Working for plenty of Elderly men and married couples who have retired, I learned a few practices....

Working for plenty of Elderly men and married couples who have retired, I learned a few practices that they do when couples are together.


Conversation: Mrs. W to her husband,” How did you sleep?” to which Mr. W replies,

”Morning dear, I slept horribly (by the way this is at 5am). Victor and I had to get up 4 times to use the bathroom and I almost fell the third time. Boy this aging thing is for the birds!”

Mrs. W asks,” What time is your doctor’s appointment?” Mr. W replies, ”It’s next Monday, but today I need to find an insurance paper I have somewhere in the office.”

Victor says, ”I can get that for you Mr. W!” To which Mr. W replies, “No thanks Vic, I can do it, but can you bring me some soup at noon so I can eat while I read?” Victor knowing very well Mr. W won’t eat in his office, much yet look for the paperwork.

Victor says,” Yes sir, what would you like for breakfast?” When Mrs. W turns and says, “I’ll bring it to him Victor, you’re so kind, we will call for you when he’s ready to dress.” See at home health, people eat and then dress, but when you move to a home or facility, it’s dress then eat.

While Victor heads back to Mr. W’s office where he is set up to stay during his workshift, Mr. W, says, “So what else do we have to do today?” “Nothing” replied the wife, “now eat your breakfast dear, I’m to market to get some vegetables for dinner!” It’s 7am.

Walkers, which are the best?

Walkers, which are the best fit? So if you ever need to use a walker, most likely a nurse or physician has diagnosed that you need some type of assistance with your gait. A walker gives the user the opportunity to maintain a straight gait (they way you walk) by allowing the user to hold on to the handlebars of the walker which is used to help you hold your head up by supporting your arms and taking weight off your foot.



The top of the walker should reach the users wrist when they are standing up. Most walkers can rise and lower by a release switch or metal push-in-buttons. Some walkers are made to sit on when you are not using the walker to ambulate. This fold-down chair is only used for short periods and is not used to sit on while transporting someone to get them somewhere faster.


Another helpful tool is the tennis ball which absorbs the vibration of the metal walkers and is used on the BACK of the walker by placing them over the back feet and used as sliders. You can also purchase hard-plastic sliders or you can also put wheels on the BACKS of the standard foldout walker which assist in getting over curbs and obstacles. Make sure a person who used a wheeled-walker is strong enough that the wheels won’t slide from underneath the resident.

They make 4-wheeled walkers but these are acceptable only if the person can use a hand-brake. All 4-wheeled walkers come with a hand-braking system. The best walkers are made in Sweden and are costly.

Remember, the more activities of daily living you can do alone, the lower your cost of entering a nursing home, assisted living or senior living.

Activities of Daily Living includes Ambulation, Pain Management, Alert to Person/Place/Time, Dressing, Eating and so forth.


Activities of Daily Living can be looked at in three ways. 1. Through the eyes of the actual person (the Elderly client/customer), 2. Through the eyes of the Nurse/Decision Maker, and 3. Through the eyes of the caregiver who assists the Elderly client.
What is an activity of daily living (ADL)? Imagine yourself in bed and only the left side of your body works and you are right-handed. You need to get up to go to work, so this usually means going to the bathroom, a shower and shave, right? You then need to get dressed and eat, before you drive to work.

-       To the caregiver, this is how we are to engage our Elderly client, as if every activity of daily living is important. Some residents will only be able to do one ADL on their own, and need assist with the rest of them. So lets say then can shower by themselves, well that is one ADL you can use to maintain their dignity. Instead of washing an Elderly client’s hair, verbally coach them and remind them how to do it themselves.

If they cannot, you an verbally tell them step by step what you are doing, I mean, don’t be weird about it, but let them know, “hey there, I’m about to wash your hair, wanna hold the bottle?” Engage them.

-       Through the eyes of the Nurse or Decision-Maker, aka management, an ADL is an opportunity to measure how much assistance this new client is going to need.


A functional assessment is necessary and the goal in providing care is the maintenance or promotion of ambulation(walking) and independence. Measuring the amount of ADL’s a client can do, assists in measuring cost from a management view and the amount of help necessary to meet those needs diagnosed by the nurse and team.


We must remember reimbursement for physicians who work with the Elderly is low.


-      Through the eyes of the ACTUAL RESIDENT, the person who we are responsible for in our duties, I cannot speak about. I can only say, it is our job (so that when we need healthcare) to make healthcare with the greatest quality, at a low cost, to serve the greatest numbers. But in truth, you only get two out of three.

Remember, the more activities of daily living you can do alone, the lower your cost of entering a nursing home, assisted living or senior living.  Thank you to Quality Care in Geriatrics Settings by Paul R Katz, Robert L Kane and Mathy D Mezey whom I used 2 sentences from their book!

Alzheimer’s Unit, Memory Unit and Reminiscence Hall or neighborhood...

Alzheimer’s Unit, Memory Unit and Reminiscence Hall or neighborhood are some of the terms you will see and hear when shopping for a retirement home, assisted living or nursing home. Many residents who have stage-one Alzheimer’s, will still function very well and need minimal if any, verbal cues (reminders).

What type of people will you see in a memory-impaired, reminiscence or Alzheimer’s unit? In a Reminiscence unit, you will see a variety of races, both genders with varying backgrounds. A Reminiscence unit will have people who are not alert to either person, place or time or any combination thereof.

Being alert to person means if you ask someone who they are, they do not struggle to remember their first and last name. Being alert to place means you ask someone where they are, the person can tell you what location they are at or what city they are in currently.

Last, being alert to time means if you ask someone what time it is and they can tell you the date, another way to determine is someone is struggling with time is to ask them who is the current President of the United States?

Being alert to person, place and time is only an indicator used to measure what type of assistance best serves the Elderly person. There are many people with Alzheimer’s who are not alert to person, place or time, but still live flourishing lives.

king kong john barry remix i did during the storm

king kong john barry remix i did during the storm.

http://www.zshare.net/audio/72767664dc28e6cf/

The alien and the administrator

“But I don’t want to go among mad people,” Alice remarked.
“Oh, you can’t help that,” said the Cat: “we’re all mad here. I’m mad. You’re mad.”
“How do you know that I am mad?” said Alice.
“You must be,” said the Cat, “ or you wouldn’t have come here.”
-Lewis Carroll

Thanks to the Gardner Report for the premise:

Imagine a strange alien from Planet Mars, intelligent but unfamiliar with our ways, walks into a hospital and starts a conversation with the Administrator.

“Greetings! I am new here, what happens in this fine institution?” asked the Space Traveler. The Administrator explains that people who are disabled by illness or injury come here for skilled examinations and judgments to determine PRECISELY what is wrong.

“This often requires great delicacy and wisdom to combat the disability.” Said the Administrator. “Wowzers!” Exclaims the Alien, ” And as the Administrator, the man in charge here, you make all the judgments and order these procedures yourself?”

“Uhh, No,” replied the Administrator, “That is the function of people we call Physicians, who qualify for these roles by long periods of intensive training and observation.”

The Alien visitor stated, “I see, the Physician then, must make many decisions that determine how your resources are used and what work your people do.”

If anything, the Physican also decides which patients to admit and when to dismiss them, thought the Administrator. “So, these Physicians,” said the Alien, “ where do these important people stand in your organization?”

Administrator-“Actually, they stand outside the organization, they are engaged and paid by our customers and a 3rd party, but they must observe our organizational rule and we, by tradition, must not interfere or seek to influence their decisions, and they must pay to insure themselves from lawsuits from those they serve.”

“But you must be joking!” said the Alien, “As anyone can plainly see, such an arrangement would be impossible to manage.”

The Administrator acknowledged it wasn’t easy as the Alien left it said. “Impossible!”

Senior Day Centers

Senior Day Centers play a vital role to the senior community. A senior day center is more than a place where you go to watch TV. The ideal Day Center is not the solution to your family problems. You are the solution to your family problems.

You are the solution.

A Senior Day Center is a business where profit margins are low and caring hearts are plentiful. The Senior Day Center is not the solution to your problems. Very often the staff may or may not have a high school degree and the management may be a new graduate or it may be someone who has worked there 20 years.

The Senior Day Center will focus on your parent or loved one with the greatest possible resources allowed, but it will never compensate for the guilt of the family who leaves a family member there. No one wants to be at a Day Center, other than the staff, who are paid to be there by a non-profit, for profit or the rare individual who owns their Elderly-Serving Business.

The Day Center in your neighborhood is a resource; golden and fresh. EXPECT them to share your burden and they will. They are healthcare at its purest form, they meet a need with the greatest resources available to them. Have patience with the Senior Day Center, they are the mother Theresa of our particular healthcare industry.

They will share your burden but they are not the solution. You are the solution.

Nursing Homes

The term nursing home is a broad term and means many things to many different people. Nursing homes, to many people are perceived as places where one goes to die. “As institutions, they were properly seen as the choice of last resort” (Pratt: 2004 70). The National Center for Health Statistics (NCHS) defines a nursing home as a “facility with three beds or more that is either licensed as a nursing home by its state, certified as a nursing facility under Medicare or Medicaid, identified as a nursing care unit of a retirement center, or determined to provide nursing or medical care” (Evashwick 1996: 44).

As the years have gone by, nursing home care, the facilities and the quality of care has greatly improved. Nursing homes are now commonly referred to as rehabilitation centers, skilled nursing facilities, health care centers, etc. according to Nancy Ferrone (2010). However, while much has changed over the years, there will always be issues that need to be addressed regarding nursing homes.

Nursing homes have evolved greatly since the beginning of the 20th century. According to Linda Zinn (1999), there were many fortunate elderly during the early 20th century who had families who were able to care for them. Others may have been cared for by religious or ethnic communities. However, those who were less fortunate often found themselves in poorhouses. “And poor it was in every way: poor (if any) sanitation, poor food, poor clothing, poor sleeping arrangements, no nursing care and little, if any, medical care” (Zinn 1999: 22).

The non-profit homes which were sponsored by churches and other services for the communities did offer more quality care to those who were in need of housing and other services, but they (like the poorhouses) did not provide nursing care in the very early years according to Zinn (1999). As the years went on, these “nursing homes” evolved and grew out of the early charity-based forms of care. “They really came into their own, however, when the federal government became involved with assisting the needy, beginning with passage of the Social Security Act in 1935” (Pratt 2004: 70).

Nursing homes provided an institutional alternative to extended hospitalization. Hospital stays began to increase in price and therefore there became a need for less expensive places of care. “Nursing homes also served (and continue to serve) as homes away from home for the elderly and others needing assistance with daily activities and some level of medical care merely to survive” (Pratt 2004: 70). “Today, they are filling a greater and ever expanding role in the community.

The objectives of the modern nursing home are of a positive and challenging nature” (McQuillan 1974: 3). According to McQuillan (1974) the objectives are:

1. To provide continuing care for those recovering from surgical or medical disorders.
2. To assist patients in reaching optimal physical and emotional health.
3. To provide for the total needs of patients- physical, emotional, and spiritual.
4. To assist the aging toward an active participation in life.
5. To provide for rehabilitation services when the need exists.
6. To work cooperatively with other community and social agencies.

Assisted Living

Assisted Living Facilities began as an alternative to retirement homes and came about in the 90's. Assisted Livings were the first to use the "Aging-In_Place model. This model is meant to keep the resident in the Assisted Living for the rest of their life. Aging in place is a model that meets the needs of the resident as more and more assistance is needed.

Though it is honorable to want to keep a resident in an assisted living, very often, after a fall, heart attack, stroke and so forth, you will find that a resident is still placed in a nursing home until that resident is deemed able to fulfill their activities of daily living with little or no assistance.

If more care is needed for a resident in an assisted living, a re-assessment is usually done every 6 months or after a life changing incident such as a fall, memory impairmenent worsens, a stroke, heart attack. At this assessment, the nurse, the assisted living director and a staff member may gather all the notes, charts and doctor's orders together and decide if a resident is in need for more care.

If more care is needed in an assisted living after a major incident occurs, the level of care may be bumped up to a level two, or ++ which are ways of determining a resident is in need of more assistance then before therefore causing a rise in care and a rise in cost.

Tomorrow, Nursing Homes.

thank you for visiting

Dear Visitor,

I am Victor and I thank you for using Verycare.9f.com.

How To Overcome Complications From Type 2 Diabetes

HOW TO OVERCOME COMPLICATIONS

It is not the high and low levels of your blood-sugar that determines its affects to the body. It is the average that may develop other health problems. Complication may be prevented using medication, altering our habits and exercising regularly. You may also be able to reduce the amount of prescription drugs you are taking-reducing prescription drug cost and lowering our Medicare spending.

There are 4 major areas that are affected by diabetes:

-the nerves
--kidneys
---eye damage
----heart damage ADA 2000

Diabetic neuropathy is caused when people have had diabetes for an extended period of time. According to the National Diabetes Information Clearinghouse, there are 3 forms of nerve damage:

-Peripheral neuropathy-most common affect is feet and legs
-Autonomic neuropathy-internal organs that function automatically
-Mono-neuropathy- affects a single nerve, commonly the eye

High blood-sugar levels damage nerves. Symptoms, according to the American Diabetes Association, may include:

-prickling, burning feeling
-bladder infections
-diarrhea
-fainting
-vomiting
-loss of feeling
-weak muscles

To prevent these symptoms, if you have diabetes:

1. Keep blood-sugar levels controlled and know your blood-sugar level history
2. No smoking or reduce the amount your smoke
3. Little or no alcohol
4. Eat healthy
5. Exercise

KIDNEY DAMAGE

Also called, nephropathy, kidney disease is the result of damage to the cells in the kidney. The kidney is a filter for the blood stream. Over time, diabetes may affect the kidneys so that proteins are lost in the urine.

Have your physician check your urine once a year or more if you have had a change of condition. There are no symptoms until it is to late, when it comes to the kidneys. Keep your blood-sugar levels at a normal range and keep a history of your blood-sugar levels.

Kidney damage CAN NOT be reversed.

EYE DAMAGE

Diabetic retinopathy is a confusing word for an eye disease in the small blood vessels. These vessels swell and leak and sight is blurred. 80% of people with retinopathy do not go beyond stage one.

HEART DAMAGE

Diabetes may also cause your arteries, veins and capillaries to function improperly. This can cause a stroke, if left untreated. Your blood may clot too easily, or blood vessels may be narrow in which the vessels are used to carry blood that takes away waste and brings in nutrients. Symptoms can include:

-itchy skin
-erection problems
-high blood-pressure
-infections in the skin

To avoid symptoms that cause damage to the body, please:

1. Keep blood-sugar levels under control and maintain a blood-sugar history
2. Don’t smoke as much
3. Lower fatty food intake and incorporate NO salt into your diet regularly, not always but regularly-schedule them into your week
4. Exercise regularly-schedule exercise into your weekly schedule, remember there are 10080 minutes in a week
5. Lose weight if you need to
6. Check your feet regularly

You can do it! Very Care can offer assistance if you need it for a little while. by Martivic. Thank you www.alegacypersonalcarehome.com

18 Questions to Ask a Nursing Home or Assisted Living to Save You Money

18 Questions to Ask an Assisted Living or Nursing Home to Save You Thousands of Dollars
Victor Martinez, 2006

We are looking for a publisher. verycare2008@gmail.com for assistance in this area
The cost incurred in a nursing home or dues, fees and rent pay assisted living facility.

The fees that remain the same for each person in an assisted living home are ones that may include:
Laundry, community fees, dining room, housekeeping.

The fee that is the most expensive is the fee incurred while giving care to a resident in a facility or home. This determines if the resident needs minimal assistance vs. maximum assistance the home is willing to tolerate.

This will vary from home to home.

A facility may be willing to take a resident who needs 3 people assistance while dressing while another home may not tolerate this type of care.

A home may choose to not accept a 3-person assist resident, because a home that serves 60-70 residents will only hire 5-8 caregivers during an 8-hour shift. Though a person who requires 3-person assist when dressing (will most likely be charged the max amount in assisted living care), a home may reject that applicant because it is not cost efficient for the home.

The higher the level of care needed for an assisted living resident, the higher the bill. If a person is oriented to person, place and time, they will receive a better score than a person who needs constant reminders to person, place and time

A potential applicant for assisted living may be incontinent person who struggles 3-4 times a week vs. a resident who is incontinent 3-4 times a day. There is more potential that this will hit the pocket two times because a person who needs assistance with their incontinence will require more caregiver hours during the day and will require more 1 on 1 assistance 3-4 times a day.

The second hit to the billfold occurs when the resident is charged for supplies used for dealing with incontinence. Higher cost incur due to the frequency of incontinence.


Why are these questions important for nursing homes and assisted living facilities?

1. Do I have the right to know?

The ombudsman program is a federally funded organization whose only job is to advocate for seniors and their families. They also protect seniors from their own families from time to time.

This program protects seniors from financial exploitation, physical and mental abuse. When it comes to your senior loved one, they have the right to let you, or not let you see their personal documents.

As your loved one turns over their documents, remember, that a good facility will do the same. If you cannot resolve an issue regarding disclosure of any type of document, just remember to communicate, remain calm and remember that all parties involved, most likely want to provide the greatest care for that facility and resident that they say they can provide.

Most people in healthcare fields care for their job and have chosen or been blessed to be hired the healthcare field because most administrators have a caring heart. You have the right to provide any questions in writing to your facility. Give them time if you can.

One season I was brought on to a facility that was in a chain. This home was the last place, revenue generating home in the State and the Executive Director instructed me that we would become #1 in one year.

How? A resident who takes longer and longer to dress, bathe, feed, toilet or walk, takes more time to assist. As the level or ability to accomplish Activities of Daily Living-such as dressing, bathing, eating, walking/transporting/ambulating, orientation to person, place and time-starts to decrease, staff notices the change in the resident.

As time of care increases, word is brought to the manager whose job is to make sure that the resident only receives the care they pay for. To go above and beyond in healthcare constitutes time and money. The time it takes for 2 staff members to bathe a 300 lb. woman is long when compared to a thin, healthy, frail-male who only needs to be reminded to shower daily.

2. What is your census now?

A census is a term used to describe how full a facility or chain of facilities can be. When the executive director meets other executive directors a common question is "How's your census?"

A census is one indicator in determining a nursing home's or assisted living facility's ability to take its mark in the community. Some questions that add value to determining factors when searching for a facility may include…

1. Do you have a waiting list? How long?

2. Do you use SPIN selling?

SPIN selling is a selling tool used to build long-term contacts in the community such as inviting community to 4th of July barbeque, learning your pets names or having a polling place in the facility and these types of techniques can be used to reach potential clients.

A husband and wife moved into a facility where I was a caregiver. They had lived there one month; their family intelligently moved them across the country into a place that could provide a safe environment for this couple.

One morning, I was in the dining room setting for breakfast for about 30 residents, when a fellow staff member told me the husband collapsed in their bathroom and could I get up there now.

I ran upstairs; I was just in their room 15 minutes ago to check on their dog. The husband had just come back from a short hospital stay and I got used to walking their dog outside to pee so the carpet didn't smell, and I liked the dog.

I opened the door and saw the man on the floor, mouth open. I ran and found another co-worker. I called 911, the nurse at home, called my boss and called the responsible family member.

All came rapidly, as it was a Sunday. As I did mouth-to-mouth, his wife and dog watched.

I bonded with those two that day. I was blessed to be there, I never thought that until just this moment.

3. When do you re-assess a resident?

A home or facility may choose to reassess the level of care that is provided for a resident. The facility may reassess if a resident goes to the hospital due to an event such as a slip, heart attack, stroke or hip/bone fracture. The facility wants to make sure the level of care provided for that resident will be sufficient upon their return.

If the level of care goes up you may want to know ahead of time if the cost will go up also.

One time, I was a coordinator of an Assisted living and two sisters who were in their 50's came in my office. Their mom lived in the facility I worked in. I was 25 and they were very nice but very tough customers. It felt like, every time the daughters came to the facility to say hi to their mother, they would find an incontinent product (depends or disposable underwear) tucked in the couch or hidden in her closet.

One of the daughters cried when she told me this, out of frustration and also the fact staff wasn't in her room often enough to remind her to use the bathrooms. Her mother had lived there less than 6 months and "professionals" say it takes 6 months to 2 years to adjust to a facility, family included. I believe them.

I asked the daughter if she had any trashcans that were her mothers. The daughter thought and said yes, they had her kitchen trash can at home. We brought it in, put it right in the bathroom and it worked.

4. How many LPNs per residents?

An LPN is an assistant to the nurse and is responsible for passing medications amd is a valuable employee.

5. How much is a room at basic service for a client at minimal care?

A facility will assess a potential client on that person's ability to function daily. This is a standard procedure and can be a useful benchmark in determining what kind of care will assist the senior in living life to its fullest to the best of their abilities.

Caring for a resident who is 300 lbs, doesn't walk and doesn't dress himself or herself, can cost more than someone who can dress and bathe themselves. Yet, if someone can dress himself or herself and they're at risk for wandering, the cost may increase.

Make sure you can determine what the regular standard of care is and how much it is and what kind of care your situation demands. I mean, if you want to upgrade your flight or hotel room, wouldn't you want to know the cost?

I once had a client with M.S. I was 23ish and he was in his late 30's and very thin. His body was balled up 95% of the day. When he needed to move from a wheelchair to a bed, I would lift him from his wheelchair and he would grab my shoulders and I would transfer him to a bed, where he would relax his body 8-10%, and if you touched him he would ball up or tighten his muscles again.

Damn M.S.

6. How much additional is incontinence care at the minimal level?

Incontinence products, such as wipes, gloves, disposable underwear and such items, are considered additional expenses when running a facility. If a senior loved one needs these items, it may be possible to bring them yourself. Just ask the staff to please label the items or label them yourself. Ask a caregiver or C.N.A. to replace any items they use because emergencies may occur on a hall or floor and sometimes it is easier to grab what supplies are the closest when assisting a resident.

Knowing the minimal cost for incontinence care and supplies is important because a resident who uses 3 pairs of disposable underwear takes more time in caring for in most instances.

A resident who uses one pair of disposable underwear for all day, may spend less on supplies than someone else. The nice thing about letting the facility stock the supplies is the convenience and most often, employees respect the residents' supplies.

7. How many nurses per resident per home?

Some facilities will have a nurse per hall or wing. Some facilities will have one nurse or no nurse even. Some facilities have a nurse or service on standby with a hospital nearby.

What is important is the response time or how available the nurse is when issues arise over time. These issues include incontinence, medication, eyeglasses, hearing aids, walkers and wheelchairs. Hopefully, the nurse(s) you communicate with love their job and aren't swamped with paperwork.

Nurse duties in a facility may include the following: Resident Assessments upon move in, oversees medication and ordering, if you pay for it; therapy ordering and consults, LPN management and Hospice set up and communication.

They also must ensure DNR (do not resuscitate) orders are available if needed, keep track of the resident's personal medical history including medications. In some capacity, this information about each individual resident if kept in their office.

8. How many clients have decubs?

Decubitus is a skin breakdown. If you have ever been sick with the flu for more than 4 days, you may notice a rash or pimple somewhere on your body. Seniors who lose their ability to ambulate (walk), or move while sitting, will begin to irritate their skin.

Areas that receive the greatest and most pressure, such as backside, or backside of legs, knees and arms. F.Y.I, if your loved one loses the ability in the short-term, to ambulate or move, do it for them. Literally lift their arms and exercise them and move their legs if possible. This helps get blood to the extremities of the arms and legs.

Residents with Decubes are documented- or should be according to law. Staff, who may assist your mother with morning dressing or bathing a father at night, will notice any new skin lesions. This is reported to a care manager or coordinator, who tells the nurse and/or documents the problem area.

A nurse administers some type of wound care or even hires out a wound care company whose job is only to get a stage 2 or 3 wound to heal. This may involve the use of physical therapy if necessary.

One time I had a senior resident and I was the coordinator for Assisted Living and she developed Type2 Diabetes, which led to symptoms that effected blood flow to her leg. 2-3 times a week, wound care people would come and try to help her with getting blood to flow through her veins.

They would come and get on their knees and did their best to physically help her. She lost her leg. But she came back months later and adjusted.

And once again, people from wound care came back took care of her stub and taught her how to protect her stub. They also ordered physical therapy for her so she could learn to ambulate in a wheelchair.

9.How many are on wound care now?

Generally speaking, a facility that cares for many residents who are on wound care at one time either….

1. take in the residents that are most difficult to physically move and do their best to pay attention to residents with wounds so they may heal and get of wound care because it is not free.

2. or staff is not doing all they can or not being provided with the resources they need to physically move residents or assist in physical therapy instructions to do more on their own.

3. sometimes residents may be dying or on hospice care. These residents still require and deserve wound care everyday if needed.

Make sure facilities are documenting wound care incidents when they occur, it's the healing process and length of time to heal that is an important determining factor.

I worked in a facility and I was in charge of a team of caregivers and every morning we would serve in the beautifully pink and rose dining room already set from the night staff. Bacon was cooking in the kitchen and I would pour cereals as the other caregivers assisted other residents with their A.M morning routine described in the resident's care plan.

Each staff member brought their perspective residents and had the same hall every time they worked, unless we were short on staff, which was not often.

Our kitchen dishwashers were not finding a reason to stay there so the turnover rate was high and still-the caregivers pulled in and washed the dishes because it had to be done.

10. What is your turnover rate for caregivers?

In any business it takes thousands of dollars to train a new employee and takes many months for the employee to adjust to a new position. The employee should be given time to train and make mistakes in their first year. The importance of maintaining a stable environment is very important when it comes to strangers going into a resident's room.

Providing a safe environment cannot be bought. It comes with training and time. Constant training and or learning should be done with any staff to make sure they grow in their positions and are given opportunities to prove themselves as management.

If a facility does have a high turnover rate and you move into the facility anyway, you will know if the turnover rate is high because you will see new different faces very often.

This can be damaging for many residents. They need stability.

A caregiver is responsible for documenting incidents in a facility. Do they know how to read and write in English?

Caregivers physically and mentally provide constant care. Stability is greatly needed in the care of seniors. Facilities with high turnover rates will no be able to provide this stability to your loved ones, for the most part.

11. How many decubes last year?

Residents move in to a facility to get their skin-breakdown issues dealt with. They shouldn't move in and then get skin-breakdowns. Are residents getting better when after they move in?

12. How many incidents of theft have been reported?

An incident of theft is always tough to deal with. Making sure a facility follows through with their procedures is very important. What is the policy on theft or missing items? If a shirt gets lost in the laundry, who pays for it?

When an incident of theft occurs in a facility, will the facility document the incident? They should document the incident and though it is tough to ask, it is important to know.

If you went to a hotel, would you want to know if that particular hotel had incidents of theft lately? You can replace real diamonds with fake ones for your own security.

A resident may feel their only way of reaching out is a pull-chord. Late at night and all alone, fragile, yet a life fully lived and able to carry more than we believe.

Still, a call for help may seem desperate, too loud or too pushy. The pull-chord should be a call to give residents better tools in dealing with stress, pain and/ or loneliness.

A home who checks on residents and cleans up if they are able, give residents a feeling of protection, knowing caring staff are awake at the facility 24/7. Everyone appreciates stability. Stability equates to smart employee investment by the organization. Employee investment equals better employee retainment.

13. How long does it take to answer a pull-chord?

There are two answers to this question. Answer number one is the one you want to hear. Answer number two is the truth.

If you are allowed, ask a current resident of the facility how long they wait when they pull the pull-chord. I've had family members of residents pull the chord to see how long the response time is, but they've already moved in the facility.

A pull chord is used in strategic locations in any assisted living or nursing home and senior living.

Independent living may or may not have them. In an emergency, a resident or staff can pull the pull-chord to call a team or single person to a room depending on the facilities procedures and policies. They must align with the state regulations protected by an ombudsman program

I worked as a caregiver for a man who every night before I left, I called the staff to come in to come tie him down, because he was a risk.

He had a catheter and dementia and if he got out of the rickety, 1960's bed they had, he would have hurt himself real bad. They didn't have the staff to check on him every ½ hour. Honestly, that would be tough to promise.

Though he was in a safe environment, I remember his eyes and the way they followed me when I left.

14. Do you ever tie down your clients ever and why?

It happens. Just ask first. If a place says yes, do not be quick to judge them. Ask them their procedures and if the state ombudsman knows they tie down residents. They may or may not know.

If someone is tied down for whatever reason deemed necessary, such as harm to others or themselves, they should be check on every fifteen minutes and the straps should be re-adjusted often. This should all be documented if it occurs.

15. Do your employees receive health benefits?

Do employees or employers pay? A caregiver or C.N.A makes less than $13 an hour, maybe more in a hospital setting. Offering insurance and providing insurance is two different issues.

16. How many lawsuits against your last year?

Is the facility in the midst of any legal turmoil? Any suicides within the last year? A lawsuit does not imply guilt or fault.

Do lawsuits affect the culture of the organization? You don't need to be nosy but disclosure of some kind is nice if were talking about caring for the lives of people.

17. What types of insurance do you take?

Insurance is a very complicated issue and out of my scope of responsibilities. I do know that a few services provided in a facility that may take insurance of some kind or Medicare: Medication and Administration, Physical Therapy, Equipment, Vision, Dental, Wound Care and Hospice.

If may help to know if your insurance or Medicare benefits are accepted.

18. Do new residents choose their seating in the dining room?

This question is very important. Imagine living somewhere new, going to a place you really don't want to be, you sit down for dinner and someone tells you to move because Mr. Smith sits there.

It happens often. When you visit a home as a potential client, you sit in the private area or get special seating. After move-in it may be different.

Do residents sit where they like or is their assigned seating? Do they get to choose a time to eat or do you have a 1st and 2nd seating? Do we get monthly food credits or do we pay per meal? Are wheelchairs allowed or must residents transfer to a chair? What if residents cannot feed themselves? Do you track weight changes in residents?

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assisted living and nursing home directory usa 2008

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