Continence and Toileting
Urinary incontinence is the inability to control the bladder. It is one of the most common reasons people seek nursing home care. Over half of California nursing home residents are considered incontinent. Incontinence and lack of toileting assistance cause many serious problems, including discomfort, skin rashes, pressure sores, falls, isolation and psychological harm.
Incontinence is not considered a normal part of aging and is often reversible. Many times it is due to medications or temporary, treatable health conditions. The law requires each resident with bladder or bowel control problems must be promptly assessed and be provided treatments and care that can improve the condition.
In particular, catheters cannot be used simply for the convenience of the staff and thus, without medical justification. Catheters cause discomfort, limit mobility and increase the risk of infection, bladder stones and cancer. If a catheter is used, the nursing home must provide appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible.
A large percentage of nursing home residents need help with toileting. The most common examples include a resident with limited mobility who may need help to reach the toilet or a resident with dementia who may need reminders to use the toilet on a regular basis. Nursing homes must help these residents use the toilet whenever needed.
Legal Requirements of Nursing Home Care
General Legal Requirements
By law skilled nursing homes are required to help each resident attain or maintain the highest practicable physical, mental and psychosocial well–being. Unless it is medically unavoidable, nursing homes must ensure that a resident’s condition does not decline. Care, treatment and therapies must be used to maintain and improve health to the extent possible, subject to the resident’s right to choose and refuse services.
Specific Accommodation of Resident Needs
Resident have the right to receive services in the facility with reasonable accommodations of individual needs and preferences. This means that the facility should attempt to adapt such things as schedules, call systems, staff assignments and room arrangements to accommodate residents’ preferences, desires and unique needs. If language or communication barriers exist between residents and staff, the nursing home is required to use interpreters or other measures to ensure adequate communication.
Staffing Requirements
The overriding legal requirement is that nursing homes must have sufficient nursing and other employees to meet the needs of each resident in the nursing home at all times. Additionally, California requires skilled nursing facilities to provide a minimum of 3.2 hours of nursing care per resident per day. If this staffing level is not adequate to meet resident needs, the nursing home must employ as many licensed nursing and certified nursing assistants as are needed. In a clearly visible place, a facility must post daily, for each shift, the current number of licensed and unlicensed nursing staff directly responsible for resident care.
Care Planning
Care Plans are the instruction manual for how to properly care for each resident. Nursing homes must establish a comprehensive, individualized care plan for each resident that spells out exactly what their care needs are and how the facility will be meet them. Do not hesitate to ask to see your loved one’s Care Plan and discuss with the facility administrator or director of nurses the care needs of your loved one and whether they are being met.
How to Choose a Skilled Nursing Facility
Choosing the best skilled nursing home for a family member is an important decision. We recommend starting your search with the online guide available at www.nursinghomeguide.org. This guide is maintained by the non-profit organization Californians Advancing Nursing Home Reform (CANHR). It has in-depth information on all 1300+ nursing homes in California, including interactive searches, comparisons and details on violations, staffing and services. Get started by using Nursing Home Guide to learn about nursing homes in your community and find out about their histories of complaints, deficiencies and citations. Additionally, lists of nursing homes by county are available at CANHR’s main websitewww.canhr.org.
Personally Visit the Potential Nursing Home
Next, it is essential to personally go and walk throughout the potential nursing home. Does the home smell? Are resident’s calling out uncontrollably? What does the food look like? Does this look like the type of place you would be willing to stay in if needed?
Resident and Family Councils
Good skilled nursing facilities have organized Resident and Family Councils. These groups are involved with staff in making sure that residents receive the care they need. Ask to speak with someone from either the Resident or Family Council about their experiences at the facility. If the facility does not have an organized Resident or Family Councils, then definitely ask to talk with some of the facility’s current residents and/or their families about the care and conditions that they are experiencing.
Location
Convenient location should help facilitate more frequent visits and residents who have frequent visitors often recover faster, are happier and tend to receive a higher quality of care. When family members and friends are close enough to visit frequently, they can monitor the resident’s condition, participate in care planning and respond quickly to emergencies.
Special Needs
If your loved one has special medical needs make sure that the facility can attend to these needs. Specifically ask to interview the special needs care providers directly to insure that they can meet your loved one’s special needs. For example, some residents need specialized respiratory care, such as a ventilator, that is only available at certain facilities. Or an individual may need extra supervision and assistance due to behaviors associated with dementia. Ask detailed questions to make sure facilities under consideration are currently able to provide the necessary care.
Recognizing and Preventing Fraud and Scams
Fraud involves deception resulting in injury to another. Most commonly fraud involves concealment, misrepresentation or nondisclosure of material facts. Statistically seniors are defrauded more often than all other age groups combined. Some of the most common frauds and scams include:
Financial Advisors and Investment Scams: Watch out for investment seminars and advisors promising get-rich-quick schemes or guaranteed returns. Always research the investment before investing. Call the toll-free hotlines at the Department of Corporations 1-866-ASK-CORP or Seniors Against Investment Fraud 1-866-275-2677. Don’t be pressured into into investing. Don’t invest without talking to a trusted friend. Don’t invest more than you can afford to lose.
Living Trust Mills: Watch out for “trust mill” marketing schemes. They usually start at a public seminar and “free” meal. Then they offer a very low price to prepare your living trust; which is really just a slick boilerplate binder with your name and data inserted. Finally, they reveal their real motive which is to sell you an annuity which will pay them thousands to tens of thousands of dollars in commissions. Don’t buy any annuity without investigating it. This means investigating the issuing company and comparing the terms of the annuity to at least three other companies. Always make sure you understand what commission the agent will be making on the sale and don’t buy without talking to a neutral financial advisor about your overall asset situation and whether an annuity should really be part of your overall investment portfolio.
Door-to-Door Solicitation: Almost anything can be sold by these salesmen and this alone should cause you to be very suspicious. Most cities require that they have a business license and you should ask to see one. The Better Business Bureau should also be consulted www.bbb.org as well as at least three past client references who you can meet and discuss the salesmen’s past work or services with.
Charitable Donation Scams: While we all want to contribute to worthwhile causes, sadly fake charities exist as well. Lawful charities must be registered with Attorney General’s Office and you can check by phoning them at 1-800-952-5210.
Medi-Cal Scams: The salesperson without any knowledge of the seniors medical history or finances, convinces the senior that most likely they will need a nursing home and that the costs of the nursing home care will devour their life savings and result in them losing their home. To avoid this financial ruin the senior can pay a sizeable amount, typically $10,000-$20,000 and the salesperson will show them how to avoid financial ruin. After the senior has paid the salesperson they are advised to immediately give away their assets. This sudden poverty will then qualify them for Medi-Cal which will pay for their nursing home care when needed.
What the senior is not told is that the State of California is well aware of this scam and has financial look back provisions typically covering the 36 month period prior to Medi-Cal eligibility. Don’t fall for this fear based sale and flat fee fraud. If you are sincerely interested in qualifying for Medi-Cal you can directly contact your local Med-Cal Office or contact the senior advocacy group CANHR 1-800-474-1116 to help you find a qualified attorney who can correctly qualify you for Medi-Cal or advise you as to other options.
Bedsores Definitions and Stages
A bedsore is the common name for a pressure sore or pressure ulcer. Bedsores are caused by prolonged pressure on the skin. Typically they develop on bony areas of the body such as heels, ankles, hips and buttocks. Bedsores are categorized or “staged” based upon severity. The National Pressure Ulcer Advisory Panel defines each stage as follows.
Stage I
The beginning stage of a pressure sore has the following characteristics:
- The skin is intact.
- The skin appears red on people with lighter skin color, and the skin doesn’t briefly lighten (blanch) when touched.
- On people with darker skin, there may be no change in the color of the skin, and the skin doesn’t blanch when touched. Or the skin may appear ashen, bluish or purple.
- The site may be painful, firm, soft, warmer or cooler compared with the surrounding skin.
Stage II
The stage II ulcer is an open wound:
- The outer layer of skin (epidermis) and part of the underlying layer of skin (dermis) is damaged or lost.
- The pressure ulcer may appear as a shallow, pinkish-red, basin-like wound.
- It may also appear as an intact or ruptured fluid-filled blister.
Stage III
At this stage, the ulcer is a deep wound:
- The loss of skin usually exposes some amount of fat.
- The ulcer has a crater-like appearance.
- The bottom of the wound may have some yellowish dead tissue (slough).
- The damage may extend beyond the primary wound below layers of healthy skin.
Stage IV
A stage IV ulcer exhibits large-scale loss of tissue:
- The wound may expose muscle, bone and tendons.
- The bottom of the wound likely contains slough or dark, crusty dead tissue (eschar).
- The damage often extends beyond the primary wound below layers of healthy skin.
Bedsore Prevention
Bedsore prevention involves a few basic task practiced consistently. These task include relieving pressure by turning or repositioning the elder every 1-2 hours. Use pillows, towels or a pressure relieving mattress to assist in reducing pressure. Keep the skin clean of feces and urine and keep the skin moisturized. Proper hydration and nutrition, especially adequate protein intake, is essential in preventing bedsores.
Treatment of Bedsores
Treating bedsores requires a multidisciplinary approach. This should include:
- A primary care physician to oversee and modify as needed the treatment plan
- Treatment nurses specializing in wound care
- A social worker who educates the resident or family and addresses emotional concerns related to long-term recovery
- A physical therapist who helps with improving mobility
- A dietitian who assesses nutritional needs and recommends an appropriate diet
- A neurosurgeon, orthopedic surgeon or plastic surgeon, depending on whether surgery may be required and what type of surgery is needed
Complications from Bedsores
Serious infections are the most common complication of bedsores. These include:
- Sepsis. Sepsis occurs when bacteria enters your bloodstream through the broken skin and spreads throughout your body — a rapidly progressing, life-threatening condition that can cause organ failure.
- Cellulitis. This acute infection of your skin’s connective tissue causes pain, redness and swelling, Proper hydration and nutrition, especially adequate protein intake, is essential in all of which can be severe. Cellulitis can also lead to life-threatening complications, including sepsis and meningitis — an infection of the membrane and fluid surrounding your brain and spinal cord.
- Bone and joint infections. These develop when the infection from a pressure sore burrows deep into your joints and bones. Joint infections (septic or infectious arthritis) can damage cartilage and tissue, and bone infections (osteomyelitis) may reduce the function of your joints and limbs.
Because of the seriousness of these infections and the compromised medical condition of most nursing home residents, death is not an uncommon result following a stage III or IV bedsore and resulting infection(s).
Sacramento Bee, November 2011
Roseville Press Tribune, November 2010
Nurse pleads no contest to elder abuse, possession
Article: Redmond Files Class Action Against The Terraces of Roseville Over Nurse Delp’s Stealing Medications.
Sacramento Business Journal, May 2010
Lawyer files 503 claims for wronged seniors
Article: Sacramento attorney Mark Redmond pushed piles of paperwork across the counter at the Secretary of State’s office May 14 in what could be the last hope for 503 seniors to get back the $7.5 million they paid former Roseville attorney and senior adviser James Walker.
Sacramento Business Journal, January 2010
Walker resigns, creditors see two paths to recourse
Article: The State Bar is shaping up as one recourse left to hundreds – if not thousands – of clients who claim Walker never did the legal work they paid for.
Consumer Reports, September 2009
Reversals of fortune The next financial fiasco? It could be reverse mortgages
Article: Use of the loans is exploding as lenders-who shoulder almost no risks-push them to the growing ranks of retired baby boomers, especially for spending on vacations, new cars, and more.