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Toledo’s newspaper The Blade did an important article on state inspections and the nursing home rating system. Attorney Nancy Iler was quoted and contributed her opinions on this important topic. Read the entire article here http://www.toledoblade.com/local/2018/06/15/Inspections-rate-three-nursing-homes-in-Lucas-County-as-lowest-overall-score(copy).html

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

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

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.
Don’t forget to join our mailing list to continue to receive news about nursing home abuse, Ohio injury law, and related topics.

Reference Links:
http://www.mcknightsseniorliving.com/news/dementia-risk-can-be-reduced-even-in-late-life-report/article/676597/
http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)31363-6.pdf

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, 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.

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.