Warning signs to look for when visiting senior homes

Washington State Long-Term Care Ombudsman Louise Ryan, an advocate for the elderly and others in long-term-care facilities, answered questions Wednesday online about caring for those in adult family homes and other settings. Her office: 800-562-6028

Q: What are warning signs family should be on the lookout for when visiting family/parents in these homes?

A: Listen to what your family member is telling you about the home. Even if they have dementia, they still might be able to report on certain circumstances accurately. Observe their behavior/body language around the staff. Are there smiles and respectful communication? Do staffers know your loved one's needs and preferences? I also think it's fair to ask your family member if you can observe their skin, depending of course on the relationship that you have with your family member. Also, know that not all bruises are a sign of abuse. If you see bruises, ask your family member what happened and ask the provider.

Warning signs of abuse/neglect/bad care can include such things as repeated falls, unexplained weight loss, sudden changes in behavior such as withdrawal or agitation, not toileting or grooming. Again those are indicators. As a family member, do not hesitate to ask questions. And if you are not satisfied with the answers, seek out help from an ombudsman, send a complaint to DSHS, and consult with your loved one's physician.

Q: The food at my mother's nursing home is awful. She doesn't eat most of it and is losing weight. How do I get them to serve more palatable meals?

A: This sounds like a project for a resident or family council. If your mother is able to attend a resident council meeting, have her put it on the agenda to discuss. Be specific about the food problems — too much starch, not enough fresh fruits, and so on. Make specific suggestions to the dietary staff and administrator. Ombudsmen are experts at resolving food complaints: Resident Councils of Washington: www.residentcouncil.org, and Family Councils: www.nccnhr.org

Q: Other than lower cost to the public, why would the state put people in family-like homes instead of institutions such as nursing homes?

A: Our state has a genuine interest in honoring consumer choice of where a person receives services — in his own home (and with a choice of home-care provider) or at a facility (and that includes what type of facility). The challenge our state faces and what was so well described in "Seniors for Sale" is that promoting choice can become paramount to other practical matters. We want choice and we also want quality care, services and support. Although our state faces a huge budget crisis, this is not the time to reduce community-based services.

Q: My mother passed away halfway through the month of December at an adult family home. Am I am entitled to get the latter half, about $3,000, refunded?

A: Yes. The law does have a provision that allows the facility to keep an amount not to exceed five days' per-diem charges for certain costs.

Q: Do you think that going to an adult day health program would provide some security to residents of adult family homes by having another set of trained eyes on the individual on a regular basis?

A: Absolutely! Adult day health not only provides another set of trained eyes, it provides necessary physical and occupational therapy, as well as nursing services. It is a cost-effective way to provide holistic care to people with physical and cognitive disabilities. Unfortunately, this program is on a slow route to elimination. The current budget proposal plans to reduce the number of people on Medicaid who can access adult day health. The series in The Times highlighted the need for this extra service as our state works to move people out of nursing homes. I wonder if Jeri Ringseth, who was featured in Tuesday's story, would have had a different outcome if she had access to adult day health while living in the adult family homes.

Q: Is there a way to get the state to require a nationwide background check for caregivers who work with vulnerable clients?

A: Actually, voters passed Initiative 1029, which now requires that all long-term care workers have background checks at both the state and federal level. This does not include people currently working in the system. Also, the law requires a federal background check if the caregiver has lived in the state fewer than three years.