So you and your family have made that difficult decision to move mom or dad out of their home into an assisted living facility, so your job is done? Nope. Assisted Living Facilities ( ALF) have become the answer for many adult children looking to provide a safer version of home for their aging parents. Many families are finding out these facilities, no matter how high the cost, are not equipped to handle all the needs of their loved ones. Families are often still spending considerable time and resources coordinating medical care, arranging appointments, fretting about medications and driving to doctor visits. Really, assisting the assisting living facility? The traditional model of Assisted Living Facilities is not meeting the needs of our parents’ generation who are living longer, with more complicated medical needs, but still yearn and are equipped for maintaining some of their independence.

Thankfully, there is some good news to report. A few innovative providers are beginning to incorporate the traditional assisted living model with medical management. For example, at a senior living organization in Minnesota, residents can get primary care from on-site nursing care practitioners who conduct ‘house calls’ to residents’ apartments. During off-hours, assisted living staff have access to consultation with the medical team, lessening the number of visits to the emergency room by residents.

As we continue to look for the best possible living situations for our aging loved ones, we need to start asking the right questions. In kind, hopefully, more facilities will start responding.

Here are four questions to keep in mind:

1. Under what circumstances will I need to hire help in addition to what’s included in your fee?

2. How do you prevent unnecessary hospital visits?

3. If my parent needs to be admitted into a hospital, how do you ease the reentry to the facility?

4. How will you spot my parent’s health problems early and communicate concerns with me?

So families must continue to be involved with their family members health and medical care needs even in an ALF . Managing your expectation is important and good and consistent communication with the staff will go a long way to keeping your family members healthy. The types of elder abuse I see in my office often have to do with ALF not transferring residents sooner once medical problems arise or get serious. So be aware that if your loved ones health begins or continues to decline , their needs may require more that the ALF can manage and skilled care in a traditional long term care facility maybe the best

Reference Links:  https://www.forbes.com/sites/nextavenue/2017/11/07/where-is-the-assistance-in-assisted-living/#4f5ba1a63cca

Keeping Our Seniors Safe During Natural Disasters – The Time For Congress To Act Is Now!

We were all shocked and horrified at the news weeks ago, that residents of a nursing home in Hollywood Florida died because there was no air conditioning after hurricane Irma. I couldn’t believe the reports that there was no backup generator and that the administration at the facility would not make the safety of the residents their number one priority. Their failure to act and protect caused the horrific death of several elderly, sick and defenseless people. I am encouraged that this got the attention of a few senators and they are looking to do something to prevent this in future.
Several senators have spearheaded a bill that seeks to address the terrible neglect of seniors during natural disasters such as the recent hurricanes that blew through Texas and Florida in September. Nine seniors died when Hurricane Irma knocked out electricity in a Florida rehabilitation center with no back-up generator to power the air conditioning. In Texas, Hurricane Harvey caused flooding that left some assisted living residents in knee-deep water.
The Protecting Seniors during Disasters Act is being introduced by Senators Marco Rubio (R-FL), Bill Nelson (D-FL), Susan Collins (R-ME) and Bob Casey (D-PA). All are members of the Senate Special Committee on Aging. Rubio commented that the tragedy in Florida “exposed….potential mismanagement at assisted living facilities in the state.” The 15-member proposed panel would offer advice concerning how to prepare and care for older adults during emergency situations.
The bipartisan bill would amend the Public Health Service Act to require the secretary of Health and Human services to establish a National Advisory Committee on Seniors and Disasters composed of federal and local agency officials, as well as non-federal healthcare professionals with expertise in disaster response. The legislation is headed to the Senate Committee on Health, Education, Labor and Pensions for consideration.
If it passes, the panel would be charged with providing guidance on how to better prepare seniors for “all-hazards emergencies,” how to most effectively evaluate their health needs during such emergencies and how to determine what activities should be carried out when such emergencies are declared.
In a separate measure, Florida Governor Rick Scott recently issued emergency rules requiring assisted living communities and nursing homes to obtain generators and enough fuel to enable them to sustain operations and maintain a temperature of no higher than 80 degrees for at least 96 hours following a power outage.
Emergency relief workers stress the need for evacuation plans to consider a storm’s size and severity, as well as the ability of buildings to withstand wind and storm surge. Also, the recommend that facilities should be built to enable sheltering in place, in case doing so is necessary, and they should not be built where regular flooding is a risk.
We cannot leave the emergency care and rescue of our seniors in nursing homes and assisted living to chance, we need to ensure the law requires nursing homes and assisted living facilities to have a plan , I am going to be watching to see if these senators do right by our seniors and taking action to prevent elder abuse

It is Never too Late…..to Reduce Your Risk of Dementia

My practice focuses on abuse and neglect in nursing homes and one of the reasons for placement in nursing homes is a family member with dementia . In 2015, 47 million people were living with dementia. This number is projected to triple by 2050. We should all be interested in reducing our risk of dementia so we can age at home instead of in a nursing home. And putting aside the human cost of this diagnosis, the global cost of dementia in 2015 was close to $818 billion.
A recent study gives us some concrete steps to reduce the risk of dementia , at any age. According a study published by The Lancet Journal diet and exercise are key as this diagram shows

There are steps that can be taken at every age to reduce dementia risk:
• Early in life- increasing education
• Midlife – address hearing loss, high blood pressure and obesity
• Late in life- stop smoking, treat depression , increase social contact, stay active, and treat diabetes
Did you see that?……. Making changes even late in life makes a HUGE affect on reducing the risk of dementia. Researchers found that the changes made even later in life can reduce the risk of dementia by 15
The researchers also found that social contact and activities worked better than medications, antipsychotic drugs at treating agitation and aggression found in early dementia patients.
So, what happens if dementia hits?
Family members are usually the first line of support as substitute decision-makers. Parent-child roles reverse. Partner relationships change and tensions and responsibilities increase. So do dangers of elder abuse. This can be verbal or psychological abuse; neglect (including allowing self-neglect) such as ignoring medical or physical care needs; failure to provide access to health or social care; and withholding the necessities of life.
Contributing factors to elder abuse are many. Sometimes the caregiver needs care too. About 40% of family care givers have depression, anxiety or some form of severe psychological symptoms. They have worse physical health and lower quality of life.
What can help?
So now it is never too early or too late to reduce your risk dementia but don’t let your planning stop there, make sure you have the necessary documents prepared in advance. Consider who you would trust to make life decisions on your behalf. Decide how you want to be cared for; have advance care planning in place that may include end-of-life care. Don’t wait until it’s too late and someone else makes the decisions for you.
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Don’t Look Now, There Goes Your Rights! Seniors Beware!

While we have all been glued to the news lately on the repeal and replacement of the Affordable Care Act, we should really be watching the dangerous roll back of regulations affecting our seniors. It could be your parent or even you someday that suffers as a result of changes the government has signaled it intends to enact.
Specifically, the Trump administration has indicated it wants to eliminate a recent ruling which banned the use of pre-dispute arbitration agreements that residents can be asked to sign upon entry into a nursing home facility. In other words, the government wants nursing homes to be able to eliminate a resident and his/her family’s ability to sue a nursing home for neglect, abuse and mistreatment, any of which can lead to death. Holding wrongdoers accountable is a cornerstone of our court’s system and a right to trial by jury is guaranteed by the 7th Amendment to the Constitution.
By residents waiving rights to due process and everything that the judicial system offers, they are at an extreme disadvantage, and nursing homes know this. It opens the door to something close to impunity, or at least, severely mitigated risk and damages, should the nursing homes neglect their residents.
Typical nursing home claims involve injuries caused by the carelessness of caregivers, and inadequate staffing and resources. These injuries can involve bed sores that can lead to lethal infections, choking, sexual assault, renal failure and other conditions caused by dehydration, malnutrition, burns, gangrene, painful and immobilizing muscle and joint problems resulting from long-term inactivity, among many other potential forms of harm. These avoidable conditions can be the result of negligence or willful misconduct by long-term care facilities.
Presenting these binding arbitration agreements is a step nursing homes take during the admission process, which is a very difficult and stressful time in families’ lives. Individuals usually feel compelled to sign the agreement because they are under pressure to be admitted, and the implied message is that they will be refused care if they don’t agree to sign the document. Requiring residents to give up their rights in order to receive care is unfair by anyone’s standards.

Arbitration is unfair because it stacks the deck against residents by usually allowing the nursing home to select both the arbitrator and the rules for the arbitration process. Arbitrators have a strong incentive to find favor with the facility since this will ensure their continued employment. Ultimately, residents will lack the ability to hold a nursing home accountable for mistreatment and harm. This also enormously limits any penalties imposed for wrongdoing. Additionally, the proceedings are confidential, so the public will never know of a nursing homes’ true track record. We all lose when wrongdoers are not held accountable and bad nursing homes stay in business undeterred by the court system.
Full disclosure is the best deterrent for substandard care, along with the elimination of pressured consent to signing arbitration agreements.

Since we all have skin in this game, it should stay on your radar.

Today is World Elder Abuse Awareness Day

Today, June 15, 2017 is World Elder Abuse Awareness Day as declared by the United Nations. I hadn’t thought of elder abuses as a world-wide issue but the United Nations committee  cite to an expected increase in such abuse due to the numbers of elderly growing. Financial exploitation and material abuse is one of their focuses this year. And the statistics are troubling, between 5- 10 percent of older people world-wide may suffer from this kind of elder abuse. This kind of abuse is often not reported as the victims are often ashamed or embarrassed. Common forms of financial abuse may vary based on the country; in developing countries there is theft, forgery, misuse of property and denying access to monies and in less developed countries this abuse can be ejection of the elder from their home, denial of inheritance or theft of property. Regardless of country , elderly are at risk because of cognitive problems or health problems that leave them frail. So what can be done to prevent financial abuse begins with first education and encouraging specific measures to monitor financial abuse and then legislation and programs to detect this abuse, report it and protect.
Throughout the world our daily lives maybe look different but i am certain we can all agree that our parents, grandparents and elders are worthy of our protection . Our elders, all over the world , deserve to live in peace and dignity and free from financial abuse and this issue  is certainly a worth a day of awareness.

What Does Climate Change Have To Do With Our Seniors?


There are a lot of reasons to care about climate change. But unbeknownst to many people, one of those reasons should be the health of your grandma or mom. A recent report issued by the Medical Society Consortium on Climate and Health makes the case that climate change is harming our health, and the Medical Society has a Report entitled just that. What is the connection? Our planet is experiencing more very hot days, along with more frequent stretches of these sizzlers accompanied by much greater humidity. And seniors, children, and pregnant women are the most vulnerable citizens affected by these temperature extremes. Seniors in particular are more affected because many suffer from chronic heart and lung conditions and their therapeutic medications tend to make them less able to regulate their body temperatures. If seniors do not have home air conditioning they are not able to get relief from these hot humid days, thereby subjecting them to sundry difficulties. As a result, health professionals, doctors and nurses see their patients affected by a variety of heat-related illnesses, including a worsening of chronic illnesses, injuries and deaths resulting directly from dangerous weather events, an increase in infectious diseases spread by mosquitoes and ticks, along with illnesses from contaminated food and water. Additionally, a marked increase in climate related mental health problems are noted.
So what can we do to improve the lives of our families? There are many groups that are already making a difference. One such example is the Regional Greenhouse Case Initiative which is a consortium of 9 States which came together in 2007 to reduce CO2 emissions from fossil fuel power. Their efforts in reducing air pollution have already documented a positive effect in preventing:
• 300-830 early adult deaths
• 40,000 lost work days
• 35-390 non-fatal heart attacks
• 8,000 asthma flare-ups
• 200 hospital admissions
• 200 asthma ER visits

That is some real and significant health benefits from combating climate change! So if you don’t already have a reason to care about the health of our planet, I have just given you one– reducing climate change will keep your loved one healthier! And don’t forget this Saturday April 22, 2017 is Earth Day! Honor our Planet and Celebrate!



It was disappointing and disturbing to see that Ohio’s nursing homes ranked as some of the lowest in the country. How could that be ? We are the land of buckeyes, the birthplace of eight  US Presidents and a great lake- so why our state’s nursing homes treat our seniors so poorly? The Cleveland Plain Dealer reporters have spent the last few months analyzing data and recent published a scathing report of Ohio nursing homes  According to the numbers set forth in the national nursing home rating system known as Nursing Home Compare.  See my April 2, 2015 blog post on this national rating system.  Let’s take a quick review of this government system here.The Center for Medicare and Medicaid who pay the greatest bulk of the bill for residents, set up a national rating system to grade nursing homes on a 1- 5 star rating system :1 star is a lowest rating and 5 star the highest or best rating. The rating system is based on 3 issues which are important to assessing good resident care :

1. Health inspections rating:
The health inspection ratings on the 3 most recent comprehensive (annual) inspections, and inspections due to complaints in the last 3 years. Though more emphasis on recent inspections.
2. Quality measures (QM) rating:

There are 16 QMs conditions that affect the residents in the facility; like how many residents have fallen recently, have pressure ulcers, have had a loss of mobility , have lost control over bowel and bladder function or have lost significant amount of weight . These condition are obtained from clinical data reported by the nursing home. These may indicators quality of care .
3. Staffing rating:

These rating are based on two factors a) Registered Nurse (RN) hours per resident per day; and 2) total staffing hours per resident per day which RNs; Licensed Practical Nurses (LPNs) and Certified Nurse Aids (CNAs). Once again these numbers are submitted by the nursing home and take into account the needs of the residents;

So this investigation looked at Ohio’s nursing homes and their ratings as compared with the nation and found that Ohio has 184 nursing homes that are rated with only one star. And nearly 200 Ohio nursing homes received a two star rating . So that tally stands at nearly 41% of Ohio’s nursing homes only earned a one or two star rating. Charlene Harrington , a distinguished Professor of Nursing and member of the Nursing Home Compare advisory committee said “ One-star nursing homes tend to have a lot of deficiencies and low staff.” Of course that makes sense, that if there is not enough nursing staff to care for the residents, the residents suffer” . Why would a nursing home not hire enough nurses and nurse aides? Yep you guessed it money – staffing is the major expense in a nursing home, so short on staffing and save some money and increase those profits. Shameful but often true.
I believe the rating system in Nursing Home Compare is an important tool for families when researching the right nursing home for their family member. One of the best ways to prevent nursing home negligence is picking a home with a high rating which usually means a well- trained nurses and enough nursing staff to care for all the residents.

Who Is Stealing From Grandma?

pursethiefWho is Stealing from Grandma?

Well, I was surprised to learn there is a lot of stealing going on! It is reported that nearly 1 in 5 of our seniors (65 years and older), are the victims of financial abuse. This is according to a recent report by Public Policy Polling.As a result, there is a renewed effort by many different groups such as doctors, nurses, family members, and financial advisors to alert and educate seniors and their families to this growing problem. When seniors lose money they may no longer be able to pay for much needed care, assistance, equipment or life-saving medications. You can easily imagine how a senior’s inability to afford care and assistance can lead directly to declining physical and emotional health. Moreover, aging people often become more dependent, both physically and financially, on family members so the effect of stealing trickles down to many more than just the elderly. So well recognized is this burgeoning concern that even the government is now prioritizing concerns to protect seniors by placing them at the top of their 2017 list. Similarly, the Securities and Exchange Commission’s Office of Compliance Inspections and Examinations plans to protect seniors by focusing on deals negotiated between investment firms and the seniors they represent. These firms will now be subject far more than previously to comprehensive reviews and audits. So while the SEC is monitoring financial advisors and their dealings with seniors, is there something we can do today to protect seniors? Yes. One of the most widespread and easiest means of ripping off the elderly comes in the form of the scam. Many seniors are victims of scammers who use the telephone to harass and steal. Remembering that sage advice that ‘forewarned is forearmed,’ here is a list of the top ten scams:
1. IRS impersonation scams
2. Sweepstakes scams
3. Robocall/Unwanted phone call scams
4. Computer tech support scheme scams
5. Identity theft scams
6. Grandparent scams
7. Elder financial abuse scams
8. Grant scams
9. Romance scams/Confidence fraud scams
10. Home improvement scams
This list was compiled by the Special Committee on Aging, and the details of these scams may be found by checking their website. Importantly, this Special Committee also has a fraud hotline (855-303-9470). This hotline is a wealth of great information and a terrific resource as they match victims with the appropriate authorities to investigate fraud cases. It is important to remember that we all have an important role to play in protecting our beloved seniors from financial fraud and abuse. They have worked all their lives for their savings, which is not only a source of pride and independence, but which may also make the life and death difference between getting the care and services they sorely need and going without. So be aware that abuse can also be financial. We are always ready to take action on elder abuse whether it is financial or physical.

Dog Bites: Are there “Bad” or “Dangerous Dog Breeds,” or is this just a Myth?


Are there really specific breeds of dogs that are vicious by nature? There seems to be alot of information that indicates a certain breeds of dog (usually the “pit bull class of dogs”), is more likely to bite than other breeds.  However, is there really any truth to this?  The “pit bull class” includes American Pit Bull Terriers, American Staffordshire Terriers, Staffordshire Bull Terriers and English Bull Terriers.  Some of the other breeds that are listed as “more aggressive” include, but are not limited to:  the American Bulldogs, Rottweilers, Mastiffs, Dalmatians, Chow Chows, German Shepherds, Doberman Pincers or any mix of these breeds, or dogs who simply resemble these breeds.

What did nature intend? While it may be true that some breeds are known to be more aggressive, we need to be reminded that all dog breeds were once known to serve a specific function for us such as their guarding & protecting skills and/or hunting & gathering skills.  Although pets of these certain breeds most likely do not fulfill these original purposes, they do still carry the DNA from their ancestors that can predispose them to certain types of aggression.  So will targeting certain breeds and banning them from your community make you safer?

Some cities are passing “Breed-Specific” laws in an effort to make their cities safer. But does a town with less pit bulls mean less dog attacks or bites? There is no evidence that breed specific laws make neighborhoods safer, (see https://www.aspca.org/animal-cruelty/dog-fighting/what-breed-specific-legislation).

Although these breed-specific restrictions are meant to make the communities safer, they can also cause negative consequences such as:

  •  Families could be forced to move
  •  Dog owners with a “dangerous breed”  may try to stay under the radar may not seek routine veterinary care, including avoiding spaying/neutering and important vaccinations
  • Less community resources for dog licensing laws, leash laws and other laws that encourage responsible dog ownership

What doesn’t seem to be a myth is to always be cautious and careful around any dog! If you find yourself bitten by a dog, regardless of breed, you may want to determine if the owner is legally responsible, and we can help with that analysis.

Do You Know the Early Signs of Alzheimer’s Disease? You Might Be Surprised!



Have you ever had the experience when visiting with a family member that their responses and behavior seems different and a little “off.”  Are they having a bad day or is there something more serious affecting their health? Alzheimer’s disease is a progressive, degenerative brain disease which destroys memory and many other mental functions. This disease affects some 5 million people and is the sixth leading cause of death, though it actually is the third leading cause of death for the elderly. Though there are many types of and causes of Alzheimer’s there seems to be a some common features. Plagues and tangles in the brain are the main feature of this disease, along with the loss of connections between nerve cells in the brain. (https://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-fact-sheet)

But how can you tell if someone is affected by this serious disease? A leading Alzheimer’s expert, Dr. George Perry, the editor of Journal of Alzheimer’s Disease recently discussed 7 signs of early Alzheimer’s disease and some might surprise you:
• Stealing or Significant Behavior Change
• Falling
• Forgetting the use of Objects
• Eating Strange items (such as paper or non-food items)
• Losing their Sense of Humor or Sarcasm (not being able to recognize sarcasm)
• Depression (new onset)
• Staring into Space

This is not an exact list. But what is important is identifying significant behavioral changes which may be indicative of brain changes consistent with Alzheimer’s. So if you notice these signs in a family member it is best to have them evaluated by a doctor.