There comes a time

Montrose Daily Press [October 21, 2018] *edited full-length version with resource links.] Kathryn R. Burke

As we age, it’s inevitable that we will face the mortality issue. No one lives forever. The end can be quick, but more often, it comes with excruciating slowness. Good health descends into poor health, then into a physical reality that says we can no longer live at home. There comes a time when patient, caregiver, and family must make some tough decisions.

Amy and George, both in their seventies, have reached this point. George has Parkinsons. Amy is his caregiver. George outweighs her by 50 pounds. Suffering from her own age-related ailments and caring for George, Amy is worn out.

Their oldest daughter, JoAnne, is a nurse and lives here in town. When George fell recently—not for the first time—Amy called JoAnne. They got him up off the floor and into his chair. Nothing appeared to be broken but his spirit.

“Mom, Pop, this can’t go on, JoAnne said. “Mom can’t keep taking care of you here, Pop, or we’re going to lose her.” Amy started to protest, tears in her eyes. “You can’t, and you both know it,” JoAnne said. “It’s time we started looking at nursing homes.” George, who is also beginning to show signs of dementia, started to cry too.

They bundled George into the car and took him to the doctor to check for damage. After looking him over, the doctor said, “Amy, George, you need to make a decision. George needs more help than you can give him at home, Amy. He needs to be someplace where they have nursing care.”

JoAnne, knowing the inevitable was coming, had already begun her research. When she Googled “skilled nursing facilities Montrose CO,” various sources listed three for Montrose: Brookdale Sunrise Creek; San Juan Living Center; Valley Manor Care Center. Three more are within 30 miles: Colorow Care Center, Olathe; Willowtree Care Center, Delta; Horizons Health Care, Eckert.

All of them have their own websites, which she reviewed, but facility websites are geared toward marketing, with a goal of attracting (and retaining) more residents. JoAnne and her mother needed to know the actual (and perceived) reports and details about how facilities managed care and treated those who were living there.

She checked their U.S. News Health reviews and Medicare ‘star’ ratings,’ which run from 5-star (highest) to 1-star, and are based on onsite state health inspections, staffing ratings, and quality of care. JoAnne and her mother carefully reviewed Colorado state inspections and resulting health, safety, and occurrences reports. JoAnne visited each facility. She talked with current and former employees, whom she knew through work. Finally, she interviewed people whose family members had been, or currently were, residents there.

What she determined was discouraging. None of the facilities in Montrose made her short list, and the others had some drawbacks. (The reviews listed below are comprised from several public resources; beds, occupancy, star ratings, or other details may have changed since these reports were accessed.)

San Juan Living Center: 104 beds, 50% occupancy, Medicare/Medicaid certified. 2-star. Long list of complaints and health department citations over several years. Former and current employees and state reports reveal abusive and inappropriate staff behavior with subsequent suspension or removal. Residents and family members, who had observed frequent, serious infractions, suggested facility is under-staffed and aides poorly trained. Food was bad. They had also lost their VA contract. Staff interviews with state inspectors contain outright fabrications. (JoAnne had personal knowledge of one of those incidents, regarding a VA patient who had since passed).

Valley Manor: 101 beds, 70% occupied, M/M certified. 3-star. Numerous Occurrences reports. Interviews with resident families somewhat positive, including staffing, food, and activities. Facility is OK, but property is not attractive and in a commercial area. VM had obtained the VA contract after SJL lost it. VM didn’t make her short list.

Brookdale: private-pay senior living facility with a small memory-care unit, but no actual skilled nursing care. 3-star. A few Occurrence Reports. Residents and families said food was good and activities OK, but many, and several of JoAnne’s colleagues, felt CNA staff was uncaring and inadequate. She found this the most attractive property of the three in town, but comments about staff and lack of skilled nursing care took them off her list.

Colorow: 82-beds, 87% capacity, M/M certified. 4-star. Nine health surveys and 18 Occurrence Reports, 8 of them this year, which was a concern. She liked the staff and facility, and although not impressed with the grounds, she liked the location, which would be an easy drive for Amy to make visits. Colorow made her short list.

WillowTree: 80 beds, 55% occupancy, M/M certified. 5-star. Very few Occurrence Reports. Joanne liked the staff, who were open to new ideas and suggestions for programs to help residents. She heard no negative comments from employees. The facility is pleasant. Resident family interviews were positive. It is an easy drive from Montrose. WillowTree went on her short list.

Horizons: 79-beds, 78% occupancy, M/M certified. 4-star. 18 Occurrence reports this year and 22 prior years. 7 Health Surveys. Pretty location, pleasant staff, but too long a drive for Amy, especially on icy winter roads. Not a good choice.

After visiting them all again, JoAnne and Amy  chose Willow Tree, mainly because of proximity and staff. When they told George, he didn’t want to go, but he also understood why it was necessary. George has been taking care of Amy through 50 years of marriage. This is just another way of caring for her, albeit a huge one.  So, although he was reluctant, George made the move and is adapting.

I went with Amy last week to visit and have lunch. It’s hard to see George there. The ride home with Amy was sad. But she can visit often, and as we all knew… the time had come.

*Note: This is the original article. The format for the newspaper was limited to 600 words. The full article appears here with some of the resource links I used. There are many more!

When the time comes to consider a nursing home, do your research, visit facilities, talk with people and their families who are or have been residents. Get to know the staff. Stay for a meal, Observe activities. If you can’t do this yourself, or live too far away, ask a person you trust to do it for you. Don’t leave it to chance or depend solely on what you find online.

When reviewing Medicare ‘star’ ratings – different websites will give varying listings. Be sure to check all 4 categories for each rating, not just the ‘overall’ rating.

Learn the differences between skilled nursing facility, assisted living, and retirement facility; they are not the same and may not provide the services you need. You may also have to select a place further away than you would like, in order to find one that provides the right level of care.

For those without Internet or anyone who would like to talk with an advocate, the local ombudsman is a good resource. In the Montrose/Delta area, make contact through Region 10, Area Agency on Aging.

When the time comes, be prepared and make the best choice you can based on study and first-hand observation.

Resources
•  Medicare Star Ratings. What they are and how they are determined.
•  Health Care for People. Area nursing homes, ratings and descriptions.
•  Senior Advice.  How to Find Medicare Ratings for Nursing Homes
•  Senior Advice. Nursing homes, Montrose, Colo.
• Directory. Skilled Nursing Facilities. Montrose, Colo.
•  Colorado, Dept. of Health and Public Environment. Nursing Home Consumer Resources. (Includes inspections, occurrence findings, health, and safety reports. With link to Medicare.gov.)
•  Medicare.gov. Nursing homes. Explanations and facility program descriptions. Tells you how to do  your research!
•  Health Care for People. Directory of nursing home providers in Colorado. 
(Note, check to make sure they DO provide skilled nursing care, if that’s what you need.)
•  US. News, Health. Nursing homes search. 
•  Hospital Data. By state.  Profiles of thousands of hospitals, medical clinics, nursing homes and home health centers.
•  Nursing Home Diaries. Helpful and provocative articles. Definitely worth reading!
•  ADRC Resources. In Montrose, Region 10, Area Agency on Aging.


Kathryn R. Burke is a former caregiver, publisher, freelance writer, and author of several books on caregiving. She is also a successful businesswoman. Learn more about her at her website KathrynRBurke, San Juan Publishing, and here on her author’s page.