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In this column I would like to talk about the marketing of long term care facilities and the pitfalls it presents for families looking to place a loved one into the best possible situation. Over the past decade or so, I have seen the marketing staff at all types of LTC facilities become more and more aggressive, at times promising care they cannot possibly deliver. What I would like to do is give the families some tools and suggestions that allow them to differentiate exactly what the care needs are of their loved ones and then help them determine more closely what a specific facility can offer.

As I have said before, the first step a family should take is to get a very good assessment of their loved ones’ physical, mental and emotional needs by a professional who works with the elderly in the community environment. A geriatric care manager or RN working in the community would be my first choice. This should be an independent professional not associated with any specific facility. The National Association of Geriatric Care Managers is easily found at www.caremanager.org. If the patient is on Medicaid, the assessment will be done by a professional sent out by the state. When you receive the written assessment, sit down with the professional (this will be difficult with the Medicaid professionals) and ask questions. Ask them to try to delineate the most important care needs in order of importance. Always try to remember that we are trying to keep the resident safe in order to maximize quality of life. A fall with resulting fracture of the pelvis/shoulder/or hip can markedly reduce quality of life.

Some families wish to work with someone like me, but other families want to do this on their own. So, when you talk with the management of any facility, you want to talk with the nursing staff. They are the folks actually caring for the residents. Do they seem concerned about your parents’ needs? Do they ask appropriate questions? Do they have experience handling residents with similar needs? What is their background and training? Is the nurse in charge of assisted living an RN or LPN, or do they have a nurse come in to oversee care only on a weekly or even monthly basis, leaving a certified nursing assistant in charge? If the facility is an adult family home, is the provider an RN or LPN? What is his/her background and experience? If the provider is not a licensed nurse, ask to speak with the nurse assessor/delegator that works with the provider. Ask about staff turnover.

If at any time you hear the nurses repeating phrases and ideas that you have heard repetitively from marketing, some of us call that "drinking the Kool Aid." It means that the nursing staff may not be thinking and acting independently. That is generally associated with a facility that is not keeping its beds full and its profits at an acceptable level, and where pressure is being applied to the nurses to somehow handle whatever problems present at their door.

So besides the assessment and talking to the right people, what else can a family do? Do not look at the chandeliers, swimming pools, linen table cloths and fancy carpets as the primary criteria. Do not succumb to pressure or special financial offers. Be suspicious. Evaluate the CARE! It is always about the CARE! When you make an appointment to visit a facility, look at the other residents. Do they look unsafe? Do they look like someone better be ready to catch them if they go down? Do they look happy? Are they clean and dressed appropriately? What is the staff/resident ratio 24/7? Pin down the qualifications of the staff working at night. What is the food like and do you see residents needing help or encouragement eating who have been left to fend for themselves? If so, should they be there or is the staff simply neglecting their needs?

After your initial visit, sit down and make lists about what you did and did not like. If you have one or two facilities you think may work, go back. I suggest you do not make an appointment, but just show up. All questions are legitimate. All concerns need to be answered appropriately.

Families are often told by physicians that it is time to seek more care for their parents and then the physicians suggest "assisted living." I do not believe that the average physician really understands the different levels of care we have in our local communities and just how many confusing choices there are. You, the family, are going to have to advocate for your own. You can only do the best you can, and then stay involved. Your involvement will be the ultimate safety net for your loved one.

My final comment is that, unfortunately, the long term care world has become a business. Although we have wonderful professionals and caregivers doing superb work, we also have a lot of individuals and corporations out there looking to profit via our aging population. It will probably get worse before it gets better, and all of us getting up there in years are going to need to rely on our children and friends. My husband and I have prepared as best we can. We have a home prepared to deal with physical handicaps if they may occur, savings, and LTC insurance. We have a will and estate plan and have given power of attorney to both of our daughters. If something happens that requires one or both of us to go into LTC, necessary decisions will still not be easy for our daughters. It never is.

Eighty percent of what children learn is presented visually; children must see well to achieve their full potential. As children grow their eyes change. These changes are influenced by genes, normal growth patterns, and luck of the draw. Often if the parents wear glasses the child will, too. All children should have their eyes checked before entering school and yearly thereafter — children change quickly!

School screenings can catch large problems but children can squeak by, listening to the child ahead in line or squinting when the tester is not looking. If there is a problem an annual examination from an optometrist can catch it early. Classroom challenges include: overheads, white boards, workbooks and computers. Children who do not see well are unable to participate in class and learn basic skills.

The annual exam is painless and fun, it even includes cartoons! A yearly examination helps the child know the importance of vision and eye health. Dr. Scarbrough will ask about medical, eye and family vision history. The child will read an eye chart (or identify animals and shapes if the child is too young to read). Eye coordination is tested — even though each eye sees well independently does not mean the eyes work well together. Examinations of the exterior and interior parts of the eyes complete the testing.

Hyperopia (farsightedness) can affect a child’s ability to read for long periods of time. The child can be distracted, cranky, sleepy and avoid near-work, which are devastating to learning. Extremely farsighted eyes can become lazy or crossed. Lazy eyes never get good focus interfering with proper brain development. If caught early, a lazy eye can be addressed; if not caught by the age of seven the chance of having good vision in that eye is small. This can haunt the person as an adult if good vision or depth perception is required for a certain job. Even a temporary injury leaves the lazy-eyed person unable to function normally.

Myopia (nearsightedness) starts with puberty. Prescriptions can change in sudden, growth-related spurts or in a slow pattern. These changes are pre-determined at birth and are triggered by normal growth. Some parents fear wearing or not wearing glasses will influence the child’s ultimate need for glasses — this is a myth. However, learning will be hampered if the child does not wear glasses when needed.

Glasses do get scratched and broken but the child’s needs must come first. Because children are rambunctious we recommend polycarbonate lenses. Polycarbonate lenses are shatter-resistant, have UV protection built in and a scratch coating included. Durable frames should be selected to help withstand constant banging and adjusting. Most frames for children are either twistable or have spring hinges. Nosepads help keep the glasses up on the nose. Glasses are often replaced every 6-12 months due to prescription changes, scratched lenses, or growth.

Parents and children often ask about contact lenses. Emotional maturity and motivation are large factors. Is the child good about personal hygiene and responsibility?

Dr. Scarbrough may recommend hard lenses as a possible retainer to slow future prescription changes. Hard lenses are less likely to harbor bacteria and cause eye infection or permanent damage.

Soft lenses are less expensive and more comfortable initially. They do, however, require more upkeep and are more likely to be abused (not kept clean or overworn). Contact lenses can threaten the health of the child’s eyes and future ability to wear contacts if not worn appropriately and kept clean. This decision should not be made lightly.

Eye examinations for children are important; a child’s vision impacts everything in life. Visual problems can be caught early and addressed before they complicate a child’s life. An annual eye examination is important for safety and success.

This week I would like to talk about dementia/memory care units. These units are usually, but not always, associated with large assisted living/boarding homes or nursing homes. They range in size from 10 to 40 or more residents, with each resident either having a small apartment or private/shared room. These living quarters are usually side by side in long corridors (that may cause confusion), with activity and dining areas mixed in. Most units have a secure outdoor area for exercise, with the actual exits from the units secured by codes that allow the doors to be opened without an alarm sounding.

As our population ages, we are seeing more and more dementia which causes many symptoms and behaviors, the most common being short term memory loss. However, this disease can frequently cause behaviors that require well trained staff to safely and lovingly care for these patients. It must be noted that these units are not appropriate for patients who are physically aggressive and a risk to themselves or others.

I believe that if a patient has serious short-term memory issues and is at high risk of falling (it comes with age), then dementia/memory care units are not good placement options. Why? Most residents spend significant amounts of time alone in their apartments with the doors shut. In fact, dementia patients tend to be self-isolating, and may have lost the ability to use a call bell or even call for help.

So, if you are considering a Dementia/Memory Care Unit for a loved one, consider the following:

1. What are the staffing levels 24/7? Ask about all three shifts. Many dementia patients do not sleep well and need considerable supervision at night.

2. What credentials and training are required for the staff? Is the staff well trained in behavioral approaches? Dementia care can be all about how you approach the individual and know when to back off.

3. What is the rate of caregiver turnover? Dementia patients do much better seeing the same faces and hearing the same voices.

4. Are the caregivers rated by their management on how they care for the residents or how many tasks they are able to perform on their shift?

5. Understand the cost structure of the facility. Most of these facilities do not accept Medicaid, so if you are concerned about your loved one running out of money you need to ask very specific questions. If the facility does accept Medicaid, does it limit Medicaid to only a few beds?

6. Know the parameters for safe, appropriate care. dementia units are generally set up to handle dementia, not complicated medical or physical issues. If your loved one has serious medical issues, discuss them with the nursing staff, not the marketing staff.

I prefer well managed Dementia Certified Adult Family Homes. Patients are cared for in a small environment with well trained caregivers in a 1:2 or 1:3 caregiver/patient ratio. In the world of dementia, we strive for moment to moment quality of life on a daily basis.

It is in this personal and small tailored environment where we see our dementia clients thrive.