ELDER ABUSE: Stories From an Assisted Living Resident
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Another Answer for Elder Care

category_bug_journal2.gif Yesterday, we spoke of assisted living homes. Today, I want to tell you about a (relatively) new solution to caring for elders that has been a part of the Department of Veterans Affairs for a dozen years: medical foster homes wherein veterans receive round-the-clock care in private homes.

Alyson Martin and Nushin Rashidian wrote about this program in The New York Times about three weeks ago:

”Medical foster homes provide an alternative to nursing homes for veterans who are unable to live safely and independently at home or lack a strong family caregiver. Conceived in 2000 by V.A. social workers in Little Rock, Ark., the program currently serves 535 veterans; it has cared for 1,468 since it began...

“Now operating through 73 V.A. sites in 36 states, the medical foster homes program is scheduled to expand to 10 more states within two years. Eventually, the V.A. hopes to introduce the program to all 153 of the agency’s medical centers...”

Like all types of home care, medical foster homes are less expensive than commercial and non-profit assisted living and nursing homes – in this case, about half the average cost – and the veterans themselves pay between $1800 and $3000 per month, depending on their needs, from their own Veterans Administration, or Social Security benefits, other forms of insurance or a combination of those.

According to the Department of Veterans Affairs website, “The specific cost is agreed upon ahead of time by [the veteran] and Medical Foster Home caregiver.”

The Times story explains that the VA takes special pains to choose caregivers for the medical foster care program – like Paulia and Bienne Bastia with whom two aged veterans are currently living.

”The Bastias, who met in Florida after emigrating from Haiti, went through months of interviews and background checks to qualify as caregivers. A social worker, a nurse, a dietitian and a fire-safety expert inspected their two-story home on a quiet suburban street, and it will be reinspected annually.

“Given the vulnerability of the older veteran population, the V.A. approval process is rigorous. Only one in 10 to 15 applicants are selected. People with no formal training can apply, however, and many with family caregiving experience do.

“Once a veteran is placed in a home, the V.A. provides training for tasks like cleaning wounds, managing incontinence and safely transporting the new residents.”

And the caregivers are provided with respite time off.

Of course, we would all rather stay in our homes until we die but the truth is, that will not be possible for all of us. As the elder population continues to grow, we are going to need as many inventive solutions for care as we can create.

Until I read The Times story, I'd not heard of medical foster homes. They seem to be one good solution and the Department of Veterans Affairs has already spent 12 years working out the kinks.

There must be a way their knowledge could help translate this solution to the general, non-veteran population of old people.

At The Elder Storytelling Place today, Johna Ferguson: My Traumatic Experience


As a veteran, this sounds like a really good solution to me. I have family, but so many don't.

This and the residential home care arrangement described by Katie in commenting on yesterday's post seem to be some of the more encouraging advancements in elder care. Since taking on fulltime caregiving for my MIL and researching and learning more about what's out there (including the Eden Homes by Dr.Bill who I discovered via TGB, thank you, Ronni), I have found myself beginning to consider looking into opening a residential care home. I waver on this, as right now, as the sole caregive even of just one person, the energy, both psychic and physical, and time that's required is a little overwhelming. Many years ago, when my children were young, I operated a licensed day care home for a few years. At times, that too, could be a little overwhelming, but the children were small, mostly healthy and much easier to keep happy and occupied. I remember reading an article when franchised, insitutional child care centers were just starting up, referring to the children they served as "Kentucky fried children." It does seem that we've gone way too far in thinking we can best care for people with something like an assembly line, one-size fits all approach. Obviously, that's more convenient for the providers, but not so much for the recipients. I hope that we can find more ways to come up with other care programs that allow for more respect of a person's autonomy and feelings, so that there are not so many of us talking about stopping eating or otherwise orchestrating our own demise to avoid the horrors we may anticipate otherwise.

I think one of the biggest drawbacks for those considering foster care for the elderly or veterans is how it restricts personal freedom for the caregivers. I would hope that anyone contemplating such a move would have a plan that would include arrangements to get away every now and then from this environment (requiring competent back up personal) so as not to get burned out and offer some respite to recharge.

It takes someone with the proper attitude and enough energy to provide care for people who become incapable of meeting their basic needs of sanitation and feeding.

To be clear, as I mentioned in the story, respite time off for caregivers is built into the program after 12 years is continuing to grow and seems to be quite successful.

I agree with Larry, it really does take the right attitude and patience to be able to care for ederly. It is such a blessing to those who can't care for themselves to have someone who is truly interested in their well-being watch over them.

Extremely interesting. Thanks for this post, Ronnie.

Something has to be done, and soon. For example, not only our vets, but the polio survivors are now left without families and the post-polio syndrome increases with aging and no one told them about this. Then we have others with neuromuscular conditions even the young aging out of a system that for some reason had lobbying NGOs that apparently forgot those children can't be "cured." Frankly, it comes down to personal values, "it takes a village" indeed, and that is what is still believed by many others as well.

Caregivers and isolation? Well, we are isolating our disabled and seniors now. In fact, most have little access to adequate transportation, and if they are on Medicade, in some states they can only have transporation to medical appointments not dental!

There is a program I was involved in establishing in one US city, Shared Housing. That is an answer for many if they know about it. It needs to be established in every county in the USA, in fact. People do care.

No one wants people to go without assistance in living. No one wants people hungry and/or homeless. No one wants people to go without health care. The next step is an individual one - act in our own cities and towns, churches, associations, and alumni groups.

This foster care program sounds like a good idea as long as monitoring is such to insure quality of care. That's also important for any private homes that take in even one or several patients. Family needs frequent contact and visits there, too, just like any of the other settings based on friends I know who've utilized such home-type setups for their loved ones. Most of the good ones cost more than basic fixed income payments.

Shared housing is a possibility, too. Expect having all the various options mentioned in this post and others you've written here, is ideal since everyone may have a different preference.

Within a local retirement community offering the typical 3 levels of care, construction has started on a 4th level -- the Green House concept -- will be the first in Calif. I'm told, and is expected to be completed next year.

My experience with those who have stopped eating has been they are individuals who had severe swallowing problems. The only way they could safely receive adequate nutrition and hydration was via tube feeding. Their health care directives specified they wanted no tubes, which they reiterated, and they had retained the mental capacity to refuse food. Once a person stops drinking fluids, there can be a problem maintaining mental abilities long enough to follow through with not eating, since lack of hydration negatively affects mental function within a very few days, long before they starve.

Choosing to not eat/drink isn't just a matter of will. The individual then often automatically requests food and water, so how that is handled has to be carefully set up with family, administration, staff for many reasons.

For example, in this situation if a patient requests eating/drinking they can't be denied -- they have a right to change their mind. So, if they're fed/drink who's responsible if the patient aspirates -- choking death (hard way to go,) or pneumonia develops?
Do you think a staff member or family member wants to feed under those circumstances? Also, what about liability? There are other complications.

Often what one can do at home under certain circumstances can be quite different than in other type settings.

These issues can be and are overcome but it requires a team approach including with family and in some instances special legal-type arrangements. Then you have families where the attitudes and views are different from one another, religious beliefs may come into play, etc. Everything is not as simple as it seems. I've been part of and seen the evolution in thinking, treatment and acceptable attitudes on patients eating issues.

I'm seeing increased interest from patients/family in palliative care. Others choose hospice. Some who've had hospice, then unexpectedly recuperate, refuse to have hospice the next time their health again declines -- typically they're mentally alert and have had private duty nurses in addition to their long term skilled nursing care. The medical diagnoses and patient's mental state often influences choice.

There are lots of elder care homes here in Arizaona. I, too, worry about the supervision and the back up and the controls, but it is a less expensive means of keeping Mom and Dad safe.

This is actually the first time for me knowing about it. If it works for our veterans, I guess there is also a way to use this method for all other elderly people that are civilians or didn’t serve the military.

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