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Elderly Care: Age-Old Question A variety of facilities offers care to seniors who in some form cannot
take care of themselves By Joan Whitley Las Vegas Review Journal, 20 July, 2003
The door
locks are out of reach of the clientele, to keep them from wandering
outside unsupervised. Many of the clients discreetly wear absorbent,
disposable underwear to handle incontinence. It feels like an at-home
child-care business when you enter. But the
average person here is seven to eight decades older than the age range for
child care. One woman
cuddles a baby doll, which she proudly and lovingly carries from place to
place in the home. Another
travels nonstop, back and forth, in a padded, plastic contraption that
resembles an oversize baby walker. Yet another
listens to music on her own portable CD-player with headset, while several
others relax on couches, watching TV together. Resident
Leonard Leland has turned away from the television to play with canine
friend Mazel, a cockapoo who belongs to Betty Gammon. Gammon is the
former administrator and owner of the household, which is a Las Vegas
adult group care home. She recently sold it to Odette Guevara. From the
outside, it's just another house in a garden-variety residential
neighborhood in the northwest Las Vegas Valley. Called Adult Assisted
Living II, it is licensed to care for up to 10 people with Alzheimer's
disease or other dementia. The home
illustrates one of the many housing options for senior Southern Nevadans
who no longer can live at home because of physical frailty or diminishing
faculties. This housing
spectrum includes: conventional single-family houses with staff to care
for one or two boarders; slightly larger group care homes such as
Guevara's; and large corporate-owned assisted-living facilities that might
house 100 residents or more. Any of these housing types can get official
permission to serve a specialty population. Besides Alzheimer's, other
specialties include serving the disabled, mentally ill or mentally
retarded of any age. At the
extreme end of the spectrum for senior housing are intermediate-care
facilities and, then, skilled-nursing homes. Residents at both need
round-the-clock medical care. Each service
level is governed by state regulations and periodic inspections. The more
complex the care, the tighter the regulations. The more intensive the care
or more splendid the amenities, the higher the cost. Owners of such
facilities set their own charges.
Paying for
that intermediate stage of life can drain the bank account of a senior or
senior's family, acknowledge local attorneys, social-service providers and
housing operators. Only two
local assisted-living facilities cater to seniors of limited means:
Charleston Retirement & Assisted Living, 2121 W. Charleston Blvd., and
Margaret Rose Residential Care Center, 100 S. 14th St. They try to
accommodate clients whose total monthly income can be less than $1,500.
Their combined bed count is 217, about 10 percent of the Southern Nevada
beds in this category. Not all
consumers or home operators realize that a family can't just pick the type
of housing that fits the older relative's budget, without also making sure
the level of supervision matches the person's functional level. Mismatches
between facility and resident account for most of the complaints and
regulation violations, according to state official Lisa Jones. Jones is
manager of the Bureau of Licensure and Certification in the Nevada Health
Division. Her agency licenses and monitors health facilities in Nevada,
from hospitals and surgery centers to licensed senior care facilities.
"Nevada
actually has some of the strongest regulation of group care" of the
elderly, notes Bruce McAnnany, deputy administrator of the Nevada Division
for Aging Services. But the state depends on continued involvement from
families for the system to function at its best. McAnnany
deplores families who presume that, " `as long as I have some place
for Mom, my job is done. She's not on my doorstep anymore.' " Outright
abuse or neglect of clients, as well as a mismatch of facility to a
declining client, are far less likely to occur when relatives thoroughly
check out a facility, and then visit their loved one regularly. Gammon, who
was interviewed on Guevara's behalf, says she expects prospective families
to have many questions about a facility and its daily routine. Guevara
charges clients $2,950 a month for a private room, and $2,500 a month for
a double room. Guevara's
home is outfitted with fire sprinklers, as required by its specialized
Alzheimer's group care license. The house also has special security
measures such as door locks, door alarms and secure yard fencing. She
staffs the house as her license dictates, with at least one caregiver for
every six residents. Administrators take mandatory Alzheimer's training.
Leland, 80,
is the newcomer at Adult Assisted Living II. He joined the household in
late May after experiencing a fall. When he first moved in, he begged his
family daily not to leave him behind, recalls his daughter, Kim Leland, of
Las Vegas. But he has
grown content. "There's nobody bugging you all the time. It's free
living," Leonard says of his living arrangement. A retired
West Coast sailmaker, he speaks with an air of confidence that conveys
credibility. But then, his lucidity slips a notch. "Oh, we
play catch, or horseshoes," is Leonard's next remark, when queried
how he spends his time. Listening at
his side, Kim, 46, smiles and refrains from correcting. His balance is so
poor he can barely walk, let alone play sports. Outside of
her dad's earshot, she says: "He comes and goes. Sometimes he thinks
I'm his sister. And then he's embarrassed," when his full memory
returns. Until early
2003, Leonard lived alone in a townhouse in California. Over time he
developed a form of hydrocephalus that impairs his mental function and
gives him vertigo. Another daughter moved in to help. But in early spring,
while she was out, he fell from a sitting position and fractured his neck,
Kim says. Leonard went
into the hospital, then rehab while Kim scrambled to find safe, permanent
housing for him in Las Vegas. Even though she is a social worker for
Sierra Health Services -- giving her an advantage when it comes to knowing
how to find social services and resources -- it took a frantic month of
research and wrong turns until she found Adult Assisted Living II, which
Gammon started eight years ago. Leonard, with
his decreasing mental capacity, didn't qualify for basic group care, only
for specialized Alzheimer's group care, which the state labels
"residential facility for groups, Category 2."
Basic group
care -- Category 1 -- helps residents with activities of daily living,
such as bathing, dressing and reminders to eat meals and take medications.
It is geared for people who still have good judgment, whose thinking is
not impaired. And they must be ambulatory -- able to transfer on their own
if they use a wheelchair. But people
with Alzheimer's, as Paul Shubert of the Bureau of Licensure &
Certification notes, "can't understand dangerous situations."
Like the very young, they need additional staff and other safeguards to
protect them from hazards as mundane as stoves, scissors, hot water and
street traffic. Inspectors
visit licensed homes in Category 1 and Category 2 every year, and upon
complaint. Southern
Nevada has about 200 sites for basic group care, accounting for about
2,200 beds, according to a June printout from the Bureau of Licensure and
Certification. It has 48 facilities licensed for specialty Alzheimer's
care, covering about 1,100 beds. In each class, most licensees are small
home-based sites, but some are large institutions. Leonard also
could have qualified for what the state calls a HIRC -- pronounced "herk"
-- which stands for "home for individual residential care." This
type of facility is inspected once every three years, or upon complaint.
Such homes care for up to two residents, with more flexibility than
Category 1 or 2 homes as to the type of individuals they may accept, as
long as the staff's credentials measure up to residents' needs. Las Vegas
HIRC owner Charlee Mae Williams says she charges from $1,300 a month to
$2,500 a month, depending on a client's health and mental status. Leonard's
daughter considered HIRCs. She concluded the format wasn't optimal for his
personality, and made her feel guilty, besides. "He'll
get real individual care there, but he won't get the socialization"
of peers, she recalls thinking. And, a HIRC is "like sticking him in
another family," since most HIRC owners operate out of their homes.
Southern Nevada has approximately 50 licensed HIRCs, according to the
bureau. One of
Leonard's housemates is Antonina Onufrieff, 82. Her son, Victor, 57,
placed her in the 10-resident home to avoid what he believes is the
impersonal, clinical, corporate nature of a large facility. But the
family of Marie LaBar, 94, arrived at the opposite conclusion. LaBar has
lived for two years at Prestige Assisted Living at Mira Loma, a
large-scale Henderson facility with 124 beds. She's in its Expressions
unit, a secured wing for up to 30 people with dementia. It costs her
family $3,200 a month, according to La Bar's daughter, Celia Ellis. LaBar had
been living with an elderly male companion in his private home. But the
companion's health problems forced him to move near relatives in Canada.
LaBar was too forgetful and confused to manage on her own, according to
Ellis. "I felt
there weren't enough people for her to mingle with" in home-based
group care, says Ellis, 65. Ellis also
likes the steady programming of recreation activities at Mira Loma.
"Her main focus is music and dance," Ellis says, "She has
to dance (at Mira Loma's musical functions). But she gets dizzy. So I get
out there and dance with both" LaBar and LaBar's partner of the
moment. When it comes
to finding appropriate housing for seniors who can't live alone,
mismatches don't occur only at the initial placement. "Aging
in place" is a misnomer, says the bureau's Shubert. Even when a
senior enters a facility in reasonable health, mobility and lucidity and
health might all eventually decline. Any change can turn a good placement
into a bad one. Family members should not expect an initial placement --
unless it is to a nursing home -- to last forever. People who
are bed-bound or have a stomach feeding tube aren't allowed, by state law,
to live in adult group care. Nor can an unstable diabetic, whose
blood-sugar and insulin levels must be adjusted through the day. Existing
clients who acquire those conditions need to be transferred, or the
operator is in violation. On the
continuum of care, skilled nursing is the form of housing for seniors with
the most complex medical needs. Dorothy
Dobson, 73, of North Las Vegas moved from the home she shared with her
husband, Ed, also 73, to El-Jen Convalescent & Retirement Center in
August 2001. Her care costs about $4,400 a month. She has been
suffering from early onset Alzheimer's since her mid-50s. Physical
impairment also set in after she broke a hip, got a hip replacement that
dislocated, and then needed a second replacement. Today she is bedbound,
which means she cannot reposition herself in bed or lift herself. She is
fed by a stomach tube because of swallowing difficulties. She also is
largely unresponsive to sensory input such as voices. Ed Dobson, a
retired Air Force fighter pilot, gave up Dorothy's care reluctantly, but
realized her demands had outclassed his stamina and caregiving skills. But he's
doing what he considers the next best thing to caring for her directly. He
visits her three times daily and is in constant communication with the
staff. Dobson knows precisely how long his drive is to El-Jen: 1.64 miles.
He is a model
for the diligence that state officials and independent senior advocates,
such as Nevada AARP's Carla Sloan, ask of all Nevadans who are placing an
older relative in supervised care. Dobson spent
about six months researching his placement choices. Too many
families make their placement in crisis. The usual trigger for a placement
is an emergency, Sloan says. "It's probably been a hospitalization.
Or an accident has occurred in the home, which has frightened the
family." And Dobson
follows through by visiting his wife's nursing home frequently. "Once
(relatives) take a person to a facility, their involvement should not
end," Shubert says. "The responsibility doesn't lessen. It
increases. After they make the first placement, they have many more
decisions they're going to have to make." Copyright
© 2002 Global Action on Aging
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