Monthly Archives: January 2010
Eric Carlson is Directing Attorney for the National Senior Citizens Law Center (NSCLC). He has specialized in long-term care since 1990 and is one of the country’s leading consumer experts on skilled nursing and assisted living facilities.
Mr. Carlson has written many articles on issues related to long term care and advocacy. I came across this one recently and think it is very helpful for consumers. Note: It has been rewritten and published recently as “20 Common Nursing Home Problems and How to Resolve Them” for purchase from this page at the NSCLC .
Part of the 20 Lies article can be read at no cost in a Powerpoint format.
The basics of the 20 Lies articles are listed below. See Mr. Carlson’s complete article for the details.
1. MediCal does not pay for the services you want.
2. The nursing staff will determine the care that your receive.
3. We don’t have enough staff. You must wake up every mroning at six.
4. We don’t have enough staff. You should hire a private-duty aide.
5. If we don’t tie your father into his chair, he may fall or wander away.
6. Your mother needs more medication to make her more manageable.
7. We must insert a feeding tube; your father is eating too slowly.
8. Your children can only visit you during visiting hours.
9. We can’t admit your mom unless you become “Responsible Party”.
10. Please sign this arbitration agreement; it’s no big deal.
11. Because of your limited needs, you can’t get Medicare reimbursement.
12. We must discontinue therapy because you aren’t making progress.
13. We can’t give therapy. Medicare has expired and Medi-Cal doesn’t cover it.
14. You aren’t eligible for Medicare, so you must leave the Medicare bed.
15. We don’t have an available Medi-Cal bed for you.
16. We don’t have to readmit you from the hospital; your bed-hold has expired.
17. You must pay any amount set by the facility for extra charges.
18. We have no available space for resident or family meetings.
19. You must leave because you are a difficult resident.
20. You must leave because you are refusing treatment.
Something I have run into in our society is a seemingly widespread belief that mental health services are primarily for younger people and not older individuals. I have heard people say that older people have had their chances and that mental health funding should go to young people where it can make a bigger difference. While I love young people, and think that kids need and deserve a lot of support, I also am saddened to think that there is a bias towards older people not getting mental health help.
This attitude seems to reflect our youth-oriented culture which emphasizes staying young in order to be important. Where is the care and compassion and respect due to our elders? The aging journey very often brings up old fears, old triggers of insecurity, old pains, old losses even from childhood. Why should older individuals – who have given to their communities all of their lives – not benefit from compassionate support as they continue their life journeys? Where is our culture’s realization that we need to hear the stories our older folks can tell us in order to gain from their wisdom and experience?
It seems to me as I grow older that I see our society having a shorter and shorter collective memory. After one year is over, we tend to go on and focus on immediate problems and immediate gains, forgetting the lessons we might have learned from what happened earlier.
While our country’s economy has been severely impacted in recent years, it has been enormously helpful to me to listen to elders’ tips about how they got through the trying years of the Great Depression and WWII. As Joan Erikson explained once, “wisdom” is not necessarily about knowing “why” but about knowing “how”.
I hope that a fair portion of mental health funding allocated by government at different levels will go to mental health services for older people. It behooves us to take care of our elders, to listen to their stories and to afford them the respect they deserve. They are survivors. We need them. We can learn things from them!
Patient Advocacy for Older Adults
One lesson I learned years ago from my mother (a retired nurse) and have continued to see the importance of to this day is how critical it is for older adult patients to bring a family member, friend or companion with them when they visit their doctors.
It is important for everyone to do this when possible but especially vital for older people who can use the help of someone they trust to remind them of their questions for the doctor and to write down what the doctor’s answers are.
Prescribed medications tend to increase as we age and many medications have side effects which are compounded by the combinations, potential contraindications, various times they need to be taken, etc. All of this information can be both confusing to remember and necessary to review on a regular basis.
Doctors can tend to change dosages and prescriptions and sometimes generic medications are suddenly substituted rather than brand ones when the generic versions become available. It is important for patients to log the effects of any of these medication changes.
A written log/chart can be brought to the doctor with them. The patient advocate can remember to bring the chart, remember questions, and write down explanations. If the patient is feeling poorly, it is especially important to be accompanied. Patients who are symptomatic at the time of the visit can find even more challenge to communicate since they are dealing directly with their illnesses and associated pain, weakness, side effects of treating medications, etc.
My experience and that of many others is that, more often than not, doctors will pay better attention to you if you are accompanied by a friendly patient advocate.
Volunteering is often talked about in terms of benefits for society and for the volunteers themselves. Older adults who reach out to share their wisdom, kindness and service in their communities generally experience higher self-esteem, less depression, an increase in friends and less overall decline in health. One of our wonderful volunteer opportunities in Marin is the Senior Peer Counseling (SPC) program, managed for 20 years by Community Mental Health.
Peer counselors receive 8 weeks of initial training in issues facing older adults. These include aging, medical problems, isolation and family conflicts. Then, after being taught basic counseling skills and introduced to Marin’s extensive range of services for seniors, they are matched with one or more homebound older adults in need of counseling. Services are offered in English and Spanish. SPC’s next training will be held in April, 2010 in San Rafael.
SPC volunteers come from all walks of life: they are retired actors, directors, nurses, mental health professionals, professors, and computer entrepreneurs. Nan Heflin MFT, one of the coordinators of SPC, says, “Our volunteers are from diverse backgrounds, but they all have in common an interest in their own aging process and personal growth, and a belief that one can change at any age… Over and over I hear from the volunteers that they get as much from being counselors as the clients get from them.”
Peter Schmid of Greenbrae and Cynthia Wood of Bolinas are among the program’s 35 volunteer counselors. “Counseling is a chance to do something for humanity,” says Schmid, age 79, who has been a volunteer for 15 years. Adds Wood, age 77: “People are really appreciative.”
For more information on how to volunteer with Senior Peer Counseling and the next training, call 415-499-6802.
It is my experience and research backs this up that older people are often dehydrated. A region in the brain called the mid cingulate cortex predicts how much water a person needs, but this region malfunctions in older people. So, in essence, our aging brains underestimate how much water we need to drink in order to rehydrate. Our sense of thirst decreases.
One of the side effects of dehydration can be dizziness or lightheadedness. If an older person experiences dizziness, particularly in the morning, he should consult with his MD of course. If he does not have ear problems which can cause dizziness, and if his medications are not the problem, and no other obvious medical problem seems to be the cause, it is a very simple step to see if dehydration might be the root of the problem.
The Mayo Clinic advises this routine: Put a large glass of water (10-12 oz) on your nightstand. In the morning *before getting out of bed*, sit up and drink the entire glass of water. Wait about 15 minutes before getting up. Try this several mornings and see if your dizziness lessens. I have seen this help numerous people. It’s free, it’s non-invasive, good for us and easy to try!
It may not help but if it does, what a relief for dizziness sufferers!
From Mayo Clinic website article on dehydration:
Older adults. As you age, you become more susceptible to dehydration for several reasons: Your body’s ability to conserve water is reduced, your thirst sense becomes less acute and you’re less able to respond to changes in temperature. What’s more, older adults, especially people in nursing homes or living alone, tend to eat less than younger people do and sometimes may forget to eat or drink altogether. Disability or neglect also may prevent them from being well nourished. These problems are compounded by chronic illnesses such as diabetes, by hormonal changes associated with menopause and by the use of certain medications.