Tag Archives: health regulations

The Best Place for New Yorkers with Alzheimer’s — New Jersey?

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Connecticut?

Many of the New York state regulations that apply to residences for people with memory issues have little to do with reality.  They prevent administrators from providing a continuum of practical, cost efficient, safe and sensitive care for Alzheimer sufferers.   My mom is 95 and has been in specialized memory care assisted living for the past 6 years, first in New Hampshire, now in New York.  Soon my mom may have to move, because she no longer will meet the requirements to live where she lives.  New Hampshire and some neighboring states don’t have these restrictions, but New Hampshire is too far away for me to move my mom back. Next stop:  a nursing home, back with family – or New Jersey?

One NY regulation states that no staff member, not even a nurse, may give a resident medication.  The resident has to be able to take that pill or liquid on his or her own.   My mother never could swallow a pill.  Her inability has nothing to do with Alzheimer’s.  However, it is necessary to circumvent the regulation so a staff member may crush her pill and serve it in applesauce or pudding. The rationale is to prevent giving medication to some one against their will.  This reasoning does not make any sense with those afflicted with Alzheimer’s and other dementias since they have lost the capability to make rational decisions.  Can’t take your medication?  Next stop:  a nursing home, back with family – or Connecticut?

On the flip side, an assisted living medication coordinator many not fill a PRN or “when needed” prescription written by a doctor.  The rationale here is that a person with Alzheimer’s or dementia does not know when a pain reliever or even a decongestant would be helpful.  Aides or nurses, especially if they have cared for a resident for several months, can see or hear when a resident is in pain or has a fever and needs medication, but the regulation prohibits their using their common sense.  Yes there will always be some staff members who may abuse the right to provide medication, but there are other ways of providing checks and balances to the process, rather than to outlaw it altogether.

Another regulation states that residents in these homes must be able to stand and ambulate on their own.  No gentle lifts or pushing of wheelchairs by staff are allowed.  If someone has become too weak to stand up without a helping hand, she’s out.  Next stop:  a nursing home, back with family — or New Jersey?

Still another regulation states that residents in these homes must be able to feed themselves.  Finger food is fine, but no help, not even from a volunteer.  Next stop:  a nursing home, back with family – or Connecticut?

A resident who is “uncooperative,” perhaps because she can’t sleep or does not want to eat or take a shower or take her meds can easily, unintentionally be pushed beyond her fragile line of self-control.  What happens when a resident is in pain or yelling in frustration or anger or confusion?  Often it depends upon who is on duty at the time.  If there is an aide present who has a solid relationship with the resident, the aide may be able to calm her.  If not, and there is no one who may take responsibility to assess the situation on-site, it is off to the emergency room, and most likely, off to the emergency room alone, secured to a gurney, with nothing more than paperwork stating that the patient is “uncooperative” and her behavior is not consistent with her norm.  How to avoid unnecessary traumas in the ER?   You must proceed to the Next stop:  a nursing home, back with family – or New Jersey?

The head of my mom’s “neighborhood” is a very compassionate, professional woman, and has gone out of her way even from home on her day off to time the ambulance pick-up so that I can meet my mom at the hospital.  She has warned me that if my mom is “uncooperative” or “combative” she could be sent to a psychiatric unit.

If there is no advocate for an Alzheimer’s patient in the ER, the doctor may have to admit her, start an IV, insert a catheter for a urine sample, take blood, order x-rays  and other tests to verify that there is nothing wrong.   The last time I was at the ER with my mom, the very wise and young head of the room wiggled through procedures and discovered my mom had a urinary tract infection, wrote a script for antibiotics and sent her back.  I was present and could assure him I was in total agreement with his approach; if not, he wouldn’t have been able to doctor as he did.

It gets worse at the hospital.  When it appears that the assisted living is not able to provide for the patient’s needs – why else would it send a cranky but otherwise healthy person to the ER room — the hospital must, according to state regulations, discharge the patient to a nursing home.  This almost happened to my mom on another occasion and for another reason.  I was there and I was able to get that wonderful head of my mom’s neighborhood to come to the hospital to offer her assessment of my mom’s condition and to vouch that the assisted living was capable of meeting her needs.  But what if I weren’t there?  Or think, what if you weren’t there for your mother?

I’ve looked at nursing homes in order to be prepared if my mom really did need to move.  Nursing homes provide skilled nursing.  Alzheimer’s and memory loss seniors do not need skilled nursing unless they have some other medical condition.  They need someone to help them transfer from their bed to their wheelchair or to eat or to toilet.   Nursing homes are also very expensive – from $5000 to $8000 more a month than what one pays for assisted living – which is already expensive.  Does it really cost another $5000 a month for someone to help a person into a wheel chair and wheel them down to the dining room?

I asked professionals at the nursing homes and in Alzheimer’s support organizations, how do people pay for this.  And the answer was:  “They don’t.”  Medicaid pays for it. “What if you don’t qualify for Medicaid?”  The answer:  “You will soon.”

Oh.

Something is out of whack here, and I’m not sure I want to try to figure it out.

Instead we will be going to Connecticut – or New Jersey.

Our Favorite Chinatown Restaurant

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I have a favorite Chinatown Restaurant. Me?

When I was a little girl my parents brought me to Chinatown in Manhattan.  I don’t remember what we did there but I do remember feeling frightened.  Nothing was familiar — the sounds, the faces, the smells, the signs, the crowds.  It was sometime in the fifties.

Now I go to the city at least once a month, and I stay with my friend Lee in his apartment on Mott Street.  Lee is not Chinese.  He inherited the apartment from his late wife.  He feels Chinese.  I don’t. This is my second Chinatown experience, and I feel just as much a foreigner.

We have two dogs – a sixty and a one hundred pounder. They are large dogs and very conspicuous in Chinatown and so are we. We take them down to Columbus Park and if the weather is good and we have time, we walk them out among the city and state government buildings and parks.  We are more or less just part of the city outside of Chinatown.  My dog has leash aggression and the whole time we’re walking I’m on a vigilant lookout for “other” dogs.  For two country dogs, they do very, very well in the crowded streets of Chinatown, where so many of the people are elderly and slow and there is so much food out on display in the markets in the streets, and incredible smells coming from the trash bags along the sidewalks. Most people smile at them.  The dogs are less intimidated than I am.

Lee and his wife frequented two restaurants, both owned by the same family.  They were very friendly with the owners, and they would joke about matching their children up.  When we go in for dinner or for meals to bring back upstate, they recognize him, and now me.  It is always nice to be welcomed into a restaurant with a big “hello again” smile and the food is great.  One of the great days in my friend’s “getting used to being in Chinatown without his wife phase,” was the day he approached the owner to work with him on the menu for a banquet for some family that were in town.  Sitting around the table with the waiters bringing out one delightful, authentic dish after another and with his family beaming, made him feel as though he really was Chinese.  (Our neighbors know him for his excellent crispy noodles and stir fry and we’ve been joking about opening up Lo Fan’s Noodle Shop in the mid-Hudson Valley region.)

Last fall we went to Hsin Wong, one of the two restaurants, and noticed a big “B” in the window.  New York City’s Department of Health and Mental Hygiene had initiated a new two-step restaurant inspection process in 2010 that requires restaurants to post their ratings in the front window.  My son Morgan has a career in public nutrition and food policy and I had read about this program with interest, as I read anything which makes me feel more connected with my sons, when it first was announced.  He had worked in kitchens a good part of his high school and college life, and had told me stories that I don’t want to repeat about kitchen conditions.  I thought the city was doing a great service by conducting the inspections and letting diners know the results.

But now, I was confronted with a dilemma.  Did I want to not eat in this less than pristine restaurant that I had eaten in with relish before?  Did anyone that we knew ever get sick from lack of sanitary practices in Hsin Wong?  There was a lot of conflict here.

Of course we went inside, had a wonderful dinner, bought our see yu gai  and Chinese broccoli and went home.  We were correct in following our instincts.  After all Thomas Farley, MD, MPH, Commisioner of the Department of Health, wrote that:

“In the first year or so of grading, we expect that most restaurants will earn a B grade. Restaurants with B or C grades should improve their overall food safety practices, but the Health Department immediately closes restaurants with conditions that may be hazardous to public health.”

The next time we were in Chinatown we went out to eat and found Hsin Wong closed.  No sign literally or figuratively of what happened – just a overhead metal gate where chickens and roast pork used to hang.

We went to Yee Li, formerly known as The Big Wang, the other family restaurant down the street, chatting with the owner while we ate.  He told us that they had lease renewal issues at the Hsin Wong and that was that.  Besides, even I was quite aware since my short re-acquaintance with Chinatown, that stores and restaurants were always opening and closing.  Business there had dropped considerably since 9/11 and the “fortification” of the NYC police headquarters made it difficult for downtown workers to get to Chinatown for lunch.

We were in Chinatown just last week, and much to our surprise we found a big C in the window of Yee Li.  Oh no.  What will the owners do?  Clean up or close up?  We don’t know any of the facts and it is better not to even venture a guess.  We had another wonderful meal and brought back chicken and pork and ribs and had friends over for dinner and everybody is feeling good.  No General Tso’s revenge.

But we are curious what will happen to Chinatown.  The city has recently designated it as one of its more than 60 “Business Improvement Districts”  and there is a movement among local groups and committees to preserve the character of the neighborhood.

The apartment house on Mott Street shares a stoop with a popular restaurant.  The shop on the other side of the door sells fans, hats, Chinese jackets and dresses, t-shirts, tote bags, and scarves that drape over onto the stoop.  Every time I walk out onto the street I squint in the bright sun and I look around and wonder how I got to be where I am.  We’re going down for Chinese New Year.  We’ll sit on the fire-escape and watch the dragons.  I can’t wait.

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We were down for a visit a few weeks ago.  Yee Li has it’s A!  — April 2013