by Tyra Phipps, Ed.D. (tyra.phipps@gmail.com)
The Kensington Algonquin
Mr. Peter Walsh is an Australian-American professional organizer. He lives in Los Angeles and was recently interviewed on NPR. At 59 years of age, he had to answer the questions of what to keep when his father passed away and deal with so much that his mother had accumulated. The answer is simple. The clutter expert recommends keeping only five items to treat with respect and honor as you move through your own life. It is impossible to hang onto everything. The keywords of treating items with respect and honor helps keep depression from setting in with the feeling of being overwhelmed by so many mementos of the past. In fact, cluttering your room or your life with so much from your past can be very depressing. The past always appears to be easier as if it were a better time in your life and keeps you from enjoying the present. It is very important to clear mental clutter according to Mr. Walsh. So how does that apply to long-term care (LTC)?
Many of the personal care homes and long-term care facilities are converted from older buildings-much older buildings and homes. The picture to the top right of this entry is from the Kensington Algonquin Hotel in Cumberland, Maryland. It depicts the entrance to the six story building. While the hotel was beautiful in its heyday and has so much charm, is there a question about function? Is it safe? The older buildings and homes lack the ADA (Americans with Disabilities Act) requirements and accommodations. In fact, it may be impossible to add elevators, concrete ramps, renovations to bathing areas, and heating air-conditioning units without damaging the internal structure of the building. The Kensington Algonquin Long-Term Care and Rehabilitation facility contract assesses a new resident a $500 building fee. It is a one-time fee for more improvements on the older building. However, there is only so much that can be done to upgrade a building that is 75 years old.
Older buildings may have doorways only thirty inches wide. The Pride Go Chair (smallest and most maneuverable of all power chairs) is a minimum of 29 inches wide so that would be a very tight fit if doorways are not modified. There may be one elevator. Entrances may be difficult to negotiate without concrete ramps. Proximity to highways without buffer areas may be unsafe for housing dementia patients. Services may be limited.
As a quick overview, this information about the long-term care facility which can accommodate a resident through Levels 1, 2, and 3. The basic rate includes:
Three meals daily and evening snack
Weekly housekeeping and laundry services
Free Transportation
24 hour staffing
Nursing services; however, if a resident needs medication supervision, bathing, dressing assistance, there is an additional charge.
All utilities included except for phone service.
Meeting Needs:
The next area covers a closer examination of typical questions that a director of a long-term care facility would like you to answer in making a determination of whether or not the staff can meet the needs of the resident.
What exactly are your needs, i.e., needing to be
fed? Do you require special foods/preparation?
Bathing assistance is usually provided
2 x a week.
If you had an accident or were going to a medical appointment:
Do you use a motorized wheelchair? Are originally from this area? Who is your PCP?
What special adaptive devices do you need to enhance your quality of life? What is your monthly income? This would give me a better idea of the space you could afford.
Can you perform your daily grooming, teeth, hair, make-up, etc.? Are you incontinent? Do you use briefs? (If so we would give you a pendant to wear so that you could call for assistance immediately. What are your mobility issues? A 1 or 2 person assist? Are you independent with bed mobility? Can you dress yourself or would you need assistance? Do you manage your finances or do you have a POA? Do you have family near?
There are a lot of questions that need answered before ever making a move to a long-term care facility. It is particularly challenging when investigating
facilities where the director needs to promote it, yet try to match the needs of the resident with what is available on site. This information is available online about the Director of the Kensington Algonquin Long-Term Care Facility.
More Perspectives:
Reverend William Carpenter, a Methodist minister who retired wrote in March, 2014 that he had visited long-term care facilities for more than thirty years. He summed it up by writing that the newer facilities are more industrial like but lack the warmth of a home environment. He and his wife were in the daunting process of deciding where to relocate in their later years. Even with the experiences of seeing so many parishioners in LTC, there was still a big question mark about what to do. He recommends planning ahead of time and going to the sites in person before ever making a commitment or move.
Mr. Dave Berry, Senior Advisor/Consultant at College Confidential and Writer wrote on February 22, 2015, “An old tennis acquaintance of mine, who lived to be 93, told me that he would never go into a nursing home. He said that if his family (the few that remained) did put him into a home, he would starve himself to death. The specter of scenes frightened him so much that he was willing to commit slow suicide rather than endure the humiliation and abuse that he would hear about from his peers who were in homes. I see those ridiculously romanticized TV ads for retirement living. They all present images of idealized, Xanadu-like surroundings where everyone is joyfully beaming, especially the staff. The reality is heartbreaking, however.”
A different reality is on the horizon because of the Affordable Care Act. This change is affecting in a positive way the quality of care for patients and increase of construction for healthcare facilities as reported on Sound Medicine (NPR, February 23, 2015). There is now an awareness of problems such as the dirtiest item in hospitals and healthcare facilities and the need for change. What was the dirtiest item? Curtains were at the top of the list, and they created greater allergens with massive amounts of dust. When deciding on a long-term care facility, look to see if there are windows with curtains that may appear very homey, but may not be washed as often as someone in the family took care of that chore. Newer buildings have transition windows that provide shading with harsh sunlight.
While there are many elderly people who may be part of the digital divide and not computer savvy, newer buildings may even provide Skype services in every room. There may be Wi-Fi in the older buildings, but the newer technology allows residents the joy of keeping in touch with family and friends. Investigate what technology is available on-site and question its reliability.
Newer facilities have also considered the fact that the average day for a nurse includes walking at least three miles per shift. That is the minimum walking distance. No wonder nursing aides get so worn out and frazzled in one shift and completely depleted during a mandated sixteen hour shift. When comparing an older building that has been converted to a long-term care facility with a newly constructed facility, assess walking distances for staff. Running up and down the hallways trying to chase call bells is a monumental task for any human being in the role of nurse. In some cases, nurses are expected to chase call bells on different floors. The more energetic nursing aide may take the stairwells, but how does that slow down the nursing aide trying to get to a resident in a crisis? Running the stairwell may be quicker than waiting for an elevator, but look at the proximity of resident rooms to the nurses station. Try to get an idea of just how fast someone could get to your loved one if the call bell is pushed, or hear your loved one yelling for help. What about the future of finding good help for your loved one no matter how the building is constructed?
Summary:
Every healthcare worker needs basic English skills and basic workaday math along with problem solving and skills in utilization of technology. Even more disturbing are news reports about the state of Florida that has a demand for 7200 additional nursing beds. There are newly constructed facilities and more on the horizon to open, but owners are having great difficulty finding people for the staff positions to provide care to residents. The question remains, what good is a new facility or an old facility if there is not adequate staffing of healthcare workers who are educated, trained, and dedicated to taking care of residents?
Questions for Consideration:
1. When looking at the possibilities of relocating to an older facility, try not to be fooled by the magic bullets or objects that elicit emotion and may be plentiful in the rooms. Upholstered chairs or antique rocking chairs, pianos, gilded framed pictures, antique tables with stained-glass lamps all make for a beautiful memory of the past. In reality, few elderly people can manage a walker over a Persian rug. It is virtually impossible for anyone in a walker, wheelchair, or power chair to maneuver around all kinds of antique furnishings or crowded rooms. Unless common areas are clear and hallways are widened with doorways at least 36 inches, managing a wheelchair, or power chair of any kind is virtually impossible.
2. Apart from stairwells and elevators, how are evacuations handled? It could be a storm and generator failure, a flood, or fire that occurs and the question is how easily can residents be evacuated safely? This can be quite a problem if freight elevators are the means for transporting people to another floor. Generally speaking, no elevator works during a power outage. How are these kinds of emergencies handled?
3. Observe the staff and interact with them as much as possible. Try to get a feeling about the culture of the community. A minister once asked the parishioners to pray for people who die without compassion or mercy. Be sure that people on staff are not just compassionate, but merciful and kind.
4. Which five items from your past would you keep to honor and respect while you try to live in the present at a long-term care facility?
March, 2015