Is the level of care keeping up with our needs?

There is a disconnect in the way we manage long term care for frail seniors. Nationally, we are moving toward taking seniors out of nursing homes and keeping them in the community, giving them more assistance in their homes or placing them in assisted living facilities. Since people generally don’t want to live in nursing homes, that’s a good thing. But we had better ask ourselves the question: are frail seniors getting the level of care they need in the community?

Here’s the problem, from an ombudsman’s perspective. In the days when there were more placements in nursing homes, assisted living facilities were intended for people who just needed some help with basic activities of daily living—bathing, dressing, eating, walking and getting to the bathroom. Our state licensing regulations were written with this kind of resident in mind. Thus, the regulatory requirements for caregiver qualifications are minimal. Caregivers must have sufficient English to call emergency services. They must have a negative TB screen and be able to pass a background check.

Caregivers have to complete some training annually, but the training does not have to relate to the type of residents they are actually serving. They do not have to be certified or licensed.

These minimal requirements make sense when the seniors in assisted living homes are still able to monitor their own care and are not seriously chronically ill.

But now we place very fragile seniors in assisted living homes. They are often suffering from several chronic diseases, needing a dozen or more medications provided to them several times a day. They may have multiple doctors. Many need special diets. They may have lost cognitive capacity, rendering them unable to direct or monitor their own care. Some are too disabled even to say where they hurt.

These frail seniors should have caregivers trained to understand their special needs, recognize signs of acute distress, and respond quickly and appropriately.

Caregivers who have the minimum qualifications can do real damage to these frail older residents out of inexperience and a lack of skilled supervision.

Recently, a diabetic resident had his foot amputated after a caregiver poured hot water on his feet and burned them. Ombudsmen discovered that another resident was given aspirin before surgery, putting him at risk of excessive bleeding. A third resident with chronic mental illness was not given his antipsychotic medication for three months and ended up in API. A fourth was given a double dose of her antipsychotic medication. A fifth resident was having a stroke, but staff did not recognize his distress and did not call 911. A sixth resident had severe pressure ulcers but did not receive appropriate wound care.

I wish these mistakes were uncommon, but unfortunately, they are all too common.

Improvements are coming. State Medicaid waiver regulations require caregivers to have medication training in the homes that serve Medicaid participants.

The state is also revising the assisted living regulations. I am hoping that the new licensing regulations will raise the bar and require caregivers to be better qualified to care for the types of residents they serve.

Better yet, I would like to see the regulations establish more than one level of care so that the highest-needs seniors can be placed in homes that have better qualified staff and more skillful supervision.

Whatever happens, we cannot continue to accept the status quo or we are failing in our duty to protect the oldest, most vulnerable Alaskans.

If you have a complaint or question, or would like information about becoming a volunteer ombudsman, call the Long Term Care Ombudsman office at 334-4480 in Anchorage or toll-free statewide at (800) 730-6393.

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