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Category: long-term care

Reflection on the NJAAW Housing Series

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A guest blog by William Cotrone, NJAAW intern

As the global population continues to grow/age, appropriate housing for older adults is now more important than ever. Most of NJ’s current housing stock was built for young able-bodied adults and nuclear families.

Currently, 30% of homeowners in the US are single and live alone. By 2030, 20% of the US population will be considered “senior citizens,” and most older adults would prefer to live in their own homes for as long as possible. But what if their home is not designed to accommodate them as they age? Fortunately, there are solutions.

Staying in Your Home

Adaptations and renovations can allow people to stay in their homes safely for longer.

For example, AARP has a free HomeFit Guide that explains how to incorporate universal design principles and products into homes, which are safe and easy to use. Most of the elements in the guide can be done without professional assistance

Another option is to hire either an occupational therapist (OT) or physical therapist (PT) who is also a Certified Aging-in-Place Specialist (CAPS). These individuals can make recommendations on how to repurpose your home to reflect your functional, mobility, and cognitive needs so that you can live safely and comfortably.

A CAPS will examine such things as the entry and/or foyer (Is it clutter free? Is there a rug that could cause a person to slip and fall? Is there enough light?). If an individual requires a mobility device such as a walker or wheelchair, are doorways and hallways wide enough to pass? In the kitchen, a CAPS will scrutinize chair height so that sitting and rising are made easier, floor space so that mobility devices can pass, lighting to assist people with visual challenges, etc.

Probably the most important place to have examined is the bathroom, especially since 80% of falls occur here.

Probably the most important place to have examined is the bathroom, especially since 80% of falls occur here. A CAPS can make recommendations on toilet height, grab bars, slip mats or bathroom chairs for the shower area.

For the rest of the house, stairs should be well lit and have handrails. Another option is a chair lift to take older adults up and down. Smart technology devices might also be beneficial for such functions as turning on the lights or a faucet.

For outside the home, thoughtful landscaping or therapy gardens make a great addition. Engaging with nature has an immense list of health benefits, so make an outdoor space age-friendly. Comfortable furniture for the patio area, safe walkways, good lighting and smart technology increase the ability to enjoy outdoors safely.

Getting Help in the Home

Knowing when help is needed and how to find it can be challenging. One option is to hire assistance directly or via an agency. While Home Health Care (HHC) covers skilled support services (including RN/PT/OT) and is usually paid for by Medicare or insurance following a hospital stay or during recovery, older adults may need a lower level of care to assist them with activities of daily living (ADLs). These services, such as toileting, bathing, dressing, eating, moving, and grooming, can be provided by Certified Home Health Aides (CHHAs). However, CHHA services often have very limited insurance coverage, leaving most people to pay out of pocket.

When deciding what type of provider to employ, consider the following: A family member/caregiver who hires privately may save money, but the “employee” might not have the proper skill set or be insured. Engaging an agency is more expensive. However, such added benefits as knowing that the agency has supervision, specific hiring requirements, insurance, licensed staff, and compliance policies, are often worth the extra cost.

Another option is Adult Day Care. These programs provide care and companionship for older adults who need assistance or supervision during the day. This provides caregivers with a much-needed break and allows them to go to work, school, do housekeeping, etc. Research has shown that social interaction in a Day Care setting improves an older adult’s mental, physical and emotional health as well as reduces the risk of developing depression and dementia.

Finally, for people who need more help or are near nursing-level care, PACE (Program of All-inclusive Care for the Elderly) programs allow people to remain at home. While limited geographically, the number of PACE programs in NJ is increasing. More information can be found here.

Residential Options

When staying in one’s home is no longer possible, what are the options to choose from and how does one assess them?

First, independent living is an option for older adults who do not have severe physical or cognitive challenges. An independent living environment usually includes age-friendly features like grab bars, walk-in showers, emergency response services, community dining, age-appropriate entertainment, transportation services, etc. They are relatively affordable at market prices and many are designated as “affordable housing.” If needed, home care, paid by the resident, can be arranged.

The next option is assisted living. Residents of an assisted living community tend to have physical or cognitive challenges but are still able to retain some autonomy. Assisted living units are often smaller than independent living settings because they lack some of the customary rooms of a typical house, like a kitchen. Staff can help residents with ADLs and medication management.

The third option is a long-term care (LTC) facility or a traditional “nursing home,” which provides shelter and around-the-clock care for people with ADL and health difficulties. Reasons for seeking LTC might include that a person suffered a severe injury or medical emergency and needs rehabilitation to return home, or their physical/mental state is diminishing, which could make them susceptible to injuries or illnesses. Long-term care facilities can also provide hospice care and many offer memory units.

Pulling these options together is the “Life Plan Model,” also known as a Continuing Care Retirement Community (CCRC). Residents can transition their living situation and care level without having to transfer out of the facility. For example, a typical transition might be going from independent living to assisted living or independent living to rehabilitation. This may be the appropriate option for couples where one needs care services and the other doesn’t.

For all of the options in getting help in the home, or relocating to an age-focused place, it is important to plan ahead.

For all of the options in getting help in the home, or relocating to an age-focused place, it is important to plan ahead. Unless related to a hospital stay, Medicare does not pay for home care or long-term care. If someone qualifies for Medicaid or affordable housing, eligibility should be established as early as possible. Long-term care insurance or private insurance may cover some costs, but most people will be paying out of pocket.

Aging is like the weather. You can plan for it, and anticipate what will happen, but you won’t know until it actually happens. Like the weather, aging and finances can change unexpectedly. Older adults deserve to live with dignity and comfort. They deserve affordable, appropriate and accessible housing and must plan ahead and know their options.

Click here for a summary of NJAAW’s Housing Series and links to the four recorded sessions.

William Cotrone recently graduated from Bates College with a degree in psychology and is and future medical student (hopefully in a field related to aging). He previously interned at senior residential sites in Lewiston, ME.

The COVID-19 Crisis at NJ’s Long-Term Care Facilities

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We’d like to thank guest blogger and NJFA friend Laurie Facciarossa Brewer, NJ’s Long-Term Care Ombudsman, for her blog post.

By Laurie Facciarossa Brewer, NJ’s Long-Term Care Ombudsman

The COVID-19 crisis in long-term care facilities is an unprecedented national tragedy. Around the country, tens of thousands of vulnerable residents of nursing homes and assisted living facilities have died.

In fact, as of today in New Jersey, more than 5,400 long-term care residents have lost their lives due to the pandemic. To better put this into perspective, these deaths are more than half of New Jersey’s total cases.

Not only are the numbers themselves horrifying, but the inability of family and friends to physically be there with their loved ones in their final moments-as facilities were locked down to attempt to prevent more infection-makes it all the more painful and traumatic.

I mourn and hold dear the loss of each of these residents and wish peace and healing for their loved ones. And I am deeply concerned about the health and welfare of the long-term care residents who remain, and about the staff who care for them.

As an independent state agency that advocates for long-term care residents by investigating allegations of abuse and mistreatment, the New Jersey Office of the Long-Term Care (NJ LTCO) Ombudsman has been in the forefront in attempting to help residents and families deal with any issues or problems they may be having during this health emergency.

The investigation process

Usually, when we receive a complaint or concern, we make an unannounced visit to the resident in question and obtain consent to do an investigation.

Unfortunately, those visits stopped on March 13 when the federal and state government decided to severely restrict any visits to long-term care facilities, including by state regulators, families and representatives of the Ombudsman program.

The sudden inability to go into the facilities to witness what was happening there–to see firsthand the staffing levels and the physical conditions­­–and to have to rely on phone calls, FaceTime and other technologies to gain insight into what was truly happening, was very jarring and required some out-of-the-box thinking.

Fortunately, the NJ LTCO has highly seasoned and experienced investigators who have deep contacts in, and experience with, long-term care facilities in New Jersey.

In addition, the NJ LTCO has more than 200 highly trained volunteer ombudsmen assigned to an equal number of nursing homes. Under normal circumstances, these volunteers would be in their assigned nursing home every week, speaking with residents and handling their concerns.

So, even though we are not visiting LTC facilities, the NJ LTCO is well-positioned to reach deep into a facility and identify the right person who can solve problems for residents and their families.

Our volunteers continue to keep in contact with residents in nursing homes and have distributed letters reminding residents that the NJ LTCO is still here to assist them with any problems they may be having.

The dramatic increase in calls and cases

Our investigators have never been busier.

During March and April, calls to the NJ LTCO intake line increased by 40 percent, as did the number of cases opened for investigation.

The types of complaints that we have been receiving reflect the deepening crisis in long-term care. Here are some examples:

  • A woman called to tell us that her 56-year-old sister was on a ventilator, fighting for her life after being diagnosed with COVID-19. The long-term care facility in which her sister lived, she alleged, had refused to send her sister to the hospital.
  • A 71-year-old, bed-bound resident called the NJ LTCO to complain that she was not receiving her medication and that she hadn’t been changed–and was sitting in her own urine for more than 24 hours.
  • A nurse called to tell us that she was the only one who showed up to care for more than 60 residents during an evening shift in a nursing home.
  • A man called to see if we could find his mother, who was COVID-19-positive, had a fever and had been hurriedly moved out of her nursing into another one–with no advance notice to the family. He didn’t know if his mother was dead or alive.
  • A family member called to report that he was informed that his father had a fever, that COVID-19 was suspected and that he was fine. He was called 90 minutes later and told that his father had died.
  • Multiple staff members called the NJ LTCO intake line to report that they were not given proper personal protection equipment (PPE) in order to care for residents safely.
  • Dozens of family members called us to state that their loved ones died of COVID-19, alone and without family by their side. Most of these callers alleged care neglect due to poor staffing.

As this crisis unfolds into late spring and early summer, it appears that there is more PPE and more testing available. These are the two things that are absolutely critical to stemming the tide of this horrific virus and getting to a place where our office, state regulators, and families and friends can once again visit long-term care residents.

Stepping up outreach

In the meantime, here at the NJ LTCO, we continue to adapt to this new reality. While we look forward to the day when we can go back into long-term care facilities, we are stepping up our outreach to residents via newsletters, direct phone calls and utilization of tablets and smart phones.

In mid-May, we began to distribute a resident-focused monthly newsletter to residents of long-term care facilities. In the inaugural edition, we remind residents that they have rights and that they can always call us for assistance. In addition, we remind them that most of them will get a $1,200 stimulus payment as a result of the COVID-19-related CARES Act and that this money is theirs-and no one can take it from them.

Conditions at long-term care facilities; hope for the ensuing months

I wish I could say that the tragedy of COVID-19 in our long-term care facilities was totally unforeseeable, but that would not be the whole truth. While the scope and speed at which the COVID-19 tragedy unfolded were certainly new, the conditions in many of our long-term care facilities were ripe to fuel this type of situation.

In the ensuing months, it is my hope that we will see the effects of this terrible virus wane in long-term care facilities. In its wake, I am sure that there will be a clear-eyed assessment of how we, as a society, could have done more to protect vulnerable elderly and disabled people living in residential settings. We have learned much about this virus and the terrible toll it can take in long-term care facilities. My expectation is that we all will apply the lessons we have learned so that we are better prepared for any future outbreaks.

The thousands of souls we have lost and the thousands of vulnerable elderly and disabled people currently living in long-term care facilities deserve at least that much.

For more information on the LTCO, visit nj.gov/ooie/. The LTCO can be reached by calling 1-877-582-6995 or by email at ombudsman@ltco.nj.gov.

Any opinions expressed within guest blogs are those of the author and are not necessarily held by NJ Foundation for Aging.