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Elder Long Term Care: Economics and Family Security

By Lillian L. Hyatt, M.S.W. and a Resident of a CCRC

Excerpted from the Fall 2008 The CANHR Advocate newsletter

Very few families become aware of how profoundly economics affects them until seniors begin to look into their options when seeking life–long care in a CCRC. Nor do they realize how many decisions are made by the administrators of these not–for–profit facilities that are primarily concerned with the bottom line, rather than the safety, care or security of the elderly they are persuading to buying this life long care service.

In my CCRC on July 30, 2008, at about 1:40 P.M., as residents were returning to their apartments, a voice came over the loud speakers in each apartment saying "Code Silver," followed by the announcement that all elevators had been shut down. I called the reception desk because in the eight years I have resided in my CCRC I had never heard such an announcement. The receptionist reluctantly told me after I insisted that "Code Silver" meant that either a hostage had been taken or someone with a weapon had entered the building. Fortunately, I was in my apartment and remained there. Later that day, I ran into the head of our building security. When I questioned him, he refused to tell me what was happening. He said that the event would be written up by our administrator and then I would know the facts.

Finally the "facts" were posted in the elevators. After a police chase, an intruder had "entered our Post Street parking lot on a bicycle, which he abandoned outside the gate to our garden. At that time he proceeded on foot through the garden." That did not sound plausible to me because the garden gate is tall, spiked and locked. After questioning a number of people, I discovered that gardeners were disposing of trash and had indeed left the garden gate open. It was not one of our security guards that had seen the intruder, but one of our maintenance crew. He observed the entire scene from an empty apartment window. As a resident, I have been aware for some time that our security staff is very sparse and not adequate for a twenty–five–story building housing many infirm elderly residents using walkers, canes, crutches and motorized wheelchairs. That the intruder walked in through an open gate was omitted from the administration’s report to the residents.

The "facts" given residents included that the intruder "jumped from the ground level to the roof of the employee dining room in the level below." From there he could have entered the building where many residents were leaving the dining room after lunch. The "facts" assured residents that "our staff was then deployed in pairs to do a full systematic sweep of the building…to insure that no breach had occurred."

On August 4th, I was walking around our two parking lots and could not locate any security personnel. When I questioned the receptionist, I was informed that there were only two security guards on duty. One could not leave the post, which monitored the cameras. The other had been called to open an apartment door for a resident. If another resident required assistance for a serious health problem, there simply would not have been a guard available. The third guard is the head of security, who is on duty only from 8AM to 4PM. In addition, he admitted that if he is in a meeting he is not available to fulfill his guard duties.

The constant turnover in the guards employed from an outsourced security company almost assures a lack of adequate training to fulfill the security needs for elderly residents. In addition, the sixteen hours of on–the–job training given to new guards is inadequate. Screening for language skills and the ability to make correct decisions is not carefully evaluated before a person is hired. In the event of an emergency, guards are not able to use the system which informs residents of what they should do. To remedy this situation, a number of residents volunteered to help by making emergency announcements in clear English to inform residents of what they should do if there is a fire alarm or another disaster. Earlier in the history of CCRCs, all guards were employees of the CCRC. Out–sourcing is currently the practice. It may work for for–profit companies, but does not serve the needs of a not–for–profit facility organized to provide long term health care for the elderly at the lowest possible cost to maintain their tax exempt status. The fees of the security company are more than double the amount paid per hour to the guards. It is unclear how this practice squares with the principle "at the lowest possible cost."

Security in a CCRC can be breached in many ways. Recently a young couple (who were my guests staying in this facility’s guest apartment), returned late at night when the Certified Nurses Aides (CNA) were leaving the building after their shift. The receptionist at the front desk had left for the night. My guests were let into the locked building by a CNA. They were never questioned by nor stopped by security guards. Only a very limited number of CNAs are employed by the CCRC. Most of the CNAs working in the building are outsourced. None of these outsourced employees are given any security briefings. Only after I brought this fact to the attention of the security supervisor was this obvious problem addressed. All such outsourced people now must leave and enter through a door in the basement constantly monitored by security.

These are just a few of the factors that address concerns about Elder Long Term Care: Economics and Family Security.