Rita Watson: Obtaining good-quality care for the elderly is critical
Published on 25 November 2013
rsing home directors often tout “patient choice.” However, it is unlikely that anyone ever knocked on their doors asking, “May I give up my home and come live here?”
People prefer to age in place. Yet this option can be difficult for caregivers to manage. As such, assisted-living facilities or nursing homes begin to look like attractive alternatives.
Aging is a process and in many instances, with proper oversight, aging in place is a viable choice. Gary Leiter, president of Home Instead Senior Care of Rhode Island, said that many services can help the elderly stay at home. In addition many community agencies provide services to the frail and elderly (if their families can get through the paperwork.)
However, it is important to see that the person at home receives help with bathing, dressing, hydration, toileting, laundry, meal preparation and the ever-critical medication monitoring. Medication mix-ups are one of the more frequent causes of hospital readmissions with the elderly.
Leiter explained that when an elderly person with a medical problem chooses to stay at home there are three levels of care options: non-medical, personal, and skilled.
“Under the Affordable Care Act (ACA) there are incentives to physicians and physician groups to prevent readmissions to the hospital in those first 30 days after a patient is released,” he said. “Now they will be reimbursed for following a patient home often by assigning a primary nurse to visit with the patient or manage the process.”
On a personal level, Leiter related the story of his late mother who was living in New York while he tried to manage her care from a distance.
“When we finally had to admit her to a nursing home, it was for rehab on her last discharge from the hospital,” Leiter said. “She was to be there for approximately six weeks. But when the six weeks were up, my mother finally admitted that she felt unsafe living alone. At the time I brought her to an assisted living center in Rhode Island where I was able to better manage her care plan.
“When my mother was living in New York, over an 18 month period she had seven hospital admissions at an approximate cost of $500,000.”
After bringing her to Rhode Island, she did not have one admission. Her care included a nurse who monitored her vital signs and made immediate adjustments to her medication. The nurse, through Medicare, visited three times a week over nine months at an approximate cost of $16,000.
As for assisted living, a new book by journalist A.C. Thompson, “Life and Death in Assisted Living” reveals that unregulated and unmanaged care can be a dangerous option, and, for those with disabilities, “exploitative.”
At the MacArthur Foundation Research Network on an Aging Society, Dr. John Rowe spoke about designing homes and neighborhoods for an aging population. He said researchers are working to develop a program effective in continuing care retirement — and perhaps extend that model to affordable housing — in which health services for the elderly will be provided at the housing site.
A recent report from a Pew Research survey found that 36 percent of adults were providing unpaid care to relatives or friends. This is up from 27 percent in 2010. Even families who choose the facility care option soon realize the need for overseeing care.
As members of society age — with too few young people to balance out the population — the need for advocacy and quality care becomes critical.
Rita Watson, MPH, is a Journal columnist who received the 2012 MetLife Foundation Journalist in Aging Fellowship through the Gerontological Society of American and New America Media and the 2013 GSA travel grant.