Are you considering moving to assisted living? The decision is a difficult one during a transition time in anyone's life. There are many questions you need answered before deciding on a location. You will need to know your level of care. For instance, do you need assistance with transferring or with feeding? Will you need help with dressing or what is called ADL, activities of daily living? Do you need assistance with medication? There is a daily rate that will depend on your level of care. There are generally three levels of care with level I being the most independent. Cost factors depend on the level of care. There is usually a daily rate that covers room and board plus the assistance of staff time that you require. It is important to note that most assisted living complexes are cash only. Long-term care policies will pay for assisted living in most cases.
Speaking of the cost factor, in my own case I was caught off guard by a $7239 security deposit. A daily rate of $119 was assessed for level II care. Telephone, Wi-Fi, cable are all additional cost factors monthly. Trips to dental checkups, a physician or specialist will appear on a monthly statement along with a fee assessed for the attendant and driver for these trips. Physical therapy or occupational therapy is billed to the insurance company, but co-pays appear on the monthly statement. Co-pays for medicines are generally on a separate statement from the pharmacy providing medications.
In assisted living at Goodwill Retirement Community there is only one nursing aide per floor. That means one nursing aide will cover assisting residents which can range in number from 8 to 13 people on a shift. The nursing aide is also responsible for serving meals in a dining room setting which can take about two hours of her time for breakfast, lunch, or dinner. She answers all of the call bells on the floor, telephone calls along with fax, orders from doctors and that can sometimes take her to another part of a nursing section. When there are special need cases, or residents who have broken bones, or are near the final phase of their lives, one nursing aide still covers the entire floor. There is usually a team approach where a nursing aide on another floor will assist the nursing aide with the most needy residents. However, that only works if there is a true team approach. The nursing aide is also responsible for passing out medicine and there are usually two med-passes per day that can take from one to two hours each morning and evening. Overnight shifts are responsible for laundry and cleaning areas that are too busy during the day. The 11 p.m. to 7 a.m. shift also answers call bells. The other shifts of 7 a.m. to 3 p.m. and 3 p.m. to 11 p.m. are responsible for cleaning rooms, and bathing residents. Along with bathing a resident, the ADLs of shaving, shampooing, moisturizing, nail grooming, or other special treatments may take additional time with the nursing aide.
It appears to be almost impossible for one person in a nursing aide position to do all that is required of her on the shift. Turnover is high. Training classes conducted by Goodwill only last about three weeks and then trainees are put on the floor for experience in working with the nursing aide. Trainees are rarely confident in working with their residents and it is no surprise given the lack of experience and classroom work.
While the Goodwill Retirement Community has a Mennonite origin, most residents and staff complain about the food. While residents hold a council meeting monthly, the quality of food rarely improves. The same menu items come up in rotation about every 60 days. Most people will agree that the food is all right the first couple of weeks or month until the reality that there is very little variety on the menu. A resident never gets a slice of cantaloupe or watermelon in season. The same desserts are served for one week at a time. While Chicken Cordon Bleu may sound like a very good menu item, residents complain of how much sodium and how often it appears on the menu. Most food items are processed with a high level of ingredients that are not conducive to good health. It is surprising that in a Goodwill Retirement Community which houses an Alzheimer's unit, skilled nursing units, and assisted living, little attention is paid to the quality of life that can be enhanced by good nutrition. Overcooked vegetables and dishes with noodles are commonplace. Heavily breaded country steak, chicken, salmon and crabcakes which all had very little meat and were served frequently. Upon investigation, I was told the reason for problems with the food centers on the amount of people who need to be served and the time it takes to get the food to the resident. In some cases, that can be an hour and 45 minutes from the time food leaves dietary until it reaches the floor. Lack of efficiency or complacency, possibly both contribute to the outcome of a poor diet for residents.
Activities are provided on a daily basis, but oftentimes those activities are difficult for less ambulatory people to attend. The setting inside and out is attractive, especially with large windows to view the changing of the seasons. Frequently, visitors comment on the cleanliness of Goodwill Retirement Community. What meets the eye or is the first impression is oftentimes very misleading.
Anyone investigating assisted living needs to be very direct about asking cost factors, provisions for laundry, cleaning, medicating, bathing (at this site it is only twice a week), grooming and that includes haircuts or beauty routines. Both the barber and a beautician are located on-site, but there is only one choice and that service is also billed on the monthly statement. If at all possible, self-medicating is a preference. The alternative of medications delivered by the facility can lead to duplicate billing. What may appear on a med cart can be different from what appears on a statement. Reviewing billing statements is essential.
A More In-Depth Look
When considering moving to an assisted living unit, realize that downsizing is emotionally traumatic. It may be easy to rationalize that possessions are just things, but things can represent so much in a lifetime. Looking at a treasured gift from a friend, fine China from a grandmother, even a pressed flower from a long-ago high school prom can elicit so many feelings. Downsizing from home or an apartment to one room requires a great deal of thought and planning even under the best of circumstances. Perhaps best to prepare for a sense of loss. Tears can be an emotional release and good friends can be quite comforting. A dear high school friend from long ago left the first voicemail message, “Stay strong.” I shall never forget that encouragement. Along with good friends providing support, compassion for oneself is essential.
Downsizing to one room and moving to an assisted living facility means giving up privacy. I am a champion of solitude, peace and quiet. Call bells, telephone ringers, speaker announcements, old CDs and almost ten weeks of Christmas music, creates annoying distractions for any resident at Goodwill Retirement Community. There are times that Mood Music plays in the background and it is very soothing. A gigantic television located in the area next to dining and music over the speaker system frequently create competing noises and add to the stress of daily living. I succeeded in getting a quiet time from 10 p.m. until 6 a.m.
Another noise factor in the facility like this is the heating air-conditioning ventilation unit. The Trane units in the rooms are extremely noisy. They make a popping sound that is almost like a gun going off and it has a startling effect. The units are designed to keep a room at a constant temperature. This can be problematic. On a winter day when it is very cold outside, but the sun is shining and the temperature warms up in the room, the air-conditioning unit cools the room. This can be very uncomfortable. Residents frequently complain that they would prefer the warmth of the sun rather than air-conditioning coming on in the middle of winter, but the units are designed to maintain a steady temperature in the room.
The assisted living rooms that are newly designed at Goodwill Retirement Community can make for very embarrassing situations. The front door to the apartment opens and the bathroom is immediately to the side with the interior and anyone in it quite visible. While it may be easy to think that the door to the bathroom should be closed, that is not always safe. I learned long ago that a power chair or wheelchair can block the entrance to a bathroom making it more difficult for anyone to assist the occupant. At this facility, a nursing aide, registered nurse, or manager need only knock twice and can walk right into the room. There are occasions when staff or visitors forget to knock and you can imagine the rather unpleasant situation if the resident is in the bathroom and the door is not closed.
There are other areas in the retirement community worth comment. There are villages with small homes and garages. An independent resident or couple can move from villages to assisted living, then move to skilled nursing if necessary. It can appear to be a nice package. However, there is no gift shop, ATM, nor essential items type of store. This means it is imperative to have family or friends willing to bring necessities to the resident. While I do all of my shopping online, I never thought to ask about basics such as an ATM. I also did not think to ask about caffeinated coffee. I thought with paying almost $5000 a month, I would probably get Starbucks. Not so. It is only decaffeinated coffee throughout the complex. I have a 1 cup coffee maker and get assistance with brewing Starbucks French Roast coffee for the morning. It is a great way to start the day.
It is the little things that mean the most while living in facilities like this. A good cup of coffee in the morning is just one of them. There was a nursing aide who went out of her way to bring in a piece of banana nut bread and say, “I thought you might like this.” Watching the seasons change through the large window in my room is nature’s way of reassuring that everything is going to be all right.
Goodwill Retirement Community: The Conflict Situations:
I was told by the manager who worked with me prior to relocating that there was a roll-in shower, and I could stand at the grab bar, an aide would remove the wheelchair or power chair whereby I could pivot backwards to a drop-down bench. The manager also told me that there were L levers on the sink. I found to my dismay that neither one of the above adaptations were in the bathroom in my room, nor anywhere in assisted living. Although the manager also promised a one-person assist (and that was in my contract) with transferring, at the end of the first month she sent an email to staff telling everyone they could not transfer me. Many nursing aides simply ignored her email. However, the other types just let me fall backwards onto the commode while I was trying to stand. One nursing aide even let me fall backwards six times before calling the manager and asking what she could do to help me.
I can stand, but I have a loss of balance and need assistance with pivoting to a commode seat, power chair seat, lift chair, or any specialty chair such as in a dentist’s office. I moved to assisted living for assistance, but learned the hard way that can mean something different to every person. Approximately 9 months after I moved into the facility and nearing the end of the academic year, the manager and the registered nurse assigned to assisted living entered my apartment to address transfer concerns expressed by someone on their staff. A nursing aide reported that I was dependent. I suggested members of the staff get training in transferring, because I had just completed occupational and physical therapy. Both an OT and PT who transferred me commented about how easy it was especially because I am so light and bear weight. The manager and the assisted living nurse commented that perhaps staff members learn transferring skills from OT/PT in the therapy room. My question would be why are transferring skills not a part of the training class for a CNA (Certified Nursing Assistant) at the Goodwill Retirement Community?
I also moved to assisted living for purposes of saving energy in order to do my job. I taught all of my courses online and was happy to find a facility with Wi-Fi. Unfortunately, every day at 3:37 p.m. my system logged off. With the change of time, my system logged off at 4:37 p.m. every day. Much to my dismay, the CEO did nothing. I was a professor with daily dedicated office hours from 2 p.m. until 4 p.m. and I frequently stay online until 6 p.m. to chat with students, or answer questions. Another very experienced computer expert assessed the problem and emailed the CEO that it was not my computer rather a problem within the system at Goodwill Retirement Community. More than a dozen requests for assistance to resolve this problem were ignored by the manager and CEO.
I learned that there was no time for a staff member to assist me with something having to do with work. With the help of a counselor at the Department of Rehabilitation Services, I connected with the Attendant Care Program in Maryland. This program is a long application process which involves some paperwork completed by the primary physician, submitting copies of income tax statements, and completing forms from the Attendant Care Program. My medical expenses were so high that I qualified for assistance. The Attendant Care Program does work on a sliding scale, but I qualified for $130 every two weeks to help pay for an attendant. The attendant who worked with me took care of paperwork as in check writing and bank statements, because nursing aides are not allowed to do that type of assistance. The attendant also helped with Blackboard, the means by which I taught. She also helped with extra cleaning beyond what can be done in less than one hour a week by the nursing aide. Lastly, the attendant helped with grooming that takes more time than a nursing aide can spare during her regular shift. While I paid a minimum of $10 an hour for attendant help, the Attendant Care Program has been an additional source of help to pay for extra hours of assistance, especially during heavy grading periods during the semester.
I found additional problems in the bathroom area that did not accommodate my particular disability. I am not ambulatory, but able to stand and pivot. The handrails were not within reach in the bathroom area, yet the CEO assured me that the facility is ADA compliant. In pursuing the matter further, I asked for “reasonable accommodation,” that are words in the ADA law. I clarified that the word, “reasonable” refers to the spirit of the law and asked for more assistance in adapting the bathroom. I was informed in writing by the CEO that he approved installation of anything I needed, but I would have to buy it. I turned to the Department of Rehabilitation Services and it was deemed that since I live in an apartment, I qualify for rehab services. After a full assessment, I did get another toilet, toilet seat, and grab bar on the wall making it easier for me to reach, transfer, and be more independent. It seemed to me that this was a lot of work for someone in a compromised health predicament who had to move to assisted living. At least there are options for pursuing accommodations in the State of Maryland beyond what is offered in assisted living facilities.
The Heart of the Matter:
Shortly after moving to assisted living, I met a ninety-year-old woman across the hall and her husband who was living in the apartment next to me. They had lived in the villages and made the transition to assisted living. She had broken her ankle and required more help. Both of them were having problems with pain. It was rumored that they both would be moving to skilled nursing, because they had run out of money. The weekend of the move was quite a debacle. Their children came in to help them, and there was much to be cleared out of the rooms. They were to receive their medicines in the nursing area on the Sunday evening, yet their beds were not ready in skilled nursing. Her room was completely cleared out and his was partially emptied. Two children were doing everything they could to meet the timeline. The father drove a power chair and his wife was in a wheelchair. The couple missed supper and found no beds in their nursing rooms. The manager was nowhere to be found. The nursing aide in assisted living was in tears trying to figure out what to do. I happened to go by the room and saw the bewildered and exhausted couple holding hands across a wooden TV tray table. As it turned out, the elderly woman joined her husband in his bed that night. At least they had each other, but the lack of planning and confusion was enough to cause anyone a great deal of stress.
After the couple transitioned to their skilled nursing rooms, he came back on Monday to get a few more items out of his assisted living room. He was met with the nursing aide who yelled, “This is not your room. If you come back here, I’m going to lock it.” He replied, “I’m still paying for that room.” It was a very unpleasant exchange. Later that day when the personal CNA I had hired came in to help me, I told her what was going on. She immediately helped him move ceramic bowls, pillows, and more items that he had tried to balance on his lap while driving the power chair back to the nursing room. It was pitiful to see someone trying to save a few precious items and meet with a nursing aide who only wanted to throw more obstacles in his way.
One evening in the dining area, a resident was using a walker and had lost weight. He was a minister and in his late 70s, but growing more frail. He had suffered a stroke and had difficulty with balance. The nursing aide was assisting him while he walked back to his room. He yelled for help because he was losing his pants. She yelled back, “Pull them up!” I watched in horror as this individual holding onto a walker with both hands tried to let go with one hand in order to pull up his pants. As one might expect, he could not do that and the pants dropped to the floor. I can only guess how much he was embarrassed and we were embarrassed for him.
That same nursing aide was helping feed me during a dinner hour when there was a loud voice that asked for help because he was losing his blanket. A resident was in the final weeks of his life. He had congestive heart failure and other problems. He was sitting in a Geri chair and he had a catheter with a blanket covering the bottom of his torso and legs. The tray table was in front of him so that he could try to feed himself. I heard the nursing aide say in a loud commanding voice, “Pull it up.” He quickly replied, “I can’t.” I told the aide to get up and help him. Another resident at the table was trying to get up, and tuck the blanket back in place. However, the nursing aide yelled to the ailing resident, “Use your left hand.” I cannot believe what I heard and saw. This resident passed away the following week. I think about that exchange and recall the words of my physician who said, “There are mean people.”
There is good quality staff that work at GRC, and their dedication to caregiving is noteworthy. However, assisted living is woefully lacking in adequate coverage of quality, responsible, caring staff. In short, it is understaffed. The training of nursing aides is minimal of about three weeks and then the trainees job shadow on each shift. This is hardly enough preparation for any nursing aide to function on the floor by herself.
It is with regret that I write the knowledge of one resident receiving the wrong medicine from six med techs. She also was without her anti-seizure medicine for three days. I know another resident who had a serious set of reactions from receiving the wrong medicine. In my own case, I was given the wrong medicine twice. I know these problems to be real and scary. My own medications are quite simple. I take Tylenol, calcium, and glucosamine. How anyone could confuse Tylenol and calcium is beyond me, but mistakes happen. I am able to speak up and right away teach the nursing aide how to correct the mistake to be sure it does not happen again.
The billing statements from GRC are stressful to deal with each month. It takes time to scrutinize every item that appears on the monthly statement, because the billing office groups items together and utilizes a system of plusses and minuses. Likewise, another complicated billing statement is from Pharmacare, the supplier of all medicine for residents at GRC. It is also necessary to ensure that there is no double billing or overbilling and pharmaceutical plans are not unjustifiably charged for medicine not received or ordered. There is yet another third-party billing for therapy. I was even told in a threatening tone that I would have to pay for almost $2500 worth of therapy if my insurance did not cover it. I investigated and learned that no one preauthorized the therapy even though there was an OT and PT evaluator. It was the intervention of the assisted living manager that helped to resolve this billing issue.
The monthly billing statement is something I dread. Rarely do I get billed without some mistake appearing on the statement. I realize that GRC needs to be paid for services rendered. However, the rumor mill is very loud. It is commonly known that the vacant houses existing around this Mennonite sponsored long-term care facility are owned by GRC. Not just Goodwill Retirement Community, but most all facilities get every dime from a resident or family before turning to the state for Medicare or Medicaid. It is a harsh reality of our society.
At GRC there are residents faces that years have aged but lines tell a story of joy and pain, laughter and tears, years of work, raising a family, retiring in the hope of remaining independent and eventually dying with family and friends comforting that final moment. While the scenery is beautiful in the mountainous area outside Grantsville, Maryland, this retirement community leaves a lot to be desired. I have heard people comment that this is the nicest facility around as if that is some reason to overlook problems. I caution you to not be persuaded by what appears to be a superficial pretty picture should you visit any Long-term care facility. There is a definite lack of transparency and questionable problems that have not been addressed at every level.
By 2018, major changes occurred, a Registered Nurse and a GNA/CNA who wished to remain anonymous reported that the Chief Executive Officer Mr. Kevin Miller was formally escorted out of Goodwill Mennonite Retirement Community. Ms. Anita Funk, Director of Nursing, and Mr. Anthony Lehman removed him from the building. It was alleged that Mr. Miller engaged in fraud and embezzlement. The GNA/CNA who witnessed the event said that all locks and passwords were changed in the building and Mr. Miller was not allowed under any circumstances to return or charges would be filed. Mr. Lehman was promoted to CEO. The Registered Nurse stated that he would never meet with her regarding mistreatments, discrepancies, and mishandling of residents. Both she and the GNA/CNA later resigned. Goodwill Mennonite Retirement Community underwent a name change to Goodwill Retirement Community with a new web page that delineated personnel changes and significant daily rate increases.