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>> Hardaway: On this edition of
"The Best Times" we explore
"The Nursing Home Puzzle" to
make sure you know what
questions to ask in choosing a
facility.
We'll talk with the author of
"Memphis Chronicles", John
Harkins.
And we'll look at the most
common eye disorders affecting
people over fifty.
>> (instrumental music)
♪♪♪
♪♪♪
>> Hardaway: Funding for The
Best Times is provided by...
Since 1988 the H. W. Durham
Foundation has been focused on
aging issues -- providing grants
to programs like The Best Times
to enrich and improve the
quality of life for our older
citizens.
The Best Times is the only
monthly news magazine
exclusively for the age 50 plus
reader.
Your copy is free at over 200
locations, with important
stories and news you don't want
to miss.
The Best Times is always the
best.
Trezevant, a lifecare community,
a celebration of life.
The responsible decision for
your well-being now and in the
long-term.
And being responsible has never
been such a hoot.
Trezevant Manor dot org.
Hello, I'm Cris Hardaway.
Welcome to this edition of "The
Best Times", a series that looks
at life after fifty.
One of the realities of dealing
with life after fifty is the
threat of a debilitating disease
or a catastrophic injury
affecting a loved one.
Imagine this scenario -- one of
your aging parents falls and
breaks their hip.
Surgery is required, followed by
post-op recovery.
And then one morning, you're
surprised when hospital
administrators tell you they'll
be discharging your parent the
day after tomorrow and they ask
you what nursing home you've
chosen.
You've gone from one crisis to
another.
How do you select the right
nursing home?
What are your choices?
And how will you pay for this?
These are just a few of the
questions that make up "The
Nursing Home Puzzle".
>> (instrumental music)
♪♪♪
♪♪♪
>> Walsh: I don't think anybody
wants to put their loved one in
a nursing home.
>> Hardaway: Ten years ago
Dottie Walsh's sister was placed
in a nursing home because of
complications with Alzheimer's.
>> Walsh: My sister and I-my
other sister and I, we would
went and we looked at a couple
of nursing homes.
We were trying to find something
close to us.
>> Hardaway: It was a difficult
decision for the sisters.
>> Walsh: When you don't know, I
mean, it's scary because you
don't know what to look for.
There are a lot of things that
people can research that people
can do now but at the time, we
didn't have it.
>> Smegelsky: People do not plan
on going to a nursing home.
>> Hardaway: In her role as
district ombudsman for long-term
care, Sandy Smegelsky knows the
difficult choices that families
often face.
>> Smegelsky: It can be very
overwhelming for a family.
The phone calls I get, people
are panicked.
They really, really are.
They want the best for their
loved ones but they don't know
how to access it.
>> Hardaway: There are over
17,000 nursing homes in the
country.
This year one in seven Americans
will spend time in a nursing
home.
For those 85 and older the
chances increase to one in five.
That's over 3 million people who
will find themselves in a
nursing home this year.
Your parent or loved one may be
one of those 3 million.
How do you locate the right
facility?
Your first stop should be the
Nursing Home Compare pages at
medicare-dot-gov -- a segment of
their website dedicated to
answering consumer's questions
and providing a ratings system
for nursing homes.
>> Smegelsky: The five star
rating is made up of survey
results inspection reports.
That's a third.
Staffings a third.
And then the quality standards
are another third.
It's user-friendly.
And folks have told me that they
found it really helpful.
>> Hardaway: A quick review of
nursing homes in Shelby County
reveals some sobering facts.
Of the 32 nursing homes listed,
only 4 received five stars.
Ten facilities rated only one
star.
The average rating of the 322
nursing homes in Tennessee ranks
the state at 47th in the nation
for quality of care.
>> Smegelsky: Serious
deficiencies that you find, for
instance, on the Medicare
website.
They often put serious ones in
red so they stand out if a home
has difficult problems.
But yes, I think one of our best
kept secrets is that we do have
good nursing homes.
We never hear about them.
We hear about the horrors all
the time.
And don't get me wrong.
We have nursing homes probably
shouldn't be operating that need
to be closed but we also have
good homes.
And we have a whole bunch that
fall somewhere in between.
>> Hardaway: The Nursing Home
Compare website has been in
operation since December of
2008.
The individual ratings are
constantly changing with each
nursing home inspection, but,
sadly, Tennessee consistently
ranks at the bottom for overall
quality of care.
Nevertheless, the website can be
a valuable tool to rate and
compare facilities.
Interpreting the ratings though
can be more art than science,
but one factor that does stand
out are the staffing levels.
>> Smegelsky: You can tell right
away that staffing plays a major
factor.
Someone might have three star
general but overall one star
staffing.
And the better homes, if you're
going to have five stars, you're
going to have a three or above
in that staffing.
>> Munchow: You know, it wasn't
so many years ago that if we had
a 2.20 staffing ratio, it was
considered adequate.
And that's still a bench mark
now.
A matter of fact, the regulation
is 2.0
And when I say 2.0, that refers
to the hours given per patient
per day.
But most of our homes around the
state now have about a 2.75 or
plus ratio.
Our company, we strive for 2.90.
>> Smegelsky: If federal studies
say that the minimum is closer
to 4.2 or 4.1, excuse me, hours
of care per person per day in
terms of giving good care to a
resident.
So you see that Tennessee is
already at half that amount.
Now to give the nursing homes
their due, most nursing homes do
staff higher than 2.0 but very
few staff closer to 4.0
>> Hardaway: The Nursing Home
Compare website can help narrow
your search, but the final step
is visiting the homes.
>> Smegelsky: You want to be
sure to use your senses.
Is there an odor?
What do you see?
Are the residents looking happy?
Talk to the residents.
Ask to observe a meal.
Look at the quality of the food.
Is it appetizing?
Would you want to eat a meal
here.
There's just a lot of indicators
you can tell by being in the
building whether you think yeah,
this would be a good fit for our
family.
>> Hardaway: But there is one
over-riding factor that may
impact your choices.
>> Coulter: Because your choices
truly are limited.
They are limited to facilities
that have vacant beds at the
time that your particular loved
one is being discharged.
>> Hardaway: In Tennessee
occupancy rates for nursing
homes hover around the 87% mark,
so a shortage of beds may be a
governing factor in your
decision making.
But selecting a facility is just
the first step.
Paying for it can be a bigger
hurdle.
According to a 2010 Met Life
study the cost for a private
room in a skilled nursing home
in Tennessee averaged nearly
$70,000 per year.
Medicare only covers post-
hospital nursing home care up to
a maximum of 100 days.
After that the resident is
responsible for private pay.
Some people may have long-term
care insurance that will defray
the cost.
But approximately 65% of nursing
home residents in Tennessee turn
to Medicaid, which is
administered by TennCare.
But qualifying can be an issue.
>> Smegelsky: You have to have
no less than $2,000, excuse me,
no more than $2,000 in cash.
Well, you know, so that means
that many people are paying down
their life savings until they
qualify for Medicaid.
It's a difficult system.
>> Trudy: He can seem pretty
alert and pleasant and happy.
And then within an hour or a few
minutes even he can just act
like he doesn't want to do
anything but sleep.
>> Hardaway: Several years ago
Mack and Trudy Parker sold their
East Memphis home and made the
decision to move to Trezevant
Manor and buy into their
Lifecare program, living in a
two-bedroom apartment in the
independent living quarters.
Then, a few years ago, Mack
began to show signs of
Alzheimer's.
As the disease progressed, he
was moved into the Assisted
Living tower.
A few months ago he broke his
arm, and now requires the
skilled nursing care provided by
the Allen Morgan nursing home at
Trezevant.
>> Trudy: The fact that he
developed this problem with
Alzheimer's that we would have
had to find some way to cope
with it.
And this is certainly the most
ideal way there is.
>> Hardaway: In a sense Mack and
Trudy have planned ahead for the
eventuality of life in a nursing
home.
They bought into one of the
latest trends in the industry -
CCRC's.
>> Poston: The CCRC's,
Continuing Care Retirement
Communities, there are
approximately a hundred and-no,
like 1,500 across the country.
And they're building new ones.
We offer the independent living,
assisted living, long-term care,
skilled nursing care if they
offer beds all on the same
campus.
So you come there.
It's one stop.
It really is a great idea.
Most of them, you can buy in to
the community, the life care.
You do a down payment.
Whatever you pay, you never have
to pay anymore than that no
matter what part of the
community you need to go to.
>> Hardaway: CCRC's are one of
the attempts by the nursing home
industry to keep up with the
changing picture of long-term
care in this country.
But 87% of people responding to
an AARP study indicated a
preference for in-home care for
long-term disabilities.
Here in Tennessee, almost every
penny of the Medicaid dollar
goes to institutional care.
In 2008 the state enacted the
"Long-term Care Community
Choices Act" designed to
increase the number of people
receiving long-term care at home
or in smaller adult care homes.
>> Munchow: What that will do
for us as a skilled nursing home
is it will give our residents
that come here for
rehabilitation more options to
consider after they've
rehabilitated.
So they won't necessarily stay
in a long-term care skilled
nursing home on a permanent
basis or even a long-term care
basis.
>> Coulter: We need to have more
services in the home because
their quality of life will be
higher if they're living in
their own home.
They will be able to contribute
to our communities better in in-
home.
And it's going to actually save
the rest of us money.
>> Hardaway: Four years after
passing the legislation, there
are only a handful of adult care
homes in operation and none are
in Shelby County.
There is an inevitable wave of
78 million baby boomers heading
toward their retirement years.
If current statistics hold true,
nearly 40% of those boomers will
need nursing home care at some
point in their lives.
Will we be prepared?
>> Smegelsky: Hopefully we'll
have more options for the
boomers like home care, nursing
homes, assisted living, and
maybe a few other options like
these adult care homes, smaller
facilities that will be
available and paid for by our
tax dollars.
What other ways can we do thing
to help respond because those
needs are only going to be
increasing.
And those people are going to be
there and they're going to be
again.
And so we need to think as a
society how do we want to deal
with that.
>> Hardaway: The medicare-dot-
gov website has a wealth of
information on nursing homes,
including the nursing home
compare tool.
You can also view and download
the "Guide to Choosing a Nursing
Home" booklet which includes a
handy "Nursing Home Checklist"
to help you ask the right
questions when you visit a
nursing home.
If you're a reader of The Best
Times newspaper then you'll
probably recognize the byline of
Dr. John Harkins.
He writes The Best in Memphis
History column for the paper and
he's compiled selected articles
from five years worth of his
columns into a volume entitled
"Memphis Chronicles".
It offers fascinating tidbits of
Memphis history served up in a
very entertaining fashion by a
man who's love for history began
when he was just ten years old.
Let's meet Dr. John Harkins.
>> Harkins: I've been a history
freak since we started having it
as a separate course in the
fifth grade at Blessed Sacrament
in the 1940s.
It's hard to engage with Memphis
history.
It just seemed to me like we
needed an explanation for why
you can't find local history
here without, you know, a guide
dog of some sort.
So that's sort of what I got
involved in doing was trying to
find ways to bring people to our
area's history which I think is
very rich.
There's an awful lot of very
interesting stuff here.
Could spend a lifetime on E.H.
Crump.
People who are idealistic and
reformed minded look for the
problems associated with the
Crump machine.
And people who I think that
taxes were low, services were
good.
They tend to find ways to
apologize for the evils that did
exist in the regime.
Power is difficult to handle and
almost anybody who has it beyond
challenge tends to take it for
granted and in many instances to
abuse it.
>> Hardaway: The Crump era was a
major part of Memphis history,
but Dr. Harkins enjoys
discovering the smaller stories
that often personalize the
history of our city.
One of his favorite stories
regards the Mackerel Brigades,
gangs of youth that terrorized
Memphis in the 1860s and 70s.
>> Harkins: A bunch of kids
start coming in on steamboats,
mainly from St. Louis and Point
Snarf.
And they were already ragamuffin
kids living by their wits.
And for the first few weeks as
these kids came in because there
was opportunity here under
federal occupation.
There was sort of conflict
between the locals and the
newcomers.
And then a guy named Tom Porter
brought them together under his
leadership and he was the
driving force behind them for at
least three or four years.
And he got hauled in one time
and rather than go back to
prison, he made a break for it
from the station house.
And they shot him down and the
local newspaper praised him for
shooting--
I think he was about 19 by then.
--for shooting this guy down
while trying to escape.
>> Hardaway: After Porter's
death, Jake Ackerman became the
leader of the Mackerels.
He, too, met with a violent
death, murdered by his wife.
>> Harkins: She had turned him
in for wife-beating.
And he had come to court and she
was there to be a witness.
And she just pulled out a
revolver and emptied it in to
him right in the court room.
And I think she got something
like five years and most of that
she got suspended.
>> Hardaway: One of the more
colorful characters in Memphis
history dates back to the
earliest
settlements in the area, long
before the city was established.
It could be argued that Paddy
Meagher (Marr) was the first
Memphian, founding two of the
earliest businesses in the area.
>> Harkins: She had a store and
he sold goods to travelers going
mainly down but up and down the
river.
And he had a tavern.
And initially, it was just
called Paddy Marr's Ordinary.
An ordinary house was a tavern
in the parlance of the day.
And later on he built the Bell
Tavern which was a landmark here
for generations and finally was
torn down I think some time
after World War I.
But he was a colorful figure,
was written about by people in
the 19th century.
And there's a little episode
where his dogs attack a bear
that was coming through town.
And the bear just rips him to
shreds.
And the narrator was glad of
that because he had big eyes for
Paddy Marr's daughter.
And the dogs were allowed to run
loose to keep ambitious sweens
away.
>> Hardaway: The German writer
and critic Friedrich Von
Schlegel said "The historian is
a prophet looking backwards."
Dr. Harkins admits to
occasionally viewing history
through rose-colored glasses,
but he is invigorated by the
opportunity to present history
in an entertaining fashion.
>> Harkins: I get excited about
it and I think that if we don't
have some sense of where we've
been, we've got no chance at all
of solving the problems that we
have now.
>> (instrumental music)
♪♪♪
♪♪♪
>> Hardaway: A few years ago I
began to notice a blurring in my
left eye -- it was like looking
through a fog.
Over the course of the next
three months the fog got thicker
and I went in for an eye exam
which revealed what I already
suspected -- a cataract.
By age 65, one in three
Americans has some form of
vision-impairing eye disease.
Cataracts are the leading cause
of low vision, affecting about
40% of people over age 70.
And age related macular
degeneration is the leading
cause of blindness for Americans
over 50.
Which makes it a good idea to
keep "An Eye on Your Future".
Dr. Chris Lievens is the Chief
of Staff at the Southern College
of Optometry.
He identifies the three most
common eye disorders for older
patients - Macular Degeneration,
Glaucoma and Cataracts.
>> Lievens: Cataracts is the
most common.
You would pretty much predict
everyone past the age of 55 is
going to have some form of
cataracts.
>> Hardaway: A cataract affects
the lens of the eye.
A cloud forms over the lens,
resulting in vision that is
blurry, like looking through a
fog or haze -- symptoms that are
easy to detect.
>> Lievens: Reduced vision at
any time of day particularly end
of day and dusk.
So twilight hours and evening
hours-poor night visions.
And during the day hours-
problems with glare.
>> Hardaway: For severe cases of
cataracts there is a remedy --
replacement lenses.
Cataract surgery is performed on
over three million people each
year with a success rate of over
90%.
>> Lievens: You take out the
lens that's gotten older and
gotten cloudy and you put in a
brand new, crystal-clear one.
A lens that's clear as birth.
>> Hardaway: Glaucoma is the
second leading cause of
blindness.
It is a disease that affects the
optic nerve.
>> Lievens: And Glaucoma damages
that nerve slowly over time.
Affects the peripheral vision
first, central vision last.
Just like macular degeneration,
once vision is affected, it's
permanently affected.
The best medications and
surgeries in the world slow it
down, hasten it, can stop the
disease process from getting
worse.
But when it's gone, it's gone.
And so this is one that we never
tell anybody to wait for
symptoms or look out for certain
things.
It's get in.
Get your eyes examined.
>> Hardaway: With no symptoms,
the only protection you have is
a regular eye exam.
Early detection and treatment
can slow the spread of the
disease.
And that's particularly
important for certain segments
of the population.
>> Lievens: In population as a
whole, we're talking about 1 out
of 200 people below age 50.
But now as soon as you get past
that threshold, now we're
talking about 1 in 10, maybe 1
in 20 if we're lucky.
But it's very much race
dependant.
If we segregate African-
Americans and Hispanics and talk
about them specifically, wow-the
numbers just explode from there.
>> Hardaway: The third most
common eye disease is macular
degeneration which is the
leading cause of blindness for
people over fifty.
>> Lievens: The macula, the
first word in macular
degeneration, is the portion of
the eye that we get 20/20 vision
out of.
Straight in the center in the
back of the eye, straight on
vision.
And that is what makes this eye
disease so problematic because
it affects right where you are
looking always.
So as you move your eyes right
or left, or up or down, this
problem with your vision follows
every where that you look.
So if you imagine trying to look
at somebody eye to eye but you
can't see their face, you can
see to the right of them, to the
left of them, above them and
below them.
But you can't see what you're
looking at.
And that's what's so bad about
this disease.
>> Hardaway: The causes of
macular degeneration are
primarily genetic, although diet
and lifestyle can play a role.
Like glaucoma, macular
degeneration has no cure.
>> Lievens: Unfortunately when
it comes to macular
degeneration, we will talk about
slowing down the worsening.
But once the damage is done,
it's done permanently.
And so regular eye exams to look
for signs of macular
degeneration far before someone
may have the symptom are of
critical importance.
Because once the symptoms there,
that vision is going to be like
that forever unlike the
cataracts that we talked about
where vision gets bad, cataract
procedure takes place, now the
visions great again.
Not so with macular
degeneration.
>> Hardaway: New treatments for
glaucoma and macular
degeneration are being
researched and Dr. Lievens is
optimistic about a future cure.
>> Lievens: And so yes, there's
a very good chance within most
of our lifetimes there could
very well be a cure for both of
these.
>> Hardaway: Until cures are
discovered the best protection
for your eyes is an annual eye
exam that can spot any of these
common eye diseases early.
If you'd like more information
about your vision go to the
website of the National Eye
Institute.
>> (instrumental music)
♪♪♪
♪♪♪
>> Hardaway: I hope you'll join
me next week for more of "The
Best Times."
Until then, please visit our
website at WKNO-dot-org-slash-
bestttimes.
And while you're online, click
over to Next Avenue, PBS's
website where grown-ups keep
growing.
Thanks for watching.
I'm Cris Hardaway.
Goodnight.
Funding for The Best Times is
provided by...
Trezevant, a lifecare community,
a celebration of life.
The responsible decision for
your well-being now and in the
long-term.
And being responsible has never
been such a hoot.
Trezevant Manor dot org.
The Best Times is the only
monthly news magazine
exclusively for the age 50 plus
reader.
Your copy is free at over 200
locations, with important
stories and news you don't want
to miss.
The Best Times is always the
best.
Since 1988 the H. W. Durham
Foundation has been focused on
aging issues -- providing grants
to programs like The Best Times
to enrich and improve the
quality of life for our older
citizens.
>> (instrumental music)
♪♪♪
♪♪♪