I suppose I shouldn’t have been surprised by this sentence in a recent report by the Federal Government. The sentence reads, “In addition, the most poorly performing homes tended to be chain affiliated and for-profit and have more beds and residents.”  The report, by the General Accounting Office, is a lengthy document about the quality of our nation’s nursing homes. To see it in print – from the federal government – that “chain affiliated and for-profit” nursing homes tend to be the ones offering the poorest care to residents only reaffirms what I have long suspected, and what I have heard from many of you who write to share your personal experiences of loved ones in senior living facilities. Time and time again, I hear that the best care tends to come from a personal connection between caregiver and resident.

And here is another interesting finding – the most poorly performing homes are distributed UNEVENLY across the states, with eight states having no such homes and ten others have from 21 to 52 such homes. Where do you find the 52 worst nursing homes? According to the GAO, that’s in Indiana. Florida has 16 that make the list, a relatively low number considering there are 664 nursing homes in my Florida Senior Living Advisor database. But we don’t do as well as another popular retirement location – Arizona has just 4 homes on the list.

According to GAO’s estimate, of the 16,000 nursing homes in the US, four percent – or 580 – could be considered the most poorly performing. If you want to understand more about the GAO’s research and conclusions, you can read the summary and recommendations, or even review the entire report. But be patient – it is 57 pages long! (The map showing numbers of poorly performing homes in each state is on page 15.)

In the past year, I’ve seen first-hand how devastating a fall can be to an elderly person. My 84-year-old father has fallen twice in his independent living apartment. The first time, he was on the floor for about 36 hours before he was found; the second time, he was down for about five hours. He has been very lucky – he has recovered fully from both incidents, with no long-term effects. In fact, I think his two artificial hips have actually been a blessing in these  falls – his right hip did dislocate both times, but doctors were able to pop it back into place; had this been his natural hip, it likely would have broken, leading to a much more difficult recovery.

The sad reality is that falls are one of the most common causes of accidental death in the elderly. A series this week in the Minneapolis Star-Tribune aims to raise awareness of the prevalence of falls in Minnesota nursing homes; I have to believe this is a similar problem nationwide, and not just in nursing homes but in assisted living facilities, independent living communities and private homes. In her commentary on the series, Star-Tribune editor and senior vice-president Nancy Barnes writes, “I urge our readers not to look away, despite the distressing nature of these stories. Nothing is more certain in life than death; we can only hope that we will be allowed the gift of dignity. In many of these stories, that is simply not the case.”

The investigative article is long and, at times, difficult to read. But it is important. Worth sharing. As one doctor quoted in the  article states, “”I think if you asked a person on the street, not one of them would know that if you take the frequency of falling and the consequences of falling, it’s as big a problem as heart attacks and strokes.” My father was one of the lucky ones. For many elderly people, a single fall can trigger a rapid decline in health. I hope you will take a few minutes to read this article. And I hope you’ll share your thoughts by leaving a comment.

I remember when my father was trying to select a Florida senior living facility. The process was frustrating (which is in part why I created Florida Senior Living Advisor) and tiring – driving around from one senior facility to the next, trying to keep track of the different features, costs, options, etc. By the time he had made his decision, we were both a bit worn down and just ready to be done with it. In actuality, that was the time we probably should have been at our sharpest – focused on reading every bit of fine print before he signed on the dotted lines. Yes, we did read over the pages and pages of paperwork very closely; but I’m not confident that we truly scrutinized every point, and we certainly didn’t have it independently reviewed by an attorney.

Thus far, my father has not had any issues, and (knock on wood) I don’t foresee any in his future. But when I came across this article from The Washington Post about contracts at continuing care retirement communities, I figured it was worth sharing. It makes reference to a specific CCRC in Northern Virginia, but the concepts are universal.

Scrutinize any contract to avoid nasty surprises at continuing care community

By David S. Hilzenrath

If you are considering moving to a continuing care retirement community, you would do well to consult a lawyer and read the fine print of any contract to determine whether the potential benefits outweigh the risks. A “Residence and Care Agreement” for Ashby Ponds, an Erickson community in Ashburn, illustrates some of the trade-offs the decision could entail.

You might be drawn to Ashby Ponds by the potential to avoid another disruptive move when you are least able to cope with it, but there is no guarantee you would be able to move to an assisted-living or nursing facility on the same campus — even when those facilities are completed. If the assisted-living and nursing home beds at Ashby Ponds are full, management could arrange for you to go elsewhere.

Some delay in building those facilities is routine at Erickson developments, said Ronald E. Walker, chairman of a nonprofit group associated with Erickson campuses. Though Ashby Ponds opened in September 2008, the assisted-living and skilled-nursing portions were not expected to open until the end of 2011 or the beginning of 2012, according to a May report from the community’s management.)

The deposit you post to move in does not limit the amount you could be required to pay on a monthly basis; management can raise the monthly fees. In addition, the fees can go up as you move from one level of care to the next. At Erickson communities, the average monthly fees range from $1,750 for singles in independent living to $5,178 in assisted living and $307 per day — as much as $9,517 per month — in the nursing homes, Erickson spokesman Mel Tansill said.

Management can decide to transfer you to a higher level of care. If you refuse to go, management can kick you out and hold on to your deposit until 60 days after it finds a new tenant. To gain admission to the community, you have to pass financial and medical reviews. If you marry a nonresident, your new spouse would have to pass such a review before being allowed to move in.

To reassure management that you have the ability to pay expenses, you must agree not to give away any assets that would bring your net worth below a minimum requirement. Evan H. Farr, a Fairfax lawyer who specializes in issues facing the elderly, recommends putting any extra assets in an asset protection trust before you move in.

Unlike a real estate investment, the deposit you post to enter the community does not grow as property values rise. But it can shrink as property values fall. If it takes management a long time to replace you, you may be offered the option of accepting a smaller payout so that management can in effect cut the price of admission for the next tenant to occupy your apartment.

Today is the first annual World Pneumonia Day. Nearly 100 health organizations worldwide have come together to call on governments to take action to address this deadly disease. This awareness campaign is focused on pneumonia in children; and rightly so since pneumonia kills more than two million kids worldwide every year, making it the leading killer of young children.

Let’s not forget, however, that the elderly are the second most-affected segment of our population when it comes to pneumonia. Community Acquired Pneumonia (CAP) causes about 500,000 hospitalizations in those older than 65 yearly in the US and is the 5th leading cause of death in people over 65.  Nursing Home Acquired Pneumonia (NHAP) is one of the most common causes of infection in chronic care facilities and is one of the most significant infection-related causes of mortality in such facilities.

The Centers for Disease Control reports that last year 60% of adults 65 and over received a pneumococcal vaccination, sometimes called PPV. The good news is that if you get the pneumonia shot at age 65 or older, you should be protected from the most common type of bacterial pneumonia for the rest of your life, and Medicare will pay for it. According to the CDC, seniors age 65 and older should consider getting vaccinated against pneumonia as well as the seasonal flu, because they are at risk for developing the two infections at the same time.

So if you have an elderly family member, particularly one living in a senior living facility, find out if they have  received a pneumonia vaccine. Some, such as my somewhat stubborn elderly father, may refuse to get the shot. But it is an important issue to raise with the individual and his or her doctor.