Coronavirus Management for Residential Care Facilities

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The close-quarters spread of the Coronavirus Disease (COVID-19) in residential care facilities poses a significant health threat to the vulnerable senior population, and the time to take action is now. RCFE Administrators and licensees in California and beyond are being encouraged by the CDC and Departments of Social Services to have a plan in place in the event of an outbreak in their community.  Assisted Living Education is here to assist you in managing  your RCFE and staying informed. 

Thus far there have been 22 deaths from coronavirus in the United States, with a total of 154 cases confirmed nationwide. California reported its first death recently following a growing outbreak in the Bay Area, but it’s Washington state that has been hit the hardest, with the ten remaining U.S. deaths all happening in and around Seattle.

By now, you’ve no doubt heard about the ongoing emergency at Life Care Center in Kirkland, WA, the nursing home that now serves as an example of what we should all be trying to prevent:  an unchecked outbreak on its premises is to blame for five deaths seen thus far.

While the global mortality rate is 3.4% (WHO, March 2), among seniors and those with underlying medical conditions the fatality rate appears quite a bit higher — about 14%. Comparatively, the mortality rate of the seasonal flu is typically about 0.1% in the U.S. The reality is that it’s difficult to fully ascertain the morbidity and mortality of coronavirus. Experts suspect that the actual number of cases in the U.S. could be in the thousands, but since many people who contract the virus experience milder symptoms similar to those of other respiratory illnesses (e.g. the common cold) — they don’t isolate themselves and continue on with their daily lives. As a result, transmission rates could be much, much higher.

Per a CDC fact-sheet about how coronavirus is spread, here’s what you should know:

  • The virus is thought to spread mainly from person-to-person [and] between people who are in close contact with one another (within about 6 feet).
  • [It is spread] through respiratory droplets produced when an infected person coughs or sneezes.
  • These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.
  • People are thought to be most contagious when they are most symptomatic (the sickest), [but] some spread might be possible before people show symptoms.
  • It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes. 

Considering these facts, the danger of COVID-19 spreading unnoticed through our communities is something we should all be concerned about, but for residential care facilities it presents a clear and present danger. The tragic situation in that Washington nursing home should serve as a wake-up call for every RCFE Administrator and licensee. There is no time to delay.

So what should senior care facilities be doing to manage the spread of coronavirus among their residents? Here’s what the California Department of Social Services and the Centers for Disease Control suggest:

  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose, and mouth.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
  • Follow CDC’s recommendations for using a facemask.
    • CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory diseases, including COVID-19.
    • Facemasks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to  others. The use of facemasks is also crucial for health workers and people who are taking care of someone in close settings (at home or in a healthcare facility).
  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
    • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if your hands are visibly dirty.

For more specific information on how a long term care facility (LTCF) can minimize it’s risk of a coronavirus outbreak, the CDC has resources for healthcare facilities to help licensees build a more specific action plan. Pages we recommend reading include:    

There is a lot we do not yet know about COVID-19, and every day brings new details about the virus, it’s spread, and the risk we might face going forward. It’s not a situation that calls for an alarmist reponse — few situations do — but it is a reality that we need to prepare for. As it stands, a vaccine for the novel coronavirus is still at least a year out, and just this week China announced that it had isolated two different strains of the virus. Meaning, it’s likely going to be a while until we are all out of the woods.

For Residential Care Facilities for the Eldery, that means taking preventative measures now to ensure they can safely manage a potential outbreak among their residents. We have a long road ahead of us, and lives are at stake.

If your facility needs assistance with formulating an action plan please do not hesitate to reach out to us for help. We offer an online infection control course as well. Here at Assisted Living Education it is our core value to empower our students to care for the elderly in the most responsible and compassionate ways possible. This includes protecting them from threats like the coronavirus to the best of our ability. Together we can make a difference and help prevent further tragedy. 

Assisted Living Education is the premier provider of RCFE classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative. They offer RCFE consulting services and share real RCFE experience that will help you be successful in this fast growing career industry.

15 Terms All RCFE Administrators Should Know

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Just a cursory scroll through the RCFE Manual of Policies and Procedures from the California Department of Social Services illustrates just how many different terms you should be familiar with as an RCFE Administrator. In fact, they number in the hundreds. Wouldn’t that be a long blog post! In the interest of brevity, we wanted to share with you some of the most important. Here are the top 15 terms that you need to know if you are an RCFE Administrator or are pursuing RCFE certification. 

  1. Dementia Plan of Operation:  An amendment to a Plan of Operation that details a facility’s dementia care intentions, policies, and procedures. The California Department of Social Services requires that you have in place a Dementia Plan of Operation before you can serve this fast and growing demand market.
  2. Hospice Waiver Request:  The written request a licensee must submit to the DSS and be approved for in order to be permitted to retain terminally ill patients.
  3. RCFE Admissions Agreement:  The contract that includes all applicable documents that a resident or their responsible guardian must sign as a condition of their admission to an RCFE.
  4. RCFE Admission Package:  The full packet of documents, rules, policies, releases, and agreements, etc., that a prospective resident or their conservator must read through, sign (where applicable), and return. This package includes the aforementioned Admission Agreement.
  5. RCFE Emergency Disaster Plan:  A plan, including emergency contacts and procedures, that is required by the DSS to prepare your facility staff and residents in the event of a disaster or emergency.
  6. OSHA Manual for RCFE:  A manual for Residential Care Facilities to help guide compliance with OSHA safety regulations.
  7. RCFE Employee Handbook:  The company policy and information manual provided to an employee by an RCFE.
  8. Plan of Operation for RCFE:  The definitive operational plan and its related materials that a facility must maintain on facility and submit to a licensing agency with the license application.
  9. RCFE Operations Manual:  The document of approved standard procedures that a Residential Care Facility for the Elderly must provide to its employees to ensure job functions are performed accurately, efficiently, and uniformly.
  10. RCFE Staff Training Classes:  The vital training classes that all prospective and current employees must take as a condition of employment, continued or otherwise. 
  11. RCFE Test Preparation:  An educational tool designed to help your study for your California Initial RCFE Administrator Certification exam.
  12. RCFE Administrator:  The person designated by the licensee to oversee and manage a Residential Care Facility for the Elderly. (May also be the licensee themselves.
  13. RCFE License:  The basic permit to operate a residential care facility for the elderly issued to you by the California Department of Social Services. RCFE Live CEUs:  The in-person, in-room continuing education classes (or units) that may be used to renew your RCFE and/or ARF certificate. The DSS requires that at least 20 of the 40 hours necessary for recertification be live.
  14. RCFE Online CEUs:  Online continuing education classes that may be used in conjunction with the 20 required Live CEUs to fulfill the 40 hour training requirement for certificate renewal

Earning your RCFE Certification is so much more than understanding a few words in a blog post. It’s a life-changing undertaking, and we’re here to guide you along the way. Enroll with Assisted Living Education today.

If you are interested in learning more about important terms, concepts, and informational resources related to running an RCFE, please check out our RCFE comprehensive glossary page.  This comprehensive list will point you in the right direction for getting up to speed with the latest industry terms and knowledge needed for RCFE certification and licensure.

We always welcome your feedback, and if you have other important terms you would like added to the list, please let us know.  Assisted Living Education is a recognized leader in the industry, and our instructors have years of professional RCFE experience that will help ensure your success in this burgeoning industry.

The 7 Do’s And Don’ts Of Hiring for an RCFE

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Starting your first Resident Care Facility or RCFE can be exciting, fulfilling and daunting all at the same time. Between securing a location and getting your certifications it can be easy to overlook the basics — the essential aspects that will help ensure your RCFE is a success.

Over the years we have worked with hundreds of newly minted RCFE administrators to make sure their facilities, policies, and business strategies are setting them and their residents up for the best possible experience. In that time, we’ve learned a thing or two, particularly about what you should and shouldn’t do when hiring your staff. After all, your employees are the backbone of your RCFE!

Here are the 7 Do’s and Don’ts of hiring staff for a residential care facility for the elderly.

Don’ts:

1. Warm body hiring:  hiring in desperation.

It’s one of the biggest mistakes an RCFE administrator can make. In your desperation to put together a staff, you might think that any warm body will do. Trust us, it won’t! It is completely okay to be patient and take your time to build your ideal team. After all, these are the people you’re going to be working with day in and day out, and they’re the employees you are going to rely on to care for your residents. You want to make sure they’re not only qualified in skill, knowledge, temperament (a big one!), and experience, but that they also have the capacity to grow into a larger role. Hiring anyone with a pulse out of desperation to fill the role is the perfect way to open yourself up to lawsuits. Remember that in the health and senior care industries, you aren’t just hiring an employee:  you’re potentially hiring a liability. That’s a whole lot of trust to place on the first person to walk through the door… who you now have to spend time (and money!) training and fingerprinting.

2. Only interviewing one person.

She’s the first person in for an interview, and you think she’s perfect. She’s warm, she’s qualified, she’s great with the residents, and she has experience to boot. There’s no two ways about it:  she is your dream candidate, so much so that you’re tempted to hire her on the spot.

This scenario is nothing new. It happens all the time in companies across the nation (and the world), but there are a few problems with only interviewing one person. Think about it, what are you doing when you interview someone? You’re gathering information. Additional candidates means more of this information, and thus more context. By allowing yourself the benefit of comparing a wider field of candidates, you’ll be able to make the most qualified choice.

In interviewing a bunch of people, you might also discover that you didn’t actually know what you wanted. It’s a surprising but true phenomenon, and the reason why you often see job postings with a seemingly endless list of impossible-to-meet criteria (another big no-no). Hiring managers just aren’t sure what they’re looking for. If you’ve ever gone on a date, and found yourself struck by someone totally not your type, you’ve seen this phenomenon in action. It’s human nature. We don’t always know, much as we think we do. The same can be said for job candidates, though. Hiring is a two-way street. As much as you are interviewing them, they are also interviewing you. That perfect candidate you’re crazy about might have multiple offers, and end up going somewhere else.

3. Not having updated job descriptions/responsibilities when interviewing a candidate.

The phenomenon continues! How often have you heard about a company deciding to “go a different direction?” In many places, this can be code for “the job we were originally hiring for has now evolved into something totally different.” Frequently this takes candidates by surprise, and can be super frustrating when everything is in flux — especially for candidates who appeared to be a shoe-in during the interview stage. It’s understandable that things change, but if you’re trying to find the right candidate for XYZ open position, you need to know what that role will entail. How will interviewing applicants know what responsibilities they will have if YOU don’t even know? 

4. Not asking the same questions of each candidate to gauge their answers.

This harkens back to what we said about comparisons in Don’t #2. In every interview you do for a given role, it’s important to have at least a certain number of questions that you ask consistently. By comparing and contrasting your candidate’s answers, you have a standardized way of judging who is the best fit. This doesn’t mean that every interview needs to follow the same script — the best interviews are more like conversations than question and answer sessions. Think about how awkward and stilted those Q&A’s are. Some people are great at interviews, but for most people they are incredibly stressful. (Who hasn’t completely blanked on even the simplest question?) Allowing some room for deviation (and personality) is a great way to put a candidate at ease, and allow them to give you their best answers. But even as the conversation evolves, always bring it back to your standard.

Do’s:

1. Introducing them to residents to see how they interact.

Your residents are the people they’re going to be caring for every day! It’s important to see how your candidates respond to them. If they are aloof, that tells you a lot about their attitude and how they might be as an employee. You want someone who engages with the residents, talks to them, and is open to hearing their concerns. Someone who is dismissive or disrespectful of the seniors in your care has no business being part of your RCFE staff.  

2. Analyzing the 3 C’s:  commitment, caring and culture.

You can’t work at a residential care facility for the elderly if you’re not a team player. Your staff is going to be working closely with one another day in and day out, so it’s important that they make a good fit for the culture. This doesn’t mean that every employee has to be BFFs, but they should be able to work together to get their jobs done. If they can’t put caring for your residents ahead of any interpersonal issues, productivity is going to suffer, and you run the risk of accidental negligence. These attitudes also go towards commitment (or lack thereof). You want someone who doesn’t just show up for work, but who actually shows up for work — someone for who this isn’t just a paycheck. Working at an RCFE doesn’t have to be their life’s calling, but it has to be something they’re committed to. The wellbeing of your residents depends on it! To put it simply, if they don’t care, how will they be able to care? Do they care about seniors, and want to do what’s right by them, or is this just going to be a job for them?

3. Remind them of the qualifications of the job.

We’re not just talking about responsibilities here. There’s more to qualifications than having the experience or abilities to perform the duties adequately (with or without reasonable accommodation).

DSS regulations require staff, persons residing in the facility, and most volunteers to have a criminal background clearance (or exemption) prior to their first day of work. This means that they will need to be electronically fingerprinted, at which point the California DOJ will conduct as background check. If the candidate has a criminal history, that won’t necessarily disqualify them. California’s Caregiver Background Check Bureau will review the transcript and decide if the conviction(s) were for crimes that may be exempted. Candidates with non-exemptible convictions will not be eligible to work in your care facility. 

The employee will also need to go to a local healthcare clinic (this is something you can arrange) for a health screening to verify their general well-being, and to demonstrate that their current health condition allows them to perform the type of work required. At the clinic, the physician will fill out and sign LIC 503, the health screening report for facility personnel. As a portion of their health screening, employees will also have test negative for TB.

Are you ready?

The process of successfully opening and staffing an RCFE in California might be a long one, but in the end it will all be worth it. The senior care industry is among the fastest growing industries in the country, and California is no different. We must be prepared to meet the needs of seniors with the best care possible. More growth means more new facilities, and more new facilities means hiring the best employees.

The need is there. Are you ready to provide it?

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Assisted Living Education is the premier provider of RCFE classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative. They offer RCFE consulting services and share real RCFE experience that will help you be successful in this fast growing career industry.

What to Know Before Buying an RCFE

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As America ages, it goes without saying that the assisted living business will be blooming for years to come. It’s no wonder we see new facilities popping up all around us – most of them doing quite well. Investment groups and private owners are buying existing homes, building out new locations, and/or expanding the facilities they already have – all to meet the ever-growing demand. There is a lot to know about this business model. Buying an existing REFE, and expecting a guaranteed profit is a lot harder than it looks, but if you are smart and buy right it can be a wise investment. In this article, we will look at many of the questions you should be asking yourself and your advisors during the evaluation process of purchasing an existing RCFE.

Indeed, there are many trips and traps when buying an RCFE (residential care facility for the elderly). And, of course, we all know that not all RCFE’s are created equal. Still, you have to ask yourself; where do I start, what should I be looking for, and what are the major red flags? Suffice it to say, there are many factors you must take seriously as well as a number of pitfalls – and, yes, as they say; “the devil is in the details,” and when it comes to purchasing an RCFE, Board and Care Facility, or Assisted Living Home you’ll need guidance and a solid strategy. First things first – you need to know what you are looking for.

What Size and Type of RCFE Would You Like to Purchase?

 Let’s get the terms straight, so we are all on the same page here. What are the differences between a RCFE, Assisted Living Home, Rest Home, and Board and Care Facility? Essentially, they are the same, at least as far as the State of California is concerned when it comes to licensing. All of these facilities must have the RCFE License to operate legally.

Out in the real world, most RCFEs are smaller with under 15-beds, and most are privately owned, often with the owners living in the local community. The larger Assisted Living facilities generally have corporate and investment company owners. These facilities are easily recognizable and usually come with private apartments (rooms) and different resident packages.

Licensed RCFEs can provide non-medical assistance such as eating, incontinence, dressing, personal hygiene, walking, supervision, and reminding and distributing a resident’s personal medicines as the prescription designates (self-administered). These facilities are not required to have doctors or certified nurses on their staff.

Consider why is the Owner Selling Their Facility in the First Place?

If Residential Care Facilities for the Elderly are such a good business model, then why on Earth is the owner selling? Do they have multiple facilities and want to sell their dogs, while keeping their flagship or profitable operations? Are the owners retiring themselves and don’t have heirs to take over the business, thus, just want to cash out? Is the facility rundown? Maybe owners don’t wish to invest in needed upgrades. Is the facility borderline and worried about licensing requirements and future inspections? Has the RCFE ever been licensed?

Has the facility been cited before for lapses in their mandatory compliance, is it at risk of license revocation? Have the owners been called into formal administrative hearings for non-compliance? Title 22 regulations are serious business, is the facility in chronic violation? How does the facility handle its compliance obligations and record-keeping, it’s easy to get into the ‘digital record-keeping doghouse’ in CA, a place no RCFE wants to be. Does the facility have a good reputation with the DSS – Department of Social Services? It’s a lot of questions, but these are all good things to know before you start making any offers.

It’s also important to look at the current residents and staff and their living/work conditions. Does the facility look clean? If you were a state inspector would you pass it for health and safety? What do their records show from previous inspections? Has the facility been paying the staff properly and recording overtime in a legitimate fashion? Are all members of the staff legal US citizens or have work VISAs? Again, if everything is on the up-and-up, try and gain an understanding as to why the owner is parting ways with their investment and make sure that they are not trying to pass on their pitfall to a new unsuspecting owner.

Remember: You are Buying a Business, Not Just Real Estate

Yes, while it is true that real estate can be a good investment over time and a hedge against future inflation, buying an RCFE is more about buying a business. The real estate should be a secondary consideration. In fact, if you separate out the two, and look at the real estate as one investment and the business as the other, you’ll have a clearer picture. Can the real estate stand on its own merit as a viable investment; long-term hold, or fix and flip? Can you afford to buy and hold the real estate if the RCFE doesn’t make a profit on its own?

How will you pay for it all if you lose the residents due to the change in ownership? There will be some attrition when new owners take over, the average is 20-30% – can you deal with that, at a time when you are planning to spend on new upgrades? What is your plan, do you have what you need to execute it? What if all the residents move out? Will the sellers consider a ‘clawback’ clause in the purchase agreement in the case that happens? Will the current owners stay on board for a while ensuring a smooth transition? Are the current owners a problem, perhaps you don’t want them anywhere near the facility?

How is the neighborhood? Are the surrounding neighbors happy with the facility? Have there been issues? Will they turn-out and speak against your future plans of expansion, upgrades or filings at the local planning commission as you try to get your construction or remodeling projects approved? Is the Neighborhood itself run down, will this prevent you from attracting residents or prevent you from commanding a fair and reasonable market price for those who come to stay?

Is the RCFE Profitable?

It is also important to evaluate if the facility is currently financially stable.  Consider if most of the residents are SSI residents. If so, keep in mind you will never be able to evict them, nor will you be able to raise prices much. If the facility isn’t making money now or barely scraping by, what will do when it is time to make repairs, upgrades, or comply with future regulations?

Will you need to expand the facility to improve revenue? Will you be able to renovate and add-on to the facility? Can you potentially do this out of cash flow? Speaking of cash flow, how timely are the residents with their payments? Are loved ones footing the bill, are they perpetually late with payments? Have the current facility owners been letting these late pays slide in the past? Are all the residents paying similar rates or have long-term ‘sweetheart deals’ been made for a few? Are all payments being made above board or are some residents paying ‘cash’ in off the books payments – if so this can cause havoc with proving revenue and financing your purchase.

How much work are the owners doing – do they have family members doing work, are they paid like regular employees? How is all this accounted for? Will your costs change drastically once you take over the business, as you will have to hire more staff than is currently servicing residents to offer the same level of care?

If you plan on doing substantial upgrades to the facility; what are the local building codes like, what restrictions are there on these types of facilities and what is the zoning in that specific area of the city? As you can see, most California cities have rules and building codes for Residential Care Facilities for the Elderly.

What other competition is in the area? Are new larger corporate Assisted Living Homes opening nearby with low-introductory offers? That is to say; can you compete with the ‘big boys’, the well-financed REITs with huge new facilities, an array of amenities, economies of scale, paid referral recruitment programs, and choice locations? You probably can if the business is profitable now, in full compliance, and/or you have a solid strategic plan.

Are the RCFE’s Facilities Well Maintained?

Title 22 is pretty specific when it comes to licensing of Residential Care Facilities for the Elderly (RCFE) and in 22 CCR 87303 “Physical Environment and Accommodations” it lays out the requirements for Maintenance and Operations of RCFEs. Inspections come every two years and if you aren’t in compliance, you will have a huge headache on your hands. The last thing a facility wants is to be considered ‘problematic’ by an inspector, the word gets around fast and it quickly snowball out of control. When purchasing an Assisted Living Home, Board and Care Facility, or RCFE you should look over the facility with a keen eye for detail as if you were a Title 22 Social Services Inspector. Looking through that lens, what do you see? Remember once you purchase the facility any of those problems you see will instantly become yours.

Can I Just Buy a Home and Turn It into an RCFE?

Yes, this is another option. Starting a new RCFE will require licensing, and more time to get up and running. You’ll need a comprehensive business plan and an expert consultant who has been through this process before, someone who knows the curves of the road ahead. You will need more working capital to start, but you won’t have to pay for ‘goodwill’ or a multiple of the annual gross revenue as you would if you were buying an existing RCFE. You will need to consider the costs and time associated with licensing, hiring, marketing, and training, and put into place a class-act compliance system. The biggest advantage is that you can build it out of your way with the most efficient and modern methodologies. Yes, it can be done. If you do it right, it might be the best option for you. Think on this, while shopping around and seeing what RCFEs are on the market.

Final Thoughts

We know that we have provided more questions than answers in this article. This was by design. Embarking on a journey to purchase an RCFE is one filled with questions that need to be answered and sometimes the hardest part is knowing what the right questions to ask are. Hopefully, this article has given you some insight into that. And if you find that you still need further guidance and/or consulting you can always reach out to our expert team to help make sure you are headed in the best possible direction. Good luck and happy shopping!

Assisted Living Education is the leading provider of  RCFE license application services, classes, products and services for assisted living. Our teachers are industry professionals with years of experience, engaging, entertaining and highly informative.

10 Steps to Open an RCFE in California

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By the year 2035 it’s projected that there will be more than 78 million person ages 65 and older living in the United States, up almost 60% from the 46 million in 2016, according to population data. Every state is expected to see massive growth as baby boomers age into retirement, but none will see an increase quite like California:  by 2036 the state will see more 10,000,000, and comprise 23% of our population.

Planning for an aging population is no longer conjecture. It is an absolute necessity. Doing so requires that we have the infrastructure in place to care for those who will need it, which means more licensed care facilities, more available beds, and more trained and certified RCFE administrators.

Getting there will not be easy, and setting out to open your own RCFE is not for the faint of heart. It’s a significant business decision, but one that carries with it one of the most rewarding acts of service one can provide:  caring for those who came before us. Here’s how you go about opening and RCFE in the state of California.

1. Find a qualified, certified Administrator.  

The first and most important step. Without having a qualified, certified administrator on your team, none of the rest can follow. In all likelihood, you’re probably intent to become certified yourself, but how do you go about doing that?

To become certified you must first take the DSS-required 80 hour Certification Course, and then take and pass the DSS-administered 100 question test with a minimum passing score of 70%. This test must be taken within 60 days of you completing the 80-hour course, after which you must submit the required paperwork and fee within 30 days of passing the test.

Not everyone is qualified to be an administrator of your facility. The general requirements call for a high school diploma or equivalent and being at least 21 years of age. For a 16-49 bed facility, you must have passed at least 15 college units and have at least 1 year of experience working in an RCFE or equivalent. To be an administrator of a 50+ bed facility, you’ll need to have a minimum of 2 years of college under your belt, and have at least 3 years of experience working in an RCFE or equivalent.

Are you qualified, and ready to take the DSS-required RCFE initial certification course for administrators?

2.  Secure the physical plant.

It will sound obvious in hindsight, but you can’t be the administrator of a residential facility for the elderly if you don’t have the actual facility part locked down. In order to submit a license application for your facility, you must show “control of property” — that is, proof that you either own the property outright, that you are either in the process of buying the property or that you will be leasing/renting the property.

3. Contact your local fire marshal for a pre-inspection.

The sooner you do this, the better! It’s possible that the fire marshal will charge you a nominal fee, but this inspection will let you know early on if you will need to make costly modifications to your home/facility in order to be compliant with local fire codes and state regulations. Money well spent! If you don’t make these modifications, you won’t be able to get the maximum number of non-ambulatory rooms or apartments out of your facility. You’ve already come this far! Maximize your investment by making these modifications, or find another location!

4. Take the online Orientation course with DSS.

You must take the DSS RCFE course.  You only need to take this course once. This is done through the DSS website, and then submit a copy of your orientation certificate.

5. Submit a license application to DSS.

Now we’re getting to the fun stuff. The next step in this process is to prepare and submit an RCFE license application for DSS, including parts A and B, along with the applicable fee. We won’t sugarcoat it:  this is not like filling out an application for a driver’s license. The Applications Instructions alone are 22 pages in length, and all told you’re looking at hundreds of pages to gather information for, prepare, and fill out. Attempting this on your own is a recipe for disaster — just one error could delay your facility’s opening by months! Instead, it’s smart to consider having yours completed by a professional. Our team has licensed hundreds of small and large RCFE’s, and worked with DSS licensing personnel for over 15 years. We have never had an application rejected due to error!

Do you have the required 3 months’ of operating costs in the bank? You must open a bank account in your facility name and deposit at least 3 months’ operating costs into it. The DSS will verify this in the process of reviewing your application.

Be patient. This process may take 4-5 months.

6. Market your Facility.

Congratulations, you’ve submitted your application! Now it is time to start meeting with the potential residents who fill your facility once you are licensed. You are NOT allowed to move residents into your facility until you secure the license from DSS. But DO start looking for residents. Don’t wait until you secure the license, because that will just be time lost! In our post detailing 6 Steps for a Successful RCFE we talked about the importance of choosing your residents wisely. Remember, your first resident is your benchmark and will set the tone for your facility in ways you might not expect.

7. DSS will schedule a Component II (face to face) meeting at their office.

This is step two in a three-part component process that must be completed by all new licensees. Once your application has been reviewed, you will be contacted by the DSS for a one-on-one with the the reviewing analyst.

Component I was the orientation course you took in #4 on this list, and Component III involves  “category specific training and discussion in areas not often understood by new licensees intended to promote successful facility operation.” Both components II and III will be done once DSS accepts your license application, but prior to actual licensure. These are all essential aspects of the license application process.

8. DSS will schedule a pre-licensing visit to inspect your facility.

You’re so close! You’re almost there! A pre-licensing inspection is by the DSS as the last step in the RCFE license application review process. DSS will send you a checklist for you to complete prior to this visit. Make sure you complete this checklist fully, and have it available for their review when they come to visit.  Note: the DSS will NOT conduct a pre-licensing until your fire marshal grants their approval.

9. Hire staff and train them accordingly.

Putting together your team and training them accordingly is arguably the most important step in this entire process. We’ve discussed before the perils of fire-drilling the hiring process in our post about The 10 Biggest Mistakes RCFE’s Make. You aren’t just looking for warm bodies to fill these important caretaking positions. You want a passionate team of people who want to come in every single day intent one making the lives of your residents better. Remember, you don’t want to wait until you are licensed to build your team, because you will not be able to move in and care for residents without staff! Once you’ve found the right people, make sure that they are properly trained and meet all the state requirements. And don’t forget the importance of ongoing CEU training for RCFE administrators and staff as well!

10. DSS issues you a facility license.

You did it! Yes, you! Let that feeling of pride wash over you. You are now the proud administrator of a fully licensed RCFE. This is everything you’ve worked so hard toward, and it’s time to open your doors. Now you can move in your residents that are on your waiting list!

The process to opening an RCFE facility in California may be long, but it’s rewarding. It’s okay if it takes you a year or more to get your facility off the ground — it’s not a race, and in the end it will all be worth it. The senior care industry is among the fastest growing industries in the country, and California is no different. We must be prepared to meet the needs of seniors with the best care possible. More growth, means more new facilities.

The need is there. Are you ready to provide it?

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Assisted Living Education is the leading provider of RCFE certification classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative.

 

The 10 Biggest Mistakes RCFE’s Make

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As humans, we are all prone to error. Even in industries where a single mistake could mean life or death, errors are made. But just because “to err is human” does not make it right. In the case of our aging senior population, RCFE Administrators have a responsibility to the health and wellness of their residents, who in their final years have become wholly reliant on others to meet their needs.

If you already have an RCFE Administrator certificate — or are soon to earn one through an RCFE Administrator course — you are duty bound to provide all individuals in your care with a safe and welcoming environment compliant with all state and local regulations.

Here are numbers 1-5 of the ten biggest mistakes made by RCFE’s — mistakes that make it that much more difficult for you to fulfill your obligations as an administrator.

1.   Admitting inappropriate residents

In 2013, nearly 7,000 complaints were made to the National Ombudsman Reporting System (NORS) regarding resident on resident conflicts in care senior facilities. Admitting sexually inappropriate, offensive, or combative residents into your community is all but certain to cause headaches down the line, and will quickly lead to a hostile and uncomfortable environment for the others in your care.

Residents have a legal right to be free from verbal, sexual, physical, and mental abuse, and to be treated with dignity and respect. Admitting inappropriate residents and those who mistreat others creates an environment counter to those rights.

2.   Hiring the wrong employees

Your employees are the backbone of your RCFE. They’re the people you interact with everyday and the hands who care for each and every one of your residents. Without them, you would not have a facility. With the wrong ones, your home will suffer for it. The hiring process is a delicate one; rife with potential pitfalls.

Fire-drilling the process of building your team is not the way you will find competent, qualified, candidates who are not only passionate about their work, but also show up day in and day out, even when it’s challenging.

You want people who aren’t just there for a paycheck, but rather come to work every day intent on making the lives of your residents better. Bad attitudes, contemptuousness, and disregard for a resident’s well-being have no place in the care industry, let alone your RCFE.

3.   Not training their employees fully and correctly

None of us walk into work that first day completely prepared for the job we’ve set out to do. The moment you are, you’ve already moved up to the next position. The assumption that someone will be able to hit the ground running and do everything perfectly from day one, is nothing short of folly. Employees need training, always. Not only when they begin, but over time as well. Training keeps us fresh and on top of shifting best practices. Without it, employees won’t be able to do their jobs properly, and if something goes wrong, you’ll have no one to blame but yourself.

Remember, always document all training an employee has done — otherwise, it did not happen!

4.   Disrespecting the LPA

Licensing Program Analysts, or LPA’s,  are state workers whose responsibility is to manage the licensing, evaluation and investigation of RCFE’s. As employees of the Community Care Licensing Division, about 50% of their time is spent out in the field conducting site visits and inspections of care facilities. They play a vital role in making sure that every RCFE meets state standards and is living up to its mission of properly serving the needs of its residents. Disrespecting your local LPA will do you no favors with the state. They have the authority to issue citations and civil penalties should an RCFE be found to be negligent or deficient — as they should. Viewing him or her as the enemy will accomplish nothing. It is not you against them, but you both against the problem.

5.   Not befriending the Ombudsman

Just as it is important for you to get up know your local LPA, so should you befriend the Ombudsman. As advocates for the residents of assisted living facilities, the Ombudsman only wants the same things you do:  a happy, healthy, and safe resident! Since it’s difficult for an aging person to advocate for themselves, somebody must. Befriending your Ombudsman will only make the process of resolving conflicts within your RCFE easier.

6.   Failing to complete proper resident file documentation

Any time there is a resident incident, such as a fall, it must be documented. Just as incidents like the above need to be reported to the resident’s physician asap (see mistake #10), it’s imperative that these incidents also have a paper trail. Liability is a huge potential problem for any RCFE, so defensive documentation is the best way to keep ahead of any issues down the line. When properly completing resident file documentation, specificity, precision, and descriptive detail are all musts. An incomplete file is not only a possible hazard to your residents, but it’s a lawsuit and a regulatory issue waiting to happen.

7.   Failing to do annual medical assessments on residents with dementia

The seriousness of dementia has lead states to enact numerous laws regulating the facilities accepting individuals with the condition. Among those is a requirement that all RCFE’s perform annual assessments on their residents with dementia. Since changes to one’s condition and behavior are all but certain to impact their care plan or which medications they take (see #9 on this list), it’s imperative that these be noted in a timely manner by licensees. Furthermore, these changes, if severe enough, may require a resident to be moved elsewhere — not all Residential Care Facilities for the Elderly are equipped or licensed to care for people living with advanced dementia.

8.   Failing to complete proper employee file documentation

A thoroughly kept personnel file is necessary to protect an employer in the event of audits or lawsuits, or any other type of employee-employer disagreement. In the case of the later, turnover becomes a risk. If another employee witnessed the issue in question, there’s a chance they are no longer available to give their account, thus forcing an employer to rely only on the documentation available in a personnel file. If few details exist in writing, that leaves the events open to debate, which can make it more difficult for an Administrator to justify cause for termination.

For a personnel file to comply, it should include state mandated  documentation. The file should also include any coaching, known policy violations, resident complaints, any disciplinary actions taken, and whether or not they met their performance goals. This record doesn’t need to be negative alone. A personnel file also serves as a justification of raises and promotions. So any noted positives should be included as well — key contributions, rewards, special recognition, client compliments, etc.

9.   Inadequate resident care plans

The Nursing Home Reform Act of 1987 was enacted by the federal government with the intention of advancing the rights of nursing home residents. This came after a study in 1986 showing that people living in RCFE’s at the time were not being afforded proper health care or personal treatment. In response, new laws were established that required all nursing homes accepting Medicare to develop detailed care and treatment plans for each resident, and follow them. Additionally, all residents were given the right to review their personal plans and to be given advanced notification of any changes.

Failure to comply with these regulations will not only be interpreted as neglect by regulators and the courts but does nothing but endanger your residents. Care plans exist to prevent elder abuse, minimize the potential for medication mishaps, and reduce the risk of medical mistakes leading to serious injury or even death.

10. Failing to notify the physician of a resident change of condition

The law mandates that any change of condition in the resident, no matter how small, must be communicated to their physician. A change in an individual’s condition could mean the difference between life or death, and a lapse in communication could prevent a resident from receiving critical treatment. It’s imperative that everyone on your resident’s care team is in the loop as changes occur, and it’s doubly important that these changes are noted in writing. We’ve all heard of the game “Telephone”:  word of mouth is terribly unreliable, but words on a piece of paper are far less likely to be misunderstood. Written records reduce the risk that a serious change in condition will get mixed up in the shuffle.

There you have it. Those are the top 10 mistakes that Residential Care Facilities for the Elderly make. Mistakes like the above put your residents at risk and your facility in jeopardy. Luckily, all of them are easily preventable.

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Assisted Living Education is the premier provider of RCFE classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative. They offer RCFE consulting services and share real RCFE experience that will help you be successful in this fast growing career industry.

6 Steps for a Successful RCFE

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Starting your first Resident Care Facility or RCFE can be exciting, fulfilling and daunting all at the same time. Between securing a location and getting your RCFE certifications it can be easy to overlook some of the important basic ideas that will help ensure your first RCFE is a success.

Over the years we have worked with hundreds of newly minted RCFE administrators to make sure their facilities, policies, and business strategies are setting them and their residents up for the best possible experience. In that time, we’ve learned a thing or two (or six) on some of the foundational elements of what makes a successful RCFE. Here is what we would say 0ur 6 most important tips for building a successful RCFE facility are…

1. Spend Time Creating Your Team

More than just a team, you are creating a culture. And where that culture starts is you and your employees. Those first several hires are vital to any new venture, regardless of the industry, and especially in a care-oriented industry like this one. The people you choose and personalities they bring set the tone and precedent for all that is to come.

With everything in flux, you might be tempted to “fire drill” the hiring process in a rush to hit the ground running. This is never a good idea. We’ve all heard the phrase beggars can’t be choosers. In hiring, no matter the circumstances, that should never apply. Give yourself permission to spend time creating your team. Yes, your team. You have a vision, and it is okay to be selective on who will join you on your path to seeing it through.

2. Choose Your Residents Wisely

Just as you are creating a culture with your first employees, so are you building a RCFE community. Your first resident is your benchmark and will set the tone for your facility in ways you might not expect. For example, if your first resident has Alzheimer’s and has repetition tendencies, then it might be difficult to admit residents who are cognitively with it.

Remember, just as you have a choice, so do your residents — and there’s a lot of factors that go into their decision to go with your RCFE facility. As facilities grow in size, culture and community are becoming increasingly important. If a resident-to-be doesn’t see a community they can engage with (even if one exists), they might very well pass. Whether it’s bound in fact or not, perception is reality.

3. Know All of Your State’s Regulations, Codes, and Policies — And Comply with Them

These laws exist for a reason, both for the protection of your residents and for yours. The quickest way to have your facility shuttered is to be out of compliance with your state’s RCFE regulations. You went into caregiving to do just that:  give care. How can you adequately do that if you’re out of compliance, or don’t even know what codes and policies your facility is supposed to be complying with?

Moreover, having a firm grasp of your state’s regulations could very well be crucial down the line. Don’t be afraid to wield them like a shield — the first line of defense towards any future liability claims.

Need to brush up on your policy? You can always turn to experts like Assisted Living Education to help make sure you are up to date.

4. Communicate Regularly

Not only is communication vital so that everyone on your team can always be on the same page, but it’s also a regulatory requirement. The law mandates that any change of condition in the resident — say, they have a urinary tract infection or they’re more confused than usual — must be communicated to their physician and responsible party (i.e. a family member), if any.

This makes sense, of course. A change in an individual’s condition can have life or death consequences, and a lapse in communication could prevent a resident from receiving critical treatment. Shift changes present a particular challenge in this regard. There’s a potential for information to get lost in the mix in the transition between your facility’s day and night teams. Certain symptoms, such as insomnia — a potential indicator and risk factor of depression — might only present themselves at late in the evening, so it’s imperative everyone is kept in the loop, and that changes are noted in writing.

And let’s not forget your duty as an RCFE Administrator to maintain communication with your State Regulators. Any time a resident experiences an unusual incident — such as a fall, an injury, or a medical emergency requiring a 911 out to the hospital — a report must be made to your Licensing Program Analyst at the Department of Social Services with within 1 business day via telephone, and within 7 days via a written report. This takes us into our next tip.

5. Document, Document, Document

Any time there is a resident incident, such as a fall, it must be documented — either internally, if it isn’t that serious, or on a State-provided form to be submitted to the DSS if it triggers a 911 call or something similar. Like the above, incidents need to be reported to the resident’s physician and responsible party, and it’s best to do this in writing so you have a paper trail.

Liability, though you might not want to think about it, should always be a concern. Thus, it’s wise to perform internal audits and random record reviews on a routine basis. You always want to be able to certify compliance if the need arises. This is where the term “defensive documentation” comes into play. When you document incidents, or anything really, specificity, precision, and descriptive detail are all musts.

Resident records (appointments included), personnel records, administrative records, dementia records — these are all things you are required to keep, keeping in mind that certain records must be secured in a HIPAA compliant fashion. As a guideline, take a look at the list of documents and records that must be kept at residential care facilities in California. Remember that every state is different, so unless your facility is located in California, what you are required to retain might be different.

6. Don’t Be Afraid to Say No

The words “this is my island” spring to mind. This facility is yours, and as an RCFE Administrator, you cannot be afraid to say no. We covered this in part in Tips #1 and #2, what to do in the beginning, but there’s a corollary on the other end of the spectrum:  what to do when an end is inevitable.

If an employee misbehaves, routinely underperforms, or puts your residents or facility in any modicum of risk (health, liability, or otherwise), then it is your duty to fire them promptly. With the safety and wellbeing of those in your care on the line, they must be your first primary concern.

But what if an individual’s medical needs exceed your facilities abilities?

It’s sad to say, but this is a quandary you will likely face dealing with residents suffering from advanced Alzheimer’s and dementia. Much as you might want to keep them in your care, your licenses might not permit it. The care they require might go beyond the scope of what you can supply. In these situations, or in cases of residents who exhibit violent behaviors or a flagrant disregard for community rules, letting go of a resident might be a necessary course of action as well.

The Essential Component of Success

Looking back on the six tips we just shared, you might notice that at their core they are all about the same thing:  Care. Caring enough to do things right. Providing the best care. Taking time to assure your level of care by maintaining compliance, and by communicating. Although there is a lot more to running a successful RCFE facility than just these 6 things, mastery of these will give you a great foundation to build your business on. And in the event that you need additional support or training, the experts here at Assisted Living Education is always here to lend a hand.

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Assisted Living Education is the premier provider of RCFE certification, RCFE classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative. They offer RCFE consulting services and share real RCFE experience that will help you be successful in this fast growing career industry.

Holiday Depression and Seasonal Affective Disorder is a Painful Reality for Many Seniors (Part 2)

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Joyous as the winter season can be for some — with fresh blankets of snow, a warm hearth, and the love of family surrounding them — for others it can be a time of struggle. Not only do the holidays and cold months often counterintuitively bring some people down, perhaps in part the result of past psychological drama, but they can also trigger persistent depression.

The Holiday Blues and Seasonal Affective Disorder typically manifest in similar ways, but their origins and treatment are different. In our last post we discussed the symptoms of each condition, as well as why they might befall certain residents in your care.

As caregivers, we play an important role in an individual’s day to day life; our close relationships with those we look after allow us to notice changes in mood and behavior, and alert other members of the care team. Keeping everyone in the loop, especially the psychiatric professional who will provide the diagnosis and treatment, gives a resident the best shot at recovery.

Here are some of the ways we can help our senior residents when the black dog begins to growl.

Helping Residents With Holiday Depression

With proper planning and program design, it may be possible to shift a resident’s mood throughout the holidays, and prevent the Holiday Blues from taking hold in the first place.

Well before the holiday season or particular event arrives, try to make an extra effort to engage with those residents who may be at risk for experiencing a depressive episode. One simple way to start is with a conversation.

Have Meaningful Interactions With Your Residents

Regular, casual engagements with your residents can turn into lasting relationships, with positive benefits for the residents. These relationships can help toward stabilizing emotional highs and lows that may be experienced during particular times of year, like the holidays, where residents can tend to feel more isolated and lonely.

Initiating daily conversations with each and every resident may sound like a daunting and time-consuming task, but even keeping it short and sweet can brighten a resident’s day. It’s not necessary to have a long, sit-down conversation, but try to create an ongoing dialogue whenever you see your resident either in passing, during medications administration, therapy sessions, mealtimes, or other times you may have scheduled contact with them.

Not every individual will be responsive, for various reasons. They may be shy, have trust issues, or they may have a disorder or cognitive issue that makes it difficult for them to interact openly with you. These individuals may take some time to warm up to you, or you may need to change your approach. Gauge how the individual reacts to conversation; you may need to back off and take smaller steps for them to open up. You may be doing most of the talking at first, but over time, you might find it balances out to a more even exchange.

Begin inviting them to group activities or outings, but ever push a resident into something they’re. not interested in doing. Nonetheless, always let them know they’re welcome to join if they want. These relationships might take longer to develop, but for resident and caretakers alike, they can be truly meaningful.

Even for residents who have advanced dementia or Alzheimer’s, or other cognitive or verbal limitations, you making an effort to reach them can make all the difference. Singing to them, talking to them, or signing with them will help these individuals feel connected to other people. Their responses may be different, but pay close attention to their behaviors and body language for positive or negative feedback.

These are all important components of trust-building, which can help you with other times in the long-run. As a trusted staff member, the resident may look to you in times of difficulty or even non-compliance to remain calm or de-escalate a tense situation.

Involve Everyone in the Festivities

Most facilities decorate and have events correlating with the major holidays, which is a great start to creating a warm and festive environment. If possible, find out which holidays in particular your residents like to celebrate throughout the year, and make an effort to have those represented if they aren’t part of the mainstream/regular celebrations. Even decorating a common area or the hall near their room can help bring some cheer. If the resident(s) are able, they can help explain the traditions with which they’re familiar and share stories they recall from their past.

The winter holidays are also a great time of year to invite people from the community to interact with residents. Local religious organizations, youth musicians, choirs, a capella or other community groups, and even schools can come sing and/or engage with residents and bring light to their holiday experience.

If possible, outings to local community events, or even driving around looking at holiday lights in the neighborhood are great excursions as well — but if that’s not doable, reaching out to the community and requesting greeting cards for the residents is another simple way to bring your residents cheer.

Recuperation Time is Important

With all of the activities and bustle of the holiday season, down time or quiet time is crucial. Even if elderly residents are enjoying themselves with all of the festivities, it is a change from their daily routine, and may be more physically and emotionally demanding on them than expected. As we age, it can take us longer to recover from activities, especially those out of our norm, whether we realize it or not. Moreover, stress and exhaustion can depress one’s immune response, causing someone to be more susceptible to illness.

Switching things up by having partial or half-day activities with ‘regular’ days in between will allow for recovery, and help reduce the mental and physical tolls the holidays can put on elderly folks.

Treating Residents Suffering From Seasonal Affective Disorder

Many of us are familiar with the term Seasonal Affective Disorder (SAD), but may not fully understand its condition, or even that there are different kinds of SAD. While we mentioned that there is a type of spring/summer SAD, the depression varietal we’re discussing here is fall/winter — the physiological condition coming to bear in the cold months.


For the period that the resident is suffering from SAD symptoms, antidepressants can be helpful, especially if the condition’s pattern is known. If a patient has a history of SAD, the an antidepressant regimen can begin prior to the expected onset of either winter or summer SAD. By starting sooner, the medication will be more effective.

Light therapy has also proven beneficial for sufferers of fall/winter SAD, especially among seniors who dislike taking medications or whom are already on multiple medications. Light therapy is also helpful for elderly who are not as able to go outside for natural exposure to light.

For residents with executive cognitive functioning within normal range, Cognitive Behavioral Therapy (CBT) is another possible treatment as well. What works best for every patient is different, and treatment can sometimes take a while to gain a foothold. In fact, there can be a great deal of trial and error in finding the right cocktail of medications or therapies, depending on one’s personal preference and brain chemistry.

A Light Through the Fog

The resident’s attending or personal psychiatrist/psychologist can determine the best course of treatment, depending on the individual’s needs, cognitive capabilities, and severity of symptoms. Even if the resident is receiving specific treatment from their psychiatrist/psychologist, it is pertinent to keep all doctors, therapists, dieticians, and other caretakers abreast of any adjustments to the resident’s routines, medical or otherwise. This helps maintain consistency and effectiveness of the treatment and resident care.

For residents suffering from Holiday Depression or Seasonal Affective Disorder, it might be a while before they can find their way to the bright side of life again, but always remember:  with your care and compassion, you are their light through the fog.

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Assisted Living Education is the leading provider of RCFE certification classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative.

Holiday Depression and Seasonal Affective Disorder is a Painful Reality for Many Seniors (Part 1)

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For many, the holidays and winter months are the time of year for family get-togethers, traditions, friends, and fun. But this isn’t always the case, and for a large number of seniors Holiday Depression and Seasonal Affective Disorder are a painful reality. The causes for each can be numerous — both psychological and physiological — and often they present similarly. However, considering the more insidious nature of the latter, it’s important that caregivers know what to look out for, and the different factors that can play a role in their onset.

Spotting the Signs of Holiday Depression

The key to any effective individual care plan is in simply knowing your residents. Familiarity with their personalities and ‘baseline’ behaviors, disposition, and temperament are crucial in detecting any kind of change.

The following are typical depressive symptoms presenting in an elderly resident around the holidays:

 

  • Subdued or irritable mood; sadness
  • Fatigue, or difficulty sleeping
  • Anxiety
  • Loss of interest in daily activities
  • Change in appetite
  • Lack of attention to personal care, hygiene

Unlike other forms of depression, the Holiday Blues are situationally dependent. They begin in the lead up to the holidays, and fade in their wake. Rather than being physiological in origin — the individuals personal biology and brain chemistry — they are based in psychology and sadness. Sometimes, the thing triggers one’s holiday depression isn’t current. Instead, the holidays might dredge up trauma of some kind from a person’s past.

Even if your residents already present some of these symptoms, it’s important to note if they become more severe or if additional symptoms arise. If you notice the symptoms worsening, or if they continue beyond the holidays, this is very likely indicative of a more insidious form of depression.

Seasonal Affective Disorder

Seasonal Affective Disorder is a type of depression whose onset is triggered by changes in seasons. The most common form of SAD occurs in fall through winter, but there are some cases in which the condition affects an individual in the spring/summer months (sometimes referred to as Reverse SAD).

In both cases, there is marked change in mood and disposition, which start out mildly when the season is in its initial stages, but become more severe as the season progresses. Considering it can be easily confused with the Holiday Blues, we’re going to focus on the fall/winter end of the spectrum.

The fall/winter manifestation of SAD resembles the more classic symptoms of depression. Here’s what to look out for:

 

  • Irritability, trouble getting along with others
  • Fatigue, lethargy, low energy
  • Emotionally hypersensitive
  • Change in appetite, especially craving for high carbohydrate foods
  • Oversleeping

People who live in regions with distinctive weather changes or where sunlight can be very limited are more likely to develop symptoms SAD. However, even in places like California, where the weather may not change as dramatically, the cooler temperatures can prevent more frequent visits outside, especially for elderly residents, and thereby makes for less exposure to the ever important sunlight.

For individuals with Fall/Winter SAD, symptoms persist for more than two weeks. The reduced sun exposure can lead result in deficiencies or imbalances in the body. For example, serotonin production drops with a lack of sunlight, and this chemical imbalance causes an individual to feel depressed. The cravings for high carbohydrate foods are the body’s way of attempting to increase serotonin levels. Vitamin D also plays an important role in our health, including supporting bone health, preventatives with certain cancers & conditions, as well as help with incontinence. However, Vitamin D is also found naturally in certain foods and also via dietary supplements. Sleep patterns can also be thrown off as well, since the body’s circadian rhythms depend on regular sun exposure. The disrupted sleep prevents the resident from getting quality rest, which can result in depressive symptoms.

Making the Call

While nurses and caretakers play a critical role in determining whether a resident is suffering for Holiday Depression or Seasonal Affective Disorder — considering the frequency with which they might interact with an individual — the ultimate determination must come from the resident’s attending or personal psychiatrist/psychologist.

Psychiatric professionals should determine the best course of treatment, depending on the individual’s needs, cognitive capabilities, and severity of symptoms. Even if the resident is already receiving specific treatment from their psychiatrist/psychologist, it is vital that team members keep all doctors, therapists, dieticians, and other caretakers abreast of any adjustments to the resident’s routines, medical or otherwise. This will help maintain the consistency and effectiveness of the resident’s treatment and care.

In our next article (Part 2 of this series), we’ll take a look at how you as a caretaker can help the seniors in your charge throughout the fall and winter months. While you might not be able to hold the effects of the Holiday Blues or SAD at bay, you can at the very least take steps make their days warmer, merrier, and bright.

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Assisted Living Education is the leading provider of RCFE certification classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative.

Understanding the Unique Challenges and Needs of Aging LGBT Adults — Part 2

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This is the second part of a two-part article. If you have not read Part One yet, we recommend doing so first clicking here.

Bullying in nursing homes is already on the level of a national crisis; enough so that the topic warrants an article of its own. But for openly LGBTQ+ people, it’s even more insidious — and often violent.

A lawsuit submitted by Lambda Legal on behalf of Marsha Wetzel against her assisted living community, which failed to protect her on a systemic level, shows just how bad it can be. For 16 months, despite dozens of complaints to administrators, Wetzel — a 70-year-old lesbian woman — was subjected to cruelty and violence by her fellow residents. Homophobic slurs were commonplace, and she often found herself targeted by the same people.

One man, a former police officer named Bob, rammed her scooter with his walker “hard enough to tip her chair and knock her off the [wheelchair] ramp,” and in a later incident told her that her partner Judy “died to get away from [her].” The harassment from Bob was so frequent and severe, that she soon felt she had no choice but to eat alone in her room, do her laundry in the middle of the night, and avoid the floor he lived on.

Sometime later, Wetzel was attacked in the mailroom — hit over the head from behind by an unknown assailant. “She went back to her room and cried but did not report the injury to staff that day because she did not think they would believe her.”

The reason she thought that was because, as she learned after dozens of complaints, the administrators never did. She was spit on by residents, assaulted in the elevator, and told that she would burn in hell — and each time she complained she was either accused of lying or told not to worry about it.  Eventually, the staff began to retaliate against her themselves, falsely accusing her of smoking in her room (an evictable offense), making fun of her because no one visited her during the Holidays, and at one point slapping her across the face.

Marsha Wetzel’s experience is not unique. It’s something that the vast majority of LGBTQ+ older adults have had to deal with — if not presently, then throughout the past. Wrote Tara Bahrampour, “Older lesbian, gay, bisexual and transgender (LGBT) people, including those among the first to come out as a political and social force, are increasingly apprehensive about encountering discrimination as they grow older and more dependent on strangers for care.” (Washington Post)

This apprehension only highlights why it’s so vital for caregivers to approach these situations with understanding and belief; their fear doesn’t exist without reason.

Compared to their cisgender1  and heterosexual counterparts, LGBTQ+ older adults are already at a much greater risk of physical and mental illness. So stark is this health disparity that it’s been identified as one of the greatest concerns in public health. Says Karen Fredriksen-Goldsen, who led the pioneering 2011 study, “The health disparities reflect the historical and social context of their lives, and the serious adversity they have encountered can jeopardize their health and willingness to seek services in old age.”

In fact, 80% of respondents indicated that they’d been victimized “at least once in their lifetimes,” and nearly 40% had considered suicide at some point.

On top of the above health concerns and decreased care-seeking, LGBTQ+ seniors also have to contend with the following challenges that their peers do not:

  • Increased social isolation and loneliness
  • Decreased social support (less likely to be married or have children)
  • Greater rates of poverty (often due to a difficulty in finding employment)
  • Poorer nutrition
  • Increased likeliness to smoke and binge-drink
  • Higher rates of depression and anxiety
  • For older lesbians and bisexual women, an elevated risk of cardiovascular disease and obesity, and a decreased likelihood of having a mammogram
  • Higher rates of chronic conditions (including low back pain, neck pain, and a weakened immune system)
  • Heightened rates of stroke, heart attack, asthma, and arthritis
  • Premature mortality

Much of these differences were not known until recent years, which only serves as a reminder that there’s a need to develop prevention and intervention strategies so that lesbian, gay, bisexual, transgender, and queer-identified seniors and baby boomers can receive the healthcare and compassion they deserve.

In the coming years, you will find more and more LGBTQ+ elders in your care. Their differing needs, and also the need to be seen on a human level — with empathy, kindness, and an inclusion — means that we must build a foundation of understanding within the assisted living community. Across the country, facilities have begun to take note. Seminars are being held with residents and staff to reduce the rampant bullying taking place within their walls, and educational courses are available to teach nurse and caregivers how to interact with a community of seniors who have, for too long, remained invisible. At Assisted Living Education, we offer LGBT training and we are more than ready to shine a light on all the ways we can help make their lives better.  Please share with us your experience and feedback.

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Assisted Living Education is the leading provider of RCFE certification classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative.