✨✨General Discussions

I'm in a California CCRC, and this question comes from the discovery of a gap for people in IL who don't acknowledge the need for any help at all.  

This seems to be a role that is quite necessary for those with no family or other close person nearby as they begin losing their ability to make good decisions or show signs of mental slippage, but are still highly functioning otherwise - and not recognizing their own decline.  If you have such a role in your community, please let me know if there is any state legislation making it mandatory.

Such a role would cover things like engaging a 'helper', attending medical visits, assuring meds are taken, making appropriate calls if more help is needed, etc.. (not physical or personal care). The person that led to this discussing does not need help with dressing, bathing, dining, etc. (AL), nor institutionalization, but not recognizing the fact there is a decline at all does put her in some danger and also causes a lot of concern among neighbors in the community. And seemingly, not much from the administration.

I find this question very useful to our community. Than you for starting this discussion. Our Resident Services staff review the functional status of each resident in IL on a regular basis, follow up on concerns of neighbors and friends, family, other staff, etc and do closely monitor if needed. However the staff identifying the need is one part of the equation. The more challenging is for the resident and especially with little or no family who live close by to accept the need and ideally identify it themselves. Many times it is the presence of the dreaded fear and often reality about leaving their IL home and moving to AL. Resident leaders encourage the addition of a social worker with knowledge and experience in seniors to be added to staff to have the skills and time to work with residents, family , friends and even staff to better understand "what's going on" during this phase of aging. and option to improve the quality of life without moving to AL. We tried to do so with reluctance from senior clinical staff and resident services who seemed threatened by this idea and believed all was well and between clinical AL staff and resident services this was being managed well. Residents who had professional experience with the role of social workers in senior care felt strongly that the skills of a social worker can significantly improved the quality of care in this transition phase beyond what a nurse can do who has some similar but different set of skills or the hands on help of a home health aide. Uhfortunately what administration found was it was very difficult to recruit a social worker at either BSW or MSW level who was knowledgeable and even more so experienced in this type of work. There was lots of confusion about this being classical "case management" even though a mutual job description was created by AL nursing leadership, resident services and residents knowledgeable in senior care at MSWs. Unfortunately a person was hired, it was not a good match and the solution implemented by administration without discussion with members was to identify a beloved part time experienced LPN I believe who had worked in AL for many years and had excellent skills in caring but from the residents perspective did not have the complex skills of understanding personal and family dynamics , seniors, etc. to help identify, communicate and support and the creation of a comprehensive team based care plan for such a resident. Currently residents continue to be observed, families are informed and sometimes some supplemental services such as help from a home health aide or a vetted part time private caretaker a few hours of week are added at the expense of the resident. This supplemental care happens only if resident and family buy into the situation which often takes way too long to just happen without the skills of a social worker. I am grateful for what our community does provide but it can and should be better especially we have the resources to do so.

I am particularly interested in learning more about how other communities use social workers to support and help IL residents and families in a CCRC community or other approaches that improve the quality of life residents during this stage of their life..

Thank you

Mary Vallier-Kaplan from NH

Note: I have very low vision so please accept the errors in this email.

At Panorama in Lacey, WA we have four social workers whose role is to address just such situations, These social workers are funded by our Benevolent Fund, not by the Corporation, but they are employees of the corporation and function as such. All have BSW, one has earned her MSW while employed here and another is working on her MSW.

Each resident is assigned to a specific social worker.We have annual visits to check on personal concerns, confirm any personal information (such as emergency contacts, POAs, etc) is still valid, etc. We can also request a conversation with our assigned social worker at any time, to discuss any concerns we may have.

If we notice a neighbor who seems to be experiencing challenges of any sort we contact our social worker who then works with that person's assigned social worker to evaluate the situation and take any necessary steps to insure the safety not only of that resident but of the other residents in the neighborhood. Our social workers are very skilled at helping determine the best course of action, including involving the POA or even state Health and Welfare if that is warranted.

I do not believe this service is required by the state - witness the fact that the corporation does not provide it directly. It is only provided because the Benevolent Fund is willing to pay for the cost of these social workers.

It is a narrow row to hoe between helping and paternalism. And if the social workers are not masters prepared (licensed, not caseworkers) and are employees of the corporation, their skills and loyalty are questionable.

Retired advanced practice psych nurse.

CCRCs contract with residents to provide continuing care over a lifetime, so you need to find out how it works in your facility. Compassionate reporting would be a very common occurrence in any CCRC and there are professionals there who know how to manage it. Typically this is done by BSW or MSW level social workers and, in these cases, experience is more valuable than credentials.

These problems are among the most difficult situations a professional is called to manage as they involve medical, psychological, social, financial, contractual, insurance, housing and more. Resident and family are involved and everything evolves over time. Residents have rights to be respected.

Report what you observed and why you have concerns and ask the facility to check it out, just as you would call security if you saw a resident in distress.

Then request your facility provide a workshop to educate the residents on this issue. After all, you may benefit from the help of a compassionate fellow resident who reaches out to get you the care you may need at some time.

Maura Conry (retired social worker)

NaCCRA

Forum Facilitator

Thank you to all who have so far replied. We are learning a lot from your answers to the question (mostly what we do not have that is more commonplace elsewhere!) The reason I wrote is that we have no BSW or MSW available to IL, and admin does not seem inclined to even address the issue.

My question, in addition to learning what could be done, was to find out as much as possible about what is already being done in other CCRCs in these situations. I'm most impressed with the full-service picture painted by Karren Lore's response from Panorama in Lacey. WA. Sounds amazing - and so far from what is available here, we might be on another planet instead of two states south!

So knowledge of any other similar or equivalent services being offered would be welcome, as well as knowing whether your state requires any particular interventions or services to IL residents who do not themselves seek it. (Again this is mostly about those residents who do not have any family or 'external' friends to call on). Thank you again for letting us know your thoughts, processes, laws or anything else to give us some fuel for taking this issue forward.

We live in a CCRC that was founded by two Episcopal churches. The CEO told me this morning that there is a committee that meets every Wednesday to discuss individual situations regarding healthcare transitions. The committee includes the CEO, the NP for independent living, the head of our three levels of healthcare, two chaplains, at least one social worker, and possibly others. When a resident is having issues dealing with healthcare, members of that team decide who is best connected to the resident and/or the resident family, and that person takes the lead for the week. Respect for independence means that the resident is still regarded as the major decision maker. Transitioning out of I.L. may therefore take a rather long period of time.

Thanks for your post. You are well served! We have no NP (for any levels of care), no SW in IL, and I don't know about a committee but will investigate.

Practical Solutions for Safety of Solo-Agers living in CCRCs:

Solo-agers are residents with few to no external support system outside of the CCRC.

1) Texting Buddy System:

• Three (3) residents, all solo agers, text each other every morning as a check-in.
• If one fails to respond by 11am, attempt to make telephone contact.
• If unable to reach the person by phone, we send security for a safety check.
• Three (3) is the perfect number as its small enough to be managed easily.

2) Motion Detection System:

• Bathroom placement of a motion detection system.
• The system is keyed into security similar to the way the emergency pendants are.
• If no motion is detected by 11am, security initiates a safety check on the resident.

3) Chosen Family Concept:

• These residents must form their own internal family system if they have the skills to.
• Network with other solo-agers to identify shared interests and goals.
• It takes work, effort, and intent to seek out kindred souls, but worth it.
• A good place to start is engaging residents, or joining groups, who share your interests.

4) Professional Surrogates:

• Hire a Patient Advocate.
• Hire a Geriatric Care Manager.
• Research what professionals may be available in your state.

These are just a few of the systems I know. Perhaps other Forum members know other solutions.

Maura Conry

NaCCRA

Forum Facilitator