Assisted Living Facility Question

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UOAA-AdvocacyManager
Posts: 14
Joined: 2017-01-24 11:39:40

Assisted Living Facility Question

Post by UOAA-AdvocacyManager »

Recently ASG Ostomy Association of Albuquerque (OAA) became aware of a state regulation for assisted living facilities (ALF) in New Mexico, which may limit the access of ostomates for admission. The regulation considers ostomy care as requiring a higher level of continuous 24 hour nursing care and thus, inappropriate for admission unless they are capable of self-care of their ostomies. In general people seek admission to assisted living because they need help in self-care so it is difficult to understand the regulation. OAA believes that the task of emptying a pouch is related to the tasks of toileting hygiene which is a service provided by these facilities. Depending on the training of the caregivers employed they also feel that an uncomplicated change of pouch could also be managed in an ALF facility. Problems regarding the stoma or assessment for pouching issues are the venue of medical professionals.

OAA contacted us here at United Ostomy Associations of America, Inc. (UOAA) regarding this concern and we are both interested in determining if people have been refused admission to an assisted living facility and if so how big is the problem. We are appealing through this Discussion Board and other means to understand how many people this has affected. We need this information to go forward and create a plan. Please contact us by post or privately by the contact button, if you have been denied admission or anyone you know has been excluded by this regulation. Please share the location of the facility as well as the reason for the admittance denial and if it was based on a state regulation versus internal policy.

Thank you!

Jeanine Gleba
UOAA Advocacy Manager
Abbi
Posts: 19
Joined: 2017-01-31 12:25:46

Re: Assisted Living Facility Question

Post by Abbi »

I don't know anyone effected by this, but it certainly is eye-opening! Thank you for raising awareness of this policy regarding ostomates. I had no idea an ostomy could result in denial of residence in an assisted living facility.
Permanent ileostomy.
lmona
Posts: 10
Joined: 2007-10-24 23:45:31

Re: Assisted Living Facility Question

Post by lmona »

Cumbersome to search for it is by state and counties, but may be useful.
http://www.assistedliving.com/laws-by-state/
LaLa
lmona
Posts: 10
Joined: 2007-10-24 23:45:31

Re: Assisted Living Facility Question

Post by lmona »

National Conference of State Legislatures (NCSL) 50-State Searchable Bill Databases at http://www.ncsl.org/research/telecommun ... bases.aspx includes many topic areas. I am familiar with the education database. The health area databases may be the ones to search that may be useful in this issue area.
LaLa
lmona
Posts: 10
Joined: 2007-10-24 23:45:31

Re: Assisted Living Facility Question

Post by lmona »

LaLa
lmona
Posts: 10
Joined: 2007-10-24 23:45:31

Re: Assisted Living Facility Question

Post by lmona »

I conducted a general search on "ostomy' resulting in a few results http://www.ncsl.org/GoogleResults.aspx?q=ostomy
The result that sounded most promising was the following.
State Insurance Mandates and the ACA Essential Benefits Provisions
http://www.ncsl.org/.../state-ins-manda ... efits.aspx
State Health Insurance Mandates and the ACA Essential Health Benefits (EHB) Provisions, with 50-state tables showing differences among states.

That Web page http://www.ncsl.org/research/health/sta ... efits.aspx
includes sections on the right under the Health category. These individual areas then each have a web page and on those web pages are subsections, REPORTS/DATABASES. These databases are where the searches can be conducted. I have tried several for "assisted living" or "ostomy" but I am not having results, so these need to be explored further for the referenced bill and any other similar emerging bills.

I hope that the above postings help.
LaLa
UOAA-AdvocacyManager
Posts: 14
Joined: 2017-01-24 11:39:40

Re: Assisted Living Facility Question

Post by UOAA-AdvocacyManager »

Thank you for going above and beyond assisting us with finding answers! Unfortunately, assisted living facilities are regulated by each state and not related to the ACA or state health benefits. However, although as you wrote cumbersome to search state-by-state those other links are the other way to find the contacts for each state to gather more information on the admission regulations in assisted living facilities and can prove useful in the future.

Have not heard of many people affected by this yet....

Thank you again! I will share all of this with the folks in NM also!
Pomma4
Posts: 2
Joined: 2017-08-24 17:36:10

Re: Assisted Living Facility Question

Post by Pomma4 »

While searching information on assisted living facilities in Mass and New Hampshire was told by rep from A Place For Mom that states regulations state that ostomy patients must be able to care for their ostomys themselves.. Also diabetics must be able to inject insulin shots themselves. My GI was stunned to learn this information. This is a situation that needs to be corrected.
UOAA-AdvocacyManager
Posts: 14
Joined: 2017-01-24 11:39:40

Re: Assisted Living Facility Question

Post by UOAA-AdvocacyManager »

Thank you for the information on these 2 states.
stacythomas22
Posts: 1
Joined: 2018-02-09 07:20:50

Re: Assisted Living Facility Question

Post by stacythomas22 »

My father is currently in a rehab facility in Delaware after a compression fracture in his back caused by falling. He has dementia and a colostomy and we were hoping to move him into an assisted living facility from the rehab, but are worried because Delaware does not do colostomy care in any assisted living facilities. My sister is actually looking an hour+ away in Maryland because they have colostomy care at the assisted living level there. I am worried that we won't be able to keep a close eye on him if he is further away. Any recommendations? We have been looking for an outside agency to take care of the colostomy as we are not sure that having us do it will be sustainable.
JZ6
Posts: 3
Joined: 2018-04-24 15:15:30

Re: Assisted Living Facility Question

Post by JZ6 »

My mom is to be discharged from rehab Friday back to the memory care section of an AL (where my father is now) in Virginia.
She was living there for 1 month and then had emergency surgery resulting in a colostomy. She has a fractured L1 and has Alzheimer's.
I was being trained on how to change the bag but now the AL says that wound care is above the level of services they provide.
What do you think my chances are of convincing the facility to get their staff trained on the care? Can I bring in an outside nurse to change the bag? What else can I do?
UOAA-AdvocacyManager
Posts: 14
Joined: 2017-01-24 11:39:40

Re: Assisted Living Facility Question

Post by UOAA-AdvocacyManager »

This is a very difficult situation especially given the other medical conditions of fracture and Alzheimers. Unfortunately, UOAA can't provide medical advice including recommending the best type of care facility for individuals.

I suggest you call a case manager or social worker in the hospital where your mother had the ostomy and see if there is a private locator type of service that can counsel you on the facilities in your area that would best meet your mother’s unique needs and to fit the financial situation.

Also you can bring in homecare or an outside WOCN because an assisted living facility is considered equal to a person’s home. I would check to see if the assisted living facility has a home health agency affiliated with it. They can do the wound care and also teach you how to change the ostomy appliance. If not – you may have to hire home health to come in.

Not knowing the financial situation another option is to pay for an aide to stay with your mother and perform ostomy care services so that she can stay with your father in the ALF.

You might want to sit with the director/manager of the AL facility and discuss the issue. If you change the appliance, will they empty it as part of toilet hygiene? Find out what options you can work out together.

Every state has different regulations for assisted living care and in Virginia In accordance with § 63.2-1805 D of the Code of Virginia, assisted living facilities shall not admit or retain individuals with any of the following conditions or care needs:
9. Individuals requiring continuous licensed nursing care;
12. Individuals whose physical or mental health care needs cannot be met in the specific assisted living facility as determined by the facility.
It also stated the following:
L. When care for a resident's special medical needs is provided by licensed staff of a home care agency, the assisted living facility direct care staff may receive training from the home care agency staff in appropriate treatment monitoring techniques regarding safety precautions and actions to take in case of emergency. This training is required prior to direct care staff assuming such duties. Updated training shall be provided as needed. The training shall include content based on the resident's specific needs. The training shall be documented and maintained in the staff record.

You can read it all here: http://www.dss.virginia.gov/files/divis ... lf_reg.pdf

I hope you are able to find the best solution for your mother.
JZ6
Posts: 3
Joined: 2018-04-24 15:15:30

Re: Assisted Living Facility Question

Post by JZ6 »

Thank you, this is very good information that I am definitely going to follow up on.
I really appreciate it!
vincefaiola
Posts: 28
Joined: 2018-02-19 10:49:57

Re: Assisted Living Facility Question

Post by vincefaiola »

Be sure to check out their Medicare star ratings and feedback here: https://www.medicare.gov/nursinghomecompare/search.html?

You can compare facilities in your area. The quality of care for ostomates can be very poor due to lack of education.

As a manufacturer rep (and president of the Oregon Ostomy Association) I am working to fix that. I’d call your manufactures education and support program if you find education is needed. Those advisors will reach out to the people in the field and let us know where to go to help
JZ6
Posts: 3
Joined: 2018-04-24 15:15:30

Re: Assisted Living Facility Question

Post by JZ6 »

I was lucky to find a new facility in my area that welcomed my mom with her dementia and colostomy. It is a dementia-only facility. There is a home health care nurse scheduled to visit and change the entire bag weekly and she is training the staff at the facility. The staff was willing to replace the bag when she pulled it off during the middle of the night. We have found some clothing solutions that work well to keep her from pulling it off, although some places consider a onesie with back zipper and crotch zipper to be a form of restraint. Seems to me that when weighing the options, it's better to have the onesie on and protect the stoma than to not use it and risk infection or trauma to the stoma...
It's called Poet's Walk in Leesburg, Virginia.
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