Security Risks while at Nursing Homes and Assisted Living Facilities

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Among the reasons suggesting Aging in Place as a discreet objective of any estate and financial plan is security. Most people find their homes well secured and safe. Further, home invasions are rare, and security threats easily and inexpensively managed.

Security while at any institution is always an additional concern, and the risk is out of your control.  Of course security from other residents and even from staff, is a concern of which most are aware.  Violence is visited on residents from both staff and other residents, and this violence is entirely avoidable if non-institutional care is an option.  One research study concluded:

"Common violence encountered in the long-term care service industry is residents assaulting staff or each other. Maintaining adequate security in these facilities can be challenging for a variety of reasons including campus design, residents who may suffer from dementia or other cognitive impairments, the potential for criminal activity due to patient valuables and residents’ inability to recall details."

Most aren't aware, however, that there are existential security threats to any institution, simply because it is a place where people and things of value are aggregated.  Whether from the possibility of terrorism, or robbery, institutions must consider, confront, and protect against unique security risks, risks that are distinct from those you face at home.  

Nursing homes and assisted living facilities also present unique security challenges in confronting the risk:

The armed intruder or active shooter is an external threat that has occurred in assisted living and skilled nursing facilities in multiple geographic locations. Of concern in this type of incident is the limitations of the traditional response of Run, Hide, Fight, when considering the resident population of skilled nursing and assisted living facilities. Aside from the ethical issues of many nurses and other healthcare providers not wanting to leave their patients or residents, the residents themselves will be vulnerable due to conditions such as mobility issues and cognitive functioning. Numerous types of violence should be considered from a security perspective when examining the threat of an armed intruder or active shooter such as; violence directed toward a group or person (administrators, medical staff), domestic violence, and mercy killings. This type of violence may begin at another location and end on the campus or inside the facility.

Dean Conner, Violence and Security in Skilled Nursing/Assisted Care Facilities (IAHSS-F RS-18-04, December 3, 2018).

The objective of breaching the security of a single home is obviously less, and ordinarily would suggest there is no sufficient incentive for invasion.  Hence, homes are generally less attractive targets.

A recent drug robbery at an Alabama nursing home is an object lesson in the security threats faced by institutions, and the risks the elderly and their families must consider in selecting institutional care.  Two masked intruders recently invaded Consult America Cottage Hills, in  Pleasant Grove, Alabama, brandishing handguns and demanding the contents from the locked narcotic box.  Police estimate the pair made off with about $5,000 in narcotics, WBRC reported.  According to the report, Lieutenant Danny Reid told WBRC that such robberies usually occur in bunches, that he was convinced that the couple knew what they were doing, skipping over any blood pressure medications:

“Nursing homes are pretty soft targets,” he said Wednesday. “We have plenty of good leads I think. We’ll continue to work it. I’m actually reaching out to some local law enforcement in other cities to see what they have in regards to nursing home robberies ’cause usually this is going to be a pattern,” he added later.

Police are reviewing surveillance footage from the incident and believe that the pair are a man and a woman. An employee at Cottage Hills declined to comment to WBRC on the investigation when reached.  

"Soft target" assisted living facilities and nursing homes will only become more valuable and frequent targets as the nation battles the current opioid crisis, and as those who are ill-willed find success. It is only a matter of time before this lawlessness visits injury or death upon a resident.  

     

You May Soon be Able to Test Yourself for Dementia

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A new tool being developed by British researchers lets people test themselves for dementia. The new tool is promising and shows some initial success. 

The test, called “Test Your Memory,” or TYM for short, is a simple questionnaire that people can take and complete on their own. In initial trials, it is reportedly faster and more accurate than other current tests.  Researchers at Addenbrooke’s Hospital in Cambridge note that it has only been tried in one clinical setting, and many further studies are needed to conclusively prove  the test's efficacy. Also, the results of the questionnaire, while generally perceived as accurate and a good indicator of dementia risk, still need to be interpreted by a professional, according to the research team.

In the first trial, 540 healthy people aged 18 to 95 completed the questionnaire. As a control, researchers also asked 139 people with confirmed cases of either Alzheimer’s disease or mild dementia to take the test. The healthy cohort took about five minutes to complete the test, scoring an average of 47 points out of 50. Those with Alzheimer’s disease scored an average of 33 points, and took longer to complete to test. The exam comprises a series of word recall, verbal fluency and sentence copying questions. Interpretations of the results of the test identified 93% of those with Alzheimer’s, compared to 52% identified by the more commonly used mini-mental state examination.

Doctors at Addenbrooke note that, while the test can be an important part of identifying and diagnosis Alzheimer’s and dementia, physician evaluations and patient histories is nonetheless important. McKnight's Long-term Care News reported the existence of the test, but test results are scheduled for future publication in an upcoming issue of BMJ. 

Full-Time Nursing Home Doctors Less Likely to Medicate

Physicians employed full-time at a nursing home reduced prescriptions significantly, while community physicians tended to do the opposite, a new study finds. The information provided by the study, and more, the insights the study suggests regarding managing pharmaceutical care are invaluable in making decisions regarding institutional care and between competing institutional care alternatives.

According to an article in McKnight's Long-term Care News, researchers followed long-term stay residents for 12 months, with a goal of learning whether prescriptions were reduced after their first year at the facility, in an.effort to develop effective models for post-acute care for seniors. Results appeared last month in The Senior Care Pharmacist and were publicized last week by BRI. 

One of the reasons medication prescription, use, and management are of importance in evaluating alternatives is that so often medication mistakes or mismanagement lead to adverse health outcomes.  In fact, medications are a large part of the reason that persons discharged to nursing homes from hospitals are forced back to the hospital for additional care, or "readmissions," as they are identified by Medicare.  “Readmissions rates are a huge stressor, with 30% of readmissions due to medication issues,”  said LAJH Chief Medical Officer and Brandman Executive Director Noah Marco, M.D., as reported by  McKnight’s. “We said, ‘Let’s focus on medications first.’ Our hypothesis was that people will be coming in on a large number of medications and at the end of the year, their medications will be reduced.” 

But the mean number of scheduled prescriptions increased from 11.1 prior to admission to 13.3 by the end of the year, they found. Marco and team were shocked. When he and researchers dug into the data, they found that physicians employed full-time by the home ordered significantly fewer additional prescriptions. The home has five full-time geriatricians, with about the same number of community physicians also treating residents.

While more research is needed, Marco suspects that the on-staff geriatricians have a different philosophy with regards to medication.  Physicians employed full-time by the home get to know the patients, and the nursing staff.  "With that knowledge and alignment, we can create a plan,” he said.  The challenge is to find more avenues to study this patient population, he said. Marco also noted that pharmacists play a critical role in long-term care facilities.

“Just as they are playing a more important role in quality of care in the hospital, it’s incredibly important for more work to demonstrate the value of pharmacists actively involved in the day-to-day future care of this population,” he said. “I’m thankful I have such skilled pharmacists who are actively helping us create knowledge.”

New Rating System for Nursing Homes Launches Today

The Nursing Home Compare website and Five-Star Quality Rating System were created to help consumers, their families, and caregivers compare nursing homes and identify areas of possible inquiry when considering and comparing nursing home care providers. Highly anticipated changes to the federal Five-Star Quality Rating System for nursing homes are supposed to commence today, ending a freeze on survey results. Providers will learn whether they have gained or lost stars, or, as is expected for about half of facilities, remained the same.

Nursing Home Compare has a quality rating system that gives each nursing home a rating between 1 and 5 stars. Nursing homes with 5 stars are considered to have above average quality and nursing homes with 1 star are considered to have quality below average. There is one Overall 5-star rating for each nursing home, and a separate rating for each of the following three factors:

• Health Inspections: Inspections include the findings on compliance to Medicare and Medicaid health and safety requirements from onsite surveys conducted by state survey agencies at nursing homes.
• Staffing Levels: The staffing levels are the numbers of nurses available to care for patients in a nursing home at any given time.
• Quality Measures: The quality of resident care measures are based on resident assessment and Medicare claims data.

CMS has periodically made improvements to the website and ratings system. Each update has been part of CMS’s ongoing effort to increase the accuracy of information available to consumers and to encourage quality improvement at nursing homes across the country.

The set of changes also will bring the addition of new measures tied to long-stay hospitalizations and emergency room transfers, along with removing some “duplicative and less meaningful” metrics. The Centers for Medicare & Medicaid Services has said it wanted separate quality ratings for short-stay and long-stay residents, and it has revised rating thresholds to better pinpoint quality variations among SNFs for consumers.

Technology and Experts Assist in Aging in Place

"Karie" organizes, schedules, and dispenses pills.
This picture is subject to
 copyright of AceAge Inc.,
but is used without permission under the
"fair use" doctrine that permits
 use for educational purposes

I often tell clients stories to illustrate why gerontologists, and other experts, are indispensable in Aging in Place Planning, and why technology empowers seniors, and their families, and caregivers to prefer home over institutional care. One such real life story involves a client who I thought, based only upon the information available to me and her family, would require institutional care.  In that case, I and the family were wrong, and the client remained independent, at home, with technology providing  the necessary solution.

The challenge involved memory deficits and medication. The client, "Jane Doe" had recently been prescribed a blood thinner.  The client's children were understandably concerned, because they, and Jane Doe's doctors, had previously suspected that Jane Doe had "over-medicated."  Fortunately, the previous instance of over-medicating, presumably occurring because Jane Doe simply forgot that she had taken her medication, was not life threatening.  Now that Jane Doe's medication included a blood thinner, where the effects of mistaken over-medication might be life-threatening, the children inquired whether it was time to consider institutional care.

The concern was well-intentioned, and justified. Like her children, I presumed the time had come for Jane Doe to relent to institutional care, especially since her rural location would make professional care at the home difficult and expensive.  Jane Does was ruggedly independent, and like most of my clients, had expressed intentions to remain at home for as long as possible, despite worsening health or impairment.  She had, in fact been independent, capably managing her rural challenging existence for more than thirty years. I suggested that the family consult a gerontologist.

The gerontologist confirmed the legitimacy of the concern, and, in fact, believed that Jane Doe had a variety of additional challenges, about which we were unaware, that warranted consideration of institutional care.  The gerontologist, however, felt that institutional care would be traumatizing and destabilizing for the rural woman who had remained independent for so long.  She developed a plan for Jane Doe to remain at home, with the help of technology, and simple, inexpensive changes made to her "environment." 

The challenge of medication risk at home is common. Nearly one-third of older home health care patients have a potential medication problem or are taking a drug considered inappropriate for older people. Elderly home health care patients are vulnerable to adverse events from medication errors, in part, because they often take multiple medications, for multiple conditions, prescribed by multiple health care providers. The majority of older home health care patients routinely take more than five prescription drugs, and many patients deviate from their prescribed medication regime. The potential for medication errors among the home health care population is greater than in other health care settings because of the unstructured environment and unique communication challenges in the home health care system.  It is not surprising, then, that some suggest that almost one-quarter of patients in long term care are institutionalized because they cannot take their medication properly. 

One available solution is a product called "Karie" a product of AceAge Inc.  "Karie" is a personal health companion that organizes, schedules, and dispenses pills with one-button technology, ensuring that patients are taking the right medication at the right time. According to its manufacturer, Karie is "easy to use, enables greater patient autonomy and ensures better healthcare through a highly coordinated program."  Technology is providing solutions precisely in the time frame for which there is great need.