Schenk: This is episode 76 of the Nursing Home Abuse Podcast: How to find the right Georgia nursing home for your loved one.
The Nursing Home Abuse Podcast is dedicated to providing news and information to families whose loved ones have been injured in a nursing home. Here are your hosts, Georgia attorneys Rob Schenk and Will Smith.
Schenk: Welcome, welcome. My name is Rob Schenk.
Smith: And I’m Will Smith.
Schenk: And that’s Will Smith. Welcome to the show. A lot of interesting topics on today’s show. We have a guest. His name is Jeff Bird. He’s going to be on. We’re talking about – for all those out there listening that have a loved one in a nursing home, how to find the right nursing home to begin with and maybe if you suspect something going on with the nursing home your loved one is currently in, where to go from there. These are the types of questions we’re going to delve into today with Jeff, and we’re looking forward to it. Will, my co-host, can you tell us a little bit about Jeff?
Smith: Sure. Jeff Bird, he began his professional corporate career in 1984 and moved into geriatric issues and senior living in 2003. He’s had a wide variety of roles in dealing with the elderly, including executive director of geriatric care and consulting. He’s got experience in senior living and care operations, arbitration and mediation administration. And he founded Bird Consulting LLC in 2012 and its purpose is to equip families caring for aging loved ones.
He decided upon this after working with church families and felt called to enhance his role in helping those who were caring for the elderly. And with the support of his church group and Parkview Church in Lilburn, he founded Parkview Aging Services from his perspective to further answer this call, and essentially what Parkview Aging Services is, we’re going to find out on the podcast, but it’s designed to help loved ones caring for the elderly find a good nursing home that fits for them and their loved one.
Schenk: That’s right, to make other transitions.
Smith: This is a highly necessary job and billet that he’s created, so we’re really happy to have him on board.
Schenk: All right, Jeff Bird, welcome to the show.
Jeff: Thank you, Rob, glad to be here.
Schenk: All right, Jeff. We were, in your introduction, just talking about your experience working with the elderly and the families of persons that are transitioning at that time in their life to living in nursing homes, and we talked about you founding in 2016 Parkview Aging Services. Can you, just from a broad standpoint, what does Parkview Aging Services do?
Jeff: Parkview Aging Services was started just out of my realization that the adult children of families were coming into these communities that I was operating with just not enough information to really understand what they need to ask the facility that was going to possibly be taking care of their mom or dad. And I loved working with seniors – that’s why I got into it – and I was kind of surprised to see how much of my time was spent with the families. And I really enjoyed that because I was able to answer their questions and feel like I helped them solve their problems, to help them understand their care, help them understand our processes, and then be better able to solve problems and address issues.
And so I started this with a different intention of being more of an executive coach, but in turn, a lot of old colleagues just began calling me and telling me their stories of an event with Mom or Dad and if I would help them through the next steps – What are my next options? Where can we go? I have no idea what to do next. They said you need a PhD to tell these places apart and compare.
Smith: I liked that Elizabeth O’Brien quote you had on there. I was thinking about it the other day, because we have people call us from so many different places on the elderly care continuum where I’m not really sure what this is. It’s not a nursing home. It’s not an assisted living facility. I don’t know what to tell you. But it’s very confusing, even for attorneys who only do this.
Jeff: Right. And that’s what I found in working in the nonprofit world and the for-profit world, there were two angles that we went at it with. In the for-profit world, there’s legitimate business models, but I felt like that there was so much pressure on the operators in a for-profit setting to fill sentences that sometimes they may have not always done the best job of describing or sometimes the nurses are pressured to kind of stretch the care. So I just felt like in some cases, not in all, in some cases, the customer wasn’t getting all the information.
And so some of the marketers out there may not like me, but I tell my clients the brochures are beautiful, the chandeliers are shiny, the cookies smell good, and it looks like they’re having a great time, and maybe they are, but maybe not. And what I want to do for them is do more of that digging in the weeds and asking more of the hard questions of these communities before a resident moves in, to ask the questions that nobody else is going to ask.
Schenk: That’s a perfect segue.
Jeff: And uncover what I think is really the platform of which the care is going to come from, and they have great nurses, but if they’re understaffed, if they’re underbudgeted, the care is not going to be delivered the highest level.
Schenk: That’s an excellent segue, Jeff. So let’s go through a hypothetical. You sat down with clients and you were talking and communicating with the family and possibly the resident, the future resident. You’ve determined that placement in nursing home is the best option that is optimal. You’ve talked about investigating. So what are the most important things that the family, or if you’re involved, what do you look for when searching for a nursing home? Can you take us through your step by step of the selection process based on the criteria provided to you by the resident?
Jeff: Sure. First I do some historical information gathering because historically is a good predictor of the future, but not always. The industry’s in expansive growth mode, so there’s a lot of volatility, so I’m really concerned about real time. So what I educate them on is the fact that I need a real time picture of what’s going on in these communities before I’m going to recommend it to them.
So my typical client, one here in Gwinnett County, he was looking for a memory care for his mom. He was caring for his mom at home, and her disease had advanced to the point where he just couldn’t take the care of her that he wanted because it was becoming more than he could be trained to do. So we determined this memory care in an assisted living, part of long-term care, would be the best provider. And we found three that on the surface looked like they would be good providers, and my job for this client was to go in to each one. And when I go in, I don’t make appointments, I don’t schedule a tour – I just walk in and I just start my tour. And if they can’t tour me, I just tour myself or I’ll find the first person to take me around the building, but I want to go in and find a real time reality of what’s happening.
The first thing I go into is staffing. How are you on-boarding? How are you training? How are you evaluating? And how are you paying? If they will tell me that – how are you paying the caregivers? The caregivers are the bottom line of the care, and if I hear the typical $9 or $10 an hour, heavy part time, little to no benefits, then I’m concerned that they will be falling into the cycle that many of them are falling into of high turnover and short-term tenures. And when the caregivers are not giving the best care, it puts more stress on management, and I’ve seen the management turnover as a result of that because they don’t feel supported. So I’m looking for a model of on-boarding and training and promotions that is really going to provide stability and longevity of the staff.
The second thing I do is I look at their compliance – how have their scores been in the past with the state, with the health department? Nobody’s perfect, but if there were some infractions, there were some things, what are they doing? Tell me what you’re doing about it. Let’s not focus on so much the problem but have you fixed it? Are you addressing it? And if so, good. If there’s a string of infractions and there’s no sign of improvement, then I’ve got a real concern.
Another thing I look at is dining. Dining sometimes is on the brochure, but the questions I ask get more into the details of how much are you spending on each resident? And is that equating into a nutrition program like fruits and vegetables, not high sugars and salt, not a lot of junk food, no potato chips? Does the chef have enough leeway to really take care of them holistically? And so that’s a big question I ask to make sure that’s part of their care.
And also if it’s a memory care program, especially when I was looking here, I want to know what curriculum they’re using. Are they just going onto the Internet and pulling off what looks good? Or are they following a certified program from Teepa Snow, from other of the providers out there that have really good programs but it takes some training and certification of employees to know how to handle a memory care patient.
So I look at that. So anyways, those are three things that I dig into, and there are more.
Schenk: Yeah. That’s a good starting point. So Jeff, when you walk in there, is there generally a typical time that you find that you get the most honest observation of the nursing home? So for example, do you think it’s more reflective of the general care if you go in at noon, 12 a.m., 6:30 in the morning on a Saturday? When do you think you get the most honest assessment?
Jeff: Yeah, I try to go in the off hours, either I walk in very early when they’re waking residents up and getting residents ready for breakfast or I will go in after 5 or 6 o’clock when most of the management or full-time staff, they have left. So I try to go in there when the rehearsal is over, when the boss is probably not on site, and that can even be weekends – weekends are a big one, holidays – just any time outside the normal 8 to 5 is when you will find something less than rehearsed or produced for your tour.
Schenk: And so when you’re walking in there, and out of several of the criteria, you mentioned three of the criteria, but the first one was you wanted to know about staffing, and you talked about what’s the hourly wage. Is this information where when you walk in there during the off hours or whenever a loved one goes in there to do their own non-professional investigation, but how do you come by that information? Are they generally willing to give you their hourly rate? Is this something you get pushback on? How do you get that?
Jeff: Yeah, sometimes you will and one thing I also say is this – one tour is probably not going to be enough. It may be going back a second time to find out information or it’s finding it out before I go. Who’s the information that I can get that from before I go in there? Can I establish the trust with the caregivers? And usually that’s what I’m able to do. I’m not an intimidating person. I come in just as a normal guy and ask questions that don’t feel like I’m a state inspector. So if I do get pushback, it may take more time, but eventually I can find that out. And if they’re happy, they will usually say, “Hey, this place pays more than my last place does. I have full-time benefits. I have a retirement plan.” And just their attitude of that will tell me what’s going on. So pay may be one thing, but how they respond to me generally is are they being well-treated or they being treated like fast food – just roll them in and hope they last?
Schenk: Yeah, like a factory.
Schenk: So Jeff, you would say then it would be almost impossible to get an accurate assessment of a facility without visiting it in person.
Jeff: Yeah, to get an accurate, real time understanding, you can go off historical, and again, that’s predictable, but in this environment today in 2018, there is just too much change happening within each community to really trust the history. Real-time – I won’t recommend a community strongly unless I’ve had a chance to go in and see it that day.
Schenk: Right. Okay, so we can all catch up to where you’re at, when you say historical, when you say complaint reports that you review, where can the average person come by this information? Is it online? Are you going to the facility?
Jeff: Yes, initially the state, the State Department of Health and Human Services with any state, like here in Georgia, it’s the Department of…
Smith: Community Health.
Jeff: Community Services. So the inspectors come out and you can go online to the state, you can go online to even some websites that they’re called nursing home compares, and what you can find there is the historical information. I went onto the state website when I recently did an investigation for a client, and one of the beautiful places here in Atlanta that has for years had great scores and marks, all of a sudden in 2017, there was a 13-page report that just was horrendous. And at that point, I told the client, “You don’t want to go here.”
So it does take some time to dig down and sometimes the average web finder won’t be able to get to it. Some of these websites are not the easiest and most user-friendly, so I’ve had to take some time to get the information, get to different websites, but usually the state is required to give them, but I can tell you sometimes the state is so overloaded right now with inspections that it takes them a while to post them at all.
Schenk: Oh yeah, in our experience, we’re noticing at least a four, five-month backlog in terms of the most recent complaints updated.
Jeff: Yeah, but they’re all required to keep their most recent inspection in an area at the front for a potential resident to read. So they’re required by law to have it out there on the floor, their last two inspections. And if they don’t, they should give you a copy. Ask for a copy. They’re required to give it.
Schenk: You had mentioned a little bit earlier when you’re going through the tour of the nursing home about asking them about curriculum. Can you dive a little deeper into that? If somebody listening to this wanted to do what you did for their loved one, what would they be asking for? What is curriculum and what’s it used for and why would it be important?
Smith: Yeah, on the memory care units.
Jeff: Yeah, what I’d be asking is what programs have they adopted into their company. Do they have their own that they’ve built off other resources? There are a lot of resources out there. One of the most common I think that people know is called Teepa Snow. She is a really well-known researcher on dementia and she does great presentations. Another one here in Atlanta that I really think a lot of is CaraVita. They did training where I worked at and there was a whole process that they brought in. And I was asking for some proof of that. They may have someone from California I may not have heard of, but if they can show me just the beginnings of a curriculum that someone has written for them that I can go back and probably check, then I’m beginning to feel better.
But I’ve walked into some where they just say, “Well I just go to the Internet and I just pull down these cute little things and we just have fun.” Well that’s great, but in memory care, there is a whole different requirement, different stages of dementia that have to be addressed in their activities, how they actually care for them every day. It’s an intellectual process that they have to understand if they’re really going to help the resident thrive. There’s a lot of survival out there, but I’m looking for the potential for that resident to thrive, to really enjoy those years, even when their mind is fading. And there’s the information out there to do that.
Smith: Yeah, that’s important. I’m glad you said that. It’s not just about surviving and being alive. It’s also about thriving. Just because you’re 80 years old and have a host of issues, being a human and being elderly doesn’t mean you still can’t thrive and have a meaningful life.
To switch gears here for a second, Jeff, in addition to helping place loved ones in the appropriate care setting, what other questions do you find that family members of the elderly come to you with and how do you respond to those questions?
Jeff: You faded at the last second there.
Smith: Well I’m asking essentially what other questions they may have or what other issues – “My mom doesn’t want to leave the house,” or “My dad doesn’t want to give up his car keys” or “How do I get benefits for this?”
Jeff: Yeah. Well what I do at the beginning is I do an evaluation of the client. I have about an 18-question questionnaire that I begin with that begins to paint a picture for me of who the elder adult is, who the family surrounding them is, what’s the history of the family, what is their occupation, what are some special things about Mom or Dad that I need to know? Are the finances – where are they? What can they afford? Do they have long term care insurance? Do they have insurance for health beyond Medicare?
So what I want to get first and foremost is a unique picture of every unique person who I’m working with. No two are the same. And from that, then I’m able to say, “Okay, based on what I see today, what I’m evaluating, and secondly, what are your goals? What do you want to accomplish next? Why are you bringing me in and what do you need to get to?”
And so what I do then is based on all those things, I try to line up options. I’ll say, “You know, there’s an option here for Mom to stay at home.” Staying at home is always possible. It’s just a matter of formatting the house to be able to do that, scheduling the help, but the resources are all there. Is Mom’s income too low? Is it a low-income family that can’t afford these nice places? And then they have to go into the nonprofit sector, more of the mission-based world and then into the state, the State Department of Aging Services, county services. What are the options there for then? So there are options for every income level. It’s just a matter of finding out what they are.
And at the end of the day, I want to give them a strategy and say, “Here are three options. Let’s investigate these and let’s see which one you feel most comfortable with and that’s the one we’ll pursue.” And that’s when I’ll begin more of my investigation – “Okay, we want to go to this place. We want to have this provider.” And then my job next is to logistically line that up with, to vet the provider and to make sure the provider I’m bringing in knows that I’m part of the picture, that there’s an extra layer of accountability they’re going to have with my client.
Schenk: That’s a good segue. Let’s say that you’ve decided on the nursing home. What’s logistically involved in the move of the family member into the nursing home facility setting?
Jeff: Yeah, that’s a big one. First thing I say is for a move, whatever size or whatever’s going on, if you’re going to use any service, a moving service or an organizing service, first of all, use the services that are out there. Don’t try to do this yourself. It can be an overwhelming process and there are senior certified movers, there are senior certified downsizing, real estate agents, people who are out there who understand older adults. They understand the issues of moving.
And the goal is, the ideal goal in moving is to take Mom from a very stable house where everything is in its place, and if she’s moving into a community, having her walk into her new apartment or her new room completely set up. Take away all the moving and the boxes, the more you can remove that from the situation, the more successful the transition will be, because the transition is enough on its own stressful. And just like children, stability is always great, so you want the transition to be as comfortable and transparent as possible.
Once the move is done, it’s also understanding the paperwork that you’re going to be filling out to move into a community. The state requirements, there are community requirements that many times I’ve seen families just rush through just to get Mom in the building. Then they haven’t understood fully what some of the house rules are, what some of the visitation requirements are, and taking the time to understand where you’re moving into, what are some of the expectations of you before you move in.
And last thing is once that move is done or during that move, notify the friends and the family and her church friends. Make sure everyone knows that’s in her circle that she’s moving because the socialization is a critical piece in her care, and keeping those relationships in line is tantamount to them thriving.
Schenk: Right. That sounds about right. Jeff, I think we’re about at the end of the show. So can you tell the listeners out there how they can get ahold of you? What’s the phone? What’s the website?
Jeff: Sure, my website is parkviewagingservices.org, and I’m happy to give my number on the air if that’s okay with you guys.
Schenk: Sure. We’ll have it on the screen, but for those people that are listening, that would be effective, so go ahead.
Jeff: Sure. Yeah, my direct number is 404-936-5746, and that’s also on my website, parkviewagingservices.org – it’s a dot-org.
Schenk: Got you.
Jeff: And on my website, I tried to put in there just all about me, what all I do, references for who I’ve worked with, so trust is a big factor here and I have to develop trust with a potential client because this is a very important decision, and so I’ve structured my website to do that, and so those are the best ways to find me.
Schenk: Excellent, Jeff. Well we appreciate what you do.
Schenk: And who you’re working for and it’s great and we appreciate you coming on the podcast. We’ll get you on some other time to talk about selecting nursing homes in the future.
Smith: And we appreciate your life-long commitment to the elderly and all that you’ve done in your different phases of life. It’s really an underrepresented area of the population, so when we find somebody like you, we really appreciate the work that you’re doing.
Jeff: Well I appreciate the opportunity and I look forward to doing more in the future.
Smith: Sounds good.
Schenk: All right, thank you so much.
Jeff: All right, thanks, gentlemen.
Schenk: Alrighty, bye-bye. Man, he knows his stuff. I feel like there’s so many angles to moving someone that’s a family member out of the family environment to a different environment. There are so many competing interests, desires, that kind of thing. He has to be a saint.
Smith: Well he’s done stuff for the elderly his entire life. He and his wife have participated in the Adopt-a-Senior program in east Atlanta. He managed a Kroger at one point – he helped start the senior discount there. So the guy has a calling and he’s meeting that calling and it’s really important.
Schenk: That’s right. Speaking of calling, I believe that the end of the episode is calling.
Schenk: So we hope that you’ve enjoyed this episode. Actually, if you’re listening to this as it goes to air, which will be July 9th, first of all, I’d like to wish a happy birthday to my mother whose birthday is on Wednesday, July 11th. She’ll be 76, because we did her 75th birthday last year, so she’ll be 76.
Smith: I would also like to wish a happy birthday to her and I will probably post it on Facebook before Rob does.
Schenk: Mom, if you’re listening, Will does not wish you happy birthday. When we were off air, he was like, “I don’t like you.”
Smith: I hope she has a horrible birthday.
Schenk: Yeah, all these things. At any rate, also July 11th is be sure to go down to your 7-Eleven, and if you’re in the South, we don’t have 7-Elevens, I don’t know where you would do this, but it’s Free Slurpee Day. Free Slurpee Day.
Smith: We do have 7-Elevens in Georgia.
Smith: They’re not local and they’re very rare. There are certainly more in the Commonwealth of Virginia.
Schenk: At any rate, go get your free slurpee, Mom, on your birthday. Tell them it’s your birthday, maybe you’ll get two. That concludes this episode of the Nursing Home Abuse Podcast. You can listen to a new episode each and every Monday morning. You can either view it on our YouTube channel or on our website, which is NursingHomeAbusePodcast.com, or you can check us out, download the audio or MP3 on wherever platform you get…
Smith: Spotify, Stitcher.
Schenk: Stitcher Puppy.
Smith: Stither Puppy. iTunes, Spotify for sure, anywhere that you get podcasts.
Schenk: Literally anywhere.
Smith: We’re there.
Schenk: Anywhere. Just throw a rock and you’ll hit our podcast. And with that, we’ll see you next time.
Smith: See you next time.
Thanks for tuning into the Nursing Home Abuse Podcast. Nothing said on this podcast either by the hosts or the guests should be construed as legal advice, nor is intended to create an attorney-client relation between the host or their guest and the listener. New episodes are available every Monday on Spotify, iTunes, Stitcher or your favorite podcast app, as well as on YouTube and our website, NursingHomeAbusePodcast.com. See you next time.