without thinking, I asked, "Are you having problems going?" The man and I stared at each other for a while and after a few awkward moments of silence we both started laughing. Luckily, the man had a sense of humor. Afterwards, I realized he was talking about the plumbing in his house. I was relieved at the man's sense of humor, as well as his reaction. Although it may seem innocent, this is a perfect example of a common stereotype about the elderly.
The elderly population is viewed as an extremely fragile and vulnerable group. While this may be true in certain instances, the elderly are very much an independent population. In fact, many communities now exist that cater to the needs of the elderly. Although these communities do exist to promote positivity in regards to the elderly, so do their resistant counterparts... stereotypes. Common stereotypes include: being grumpy, frumpy and stingy. Some people completely disregard the elderly as a group. Others baby them as if they are completely helpless. But, many elderly people are just the opposite. Being self reliant is important to many members of the elderly population. Because the life expectancy is rapidly growing in this country, people are making changes to their lives now, in hopes of living to their full "term". The elderly population is often disregarded in society, but things are starting to change. The AOA, better known as the Administration on Aging, is putting forth a huge effort in order to educate the rest of our society on the elderly population, and to promote understanding for both parties across the board.
In my experience I upheld the stereotype that the elderly population may not be as healthy as the youthful ones. However, the man in Wal-Mart was not constipated at all. In fact he was disproving the stereotype of helplessness by fixing the plumbing in his own house. It just goes to show, stereotypes are generalizations, and can be very misleading.

Autonomy and Freedom of Choice

Contrary to popular belief, residents in long term care facilities are not always fully dependent. Many residents, residents of assisted living facilities, for example, are very independent, and taking that away from them may harm them, rather than help them. Autonomy represents a persons motivation and willingness to participate in certain tasks. Performing certain tasks for these individuals may actually decrease their willpower to do so for themselves in the future. However, this decision can be a very difficult one to understand. Ignoring a patient or residential need in which they require assistance could be viewed as neglect. Activities of daily living, including, feeding, dressing, and toileting may often require a need for assistance. If the patient displays a willingness to attempt any of these activities on their own, this may be a positive sign of autonomy, however, they should not be attempted without close monitoring.
Another important factor to consider in the way of patient and residential rights, is the right for advance directives. Although some states do not recognize all of these advance directives, they are still important when considering an incapacitated individual. Advance directives are documents used to make health care decisions when the person is no longer capable of doing so themselves. The incapability's include both physical and cognitive disorders. This documents can be in the form of living wills and power of attorneys. Each are designed to execute health care decisions on the patients behalf.
Although the elderly are seen as an extremely vulnerable race, they are still human beings. If capable, they should maintain the right to make their own decisions. They should also maintain the right to perform tasks they are capable of doing without harming themselves. Autonomy and advance directives are equally important in health care ethics, and are not to be taken lightly. The long term care population is vulnerable, and therefore require everyone to be advocates to their well-being.

Cost Control and Quality

Chapter ten of our text outlines external controls of long term care. One of the issues that presents a potential problem as stated in our text is management of care. This section discusses the balance that is attempted by the healthcare spectrum to equally control quality, access, and cost. However, it is often times difficult to manage all three without compromising one.
One of the examples the text used was the case management method. In case managment a managed care organization may assign a case manager to a patient if the qualifications have been met. The text does point out an important fact though, case management may provide the patient with high quality care, but at the same time may sacrifice efficieny due to the high costs associated with this personalized method of care.
Due to the expense of case management, MCOs are reluctant to qualify enrollees for this type of service. In fact, as stated on the Blue Cross Blue Shield website for Florida, patients are required to submit a case management referral form to their primary physician. Once this form has been completed by the physician it is then sent back to the MCO provider and reviewed for the patient's possible eligibility. Of course, the patient in question must been certain eligibility criteria.
The main focus and objective of case management utilization is, of course, to save money...however, this does not always occur. Assigning a case manager to a patient is strictly based on patient need for a reason. It is costly, not only for the patient, but for the provider, and healthcare facility to assign a case manager for individual patients. On the other hand, it may be beneficial for the provider in terms of cost by deciding just how long and what types of services this patient should be eligible to endure. There are many types of cost control methods in long term care, the above mentioned just happens to be one of the more popular ones. Eventually a cost control method will need to be put into place that can accurately manage quality, access, AND control.

In Recent News...

A recent article published by the Orlando Sentinel describes an unfortunate event for a consumer of long term care...

Nursing home fined after maggots found in patient's cast
The Associated Press 7:22 AM EDT, June 4, 2009
WEST PALM BEACH, Fla. - State regulators have fined a West Palm Beach nursing home $16,000 after a patient was found injured on the floor with maggots crawling out of his leg cast. The state issued the fine in March against Azalea Court, but the nursing home has appealed the penalty. An August 2008 report states that the 120-bed facility failed to provide the necessary care and services to a resident with the cast on his lower leg, which led to an infestation of maggots. The report says the patient's leg was supposed to be treated every three days, but the nursing home could only provide documentation that it cared for the wound about once a week. A statement from Azalea Court says the nursing home is cooperating fully with regulatory agencies. (Press, 2009)
Press, T. A. (2009, June 4). Nursing Home Fined… Orlando Sentinel.

Unfortunately, articles like these are not a distant reality for some long term care facilities. When I came upon this article it made me sick. I was in complete disbelief that a patient wound would be left untreated for that length of period. After reading this article as well as the assigned chapters of our text, I can definitely agree that some level of improvement needs to take place in terms of patient care. In the first chapter of our text one of the weaknesses outlined of LTC facilities is poor public image. In this section the author goes on about how important it is to choose a well-known facility with a good reputation.
After reading this article it's easy to understand how some facilities earn such a poor reputation. Not only will Azalea Court suffer from its now negative reputation, but state regulators that may have been contributing funds to this facility may reduce or even cut off those funds. This would be another unfortunate event that would not only harm the facility, but also the residents within the facility. When budget cuts occur, lay-offs, and the cancellation of certain amenities are not far behind. Although some facilities (like the above mentioned) are of poor quality, fortunately other facilities are maintaining their image as well as their standard of care.
At the age of 86 my great grandma entered a nursing home and continued to reside there for 6 years, until she died at the age of 92. While searching for a nursing home, my grandparents took much time and deliberation. They visited dozens of homes in and out of town. They were reluctant to visit homes that were open to the pubic "by appointment only". Finally, after searching for over a year, they found the Sunbelt Living Center located in Orlando, FL. They chose this facility based on many factors. I visited my granny there frequently. She seemed to be happy overall and I was very pleased with the numerous activities that were made available to her, not to mention, the food. I ate several meals with her while she resided there. The food was of good quality. She also had a bird feeder outside of her private room. She enjoyed watching the birds come and sit by her window. Overall, her experience was a positive one.
With that being said, forming an opinion about nursing homes can be done based on both their strengths and weaknesses. My grandma was fortunate. She had the support of her family (informal caregivers) visiting each week; she also reaped the benefits of a system that cared deeply about satisfying their residents.
However, not every resident is as lucky, as seen above with the ill-fated resident at Azalea Court. Abuse in nursing homes and all facilities must stop. The elderly population is an extremely vulnerable one, not only to illness and disease, but also to physical and emotional abuse. Each person, no matter what their age deserves to be treated like a human being. Sadly, sometimes the shortcomings of these facilities result in extreme abuse and even death. I hope that with an ever-aging population we can all realize the reality of growing old, and learn to be empathetic to the needs of those that are already there.