What is a Continuing Care Retirement Community (CCRC)?

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The population in San Diego County is aging, with many people exploring their options for housing and lifestyle in retirement. One option that is attractive to many older adults is the possibility of moving to a Continuing Care Retirement Community (CCRC).

What is a Continuing Care Retirement Community (CCRC)?

CCRCs are sometimes called “life plan communities,” offering the support and resources older adults need as they move through the stages of aging. This support encompasses daily living assistance, such as dining options, housekeeping, transportation, recreational events,  and more. Additionally, wellness, fitness, and healthcare providers are provided as needed.  A robust activities calendar and resort-like amenities are other features of CCRCs that are attractive to many.

A full range of care options is available at most CCRCs, including everything from independent living to assisted living to memory care to skilled nursing care. The goal is to create a “one-stop” solution so that residents can age in place, even as their needs change.

Moving into a CCRC involves a significant investment of resources, so it is important for potential residents to make an informed decision. According to the California Advocates for Nursing Home Reform (CANHR), “The decision to move into a Continuing Care Retirement Community or not represents one of the most important decisions a person can make in their lifetime. The relationship between a CCRC and a resident is expensive, lengthy, highly personal, and complex.”

Types of CCRC Contracts

When choosing a CCRC, a contract will be established with a promise of care for at least a year or more. The cost and services provided vary depending on the CCRC that is selected and the specific services offered through the contract. Basic contract types include:

  • Life Care: Structured with an annual monthly rate and includes a guaranteed promise of care for life. Services typically include both primary and acute care, as well as nursing home and assisted living care on-site when needed.
  • Modified: The contract is designed with entrance fees and monthly fees, as well as a promise of reduced rates for higher care for a specific period. This option tends to be less expensive compared to a Life Care contract, but the resident bears more of the risk of future care costs. The provider also shares the risk of future costs.
  • Fee-for-Service: Like the modified contract, this option includes entrance fees and monthly fees. Guaranteed access is promised for higher levels of care, but the services are offered at the current market rate, and the resident bears the full risk of these costs.
  • Rental: The rental contract is designed with a monthly fee determined by the level of care that is received.

Is a CCRC Right for You?

Are you shopping for a CCRC? It is essential to understand the pricing structure as well as the level of services that will be provided. Education about your options is the best solution to find the community that is a good fit for your needs. Many consumers also choose to work with an attorney to review CCRC contracts. Our team at Windward Life Care is here to help you find the right solutions for care and housing. Contact us to learn about the available services.

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Surviving and Thriving as a Sandwich Generation Caregiver

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Are you part of the “Sandwich Generation?” This is the group of Americans juggling the demands of their own lives while trying to meet the care needs of their children and aging family members. According to US News, a 2012 Pew Research report found that about half of all U.S. adults in their 40s or 50s have a parent age 65 or older and are raising a young child or financially supporting a grown child.

Caring for Older and Younger Generations

Both aging parents and children at home need assistance with daily activities, doctors’ appointments, and rides. A family caregiver’s stress level can go up when they have to manage therapies and treatments that must be administered at home. It can be stressful to manage your household, hold down a full-time job, and manage caregiving responsibilities at the same time. The required extra care can be quite time-consuming, like taking on a part-time job in your free time after your regular employment. Over time, it can take a toll on the family caregiver.

Caring for Yourself

As a caregiver, it is essential that you are proactive in caring for yourself to reduce your stress. Here are a few tips:

  • Prioritize your self-care. Ensure that you have time in your schedule for good sleep, regular exercise, healthy eating, and relaxation. Even small changes, like a daily 10-minute walk during a lunch break, can make a difference in your physical and mental health.
  • Seek expert assistance and advice, including care management, counseling and respite services available through community organizations. Don’t wait until you are in crisis to get help.
  • Maintain open communication with your aging parents, so they feel in control of the situation and you can problem-solve together.
  • Make it a team-effort by incorporating other family members into the required caregiving tasks. When others offer to do something to help, give them a specific job to do.

The most important thing that you need to remember is that you don’t have to do it on your own. Family caregivers can struggle with this because it takes time to tell other people how to do things “the right way,” but it this investment of time is worth it. It can also be hard to give up control when you are used to being the main organizer and caregiver for the family.  Remember that it does take a village to ensure the well-being of children, older family members, and the family caregiver.

Support Resources for Family Caregivers

If you are carrying the burden of caring for a loved one, rest assured knowing that local resources are available to help. These local non-profits offer the assistance that San Diego family caregivers need by providing support groups, counseling, respite care, adult day care and/or educational classes:

Windward Life Care is here to assist with personalized help for your family’s situation. Contact our team to learn about an individualized care plan for your loved one, as well as the local resources that can help you.

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How Safe is Your Loved One’s Medicine Cabinet?

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By Bita Naderi, PharmD, BCGP

Note: This article is intended for informational purposes. It is important that you or your loved one(s) do not make changes to your medication(s) without first discussing with a physician or other prescribing healthcare provider.

 

Dr. Bita Naderi, PharmD, BCGP

People commonly believe that medications and supplements available to them over the counter must be safe. They are available, after all, without a prescription. However, over-the-counter does not necessarily translate to safe, and people should still exercise caution with these medications. Many factors go into determining safety: dose, duration of use, and interactions with other medications, among many others. Older adults often have multiple medical conditions, are on a variety of medications, and have physiological changes associated with aging that can put them at greater risk of adverse effects from medications. In fact, an outpatient study found people taking 5 or more medications had an 88% increased risk of an adverse drug event.

Considering that older adults account for 40% of all over-the-counter medication purchases, think about the following: Did you know that diphenhydramine (Benadryl®), often used for allergies and insomnia, may increase one’s risk of cognitive impairment, confusion, delirium, and dementia? Did you know that commonly used stomach acid suppressing medications, proton pump inhibitors, such as omeprazole (Prilosec®) when used over-the-counter, should be limited to 14 days of treatment? These medications are associated with increased risk of Clostridium difficile, a life-threatening bacterial intestinal infection, and impaired absorption of important vitamins and minerals such as calcium, iron, magnesium, and vitamin B12. Despite this, people sometimes use these medications indefinitely when not indicated. Did you know that commonly used non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Aleve®) and ibuprofen (Advil®), may carry an increased risk of heart failure exacerbations, stroke, heart attack, bleeding, and acute kidney injury?

And don’t forget about dietary supplements. Studies show that 70% of older adults use at least one supplement daily. Many herbs and supplements such as fish oil, garlic, and ginkgo biloba can increase the risk of bleeding, especially when used in combination with other medications that carry a bleeding risk. Some supplements, such as iron, magnesium, calcium, or aluminum, can impair absorption of some medications. You can discuss these drug interactions further with your pharmacist.

Paracelsus, the famous Swiss physician and alchemist of the 16th century, once said, “All things are poison, and nothing is without poison, the dosage alone makes it so a thing is not a poison.” In short, all medications, including those available over-the-counter, have the potential to cause harm if not used appropriately. In fact, we now know that is it not just the dosage alone that can impact safety, but a multitude of other factors. These include the person’s chronic disease states, other medications they are on, length of therapy, their ability to be adherent to a medication, and many others. These factors are unique from person to person. As such, every treatment plan must be individualized.

How can patients know if an over-the-counter medication or dietary supplement is safe for them? Pharmacists can serve as a great resource. Medication Therapy Management (MTM) is a growing field for pharmacists with the goal of improving therapeutic outcomes for patients. MTM aims to decrease the utilization of high-risk medications and medications that are ineffective or no longer indicated. MTM can decrease adverse drug events, drug interactions, and therapeutic duplications. Older adults can benefit greatly from MTM services, as many have multiple chronic conditions, complex medication regimens, and are experiencing growing healthcare costs. Furthermore, these patients often have multiple prescribers and multiple pharmacies. This is even more reason for a pharmacist to oversee and manage their medications as a whole, which when complicated by over-the-counter medications, can put them at greater risk for adverse drug events.

UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) offers MTM services to clients through a program called Partners in Medication Therapy. UC San Diego SSPPS clinical faculty, who are also licensed and credentialed pharmacists, ensure effective and safe use of drug therapies according to recommended guidelines and best practices in order to meet treatment goals.

Windward Life Care clients can access the services of the UC San Diego SSPPS Partners in Medication Therapy program. Just contact us to find out next steps.

Dr. Bita Naderi is a California licensed and Board Certified Geriatric Pharmacist. She completed a UC San Diego geriatric pharmacy postdoctoral fellowship and served as a pharmacy consultant at a local Program of All Inclusive Care for the Elderly (PACE). She currently works as a pharmacist at Southern Indian Health Council and strives daily to optimize medication therapies and improve adherence.

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The Looming Crisis in California: A Shortage of Health Care Workers

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One of the biggest problems facing older adults in the United States is the growing shortage of professional caregivers. San Diego is feeling the pressure along with other cities across the nation. The demand for caregivers is increasing as the Baby Boomers need more services. Something needs to be done to ensure that the support they need is available to them.

Why are We Experiencing a Shortage of Professional Caregivers?

According to the Paraprofessional Healthcare Institute (PHI), the shortage is occurring due to an increase in demand from consumers, as well as turnover because of career changes or people leaving the workforce.

The Bureau of Labor Statistics (BLS) reported that 7.8 million direct care openings are projected from 2016 to 2026:

  • 4 million new jobs created due to growth in the industry
  • 6 million jobs that need to be filled due to employees leaving the labor force
  • 8 million jobs to fill due to employees making a career change to other industries

This $103 billion industry is facing a serious crisis as more people reach retirement age and require care in medical facilities and at home. The health care system is strained and working to keep seniors at home and out of the hospitals. Many of the people in need of care suffer from chronic health conditions and require ongoing assistance.

Finding a Solution

Recommendations have been released by the California Future Health Workforce Commission, to close this gap by 2030. Not only is it anticipated that we will have a shortage of professional in-home caregivers, but there will be additional need for nurse practitioners, primary care physicians, social workers, and physicians’ assistants.

On a positive note for workers, the increased demand for healthcare professionals with geriatric expertise means there is great career opportunity for people with the heart and skill set to work with older adults. Many people choose to have a lifelong career in professional caregiving, while others enter the workforce in this position, then use their valuable experience to move into nursing or other healthcare careers.

Home care agencies looking for qualified, desirable candidates are working harder than ever to attract and retain professional caregivers, competing with other care providers like residential care facilities, as well as employers in other service industries.

The shortage of professional caregivers is a serious issue, but there is hope on the horizon.

Kimberly Torrence, Director of Operations

Kimberly Torrence, Director of Operations

What is Windward Life Care doing to recruit and retain the best professional caregivers? We actively track local, state and national trends affecting recruiting and retention.  We have adjusted to labor force challenges without sacrificing our Home Care Aide skills and experience requirements. Retention of quality employees is one of our highest priorities because it benefits our clients, our company and the community we serve.  Our comprehensive orientation, ongoing training, and professional support from Aging Life Care Managers help our Home Care Aides to thrive in their role at Windward. This training and support, in addition to our competitive pay and outstanding benefits package, enables us to retain experienced caregivers. Understanding our employees’ needs and working with them to create the schedule they desire makes Windward a partner in their career and life satisfaction.  A strong indicator of our success in this area is the fact that our caregiver turnover rate is 28% less than the national average. We are proud to be the employer of choice for experienced and professional Home Care Aides in San Diego County. Contact us if you want to see how our Home Care Aides can enhance your life!

– Kimberly Torrence, Director of Operations

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Fair Senior Housing for All

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June is Pride Month, which is a great time to celebrate diversity and evaluate how we can better support equality for all older adults. We’d like to highlight an important topic: how discrimination affects the LGBTQ population living in senior living settings, and what needs to be done to fix this problem.

Problems in Senior Communities

It’s a tragedy that many LGBTQ older adults feel they must go “back in the closet” in senior living to avoid harassment/discrimination. Some LGBTQ older adults experience mistreatment from facility caregivers on a one-on-one level, and some facilities have cohabitation policies that discriminate against same-sex marriage and relationships. In addition to facing discrimination and mistreatment from facility staff, LGBTQ older adults may also find that other residents are exclusionary, or even abusive. As a result, older adults sometimes feel that their only option is to conceal their sexual orientation and/or gender identity so they can have a place to live and receive the care they need.

This situation can be difficult to face when a person has for decades of lived openly. It is a step in the wrong direction if seniors need to pretend to be siblings or “just friends.” In addition, LGBTQ older adults should not fear elder abuse in the form of emotional or physical harm from staff or other residents.

While these problems are common across the nation, some providers are looking for ways to accommodate all people. Many forward-thinking senior housing communities see the problem and are opening their doors to the LGBTQ community.

Legal Protections for LGBTQ Adults

If you or a loved one is being discriminated against in a senior housing setting, then it is important to know that legal protections are available. LGBTQ older adults need to be aware of their legal rights and tap into the resources and support that is offered. For example, a U.S. District Court recently ruled that senior housing landlords cannot discriminate based on sexual orientation.

Where should you turn for the legal support and advocacy that is needed? SAGE is a national non-profit organization that advocates for LGBTQ older adults. They have a “National LGBT Housing Initiative” designed to tackle the problems LGBTQ seniors are facing when looking for housing options. The goal is to improve and expand senior living options for older adults, giving them a safe place to live without fear of discrimination or harassment. Elder law attorneys experienced in working with senior housing issues are another good resource.

Windward Life Care is here to help you find the right services and support in San Diego County. A member of the San Diego Equality Business Association, Windward is committed to providing compassionate and inclusive services for older and disabled adults in our community.

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Navigating Hospital Discharges with an Aging Life Care Manager

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Windward Life Care’s professional Aging Life Care Managers provide an array of services that benefit clients and their families. One particularly important function is assisting clients and their support systems in managing medical conditions and related problems. This includes helping clients and their families navigate through often stressful and confusing hospital visits, whether the visits are routine or urgent. Care managers like Windward’s Terry Ehlke, RN, BSN, CMC, serve as the client’s primary advocate to facilitate the entire process. Terry took some time out of her busy schedule to answer questions about some of the essential services a care manager provides at such critical moments in a client’s care.

Terry Ehlke, RN
Clinical Services Manager
Windward Life Care

How can Aging Life Care Managers help when an older or disabled adult is hospitalized?

Care managers function as patient advocates, making sure the client is cared for properly during hospitalization all the way through discharge. Care managers work closely with the client and hospital team to ensure everyone understands the history and special needs of the client, any unnecessary trips back are avoided (such as for tests that can be handled during the current visit), the client is safely discharged, and adequate discharge instructions are provided to the client and caregiver. A care manager can also step in with any appeals to pause or slow down the discharge process if need be. Often clients don’t realize they can say “no,” so they just go along. The ultimate goal is for clients to experience the safest and most effective and efficient hospital stay possible.

What are the risks when the hospital says it’s time for a patient to be discharged?

Unfortunately, the discharge process can often be too fast and disorganized. Without any standard of care for hospital discharge in place, every hospital does their own thing. Hospital staff are under great time pressure and can rely on “cookie cutter” discharge plans that don’t account for the client’s unique circumstances. The very real situation at the client’s home is often overlooked, so failures stemming from not considering certain bigger-picture issues are common. Elderly clients especially are very medically fragile. In addition, communication and referral delays can lead to unsafe situations at home and treatment delays. Instructions to the patient regarding follow-up care, if even provided, can be rushed and inadequate. This is particularly dangerous in the case of a new diagnosis for diabetes or congestive heart failure. There is a significant risk that problems that could have been easily prevented through a better discharge process will lead to readmission.

Why is preventing readmission such a big deal?

I recently read a study that revealed up to 27% of rehospitalizations were preventable. While it’s true that many readmissions are simply not avoidable, medical issues that are not resolved prior to discharge or failures in the transition to home can often result in an otherwise unnecessary return to the hospital or emergency department. Readmission has a huge impact on the client’s quality of life and safety. Each hospital visit poses that much more exposure to potentially lethal complications (medication errors, hospital-acquired infections, blood clots, etc.) while putting added stress on the client who is once again away from the comforts of home in an unfamiliar environment. Worsening cognition, including delirium, can result from being in the hospital environment. Ultimately, readmission delays recovery, possibly introducing new complications.

Who is most at risk for recurring hospitalizations/readmission?

There are myriad factors that increase the risk of repeat hospitalizations. These include taking certain medications, such as antibiotics, glucocorticoids, anticoagulants, narcotics, antipsychotics, and antidepressants to name a few, as well as certain chronic health conditions, like advanced chronic obstructive pulmonary disease, diabetes, heart disease, stroke, cancer, and depression, among many others. Prior recent hospitalizations and premature discharges also increase risk, as does low health literacy, a limited social network, and low socioeconomic status.

A key advantage of working with a care manager is that we have detailed knowledge of a client’s daily life, health, diet, medication regimen, and other circumstances that can impact his or her health and well-being when it comes to hospital readmission.

Medications can be confusing and the risks of taking them incorrectly are high. What can families do to help reduce errors and complications in this area upon hospital discharge?

The client and/or family caregiver must be clear on all medication instructions. Families and caregivers need to determine who will set up and manage the medications, as the client may not be the best person to do this for him- or herself. All medications, including pre- and post-hospital meds and over-the-counter meds, should be reconciled. Be sure to update and consult with the primary care physician as soon as possible following a hospital discharge. Due to the complexity of managing the administration of multiple medications at multiple times of day, enlisting the services of a home health nurse may be the best option. Pharmacists can also be an invaluable resource.

What are some of the issues where multiple healthcare providers are involved?

There are often many providers involved after a discharge. Inadequate hand-offs and communication problems between them are major impediments to a smooth transition to home. Home health providers, including nurses and therapists, may get incomplete information from the discharge planner’s referral. Equipment is ordered (or maybe not) and does not arrive on time. Home care aides are often not provided with basic information prior to working with a new client. There’s the potential for no one to follow up on hospital lab results after discharge if the discharge papers didn’t indicate any were pending. Pharmacies are also known to transcribe orders incorrectly, or not know some medications were discontinued or changed at the hospital, and then they don’t fill them correctly or at all.

Do doctors ever talk to each other about their shared patients?

Hospital doctors, or hospitalists, do not talk to primary care doctors as a general rule. This often comes as a surprise to our older clients who were used to a different system for most of their lives. Doctors may share computer records, but those are sometimes incomplete. Up to 50% of patients do not see their primary MD following a hospital stay, though this is essential to the success of ongoing care and is usually included in the “to do” list in discharge instructions. The hospital discharge planner typically does not make this appointment for the client. Referrals are mostly made to specialists, but if the client does not follow up to make an appointment, the specialist may never see the client.

What steps does a care manager take to ensure a smooth transition to home when a client is leaving the hospital?

This is often the time when we first get involved with a new client because the family or involved professional realizes they need an advocate. The Aging Life Care Manager conducts a full assessment that starts with a review of the discharge instructions. Particular attention is paid to any signs that require medical attention, medication changes, any restrictions on physical activity and diet, and any treatments that are needed. The care manager also follows up with the primary care physician and specialty providers while making sure the client and family have a complete understanding of all of the above and consults with them regarding possible needs for home healthcare assistance.

The care manager also discusses with the client and family meal preparation, physical and social activities, transportation needs, financial resources, and client preferences, because a care plan that does not align with the client’s preferences cannot be effective.

The care manager then develops a customized care plan based on this thorough and holistic assessment of the client. The plan addresses both immediate needs and long-term care goals, and it clearly identifies who is responsible for each service. The care manager communicates the completed plan with the client, family, caregivers, and other professionals who may be involved in the client’s care. The care manager then supervises the plan’s implementation.

 

Terry Ehlke recently presented on the topic of hospital discharge planning best practices at the San Diego Regional Home Care Council Spring Symposium in May 2019. Terry was recently promoted to the position of RN Clinical Services Manager at Windward Life Care and is available for assessments and consultation.

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