Assisted-living
facilities (ALFs) in New York (NY) can hold one or a combination of different
types of licensure and certification: basic, enhanced, and/or special needs.
According to NY Health Department regulations,
ALFs with enhanced certification can provide “aging in place by admitting and
retaining residents who desire to continue to age in place…able to provide
skilled nursing services and to accommodate residents who exceed the retention
standards” that are found in ALFs with only basic certification.
ALFs
with a “special needs” certification are authorized “to provide services to
residents with special needs, most commonly Alzheimer’s disease [AD], dementia,
or cognitive impairment. In addition, the assisted living operator may choose to
be dually certified to provide enhanced and special needs services, thereby
further allowing residents to age in place.”But there will be times when
residents with AD may require additional care, even in ALFs with both enhanced
and special needs certification.
My
late wife, Clare, was a resident with AD in a dually certified ALF in NY.
However, at a certain point, the ALF required me to hire personal “home health”
aides to be with her in order to remain there to age in place. (Even if care is
given in ALFs and not in private homes, these aides are still referred to as
home health aides.) According to NY regulations,
“Personal care tasks that exceed the approved scope of tasks in which an
assisted living resident aide is trained must be performed by trained home
health aides.
Regulations
governing enhanced ALFs also state: “A
resident shall be permitted to…continue to reside and age in place…provided the
operator, the resident’s physician, and, if applicable, the resident’s licensed
or certified home care agency agree that the additional needs of the resident
can be safely and appropriately met at the residence.”
According
to the National Center for
Assisted Living, ALFs are responsible for providing “coordination of
services by outside health care providers.” But what exactly does this
responsibility imply? What is meant by “coordination,” and what procedures
should ALFs implement to provide this coordination?
Below
are some experiences I had when my wife was a resident in an ALF, demonstrating
the many instances where care coordination in long-term care facilities needs
improvement.
- When my wife needed services
provided by an outside health care provider, the ALF chose the agency. As
the caregiver, I had no input. After observing and reporting negligent
care and/or shoddy work habits of outside aides assigned to care for
Clare, the AD unit supervisor told me I should contact the care provider.
To their credit, new aides were assigned each time I complained to the
care provider. But why didn’t the facility complain to the outside care
agency to ensure that Clare was receiving proper care?
- My daughter and I spent time
with each new agency aide to provide specific instructions for my wife’s
care regarding food, clothing, personal hygiene, etc. But too often a
different aide would be assigned the following day, an aide who had no
knowledge of the specific instructions for my wife. When I would find out,
my daughter and I would meet with the new aide, but why didn’t the AD unit
supervisor communicate those specific instructions to new aides initially?
- I visited my wife on a daily
basis, and several times I noticed aides arriving late or leaving
early. But no one at the facility ever informed me of when an aide
arrived late or left early. Shouldn’t outside aide arrival and departure
time be monitored by facilities?
- When I received statements from
the outside care provider detailing charges already billed to my credit
card, I sometimes noticed billing for hours when the aide was not there,
or overtime charges without advance notice that overtime rates would
apply. But I could never be sure that aides worked for all hours billed
when I was not personally there to verify such hours, and again, no one
from the facility had recorded their presence. Shouldn’t outside care
agencies submit their statements first to facilities for verification?
- It would be very helpful for
already stressed caregivers if care facilities took more responsibility
for supervising and coordinating personal aides hired by caregivers to
allow their loved ones to age in place.
_____________________________________________________
Dr Vann is a frequent writer in caregiver magazines, medical journals, and in major newspapers. After his wife, Clare, was diagnosed with early onset Alzheimer’s disease, Dr Vann made it a point to increase public awareness of Alzheimer’s and to help fellow caregivers. You can read his other pieces at www.allansvann.blogspot.com. If you would like Dr Vann to respond to questions or comments about this article, please email him directly at acvann@optonline.net.
Dr Vann is a frequent writer in caregiver magazines, medical journals, and in major newspapers. After his wife, Clare, was diagnosed with early onset Alzheimer’s disease, Dr Vann made it a point to increase public awareness of Alzheimer’s and to help fellow caregivers. You can read his other pieces at www.allansvann.blogspot.com. If you would like Dr Vann to respond to questions or comments about this article, please email him directly at acvann@optonline.net.
© Copyright 20
Published in Annals
of Long-Term Care, August
7, 2017. Access online only at:
