Friday, July 26, 2013

What and who do I believe....

We live in a technology age where information is at our disposal with the click of a button.  My motto is do not always believe everything you read.  There is much more to any agency than what you read about them.  All information can be valuable if used correctly.  Below are some links to research skilled nursing facilities in Texas.  I recommend pulling up the information, then if there is something that concerns you, ask them about it!  Sometimes what really happened is as severe as it sounds, and sometimes it is completely different from what you are expecting.  Take the time to ask the facility about your concerns.  Often times facilities put a plan of action in place to fix any past problems and they should be able to discuss in detail how they are combating that particular issue.  The technology we have is valuable, but we cannot forget the basics of building relationships, using our intuition and making a well informed decision based on more than just information we got at the click of our fingers!

Texas Nursing Home Compare

Federal Nursing Home Compare

Wednesday, October 17, 2012


Q: I’ve heard if I place my loved one in a facility while they are still continent they will become incontinent immediately?

While individuals become incontinent at times as their particular disease progresses, admitting to a skilled nursing facility does not automatically equal incontinence.  Skilled nursing facility have programs such as the bowel and bladder program to help facilitate continence and maintain your loved ones independence as long as possible.  The bowel and bladder program is a study of your loved ones daily schedule.  This allows staff to accommodate and assist at the appropriate times to ensure continence remains as long as physically possible.     

Monday, September 24, 2012


I often get the question, wouldn’t my loved one be more depressed living in a skilled nursing facility?  In the community often times individuals become isolated and that attributes to their depression.  FYI 20% of elderly living in community have depression.  Depression is often mistaken for normal aging, but that is incorrect.  Some symptoms include: complaints of aches and pains, feeling of sadness or loneliness, interference with ordinary daily activities, weight loss, and lastly confusion and memory loss.  Skilled Nursing Facilities and even assisted livings are designed to give individuals social interaction which we all crave/need for our well-being. Interaction with others occurs during meals, activities, with roommates, and even in the beauty shop.  Living within a structured environment with set meals and activities, gives someone a reason to get up in the morning! 

Thursday, August 30, 2012

When is the right time for skilled nursing???

Q: What are signs that my loved one needs skilled nursing services?

A: Here is a list of the top needs potentially requiring skilled nursing facilities.  We use the phrase MIAMI DAWN.   

M: Memory Loss
I: Incontinence
A: ADLs (Activities of Daily Living)
M: Medication Administration
I: rehabIlitation

D: Depression/Isolation
A: Ambulation/Falls
W: Wound Care
N: Nutrition

Your loved one may have one of these needs or all.  Each facility is designed to coordinate their care based on their individualized needs.  The most prominent problems seen in the skilled nursing setting are related to memory loss, falls, medication administration, rehabilitation, and depression.  

Also, when in doubt, speak with professionals: doctors, care givers, home health, etc.  This is a difficult situation and a decision should not be entered lightly.  


Wednesday, August 15, 2012

Solving Problems...

No facility is perfect, not even mine :) and there are bound to be problems that arise.  With that being said, how do we approach the issues, how do we resolve, and at what point is it time to make facility changes?  Communication is key.  During the admission process the facility should lay out the ground work of what you can expect from them, this includes: care provided, meal services, activities, amenities, etc.  This is the perfect time for you as the family to lay out your expectations of the facility.  I always tell my staff, I cannot expect you to read my mind, so I always lay out my expectations upon hire, that way there are no excuses.  This goes the same with laying out expectations to facilities.  I can only speak about my own, but our intentions are always to do our best, and knowing your expectations gives us the best chance at excelling.  Does laying out expectations exempt you from potentially having problems, unfortunately not!  So, if a problem does arise what is the next step.  I always tell family members to let us know immediately.  Make an appointment with the department that it pertains to and speak directly to the supervisor, or set up a care plan meeting to discuss with the entire management team in charge of your loved ones care.  Some problems should be resolved immediately, others may take time as new processes are put in place.  I always say give it a week and if the problem does not resolve then speak with the Administrator.  It is important that you make everyone aware of the problem.  The Administrator is in charge of the entire operation, and the what is or isn't happening as it should.  One great thing about my facility is that we have video cameras in the hall.  I can confirm or deny most complaints related to call lights, not checking on a loved one, who was working, etc immediately by reviewing the video tapes.  One thing to remember is to give the facility the benefit of the doubt.  Your loved one may tell you things that is half true, or true based on their reality.  Make sure you investigate and find out the facts.  For example, if a resident has just had a procedure and is in extreme pain, if they ask for more pain medication and it takes them 10 minutes to get the medication, because of the level of pain, it may feel like one hour.  Another thing that I have witnessed is residents/patients attempting to put guilt on their loved one by telling them incorrect information.  This does not mean do not believe your loved one, it just means, get to the bottom of the situation.  If the facility has cameras like mine, ask to review with the administrator, come visit at off hours to see if what they are telling you is true.  If you have done all this, nothing is getting better, and you are first hand witnessing the injustices it is time to move your loved one.  Everyone deserves the highest quality of life!!!

Tuesday, July 31, 2012

Medicaid...How do I qualify for Long Term Care Medicaid

Being in long term care myself, I am blessed with tons of resources to help explain the difficult world of Medicaid. Today my facility Conroe Health Care Center hosted a community event with a presentation by Elder Law Attorney John Dantche.  The presentation was over the Ins and Outs of Medicaid and protecting your assets; this is strictly in reference to long term care.  Here is some great information he gave us that I wanted to share with you!

Medicaid Eligibility for the Nursing Facility (aka long term care or skilled nursing facility)

Maximum Income:
Individual- $2,094
Couple- $4,188

What constitutes income:
Basically this is anything you receive benefits on or payments such as: social security, pensions, annuities, wages, dividends, and retirement benefits.

Maximum Amount of resources:
Individual- $2,000
Couple- $3,000

What constitutes a resource:
Anything that can be exchanged for cash value such as: bank accounts, property, life insurance, stocks and bonds, etc.

What can be excluded for eligibility:
Life insurance with face value of $1500 or less per person
One vehicle
Burial spaces for the individual, spouse, and close relatives

Protected resources amount for a spouse in the community
$22, 728 Minimum- $113,640 Maximum (does not include resources under the excluded list)

Some other information to know is that they must be a resident of Texas, be in a medicaid contracted long term care facility for a minimum of 30 consecutive days AND meet Medical necessity which is determined through the assessment process. 

There are so many individual situations, so if you have any questions please feel free to ask.  If I do not know the answer I will find out for you!  I hope this information clarifies about what SOME of the qualifications are for Medicaid application and approval.

Conroe Health Care Center

Saturday, July 21, 2012

In the hospital...need therapy...what next?

At one time or another there will be a need to be admitted to the hospital.  Whether its for pneumonia, a fall, a stroke or even surgery there will be a decline in physical abilities potentially needing physical, occupational, or even speech therapy.  How do you decide where to go?  This is where the challenge begins.  Rehab hospitals are designed for individuals who can complete 3 hours of therapy.  However, those with a compromised immune system and need to go at their own pace would benefit from a skilled nursing facility.  Some people think this means they are going to a nursing home and will never get to leave.  This is incorrect.  Most facilities much like my facility have a short term side and a long term side.  The focus of the short-term side is to get individuals back into the community.  They receive individualized therapy 5 times a week, sometimes more, and work to restoring an individuals prior level of functioning.  But how do you even select a place, or even pay for it.  Great news.  If the individual needing skilling nursing services is a Medicare recipient, Medicare will cover the first 20 days at 100% if you meet their criteria and are participating in therapy.  After day 20, Medicare pays 80%.  That leaves a secondary insurance that potentially will pick up the co-pay or private pay.  Every private insurance or Managed Care (Medicare Replacement plan) has there own coverage guidelines, and any facility can identify that information for you, so you can be well informed.  The last order of business is how do you select a facility...this is the most crucial step.  Never place a loved one somewhere that you haven't toured, and I would tour several places unannounced.  You want to see how they do on the spot, without any notice.  The first thing I observe is the smell.  There should be no odor when you walk in...if there is I recommend you turn around and walk the other way.  If they pass the odor test, I observe the general cleanliness of the building.  Just because its a new building doesn't mean its the best.  If they can't maintain and keep their new building looking new, how will they care for you or your loved ones.  Next, I look at the staff and then patients.  How is the staff, are they smiling, speaking nicely to patients, laughing, and enjoying what they do, if not you want want to look somewhere else. Then the patients, how are the dressed, do they look neat and clean, dressed appropriately for the time of day, are the staff members talking to them?  Like I say to all my new hires, happy staff will make for happy patients.  Patients pick up on how staff likes or dislikes their job and will respond accordingly.  If you can find a place new or old that smells great, is clean, has happy staff and patients, you can almost be content in knowing that you or your loved ones will receive great care.  If you need any more suggestions...let me know...I'm only here to help!