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A couple of weeks ago, I posted a story about a remarkably good book about long-term care: It Should Be This Way: The Failure of Long-Term Care. One of it's authors, Dr. Robert L. Kane, agreed to take questions from readers. I also posted the story on my blog, Time Goes By.
Here are his answers:
From Cop Car:
Dr. Kane, what is your experience with the Long-Term Care Ombudsman program that is federally mandated to be in place in each state of the US? Although the ombudsman's jurisdiction is only within state-licensed facilities, I should think that the program would be having a distinct impact.
KANE: The ombudsman program was reviewed by the Institute of Medicine a few years ago. Its performance varies across the country. In many areas it is a useful source for advocacy, but it tends to be reactive rather than proactive. It investigates complaints but it does not often pursue an agenda to change the system.
Does the statement, "...40 percent of all adults in this country who live to age sixty-five will enter a nursing home before they die" include those who use a nursing home in the short term - for a few weeks following surgery, for example?
KANE: You are quite correct. That quote does include short-term, post-hospital stays in nursing homes, which are usually covered by Medicare. They account for at least half of all nursing home admissions today, probably more, but they account for far fewer days of nursing home care.
Comment: The statement, “Because family, not the resident, is often the real customer...." reflects unethical behavior. If the resident is not considered to be the "real customer", their best interests are not being served.
KANE: There are at least two implications to this observation. 1] Many nursing homes and other agencies that serve older people see the familiy as a major target. For better or worse, families do play a big role in decision making. Even when older clients are competent to make choices, many rely on (or confer with) their families. 2] Many older people are not cognitively competent to serve as their own agents; in those cases family members may serve as their agents.
From Darlene
From a reader in her 80s who lives (I believe) in San Francisco:
My question for Dr. Kane is: "What are the ramifications financially of moving from one state to another after becoming disabled?" I am low income and cannot pay for more than 3 months care in a nursing home so would need public assistance.
KANE: The residency rules for Medicaid eligibility (and for financial eligibility) vary from state to state. You need to check on those for the state to which you plan to move.
From Mage who blogs at Day Tripper
My husband and I are taking care of an old friend. Four of us have formed a sort of caretaking committee to take care of our friend Duck. (He stutters and Dick became Duck one day.) One of these friends is ill. One travels. Another lives out of state. My husband has his power of attorney and medical power of attorney, so we are the ones who are there with him every day.
There are millions of elders who, like Duck, have only their Social Security and Medical. Single men or women, gay or straight, who find themselves with Alzheimer’s or dementia also find themselves helplessly unknowing. If Duck hadn't had friends to take him to the hospital when he had a thrombosis in his brain, anything could have happened that day.
And again when he fell later at home, we are all so grateful that he remembered how to use the speed dial on his phone. Again hospitalized, and this time placed in long-term nursing care, he can't be put on the street but is unwanted.
He's so like many others - dapper, dressed perfectly, charming, smiling, and - unable to remember anything that happened during his day. We care. We are there every day. We follow every suggestion and because they don't have a bed for him there, we have been on hold waiting for a final decision for two months.
There are so many like me writing blogs everywhere...
If there are any suggestions on how just friends can help an older friend when dementia or Alzheimer’s has taken their lives away, we would appreciate it. What preparations could be made in advance for the single person who has no family or few friends remaining?
Thanks.
KANE: Duck is very lucky to have friends like you.
