Sexual Assault in Many Nursing Homes Goes Uninvestigated

In Washington State an 83 year old dementia patient was raped, and it was caught on film. The family of the victim had suspected abuse and so they set up a hidden camera. The result was a video of the facility’s owner sexually attacking the elderly woman. Authorities arrested the man, shut down the facilities he owned and ran, and sent all remaining patients to the hospital to be checked for signs of abuse. This instance was handled with swift action, but sadly this is the exception to the rule.

A study was done in Chicago nursing homes and found that over a two-and-a-half year period authorities investigated 86 cases involving sexual assault of a resident. Of those cases, only one led to an arrest. Eighty-five people were reported as victims of sexual assault and found no justice. The study found that the vast majority of these crimes were perpetrated by another resident who forced his way into a woman’s room or abused her while staff was not nearby. Incidentally, the one case that was actually prosecuted was one in which a staff member was accused. Outside of nursing homes, Chicago police make approximately one arrest for every three reports of sexual assault filed. There is a huge disconnect between typical arrest patterns and those in nursing homes.

The study dug a little deeper into the locations where assaults were reported.  Instances of rape were found to be reported from only 30 of the 119 communities in Chicago, and these particular locations were twice as likely to have residents who were felons or mentally ill. They also have substandard staffing as compared to those where rapes were not reported. A picture is painted of predators roaming around unchecked, terrorizing the elderly, the sick, and the helpless.

In one instance, a 28 year old man confessed to beating and raping a schizophrenic elderly woman in the facility where he lived. The woman corroborated the story at the time, but was not as cooperative later in the investigation. Despite the confession and physical evidence to back it up, no arrest was made.

Another case involves a dementia patient in hospice care. A call reporting sexual abuse was made to the nursing station of the facility in which she lived. The head nurse did nothing for one whole day. The victim was bathed, her clothes were laundered, and her room was cleaned – in other words, the evidence was removed. The alleged perpetrator was allowed to continue caregiving duties in the area where the victim lived. After a full day, the patient was sent to the hospital for a routine physical, not for a suspicion of assault. It was only when the hospital declined (she was not due for her exam) did the story come out. Even then, the nurse only called authorities after the hospital threatened to do so themselves.

Cases like these are fraught with problems for law enforcement. Victims are often mentally ill, afraid for their safety (as they live with the rapist), or unwilling to cooperate. However, it is appalling and unacceptable to allow this type of behavior to go unchecked, especially in cases where the supposed caregivers are turning a blind eye to the problem. Instances where staff members impede the investigation should be treated extremely harshly. Losing a job or a license is not enough; there ought to be criminal culpability for helping a predator to escape.

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Sex Is the New Bingo

Retirement isn’t just card games and gardening anymore. The flower children of the ‘20s are now filling up assisted living communities and they are definitely making love, not war. According to the National Survey of Sexual Health Behavior, over half of men and forty percent of women above 60 are sexually active. Put all those consenting adults together into an apartment complex 24/7, and it becomes more like a college frat house than a nursing home!

The abundance of sex is not the problem by itself, but the spread of disease is a concern. Senior citizens are charging ahead with astonishing growth in STDs, and the trend isn’t going soft. Numbers reported from the CDC show that over a four year period chlamydia infections among the senior population grew by more than 30% and syphilis cases rocketed upwards by 52%. HIV has been on the rise as well. The generation now in retirement received far less sex education than those coming up behind. Aside from warnings about ladies in foreign ports, there was no talk of safe sex for this group. Studies show that across all age groups, condoms are used about 40% of the time, but in the senior population they are only used in 6% of sexual encounters. Medicare does offer free screenings for STDs, but that seems akin to a morning-after pill, and only about five percent of qualified people use them anyway.

So why the sudden rise in…figures, shall we say? The most obvious answer would be the assortment of pills for male performance that were not as widespread in previous generations. Overall health and mobility are improved, as well. More senior men are physically able to have sex, and post-menopausal women with no fear of pregnancy are abundant. Besides, sex is fun! Just because you don’t think of grandma as a minx between the sheets, doesn’t mean she hasn’t learned a thing or two in her time.

There seems to be an untapped market for condom education and sales here. A vending machine in every retirement community? Or maybe housekeeping could leave something besides a mint on the pillow when they clean apartments? Whatever your personal opinion on the matter, Bingo is out – sex is fast becoming the favorite activity of retirement communities!


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One in Five Nursing Home Residents Are Harmed By Their Stay

The Department of Health and Human Services recently published a study finding that about 22% of Medicare patients who go into a skilled nursing facility are actually harmed while they are there. Over half of these incidents were deemed preventable in the study, meaning more than ten percent of the people who go into nursing homes get sicker when they should have gotten better. Another 11% of residents experienced temporary harm, but their overall condition did not worsen because of it. That probably doesn’t make them feel better about it.

The HHS study found that more than half of the instances where a patient was harmed could likely have been prevented with better quality of care. Reasons found for these events are things like lack of monitoring, substandard treatment or, worse yet, necessary treatment not being provided at all. And sometimes the reason is simply a lack of skill in the person administering care – nurses hired and trained to provide healthcare are not very good at it. We’ve all known of someone who isn’t good at their job yet, inexplicably, stays on staff. But did you ever think it would be the person responsible for your life? Incompetencies like these resulted in the death of 1.5% of all Medicaid patients in a skilled nursing facility.

Aside from the horrible outcome of sick and dying people, these types of events lead to longer stays in SNFs, more readmissions to hospitals, and more time and money spent on care. The study estimates that $136 million was spent in August of 2011 on hospital readmissions from these likely preventable incidents. And yes, that is in just one month!

Instead of suggesting measures to improve training and programs, HHS’s recommendations were to enforce much the same oversights and reporting that hospitals face. While the threat of losing money can be a great incentive, a system that is already woefully under-financed might need a bit more to make the kinds of gains that patients need. Further, changing the payout system to force SNFs and hospitals to share one purse (another reform) sounds like elementary school justice rather than positive change. If you can’t share it, nobody gets any! Wouldn’t it benefit everyone to put a bit of that misspent money into improving nursing home care?

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Hospice Denied

End of life care is as tender, emotional, and difficult as it comes. There are so many different factors that lead people to hospice, but the common thread is the search for comfort for both dying patients and the families accompanying them on the journey. Hospice workers take on patients knowing that hope is essentially gone and all that is left is to ease pain and provide support until the end.

Yet hospice is not always the end. In fact, about 20% of hospice patients are discharged alive each year. Of these, about a third chose to leave the program, which means that nearly 13% of patients relying on hospice services are expelled from the program. It sounds like this means terminal patients are recovering, but sadly around 40% of these people die within six months of being released. If you’re not doing the math, that’s 5% of people who qualified for hospice dying without services. Fifty-five thousand people, every year.

Hospice is supposed to be a comfort – pain management, grief counselling, an easing of suffering and the fear of death. It seems worse than cruel to offer help to these desperate people and then yank it away, leaving them to find their own way again. And it is happening more and more often. Between 2002 and 2012 the number of people discharged from hospice rose by fifty percent. I’m sure the reason will come as no surprise: budget cuts. Many patients have their care covered through Medicare or Medicaid. In the year 2000, Medicare spent $2.9 billion on hospice; in 2009 the bill rose to $12 billion. And now the budget is shrinking. CMS has had to get tougher about approving payments. Payments that can be held up for months (or more) while being reviewed put small hospice centers under a financial strain. Rather than risk bankruptcy from delayed or denied claims, they are getting stricter about who receives care.

Hospice is intended for patients who have less than six months to live. If their prognosis improves while under hospice care, it is legal (or in CMS’s case, required) to discharge them. Whether it is ethical is another question, actually one of some debate. The difference between true recovery and a temporary plateau is hard to determine, especially over just a few weeks. Even though people can be readmitted if their condition worsens, the trust is gone. Hospice care cannot be a yo-yo, jerking people up and down, leaving them uncertain what each week will bring. This is not comfort and support, but torture at the worst time in families’ lives. Yet, where will the money come from to pay for services? Doing the ethical thing can put for-profit hospice centers out of business, and then all of their patients suffer. Where is the line?

It is a terrible thing to have to judge how fast a person should die.

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Do You Plan to Reach 100?

Living to be 100 used to be practically unheard of, but more and more people are making the trek thanks to better medical care and healthier lifestyles. Dissecting the choices these centenarians made has led to some interesting pointers for how to live to 100.

Some things won’t surprise you. Healthy eating and regular exercise are at the top of the list. A Mediterranean diet is the best for a long, healthy life. Foods like olive oil, fish, and vegetables are ideal for keeping your heart healthy and reducing the risk of certain cancers, Parkinson’s disease, and Alzheimer’s. One small change that may make a big difference is to eat a handful of nuts every day. This can reduce your chance of death by twenty percent. Beans and berries, especially blueberries, are the best source of antioxidants (which help reduce the effects of aging on cells). Rather than taking vitamins, get your nutrition from healthy foods. Add balance training to your exercise routine to reduce your risk of a fall, which is a serious danger for those of advanced age. Also, exercise your mind with mentally challenging activities to improve your chances of avoiding dementia. Likewise, social engagement and some type of religious affiliation will keep your mind healthier.

Living longer means making healthy lifestyle choices, but it also means avoiding certain risks. Obviously, avoid cigarettes and excesses like overeating or too much couch time. But did you know overtime can keep you short of your 100th birthday? So can traffic (think air pollution and frustration). People who leave work on time and take regular vacations tend to live longer. Keeping stress and anger levels down plays an important role in long term health.

It turns out that well-rested, optimistic, happy people actually live longer. Yes, into every life a little stress must fall, but don’t let it become an ongoing state. If you want to live to 100 (and enjoy it), here are a few more tips gleaned from those who have already made the journey:

∞  Be female. Of the 105,000 centenarians in the US, 80% are female. Sorry, guys!

∞  Have money. At least enough to be comfortable, take care of your health, and go on vacation now and then.

∞  Sleep. At minimum, 7 hours a night is recommended.

∞  Do it. Getting intimate around twice a week increases your life expectancy. But play it safe, diseases will shorten it.

∞  Get up. Keep TV time under 2 hours a day, especially as you age. After retirement, television keeps many people on the couch longer than is healthy.

∞  Pat a dog. Pets reduce stress and pet owners tend to live longer than those who aren’t.

∞  Laugh. As it turns out, it really is good medicine.

Sadly, there is no perfect formula to having a healthy, happy 100th birthday. But, as Theodore Roosevelt said, “Old age is like everything else. To make a success of it, you’ve got to start young.”

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Largest Senior Living Companies (combined list)

Each year different publications publish different lists of the largest senior living providers (read: companies). Senior Living Executive, a magazine published by the industry lobbying group Assisted Living Federation of America, just released their updated list for 2014. You can get a copy of it here, but be warned that they stuff it in a bloated, write protected PDF, in a clunky web viewer. Another annual list is put out by Ziegler, an investment bank in the industry, and LeadingAge, a buying-club for not-for-profit senior living providers. Their 2013 LeadingAge Ziegler 100 list is here, but again stuffed in a hard-to-use PDF.

As many of our long-term readers know, we’re obsessed with data at Senior Reports. The multiple lists (in a format that is pretty useless) frustrated us (and some others in the industry) so annually we ‘digitize’ and combine the lists, a process that is scripted and automated. In the spirit of open data, below is the combined full list. Here is the Google spreadsheet of all of the data, in case you need it in a better format that allows sorting and exporting.

Note 1: These lists are not de-duped (although there shouldn’t be any dupes) or verify  (which we do elsewhere) this raw data.

Note 2: Brookdale and Emeritus are merging but haven’t done so yet. The new Broomeritus will be massive.


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Did Grandma Know How to Keep Us Well?

When it comes to getting sick, and then getting better, wisdom has been passed down through the generations in the form of old wives’ tales. In today’s age of scientific evidence, many have been devalued as ways to control kids (for better or worse) rather than actual health advice. Scientists have looked at some of the more common tales and you might be surprised what they found.

Don’t go out in the cold, you’ll get sick!

We now know that illness comes from germs and bacteria, not simply cold weather. But there is some validity to the tale. One study had half the participants dangle their feet in buckets of ice water for twenty minutes. Surprisingly, about 30% of them caught a cold as opposed to 9% of those who kept warm. This is pretty compelling evidence that getting cold does indeed lead to a cold.

What really happens is that blood vessels constrict when the body gets cold, reducing blood flow to extremities. The purpose is to keep the core of the body warm enough to survive, but a side effect is that fewer infection-fighting white blood cells get to the nose to protect against illness. Add in the reduced humidity, where viruses travel better, plus people spending more time indoors together and you have the perfect recipe for spreading the common cold.

You lose most of your body heat through your head.

So, if you do go outside in the winter, bundle up, right? And definitely remember your hat. An old study had volunteers dress warmly, but leave their heads bare. It isn’t shocking that 80% of their body heat escaped through their heads – where else would it go? Later studies found that in a burst of activity, blood flow initially increases to the brain, so that about 50% of heat loss is through the head. But after a little while, the body compensates and heat loss is more evenly distributed. At rest, only about 7% of body heat escapes from the head. While I still suggest a hat in winter, it isn’t quite the emergency situation we once believed.

Starve a fever and feed a cold.

Once you get sick, there is a ton of advice out there on how to get better. This is one of the most well-known…and untrue. In medieval times it was thought that a fever meant there was too much blood in the system and it needed to be bled out. The idea of starving a fever may come from the old idea that one’s system is overloaded and needs to be slowed down. Similarly, coughing up phlegm was thought to mean the system was depressed and so it needed to be boosted – feed a cold. Modern study has found that good nutrition is the best solution to illness, not an under- or over-abundance of food. In both cases, lots of rest and enough liquid to keep hydrated is well prescribed.

Chicken soup helps you get well.

This one seems like an ad campaign for soup companies. While there is little doubt that warm, yummy comfort food feels good to a sick body, does it actually help you get better? Recent studies suggest that it does. Chicken soup has anti-inflammatory properties and contains a compound which is very similar to medicine often prescribed to clear out congestion. Definitely a remedy worth trying!

Moms, grandmas and great-grandmas have been passing down these health tips for generations. It’s nice to have a little science to back them up. I would not automatically assume that all the tales are true, but not every bit of wisdom has to come from a laboratory, either.

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Can Your House Grow Old With You?

As the newest generation of seniors boom into retirement, the question many are asking is this: Will I be able to age in my home? Studies show that two-thirds of people over 45 would prefer to age in place. And as age increases, so does the desire to stay at home, up to ninety percent of respondents saying they would stay home given the choice. Unfortunately, the desire to stay at home does not always meet the reality of aging. Sometimes a home’s design presents insurmountable challenges. Too many stairs, narrow doorways, or an inaccessible bathroom could all force owners to remodel or leave their homes.

Enter a new trend in housing: Universal Design. This design plan creates a space everyone can enjoy at every stage of life. For the young homebuyer, the house is attractive and comfortable with subtle variations on traditional home design. The modifications generally go unnoticed, except that the whole house is a little easier to live in overall. Features like an entryway without stairs, wider doors and halls, and easier to reach switches and outlets are convenient for those without disabilities, but necessary for others who need a wheelchair to function. Many people find they need to make small adjustments to their homes as they age. In Universal Design homes, those modifications are integrated into the house. This saves remodeling time, cost, and frustration during an already stressful, life changing situation.

More of the features builders of Universal Design homes opt for are:

  • Single story accessibility
  • Lever-style handles instead of knobs
  • Raised and front loading washer/dryer units
  • Kitchen design with easy to reach cabinets and counter space accessible to wheelchairs
  • Bathrooms with raised toilets and non-slip surfaces
  • Easy open windows
  • Extra floor space for maneuverability
  • Thresholds level with floor
  • Good lighting for those poor vision

In some instances these homes are designed in neighborhoods called livable communities which also have aging in place in mind. Nearby shopping and services make life a little more convenient if driving is a problem and public transportation is easily accessible. Sidewalks may be a little wider and well maintained so those with ambulatory issues have an easier time being outdoors. Support services are located nearby and may even come directly into the community. Also important are community centers where neighbors can gather for social events and fun without having to travel too far.

The key to Universal Home Design and Livable Communities is options. They are created so that people can adapt to the challenges of aging without having to find new housing. Some loss of independence can be managed if the setting is appropriate, and well-designed homes allow for that level of flexibility. Technology can be installed, rooms can be repurposed, kitchens and bathrooms are ready for a variety of needs, and the home is accessible to people with different levels of independence. Of course, sometimes choices are removed and it is simply necessary to move. But for many, planning to age at home is a compelling reason to seek out a house that keeps that option a possibility.

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We’re All Senior Olympians

Are you gearing up for the next round of The Games? Whether your sport is Racing, Swimming, Archery, or Shuffleboard, it is already time to get ready for qualifying rounds. Of course, I’m talking about the 2015 National Senior Games! Every two years senior athletes and their supporters gather to compete in events like Badminton, Bowling, Cycling, Racquetball, Pickleball, and more. Participants range from 50 to 100+ years old and must qualify through state level events. It is a serious competition, though the ultimate goal is fitness and fun for the senior population.

Some of the sports require more athleticism than others, but The Games are intended to encourage seniors at all levels to stay fit and healthy throughout their lives. To that end, there are a variety of events offering people of different abilities the chance to participate. Some Olympic-style events are held, like swimming and racing competitions, but there are also less demanding competitions like Horseshoes and Table Tennis. Since its conception in 1985, the event has grown to attract over 10,000 athletes and 20,000 spectators. From seniors who have spent their lives as athletes, to those looking for new ways to stay healthy in retirement, The Senior Games gives those over 50 motivation to stay active.

For others who are not as motivated by competition, there is a personal best category of award. Every year the committee looks for entrants who have overcome difficult obstacles and personal challenges to bring their best to the games. Anyone can achieve this goal and it is a great way to shine the spotlight on people whose perseverance may not lead to a competitive win, but a personal one.

Those looking to compete on a global scale can check out the Huntsman World Senior Games. Every year participants from around the world come to southern Utah to test their skills and have some fun. In addition to the traditional competitive games, seniors can show off their expertise in bridge, horseshoes, shooting, and square dancing. The goal of the event is to promote healthy living and friendship between nations. While there, screenings are available for health risks like diabetes, cancer, glaucoma, and high blood pressure. Socials are held to give competitors a chance to become friends and to foster positive international relationships.

Both events give seniors a fun reason to stay active and engaged at a time when many feel like life is slowing down. Depression and decreased activity are common problems for retirees and both conflict with the goal of a long, happy life. For many, the time spent training is more valuable than the event itself. While the goal is meaningful, it is only the last step in a journey that improves one’s health and happiness. For those needing more social time, a team sport offers a reason to gather and a common goal to work towards. Some retirees lose that shared purpose that can be so rewarding in the workplace. Others may find that kind of camaraderie for the first time. The National and World Senior Games are a great way to make friends, stay healthy, and have fun throughout the senior years.

And in case you’re wondering…Pickleball.

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