Tuesdays with Tom

CCLD Adult & Senior Care Reorganizatiion

2012-01-24T13:59:00.000-08:00

Community Care Licensing Division just posted an announcement on their website about their plans to reorganization the ASCP assignments to CCL staff. Click here to view the map. Here is a copy of the statement:

"The Adult and Senior Care Program (ASCP) is reorganizing to maximize its ability to meet its mandates and protect health and safety. The reorganization will generalize facility category assignments so that all ASCP employees will work with both the adult and senior care facility categories. The reorganization will also realign the current Adult and Senior care regional lines to combine them and more equitably distribute workload. These changes will improve efficiency, reduce costs, and increase flexibility.

These improvements will provide greater assurance of health and safety to vulnerable persons residing in or receiving services at adult and senior community care facilities. Implementation is planned for early 2012. Please check back periodically for updates."

New SSI/SSP Rates

2012-01-06T09:17:00.000-08:00

Many of you have asked us about the new SSI rates. Since there seems to be such a big interest we've posted this information on our website so you can refer to it as often as you need it. Take note of the paragraph at the bottom of the webpage that details when you can charge an additional $20 to recipients who have additional income.

Also, be sure your admission agreement reflects the regulations in Title 22, 87507(c)(4)(A).

The link is here.

http://www.communitycareoptions.com/ssi_ssp_rates.html

Happy New Year!

2011-12-27T11:45:00.001-08:00

Another year is ending and we would like to share our gratitude to all of you for using Community Care Options as your continuing education provider.

Thank you to all of our loyal members and new members alike.

Thank you to vendors who have sponsored and professionals who have spoken at our conferences.

Please have a Happy and Safe New Year. We look forward to more in 2012!

Fingerprints

2011-12-27T10:50:00.001-08:00

I've been getting this same question about the Background Clearance Listing page on CCLDs website lately.

The question is "I'm used to seeing two clearances for people, what if I only see one?"

The answer is that only one is required because those clearances posted have been reviewed by CCLD and are therefore cleared to work. Please review the Background Clearance Listing page for a complete explanation.

Merry Christmas and Happy Holidays to all!

Depression and the Holidays

2011-12-14T11:46:00.000-08:00

We're all aware of it. We hear about it, we take classes about it, but we forget to do anything about it. Depression. The Centers for Disease Control and Prevention report that nearly 13.5% of older adults receiving some kind of residential or home health care are depressed. In contrast, only 1% of older adults in society are depressed. What does this mean? People who live in our facilities are at a higher risk of becoming depressed. It means that we have our work cut out for us. What do we do?

Clinical depression can set in over time do to biological changes in the brain. Look for weight loss, talk of being worthless, extreme changes in appetite, or talk of dying for starters. When it does seem like depression then the best advice is to seek medical attention.

Before depression sets in we can help prevent "the blues" by considering these ideas:

Help residents feel needed or that they have a purpose.
Look them in the eye and tell them why they are important to you.
Share a special memory with them.
Seek their advice or opinion on holiday plans
Smile

Maybe you and your staff have some additional good ideas to share. Join us on Facebook and leave your comments or ideas.

Good information on Depression HERE.

More Holiday Tips! Something to Share with the Families of Your Dementia Residents

2011-12-06T13:14:00.000-08:00

We're going to stay on theme with the Holiday Season. I just wanted to share another resource that could help your families adjust to their loved ones and make the season more enjoyable.

According to ALZ.ORG there are two main considerations:

Adjust your expectations.
Include the person in the festivities.

This is a great page from the Alzheimer's Association. Please share it with you staff as well.

Alzheimer Families and the Holidays: Tips to Enjoy the Season

5 Tips for Families to Help Seniors Enjoy the Holidays

2011-11-29T14:34:00.000-08:00

Some residents go home with family for the holidays. When the senior is able to do so it is generally a good idea. However, sometimes in the hectic holiday activities, seniors become fixtures in a chair instead of participants in the festivities. Help your residents family members and your caregivers by sharing these tips.

Plan Ahead. Whatever the activity, outing or event is, make plans to accommodate the elder. Consider food, location, seating and restrooms.
Be Inclusive. Try to include everyone in holiday preparations. Examples are decorating cookies, folding napkins, setting out dinnerware, or arranging flowers.
Share Memories. Get out the old photo albums, listen to nostalgic music, tell stories, and ask about the old days.
Make New Memories. Tradition is fine but mix it up a little. Don't forget that elderly folks look forward to new things just as much as the rest of us. Try a party game or karaoke.
Monitor Alcohol & Medications. It's easy to make the mistake of filling the wine glass to often without consideration of your loved one's medications. Know what medications are being taken and be familiar with the alcohol interactions.

There are many other ways to make the holidays fun and safe for seniors. Consider having a staff meeting where your staff can brainstorm for new ideas.

Have a very happy and safe Holiday Season!

Thanksgiving Food Safety

2011-11-21T15:31:00.000-08:00

It's the start of another holiday season so to get it going in the best way possible let's talk about food.

We all love to enjoy a holiday feast but when food is not prepared with care the feast can cause foodborne illnesses that can be severe or life threatening to our elderly or frail residents. According to the FDA there are 4 things to remember to prevent foodborne illness.

1. Keep it CLEAN! - Make sure hands, utensils and prep surfaces are constantly kept clean.

2. SEPARATE Foods! - Do not allow bacteria to cross contaminate from raw foods to prepared foods.

3. COOK it Through! - Make sure cooked foods, especially meat and poultry, are cooked to the proper temperatures. Turkey should be 165 degrees internal temperature.

4. Don't Forget to CHILL! - Refrigerate leftovers quickly! Bacteria grows fast at room temperature.

One more tip. Do not stuff your turkey. Stuffing is the leading cause of foodborne illness on Thanksgiving. Why? This is classic cross contamination. In most cases the stuffing does not reach 165 degrees so it's an ideal spot for bacteria to grow. It's safer to cook your stuffing in a casserole dish. Here's a recipe and a related article.

When the food is on the table have a glass of wine.

For more Food Safety info click these links!

Countdown to Thanksgiving
Food Safety for Older Adults
Don't Cross Contaminate
Cooking for Groups
Don't Forget the PIE! (Safety related - because it's not safe for the cook to forget the pie. There could be a revolt.)

HAPPY THANKSGIVING!

New Veterans Homes in CA

2011-11-15T14:44:00.000-08:00

I've been hearing about these two new veterans residential care facilities for quite some time. As many of you know there is a great need for them. So many of our injured and aging veterans are left without options due to the high cost of residential care and not qualifying for long term nursing care. It's disappointing now to learn that these two brand new facilities, one in Redding and the other in Fresno, cannot open due to budget woes. Who knows, maybe this would be a good opportunity for someone to come in and manage these buildings for the state. Who's ready? Read the Sac Bee article here.

DOJ Fingerprint Alert

2011-11-09T15:00:00.000-08:00

The Department of Justice is upgrading their fingerprint system which will require them to take it offline for about a week starting November 9,2011. If you're planning on sending someone in to get fingerprinted I'd suggest getting it done today. You can still utilize the Livescan services but a complete report will not be available until after November 15, 2011. Please be aware of this. Go to the CCLD website to read the actual alert by clicking here.

EVICTION PROCEDURES - New for the Evaluator's Manual

2011-11-01T11:00:00.001-07:00

A really hot topic with administrators I've met across the state is how to properly evict and stay out of trouble doing so. Now, The Evaluator's Manual (aka The Blues) has been revised a bit to address this procedure. The first noted change is that you no longer need to seek approval from licensing to give a 30 day notice.
Thirty (30) day evictions do not need prior approval by the licensing agency. A resident may only be evicted for the reasons cited in California Code of Regulations, title 22, section 87224(a).
This change effects 17 pages in the Evaluator's Manual. Please click here to view and download a new copy from the state website.

NEW DVD from ALZ.ORG

2011-10-25T15:20:00.001-07:00

This week I am in Southern California at the CALA Conference. I will share with you next week a little about it.

This week I just wanted to bring to your attention a new educational DVD from the Alzheimer's Association. It is a two program disc which includes "Understanding Alzheimer's" and "Alzheimer's and Safety". It's a really great DVD to have and for those of you who care for Alzheimer's residents it should be shared with your staff and families. Here is the link where it can be purchased. New Education DVD.

Check back next week. Thanks for listening.

CAREGIVERS UNDER STRESS

2011-10-18T16:22:00.000-07:00

This article focuses on the home caregivers, the so called "Sandwich Generation", those who find themselves caring for both elderly parents and their own children. While it's not something our employees are dealing with it is something that is worth considering if these folks decide to place mom or dad in an assisted living. It provides us with a chance to show some empathy and by doing so we might move in a new resident. It is also worth considering that our own staff may experience similar kinds of stress and depression as the people they are caring for become in need of heavier care or pass on. Tell us what you think on our Facebook page. See the article here.

CCLD ETHICS HELPLINE

2011-10-11T14:58:00.000-07:00

This week I just want to draw your attention to something at the CCLD Website. It's a little link at the bottom of the page called CCLD Ethics Helpline. I'm encouraging you all to check this page out only to be familiar with it in case you should need it.

In the past there have been incidents of CCL employees involved in inappropriate situations involving gifts, favors and power struggles. The helpline exists to aid in discouraging this kind of behavior with CCL employees as well as stop it quicker if it should occur. In my experience CCL employees have been top notch and by the book, as they should be. This little tool is there for the protection of the residential care providers. Share it with your staff and colleagues. The link is here at CCLD Ethics Helpline.

ADMINISTRATOR RECERTIFICATION REQUIREMENTS

2011-10-04T14:14:00.000-07:00

I often encounter the question "Can I take all 40 hours of continuing education during one year of my 2-year certification period?" My standard answer is no. Many administrators do just that though. They wait until a few months from expiring to do all 40 hours. Here's why I discourage this method.

In Title 22, Administrator - Qualifications and Duties, Section 87405(g) it states:

All administrators shall be required to complete at least 20 clock hours of continuing education per year in areas related to aging and/or administration.

The regulation sounds pretty clear to me. At least 20 CEU's per year sounds like a duty and a requirement. So why is their confusion about this? The confusion comes from another place in Title 22 entitled Administrator Recertification Requirements, Section 87407(a) which reads:

Administrators shall complete at least forty (40) classroom hours of continuing education during each two (2)-year certification period.

What I focus on here is the word during. "During each two year certification period" implies it should be a regular, ongoing practice. When you consider these two sections together it becomes apparent that CEUs should be achieved each year of the 2-year certification period. Besides, who really wants to jam that much training into a short period of time? Trust me, you'll learn more and retain what you learn longer if you spread it out a little.

FALL PREVENTION

2011-09-27T16:04:00.000-07:00

The Centers for Disease Control and Prevention have a great resource on falls among our aging population. According to the CDC, in 2008 over 19,700 elder adults died as a result of an unintentional fall. As care providers, preventing falls is our #1 priority 24 hours a day. We know first how how devastating a fall can be. Injuries range from bruises, to broken hips, to head trauma. In fact, the leading cause of brain injury in the elderly is falling.

Please visit this web resource for more information on falls.

www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

Food Handler Card Update

2011-08-16T15:20:00.000-07:00

This question regarding the Food Handler Card is still floating around and as of yet there is no clear answer. Some have said that RCFE's are exempt from the requirement while others suggest it is a Health Department issue. The truth is, until either CCLD or the Health Department make a statement on the matter we are uncertain. Our position at Community Care Options is to stress the importance of detailed training for your food staff. While it may not be a requirement yet, it may be wise to have your staff trained and assessed in the same way as the retail food service community. Training of this caliber is also a great marketing tool for those facilities who serve in a restaurant style. Tell us your thoughts on Facebook. Click here to leave your feedback.

MRSA in Residential Care Facilities for the Elderly

2011-08-09T15:56:00.000-07:00

We frequently get the question of what to do with MRSA in the assisted living.

Licensing classifies MRSA and other antibiotic resistant bacteria as "Prohibited Health Conditions". The reason being that elderly individuals usually have weaker immune systems than younger individuals. As such, it is to be dealt with in a very serious way.

The RCFE Evaluators Manual (The Blues) says the following"

"If a resident is diagnosed with a methicillin-resistant staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) infection, the resident must be relocated elsewhere, such as to an acute care hospital or a skilled nursing facility, until the infection is cleared unless the facility applies for and receives an exception."

To read the entire Section 87615, Prohibited Health Conditions click HERE. Go to page 108 in the PDF, the section begins near the end of the page.

Guidelines for treatment of MRSA from the Infectious Diseases Society of America - click HERE.

Responding to Confusion in our Residents with Dementia

2011-07-27T09:55:00.000-07:00

Q - How do we interact with are residents when they are confused?

A - When our residents are confused or even forgetful it is so easy to become impatient. We're often busy with many issues at a time and forget that we are there to be a support for our people. It is important in these situations to remain calm and patient. Our responses need to be loving and respectful. It is even helpful in your response if you use words like "I think" or "maybe" instead or "remember". Please look at this checklist from the Alzheimer's Association and share it with your caregivers.

The checklist is here .

California Food Handler Card Law (SB 602)

2011-07-05T14:24:00.000-07:00

In the last few weeks our office has received several calls requesting information about Senate Bill 602 (SB 602), aka The California Food Handler Card law. This law took affect July 1, 2011. Currently, clarification on how this affects residential care facilities is hard to find. There is some great information out there on the subject, however. Thank you ACCA member Brian P. for your help on this.
For starters, this law seems to specifically address "retail" food handlers. It raises the question, how do we define "retail"? Since the care we provide is charged to the resident and it must require food service then it is safe to assume we fall into this "retail" area. We recommend having your staff trained and assessed with a Food Handler Card on file. At the very least it will keep you out of hot water and your staff will be better as well.

We plan on providing the California Food Handler training in the near future. We'll keep you posted.

Check out the following links for more information.

Read the Guidelines & FAQ

Read the Bill (SB 602)

What is a KIT Inspection? & Heat Related Information

2011-06-21T15:35:00.000-07:00

We have been getting a lot of questions on the new "KIT" Inspections process by the LPA's.

"KIT" stands for "KICKED in the TUSH"!

Just kidding, it stands for Key Indicator Tools. The Community Care Licensing Division (CCLD) is continuing to test the Key Indicator Tools (KIT) that have been developed for use during inspections to facilities and homes to check for compliance with licensing standards. This test will be used to further refine the KIT inspection protocol and develop additional tools for all facility types. All inspections are still subject to all laws and regulations regardless of the type of inspection. For example, if during a KIT inspection, CCLD observes a violation that is not listed on the KIT, CCLD will still address that violation. For additional information, visit the MYCCL website at http://www.myccl.ca.gov/ and click on New Directions.

Heat Related Information

Tips for Licensees to Prevent Heat-Related Illnesses:

http://ccld.ca.gov/res/pdf/heat.pdf

Tips for Licensees to Prevent Heat-Related Illnesses (Spanish):

http://ccld.ca.gov/res/pdf/heatSP.pdf

Office of Emergency Services - Heat Preparedness:

http://www.oes.ca.gov/Operational/OESHome.nsf/ALL/AA07C0C051F70991882572F3005C15CF?OpenDocument

CA Department of Public Health Tips for Preventing Heat-Related Illness:
http://bepreparedcalifornia.ca.gov/EPO/BeInformed/NaturalDisasters/ExtremeHeat/TipsPrevHeatIllness.htm

Licensing News on Hospice and Oral Syringes

2011-06-14T17:10:00.000-07:00

Happy Father's Day to all you Dads and bless all you Moms for putting up with us.

News from Licensing. Licensing is now asking the facilities that have the Hospice Waiver to apply for a "Total Care Exception" and submit it as an addendum to be added to your Hospice Waiver. Once your Total Care Exception is approved you will still have to notify licensing when a resident on hospice becomes total care. We will have this available to purchase next week. Please call the office, if you purchased the Hospice Waiver from us then the addendum will be $49.00. If you need the Hospice waiver with the addendum the price is $159.00.

Medical Marijuana is a hot topic. Licensing has little to say about it but did say to treat it as any other medication.

Clarification on the use of oral syringes. It is now clear that unlicensed trained staff can use an oral syringe to draw up and measure liquid oral medications. The oral syringe can then be handed to the resident to self administer. Staff may not administer the medication.

Our Irrational Fear of Forgetting

2011-05-31T19:39:00.000-07:00

One of our members shared a great article with us last week while we were at RENO 2011. It addresses what has become a hyper-sensitive topic among the "Baby-Boomer" generation - getting Alzheimer's Disease. We are huge supporters of the Alzheimer's research movement but it stands to reason that all the talk has caused people to become fearful of dementia. What we need to remember is that simply forgetting a name, struggling for a word, or losing track of your thoughts does not equate to Alzheimer's Disease. Please read the article here and give it some thought.

Additionally, RENO 2011 was a huge success. We had 280 attendees including vendors. Unfortunately, we missed a few handouts for you, so, they are available for download here.

Hug a Nurse Today

2011-05-10T15:35:00.000-07:00

It's National Nurses Week!

Take some time to voice your appreciation to the nurses who work so hard to care for those in their charge. Visit the American Nurses Association online to read more about this celebration and learn some history behind the profession.

http://www.nursingworld.org/NationalNursesWeek

Sun and Heat Protection

2011-04-26T14:53:00.000-07:00

The warm weather is approaching. Soon it will be hot. This is the time of year when we start taking our residents outside for cookouts and garden parties. You've planned out all the details for your parties - the food, the drinks, the music - but don't forget the most important details for your residents - THE SUN PROTECTION!

As people grow older their skin gets thinner. Skin damage among the elderly is a high concern since their aged skin cannot rejuvenate as well as it once could. Elderly people may forget that fact. Sun damage is the greatest threat to skin, especially among the very young and the very old. We must be diligent about protecting their skin. Here are a few tips to help out.

Sunbathing is a bad idea. Use an umbrella or sunshade whenever sitting outside in the sun. Any shade will help. Trees are our friends.
Use sunblock that protects against UV-A & UV-B with a sun protection factor (SPF) of 30 or higher.
Limit outside time between the hours of 10am-4pm. The sun is strongest during these times. If your residents like to walk have them do so before 10am or after 4pm. Mornings are best!
Don't forget the eyes. Eyes can burn as well. Be sure the sunglasses have a UV protection rating.
Stay hydrated! Drink plenty of water. After coming in from the sun drink juice or Gatorade to replenish salts and electrolytes.
Limit physical activity. Lay low on hot days to prevent heat related illnesses.

For information on heat related illness try the following links:

Download this guide from Californian Department of Social Services on Heat Related Illness

http://www.ccld.ca.gov/res/pdf/heat.pdf

Download this guide from the American Cancer Society on Skin Cancer

http://www.cancer.org/acs/groups/cid/documents/webcontent/003184-pdf.pdf

If you have a question that you would like to have answered on Tuesdays with Tom send him an email. Use the subject line Questions for Tom in your email.

Email Tom at info@communitycareoptions.com

New Guidelines for Early Alzheimer's Detection

2011-04-19T15:42:00.000-07:00

It seems that things change quickly in Alzheimer's research. As with any disease finding a cure is the ultimate goal. But while we wait for that time to come we are encouraged by new information and new milestones in Alzheimer's research.

In today's news you may have seen headlines about revisions in Alzheimer's Disease diagnosis guidelines. This revision is the first in 27 years. The earliest stage of the disease is referred to as "preclinical Alzheimer's" and diagnosis occurs nearly 10 years before any symptoms are present. The new guidelines officially refer to mild cognitive impairment, or MCI as the beginning of the disease.

Click here to read the entire article at www.reuters.com

Lets start a discussion on Facebook.

If you have a question that you would like to have answered on Tuesdays with Tom send him an email. Use the subject line Questions for Tom in your email.

Email Tom at info@communitycareoptions.com

Elder Abuse

2011-04-12T15:40:00.000-07:00

I have just been sent another article about staff abusing residents in a Residential Care Facility. Last month it was in the Sacramento area. This incident was at a Sunrise Facility in Pennsylvania. In each case the families have placed nanny cams in their loved one's room after suspicions had been raised about the potential abuse.

Although the staff members have been arrested it still makes me mad as hell that this continues to happen in some facilities.

Families bring us their loved ones to make sure they are taken care of and protected. Overall, I feel we are doing a great job but a few can give the whole industry a bad name.

Maybe it is time to train staff in Elder Abuse like we do for universal precautions. The staff would be trained to assume that all rooms have a camera in them. In any case this has to stop.

Click here to read the article

If you have not had abuse training for a while, the Elder Abuse Training Video is now on the D.O.J. web-site, or email my office at info@communitycareoptions.com with the subject "Elder Abuse Training" and we will give you a DVD Class including the abuse training video for free.

Updated POLST

2011-04-05T15:43:00.000-07:00

The California POLST task force have conducted their two year review and have released an updated version of the POLST form. Please review the new form and read the Summary of Changes so that you understand what has been changed and why.

It is important to note that CaPOLST.org suggest a best practice of using the revised 2011 POLST form starting April 1, 2011 rather than using up any old forms. Additionally, a POLST form completed prior to the April 1, 2011 date remains valid, meaning they are still good. Lastly, the color of the form has no bearing on its validity.

Get the new form HERE

http://www.capolst.org/documents/CAPOLSTform2011v13web_000.pdf

Review the Summary of Changes HERE

http://www.capolst.org/documents/SummaryofChanges.pdf

Disaster Plan

2011-03-22T14:28:00.000-07:00

We've all been shaken by the events in Japan. Our hearts and prayers go out to those who have been affected by the tsunami and to those who are risking their lives to help.

Natural disasters like this should remind us to evaluate our own emergency and disaster preparedness. CCLD has a great self evaluation resource for this purpose. Compliance should not be the only reason for good planning. We have committed ourselves to providing excellent care to our residents. Their safety is our first priority. Please take the time to review the self evaluation and make sure you meet or exceed every item on the checklist.

You can print the CCLD Emergency and Disaster Preparedness Self Evaluation here.
http://www.ccld.ca.gov/res/pdf/DisasterGuide.pdf

You can review and print the FEMA guide here.
http://www.fema.gov/areyouready/

The American Red Cross and CalEMA offer a Preparedness Training and other resources here.
http://www.prepare.org/home/

Overtime for Caregivers

2011-03-08T15:25:00.001-08:00

Q - Tom, According to some websites we’ve researched, caregivers who work in a facility get overtime after working: 10 hours a day OR 40 hours a week. Another website said that caregivers will only get O.T. after they work 80 hours in TWO weeks (so they can work 60hours 1 week, then 40 the next).

Can you clarify the O.T. law for caregivers working in RCFE's (care facilities)?

A - Both are wrong. They start getting overtime if they work more than 8 hours in a day and also more than 40 hours in a week (unless they have voted and agreed to work 4-ten hour days).

Care facilities are governed under the Industrial Welfare Commission Order #5 (IWC 5). Please go to the attached link for the full order and get the answers to other related questions like how much you can deduct for meal and lodging AND should you be paying for uniforms, etc.

http://www.dir.ca.gov/IWC/IWCArticle5.pdf

Cold Weather Prep

2011-02-22T14:35:00.000-08:00

The entire state of California has been experiencing cold weather this past week. While I am sure you are all aware of the dangers of cold weather and the elderly, it is still a good idea to re-evaluate your current practices. On the CCLD website you can find some information or guides to cold weather preparedness. Some of the information will refer to your garden, pets, and even your home. Please download these guides at the following links and share them with your staff?

Medications - Shadowing

2011-02-15T10:11:00.000-08:00

We are still getting calls from facilities that have been cited from licensing for lack of Medication Training. If you have completed the live medication class or the medications training on line then the problem usually is that the shadowing part has not been completed.

Shadowing has to happen in the facility and should be individualized training. You can not complete this part of the training in a class. Be sure to have documentation that this training is completed for yourself and all of your staff.

The other items that you may have overlooked are that every employee needs to pass the medication test and have the documentation in the files. The test also has to be completed in the facility. You should have in each employees file, documentation that they have completed the classroom training (four hours for 15 beds or less and eight hours for more than 15 beds), completed the shadowing (2 hours for 15 beds or less and eight hours for more than 15 beds), and then a copy of the completed test.

The employees do not have to repeat the shadowing or take another test each year but they do need to have four hours of annual training on medications. This applies to all employees who currently do or might pass medications.

Residents Refusing Meds

2011-02-08T14:52:00.000-08:00

Q - I have a resident who refuses to take their medications, now what?

A - There are many reasons why a resident might refuse medications. By the time an elderly individual enters into residential care they have already released control of many portions of their lives. Controlling their medications is something they still have. Take the pill or not. Only they can decide. Unfortunately, it may be a risky choice. Here are a few things to consider if you or your staff encounters this problem.

Start by finding out whether they really need to take the medication. If the medication is not needed to sustain life then you may want to check with the doctor and ask about stopping the medication.

If stopping the medication is not an option, consult the doctor about changing the time of day, or changing to before or after meals. You will need to check the order and see if the medication is to be taken with or without food. You should also get an order from the doctor for changing the time of day.

If swallowing is a problem, see if you can get permission to crush the meds or cut them in half. You may want to consider asking about different delivery option s. Ask the doctor & the pharmacist if there are other forms of the medication such as a patch, lotion or liquid.

It may also be the color of the pill. Bright colored pills like red or orange can appear threatening. There may be another generic or brand that is a different color.

Trust can play a part. You may want to try having a different staff member present the resident with the medication. It may not be about persuading the resident to take the medication. It may be about the resident’s feelings toward a caregiver.

Other considerations:

· The medication may affect the flavor of food.

· The resident may be embarrassed to swallow pills in front of other people.

· The medication may make the resident feel ill, make keep them awake, or constipate.

· The resident may not like the texture or aftertaste.

· Changing the resident’s routine may have positive or negative results.

Remember you need to notify the doctor every time the resident refuses to take a medication.

If you have a question that you would like to have answered on Tuesdays with Tom send him an email. Use the subject line Questions for Tom in your email.

Email Tom at communitycareoptions@usa.net

No business this week. Let's Talk Football

2011-02-01T13:55:00.000-08:00

The Super Bowl is a distraction this time each year to many people. It is no different for me. Let's just say football is a distraction. I share season tickets for the 49'ers and tried to attend as many home games as I could. Would have loved to see them in the Super Bowl. My daughter is also a football fan, so it was no surprise to me when she forwarded the following article to me. You see, the quarterback for the Green Bay Packers is a bit of a local hero around our hometown. He went to high school here at Pleasant Valley High, as did my kids, and keeps close contact with the community. That's right, Aaron Rodgers is a Chico local hero. Check out the article HERE.

Next week we'll be back to business. What would you like to talk about?
Email me at: communitycareoptions@usa.net

California ARF & RCFE Orientation Update

2011-01-27T13:41:00.000-08:00

RCFE and ARF Orientations are back underway and it looks like business as usual. If you are not on a current waiting list for orientation you can now get on your local area list.

You can get more information for orientations by calling the respective Orientation Information Lines. We called two local units and the information is below. Please see the link at the bottom for a list of more offices.

Sacramento Local Unit:

ARF call 916-263-4803

RCFE call 916-263-4804

Please call for very specific information on how to attend and pay.

February 8th Orientation for RCFE is booked in full. The next Orientation for RCFE is scheduled for March 8th. Orientations are on the 2nd Tuesday of each month unless it is a State holiday. Orientations for ARF may still have availability.

Rohnert Park Local Unit:

(Lake, Marin, Mendocino, Napa, Solano, and Sonoma Counties)

ARF call 510-286-0379

RCFE call 707-588-1407

Please call for information on how to attend and pay.

Please CLICK HERE for a list of CCL Regional Offices.

If you have a question that you would like to have answered on Tuesdays with Tom send him an email. Use the subject line Questions for Tom in your email.

Email Tom at communitycareoptions@usa.net

Employee Fingerprint Clearance

2011-01-11T13:10:00.001-08:00

Just a quick tip this week with regards to fingerprint clearances.

A common question I receive in classes and in consulting is how can you get quick results on a fingerprint clearance?

Naturally, the clearance itself may take a while, but once it clears it is posted on the California Background Clearance Listing. If a name shows up there then the individual is cleared to work in a community care facility. Most often you will see the name of the individual listed twice. Without this second clearance listed you need to wait for a clearance letter from the State. If the individual's name appears twice then you can hire them immediately.

We've created a shortcut to this listing. Go to our website at www.communitycareoptions.com and look for the Fingerprint Clearance link at the bottom left. This link will take you directly to the search page and you can bypass all of the CCLD pages. You can also click HERE to view it.

If you have a question that you would like to have answered on Tuesdays with Tom send him an email. Use the subject line Questions for Tom in your email.

Email Tom at communitycareoptions@usa.net

Generating Positive Emotions for Alzheimer's Patients

2011-01-03T14:46:00.000-08:00

Happy New Year! While making your New Year Resolutions, it might be worthwhile to consider the attached article when you are caring for your dementia residents. Remember, if you have an Adult Facility with clients with Down's Syndrome you will most likely be dealing with Dementia when they get into their fifties.

This is a great article and talks about some non-medical techniques that include using food, scheduling, art, music and exercise to generate positive emotions; engaging patients in activities that salvage fragments of their skills; and helping caregivers be more accepting and competent.

Click HERE for the NYTimes article.
If you have a question that you would like to have answered on Tuesdays with Tom send him an email. Use the subject line Questions for Tom in your email.

Update on RCFE Orientations

2010-12-07T11:58:00.000-08:00

There have been some rumors floating around about California Community Care Licensing Division reinstating the RCFE orientation classes in January 2011. While it is true that some licensing offices throughout the state have made this admission, there is no definite word from C.C.L.D. regarding this action. I have heard from only one individual that they have been contacted and asked to appear for their orientation class in early January. We have made contact with several licensing offices and have had mixed messages regarding a schedule. It sounds like we may nearly be back to business as usual. You should check with your local licensing office for more information.

How do I evict a resident?

2010-11-23T14:43:00.001-08:00

Q - I am having trouble with one of my residents and would like to evict him. How do I do this and stay in compliance with licensing?

A - There are two ways to evict a resident within licensing regulations.

The first is to give the resident a 30 day notice. You do have to have a reason for the 30 day notice. The regulations say one of the following five problems are reason for eviction; Title 22 Section 87224(a) (Page 71)

1. Nonpayment of the rate for basic services within ten days of the due date.

2. Failure of the resident to comply with state or local law after receiving written notice of the alleged violation.

3. Failure of the resident to comply with general policies of the facility. Said general policies must be in writing, must be for the purpose of making it possible for residents to live together and must be made part of the admission agreement.

4. If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted pursuant to Section 87463, and the licensee and the person who performs the reappraisal believe that the facility is not appropriate for the resident.

5. Change of use of the facility.

You do not need permission from licensing but you need to send them a notice of the eviction within 5 days.

The second way is to give the Resident a 3 day notice. You do need permission from licensing before you give a 3 day notice. The licensee may, upon obtaining prior written approval from the licensing agency, evict the resident upon three (3) days written notice to quit. The licensing agency may grant approval for the eviction upon a finding of good cause. Good cause exists if the resident is engaging in behavior which is a threat to the mental and/or physical health or safety of himself or to the mental and/or physical health or safety of others in the facility. Title 22 Section 87224(b)-(Page 71)

You need to send a copy of the notice to licensing within 5 days. Title 22 Section 87224(f)-(Page 71)

The licensee shall, in addition to either serving thirty (30) days notice or seeking approval from the Department and service three (3) days notice on the resident, notify or mail a copy of the notice to quit to the resident's responsible person. Title 22 Section 87224(c)-(Page 71)

My first recommendation is trying to fix the problem with the resident. If that is impossible, and to avoid the formal paperwork, you may want to suggest to the resident that it may be best for them to relocate. If the resident chooses to leave based on your suggestion it makes things much easier.

Remember even if you get permission for a 3 day notice or the 30 days is up you cannot simply roll the resident to the curb and leave him/her there. It then might help to get the Ombudsman, the Public Guardian and/or APS involved to help you. If none of this will work you will have to go to court and do an eviction similar to the resident being a tenant.

Good Luck!

Be Ready for Your Inspection!

2010-11-16T13:51:00.000-08:00

The new Fall Licensing Update is out. Please follow this link for a copy.

Fall 2010 Update

One of the items to follow in this update is the new proposal for inspections. Currently, CCLD's inspection protocol is to conduct compliance inspections of all facilities at least once every five years, with an additional annual 30 percent random sampling of all facilities receiving inspections. All of these inspections include a comprehensive review of compliance with all licensing laws and regulations. Due to budget constraints, the CCLD is unable to meet these inspection mandates and has made the proposal to align its resources with its mandates while also strengthening health and safety protections.

The "Strengthening Health and Safety Protections" proposal will require annual unannounced inspections of all facilities with the exception of family child care homes, which will receive a biannual inspection. Certain facilities will not be eligible for a key indicator inspection and will, therefore, receive an unannounced comprehensive health and safety compliance inspection. This would include facilities that are under a noncompliance plan, are on probation, or are pending administrative action. Facilities that do not fall within the parameters described above would receive an inspection using the Health and Safety Compliance Review Tool to review the key indicators of compliance and risk. The CCLD's annual compliance inspections would expand to a comprehensive review when warranted. The CCLD anticipates that inspections conducted using the Health and Safety Compliance Review Tool will take approximately half the time it currently takes to complete a health and safety compliance inspection.

We should always be ready for a visit from licensing. You can use the self inspection tools from licensing to prepare your facility for any inspection.

The first tool is the Facility Review Worksheet.

http://www.ccld.ca.gov/res/pdf/rcfe1.pdf

The second tool is the Administrative Assessment Tool which covers the whole facility operations.

http://www.ccld.ca.gov/res/pdf/RCFEAdministrativeAssessment.pdf

If you have a question that you would like to have answered on Tuesdays with Tom send him an email. Use the subject line Questions for Tom in your email.

Email Tom at communitycareoptions@usa.net

Hospice or Comfort Measures?

2010-11-09T16:09:00.000-08:00

Q: The family of one of my resident’s wants the resident to be placed on comfort measures instead of Hospice even though Hospice would be appropriate right now. The family and the doctor are willing to sign a release to do this. Do you think it is OK? What about licensing?

A: First of all we always recommend Hospice when it is appropriate. Remember Hospice is not just for the resident. It is also for the family and for the caregivers. There is also the benefit of counseling for those grieving during the first year after the Hospice patient dies.

You cannot force the resident to go on Hospice. However, without the resident entering into a Hospice program they may quickly move to a level beyond the scope of residential care. The resident could ultimately end up in a skilled nursing facility to live out their days. It is important to have a straight forward discussion with family members about Hospice and educate them on the it's benefits.

The Hospice regulations can be found in Title 22 on page 172

section 87633 (HOSPICE CARE FOR TERMINALLY ILL RESIDENTS)

Remember that when the resident becomes total care you still need to send in for a Total Care exception. This should change with licensing in the near future when it will be part of the Hospice Waiver.

If you have a question that you would like to have answered on Tuesdays with Tom send him an email. Use the subject line Questions for Tom in your email.

Email Tom at communitycareoptions@usa.net

Baby Boomers and The Age of Alzheimer's Disease

2010-11-03T10:21:00.000-07:00

An interesting OP-ED article from The New York Times was sent to me recently. It is concerning Baby Boomers and Alzheimer's Disease.

We've all been saying "the Baby Boomers are coming" when talking about the future of residential care. It's true! Starting January 1, 2011 there will be 10,000 Boomers turning 65 each day. Startling! So, we need to plan for it. One area we need to focus is in the field of Alzheimer's research. Have a look at the N.Y. Times article. It's an eye-opener.

"The Age of Alzheimer's" - NYTimes

If you have a question that you would like to have answered on Tuesdays with Tom send him an email. Use the subject line Questions for Tom in your email.

Email Tom at communitycareoptions@usa.net