Will I Get the Healthcare I Need?

 

The siren of an emergency vehicle is a common phenomena in a large elder care community. It means that someone has fallen or fainted or might be dangerously sick. An ambulance or the fire department EMTs have arrived.

This is not surprising, since the organization has gathered into a small space a crowd of people whose tired bodies have begun to wear out.

Among the many questions we must ask before putting ourselves or a family member into a retirement home or any kind of continuing care community, none is more crucial than the question of quality health care.

Will I get the care I need when I need it?

Or:

Can the specific needs of my elderly parent be addressed effectively in that place?

 

The Role of Location

The first basic truth we must recognize is that an elder care home is just that: a home, not a hospital. Its residents, like all residents of the city where it is located, are dependent on the area’s existing medical facilities: emergency rooms, hospital beds, doctors, specialists.

Any home for the elderly should not be far from these services. Without them there is little serious health care. In recognition of this perpetual need, retirement homes normally make transportation to medical appointments the highest priority for the company van.

Significant to this subject is the issue of an in-house doctor. Some homes claim that a certain local doctor is a part of what they provide their residents. At the same time every resident is free to use this doctor or another whom they may prefer.

On the surface it might seem really good to a new resident to choose the services of the doctor who comes to the home. Surely it saves a lot of going to and fro for appointments, we think. And usually this doctor is well-known and highly regarded in the city. Their name lends prestige to the elder care home.

But there are questions the new resident needs to ask: 

Will the doctor take full responsibility for a resident, like a normal gp, providing regular checkups and recommending needed specialists?

When does the doctor come to the home? (We know that he/she still has their practice in the city.)

How many in-house patients can the doctor see in a week? A month?

How much time will any resident have with the doctor, having chosen him/her as their general practitioner?

Recently a resident who uses an in-house doctor told me: “I have never seen him except at 6:30 in the morning. So I am never awake enough to remember my questions.”

Of course, the doctor may have an assistant, who is easier to contact, but both the doctor and the assistant have an office somewhere else, not in the retirement home. In other words, the in-house doctor is not actually in the house, but does make house calls.

And then there is the annoying question:

How much of the resident’s monthly fee goes to this doctor, whether or not the resident opts to use him/her? 

The Role of Insurance

Though I hate to mention it, in America medical care must be paid for, and without insurance the cost can be astronomical.  Living in a home for the elderly does not change this.

Medicare is basic, of course, but a dependable supplement, accepted nationwide is hard to live without. Prescription drug coverage is a major need, too. Without it, elderly people may spend a major part of their income for medicines, and being in an elder care home will not change that.

Some people also have long-term care insurance which may or may not be accepted as part of the cost of services in the elder community.  Read the fine print on your policy and ask before you make a choice. Never assume. I have friends who have waited years for their insurance company to pay and finally moved to another home that, for some reason, the insurance company preferred.

Just like people living in their own homes, residents of the elder community should have their insurance cards always with them. Though the cards are on file with the home’s office, it is residents or guardians who must pass them to medical offices. If a technician comes to your room to make an x-ray or take your blood for a test, don’t cooperate until you see them copy your insurance cards.

The Role of the Institution

Essential to our understanding of health care in a home for the elderly is that every new resident must be classified according to level of need. Designations will be made on the basis of the applicant’s own claims, statements from guardians or a power of attorney, medical reports and possibly an evaluation by the home itself.

The common categories are: Independent Living, Assisted Care, Memory Care, Rehabilitation and Skilled Nursing.

Health care is required at every level. The healthiest, most capable people in the community may be any age, young or very old, but because they are able to be responsible for themselves, mentally and physically, they are classified as independent. They are in the home for the benefits of security and easier living than possible alone, and they have situated themselves for transition to stages in which they may need daily assistance. Of course they need at any stage the observation and support of medical professionals.

Not all homes provide services to all of these categories, and most like to advertise themselves as happy, active communities, which they may be. But, if the facility you are considering lacks memory care, and your loved one is in the early stages of Alzheimers, then you obviously need to look somewhere else. If it lacks rehab facilities, then it would be good to know where their residents might go for a while, immediately after surgery or a stroke.  Anyone might need that.

And while we all hope to avoid the need for long-term skilled nursing, we need to know what options the home is likely to choose when residents reach that level of need.  If their home doesn’t have it, where do they send residents who develop needs for these services?

It is very important that every person in the home have an accurate classification. If a resident needs help in the shower and doesn’t get it, he becomes a fall risk. If a man who should be in memory care is left in independent living, he may wander off and be lost. If a woman who can’t manage her meds is not moved to assisted care, she may take a dangerous combination of drugs or forget to take her medicine at all. For this reason, the institution must be diligent and families cooperative.

Accurate classification is especially crucial when people with different levels of need live together on the same halls. While able-bodied people are happy to live with those who are physically handicapped, they are usually prohibited from coming to their assistance, because of insurance issues. Even pushing a neighbor in a wheelchair may be forbidden. And more serious problems develop if people who should be in memory care are sharing facilities with a general population that simply doesn’t know how to react to them. This is not only unfair to everyone involved but results in a needy person not being cared for appropriately.

Sometimes families may resist moving their relative to another level, because every added service increases the monthly cost. The good news is that there exist a few senior communities that provide for all of these types of care in separate quarters but on one campus and enroll their residents in a life care plan that avoids the raising of fees as services increase.

A basic issue in residents’ health care is the institution’s ability to simply provide a safe and healthy environment. A good home will have certain built-in safety features:

Call buttons that stay with the needy resident, emergency cords strategically located in apartments, non-slip showers and floors, grab bars in appropriate places, wheelchair accessible apartments, sufficient elevators, automatic doors and efficient systems such as heating, cooling and ventilation.

A good home will have also routine health services offered to the whole community. These might include vaccines, given as recommended by the medical profession, well-equipped exercise rooms, strengthening classes led by trained physical therapists, and perhaps a podiatrist who comes periodically to cut everybody’s toenails. (Very few elderly people can manage this without help.)

Therapists employed by another organization may come to the retirement home to conduct exercise classes, notice needs, respond to requests for help and perform prescribed therapy for residents.

A professional nursing staff is part of the normal staff of a retirement community. There are legal requirements relevant to the ratio of nurses to residents. A head nurse will take responsibility for health maintenance in the community and can be called in all kinds of circumstances.

A high quality, efficient organization will obtain health information about new residents even before they come into the community. An applicant is asked to record physical ailments, past surgeries, medicines that have been prescribed, etc.

In one home, the marketing department explains, “We don’t refuse anyone because of a health issue, but we want to be prepared in advance to take care of anyone who moves in.”

In this same community the head nurse pays a visit to every new resident, bringing a small transparent bottle. In the bottle is a list of the resident’s health issues, along with their list of prescription drugs and supplements. The nurse explains that this little bottle must be, always, inside the door of the resident’s refrigerator.

“If you should fall or get suddenly sick and I have to send you to the hospital, this will go with you. We call it your ‘Lifeline’ and everybody, including the ambulance crew, knows where to look for it.”

Then the nurse and the resident choose a place on the refrigerator door and put it there. This is an encouraging little ceremony. The resident knows now: “When the siren wails for me, we are ready.”

In addition, a physical therapist calls on the new resident to schedule a small test to determine the resident’s baseline abilities, especially those related to balance. This enables the therapy department to know if the resident’s health is improving or declining.

An exercise room with basic equipment is necessary in a retirement home. It should be a place where therapists can take clients for prescribed workouts, residents can use as they wish, and there should be a separate room designated for group activities such as exercise classes.

Pleasant, safe walking areas are also very important. The presence of trees and green grass with smooth paths encourages residents to spend time in fresh air and sunshine. Ideally there should be scattered benches, never too far from one another, to accommodate people with little stamina. Wide carpeted halls are good for indoor walking. Such assets inspire residents to keep moving. Sometimes, hobbling along with walkers or canes, they meet on the sidewalk, smile and remind one another, “you use it, or you lose it.”

Because nutrition is basic to health, and food is both a need and a pleasure, the dining room is a crucial part of any home. There should be a dietitian who understands the changing needs of the elderly. Individual dietary needs must be respected.  At the same time it is important for residents to like the food and enjoy chatting with friends as they eat.

The Role of the Resident

Finally, with all of this in place, the resident’s health is in his or her own hands. Part of being classified as independent should be the personal motivation and good sense to eat well, exercise, keep medical appointments, take prescribed medications at the right time, go to bed without being told and ask for help when it is needed.

If the resident will not or cannot do these things, he/she may have to be reclassified and moved to Assisted Care.

Other choices that may not seem to be about health prove to be highly significant. A good home offers a constant menu of activities: social, intellectual, entertaining, as well as physical. Playing Scrabble or Bridge or Bingo, attending a concert, taking a walk in the garden or joining a book club or a Bible study class may contribute as much to health as taking a blood pressure medicine. (Okay, I confess that I did not clear this statement with my doctor.)

We have determined four basic keys to medical care in the home for the aging:

the level of medical care in the surrounding community;

the insurance coverage of the resident;                   

the provisions of the home itself for the promotion of the health of its residents;

and the level of the resident’s cooperation.

The answer to our question is a sum of these parts.