Table of Contents
Introduction
There are numerous research tools on the Internet for "grading" facilities. These are useful tools if you keep in mind that they report information collected on a given day (like a snapshot). Conditions and situations can change; deficiencies can be corrected or new ones can occur. Your best resource is a combination of all resources, especially on-site visits to the homes. Narrow your choices and re-visit three or four more times, after hours and on weekends. You will find your observations may vary from visit to visit. Think about all data collected and go with your best gut feeling.
Visit our web site at www.aaacap.org . Under the Ombudsman link, click on Long Term Care Options. On the topic “When You Visit the Facility,” you will find helpful questions to ask of the facility staff and some tips on how to observe as you tour the homes.
Another beneficial web site is www.medicare.gov . Go into Nursing Home Compare for useful information on specific nursing homes. This information provides quality measures, deficiencies based on State inspections, and average staff to resident ratios. By clicking on “View all information for this nursing home”, you can see the history of the facility, the level of harm for each deficiency listed, and the National and State averages as compared to the selected facility.
A State of Texas web site is www.dads.state.tx.us . Under “Find Services” at the top left, click on “Find and Compare Long-Term Care Facilities”. Choose from Free Standing or Hospital Based Nursing Homes or Assisted Living – Types A or B. You will get a brief history of the selected facility with State investigation results.
The Major Options
Remaining in current residence
Adult Day Care
Personal Care Homes
Assisted Living
Nursing Facilities
There are numerous research tools on the Internet for "grading" facilities, i.e., Healthgrades.com and DHS.state.tx.us These are useful tools and generally only as valid as the information collected. Your best resource is a combination of all resources, especially on-site visits to the homes. Narrow your choices and re-visit three or four more times, after hours and on weekends. You will find your observations may vary from visit to visit. Contemplate on all data collected and go with your best gut feeling.
Remain in Current Residence
A recent study showed that 85% of older adults would prefer to remain in their own homes if at all possible. Being in your own home with your own belongings, your own memories, and being near your friends is truly ideal. A healthy, secure, and independent lifestyle is the goal of each senior, but sometimes to reach that goal they need a lithe help.
One of the ways you can get that extra help is by contracting with a Home Health Care agency for a "certified nurse aide" or a "homemaker". The difference between the two individuals is that the Home Health Aide is able to do the "hands on" tasks such as dressing, bathing, assisting with walking, and providing assistance getting in and out of bed. The homemaker could prepare meals, remind you of medications, help with errands and shopping, do light housekeeping, but is not able to do actual physical care. Both provide companionship and friendly conversation.
You could privately recruit a certified nurse aide or homemaker through the local newspaper or perhaps find an individual or couple that would trade room and board for doing the activities we have mentioned. But no matter how recruited, you need to make every effort to ensure the individual is an honest, caring individual. Careful, close screening, with as many personal references you can get, is certainly a must.
Now if you have a health crisis and have been in the hospital and have a "skilled need" i.e., a dressing needs changing, blood pressure must be monitored, or are receiving physical therapy, then the doctor could order Home Health Care under Medicare. While the individual caregiver will take care of the skilled needs, the other needs such as bathing, dressing, toileting and skin/hair care can also be accomplished. However, the visit will only be as long as necessary to complete the assigned tasks and only for as long as there is a "skilled nursing need". Therefore, it is not a long-term solution.
If the need is long term, then you may be able to obtain help through the Texas Department of Human Services (TDHS) Community Care for the Aged and Disabled program. This service is based on "need" and there are certain income and resource criteria that must be met. It is best to talk to TDHS about this program.
Another TDHS program designed to allow you to "Age in Place" is called the Community Based Alternatives (CBA) Medicaid program. This program provides home and community based services to the aged adults in lieu of nursing facility placement. This program also has specific income and resource criteria. TDHS should be contacted if you feel this is an option. They will then assign a case manager to first determine eligibility and, if approved for the program, develop an Individual Plan of Care. If you feel you may qualify for CBA Medicaid contact the TDHS caseworker for your county. The phone numbers are:
| Bastrop County | .................. | 512-321-3995 |
| Blanco County | .................. | 512-756-6082 |
| Burnet County | .................. | 512-756-6082 |
| Caldwell County | .................. | 512-398-4541 |
| Fayette County | .................. | 979-968-3196 |
| Hays County | ||
| Dripping Springs area | .................. | 512-753-2246 |
| Kyle, Buda areas | .................. | 512-908-9435 |
| Lee County | .................. | 979-542-3621 |
| Llano County | .................. | 512-556-3629 |
| Travis County | .................. | 512-908-9435 |
| Williamson County | ||
| Cedar Park, Leander, Round Rock areas | .................. | 512-244-1592 |
| Georgetown area | .................. | 512-863-6581, ext 202 |
| Taylor, Granger areas | .................. | 512-352-4457 |
You might combine the CBA or the nurse aide help with a move to the home of a family member. The option of moving in with a family member or members has much in common with remaining in your current residence, as you can use the CBA program, Adult Day Care, or the Home Health Care Agency to assist you with meeting identified needs. However, you must factor in the size of the home or apartment, their family's health needs, their work schedule, size of their family, their financial commitments, etc., before you make this decision.
In summary, the pluses of remaining in current or family residence are:
- Friendly surroundings
- Close to neighbors and friends
- Enhances personal freedom
- Retains dignity
- Allows independent lifestyle
If you are generally healthy and only need to be reminded to take medications, then a work week, daytime only solution might be Adult Day Care, which will be covered next.
Adult Day Care
Adult Day Care is licensed as a Type C facility. An Adult Day Care provides a safe, secure, and stimulating environment for older adults. The facility has a nurse on site 8 hours per day, and is equipped to help individuals who may need assistance with daily living skills.
Individuals at a day care enjoy being with their peers and may participate in many activities that make the day-out an enjoyable experience. Hours for centers vary, but they usually are open from 7:00 A.M. to 6:00 P.M. each weekday. Some may even offer weekend or overnight stays for respite care. Respite means taking a break from care- giving just to recharge those batteries for a few hours, a day, or longer.
Some Adult Day Care Centers are stand alone licensed facilities. Others may be services offered as part of an Assisted Living or Nursing Facility. All will offer nutritious meals and a wide range of activities like exercise, arts and crafts, field trips, games, shopping trips, etc
The costs vary depending upon the amenities, number of hours/days used, etc. Some centers may even have a sliding scale of charges depending on the income range of the member. Be sure to check them all out and compare the services with the costs, the training of the staff, and the overall professionalism.
In summary, the pluses of Adult Day Care are:
- Enhances emotional and mental well-being of the care receivers and their caregivers
- Helps the care receiver remain self-sufficient
- Gives respite to the caregiver.
Personal Care Homes / Assisted Living Facilities
Assisted Living Facilities are designed to meet the needs of the individual who requires some assistance in their daily lives, such as meal preparation, medication monitoring, laundry, maid service, and help with bathing and dressing. An Assisted Living facility can give you the best of both worlds - the independence you truly want and the support you really need.
Assisted living facilities emphasize independence and choice as vital to their philosophy. They also have rules and procedures designed to protect residents from harm. It is important to match the residents' ability with the extent of choices and opportunities offered by the facility, as well as the limitations it will impose on the resident. Facilities vary with regard to the extent of protection they offer residents and may use negotiated risk agreements when issues of safety and choice arise. Because each facility may define the terms differently, use a different term, or not believe in using such agreements, ask the facility whether it uses any form of negotiated risk agreement. If they do, have the Administrator clearly explain what is meant by the terms that they use and how they use such agreements in practice at the facility.
The services and activities provided or arranged for in assisted living facilities generally include:
- 24-hour supervision
- Three meals a day in a group dining room
- Personal care services, (help with eating, bathing, dressing, etc.)
- Social Services
- Supervision and assistance for persons with Alzheimer's or other dementias and disabilities
- Medication management, or assistance with self-administration of medication
- Social and religious activities
- Exercise and recreational activities
- Arrangements for transportation
- Laundry and linen service
- Housekeeping and maintenance
Assisted Living Facilities may be stand-alone facilities, part of a retirement community, or part of a nursing facility. Some may be designed as one room with shared bathrooms (dorm style) or full apartments. Some apartments may be set up with a kitchenette while others may offer full kitchen options. Additionally, they may be residential type settings where an individual has modified a home to accommodate several residents. All Assisted Living Facilities must be licensed if they have 4 or more residents in the facility. What sets an assisted living residence apart from a nursing home is that assisted living does not provide continuous skilled nursing care. The regulations affecting assisted living settings are quite diverse and constantly changing. Basically, assisted living residences have met local building and fire safety regulations. Some states require special certification or education for key management personnel.
Assisted Living Licenses
Assisted Living facilities are designated as "Small" (up to 16 residents) and "Large" (17 + residents), Type A, Type B, Type C, and Type E.
In a Type A facility:
- The resident must be physically and mentally capable of evacuating the facility unassisted in the event of an emergency. This may include the mobile nonambulatory, i.e., persons in wheelchairs or electric carts having the capacity to transfer and evacuate themselves in an emergency.
- The resident does not require routine attendance during nighttime sleeping hours.
- The resident must be capable of following directions under emergency conditions.
- The night shift staff in a small facility must be immediately available. In a large facility, the staff must be immediately available and awake.
In a Type B facility:
- The resident may require staff assistance to evacuate.
- The resident may be incapable of following directions under emergency conditions.
- The resident may require attendance during nighttime sleeping hours.
- The resident may not be permanently bedfast, but may require assistance in transferring to and from a wheelchair.
- The night shift staff must be immediately available and awake.
Assisted Living Facilities that have a Certified Alzheimer's unit attached would be licensed as a Type B, and have other specific requirements as well that they must meet. There are some Assisted Living facilities that have "memory units", which are not Certified Alzheimer Units, but are under the general licensure.
Certified Alzheimer Facilities
- Licensed Type B
- Special Disclosure Statement
- Activity plan must specifically address cognitive, recreational, and activities of daily living
- Person designated to plan activities (less than 17 beds)
- Must employ activity director 20 hours weekly (17+ beds)
- All staff must receive 4 hours of dementia-specific orientation prior to assuming any job responsibilities
- Direct care staff must receive 16 hours of on-the-job supervision and training within the first 16 hours of employment
- Direct care staff must annually complete 12 hours of in-service education regarding Alzheimer disease
Type C - Adult Foster Care provides 24-hour living arrangement with supervision for persons who, because of physical, mental, or emotional limitations, are unable to continue independent functioning in their own homes. Providers of Adult Foster Care homes must live in the household and share a common living area with the clients. Services may include minimal help with personal care, activities of daily living, and provision of, or arrangement for, transportation.
Type E - Residents require only medication supervision and general supervision of safety and welfare. Facility may not provide substantial assistance with activities of daily living. Residents must be physically and mentally capable of evacuating the facility unassisted, must not require routine attendance during nighttime sleeping hours, and must be capable of following directions under emergency conditions.
Personal Care Home - an unlicensed facility of less than four residents. A Personal Care Home, can be a very fine facility and should be included in your sampling. There is nothing inherently wrong if a facility does not want to be licensed. There are fees, some modification costs, and some governmental oversight involved with being licensed that some owners just may not want to be involved with. These smaller facilities are generally modified residences. Some will be on quiet residential streets, while others may be in the country in a "farm like" atmosphere.
Once again, you will need to spend some time shopping around. You will want to be sure that the care is good, the facility is safe, and your needs can be fully met. The homelike setting may offer more privacy, space and dignity than other options.
The first step in your search for an assisted living facility would be to call all the facilities you may be interested in and ask pertinent questions such as:
- Do they have a vacancy?
- Are there any restrictions on the type of resident they admit?
- What is provided for in the basic daily rate?
- What services cost extra?
- Are residents required to purchase renter's insurance for their individual units?
- Is a deposit required? Is it refundable?
- What happens when funds are depleted and full payment can no longer be made?
- How much training does direct care staff receive?
- How do you provide for on-going training?
Other good sources for information are:
- Hospital discharge planners
- Physicians who serve seniors
- Geriatric case managers
- Clergy
- Friends and family of residents in facilities within your area
What are some of the advantages of an Assisted Living Facility? Someone is always on duty to provide for the security of the residents. Further, the staff ensures medication is taken at the right time and in the correct dose. If a health crisis develops, the facility will follow the same procedures as one would in their own home, i.e., 911 will be called, family notified, and the resident transported to the hospital, if necessary. This may vary somewhat from facility to facility. Those facilities that are part of a Nursing Facility will have more caregivers available for an emergency due to physical proximity. Three nutritious meals are available every day and many opportunities exist for socialization.
Costs for Assisted Living Facilities vary based upon the amenities that are provided. In fact, it may be even more expensive than a Nursing Facility. Be sure to understand what the charges include or do not include. For example, some facilities include medication administration in their rates, and some charge additional fees for this service. Some contracts discuss level of care and others mention additional costs. Review carefully how these are defined, or which services are provided at each level, who determines which level or additional services the resident will receive, when a resident will need to change levels, who is consulted when a change is necessary, and whether the resident can appeal a decision regarding a level change. If a resident slips and falls once, does this constitute a "fall hazard" increasing the level of care costs? Does the contract state whether assistance is available around the clock or only during specified hours? Read the contract closely to be sure everything is clear to you. The contract is a legal, binding document not to be taken lightly. Take it home and read it carefully before signing. Ask for clarification on anything you do not understand. Take it to an attorney specializing in Elder Law for review.
Under what conditions may a contract be terminated? Under what conditions are deposits refunded if a resident chooses to leave the facility? Is there an appeal process? Some facilities state that they allow residents to "age in place". What does this entail? How does the facility assist a resident being discharged?
Financing of Costs
There are four basic ways in which assisted living costs can be financed.
Personal Resources
Generally, the cost of room and board plus personal care is paid for out of personal resources. On average, assisted living costs $1,807 monthly for basic room and board. There may be additional charges based upon amenities and services. Some facilities require entrance fees or deposits. Ask if the fees are refundable and under what circumstances you would be entitled to a refund.
Private Insurance
Long-term care insurance is on the rise with more insurance companies offering insurance plans to cover assisted living/residential care. The details of coverage depend on the insurance policy. Some pay only for nursing home care and do not cover assisted living care. It is a good idea to have an Elder Law Attorney look over any policies before you sign them.
Medicaid
Medicaid is funded by both state and federal sources and is health insurance for eligible low-income individuals. Medicaid may pay for some services or room and board. The assisted living residence must be licensed by the state. Refer to the County/Telephone chart under "Remain in Current Residence" to contact an intake person for CBA (Medicaid) payment.
Medicare
Medicare (Part A) will not pay for assisted living room and board. Medicare may cover certain health services within the assisted living setting, such as physical or occupational therapy, in specific circumstances.
When you visit the facility
Evaluate each facility and decide which facility you want to visit. Call the Administrator or Admissions Coordinator to schedule an appointment for a tour. Visiting the residence is essential to gathering information. It will give you the opportunity to meet with administration, chat with other residents, view the condition of the residence, watch the staff in action, and feel the atmosphere. If you are seeking placement for a loved one, involve that person in the decision making process as much as possible. They may not be happy in the placement if they are not allowed a choice.
Ask questions that are most important to your specific needs. Ask for a copy of the contract. If you are visiting with a family member, does staff speak only to them or do they direct questions and comments to you, the client? While visiting, it is important to remember that the most important consideration is your specific situation. It is important to properly assess your needs as they are now and ask how the facility might accommodate any changes over time. Under what conditions are individuals asked to move if there is a change in health status? If you hope to avoid having to move again, take into consideration future care needs, such as incontinence, mental health, need for supervision, or dementia.
Do not hesitate to ask questions. Each resident has different needs, preferences, and desires that should be taken into account in choosing an appropriate residence. Although the value you place on any question is up to you, remember that you cannot change the resident to fit the facility, and definitely not the facility to fit the individual. Select the facility that best meets your needs and those of your family. Visits are important! Is the facility convenient for frequent visits by family and friends?
Finances
It is imperative to examine your finances and ask about costs. What happens if you exhaust your finances? Monthly rate and fee structures vary. Is there a security deposit? What is the refund policy? How are service agreements and/or contracts amended or modified? Because contracts often do not spell out in detail the scope of services provided, it is important to know which are covered and which require extra payment, such as cable TV and telephone.
Ask for a copy of the resident agreement outlining, at a minimum, services, prices, extra charges, admission/discharge criteria, staffing, and facility rules.
Admission Policy
Each facility will have a unique operational and admission policy. Each operational and admission policy must contain certain elements:
- Type of residents accepted
- Services provided
- Refund policy
- Responsibilities of facility and residents
- Other rules and regulations
These operational policies must be furnished to residents and/or the residents' responsible party at the time of admission. If families feel the need to have their own copies, ask the facility to provide an extra set. These should remain with the resident for reference.
The facility's admission policy must include the requirement that each resident have a health examination by a physician performed within 30 days prior to admission or within 14 days after admission, during which time a service agreement is developed to coordinate the delivery of services to each resident. The agreement, which includes an assessment or evaluation of the resident's physical and psychosocial needs, is reviewed and updated regularly by the staff, and as the resident's condition indicates. Ask the Administrator how resident and family members are notified of assessments and who is involved, such as a doctor, a nurse, and staff members. More information about the Care Plan can be found under "Nursing Facilities - Questions to Consider About the Care Plan". The resident, family, or responsible party should play an active role in the development of the service agreement, and should be provided a copy of each agreement. What procedure should be taken if the resident or family disagrees with the facility's plan of care?
Regulations / Surveys
There are several mandated postings, i.e., the Residents' Bill of Rights, the Provider Bill of Rights, information on the Ombudsman Program, the current staffing pattern (now is a good time to ask about the current resident population), and the latest Survey report. This is a good time to review the Survey and ask what course of action was taken to correct the deficiencies. Keep in mind that viewing a facility through a surveyor's eyes is limited only to the regulations that a facility must meet. These regulations are, at best, minimal requirements for licensure. If you are looking at an assisted living facility connected to a nursing home, ask to see the inspection report (Survey) for the nursing home. It may shed light on how the organization is administered.
Do you feel comfortable with the response given for the Survey deficiencies? Does the Administrator seem sincere with the response? Keep in mind that this is the person you will deal with for any concerns you may have in the future. Is this a workable relationship? This is a good time to ask what are the complaint/grievance procedures? Is the Administrator the primary contact person? How long has this Administrator been at this facility? In the long-term care setting? Does the Administrator belong to professional associations? Which ones and how are they related to the care of residents?
Emergency Evacuation
What is the emergency evacuation plan, and is it among the postings? How, and how often, are drills managed? Does the facility provide ample security? Are exit doors alarmed or monitored?
Medical Needs
The facility will assist in arranging the appropriate medical, health, and dental care services for each resident. The physician of your choice generally provides for the health care of each resident. However, if a medical emergency should occur, how is it handled? Residents who experience periods of incapacity due to illness, injury, or recuperation from surgery can remain in the facility, or be readmitted from a hospital if appropriate services can be provided by the facility.
If you temporarily need hospital or nursing home care, is the assisted living room held? What are the associated fees? Is there a discount for unused services, such as medication management or meals, while you are away?
Narrow Your Selections
By now you have a feel for the management of the facility and can perhaps narrow your selection to two or three. This is the time to visit the facilities again after normal business hours and/or on the weekend. Compare the tour guide's comments with what you actually see, hear and feel. Do you like the outward appearance? Is the decor attractive and homelike? Did you receive a warm greeting from staff? Do residents appear happy and comfortable? How do residents feel about their home/staff? Is staff appropriately dressed? Does staff treat each other professionally?
Here are some more things to consider.
Medication assistance should be provided by a skilled staff member. Is self-administration of medications allowed? What procedures are followed to ensure the resident is taking medication appropriately? Health and minor nursing services should be available. Whose role is it to note changes in a residents' condition and report them to a doctor and/or family member? Are residents closely monitored when new medications are added, or when old medications are removed? How are staff trained and supervised? If the resident requires around-the-clock medication, is this available? To what extent will the facility monitor the residents' health? Is there a Registered Nurse on staff? What hours does the RN work? Who is responsible when the RN is not available? What safeguards are in place to ensure the resident gets the appropriate medications on time and in the correct dosage? If the resident refuses the medication, how is this handled? Is another attempt made to offer the medication? Is the residents' doctor or family notified? Does the facility use a pharmacy that provides delivery, consultation, and review of medication? Do I have to use the facility pharmacy? If private health care insurance is used, can residents obtain prescription medications on a three month basis through mail order?
Transportation - Contracts generally state if transportation is available. Sometimes this is an added cost. How far in advance must a resident schedule for transportation and with whom? Is transportation available at any time, evenings and weekends, and to what destinations? Is transportation available if the resident wants to go to an event alone or with another resident? Is there a staff member available to coordinate or assist with transportation for doctor visits, therapists, or other health care professionals? Is the vehicle equipped to accommodate residents with varying degrees of physical mobility? Can a resident have their personal vehicle and is there a parking fee? Is the facility convenient to public transportation? Will the facility assist in obtaining other transportation services?
Dining Service - Review a copy of the menu, which should be posted near the dining room. Does it look appealing? How often do menus rotate? Are residents involved in menu planning? Are residents allowed to invite guests for meals? Is there a separate guest dining room available for family parties or family gatherings? Is the meal being served consistent with what is on the menu for that day? Does the food smell and look appetizing? Is the wait staff sufficient for the residents being served? Does the wait staff appear friendly or rushed? Are residents socializing or do they appear impatient?
The facility should provide 3 nutritious meals daily. Most will encourage residents to eat in the dining room for socialization. What is the normal waiting time for the meal to be served? Are beverages or an appetizer being offered while waiting for the entrée? If the resident is ill, what is the procedure for getting a meal tray delivered to the room? Is there an additional charge? Is it possible to get a meal at any time during the day? What happens if the resident is late, misses a meal, or refuses a meal? Is the answer different if the resident is confused? If the resident does not care for a food item, what is the procedure, or can the resident get something else? Are dietary preferences honored? Are there diabetic or no salt/low fat diets available? Are nutritious between meal and bedtime snacks offered or available? Does a nutritionist or dietician review meals? How often?
Living Space - What is the smoking policy? Do community areas appear to be adequate for the number of residents? Are the open areas clean, neat, and temperature comfortable? How is the temperature controlled? Do all areas have good natural and artificial lighting? What is the overall atmosphere? Are there any obvious safety hazards, such as throw rugs or dark hallways? Is the furniture attractive, comfortable and safe? What is the policy for overnight guests? Are guestrooms available and at what cost? Does the residence meet the rules for people with disabilities? Are patios/courtyards inviting and furnishings in good repair? Are pets allowed to reside in the resident's room? If so, how many pets, and what kind, are currently in the facility? If not, are pets allowed to visit? Who is responsible for the care of pets? What are the additional fees/costs/deposits?
Personal Quarters - Are all rooms private or does the facility have some share rooms? If sharing a room, does the resident have a choice of roommates? Are the living quarters comfortable, clean and have a window to the outside? Do windows have security locks? Are residents allowed to lock the doors to their rooms? Who has passkeys? What safety measures are in place to keep personal property from being stolen or lost? Are phones available in every room or is there a private telephone available to residents and accessible by wheelchair? How does the resident call for assistance at night? How does the staff help the resident maintain their abilities to care for themselves, especially in regard to toileting, dressing, and eating? What if the resident does not like the staff person assigned to them?
Does housekeeping include only light dusting and vacuuming? Does this include the bathroom, floors, windows, and emptying of the trash? How frequent is the cleaning? Are towels and bed linens provided? If bed linens are laundered, are residents required to make their own beds? (As much as possible, residents should try to maintain as much independence as possible, but it should not be a requirement, if they are unable to do so.) How often is laundry done? Is personal laundry included, or can you have access to the washer/dryer? What measures are in place to prevent lost laundry?
Do the bathrooms have solid grab bars at toilets and bathing areas? Do the bathing areas have non-slip surfaces? How many residents share the same bathroom? How is cross-contamination avoided? How does the facility tailor the schedule for bathing and dressing to accommodate the preferences of the resident? How are incontinence needs handled? Are there call lights in each room and bathroom? How often are they checked to be sure they are working properly?
Activities - Observe staff and resident interactions. Are they positive? Courteous? Are residents addressed by name? Does it appear that resident requests are being handled timely? Does the Administrator practice an "open door" policy? Do residents appear to be "involved" or merely sitting around with nothing to do? Does there appear to be adequate staff for the needs of the residents? Is it sufficient to assist with bathing, dressing, mobility, feeding, shopping, laundry, etc.? Are residents clean and dressed appropriately for the climate? Do the residents appear well cared for and content? Does the direct care staff speak the residents' native language clearly? What is the staff turnover rate? Keep in mind the posted staffing pattern and the total number of residents in the facility, which was discussed with the tour guide.
What kinds of group/individual recreational activities are offered? Is there an appropriate area provided for activities? Are there supplies for social activities or hobbies? Is there involvement with community events? Are residents active in planning events and activities? Are the activities posted actually being initiated? Who is responsible for developing activities? What training does this person receive? What religious/spiritual activity is offered? Can the resident walk on the grounds? Are there protected walking areas for residents with dementia?
Resident Council - Each facility is required to have a Resident Council. This enables residents to have some choice in their daily lives. When does the council meet? How does the facility encourage residents to become actively involved? Volunteer activities are sometimes encouraged through the council. If not, the facility may have a volunteer program. If so, find out what types of activities are offered, i.e., computer training for residents, gardening, raising and lowering the flag, etc.
Family Council - Is there an active Family Council? If not, what is the Administrator's feeling for Family Councils? All families should become involved in some way.
If you have more questions than answers after the subsequent visits, call the Administrator for a second appointment to ask the questions. How does the Administrator deal with your questions?
After you have narrowed your choice, arrange to stay overnight or a weekend in the first choice facility. There is no better way of determining the likelihood of your future satisfaction. Choose the facility that comes closest to your needs, remembering that nothing is perfect.
Nursing Facilities
Nursing Facilities provide a viable option for the person who needs 24 hours-a-day supervision under the direction of a registered nurse or physician. Although the nursing facility may become a permanent home, it is often a temporary or short-term option after a fall or perhaps a stroke, while receiving rehabilitative services.
Payment may be from personal resources or, if eligible, be covered under Medicaid. For Medicaid to be the source of payment, an individual must meet financial eligibility criteria, along with identified needs for skilled nursing care. Because each case is different it is advisable to contact the TDHS Medicaid Eligibility Office. Those numbers are:
| Bastrop - Elgin area | .................. | 512-285-9665 |
| Bastrop - Rest of County | .................. | 512-321-3995 |
| Blanco | .................. | 512-756-6082 |
| Burnet | .................. | 512-756-6082 |
| Caldwell | .................. | 512-398-4541 |
| Fayette | .................. | 979-968-3196 |
| Hays | .................. | 512-753-2246 |
| Lee | .................. | 979-542-3621 |
| Llano | .................. | 512-556-3629 |
| Travis | .................. | 512-919-7306 |
| Williamson | .................. | 512-244-1592 |
Contrary to popular belief, Medicare and private Medigap policies (policies designed to pay for the amounts not covered by Medicare) contribute little to nursing facility stays. Medicare, the health care program for people over 65 and the disabled, will fully pay the first 20 days of approved skilled care coverage. However, if the resident "plateaus" (for instance, they can't be helped further, they improve significantly or they refuse to cooperate), then the entitlement ends. If the resident doesn't plateau, days 21-100 will be cost shared before Medicare pays anything. And, once again, if the resident plateaus, their condition improves, or they refuse to do the rehab exercises, then they will not receive the whole 100 days. If you do not have Medigap coverage, that cost share amount can accumulate very quickly. Keep in mind we are talking about skilled nursing care only. Medicare pays nothing for custodial nursing facility care.
For veterans, there may be some benefits available through the Veterans Administration. If you have any military service history, you should check with:
VA Benefits Information and Assistance 1-800-827-1000.
Few people plan to go into a nursing facility. Consequently, people are unsure what they should be looking for when faced with this difficult decision. Often there is little time to make the decision, making it that much more difficult. However, there are some steps you can follow that will help you through the decision making process, allowing you to make an informed choice.
Choosing a facility begins with reviewing this directory and then factoring in criteria such as distances to family, your physical and psychosocial needs, financial status, appearance of the facility, reputation, etc. Ask the Administrator what programs are in place to keep residents mobile, preventing atrophy and rigidity. What steps does the facility take to prevent pressure sores? Is there a written procedure for incontinent care? What is the facilities' policy on restraints? Referrals are also important in making your selection of nursing facilities to visit. Talk to your friends who have had experiences with nursing facilities as well as your doctor or other professionals in the health care field. By using referrals, medical needs and financial criteria, you should be able to create a list of 6-8 nursing facilities to visit.
Now that you have selected your facilities, it is time to go visit each one. Call and make an appointment with the Administrator or Admissions Director. If you do not meet with the Administrator initially, be sure you meet before you decide on a certain facility. This is important because the Administrator generally sets the tone, sets the standards and sets the style of the Nursing Facility. You will be interested to know how the Administrator got into the long-term care business, what their management style is, how they anticipate staffing needs and what some of the current issues are in the facility, i.e., staff turnover (not unusual to be 200% a year), how often are temporary agencies used, are all employees Certified Nurse Aides, and how they handle lost/missing items of residents such as dentures, eyeglasses, clothing, hearing aids, etc.
Remember, most nursing facilities will provide a satisfactory level of care, but you want to find the one that does it with love. That is where the expenditure of shoe leather comes in! It will be time well spent.
As you tour the facility, you will want to look at the residents as well as the physical facility. Good care will be evident in the appearance of the residents. They should be dressed in clean, appropriate clothing, have clean faces and fingernails, combed hair and shaved faces for men. Watch the interaction between the staff and the residents. Staff should be caring and patient when working with the residents. Observe if a residents dignity is maintained - aides knock before entering a residents room, curtains are drawn if care is being given, residents are covered properly, etc. There should be activities that residents can participate in. Look for an activity calendar to see what type of events are planned and how often. Are the activities mentally and socially engaging? Residents should appear happy and content. Look at the staff - do they appear happy in their work and do they look and act professional?
There are several areas to look at in order to check the cleanliness of the facility. Wheelchairs should be clean and in good repair. Floors, countertops, windows, and bedside tables should be clean. The facility should be free of overwhelming odors. If you encounter spills or odors make a note of the location and come back to that area after 30 minutes. The area should be cleaned and odor free by that time.
There should be a dietary menu posted. Check it for variety and ask how special diets are accommodated. If you are there during mealtimes, observe how the meals are served and transported to keep them at proper temperatures. Observe how the facility provides feeding assistance for those residents who need it. Do the meals look appetizing to you? Your eyes and nose should give you a good idea about the dietary service of the facility.
One of the reasons that you set appointments to visit the facility is to meet administrative personnel. You want to meet not only the Administrator, but also the Director of Nursing. These are the people who are responsible for the nursing facility and you want to feel comfortable going to them with questions, which you will have after being admitted to the nursing facility.
The first visit is also a good time to take a look at the facility's last State Inspection. It is required to be "readily available". The State visits each facility, on the average of once every year. Don't necessarily rule out a facility for unsatisfactory inspection results. Discuss the results with the Administrator to determine if corrections have been made and improvements are apparent. You can also go on line at www.medicare.gov to get the latest inspection report.
Once you have narrowed your list of possible facilities to 2 or 3, make several unannounced visits to these facilities. Vary the times of your visits i.e., evenings, weekends, and breakfast. Observe the same things you did the first time, but also talk to the residents and their family members to get their feelings about life in the facility. These visits should give you the information you need to choose a nursing facility that will provide quality care in a homelike, caring environment. If you like a facility on nights or weekends you should be very happy with it during the normal dayshift when there is increased staffing and more management personnel.
When you have chosen a facility, the key individual in your care will be the Certified Nurses Aide (CNA). That is the person you should remember to say thanks to every now and then, brag on them to their boss, and be genuinely appreciative of their efforts. All of us like to be given a pat on the back - they just need it more often as being a CNA is a tough job. The CNA gets only 75 hours of training and is often paid slightly above minimum wage. The CNA is the person to raise the red flag when there is a problem as they will see you more than anyone else. Additionally, you should make every effort to attend the Comprehensive Health Care Plan (Care Plan for short) meetings that will be held routinely. In these meetings you will be able to talk with all the various department heads and get a good idea of what they feel your needs are and how they feel these needs can best be met. You will also be given the opportunity to agree or disagree and voice your concerns about your health care needs and how you perceive they can best be accomplished. Read the section entitled "Questions to Consider about the Care Plan".
Encourage your family members to join the Family Support Group or Family Council to meet fellow family members and provide feedback to the Administrator on what is going well and, if necessary, not so well. Read the Residents Rights section of this Directory so you will know how a resident is to be treated. The bottom line for Resident Rights is that anyone entering a Nursing Facility doesn't lose any rights. The only way rights can be lost is through the courts with a Guardianship of the Person or some medical decision making rights are lost when there is a Durable Power of Attorney for Health Care and a doctor has stipulated the resident can't make their own decisions any longer. As an aside, you should prepare a Living Will, a Durable Power of Attorney for Health Care and a Financial Power of Attorney. With those documents you are assured your wishes will be followed as your health changes.
Once you have made the choice of Nursing Facilities, given the different limitations such as your health needs, driving distances, monetary constraints, available Medicaid Certified beds, etc., try to become the best supporter of the facility that you can. Work with the staff so they will know how to provide the best care possible. But if a problem does arise, take it to the Administrator or Director of Nursing (D.O.N.) to see if they can resolve it.
Managing Local Ombudsman
If you feel it has not been resolved, contact the Volunteer Ombudsman assigned to the facility, or the Managing Local Ombudsman at the Area Agency on Aging of the Capital Area, located in Austin at (512) 916-6062 or toll free at 1-888-622-9111. If your concern involves abuse or neglect, contact the TDHS Complaint Hotline directly at 1-800-458-9858.
Questions to Consider about the Care Plan
1. Is the Care Plan oriented toward preventing functional declines?
2. Does the Care Plan attempt to manage risk factors?
3. Does the Care Plan build on resident strengths?
4. Have you been given sufficient information about treatment options so that an informed choice can be made?
5. Are your goals and wishes being discussed?
6. If you decide to refuse treatment, does the Care Plan provide for alternative means of addressing the problem?
7. Does the whole interdisciplinary team contribute their expertise in developing the Care Plan, including the resident and any family members?
8. If appropriate, are the following general Care Planning areas considered? (Ultimately, your status determines what should be addressed on the care plan.)
Functional Status
Health Maintenance
Medications
Daily Care Needs
Rehabilitative/Restorative Nursing
RESIDENT RIGHTS
The resident has a right to a dignified existence, self-determination and communication with and access to persons and services inside and outside the facility.
Exercise Of Rights
The resident has the right to exercise his/her rights as a resident of the facility and as a citizen or resident of the United States without interference, coercion, discrimination or reprisal from the facility, including observance of religious beliefs.
In the case of a resident adjudged incompetent under the laws of the State of Texas by a court of competent jurisdiction, the rights of the resident are exercised by the person appointed under Texas law to act on the resident's behalf.
No resident will be denied appropriate care on the basis of race, religion, color, national origin, sex, age, handicap, marital status or source of payment.
Notice Of Rights And Services
The facility must inform the resident, both orally and in writing, in a language she/he understands, of her/his rights and all rules and regulations governing resident conduct and responsibilities. This should be done prior to or upon admission and during her/his stay in the facility.
The resident or legal representative has the right, upon an oral or written request, to access all records pertaining to herself/himself, including clinical records, within 24 hours (excluding weekends and holidays), and after receipt of the records for inspection, to purchase photocopies of all or any portion of the records, at a cost not to exceed the community standard, upon request and two work days advance notice to the facility.
The resident has the right to be fully informed in language that she/he can understand, of her/his total health status, including but not limited to, her/his medical condition.
The resident has the right to refuse treatment and to refuse to participate in experimental research. If treatment is refused, she/he must be informed of possible consequences.
The resident should be informed of what she/he is entitled to in Medicaid benefits and which items and services are included for which she/he may not be charged.
The resident should be informed of other items and services for which she/he may be charged, and the amount of the charge.
The facility must inform each resident of services available and charges for those services.
The facility must furnish a written description of legal rights including:
- The manner of protecting personal funds
- A description of the requirements and procedures for establishing eligibility for Medicaid, including the right to request an assessment which determines a couple's nonexempt resources at the time of institutionalization and attributes to the community spouse an equitable share of resources which cannot be considered available for payment toward the cost of the institutionalized spouse's medical care in her/his process of spending down to Medicaid eligibility
- A posting of contact information for all pertinent state client advocacy groups
- A statement that the resident may file a complaint with the Texas Department of Human Services concerning resident abuse, neglect, and misappropriation of resident property in the facility
The facility must inform each resident of the name, specialty, and way of contacting the physician responsible for her/his care.
The facility must prominently display in the facility written information about how to apply and use Medicare and Medicaid benefits.
The facility must immediately inform the resident, consult with her/his physician, notify legal representative or an interested family member when there is:
- An accident which results in injury
- A significant change in physical, mental or psychosocial status
- A need to alter treatment significantly
- A decision to transfer or discharge her/him from the facility
The facility must promptly notify the resident, the legal representative or family member when there is a change in room or roommate assignment or a change in residents' rights.
Protection Of Residents Funds
The resident has the right to manage her/his financial affairs, or upon written authorization of the resident, the facility must hold, safeguard, manage, and account for the personal funds deposited with the facility.
The resident has a right to designate in writing another person to manage personal funds. The facility may not charge for handling a Medicaid recipient's personal funds.
Free Choice
The resident has a right to choose and retain a personal attending physician.
The resident has the right to be fully informed, in advance, about care and treatment and any changes in that care and treatment which may affect her/his well-being; and unless adjudged incompetent or otherwise found to be incapacitated under Texas law, participate in planning or changing care and treatment.
The resident is free to exercise her/his will in making written or unwritten directives to reject life-sustaining procedures.
The resident has the right to complete freedom of choice to obtain any Medicaid services from any institution, agency, pharmacy, person, or organization that is qualified to perform the services, unless the provider causes the facility to be out of compliance with state requirements.
The resident may request a hearing before the Texas Department of Human Services (DHS) if she/he believes that her/his right to freely choose providers has been abridged without due process.
Privacy And Confidentiality
The resident has a right to personal privacy and confidentiality of personal and clinical records.
Personal privacy includes accommodations, medical treatment, written and telephone communications, personal care, visits, and meetings of family and resident groups.
The resident may approve or refuse the release of personal and clinical records to any individual outside the facility except in the following:
- The resident is transferred to another health care institution
- Record release is required by law
- During Medicare, Medicaid or licensure surveys
Grievance
The resident has a right to voice grievances without discrimination or reprisal with respect to treatment or care.
The resident has the right to prompt efforts by the facility to resolve grievances, including those with respect to the behavior of other residents; and notify state agencies of complaints against a facility.
Examination Of Survey Results
The resident has the right to examine the most recent survey of the facility conducted by federal/state surveyors and any plan of correction. The results must be available for examination in a place readily accessible to residents, and a notice of its availability must be posted.
Refunds
The resident has the right to a refund of any private funds paid to the facility for periods covered by Medicaid within 30 days of the receipt of vendor payment from DHS to the facility.
Work
The resident has the right to refuse or choose to perform services for the facility.
Mail
The resident has the right to privacy in written communications including sending and receiving mail, promptly, that is unopened; requesting facility staff to help open and read incoming mail and help address and post outgoing mail, and having access to stationery, postage, and writing implements at her/his own expense.
Access And Visitation Rights
The resident has the right and the facility must provide immediate access to any resident by the following:
- Any representative of the State of Texas
- The residents individual physician
- Any representative of the Office of the State Long-Term Care Ombudsman
- Any representative responsible for protection and advocacy of the developmentally disabled
- Any representative responsible for protection and advocacy of mentally ill persons of the Texas Department of Mental Health and Mental Retardation
- Immediate family or other relatives with the consent of the resident
The facility must provide reasonable access to any resident by any entity or individual that provides health, social, legal, or other services to the resident, subject to her/his right to deny or withdraw consent.
The facility must allow representatives of the state ombudsman to examine a resident's clinical records with the permission of the resident or her/his legal representative, and consistent with state law.
Telephone
The resident has a right to have reasonable access to the use of a telephone (other than a pay phone) where calls can be made without being overheard, and which can also be used to summon help in case of an emergency.
Personal Property
The resident has the right to retain and use personal possessions including furnishings, clothing, and so forth, as space permits.
Married Couples
The resident must be ensured privacy for visits with her/his spouse. She/he has the right to share a room with her/his spouse when married residents live in the same facility and both spouses consent.
Self Administration Of Medications
A resident may self administer medications if the interdisciplinary team has determined that this practice is safe.
Directives/Durable Powers Of Attorney For Health Care
Competent adults may issue directives or durable powers of attorney for health care subject to the Texas Natural Death Act, the law governing Durable Powers of Attorney for Health Care.
Refusal Of Certain Transfer
A resident has the right to refuse a transfer to another room within the facility if the purpose of the transfer is to relocate a resident of a:
- Skilled nursing facility (SNF) from the distinct part of the facility that is a SNF to a part that is not a SNF
- Nursing facility (NF) from the distinct part of the facility that is a NF to distinct part that is a SNF
Admission Policy
The facility must not require a third party guarantee of payment as a condition of admission.
The facility must not charge, solicit, accept, or receive, in addition to any amount otherwise required to be paid under the Texas Medicaid plan.
The facility must not require the resident or potential resident to waive her/his rights to Medicare or Medicaid.
Transfer And Discharge
The facility must not transfer or discharge a resident unless:
- Necessary for the resident's welfare and the resident's needs cannot be met
- The resident's health has improved sufficiently so the services are no longer needed
- The health or safety of individuals in the facility is endangered
- The resident has failed after reasonable and appropriate notice to pay for a stay at the facility
- The resident, responsible party, family or legal representative requests a voluntary transfer or discharge
- The Texas Department of Mental Health and Mental Retardation determines that the resident presents evidence of mental illness, mental retardation or a related condition, does not require the level of service provided by nursing facility, and does or does not require specialized services
- The facility ceases to operate or participate in the program which reimburses for the resident's care
Before a facility transfers or discharges a resident, the facility must notify the resident, a family member or legal representative about the reasons. Thirty days notice must be given, unless it is an emergency.
The written notice must include:
- The reason
- The effective date
- The location to which the resident is transferred or discharged
- A statement that the resident has the right to appeal the action to the DHS by submitting a written request for a hearing to the Medicaid eligibility worker at the local DHS office within ten days;
- Name, address and telephone numbers for the Texas long-term care ombudsman program
- In the case of residents with mental illness and mental retardation, the address and phone number of the state mental health/mental retardation authority, and the phone number of the agency responsible for the protection and advocacy of persons with mental retardation and related conditions
The facility must provide sufficient preparation and orientation to the residents to ensure safe transfer or discharge from the facility.
Notice Of Bed-Hold Policy And Readmission
Before a facility transfers a resident to a hospital or allows a resident to go on therapeutic leave, the facility must provide written information to the resident and family member or legal representative that specifies the facilities bed hold policy. If hospitalization or therapeutic leave exceeds the bed hold period, she/he is readmitted to the facility immediately upon the first availability of a bed in a semi-private room if she/he requires the services provided by the facility, and is eligible for Medicaid nursing facility services.
Equal Access To Quality Care
A facility must establish and maintain identical policies and practices regarding transfer, discharge, and the provisions of services for all individuals regardless of source of payment.
Restraints
The resident has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat medical symptoms.
Abuse
The resident has a right to be free from verbal, sexual, physical, or mental abuse, corporal punishment, or involuntary seclusion.
Staff Treatment Of Residents
The facility must not use verbal, mental, sexual or physical abuse nor employ individuals who have been convicted of abusing, neglecting or mistreating residents by a court of law.
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Dignity
The facility must promote care in a manner that maintains or enhances each resident's dignity and respect in full recognition of the resident's individuality.
Self-Determination
The resident has a right to choose activities, schedules, and health care; interact with members of the community, and make choices about life in the facility that are significant to her/him.
Participation In Resident And Family Groups
The resident has the right to organize and participate in resident groups in the facility.
The resident's family has the right to meet in the facility with the families of other residents. Staff or visitors may attend meetings at the group's invitation.
The facility must provide a designated staff person responsible for providing assistance and responding to written requests that result from group meetings.
When a resident or family group exists, the facility must listen to the views and act upon the grievances and recommendations of residents and families concerning proposed policy and operational decisions affecting resident care and life in the facility.
Participation In Other Activities
The resident has the right to participate in social, religious, and community activities that do not interfere with the rights of other residents in the facility.
Accommodation Of Needs
The resident has the right to reside and receive services with reasonable accommodation of individual needs and preferences, except when the health or safety of the individual or other residents would be endangered.
The resident has a right to receive notice before her/his room or roommate is changed.
Activities
The facility must provide for an on-going program of activities designed to meet the interest and the physical, mental, and psychosocial well being of each resident.
Social Services
The facility must provide medically related social services to attain the highest practicable physical, mental, or psychosocial well being of each resident.
Environment
The facility must provide:
- A safe, clean, comfortable and homelike environment
- Housekeeping and maintenance services necessary to maintain sanitation
- Clean bed and bath linen that are in good condition
- Private closet space
- Adequate and comfortable lighting levels
- Comfortable and safe temperature levels
- Comfortable sound levels
ELDER ABUSE, NEGLECT AND EXPLOITATION
America is aging and aging quickly. Between 1990 and the 2020 the number of persons over 50 will increase by 74%. Those under 50 will increase by only 1%. America is also living longer. If you are a 50-year-old female with no illnesses related to the heart or cancer, your life expectancy is 82; if you are a 65-year-old male with the same health scenario, you can expect to reach 78.
As you can guess, with more of us getting older and living longer there also comes the distinct possibility of elder abuse. It is estimated that at least one out of every twenty elderly persons will be abused each year - that was over 2 million people in 1988. But these aren't really good statistics because abuse is not generally reported. Although 1 out of 3 child abuse cases are reported, only 1 out of 8 elder abuse cases are reported. That's despite the fact that it is the LAW to report any suspected cases of abuse! It goes even further. If you see the abuse and don't report it, and it is discovered, you can be prosecuted as if you DID the abuse. One study found that only 16% of the abusive situations are reported - 84% remain hidden. A good source of information can be found at www.elderabusecenter.org.
When most individuals think of abuse they think of Physical abuse. That is only 1 out of 6 types of elder abuse. The 6 types of abuse are:
- Sexual Abuse
- Emotional or Psychological Abuse
- Neglect of yourself/neglect by your caregiver
- Financial Exploitation
- Physical Abuse
- Abandonment
These types of abuse can occur at home, a personal care home, an assisted living facility, and a nursing facility - in other words -- ANYWHERE. The occurrence of each type of abuse may also surprise you as we rank and order them:
| Neglect | ........ | 58.5% | Physical | ........ | 15.7% | |
| Financial | ........ | 12.3% | Emotional | ........ | 7.3% | |
| Sexual | ........ | 0.4% | All other types | ........ | 5.1% | |
| Unknown | ........ | 0.6% |
When we speak of neglect, it is estimated that 38% is self-neglect or self-abuse. This entails things like taking medicines improperly and not eating properly. Physical abuse is the non-accidental use of physical force that results in bodily injury, pain or impairment. Sexual abuse is the non-consensual contact of any kind with an older person. Emotional or psychological abuse is the willful infliction of mental intimidation, or other verbal or non-verbal abusive conduct. Financial or material exploitation is the unauthorized use of funds, property or any resources of an older person.
Now that we have an idea of the kinds of abuse, lets look at who does the abusing. The most recent data available is only from 30 states in 1994, but it gives a clear picture of the perpetrators of elder abuse. It shows that more than two-thirds of the abusers are FAMILY MEMBERS! But many individuals think the majority of abuse is by the service provider (nurse aide) - when in fact it accounts for only 6.2% of the abuse cases reported. The overall breakdown is as follows:
| Spouse | ........ | 13.4% | Sibling | ........ | 2.9% | |
| Adult Children | ........ | 35.0% | Grandchildren | ........ | 5.9% | |
| Other Relatives | ........ | 13.6% | Service Provider | ........ | 6.2% | |
| Friend/Neighbor | ........ | 5.2% | Unknown | ........ | 7.4% | All Others | ........ | 10.3% |
Elder abuse, like any other type of domestic violence is extremely complex and many different factors contribute to its occurrence. It is generally assumed that a combination of psychological, social, and economic factors that affect interpersonal and intra-familial relationships is responsible for domestic elder abuse. The existing causal theories of domestic elder abuse can be divided into four major categories. These categories, however, are not independent of one another, but are closely related.
Let's look at them one at a time:
Stress of the caregiver
Caring for an older adult family member is a tough job. According to the National Family Caregivers Association, "heavy duty" caregivers do not get consistent help from other family members or outside sources. As many as 75% of these caregivers are "going it alone".
Caregivers may have increased feelings of frustration, isolation and despair. They may be hesitant to ask for help and/or may not know where or how to access formal support services.
Cycle of violence
This theory holds that violent behavior is a learned behavior and is transmitted from one generation to another. The abuser was once abused and now does the abusing.
Personal problems of abusers
Researchers have found that abusers of the elderly (typically adult children) tend to have more personal problems than do non-abusers. These children frequently suffer from such problems as mental and emotional disorders, alcoholism, drug addiction, and financial difficulty.
Impairment of dependent elders
Researchers have found that elders in poor health are more likely to be abused than those in good health. Among the estimated 6 million dependent elders in this country many are severely disabled older people who suffer from mental or physical disabilities or both. This theory postulates that abuse often occurs in a situation where the stress of the caregiver is heightened as a result of the older person's increased dependency on the caregiver due to worsening of the older person's impairment.
Learn to recognize possible indicators of abuse, neglect, and exploitation.
Physical signs:
- Injury that is inconsistent with its explanation
- Pain from touching
- Dehydration or malnutrition not caused by illness
- Poor coloration, sunken eyes or cheeks
- Inappropriate administration of medication
- Soiled clothing or bed
- Lack of necessities such as food, water or utilities
- Lack of personal effects and comfort in living environment
Behavioral Signs
- Fear, anxiety, agitation, anger, withdrawal, depression
- Non-responsiveness, resignation, ambivalence
- Contradictory statements, implausible stories
- Hesitation to talk openly
- Confusion or disorientation
Signs by Caregiver
- Prevents elder from speaking or to seeing visitors
- Anger, indifference, aggressiveness toward elder
- History of substance abuse, mental illness, criminal behavior, or family violence
- Conflicting accounts of incidents
- Talks of elder as a burden
Signs of Financial Abuse
- Frequent expensive gifts from elder to caregiver
- Missing personal belongings, papers, credit cards
- Unpaid bills, unusual activity in bank account
- Caregiver's name added to bank account
- Frequent checks made out to "cash"
- Documents (will, loan, etc,) signed when elder seems incapable of understanding
- Elder unaware of reason for appointment with banker or attorney
- Caregiver's refusal to spend money on elder
- Signatures on documents that do not resemble elder's
Now that we have an understanding of elder abuse, what can we do?
- We can report to the Texas Department of Human Services, Adult Protective Service Division 1-800-252-5400 any cases of abuse of which we have knowledge or reasonably suspect.
- We can also be ever mindful that care giving jobs are stressful. Care givers must learn to deal with the added stress through such things as an exercise program, good nutrition, relaxation and participation in support groups. For more information on local caregiver support services in your area, call the Area Agency on Aging Caregiver Support Program at 1-888-622-1111.
- And lastly, we can share these comments with friends and neighbors so they can be aware of the significant problem of Elder Abuse and help stop it.
Helpful Phone Numbers
Automatic call routing to your Area Agency on Aging: 1-800-252-9240
| Information on the Ombudsman program
John Willis, State Ombudsman Texas Department on Aging P O Box 12786, Capital Station Austin, Texas 78741 (512) 424-6875 1-800-252-2412 Harry Comer, Managing Local Ombudsman Area Agency on Aging of the Capital Area 2512 South IH 35, Suite 340 Austin, Texas 78704 (512) 916-6054 Toll Free 1-888-622-9111 Information on Medicaid/Medicare Texas Department of Human Services: (512) 834-0162 Medicaid Hotline: 1-800-252-8263 Medicare Hotline: 1-800-633-4227 Information on Social Security 1-800-772-1213 Adult Protective Services Adult Abuse and Financial Exploitation Hotline: 1-800-252-5400 Information on Assisted Living/Nursing Facilities Ombudsman, Texas Department on Aging, Long Term Care 1-800-252-2412 Nursing Facility Information Help line: 1-800-252-8016 Texas Department of Human Services Nursing Home Complaint Hotline 1-800-458-9858 Information on Unlicensed Facilities Texas Department of Health 1-888-963-7111 Locally at 512-438-7111 or 834-6650 To report unsafe situations or practices Home Health Agency Abuse Reporting 1-800-228-1570 Veterans Administration Benefits Information and Assistance 1-800-827-1000 Other Helpful Numbers Legal Hotline for Texans 1-800-622-2520 Austin local 477-3950 Advocacy Inc. 1-800-252-9108 Special care needs, mental health, retardation and development disabilities Alzheimer Association: 1-800-272-3900 Texas Attorney General Consumer Help Line: 1-800-621-0508 Texas Silver Haired Legislature: 1-877-718-8745 |
Pharmaceutical Discounts
Eli Lilly: 1-877-RXLILLY www.lillymedicareanswers.com
Together RX: 1-800-865-7211 www.together-rx.com
YOURxPlan: 1-877-733-6765 www.yourplan.com
The Medicine Program: www.themedicineprogram.com
Prescription Assistance: 1-877-672-6337 www.pameds.com
Everyone's RX: www.everyonesrx.com
Medicine Research Center: www.medicineresearchcenter.com
Medical Mall: 1-800-380-MEDS www.wecaremedicalmall.org
Others Mail Order Medications:Drug Place: 1-800-881-6325 www.drugplace.com
RxUSA: 1-800-798-7248 www.rxusa.com
Rx Universe: 1-877-624-5879 www.usmedication.com
Drugs Mall: 1-877-624-5880 www.onlinedrugsrx.com/?a=3300793
The information contained in this website is provided for informational purposes only. There is no implied endorsement by the Area Agency on Aging of the Capital Area or its parent organization, the Capital Area Council of Governments. We do not promote, recommend or endorse any specific organization or product.
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Area Agency on Aging of the Capital Area
2512 South IH 35, Suite 340
Austin, TX 78704
Please Note: This form is available in PDF format which can be downloaded, printed, and mailed to Area Agency on Aging of the Capital Area (see address above) CLICK HERE
This form is also available as an electronic version (EMail) by CLICKING HERE
To see a list of Nursing Homes/Assisted Living Facilities Go to:
1. Service Area Map and click on the appropriate county name.
2. Alphabetized Listing (Nursing Homes)
2. Alphabetized Listing (Assisted Living Facilities)
3. City/County Listing (Nursing Homes)
3. City/County Listing(Assisted Living Facilities)
3. County/City Listing (Nursing Homes)
3. County/City Listing (Assisted Living Facilities)
Questions/comments concerning this page,
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