Fact Check: Six Red Flags

by Tyra Phipps, Ed.D. (tyra.phipps@gmail.com)

"People would rather die than eat food that is not appetizing." Ms. Cherie Soria, Chef Extraordinaire

The National Education Services reported during September, 2015, that nearly half of all people over the age of 65 will require extended care.  The cost of long-term care can quickly exceed salary and eat up all of the reserves that the family has saved.  The caution from NES is that if you are worried about caring for your parents or being a burden to your spouse or children, do not wait any longer to plan for the probability of requiring and paying for long-term care.

There are 10,000 people retiring every day.  The Baby Boomer population is worried about one major life threatening condition and that is going crazy or dementia.  This information was reported on the NPR program, Growing Bolder, September 27, 2015.  One in nine women and one in eleven men have dementia.  The current retiring population may be well-informed, but unprepared for what living accommodations may be necessary during physical and mental life changes.

Ms. Michele Lerner summarized important checkpoints in the blog post, Beware of These Six Red Flags When Touring Senior Housing, September, 2015, SENIORLIVING.

“When it's time for you or a family member to move into senior housing -- whether it's a seniors-only community, an independent or assisted living facility, or a nursing home -- you don't want to find blank-eyed residents slumped in front of an ancient TV game show in a dirty, smelly, common room.

The residence should have the right look and feel to the person who will live there, so visiting more than once is a good idea, says Dr. Paula Carder, an Assistant Professor with the Institute on Aging at Portland State University in Oregon.”

1.  If it smells bad or looks dirty, just leave.  Always try to take a tour on your own without any administrator guiding you through the building or rooms.  Be sure to take time to check the public restrooms in the building and the shower areas.  Often times, the main areas can look clean and organized, but that may not be the case with toileting or bathing areas.  Looking behind the main areas can be much more telling about the facility and its management.

2.  Resident safety is of utmost importance.  Look to see if the hallways are crammed full of equipment, wheelchairs, Geri-chairs, food carts, medicine carts, laundry, or trash bins.  All of these spell real dangers for any senior especially those with macular degeneration.

3.  Read the reviews and it is probably best to do this ahead of time.  With names and faces attached to reviews, it is now possible to contact people online and get more information.  Shared information about problems at any facility is a way to prevent disaster.

4.  Is there too much TV time?  While a television can provide programming that is entertaining or educational, notice if people are just laying around or sitting in chairs half slumped over and sleeping while the television is blaring.  Not only does the television cut down on social interaction, or any kind of meaningful conversation because of hearing difficulties, it is not the stimulus that helps people stay alert.

5.  Notice what the interactions are like with the staff.  Poor staff interaction indicates there will be poor treatment of anyone staying in the facility.  Do the members of the staff have a genuine smile?  When they interact with a resident living in the facility, pay attention to an attitude that is snippy, curt, sarcastic, patronizing, or condescending.  In all likelihood, that is the dominant attitude among staff members in the facility and it spills over to every resident.  Be wary of the words that we treat each of our residents as we would treat our own grandparents.  Actions speak much louder.  Is the staff quick to assist?  Is there a caring feeling that permeates the center, or is that just part of a mission statement filled with hollow words?

6.  Look for the familiarity of faces by making multiple visits.  In short, unfamiliar faces means inadequate training.  Too many of the long-term care facilities run in-house training of seventy hours or less for people seeking a job as a nursing aide.  No one can learn how to be a nursing aide and assist ten to fifteen residents on the floor with that kind of training.  Once on the floor, the overwhelmed nursing aide quits within weeks of training.  Another training class starts at a facility and the same cycle means that nursing aides are unfamiliar with the needs of the resident.  Stress for the resident is overwhelming because the expectation is that the aide will have a good idea of what needs are to be met.  When that is not the case, frustration, anxiety, and even shortened life spans are the result.

Ms. Rachel Reeves, is a spokeswoman for the National Center for Assisted Living in Washington, DC.  She is quoted in the same article about the Six Red Flags that, “It’s especially important that the staff members are trained in medication management if your family member will need help with medicines.  If your family member has dementia, you should also ask if the staff is trained in working with people with memory or cognitive issue.”  Why is this an important question?  Some of the long-term care facilities give 25 hours or less training in medication management.  It is not uncommon for elderly patients to take a myriad of medications.  An oversight, or a simple mistake blamed on a human error of the nursing aide can result in death.

Personal Stories:

Ms. Janet Williams wrote on August 27, 2015, that she is taking care of an Alzheimer’s patient because the children are so afraid of placement in a facility.    Mr. Dick Knickerbocker stated on July 30, 2015 that you have to go to places unannounced and you will be really surprised at what you see.  On September 28, 2015 Father Eric, a Catholic priest spoke of the importance of daily visits even with his own Catholic-based facilities.  He told the story of the family member who almost died because of a severe allergy to feathers.  Despite the fact that everyone on staff had been warned about the allergy, new members of the staff on the floor were unaware.  The mistake caused the family member to stop breathing.  Ms. Liz Medcalf wrote in February, 2015 of how comforted she was with the familiarity of faces working at Kensington Algonquin where her mother is a resident.  She found it reassuring that the staff had knowledge of her mother’s heart condition and immediately got her to the emergency room when they noticed a change.

With more colorful language, Mr. David Cravey wrote on September 22, 2015, “I have dealt with the mentality in these long-term care facilities for so long.  In my life experiences I have determined that there is no way to make a turnip think.  Staff can look right at you with the response that they are listening and all the while thinking I don’t give a shit.  Frustration junction is not a nice place to live.  We must get some national exposure on the cancer that pervades the attitude for care of our families.” 

On September 27, 2015, Ms. Rosita Owens, a retired registered nurse also warned, “People need enlightenment about long-term nursing care.  There is such a need for it!  My neighbor’s father just died last week.  She was so frustrated with his care in a local nursing home that she moved him to the VA Hospital the week before he died.  By the way, the father of my neighbor was also a WWII veteran and a cousin of Louis Zamperini who was the hero of the book, Unbroken:  A World War II Story of Survival, Resilience, and Redemption.” 

During the month of October 2018, Ms. Tammy Todd wrote about her husband Steve, who was diagnosed with ALS in August of 2016.  Her story compares the treatment in long-term care with the treatment in VA hospitals.  She explained, “Steve is on a ventilator and bedridden, but I have him at home.  Thank God for the VA.  They take full responsibility for ALS and Agent Orange.  They trained me in all things he needs.  I have become a CNA, Respiratory Therapist, Nurse and everything else.  The whole medical system is broken from hospitals to nursing homes.

Steve was in Lake Nona VA Hospital at first.  New hospital and supposed to be state of the art.  Not so. Had to be sent to ORMC, then to Shands in Gainesville.  We went to Select Specialty Hospital in Orlando to be sent to Avante nursing home which is a skilled nursing home.  At Avante they dehydrated him so bad he had to go to Florida Hospital in Winter Park.  Tammy clarified later that 911 was called because Steve had a breathing problem.  It turned out to only be a mucus plug but once 911 is called, they must complete the run.  Hospital would try to keep patients if they could.  After a few days, I got the word that we were headed to the VA in Tampa.  Thank God!  That was Thursday, so I called the nursing home and told them I would be by to pick up his stuff.  Got there at about 5:30 p.m. and I was told that all his stuff was in the office and that I would have to come back before 5 p.m. the next day.  Next morning around 9:30, I was told they were in a meeting.  I told them, “Someone better find the key. I’m not coming back.”   The key found, and they hand me one book and a dry erase board. This was not all his stuff.  We walked into Steve’s old room to find all his cards on the wall and pictures of our house and dog. His clothes were still in the closet and all his things on the nightstand, but someone else in his bed.  As I collected his things, all I could do was tell the man in the bed that I’m sorry.  I explained that this were my husband’s belongings. They didn’t clean the room or anything, just put a new patient in the bed and blamed it on housekeeping. 

 Finally, on October 21, 2016, a nasty case manager told me to pull the plug.  Steve was alert and responding to everything. We had been trying to get to the Tampa VA Hospital from the very start.  However, due to overwhelming Case Management they did whatever they wanted.  I had to contact Congressman Bill Nelson and the White House.  I spend every free minute when Steve was asleep on the phone with people. We were finally able to get to the Tampa VA.  They have been fantastic to us. 

We came home December 15, 2016.  Even at home the nurses and CNAs and all other health care people that come here are terrible.  Last week a nurse came to change his Foley catheter, it was not done right and off to the Emergency Room we went.   Had to use an ambulance to get there and back. Nasty case manager did not do her job as she should have, so we had to stay four hours longer then needed.  Steve was placed on the wrong bed, so he came home with a skin wound on butt.  Every time we go to a hospital, Steve comes home with another wound.  I can go on and on about bad care he has received.  It is so sad, but he is a happy camper with the VA and being at home with his favorite nurse -- Me. 

The good thing is that the VA had our house handicap accessible.  Added a huge room on back with a big role-in shower, ramps and sidewalk widened. It is nice.  Steve was in the living room. He loves it now. He can see out the windows.  Now to find good home help to assist me with the lift to get him in his shower chair.  It has been very difficult to find good home help.  There is a company that finds aides, but they are not trained.  Scared to death to let them touch Steve.  We had a good one for over a year, but she moved out of town.  The last couple of months, OMG, terrible home help.  The VA pays for me to have help 6 hours every day.  If only we could find some good help.  The VA has been great, they pay for so much.  I tell everyone if anyone has been in the military at any time and gets ALS go to the VA.  They take full responsibility ever in younger vets. They also help with MS.  With Steve the VA pays for all supplies for respiratory therapist twice a day, CNA six hours a day, and part of his handicap van. He gets a check every month. They pay me a little every month. His power chair, lifts and the remodeling of the house were also covered.  Before getting to the VA, the nursing home was telling me to get on Medicaid to pay for his stay and that way they could get all his assets except for the house.  It was a nightmare.  I thank God everyday he gave me a steel backbone.  Case managers can drive you crazy.  All about the money and not the patient or family.  It is so sad.”

Mr. Steve Bennett Todd died on January 21, 2019.  His wife, Tammy, remained steadfast in confronting the system that ultimately contributed to his death.  Tammy was by Steve’s side every step of the way including his finial moments.  She is now resolute in advocating for change in long term care.  On February 9, 2019, Tammy wrote, “I am determined to change things for better care for all people.  From the VA to hospitals, nursing homes to hospice. They all put Steve and myself though hell and I am going to try and change things. People must become more compassionate for others.” 

Mr. Tom Bender, Licensed Certified and Clinical Social Worker, also an Associate Pastor spoke candidly of his visitations with residents in a long-term care facility on September 26, 2015.  He talked about the fact that for many of the people in long-term care, one thing they often have to look forward to is the next meal.  He said that he would definitely want to give his children the best nutritional food possible and that is what long-term care facilities should be doing.  He believes the question to be answered is, how can we best be human beings caring for other human beings, creating a healing environment for patients, families, and staff members? 

Questions for Consideration:

1.  Checking the Internet for reviews is not always the best or most reliable source without follow-up.  Siemens’ Lakeview Manor Nursing and Rehab Center is located in Somerset, Pennsylvania.  It is rated highly and endorsed by A Place for Mom, which is advertised by Ms. Joan Lunden, former TV news host and breast cancer survivor.  Somerset County Vocational and Technical Institute located in proximity to the nursing home has eliminated the site for clinicals or nursing training of students in the LPN program.  The reason is that the residents receive such poor care.

2.  Meadow View Nursing Center located in Berlin, Pennsylvania is every bit as problematic, but the nursing students need someplace to train.  Ms. Angie Cave, a current nursing student reported October 3, 2015, that on the morning rounds of clinicals, they found the first resident soaked in urine from her neck to her feet.  No one had checked on her every two hours as is the recommended procedure.  No one had repositioned the bedridden resident, nor changed her.  There were a myriad of other problems that the instructor used for examples of what should not take place in nursing.  Yet, this facility advertises a five-star rating online.  As the young nursing student pointed out, it is important to go to these places unannounced and go multiple times before making a decision about moving anyone into long-term care.

3.  Despite numerous attempts at improving the quality of food at Goodwill Retirement Community (GRC), the management is not responsive.  With a multitude of complaints from assisted-living Resident Council meetings, or nursing Council meetings, the food has remained the same for more than five years.  Even worse, the same food is in rotation for fourteen weeks at a time throughout the year.  There are no seasonal changes to the food menu.  Ms. Breeanna Ford, a nursing aide who left Goodwill, commented that “I had better food in boot camp.”  Mr. Ralph Lee, a 92-year-old resident asked, “I wouldn’t pay 10 cents for this hamburger on the outside.  We only had corn on the cob once and I ate two ears.  Why can’t have more corn on the cob?”  Another resident of the same age added, “Piss poor system, but what are you going to do?”  The food that is served at Goodwill is over processed, frequently overcooked, and not at all appetizing which raises questions as to how many people have refused to eat and die, rather than eat food that is not appetizing?

4.  What about making use of social media?  The Goodwill Retirement Community staff was told by management to put disclosure statements on Facebook.  It is well known that no one working at GRC is allowed to comment on Facebook about anything happening within the facility.  What does this say about the long-term care facility management?  Does this suggest that management at Goodwill Retirement Community located in Grantsville, Maryland, is ruthless, cunning, and/or profit driven?  Would a proud CEO of any organization be happy to see comments from employees anywhere on social media especially if those comments were complimentary?  Yes, free publicity and word-of-mouth are the best ways to advertise.  Look over reviews of all kinds in places online to get the best perspective about a long-term care facility.  Sometimes the absence of comments or censored material may indicate there are serious hidden problems behind the welcoming entrances of nursing and rehab centers.

5.  Along with checking social media and reviews online, try to inquire about a resident council meeting in place.  Even more important, talk to people about what takes place at those meetings.  Try to find out if these meetings are held to improve operations of the facility and needed care of a loved one.  If the meeting is nothing more than an administrator standing in front of the group of people who have difficulty hearing and struggle with dementia, then nothing will be accomplished.  Residents are frequently marginalized in council meetings.  It is even more important to inquire about monthly care meetings for family members?  It is imperative that the family member communicates regularly with the staff.  This can make a real difference in the quality of care that a loved one receives.  Ms. Jody Gastfriend, Vice President senior care services with Care.com recommends asking if there are monthly care meetings for family members.  If the facility has no family member care meeting where voices can be heard for loved ones who may not be able to speak, then there is a problem with the facility management.

6.  Even with resident council meetings, recommendations may not always lead to improvements.  Here is a documented case from the September, 2015, request for improvements that was a written email sent to Mr. Kevin Miller, Ms. Janet Kepple, Mr. Anthony Lehman, Ms. Julia Tice, Ms. Shelley Durst, Ms. Linda Bender, and Ms. Anita Funk, Mr. Tom Bender.  The aforementioned are administrators at the Goodwill Retirement Community.  Mr. Tom Bender is an Associate Pastor at Oak Dale Church.

Good morning,

I am writing to suggest we move to a different distributorship for food at Goodwill Retirement Community.  With more than three years of trying to call attention to the need for a different menu, more options, fresh fruit and vegetables along with a rotation of foods, it appears to me that the only alternative is change from US Foods out of Altoona.  I suggest investigating Sysco.  People in decline and dealing with chronic conditions deserve quality food because it is our natural medicine.  I hope to get better cooperation and bring change of food distributorship for the good of everyone working and living here.

Additionally, I am requesting five printers to be distributed, one on each floor of assisted living nurses stations, also North Hall nurses station, and the Alzheimer’s unit nurses station.  The members of the staff should not have to leave the assisted living floor just to get something printed.  It is not only a great danger to leave the floor unattended in assisted living because there is only one nurse aide per floor, is also a waste of human energy.  The people who work in this facility should not have to expend their energy going down long hallways just to get a copy.  Staples has printers for as little as $99, but there are probably better prices for nonprofit organizations.

It is time for change.  Mr. Tom Bender, Associate Pastor has displayed a commitment to building relationships and improving conditions for current and future residents and staff.  His communication skills, perceptiveness, and ability to critically analyze provide an exemplary role model for solving problems and moving forward.

I welcome your response,

Tyra Phipps

The Mennonite churches that sponsor Goodwill Retirement Community are Cherry Glade in Salisbury, Pennsylvania, Maple Glen in Grantville, Maryland, and Oak Dale in Accident, Maryland. 

*Sadly, as of this writing, no administrator has responded to the above September, 2015, request for improvements at the Mennonite sponsored Goodwill Retirement Community. 

February, 2019