Professional Home health Care Nursing Service

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5 THINGS TO CONSIDER WHEN CHOOSING ELDER CARE SOLUTIONS According to a survey by the American Association of Retired Persons a nearly 75 percent of adults over age 45 reported a strong desire to remain in their homes as they age. 1 In other words most people want to age in place in their own homes with familiar surroundings. There’s no place like home. Another survey conducted by Clarity and The EAR Foundation in 2007 reported that 89 percent of senior participants expressed a strong desire to age in place and 26 percent said they fear losing independence and fear having to move into a nursing home environment more than death. 2 Clearly remaining in the home and living independently is of utmost importance to the majority of older adults. Hopefully you as caregiver or trusted advisor would support the desires of your elderly loved one as he or she enters these golden years. At some point though your loved one will begin to require some level of outside assistance. This may simply come in the form of help completing household chores transportation to appointments or social activities or common self-care activities like dressing and bathing. If a progressive physical illness or deteriorating mental status is involved you will need to fnd a solution that includes appropriate health care services. You want what’s best for mom dad or other elderly loved one. The importance and daunting scope of this selection process can cause uncertainty and anxiety in those tasked with making the arrangements. An Uniformed Hasty Choice Is the Wrong Choice Choosing the right long-term care solution is critical. The wrong choice has the potential to wreak devastating health fnancial and legal consequences for the senior adult and the loved one who made the decision. Sometimes an older adult experiences a gradual decline in health allowing time to research the available care options. But frequently the need for long-term care services comes on quickly and without warning. Consider the following scenario: You’re driving your daughter to the university where she will attend school for the next four years. Just as you pull into the dorm parking lot your cell phone rings. Your dad has fallen and is en route to the ER. Mom is panicked and wants you to rush home right now. 1 Home and Community Preferences of the 45+ Population - AARP . n.d.. AARP . Retrieved May 7 2014 from info-11-2010/home-community-services-10.html 2 Seniors Fear Loss of Independence Nursing Homes More Than Death. n.d.. MarketingCharts. Retrieved May 7 2014 from demographics-and-audiences/boomers-and-older/seniors-fear-loss-of-independence-nursing-homes-more-than-death-2343/ 75 number of adults over age 45 who reported a strong desire to remain in their homes as they age 1 89 number of seniors expressing a strong desire to age in place 2 26 number of seniors who fear losing independence and having to move into a nursing home environement more than death 2

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5 THINGS TO CONSIDER WHEN CHOOSING ELDER CARE SOLUTIONS Home is 500 miles away and you had planned on staying near the university a couple of days to help your daughter get settled. She still needs sheets for her bed and other things to make her dorm feel like home. On top of that you’ve got an important presentation to put together for your biggest client. You originally thought you could work on it at night in your hotel room. And your husband left for a week-long conference in another state. You’re worried about your dad and mom your daughter and don’t want to make your husband feel obligated to cut his business trip short. You knew this day was approaching. After all mom and dad are both pushing 80 It’s just that when the inevitable happens it all seems so unexpected and daunting. Even when the need for care arises slowly over time you may fnd yourself reeling from the many options available as you try to sift through the details and pick the best one. You want to make the right choice – You must make the right choice. But how do you know which one is the right one You want your aging senior to have competent loving and compassionate care. What about assisted living or a nice nursing home If you choose home care services should you use a professional agency or save money and hire an independent contractor How will you know whether the staf is qualifed and have the necessary experience to provide proper care What if the professional caregiver abuses your loved one Unless you’ve taken the time to research and investigate elderly care solutions well in advance you won’t have any factual knowledge on which to base your decision. You may feel pressure to secure help quickly from a variety of people in your life. Additionally you’re acutely aware that you lack a solid understanding of what constitutes appropriate and supportive care. This emotionally charged state makes you prone to jump to a decision just to bring some relief. You might rely on the advice of a well-meaning friend or relative who is just as uninformed or even more so as you are. Maybe you’re worried about costs and friends advise you to hire unskilled help to look in on mom or dad a couple of times a day. You already have the seeds of guilt gathering in your belly as you imagine the consequences of making the wrong choice. It doesn’t have to be this way. What’s the Right Choice

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1 5 THINGS TO CONSIDER WHEN CHOOSING ELDER CARE SOLUTIONS You can avoid this uncertainty and the emotional turmoil that goes with it. Take action and empower yourself with the facts and empirical data associated with typical elder care options. 5 Things to Consider When Evaluating Elder Care Options There are fve things to consider when deciding between private home care or institutional care for your elderly loved one. As you read through the facts and data included with each of these you will begin to gain clarity. A clear right choice will become evident. Risk of death or permanent injury from falls. Elderly people do not recover from injurious falls like their younger counterparts. When they break a hip arm or sufer cranial fractures these injuries often cause permanent disability functional decline and reduced independence. The Centers for Disease Control CDC report that falls occur most often in nursing home environments. Consider these CDC statistics 3 : • Although only about 5 of Americans aged 65 and over live in nursing homes nursing home residents account for approximately 20 of deaths from falls in this age group. • Nursing home residents typically fall repeatedly averaging 2.6 falls per person annually. • Approximately 35 of fall injuries occur among nursing home residents who cannot walk. • Approximately 1800 elderly nursing home residents in the US die from fall- related injuries annually. The astonishing number of falls in nursing homes occur largely because of environmental hazards like wet foors dim lighting incorrect bed height collapsed bed rails insufcient stafng and improperly ftted and maintained wheelchairs. Other causes include mobility issues poor foot care improperly ftted shoes and certain medications. Elderly adults who age in place and have one-on-one professional home care experience signifcantly fewer falls. Why They have likely lived in the same home for years maybe even decades and are very familiar with the layout and placement of furniture and potential hazards. 3 Falls in Nursing Homes. 2012 February 29. Centers for Disease Control and Prevention. Retrieved May 6 2014 from Falls/nursing.html

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2 5 THINGS TO CONSIDER WHEN CHOOSING ELDER CARE SOLUTIONS Nursing home and assisted living staf to patient ratios. In any institutional setting --whether it’s a hospital nursing home or assisted living community – staf to patient ratios afect the timeliness and quality of care. There are over 1.7 million nursing home beds approx. 108 beds per facility with an occupancy rate of about 86. 4 In the past nursing homes have been notoriously understafed and things haven’t gotten much better. Inadequate stafng levels in nursing homes and similar assisted living facilities pose a grave threat to patient safety and overall clinical outcomes. Even with a federal law requiring Medicare and Medicaid certifed nursing homes to employ a full time RN as director of nursing and an RN on duty for a minimum of 8 hours per day and a licensed practical nurse LPN the rest of the time staf to patient ratios at these facilities are abysmal. However nurse’s aides provide most of the daily direct care and the law doesn’t include minimum stafng levels for them. Instead it includes this vague language “ …to provide sufcient staf and services to attain or maintain the highest possible level of physical mental and psychosocial well-being of each resident. ” The important factor in improving quality of care is the amount of time each patient receives with the nurse. 5 If a nursing home just met the federal nursing staf minimum requirements above a patient would receive 20 minutes of nurse time per day. In 2000 the Centers for Medicare and Medicaid Services CMS reported that the preferred minimum stafng level is reached when nursing home patients receive a total of three hours of staf time daily two hours with a nursing assistant and one hour with a licensed nurse. Oddly according to the CMS the optimum stafng level is one hour of licensed nurse time and three hours of nursing assistant time – only one hour more than the bare minimum. 6 Most states including Florida have implemented standards that exceed the federal requirements but still fall well short of CMS recommendations. According to Families for Better Care a non-proft organization dedicated to creating awareness of adverse conditions in US nursing homes and other residential care settings for the elderly Florida 7 received an F in RN stafng and hours. While the state received average and above average marks in some areas the group found the following: “Professional nursing services were almost non-existent in Florida’s nursing homes wherein each resident averaged on 39 minutes of professional nursing care per day. ” 8 4 The National Nursing Home Survey 2004. n.d.. Centers for Disease Control. Retrieved May 7 2014 from 5 Healthcare 411. n.d.. Hospital Nurse Stafng and Quality of Care. Retrieved May 8 2014 from nursestafng/index.htmlStafng 6 AMDA: Publications - Caring for the Ages - July 2002. n.d.. AMDA: Publications - Caring for the Ages - July 2002. Retrieved May 8 2014 from publications/caring/july2002/stafng.cfmprintPage1 7 The Florida Senate. n.d.. Chapter 400 Section 23. Retrieved May 7 2014 from 8 Florida - Nursing Home Report Cards. n.d.. Nursing Home Report Cards. Retrieved June 14 2014 from

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What is the nurse/aide to patient ratio for those who use a private home care agency to provide assistance to an elder living at home One nurse/aide to one aging-in-place resident. Again the clear choice for your aging in place loved one is personalized home health care. Further if your loved one has an accident and breaks a hip or shoulder consider not leaving him or her overnight in the hospital. Instead hire a home health agency to send an aide to stay overnight with your senior at home. Hospital nurses and aides have so many patients to care for that they often cannot come to patients right away when called. Nurses at Naples Community Hospital are responsible for an average of fve to seven patients each with the exception of nurses assigned to critical care units. 9 It’s not much better in the Lee Memorial Health System where each nurse cares for fve or six patients at once. 10 Proper nutrition and weight maintenance. Older adults who eat enough of the proper foods maintain a healthy body weight enjoy better digestive health and are less likely to become ill. One of the most common issues with nursing homes is weight loss due to poor nutrition. If not addressed weight loss can lead to serious injuries bedsores depression higher risk of infection and even death. Pressure ulcers also called bedsores represent one of the most common injuries associated with weight loss. According to the CDC one in fve nursing home residents with a rapid weight loss developed pressure ulcers. Left untreated pressure ulcers cause intense pain and the infection can develop into osteomyelitis infection of the bone or a potentially fatal condition called sepsis. A study published in the Journal of General Internal Medicine investigated the efect of rapid weight loss on the health of nursing home residents. The researchers found that residents who lost 10 percent or more of their weight over six-months were signifcantly more likely to die within the next six months. Robert A. Murden Associate Professor of Internal Medicine at Ohio State University principal investigator warns that nursing home staf should pay close attention to patients who are losing weight .11 According to the National Institute of Mental Health NIMH depression represents the most common cause of weight loss in nursing home settings and psychotropic drug 5 THINGS TO CONSIDER WHEN CHOOSING ELDER CARE SOLUTIONS 9 Nurse to Patient Ratios - NCH Healthcare Naples FL. n.d.. Nurse to Patient Ratios - NCH Healthcare Naples FL. Retrieved May 8 2014 from default.aspxid828ref828 10 Nocturnists on hand for the critical hours. n.d.. Cogent Healthcare. Retrieved June 15 2014 from for-critical-hours/ 11 Kershner K. n.d.. Weight Loss Linked to Death in Nursing Homes. Retrieved May 8 2014 from archive/old.htm 3 Most common issue in nursing homes is weight loss due to poor nutrition.

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5 THINGS TO CONSIDER WHEN CHOOSING ELDER CARE SOLUTIONS side efects may contribute as well in patients who take them. Medicaid reported in 2007 that it had spent more money on antipsychotic drugs than on any other class of prescription pharmaceuticals. Why the massive increase in antipsychotic drug use Almost 30 percent of the total US nursing home population was receiving these powerful medications. Nursing home staf used these drugs to subdue patients with Alzheimer’s and dementia. Fast forward to 2009 and nothing had been done to stop this practice according to a news story that appeared in the Chicago Tribune. The investigative reporter who wrote the article describes how one 74-year old patient Lloyd Berkely had been a resident for less than a day when nursing staf members held him down and injected him with a large dose of antipsychotic drug. Hours later he died after falling and sufering a fatal head injury. Staf in another nursing home gave a female patient a psychotropic drug because she refused to wear her bra. They then administered an antipsychotic to an 89-year old man because he got annoyed easily. 12 This abuse of antipsychotics and other psychotropic drugs by nursing home staf occurs everywhere in the US not just Illinois. In 2012 The National Partnership to Improve Dementia launched a nationwide efort to prevent the unnecessary and illegal use of psychotropic medications in nursing homes. While public health ofcials report an improvement in nursing home policies regarding these medications there’s still a long way to go. Not only is it highly unethical and abusive to administer these powerful drugs to nursing home residents unnecessarily as stated above NIMH states that they also contribute to dangerous weight loss in elderly patients. Do you really want to risk exposing your elderly mom dad or other loved one to this Would you know if it were happening Quality of life. What kind of life do you want your elderly loved one to have during this last stage of life As mentioned in the introduction a study conducted by Clarity and The EAR Foundation found that seniors fear nursing homes more than they fear death. Foundation researchers also reported that 82 percent of baby boomers fear that their parents will be mistreated in a nursing home setting and 89 percent fear their parents will experience depression. 12 Psychotropic drugs given to nursing home patients without cause. 2009 October 27. Chicago Tribune. Retrieved May 8 2014 from http://articles.chicagotribune. com/2009-10-27/health/chi-nursing-home1-psychotropics-oct27_1_nursing-home-psychotropic-drugs-antipsychotic-drugs 4

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30 - 40 number of nursing home residents sufering from clinical depression 44 number of nursing home residents claiming they have sufered abuse 95 number of nursing home residents who said they have been neglected or witnessed neglect of another resident 5 THINGS TO CONSIDER WHEN CHOOSING ELDER CARE SOLUTIONS Let’s discuss the issue of depression frst. According to the American Geriatrics Society approximately 30 to 40 percent of nursing home residents sufer from clinical depression. The society also found that depression in these residents frequently goes unrecognized and thus untreated which leads to low quality of life and sometimes suicide. 13 Reasons for unrecognized or undertreated depression in nursing home patients include inadequate stafng undertrained staf and even willful neglect. In addition to depression abuse of varying degrees occurs in about one third of long- term care facilities i.e. nursing homes and assisted living communities according to the National Center on Elder Abuse. 14 The center warns that many incidences of elder abuse in these institutional settings go unreported and never get addressed. Further research compiled by the NCEA on abuse occurring in long-term care facilities found the following: • A study conducted in 2000 reported that of the 2000 nursing home residents they interviewed 44 percent claimed they had sufered abuse and 95 percent said they had been neglected or witnessed the neglect of another resident. • In May 2008 the U.S. General Accountability Ofce conducted research revealing that state surveys underestimate issues in long-term care facilities. The study reports that 70 percent of the surveys fail to report at least one defciency and that15 percent of state conducted surveys miss incidents of actual harm to nursing home residents and fail to observe situations putting nursing home residents in immediate jeopardy. 13 Depression in nursing home residents often unrecognized. n.d.. Depression in nursing home residents often unrecognized. Retrieved May 9 2014 from 14 Elder Abuse Statistics/Data. n.d.. Statistics/Data. Retrieved May 8 2014 from Abuse in Nursing Homes Abuse in Board Care Facilities Physical Abuse Sexual Abuse Psychological Abuse Financial Exploitation Gross Neglect Resident to Resident Abuse

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5 THINGS TO CONSIDER WHEN CHOOSING ELDER CARE SOLUTIONS • A 2010 study published in the journal Nursing Management reported that over 95 percent of nursing home staf admitted to mistreating e.g. physical violence mental abuse neglect older patients within the year prior to the study. • A survey of Certifed Nursing Assistants CNA working in long term care facilities found that 17 percent of CNAs admitted to pushing grabbing or shoving a nursing home patient 51 percent said they had yelled at a resident 23 percent had insulted or sworn at a patient. Elder abuse occurs in all types of long-term care facilities. A US DHS/OIG report states “Studies of the process States use to detect investigate resolve and prevent elder mistreatment in nursing homes assisted living facilities and board and care homes are deeply fawed. As a result the State’s estimates of elder abuse are lower than actual prevalence and the process must be strengthened to protect residents. ” 15 Don’t be fooled by a particular nursing home’s lovely façade beautiful inside décor or polite and well-spoken front ofce staf. The above facts and statistics were pulled from investigations and surveys involving all types of facilities. These research fndings certainly explain why seniors say they fear nursing homes more than death. Home care agency vs. home care independent contractor. When arranging for home health care for your senior you may think hiring an independent contractor is the way to go. After all independent contractors cost far less than hiring a caregiver from a private agency. As long as you verify the person’s credentials and check references there shouldn’t be a problem right Not so fast. Once you hire an independent contractor you become liable for them. Independent contractors are supposed to handle their own taxes but if they don’t the person who hired the contractor becomes responsible. The IRS classifes home health aides as employees regardless of what you call them making you responsible for social security taxes Medicare unemployment compensation withholding payroll taxes and completing all of the government reporting forms. 16 Of course independent workers seldom complain about lack of tax reporting and payment until they terminate. Often they then fle a complaint that their “employer” 15 Abuse of Residents of Long Term Care Facilities. n.d.. Retrieved May 9 2014 from docs/NCEA_LTCF_ResearchBrief_2013.pdf 16 Publication 926 2014 Household Employer’s Tax Guide. n.d.. Publication 926 2014 Household Employer’s Tax Guide. Retrieved May 10 2014 from http://www.irs. gov/publications/p926/ix01.html 5

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5 THINGS TO CONSIDER WHEN CHOOSING ELDER CARE SOLUTIONS failed to pay their social security or overtime. In some cases they may choose to sue the estate of a client who has recently passed away because payroll taxes were not withheld or properly reported to the IRS. So what seemed less expensive at frst becomes not only expensive but also tedious and time consuming. And the hidden costs don’t end with the additional taxes and paper work: • Coverage gaps – What if your independent home health aide gets sick goes on vacation or just needs a break How will you fnd a qualifed temporary replacement • Personal risk – This person has access to your or your loved one’s home personal property i.e. jewelry heirlooms silver tableware other valuables mail and sometimes even a credit card. Is she bonded How will you ensure that she’s honest and drug free To do this you’ll need to perform an extensive background check that includes criminal records driving history insurance claims and medical or state licensure and knowledge. • Personal liability – If your independent caregiver claims injury for a sprained back or auto accident while shopping for groceries failure to provide workers compensation can leave you vulnerable to a lawsuit for hospital costs injuries lost wages and damages – costly enough to bankrupt even the wealthiest person. A state licensed home care agency ofers you an array of protections and compassionate relationship-based professional care that enhances everyday life for your loved one. What’s more you don’t bear any risk when it comes to personal liability background checks drug testing etc. Home health agencies take care of all of that for you. Benefts of hiring a home health agency like Dial-a-Nurse TM include: • Continuous coverage – When your caregiver needs a break goes on vacation or gets sick Dial-a-Nurse will send a qualifed temporary replacement immediately to fll the gap. • Highly educated caregivers - Dial-a-Nurse boasts the most well educated caregivers in the country. All nurses and aides have access to continuing education courses so they can easily keep up with state requirements. Nurses

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5 THINGS TO CONSIDER WHEN CHOOSING ELDER CARE SOLUTIONS have access to the full education library where they can view videos and articles on various procedures and protocols whenever needed. • Client education programs – The Dial-a-Nurse education company NEVCO provides patient education programs about dealing with breast cancer osteoporosis Alzheimer’s disease women’s issues and many other common health concerns. • Carefully selected professionals – All employees are carefully screened undergoing background checks reference checks and credentials verifcation. Each prospective employee is interviewed personally and selected based on his or her compassion skill and expertise in enhancing quality of life and ability to focus on specifc needs of the client. • Customized service – Dial-a-Nurse tailors care services to ft each individual client’s needs. Please note: other home health agencies don’t have these education programs mentioned above readily available for staf and clients. Private home care agency staf members get to know their clients personally due to their one-on-one interactions. The nurse aide or assistant knows about medications and any side efects as well as her client’s individual physical abilities and emotional state. Dial-a-Nurse client Wendy K. Rex has this to say about the agency “ …in addition the very real compassion and true instinct your nurse displayed is not something that can be taught she obviously has chosen the right feld. She managed to maintain a level of professionalism composure and skill that was nothing short of exemplary. ” By hiring a well-established reputable private home health care agency such as Dial-a-Nurse you’ll never have to worry about someone abusing your loved one. Dial-a-Nurse provides compassionate expert home health care and exceptional supervision for older adults. Exceptional companion-based care right at home. There’s no place like home. It comes down to this: Do you want your loved one cared for by a person who thinks of it as a job or a person driven by a vocation to provide the best care and support possible A high quality agency knows what good home health care looks like. It’s their vocation. Give your client patient or loved one what he or she truly desires – to age in place in the comfort of home. There’s no place like home and Dial-a-Nurse makes home even better for our aging loved ones. 599 9th Street N. Suite 207 Naples FL 34102 License 20304096 Ph: 239 434-8000 3949 Evans Ave. Suite 303 Fort Myers FL 33901 License 30211116 Ph: 239 939-1228

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