Creating a New Culture of Long-Term Care

When you walk into a nursing home, what do you expect to feel?  Think about the sounds, the smells, the atmosphere of the building.

Most people expect to hear the buzzing of bells, the whirring of machines.  They expect the smell of antiseptic and a very sterile environment.  The atmosphere is very institutional – more like a hospital than a home.  They imagine a place where the residents cannot walk, talk, or interact with people.  Most people are bed ridden, and those who aren’t bed ridden are unable to carry on a conversation. 

Now I want you to imagine what you would want if you were to go into a nursing home.  Imagine how you would want it to sound, smell and look.  Imagine children coming and going, live plants through the building being tended by the residents, pets that live in the home and that staff members bring from their homes.  Think about residents and staff members laughing together, crying together, and creating lasting relationships. 

At our homes we want you to be a person, not a number.  We want you to be known for your personality and your story, not your diagnosis or condition.  Just because someone needs to go into a nursing home for medical care doesn’t mean they want to stop living.  They crave companionship and the feeling that they can make a difference, just the same as anyone else.  They want to be able to do the things they did before living in a nursing home. 

We recognize that we need to care for more than the medical portion of a person – we need to care for his or her spirit or soul.  That’s why each of our buildings has a chaplain on staff.  They also hold weekly worship services that you are free to attend if you feel so moved.  Some of the residents in our homes are there for short-term, after hip or knee replacements, or receiving therapy for an accident.  We make sure to care for these people too. 

Would you like to help make life better for these residents?  Do you have a special talent you would like to share?  Looking for volunteer opportunities?  Call me (724.822.8324) and I will put you in contact with the Activity Director at a home close to you.  We would love to have you come meet our residents and get to know them!

Tabitha Sperring, Cultural Coach

How to Pay for Nursing Home Care

Medicare Part A

• Covers up to 100 days of skilled care at a Medicare certified nursing home
• Must have a three day hospital stay within the 30 days prior to admission (observation stay and emergency room visits do not count)
• Must meet skilled care requirements – therapy of 150 or more minutes per week, stage 3 or greater wound, IV antibiotics, etc. 
• Medicare pays in full for the first 20 days, then there is a coinsurance due of $157.50 per day for days 21-100 of the stay which can be covered under a supplemental policy if coverage is in place, but would be due privately otherwise
• Some days may be used while in the hospital prior to admission if cared for in their skilled or transitional care unit so you may not have 100 days available when you arrive at the nursing home

Medicare HMO or commercial insurance plans

• Each plan has its own rules on coverage eligibility, coinsurance amounts, maximum number of days, and which nursing homes you can go to for care

Veterans Administration

• May cover services but is based on VA rules and individual needs
• Must go to a VA home or one that is contracted with the VA to provide services

Long term care policy

• Policies differ greatly and must be looked into on an individual basis – some pay only after Medicare stops or only for a certain number of days or only if at a skilled level of care and daily rate can be as low as $25 
• Patient or family must generally complete claim forms and get required documents from the nursing home to make an initial claim and usually have a short time limit to do so

Private resources

• Savings, income, retirement plans, reverse mortgages, etc.

Medical Assistance

• Payer of last resort
• Must reduce assets to below government limits and pay your income to the nursing home as your portion of the cost of care (allowed a small personal allowance each month for clothing, newspapers, TV, etc. of $45 currently)
• Cannot give away or sell property at below the fair market value or you will be penalized and can risk losing coverage for months or even years and would be responsible privately for nursing home care for that time period
• If you are deemed to be a short-term patient, may qualify for a home maintenance deduction, which allows you to keep part of your monthly income to maintain your home (mortgage, taxes, utilities, insurance, etc.) to a maximum of six months
• Special rules apply for patients who have spouses in the community or blind/disabled/minor children
• Must meet the qualifications as a “skilled nursing” level resident through the Area Agency on Aging’s “OPTION” process – the agency will review the case and make the assessment on whether a patient is personal care, skilled nursing, or other level of care eligible

The Challenge Program Kicks Off Program at Freeport Area High School

Students at Freeport Area High School were recently introduced to The Challenge Program, Inc. during a kick-off assembly at their school. During the assembly, student volunteers participated in a mock interview challenge to demonstrate how developing the right work habits and behaviors will set them apart from other job seekers. Each interview question was linked with one of The Challenge Program, Inc.’s five award categories—Attendance, STEM (Science, Technology, Engineering, and Math), Community Service, Academic Improvement, and Academic Excellence. Students will be eligible to compete for financial incentives in these categories throughout the school year.

Our very own Fair Winds Manor is the sponsor of the program at the school. Pictured here are 2013/14 winners of The Challenge Program, Inc. awards and participating sponsors. Front, from left to right: Matt Horm, sophomore attendance and Kris Keppel, sophomore academic excellence. Standing from left: Ryan Carcia, junior academic improvement; Lauren Arnold, junior academic excellence; Svetlana McCalmont, junior attendance; Andrew Romanchak, junior community service; Derek Jones, sophomore STEM Award; Jon Nigra, junior STEM Award; Derrian Alcorn, sophomore academic improvement; John Hughes, sophomore community service; and Jennifer Tomanio with sponsor, Fair Winds Manor.

Caring for a Loved One with Alzheimer's

Alzheimer’s disease is a progressive disease of the brain that leads to dementia. Alzheimer’s disease is characterized by the finding of unusual protein filaments in nerve cells of the brain. These twisted filaments are called neurofibrillary tangles in the brain. Alzheimer’s disease involves degeneration of the cortical regions, especially the frontal and temporal lobes. There is currently no cure for Alzheimer’s disease but new medications and therapies appear to be slowing the progress and improving the patient’s ability to function.

There are seven stages of Alzheimer’s:

In the first stage there is no impairment, able to safely live at home without caregiver support.

In the second stage there is a very mild cognitive decline, the person exhibits some memory loss, forgetting familiar words, location, or everyday objects. At this stage able to live alone with some caregiver support can be informal such as family or friends.

In stage three there is a mild cognitive decline. During this stage friends and family begin to notice difficulties, trouble with remembering names, difficulty performing tasks, losing or misplacing valuable objects, and increasing trouble with planning and organizing. At this point loved one should be evaluated by a physician to ensure they are able to continue driving , and  living alone. Caregiver at this point should be starting their search for a personal care home.

Stage four is a moderate cognitive decline. During this stage there is forgetfulness of recent events, impaired ability to perform challenging mental arithmetic, counting backwards, a greater difficulty with performing tasks such as paying bills, managing finances, forgetfulness about one’s own personal history, becoming moody or withdrawn. Loved one at this stage is not safe to live alone.  The loved one requires caregiver support for safety and assistance for activities of daily living. The needs of the loved one may grow.  They may need to have more formal care like home health aides, companions, or placement into personal care that offers assistance with activities of daily living.

Stage five exhibits a moderate cognitive decline. Being unable to recall their own address, telephone number, becoming confused about where they are or what day it is, they require help to choose proper clothing for the season or occasion, not being able to remember significant details about themselves or family. The need for supervision is great in this stage.  This will definitely exceed the abilities of informal caregivers and families consider placement at a personal care home. Therapy is incorporated to promote strength and steady gait.

Stage six is a severe cognitive decline. They lose awareness of recent experiences as well as surroundings. They will remember their own name but have difficulty with personal history. They struggle with unfamiliar faces and have trouble remembering the name of their spouse or caregiver. They need assistance dressing, major changes in sleep patterns such as sleeping during the day, and being restless at night. Require assistance with bathroom hygiene, they have a hard time controlling there bowel and bladder, they exhibit extreme personality and behavioral changes including suspiciousness, delusions, verbal and or physical aggression, wandering and meandering. During this stage residents needs would able to be met in a personal care home that offers a secure dementia unit for safety due to wandering and meandering.

Stage seven is the last stage. During this stage they lose the ability to control movements, need assistance with eating, positioning, and are unable to ambulate. They are unable to respond to the environment or carry on a conversation. During this stage resident would require a higher level of care such as a skilled dementia unit.

Tips on caring for a loved one with dementia:

1. Schedule wisely-establish a routine to make each day more predictable and less confusing. Schedule the most difficult task, such as bathing or medical appointments for the time of day when your loved one tends to be most calm and agreeable.
2. Take your time- expect things to take longer than they used to.  The caregiver should allow more time to complete tasks so that neither the loved one nor caregivers are pushed.  
3. Involve your loved one-allow your loved one to do as much as possible with the least amount of assistance. For example, lay out your loved ones clothing in the order they go.
4. Limit choices-the fewer the options, the easier it is to decide, for example provide two outfits to choose between, not a closet full of clothes, eliminate belts or accessories that are likely to be put on incorrectly.
5. Provide simple instructions. When you ask your loved one to do something, do it one step at a time.
6. Reduce distractions- turn off the television and minimize other distractions at meal time and during conversations so that your loved one can better focus on the task at hand.
7. Create a safe environment: remove throw-rugs and other obstacles to prevent falls: use locks, check water temperature, and take fire safety precautions.

In the event that there is no caregiver available or the caregiver is unable to meet the loved ones needs, adult day care, or admission to personal care may be appropriate.

When a caregiver is no longer able to meet a loved ones need safely in the home, they often seek an evaluation is by a healthcare professional, whether it be the doctor, a nurse, or a liaison to determine their appropriate alternatives.  Alternative placement may be personal care sometimes referred to as assisted living. Years ago personal care was never an option the individual would be forced to rehabilitate or live the rest of their life in a skilled surrounding. Quality Life Service homes have made it possible for individuals to receive therapy, rehabilitation, and comfort in a homelike setting that enhances their quality of life. Our company is unique in the sense that we offer both a personal care secure dementia unit and a skilled secure dementia unit. The personal care secure dementia unit is perfect for those with early stages of dementia who are ambulatory and able to perform some activities of daily living with supervision but somewhat independently. Skilled secure dementia unit is designed for the later stages where the individual is unable to ambulate, and requires physical assistance to complete activities of daily living such as eating, dressing, and bathing.

For more information and caregiver support, please call the Q-line at 1-866-884-6852 or visit one of our communities. Our care partners are there for you and your family.

How to Enjoy the Holidays without Gaining Weight

The holiday season is upon us. Oh how I love the magic of the season, the lights, music, decorations and of course the food! Cookies, candy, cakes and pie, Oh My! It seems everywhere you go there are sweets and tempting treats calling out to you to eat and eat a lot! Christmas has always been a joyous time of year for me growing up in an Italian culture where food is such an important part of life, family and love. I remember as a child the wonderful smells of fresh baked cookies, nut rolls and sweet Italian treats that would waft through the house as my mother would spend days baking and preparing for the family gatherings. Having grown up with a wonderful baker in the family I understand the temptation to eat. As the amount of sweets and cookies pile up so can the weight. Research is now showing that the average weight gain over the holidays is 1-3 pounds. This may not seem like a lot but the problem is that this weight is not being lost after the holidays and over time this 1-3 pounds can add up.

The following are tips for you to be able to enjoy the holidays and not gain weight.

Moderation and Portion Control 

You do not have to avoid eating your favorite foods. Denying yourself a piece of cake or pie will only make you crave it more and ultimately cause binge eating or eating more than you should. Portion control is key to weight control. For example if you decide that you really want to eat a piece of pumpkin pie then make a sacrifice elsewhere in the meal such as eating only a ¼ cup of mashed potatoes or vice versa. Decide what it is that you really want to eat and choose the food that you will eat a smaller portion. An easy tip for portion control, fill one half of the dinner plate with vegetables and the other half with a lean protein and one starch. Also try using a smaller sized plate.

Plan Ahead 

Never go to a party hungry and do not skip meals during the day as this will only cause you to be starving and eat everything in sight. Be sure to eat three healthy meals a day plus small snacks between meals. Include fresh fruits and vegetables, lean proteins and whole grains. Try eating a snack prior to going to a party like a piece of fresh fruit and 1 ounce of low fat cheese or 1 ounce of almonds. The fiber and protein in these foods will help to make you feel full and prevent overeating. Drinking a glass of water prior to eating will also help with the sensation of fullness.

Be Prepared 

Try bringing a lower calorie dish or dessert to a party this will ensure that there will be a healthier option for you to choose. Some ideas would be fresh fruit and a fruit dip such as low fat Greek yogurt, a vegetable platter with a low fat dip, shrimp cocktail or a bruschetta made with tomatoes, olive oil, fresh garlic and basil on top of a small slice of toasted bread. If you are at a party or gathering and it is buffet style scope out the food that is being served and decide what you really want to eat. Avoid standing by the buffet and once you have your food do not go back.

Avoid Drinking too much Alcohol 

Not only will alcohol will cause the body to become dehydrated it also causes lack of control in decision making and lead to overeating. Alcohol contains “empty” calories or in other words a lot of calories and few nutrients that are beneficial for the body. For example, a regular 12 ounce beer contains 155 calories, a 4 ounce glass of wine about 90 calories and 1.5 ounces of hard liquor about 90-100 calories. Most people have more than one drink and these calories can add up quickly. Try drinking club soda or sparkling water. As always water is the best choice. If you choose to have alcohol be sure to drink plenty of water between drinks.

Exercise, Exercise! 

Exercise is a great way to burn calories and manage stress. Do not stop your exercise program if you already have one in place. A lot of people will stop exercising due to their busy schedules over the holidays but you have to make time to exercise. Exercise does not have to be strenuous. Doing any type of activity for 30 minutes a day will help keep off those unwanted pounds. It can be taking a 30 minute brisk walk which can burn up to 80 or more calories depending upon how fast you walk. Try making it a family affair. Instead of watching television go out and take a walk or go bowling. No matter what type of exercise or activity you choose the key is to keep moving.

Get Plenty of Sleep 

Research has shown that sleep deprivation has a direct correlation to weight gain. Lack of sleep causes the body to release increased levels of a hunger hormone called grehlin. As the level of this hormone rises the body craves more and more high fat, high carbohydrate foods. It is important to get 7-8 hours of sleep a night.

Avoid Stress 

The holidays can be a stressful time for many people. Stress can cause overeating and as the stress level increases we have the desire to eat high fat, high calorie foods. Stress causes a rise in the hormone cortisol which can contribute to weight gain. Ensuring that you follow a healthful diet, get adequate sleep and exercise daily will help you to better manage the holiday stress.

To Summarize: 

You do not have to give up your favorite foods over the holidays. Moderation and portion control are key to preventing weight gain. Plan ahead and be prepared, do not starve yourself or skip meals, include fresh fruits and vegetables, lean proteins and whole grains throughout the day, avoid alcohol, drink plenty of water, get adequate sleep and exercise.

Remember what the holidays are about, spending time with family and friends and giving thanks. 

Merry Christmas and Happy Holidays to everyone in the Quality Life Services family! 

Cindy Closser, RD, LD, Clinical Dietitian for QLS 

Cindy is a graduate from the University of Cincinnati and has a Bachelor’s Degree in Nutrition and Dietetics. She has been practicing as a Clinical Registered Dietitian for 16 years.

Growing Old with God

There is one thing we all have in common ... we are growing old.  Some of us are already old, and we're just growing older.  What does it look like to grow old?  It can be scary in many ways, and aging body that is more prone to illness; strength that is deteriorating; feelings of uselessness; loss of friends and loved ones through death; reality of our own death; loneliness; financial concerns; and the list goes on and on.

Some people talk about old age as the "golden years" but those living in them don't find much gold (it usually belongs to their doctor).  It is said that elderly people are rich because they have: silver in their hair, gold in their teeth, stones in their kidneys, gas in their stomachs and lead in their feet.  The human body was never designed to live forever, and we will all advance through the stages of old age as we proceed through toward the end of our lives.

So what does it look like to grow old with God?  One area that provides room for continual growth in our senior years is the spiritual domain.  The body may break down, but the spirit is still capable of growth, renewal, and even new birth in old age.  What should I be doing now, however old I am, to prepare for old age?  Hebrews 13:8 reminds us that "Jesus Christ is the same yesterday, today and forever."  God does not change, God is always the same!  But our perception and understanding of God must change; we must be willing to always increase our knowledge of God.

To do so, we must be willing to develop godly habits.  Psalm 71 gives us a little insight on this growing old business.  Scholars have agreed that this psalm is the prayer of an aged believer.  The psalmist is confident in his faith, strengthened by his long experience, rejoices in hope, turns to God in prayer and proclaims thanksgiving.

Within Psalm 71 we find three godly habits: the first is the habit of TRUST.  The entire Psalm is an affirmation of the psalmist's trust in the Lord.  Charles Spurgeon calls it "the utterance of struggling, but unstaggering faith."  It is safe to say that the psalmist was struggling because of the difficult circumstances of life, but he was unstaggering in his faith because he knew the Lord and believed God would see him through.  This kind of faith comes from his knowledge of God.  The psalmist knew God, he had learned to trust God, and he knew God would see him through.

Are you developing a habit of trusting God in the difficult times of life?  Or are you frequently filled with worry, doubt or fear?  If you have trouble trusting, concentrate on getting to know God and review the things God has already done for you.

The second godly habit found in Psalm 71 is the habit of PRAISE.  Praise is not always a natural habit.  Some people just seem to grumble and complain naturally, but God wants us to be a people of praise!  How can we learn to praise God when trials come?  By learning to trust God!  Just as trust comes from knowing God, praise comes from trusting God.

The third godly habit found in Psalm 71 is the habit of HOPE.  We find hope for things: I hope my investment will earn a profit.  I hope the price of gas goes down soon.  But when we hope in God, a God that is unchanging, we know we will find God trustworthy and faithful.  The psalmist was in good shape in his old age, because he had developed a deep knowledge of God and had developed the godly habits of trust, praise and hope.

Growing old with God should bring a level of maturity and refining gained by experience.  We accept life.  We absorb life's blows.  We heal and we scar; but we all carry lessons that can be learned and passed along.  A poster in our senior center boldly declared, "Growing old isn't for sissies!"  As the years go by, we will all identify with that statement more and more.

Growing old has it's challenges.  With age comes the realization of how physically close we might be to the Kingdom of God.  In a very real sense we stand on the brink of eternity.  The God who has made us also planned a wonderful future beyond the certainty of growing old and ending our days on earth.  "It is written: no eye has seen, no ear has heard, no mind has conceived what God has prepared for those who love him" (1 Corinthians 2:9).  We can look forward to that time with anticipation, while learning to navigate the later years with grace and dignity.

Amy Worline
Chaplain
Trinity Living Center, Chicora Medical Center

Ministry for Aging Adults

How do we as ministers of the Gospel of Jesus Christ effectively accentuate these truths when ministering to aging adults - particularly those in Nursing Home or Care Home settings?  How do we instill hope when we walk into a room and find someone who is almost lifeless and we become so emotionally torn inside we just want to exit the scene?  How do we dare articulate these things - as long as you have a breath you have purpose?

My three points today are things I have learned over the years from "the school of personal life experiences."  What I share is from a Spiritual and Biblical perspective - I am not medically qualified to make any medical judgments.  

First, we must RECOGNIZE the wisdom of the aged and the grace of God in the process of aging.  Have you ever noticed when you light a candle the flame is first small - as it continues to burn it gives off more light - it burns the brightest and offers the most warmth just before it goes out.  The same can be said of aging seniors - yet we so often do no view them this way.  

Secondly, we must REMEMBER and help those we are ministering to to understand that God's ways are not our ways and his thoughts are not our thoughts.  As long as we have breath we have purpose.  Until God calls us home there is a reason for our existence here.  Even when we do not understand it, we must trust that one day it will be fully revealed.  

Lastly, we must bring RECONCILIATION.  Never assume all is okay spiritually with your silver haired saints.  Everyone needs assurance that their sins are forgiven and they have been reconciled - reunited to Christ.  This is the most important part of our ministry because it has eternal, everlasting consequences.  

Even if someone is no longer coherent or responsive, pray the prayer.  We do not know what they may be able to hear.  We do not know what God in heaven is revealing or opening up to their mind s owe pray as though they can hear us.

Susan Brown

Chaplain

West Haven Manor