The Caring Generation® Advocating for Elderly in Nursing Homes

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The Caring Generation® – Episode 25 February 5, 2020 On this caregiver radio program Pamela D. Wilson, caregiving expert talks about Advocating for Elderly in Nursing Homes to avoid elder abuse and neglect. Guest Jim Berklan of McKnight’s Long-Term Care News shares Medicare’s New Program to Pay Nursing Homes for Patient Care (PDPM).

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Advocating for Elderly in Nursing Homes – Avoiding Elder Abuse and Neglect Radio Show Transcript

00:49 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host. You’re listening to The Caring Generation radio program coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. The Caring Generation focuses on conversations about health, well-being, caring for ourselves and loved ones, all tied together with a little bit of humor and laughter that are essential to being a caregiver. Our topic for this evening is Advocating for Elderly in Nursing Homes: Tips for Avoiding Elder Abuse and Neglect.

This week, in talking about advocating for elderly parents in nursing homes and tips for avoiding elder abuse and neglect, we’ll look at nursing homes from the perspective of common fears. Why elderly parents fear going to nursing homes. I’ll share the most common types of elder abuse and neglect that happen, and the importance of advocating for the elderly in nursing homes. I’ll also share information about nursing home regulations and how these rules complicate getting the care you want for elderly parents.

Why Hospitals and Nursing Homes Dump Elderly Patients

My guest is Jim Berklan. He is the Executive Editor of McKnight’s Long-Term Care, McKnight’s Assisted Living Magazine, and These are healthcare industry publications. Under his direction, McKnight’s has been honored with more than 100 national journalism awards. He is a specialist in the field of senior housing and care, and he works with many professional companies in the care industry. Jim will share information about Medicare’s new program to pay nursing homes for patient care called PDPM.

03:02 Pamela D. Wilson: If you work in a nursing home or know someone who does, PDPM was implemented on October 1st, 2019, and it’s caused quite a stir. Separately, I want to send out condolences and a celebration of an amazing life to the family of Kirk Douglas, the actor. He passed away today at the age of 103. What an amazing life. Let’s start by talking about fears that elders may have about nursing homes. One of the things that my mother said to us repeatedly was, “Never ever put me in a nursing home.” The physical appearance of nursing homes has changed a lot in the past 100 years. If any of you remember the movie “One Flew Over the Cuckoo’s Nest” with Jack Nicholson, that movie showed the idea of a mental institution, which is more of what elders think of when they think of a nursing home.

03:54 Pamela D. Wilson: Our parents may have had a bad experience with their parents or another family member who suffered from elder abuse and neglect. There are so many concerns about mistreatment and having to live in an environment that feels more like an institution than a home. The range of people in nursing homes varies from persons who are there for short-term physical rehabilitation as a result of an injury like a hip fracture to others who live in a nursing home permanently. Seeing others in poor physical or mental condition does result in worries and more health concerns about needing care. Parents worry about being more dependent and a greater likelihood of experiencing elder abuse and neglect.

04:39 Pamela D. Wilson: How many of you have visited a nursing home? The newer homes are less institutional-looking, but based on my personal experience, it’s not the way a nursing home looks, but the care that is provided that’s important. This is one of the areas where I’ve seen adult children make so many mistakes. Be careful about choosing a nursing home that looks beautiful, but that may provide the worst care that does result in elder abuse and neglect. Advocating for the elderly in nursing homes means that you are proactive. You want to learn how to get better care for elderly parents and learn how nursing homes work.

05:16 Pamela D. Wilson: Let’s talk about the definition of elder abuse and neglect, and I’ll give credit to the Toronto Declaration on Global Prevention of Elder Abuse. Elder abuse and neglect is a lack of appropriate action in a relationship where there is an expectation of trust that causes harm that is physical, psychological, emotional, financially or materially motivated, sexual in nature or neglectful. The definition focuses on the relationship with the person who is more likely a family member than anyone else who commits elder abuse and neglect. Elder abuse and neglect can also be self-imposed by an older adult who doesn’t take care of him or herself. In other cases, elder abuse and neglect happen outside of a family relationship and outside of the home.

06:03 Pamela D. Wilson: For example, in nursing homes. In a couple of weeks, we have a show coming up where we’ll talk about elder abuse and neglect, which is self-abuse mostly happening in the home by elderly parents, and what family members can do about it. Let’s talk about nursing homes the types of issues that result in elder abuse and neglect, and the need for advocating for the elderly in nursing homes. There are three areas where issues happen.

06:29 Pamela D. Wilson: Community issues. I don’t like using the word facility, so I say community. Resident issues, meaning issues caused by elderly parents or other residents in the nursing homes and staff issues. Let’s talk first about staff issues. In my opinion, and this is based on 20 years of experience, most of the staff issues are a result of a lack of training and support by supervisors. The care staff want to do a good job. Many of the staff who work in nursing homes and other care communities, they’re not highly educated. They may have a CNA, which is a Certified Nursing Assistant license, but no other advanced education. The nurses and doctors are more highly educated. However, the staff taking care of your elders are CNAs and the other staff. This is where advocating for the elderly in nursing homes becomes your responsibility. You must become more aware of the issues that can happen so that you can avoid them.

07:31 Pamela D. Wilson: Types of nursing home neglect that create the need for advocating for elderly in nursing homes are medical, basic needs, personal hygiene, and social or emotional neglect. We will continue the conversation about types of nursing home neglect in the second half of the program. Up next, we are going to be talking to Jim Berklan. He is the Executive Director of McKnight’s Long-Term Care. He joins us to talk about Medicare’s new program, which pays nursing homes for patient care. It’s called PDPM. You can learn more about McKnight’s at

08:11 Pamela D. Wilson: Jim is going to share important information for elders, for caregivers, and for the staff who work in nursing homes about this Medicare program that really has changed the way that care is delivered to our elderly parents. It’s kind of gone away from the old, what I call the physical therapy model, where you had to be in a nursing home for a physical need. You would receive care and treatment, and you had to make continual progress. The new program is focusing on a lot of different things that are very important for caregivers. Share The Caring Generation with friends and family members. You can follow this and all of our past programs on my website and read the transcripts at Go to the Media tab and scroll down to The Caring Generation radio show. This is Pamela D. Wilson on The Caring Generation, live on the BBM Global Network Channel 100 and TuneIn Radio. Stay with me. We’ll be right back after this break.


11:35 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host. You’re listening to The Caring Generation coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. We’re back with Jim Berklan, Executive Editor of McKnight’s Long-Term Care, McKnight’s Senior Living, and Jim is a specialist in the field of senior housing and care. Jim, thanks for joining us.

12:00 Jim Berklan: Thank you very much, Pamela. Glad to be here.

12:01 Pamela D. Wilson: Medicare’s new patient-driven payment model, called PDPM, appears to be decreasing the time for physical and occupational therapy services in skilled nursing communities. Is my understanding accurate of that?

12:16 Jim Berklan: Well, technically, not yet, you can say that. Because certainly, the Centers for Medicare and Medicaid Services, regulators, everybody’s keeping an eye on this. What’s important to know about this is, as you indicated a little bit earlier in the segment, that the emphasis has gone away from, “What do you need for therapy? This is how much you’re going to get paid for an entire stay,” to a broader nursing component. So, what it’s done is it’s really taken the spotlight off of therapists and therapy and taking them a little bit off the pedestal. And so, what we’re seeing in conjunction with that is a little bit more group and concurrent therapy. So, what you may have seen in the news, some of the listeners as well, is that some therapists have been peeled off. There’s less work out there for them. So, the provider groups are combining those efforts. But it’s too early to say that, hey, people aren’t getting the therapy they need because, of course, CMS is going to be monitoring that very closely.

12:28 Pamela D. Wilson: And there was an old system, and I laugh at these acronyms. But the [chuckle] old system was called RUGs, and now it’s PDPM. Is PDPM better for patient care?

13:30 Jim Berklan: Well, that can be a little bit of a loaded question because, again, there are so many things regulated that nobody’s going to say, “Well, you didn’t fit in the slot, you don’t get taken care of.” But by and large, yes. The people that I write for, the professionals out there, as I said, it serves a broader spectrum. What it does is it puts the nursing, they say, back in nursing homes. Meaning that the nurses feel more involved. There’s an integration of everything, whereas it focuses more on clinical areas for reimbursement. It’s a more holistic look, if you will, and that way, the provider companies are able to allocate their resources so that, as we’ll talk a little bit up coming up, is that you’re going to serve and you’re going to get paid directly for, “Are you doing more swallowing studies? Are you doing more mood disorders, that type of thing?” Whereas before, believe it or not, a lot of this was triggered by how much physical OT therapy you needed.

14:28 Pamela D. Wilson: And so, it sounds like, I call it, this clinical care for non-professionals, it would be like managing a disease, correct?

14:37 Jim Berklan: Yes, it’s a lot…

14:37 Pamela D. Wilson: Or managing a diagnosis.

14:40 Jim Berklan: Yes, it’s a little bit akin to the DRGs in hospitals, diagnostic resource groups, or whatever. But this is, again, taking it a little bit broader. And I mean, remember, this has been scored by the industry panels and experts to say, “This is where some of the care should go.” So sometimes I think there’s a little suspicion, “Where are we going to get away with cheaper care?” and this or that, and we’ll talk about that maybe a little bit later. But there are some things still mandated. And where the enthusiasm comes from is, that they say they’re getting “paid for work” that was “free” before. Because it had to be included, but it was just like, “take care of it,” but it comes under this umbrella for this therapy segment that you’re being paid for.

15:28 Pamela D. Wilson: What are the main challenges that nursing homes are seeing in changing to this new system?

15:34 Jim Berklan: Well, a big one is that all of a sudden, they’re–well, all of a sudden that they were advertised as they have to take account ICD-10 coding, and there are thousands of more options now to do this. And so, they had their own coding systems, if you will. So, this is coming more in line with hospitals. Now, that opens up a lot of great opportunities because you can slice your diagnosis in so many different ways. The other challenge is they really need to get these assessments right when a patient comes into a nursing home for the first time. There used to be a handful of different markers, five-day, seven-day, different.  Where you’d reassess. But now the real hullabaloo is, “Hey, we’ve got to get our MDS coordinators,” the minimum data set. This is what assesses the patient when they come in, of course, and that sets the payment rate. Now, there’s only one intermediate range in there now, so if you don’t get it right at first, you could be leaving dollars per day on the table from the provider’s point of view and really goofing yourself up. So, what that needs, then, is more interdisciplinary help. You’re really talking to your nursing staff. You’re really talking to others to come in with their assessments, and put this matrix, this jigsaw puzzle all together so that you start at an appropriate reimbursement rate and, like I say, not leaving your own payment on the table.

17:00 Pamela D. Wilson: And is that, so I saw an opinion in the McKnight’s in November. There was a quote from John O’Connor saying, “Long-term care has a proven history of following the money.” Is that kind of what you’re talking about?

17:11 Jim Berklan: It really is. Because, after all, these are businesses just like any healthcare provider. But the key with nursing homes, we have to remember, is Uncle Sam is the predominant payer. I mean, I was surprised when I came into this 19 years ago in this business that private insurance does not pay, or even private funding very much. So, Uncle Sam is calling the tune, and as you may know, it is very limiting, and the margins are very low. Medicaid, after all, pays for three out of every $5, or a little bit more of that of everything. So what John was talking about, he can be as right as anybody is — is that where Uncle Sam will pay. That’s where somebody who’s working within this industry is going to migrate a little bit. Now, we’ll talk about maybe a little bit more later, but PDPM doesn’t look like it’s going to be overdrawing its own bank account as it happened in 2011-2012, when this resource utilization group was introduced.

18:09 Pamela D. Wilson: And we’ve got about a minute left. You mentioned that the assessment has to be done right away, and there were evaluations. Are the evaluations every week now? ‘Because it used to be my clients would get evaluated every week to see if they would stay another week.

18:26 Jim Berklan: Well, under certain diagnoses and certain conditions, yes. However, if we’re talking toward more of a long-term stay and nursing home, you’re getting that initial assessment, and that’s what you’re in for. Of course, that will be modified, but then, under this new system, the payments dwindle very quickly under many diagnoses. So, it behooves the provider to get it right, and then you’ll be dribbling off really quickly. Now, speech-language pathology is an exception to that. So, it’s something people are really keeping an eye on. Where the utilization patterns are with that. And I’m sure we’ll want to talk about that a little bit more later.

19:05 Pamela D. Wilson: We will. We are going to continue our conversation with Jim Berklan of McKnight’s about Medicare, nursing homes, and PDPM after this break. I’m Pamela D Wilson, your host. You’re listening live on the BBM Global Network channel 100 and TuneIn radio. Stay with me. We’ll be right back after this break.


21:39 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host. You’re listening to the Caring Generation Radio program for caregivers and aging adults, coming to you live from the BBM Global Network Channel 100 and TuneIn radio. Let’s continue our conversation with Jim Berklan of McKnight’s. Jim, during the break, we were kind of talking about how skilled nursing facilities get paid, for therapy versus other services. Can you talk about that and just the guidelines of CMS, making sure that people get good care?

22:10 Jim Berklan: Sure. Under this new PDPM system, it spreads it out a little bit more. We go into more interdisciplinary care, as I mentioned earlier. Taking in more segments and more sections of the caregiving staff. One of the things it talks about is that the providers like it. That they’re getting paid for non-therapy services that they’ve always delivered, so to speak. And they’ve always provided these services. But some examples of the services that they’re receiving increased payment under PDPM include things like wound care, and management of diabetes, and IV feeding, medications, use of ventilators, respiratory. All of these things need more resources. So, from the provider angle, they’re glad, because they’ll be paid. They’ll be compensated for this. So then they can do that. So, what we’re going to see, and it’s happened for quite a while, is higher acuity being taken care of, and this is what the government wants as well. That whole acuity slide, what was in a hospital 20 years ago, is now in a nursing room. What was in a nursing home goes to assisted living. That’s going to continue. But this really is a positive, because now the providers will be more open to taking more complex patients.

23:20 Jim Berklan: And this gets in other things, too. Like depression and therapeutic diets, and respiratory therapy, as I mentioned. So, there are really five different reimbursement case mixed groups that build into the code for the overall pay. So, you have physical therapy, and occupational therapy is one. Speech-language pathology is another one. Nursing, if you can believe it, now has its own, and non-therapy ancillary, a lot of medication and whatnot, and then the room and board. Whereas before, therapy used to be the King Kong in there. So, this is why they’re interested in the complexities that are involved there. And there are CMS statisticians keeping an eye on us, as we said. And with these non-therapy ancillary areas, you get points for what you take. Now, just for example, here, there are big charts and everything, but if you have an HIV AIDS patient, for example. You get eight points, and more is better. Whereas if you have a wound infection code, it’s perhaps two. There are a whole bunch of things with “ones.” But for a lung transplant status, you’re getting three. If you have somebody end-stage liver disease, that’s only one. Cystic fibrosis is one. So, this is where this has all been scored out.

24:28 Jim Berklan: What takes more resources? That will reward. But this, I think, brings the provider then more willing and able, frankly, to serve these people, and that’s what’s really needed out there. So, I really can emphasize that things are being watched, as far as everybody knows, very closely. And we’ll talk about that later.

24:49 Pamela D. Wilson: And I think, so consumers hearing this are hearing like ICD-10 codes and MDS, and they don’t understand all this language. I think they don’t realize that when a parent goes into a nursing home, all of these things that you’re talking about are done by the nursing homes, and they’re getting points for things. How can family members become more aware of how all of this works?

25:11 Jim Berklan: Well, as always, and as I mentioned a little bit in one of our breaks, I’m a consumer now, too. My mother’s in the system, as we might say. With some assisted living help and independent living help. As always, you need to be present. You need to ask things about where you’re getting services. You need to be discussing with the directors and the managers there, “What can I be doing? What should I do?” Because keep in mind, this is so heavily regulated. I come from a full news reporting background. That it’s so heavily regulated that providers are bound to do certain things each step of the way. And so, it never hurts to be present. But they still have this code, no pun intended, following them. Okay. PDPM doesn’t change the improvement standard. I’ve seen that mentioned. That there has to be improvement. There was a case called the Jameel Case, which you may very well have reported on previously, that no longer says that improvement has to be shown to be getting services. So that’s a little bit different.

26:19 Jim Berklan: The key is CMS expects beneficiaries to know their policies when they go in. There are many resources CMS has on its Medicare website. So, ask in each location and understand any special requirements or limitations of the coverage you have. Being present is really one of the things I can say. And also, as I may have mentioned, they’re not out to necessarily take one over on anybody because they have obligations, rest assured on that.

26:51 Pamela D. Wilson: I think consumers could benefit a lot from learning more about McKnight’s. You’re a business magazine. You’re long-term care. You’re assisted living. Tell the listeners about the goal of the magazine and share your website, talk about how consumers can become more educated about this by checking you out.

27:09 Jim Berklan: Sure, sure. The B to B, a professional magazine, we are for, to help those who run, own, operate nursing homes, and then we have a fully second division, as you mentioned. We have McKnight’s Long-Term Care News, which is skilled nursing, nursing homes, some of the retirement communities. But then our other one is McKnight’s Senior Living, which covers assisted living. Which as you know, is much less regulated or regulated at the state level, should I say, and much more with private pay and other things like that. So, we have for the skilled side and Each of those has a magazine. Each of those has daily newsletters.  We just have three/four news items, and then other high items of the day. Very highly educational. If you go to either of those websites and look on the right, you can elect to receive those as a daily newsletter. They come in the morning like your morning newspaper. My staff, everything is staff-written. It’s not from wires or anything like that. And we bring it into the perspective of, “Hey, is there going to be a Medicare payment change?” Well, that means something different for the people providing the services than, perhaps, for grandma. It doesn’t mean they’re the opposite or anything like that, okay?

28:26 Jim Berklan: So, it’s a great way to educate, and we welcome anybody who would like to learn more about the industry. Otherwise, of course, I’m sure you’ve spoken about the ombudsman to get the consumer education on different things like that. But and are the two places to look.

28:42 Pamela D. Wilson: Great. Jim, thank you so much for joining us. We are going to continue with more examples of nursing home neglect after this break so that you can become a proactive advocate for your older adults in nursing homes. I’m Pamela D. Wilson, your host. You’re listening to the Caring Generation live on the BBM Global Network Channel 100 and TuneIn radio. Stay with me. We’ll be right back.


31:20 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host. You’re listening to the Caring Generation radio program for caregivers and aging adults, coming to you live from the BBM Global Network Channel 100 and TuneIn radio. We’re back to talking about the four types of nursing home neglect and the importance of advocating for elders in nursing homes. The first type of neglect is neglect. Neglect in nursing home happens in a couple of areas. Medical neglect, which means poor or inadequate care that results in health conditions getting worse. A worsening condition might mean an infection, like a urinary tract infection, or the health of your elderly parent getting worse instead of better. A skin wound or a bedsore might also be identified.

Part of advocating for elders in nursing homes is learning to identify and report these concerns. My personal experience advocating for my clients in nursing homes is that the staff is too busy to notice small changes. You know your family member better than the staff in the nursing home. When you notice unusual behaviors or changes, you have to report them to management in order to advocate for your elder in that nursing home.

32:32 Pamela D. Wilson: The second type of nursing home neglect is a neglect of basic needs. Examples are food and water, a clean room, a clean bathroom, and things like clean sheets on the bed. It also includes helping to feed an elderly parent who can’t feed him or herself. I have arrived many times to see my clients and find them sitting with a full plate of cold food in front of them. Not touched, because they couldn’t feed themselves. This happens more when elderly parents don’t feel well, or they have cognitive issues, like dementia or Alzheimer’s disease. I’ve also arrived and found my clients dehydrated. If you’re a caregiver for an elderly parent, you know this: parents don’t always eat or drink like they should. Especially if they’re not encouraged. Other basic needs include general cleanliness. When you walk in the door or down the hall of a nursing home, are there odors? Does it smell like urine? Report this to the staff. Don’t ignore these concerns, because if neglect or abuse happens to your elderly parent, it’s probably happening to others who may not have family members to visit. Noticing gaps in these basic needs is part of advocating for the elderly in nursing homes.

33:45 Pamela D. Wilson: The third type of nursing home neglect is the neglect of personal hygiene. Good hygiene is a major, major issue in advocating for the elderly in nursing homes. Be attentive to your elder’s teeth. Are they brushed? Is their hair brushed? Are they sitting in soiled clothing if they are incontinent? Many elders need help with personal care. Nursing homes without enough staff will rush through hygiene tasks or skip the assistance if, when they ask your elderly parent if they want care, your parent says no or they say, “Oh, come back later.” Which we know always doesn’t happen. What about clean clothing and laundry being done, and clothes not being lost?

34:28 Pamela D. Wilson: If you haven’t learned this yet, things you take to a nursing home get lost. Make sure that you mark everything. Including labeling clothing, shoes, socks, and personal items. If your elderly parent wears dentures, have the dentist mark them. The same for eyeglasses and hearing aids. Dentures, eyeglasses, and hearing aids are lost all the time in nursing homes. And the nursing home will take zero responsibility for the loss. Half the time, they’re accidentally thrown into the trash with a Kleenex. When your elderly parent arrives, there is usually an inventory form in the admission packet. My suggestion is to write everything down. Even go to the extent of creating a typed spreadsheet. Make the list as detailed as possible. For example, A green, short-sleeved shirt with polka dots. [chuckle] Watch the staff member check the items in, or you’ll honestly leave with half of the things that you brought. And never bring anything you don’t care to lose. This includes jewelry, earrings, and things like that. The likelihood of lost items in nursing homes is so high. A very detailed list is part of advocating for the elderly in nursing homes.

35:43 Pamela D. Wilson: More on the subject of advocating for the elderly at nursing homes. Let’s take a moment to talk about the nursing home agreement. Some of these are 40 pages or more if you’ve ever looked at them. Don’t sign it without reading it, and if you are not the power of attorney or the conservator, make sure your elderly parent signs that document. Otherwise, you can become the financially responsible party. The nursing home will go after you for payment. If you are the power of attorney or a conservator, sign this way: You sign your name, and then after your name, you write these words: “Without any financial or personal responsibility.” This helps avoid the nursing home coming after you for payment. Also, every agreement has an arbitration agreement. Do not sign it. You don’t have to sign it by law. Cross out the pages with a big X, and on the signature line, write the word “declined.” By law, a nursing home can’t require you to sign that agreement as a requirement of admission. Arbitration can happen later if your elderly parent is injured. Read the entire agreement, so that you understand all of the rules and the regulations, there are so many. The goal is to avoid surprises and you saying, “Oh my gosh, no one told me that.” All of those little details are usually in the paperwork.

37:08 Pamela D. Wilson: Ask questions about anything that you don’t understand. Express to the staff immediately about concerns about lost items. Document everything. Document who you talked to.  When you reported the concern, they couldn’t say, “You never told us about that.” The nursing home staff will also cite patients’ rights because they leave their parents in bed all day in soiled clothing. Social or emotional neglect and abuse are linked to the interactions with nursing home staff. So, research confirms that CNAs will actually report on each other. Which is a good thing. But sometimes, these issues happen when residents are difficult. Elderly parents can have a bad day. Staff isn’t always well-trained to react to these situations. It’s important to show up, to have conversations, to be aware of everything that’s happening so that you can avoid elder abuse for your parents.

38:04 Pamela D. Wilson: After this break, we will continue our conversation about advocating for elderly parents in nursing homes and how to avoid abuse and neglect. You can take The Caring Generation with you wherever you go: Apple Podcasts, Google Podcasts, Pandora, iHeart Radio, Spotify, Spreaker, Stitcher, SoundCloud, and Castbox. [chuckle] This is Pamela D. Wilson, caregiving expert. I am your host. You’re listening to The Caring Generation live on the BBM Global Network Channel 100 and TuneIn Radio. Check out my website. It is There is helpful information there for caregivers and aging adults. Stay with me. We’ll be right back.


41:04 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. This is The Caring Generation, coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. Let’s continue with advocating for elders in nursing homes. What can you, as a family member, do to make sure your elderly parent avoids nursing home abuse and neglect? Other actions for advocating for elders in nursing homes include believing your elderly parent and being observant of what goes on in the nursing home. Regularly calling and visiting, initiating contact and meetings with nursing home staff, and being attentive to signs of neglect or abuse.

41:47 Pamela D. Wilson: Let’s talk about believing your elderly parent. This is important because you may hear something that sounds absolutely positively crazy that turns out to be true. Maybe your mom reported that the staff was yelling at her or her roommate. Mom may report that her medications weren’t given on time. That no one took her to breakfast. They left her in the bathroom. Listen and investigate these concerns as they may relate to elder abuse and neglect. Get to know all of the staff by name on the wing where your elderly parent resides. Most of the staff will wear name tags. You would be surprised at the things that the staff will tell you that they probably should not when you take a personal interest in them and talk about the care of your mom or dad.

42:38 Pamela D. Wilson: Let’s talk for a moment about care conferences, which nursing homes sometimes forget to tell families about, that is, until about one hour before the care conference when it’s impossible for you to show up. Rather than waiting for them to tell you about a care conference, it’s important that you ask. What is a care conference? It’s a meeting with all of the staff involved in the care of your parent. Attending a care conference by telephone or in-person is part of advocating for elders in nursing homes. Staff will review your mom’s or dad’s chart. They’ll talk about all aspects of care. It’s essential to request a care conference right after an elder is admitted so that there is a plan for discharge.

43:22 Pamela D. Wilson: Jim Berklan talked about this earlier, saying that it’s important for nursing homes to get these plans done so that they know what the care of your parent will be. Discharge is another one of those subjects that is rarely mentioned to you as a family member until the last minute, and then you’re scrambling trying to figure out what to do about mom or dad’s care when they leave the nursing home. So, back to the care conference subject, questions that you want to ask: how long will insurance pay? Meaning, how long might mom or dad be here in the nursing home? What are the health concerns identified, and how will these be resolved? What about physical and occupational therapy? It’s a really important one. How much notice will I receive before mom or dad has to leave? Leaving means being discharged.

44:09 Pamela D. Wilson: By law, the nursing home has to give you three days’ notice. But you know what? They may tell your elderly parent who forgets to tell you. Then you’re scrambling at the last minute. Even more important, ask what if mom or dad can’t care for her or himself upon discharge and returning home? What then? Your goal with this whole nursing home issue is to be able to avoid surprises and stay in control of the process rather than have it control you. Advocating for elders in nursing homes means being proactive. In addition to getting to know the staff, ask to talk to the doctor who sees your elderly parent. Ask about medications being given. Nursing homes are great about changing medications without telling you. You might notice a significant change in the health of your parent, and you don’t know what happened. It could be a change in medication. Also, know that the nursing homes are very hesitant to send your elderly parent back to the hospital if this is how the nursing home stay started. Meaning your parent was in the hospital and then went to the nursing home. Hospitals are financially penalized for patients who come back, so the nursing homes don’t want to do that because then they have a bad relationship with the hospital.

45:21 Pamela D. Wilson: You can find more about this in an article on my website. Search for the words Rehospitalization Act. If your elderly parent is the subject of elder abuse or neglect, you want to contact the administrator or the executive director of the nursing home to make a complaint, a written complaint. Second, contact the County Department of Health. How do you find them? It’s easy. You Google County Department of Health Complaints, and a website should come up with a process for issuing a formal complaint that you can enter online. You can also call a phone number also contact the Long-Term Care Ombudsman or Adult Protective Services. I know you’re hearing this, and the first thing you’re thinking of is, “Oh my gosh, if we complain, will the nursing home treat my elderly parent worse?

46:09 Pamela D. Wilson: No, not if you complain in the right manner. You go to the executive director. You explain your concern. Let them know that you’re making a report to the county so that it can be investigated. Being upfront and honest is more likely that your concerns will receive attention. Your parent will get better care. When I was a nursing home advocate for my clients, I did this as a regular part of my routine. The reality is that, unfortunately, nursing homes are understaffed. This is the main cause of nursing home neglect and abuse, and it’s the reason that advocating can be so difficult for elderly parents. But you want to be upfront, be honest. Just work with the nursing homes. They have staffing problems we know about it. They have difficulty finding qualified staff. The work is difficult. Can you imagine working in a nursing home? The staff is not trained, and when caregivers don’t receive that type of training, that’s when all of these abuse and neglect issues occur. Ask, when you go, how long have the managers worked in that community? Staff retention is one sign of a really good nursing home. Nursing homes that have higher turnover really aren’t taking care of or training their staff. It’s a sign of poor management. And call the ombudsman. They should be able to tell you whether they recommend that nursing home or not.

47:34 Pamela D. Wilson: Next week, our subject is How to Talk to Loved Ones With Memory Loss, a very difficult subject for some family members. Helpful information for caregivers and aging adults is on my website at There, you will find my caregiving library of articles, videos, my blog, online courses, and podcasts from The Caring Generation radio show, going all the way back. I’m Pamela D. Wilson, your host. You are listening to The Caring Generation live from the BBM Global Network Channel 100 and TuneIn Radio. Check out my website,

Also, if you are a working caregiver, make sure to talk to your company about caregiving programs in the workplace. I offer a variety of programs for corporations to help working caregivers manage through all of the caregiving issues that we talk about on these radio shows, and the radio shows do address all of the emails that I receive. So, you can always contact me through my website or through my Facebook page. My website, again, is Hit the contact button and send me an email. Stay with me. We’ll be right back after this break.


51:57 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host. This is The Caring Generation radio program for caregivers and aging adults, live on the BBM Global Network Channel 100 and TuneIn Radio. I want to talk about the other side of nursing homes, elder abuse, and neglect, with respect to the hard-working staff and the CNAs. The other side is resident concerns. Resident concerns include physical or verbal aggression by residents who are your parents. Inappropriate sexual behavior in residents who have mental illness and other disorders. What you may not realize is that the activities, behaviors, and participation of elderly parents in hospitals and nursing homes is all documented.

52:43 Pamela D. Wilson: For example, let’s say that your father was at a nursing home. He refused to participate in care, or there was an issue where he might have harmed a staff member. After this nursing home stay, he goes home. Then he has another accident. He’s in the hospital, and you want him to go back to the same nursing home, but they refuse him. Do you wonder why? It’s because of concerns that were documented about your father’s behavior. Maybe you were involved in your father’s care, and you were documented as being unhelpful. This stays with you for a long time, this documentation. There’s also a pre-admission and a screening tool called a PASSR. It’s spelled P-A-S-S-R. It’s a federal requirement that nursing homes have to evaluate people who have a mental illness, and intellectual or developmental disabilities to make sure that they’re not taking too many people that they can’t care for. So, like Jim talked about earlier, nursing homes want to make sure that they can provide care for people coming in. This pre-admission and screening tool helps with that.

53:45 Pamela D. Wilson: As you can hear from all of this, advocating for elders in nursing homes it’s very complex because of everything that’s involved. Nursing homes have very strict regulations for residents’ rights, physician and nursing services, behavioral health, their pharmacy, food and nutrition, and so many other areas. If you’re curious, you can Google CMS Medicare and Medicaid programs and requirements for long-term care facilities. There is a document that is about 100 pages long that you can read if you like. The challenge in advocating for elderly and nursing homes is that consumers, you’re unaware of all these rules and regulations because they’re not really explained. Simple language is in those nursing home admission packets. But other information usually doesn’t come up until there are problems. So, the more educated you are, the fewer problems that will show up. As Jim and I talked, the best that you can do as a family member is to continually ask questions and be educated. Find out about making appointments with nursing home staff to talk to them. Communicate with the doctor on staff, Be friendly. Know everybody who is helping your parent.

54:56 Pamela D. Wilson: Know that you can also hire companions to sit with your elderly parent if you can’t be there. You can hire a care manager. Sometimes, this does require telling the nursing home that you are doing this, so if you want to hire extra help, just talk to the nursing home management. It’s so important. The care that you provide to your elderly parents and spouses it is so important, it is so needed. Without you, things would happen in nursing homes that would be unfortunate and could cause harm to your elderly parents.

I thank you all, listeners for being so proactive and interested in caregiving, health, and well-being. Please do share The Caring Generation with your family members and your workplace so that we can make caregiving something we talk about. Podcasts of all the shows are on my website, at Thank you for joining me on The Caring Generation radio program for caregivers. I’m Pamela D. Wilson, caregiving expert, advocate, and speaker. I look forward to being with you again next Wednesday evening. God bless you all, sleep well tonight, and have a fabulous day tomorrow, and a great week until we are together again.


56:02 Announcer: Tune in each week for The Caring Generation with host, Pamela D. Wilson. Come join the conversation and see how Pamela can provide solutions and peace of mind for everyone, here on Pamela D. Wilson’s The Caring Generation.

Looking for More Help Advocating for Elderly in Nursing Homes to Avoid Elder Abuse and Neglect?

You’ll Find What You Are Looking for in The Caring Generation® Library in the Section Called Care Communities and Housing.

About Pamela Wilson

PAMELA D. WILSON, MS, BS/BA, NCG, CSA helps caregivers and aging adults solve caregiving problems and manage caregiving needs through online programs, live support groups, and an extensive caregiving library that includes articles, podcasts, videos, and webinars.

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