• 
• 
• 

Cedar Community: Life the way is should be. The way you want it.

In the tenth chapter of his book titled, Jump the Curve (understanding the exponential growth of technology), author Jack Uldrich discusses the need for ‘Learning to Unlearn.’ He would suggest that, not only is it important for us to learn new concepts, but we must also ‘learn to unlearn’ the outdated concepts. We must refresh (re-program?) our brains to accept new versions of reality and to be open to project future realities in a hyper-changing world, without clouding ourselves with outdated education, notions and trivia that can get in the way with new learning!

In my 26 years of administrative experience in long-term health care (nursing home), I am astonished to see the amount of change in virtually every aspect of resident care.

In 1984, the average resident lived in our nursing home for 6.5 years. Today our statistics show our average length of stay is about 9 months! In the ‘old days,’ nursing home residents would line up (typically in wheelchairs) an hour or more before meal times in a long hallway, waiting for the ‘magical’ moment when the food was ready and a mad wheelchair dash was created, as dozens and dozens of seniors eventually made it to ‘their’ assigned table. Basic nursing care was provided, but it pretty much was to maintain one’s condition, all with very basic medical equipment. Any real medical ‘episodes’ meant a trip to the local hospital. A part-time physical or occupational therapist occasionally appeared, thus any aggressive ‘therapy’ was not likely. Resident rooms typically held 2, 3, or 4 people. Bathrooms were located at the end of the hall. Activities were few and far between with the usual bingo, card playing, or singing providing the full array of activity options. Highly waxed and polished linoleum floors, offset by cream colored painted block walls, was the interior design which permeated the entire building, including resident rooms! Nursing homes were basically considered the ‘final destination.’

It’s now 2010! It’s time to UNLEARN your old nursing home lessons! It’s time to LEARN the new nursing home reality! ‘Cause WOW have things changed! Meet the new nursing home!

The new nursing homes are generally referred to a Health and Rehabilitation Centers, indicative of a huge change in the health care ‘focus.’ In the past, the goal was generally to provide care and comfort. Today, the focus is on rehabilitation and a possible discharge sending residents back to their ‘real’ homes! This is why statistically the average length of stay is just 9 months (though appropriately, many live some long wonderful years as residents or as we prefer ‘Community Members!’), instead of 6.5 years in the past! Last year we had over 80% of our residents return to their homes, who entered seeking sub-acute care and rehabilitation!

At the Cedar Lake Health and Rehabilitation Center, a huge effort has been made to make mealtime a time of fine dining, choice and dignity! Each household (about 30 residents) has its own beautiful kitchen and dining area. Most food is prepared right at the individual household kitchens by training cooks who become part of the care team. Meals are available at the decision of the resident and a time that feels right! Choice of menus and custom meals are the goal. Mealtime is a wonderful time of conversation and relaxation!

Highly skilled nurses and certified nursing assistants, with advanced medical equipment, computerized records, immediate access to physicians, and advanced training has brought medical effectiveness to new levels.

Today, resident rooms are all private or semi-private. Carpet, wood grains, colors, accents, paintings, soft lighting, and music in the air create a stark contrast to the old nursing home environment.

With a plethora of new and exciting activities, our nursing home residents participate in computerized ‘brain exercise,’ pontoon boat rides, casino days, ‘senior’ proms, dog shows, county fairs, golf cart rides through the woods, fishing,
and oh yea, bingo!

With a very strong focus on rehabilitation, large teams of physical, occupational and speech therapists work with a single therapy goal of pursuing discharge for each resident! Bottom-line: In the old nursing home, administratively our goal was to ‘fill’ all the resident beds [Get people IN to the nursing home]. Today the goal, is to empty of resident beds [Get people OUT of the nursing home]. Time to unlearn and relearn your thinking about the status of nursing homes!

When it comes to considering the benefits of Senior Retirement Community living, we find two parties most likely to do the necessary research: the potential senior residents themselves and the key family members of those seniors. Many times, the oldest daughter becomes a significant researcher/decision-maker.

The first step in this important research is simply understanding the terms/definitions used by the providers of senior retirement communities. So here is a very basic list of those terms and definitions:

AAHSA (American Association of Homes and Services for the Aging): A national association of not-for-profit senior care organizations devoted to senior issues advocacy and member education. Headquartered in Washington DC. (See: www.aahsa.org)

ADLs (Activities of Daily Living): Bathing, eating, grooming, dressing, toileting, and other usual day-to-dat activities.

Administrator: Licensed director of a clinical health care facility or organization.

Adult Day Care: Structured programs including social activity and interaction with health related programs, services and therapy for seniors, generally for up to 8 hours per day.

Alzheimers: A progressive, neurodegenerative disease characterized by loss of function and resulting in death. Universal syptoms include memory loss and confusion.

Ambulatory: Ability to walk freely and without assistance.

Assessment: May include physical, cognitive and emotional evaluations performed by a qualified health care professional.

Assisted Living: Housing and supportive services, generally provided in an apartment setting.

Caregiver: The primary person in charge of providing care.

CBRF (Community Based Retirement Facility): A senior care facilty providing supervision and supportive services to people unable to live independently but do not require nursing home services. They allow five or more unrelated adults to reside in a CBRF and individuals may receive up to 3 hours of nursing services per week.

CCRCs (Continuing Care Retirement Communities): A ‘full service’ retirement community providing a wide variety of services and levels of care including: Independent Housing, Assisted Living and skilled nursing services.

CCRC’s without Walls: An array of health care services for seniors provided in the private homes of seniors.

Congregate Housing: Generally senior apartments with the availability of activities and meals focusing on social interaction.

Dementia: The loss of intellectual functions (memory, thinking and reasoning) stemming from a variety of neurological diseases or conditions.

DME (Durable Medical Equipment): Assistive equipment such as wheelchairs, walkers, ‘hospital’ beds, lift chairs, etc.

Geriatric Case Management: Professional assistance from a trained advocate assisting a senior in a variety of areas.

HCBS (Home and Community Based Services): Senior services provided in private homes of seniors and for the wider community.

HIPAA: The ‘Health Insurance Portability and Accountability Act’ of 1996. Amoung other things, assures privacy of health information.

Home Health: Can be either ‘medical’ and/or ‘non-medical’ care services for individuals in their private homes.

Hospice: End-of-life medical care services with specific protocols to comfort the dying and their families. Service costs are generally covered by Medicare in the final 6 months of life. Hospice can take place in private homes and/or in institutions.

Independent Living: Residential living for seniors that promotes activities, wellness, and social interaction. No or limited health care services are provided.

Medicaid: Public assistance programs giving funds to medical providers assuring health care for people of limited or no financial means.

Medicare: A federal health insurance program, generally for those 65 and older and those with disabilities, providing physician services, therapies, home health care and hospice care.

Not-for-Profit (or Non-profit): Organizations created to provide services and charitable assistance. Generally church affiliated, not-for-profits have no individual owners or investors and depend on support of donors and sponsors.

Palliative Care: Focus is on providing medical ‘comfort’ care and assistance to those with chronic disease.

Skilled Nursing Care: 24 hours of skilled nursing care for more medically acute patients.

Skilled Nursing Facility (SNF): Nursing home care providing 24 hours of skilled nursing care, activities, meals, therapies and multi-level services.
RCAC (Residential Care Apartment Complex): An RCAC has at least 5 apartments and may provide up to 28 hours per week of services such as housekeeping, personal assistance, dining, nutrition and medication management. 24-hour emergency services are also available. Each apartment has a lockable entrance.
Rehabilitation: Therapeutic care for persons requiring intensive physical, occupational or speech therapy.

Respite: Overnight stays providing people with temporary services.

Senior Apartment: Age restricted multi-unit housing for those 62 years and older who are able to care for themselves.

Senior Center: A place organized to provide activities, education, meals and social interaction for seniors, generally located in villages, towns and cities.

Support Groups: A facilitated gathering of caregivers, family, friends or others affected by a common condition or disease for the purpose of futher education and emotional support.

WAHSA (Wisconsin Association of Homes and Services for the Aging): An association of not-for-profit senior care and retirement organizations located in Wisconsid design to provide education and advocacy for both seniors and membe providers. Headquatered in Madison, Wisconsin (See www.wahsa.org).

Good Planning!

The most important aspect of adjusting to retirement is good planning for a smooth transition. The authors of Retiring on Your Own Terms suggest a “retirement rehearsal.” Consider their rehearsal plan:
1. Practice living on your estimated retirement income, after business expenses.
2. Start developing some of the retirement activities you think will interest you. There are contacts to make and research to do, whether you have in mind volunteer work, further education, or a second career.
3. If you plan to move, learn everything you can about your prospective new home. It’s not likely that you will be able to move repeatedly, nor would you want to, so spend time, if you can, in the new community, during the off-season if there is one. Talk to people who live there; keep looking for disadvantages. You already know the advantages because they’re what attracted you in the first place.
4. Strengthen relationships outside the business environment — with family, friends, and neighbors.
5. Check how long it takes you to do various activities around the house or yard that you look forward to doing in retirement. You may think there are enough chores to keep you busy forever, but you’ll probably zip right through them in a few weeks and then have to start looking for something else to keep you occupied.
6. As important as working out a viable financial future is the planning you and your spouse can do in anticipation of your retirement. Couples who have lived together in the evenings, on weekends, and during vacations for virtually all their married lives don’t necessarily find it easy, especially at first, to be together all day, every day. You and your spouse might want to talk together about seemingly minor potential irritants.
* Source: Wis. Assoc. of Homes and Services for the Aging, Madison, WI