Facility referral?

[DiDi]

Hello all

Am a newly subscribed user - seeking some more 'subjective' information from those in the know. A close family friend is most likely going to be forced into a nursing home in the near future. She is currently in a rehab centre having suffered a fractured pelvis. She has lived relatively independently in a self-contained 'granny flat' on her daughter's property for many years (she is 89). There seems to be some issue with her health insurance covering the rehab centre fees and a nursing home is now looking like the only option. As a professional in the finance industry I am well on top of the costs of care etc but can find no forums that provide the 'real' story on which facilities in her area have the best reputation etc. We'd obviously like to target the better homes if we can - the formal 'accreditation reports' don't seem to offer up much useful information...is this considered too touchy an area or can someone point me in the right direction?

Any help would be greatly appreciated!

Thanks in anticipation

[Snappo]

Hello DiDi, welcome to the forum. Aged care crisis (click on the link top right hand corner) have some thoughts on this issue. My personal experience, both from a child, who had a parent in care, and from a carer, who currently works in aged care, is to pay a visit to all the facilities that are available in the area. It all depends on the type of accomodation you require, and the type of care. As you have no doubt noticed if you have been browsing this website, there are no mandatory staff/resident ratios in aged care, the staffing level depends upon what the facility manager/DON sees as 'appropriate'. Your idea of 'appropriate', and theirs, could very well differ. You need to know what the staffing levels are, and if there will be set staff who will care for your friend, this is so important for continuity of care.

My father was in a very old facility, not much in the way of 'mod cons', but his care was wonderful due to the continuity of staff, and a fairly good staffing level. I have worked in a brand new facility containing everything that opened and shut, but the care was appalling due to the lack of staff. Just because it looks good, it certainly doesn't mean it is good.

Not too much help, is it? It would be great if there was a website we could access to get this information, but there isn't, From my personal experience, leg work, and asking the right questions, is the best way to suss out a facility.

Good luck

[industrystandard]

You're saying that she will be forced into a nursing home because her health insurance won't pay for longer in rehab which seems to imply that you think that she would benefit from further rehab. If you think this is the case, has any-one considered the Transition Care Program? This provides three months slow stream rehab for elderly people with the aim of preventing a permanent nursing home placement. Her ACAT assessment must specify Transition Care - if she has already had an ACAT done specifying high or low nursing home care it cannot be changed, sorry. Link to TCP:

http://www.health.gov.au/internet/main/ ... sition.htm

If you do need to look for a facility, you need to bear in mind that getting a bed at a good place can be difficult and therefore you need to start looking as a matter of urgency. If the health insurance runs out, you do not want to be in the position of having to take the first bed available. I would recommend using an aged care consultant. This is a private contractor who will drive the placement process. Aged care consultants tend to know which facilities are good and which are not; and a lot of beds are filled by these consultants without ever becoming available to the general public. The hospital should be able to supply you with some names.

I agree with Snappo, don't be fooled by the decor and the spas etc. Often there are no staff to help residents use the nice facilities. Also, don't be fooled by the offer of an 'extra services' bed. Extra service facilities are allowed to charge a bond and a daily fee for a high care place (bonds for low care are normal) and the fee supposedly pays for extra physiotherapy, nicer meals, wine and so on. There's a table on the Dept's website of what extra services facilities must supply to be able to charge the bond and fees. The most important thing to remember is that extra services fees do not cover extra care or staff and very rarely are the goods, services or accommodation any better than elsewhere.

Do ask about staffing levels and in particular, how many registered and enrolled nurses (Div 1 and 2 nurses in Vic) there are as opposed to carers (unregulated personal care workers). Observe the staff when you are looking around - do they look happy or do they look harried and how do they speak to each other and the residents? Ask how long the management and senior nurses have worked there and if they have any carers who have worked there a long time - this will tell you a lot.

I actually can't think of anything more important than the staffing. I hope this helps somewhat.

[linda_m]

My advice is to resist the pressure which is often applied at this stage. Hospitals and rehab places are always anxious to clear beds. This is quite understandable from their point of view. From the point of view of the person involved, it is important to ensure that you are happy with with any place you nominate. When I have been in this situation I have had social workers say to me that the only places I chose were the ones most in demand. Of course! Because these were the ones which had good reputations. I refused to allow my relatives to be discharged from hospital until I had visited and chosen homes that I thought were suitable. I think that Industry Standard is right in that a good broker can help. I say this reluctantly as I believe that families should be able to navigate the system themselves without resorting to having to pay private brokers. Also, there is often a great difference in the quality of the brokers and the fees they charge. This is such a stressful time for families and friends. Good Luck!

[danielle]

You could try and contact www.agedcarecrisis.com/contact-us - if they have any additional information about a facility, or the provider/s behind the facility, I'm pretty sure they may be able to shed some light for you. And you're right, those accreditation reports are pretty useless - you could pick up a dozen or so, and the wording never changes. I've personally known of some shockers that received 44/44 accreditation - so, don't believe everything you read!

[Snappo]

I actually contacted accreditation, questioning one of their reports. They admitted that there had been an error in the transfering of information from the written report to the website, and said they would correct it. To my knowledge, 12 months down the track, nothing has been changed. I might add, that the lady I spoke with was obviously ticked off with me for bringing this to her attention. As stated, these reports are pretty useless.

[paulinek]

No wonder Aged Care is such a minefield. What is the purpose of having Accreditation if it is useless? This is what has annoyed me greatly. People are paid to do a job. All these Government Agencies are set uup, funded and staffed at a great cost to the community. I wish that just one of the people that I complained to did their job. I wish that one of the agencies actually had any teeth to change something or make something better.

Whatever I do, I always think that I have to do it not just for my mother but for all those people who can't speak up for themselves or don't have family visiting them.

[paulinek]

I did allow myself to be pressured by Social Worker at the hospital, as they needed the bed so we had to find a high care bed very quickly for my mother. There was only one I could get mum into and it was a public one and I believed it was just temporary until we could find a better place nearer to home. Unfortunately, I now realise I judged all public nursing homes based on our experience there and perhaps that's not fair. Our family did not have any experience in aged care and I couldn't find good information anywhere.

Mum went into a two bed room in the high care area. There was no separate area for dementia patients and it was quite frightening at times visiting mum, let alone being a resident there. The lady in the other bed could not speak English (she was Italian), was in terrible pain and moaned 24 hours a day. Her television was on all the time as it apparently calmed her (this was not noticeable though). The food was disgusting. Just one of the meals I'll mention was mashed potato (looked like it came from a packet) and gravy - that was it. There were not enough staff on duty at any time. It was extremely difficult to get any help. We brushed our mum's dentures twice a day as it was not being done. It was dirty and even the cooks and serving staff wore dirty uniforms. The stench in the home and the state people were left in was appalling. Mum was left in bed day after day. Mum got a terrible bladder infection. High fever, in pain and very unwell. Two or three times a day, I would ask if they could get a urine test done. They kept assuring me it would be done. Every time I came in, it had not been done. Days and days went by and nothing happened. One day, I told them that I would stay with my mum and not leave until they did the urine test. (I was scared - would I have to sleep there?) Two hours later, they had a result, doctor called and antibiotics prescribed. I asked them how could it be done so quickly and they told me they did it in the nursing home. That really annoyed me. I thought they had to send it away and wait days for result. It was so easy and they could have avoided letting her suffer for so long. It was really inhumane and it broke my heart.

Ok...will cut this down otherwise I will be here all night typing!! My point is - the temporary nursing home was a nightmare hell hole - no other word for it. POA would not let me move mum and it took weeks and weeks with legal intervention to try to get her moved. The Director of the home was a nightmare. They do not like to give up patients easily and will do and say anything to keep them there. I would have moved my mum the very day she could be moved, but no, she was left there until the money already paid ran out and of course the care went downhill to an even worse level. For every day the POA left her there, my anger grew. It was cruel. So - never believe it is temporary. Try to be fairly sure and if you make a mistake, tread carefully as it becomes incredibly hard and intimidating, to try to move when something better comes up.

Even now, the nursing home we have mum in has heard from her that we would like to move her. Suddenly, staff are over-friendly. Someone came today and asked her questions that they wrote down the answers to about her youth, where she went to school, things that she did, what she enjoyed. Two years late!! I think they're getting ready to actually converse with her!! Mum had a colour brochure on her table all about the nursing home she is in. She asked me to read it to her. I said I was not able to as it was a fictional document and I wouldn't make myself ill by reading it!!

[paulinek]

Is there a way we can get a list together of good nursing homes based on people's real experience rather than bogus accreditation?

[Administrator]

Aged Care Crisis has been long calling for much more information to be made available about the aged-care homes where many older Australians live.

The Deputy Prime Minister, Julia Gillard, states that the recent government - sponsored website, ‘My School’, will provide significant information about schools and allow parents to make informed decisions about their child’s education. These arguments apply equally to aged care.

Why can’t people go online and find about staffing levels, menu plans, the availability of allied health professionals and much more? Aged-care providers receive billions of dollars of taxpayer funding; it should not be too much to ask for full disclosure as to how that money is being spent. As well as increased transparency, such disclosure may well encourage improvement in residential aged-care services.

Here are some things that people don’t know when they are trying to locate a suitable aged-care home:

What is the staff/resident ratio?

Do residents get permanent assignment of staff?

Is a registered nurse always available on-site?

What is the number and nature of substantiated complaints levelled against the facility?

How have the complaints been resolved?

If a bond payment is required, would it be a $50,000 bond or a $500,000 bond, for example?

Does a dietician plan menus for residents who require special diets?

How are residents and families involved in treatment / care plans?

Are resident support groups encouraged - and run independently by family members?

Is air-conditioning available in bedrooms - as well as in living/activity areas?

What is the availability of allied health professionals (eg dentists, podiatrists, speech therapists, etc)?

People who contact ACC are often shocked to learn that It is still possible for a home to breach their responsibilities as an approved provider, as well as having serious complaints substantiated against the facility, and avoid any public scrutiny whatsoever.

Record complaints 'a sign of system under pressure'(Sydney Morning Herald – 28 Feb 2010)

[paulinek]

This is such a good article! We need better information exactly like this. I love the list. I would never have thought to ask about air conditioning being available in bedroom which it is not in mum's current nursing home and on those 40 degree days we had it was really hot.

Let's all add to this list : we really need to think about what we need to know before admitting a loved one.

If a doctor is required, does the patient have to wait until the evening for an after hours visit? This makes a big difference when something is not treated quickly. A delay of 10-12 hours makes a big difference to an elderly person.

If a prescription is requested by the doctor for the patient - what is the timeline with the chemist? Do they have to wait for the evening run to the nursing home. Again another delay.

If the resident has a fall, will the family contact person be advised?

Good point to about a support group. At mum's nursing home it is run by the Director of Nursing. Really not good as you just don't want to speak up as you leave your vulnerable loved one dealing with any back lash when you're not there.

What is the availability of allied health professionals (eg dentists, podiatrists, speech therapists, etc)?

- very important!! I think most families would be happy to pay extra for these services if available. If they are not willing to pay for these services - this should be a warning sign and perhaps the Guardian Board called in. No elderly person should be left in pain and not provided with the best care possible, particularly if they have the resources available that they have worked all their life to accumulate. I know this is a tough one - nursing home doesn't want to put the POA off side - but who is their client?

How are residents and families involved in treatment / care plans?

- Really important too. Do not think that because people run a nursing home that they know what they are doing. We already know that is a fallacy. Family needs to be involved in care plan.

Very much is made of the privacy of the resident and confidentiality. I do not believe that even exists once you are in a nursing home. All dignity, privacy etc., is stripped from them once admitted. Why can't they have a chart up in resident's room. I would love to have seen the documentation of when and how often mum was changed. Communication in a nursing home is really hard. You often can't find anyone to ask anything. They tell you whatever it is they think you want to hear without any accountability for the truth. It is not good!!

I will think on this and come back to it. Too many things going through my head and not enough time!!

Aged Care Crisis has been long calling for much more information to be made available about the aged-care homes where many older Australians live.

The Deputy Prime Minister, Julia Gillard, states that the recent government - sponsored website, ‘My School’, will provide significant information about schools and allow parents to make informed decisions about their child’s education. These arguments apply equally to aged care.

Why can’t people go online and find about staffing levels, menu plans, the availability of allied health professionals and much more? Aged-care providers receive billions of dollars of taxpayer funding; it should not be too much to ask for full disclosure as to how that money is being spent. As well as increased transparency, such disclosure may well encourage improvement in residential aged-care services.
.

Record complaints 'a sign of system under pressure'(Sydney Morning Herald – 28 Feb 2010)[/quote]

[Administrator]

We'd be more than happy if anyone could make any suggestions to the list we have on the website - we haven't updated it for some time now...

I really liked paulinek's posts in this post - High Care room needs

paulinek, do you mind if we publish that on the website in the same section as the checklist - and what author name would you like (if any) for it to be attributable to?

Nearly forgot - here's the link to the Nursing home checklist on the ACC website.

[paulinek]

Thank you. I think the list needs more input. Some great points brought up that really do need addressing. Have addressed some but I think we can really refine this with more input. Everyone has such different experiences and perspectives.

Name - can't we do it as coming from our group? That would be a really good outcome for a discussion group that we develop something to help others. Believe me, people need help!!

[Administrator]

hopefully we may be able to inspire some more excellent input from other family members or staff working in aged care...