1-20-2009 Idaho:LEWISTON, Idaho -- When Lori Hagedorn was working at area nursing homes, she never dreamed she'd be living in one at age 45.
"I used to help elderly people and now I'm living with them 24/7," says Hagedorn, who has been a resident at Orchards Rehabilitation and Care Center in Lewiston since June.
Plagued with chronic medical problems, she is part of a growing population of younger people who need the long-term care, skilled nursing and structure offered in a nursing home.
Two decades ago, about 1 percent of nursing home residents were under the age of 65, estimates Robert Vande Merwe, executive director of Idaho Health Care Association -- Idaho Center for Assisted Living, headquartered in Boise.
Now it's closer to 10 percent, according to statistics from the Department of Social and Health Services in Washington state.
"It used to be a place where the aged went," Vande Merwe says. "Now 80 percent of new admissions are coming for short-term rehabilitation."
Some eventually return home or go to an assisted living setting. Some stay until their death, he says. "It becomes their home and we do everything we can to make it a home environment."
Four or five people under the age of 55 are currently living at Orchards, says administrator Mindy Shepard.
"It's not that uncommon because we have a gap in the health care system between the hospital and the nursing home. People like Lori are younger, but they need the medical care. The structure and support of the staff helps people to remain as independent as possible."
Vande Merwe expects the upswing in younger patients to continue. A major cause is obesity and all of its complications, such as diabetes, he says. "People are crashing earlier now because they're not managing their chronic diseases."
Some children are in nursing homes because of severe birth defects and disabilities caused by drug and alcohol abuse during their mothers' pregnancies. Other young people have diseases with no cure, such as multiple sclerosis, and may reside in nursing homes for many years.
In addition, stroke and heart attack victims are surviving at higher rates and they often need rehabilitation, Vande Merwe says.
"A lot of the younger people are there for a short term to stabilize so they can live on their own again," he says.
"They're not just coming there to die. They're coming there to live, and, hopefully, achieve a higher quality of life. That's not how people saw nursing homes 20 years ago."
Hagedorn's lengthy list of ailments include chronic kidney disease, chronic obstructive pulmonary disease and chronic asthma.
"My major problems are my lungs," she says, adjusting the tube that connects her to an oxygen tank. "I smoked for over 30 years. I started when I was 13 and, over the years, progressed to almost three packs a day."
She also believes inhaling volcanic ash when Mount St. Helens erupted and working at a fertilizer plant may have caused some damage.
Her chronic health problems forced her to stop working about six years ago. It was when she began having trouble managing her pain medication that she had to leave her apartment in Lewiston.
"My doctor said I had to go to assisted living or a nursing home or find a new doctor. I ended up in the hospital way too much. I was on a lot of pain pills and I was overdosing myself. I agreed, as long as I could take some of my hobbies, my TV and VCR and my cat."
She was living alone in low-income housing when she moved to Orchards, and most of her belongings were sold at a yard sale. Choking back a sob, Hagedorn says she had to leave her cat with a neighbor.
"My cat and my computer were my best friends at the time. It seems like I got sick and my friends just disappeared."
She doesn't sit in the blue recliner in her room because it brings back too many memories of what her life used to be like. "It was me, my blanket and cat all snuggled up. I would rather be home in my own place."
Hagedorn, who is single, has been married three times and has three children and four grandchildren. Her oldest daughter, Christina Erb of Lewiston, visits at least once a week.
"It's hard knowing she's 45 and has to live with older folks and doesn't have anyone her age to socialize with," Erb says. "In the other sense, it's a relief to me knowing she's there getting proper care and has someone with her 24 hours a day. She was unable to live on her own with no one to monitor her meds."
Instead of dwelling on the past, Hagedorn tries to keep busy. In addition to watching TV and taking naps, she works on beading projects and crafts. The rest of her time is consumed with the daily routine of a nursing home. Activities are posted on a calendar at her bedside table, along with a menu listing the current month's meals.
One of Hagedorn's favorite activities is going to Rosauers once a week and using her laptop in the coffee shop area there. She also enjoys a monthly trip to Wal-Mart and an occasional restaurant outing.
"I thank my lucky stars I can do all I can," she says.
At the nursing home, Hagedorn begins her day at 5 a.m. when the staff wakes her to take her first round of medications. "Sometimes I can get back to sleep, sometimes I can't."
Meals are brought to her room when she doesn't feel like going to the dining room. On a recent morning, breakfast consisted of scrambled eggs, toast and milk. "The food here is actually pretty good," she says. "The spaghetti is my favorite."
Hagedorn showers twice a week and can walk around her room and use the bathroom on her own. When she leaves the room, she uses a wheelchair. She is looking forward to getting an electric wheelchair and plans to go for a spin around the block on the day it arrives.
When she visited nursing homes as a kid, she remembers seeing old people tangled in bed sheets or sitting in the hallways and the smell. "It's a lot better now. There are times it reeks and I tell them."
The administrator says when you get so many people living in close quarters, there are bound to be some odors. "For the most part, they eat on the same schedule and go to the bathroom on the same schedule. If the smell is the first thing you notice when you walk in a nursing home, you have a problem."
Hagedorn never turns off the television because the constant drone keeps her company. Her days are often lonely, and she finds conversing with the older residents somewhat difficult. Some are bedridden, others are hard of hearing or have trouble communicating. Her elderly roommate rarely speaks.
"The worst thing for me is the loneliness. It's hard. I suffer from depression anyway, and it's worse this time of year."
Activity directors say keeping younger residents active and stimulated can be a challenge. For years, most programs were geared to a different generation. The new clientele would rather surf on the Internet, send e-mails or play video games.
"They don't want Lawrence Welk," says Judy Wood, who has been an activity director at Orchards Rehabilitation and Care Center for more than 20 years. "The younger residents have different interests in music, technology. It's challenging. I try to gear activities to their interests and give them group opportunities to express their feelings about being in a long-term care facility."
Wood recently tried to organize a group activity for younger residents, but it kind of fizzled out. She doesn't push it, if the interest isn't there.
"I try to make them decide what they want to do," Wood says. "You want them to have self-esteem, self-worth and have a choice. We try to maintain their independence as much as possible."
Among the older population at Orchards, bingo is a big draw, along with exercises, reminiscing and music. "Religious programs and musicians are popular, and the residents love the Wii games. They like the bowling and the baseball. It's good exercise."
Wood has worked in nursing homes since 1974. She says it's not an easy job, but it is rewarding.
"I think I make a difference in people's lives, at least I hope I do. I hope I increase their quality of life. I like the elderly people. I love listening to their stories, their history, the technology changes they've seen, their hardships and how they met their spouses. It's interesting, and I've learned a lot from them."
At Orchards Rehabilitation and Care Center, there are about 100 employees and 66 residents. The majority of people who reside there are covered under state-funded Medicaid. For the 10 percent or so who have to pay privately, the cost is $5,500 per month.
The staffing ratio at the nursing home is good, Shepard says. The state mandates 2.5 hours of care per day for each patient. At Orchards, she says the average is 3.2 to 3.3 hours.
"It's definitely not a job for everybody," she says. "It's for people who have a lot of patience, energy and a true desire to care for people. It's not for the weak stomached because you're dealing with human bodies and all that entails. It takes integrity. And it's very addictive if it's a good fit."
Each nursing home has its own admission guidelines. Considerations include how much it will cost to care for a patient, the level of skills required, staffing and equipment. Lately, there has been an increase in patients who weigh more than 300 pounds, Shepard says. They require special equipment and lifts.
People who are considering placing a loved one in a nursing home should tour various facilities without an appointment, she advises. "You need to be comfortable."
Idaho has about 6,075 nursing home beds and the occupancy rate is about 76 percent. In Washington, there are approximately 21,000 beds and 87 percent are filled.
Some families opt to provide care at home, which can be a major undertaking for the primary caregiver. "Any family member who does this I give my kudos to," Shepard says. "It's a full-time job, emotionally, physically and financially."
For those looking for information about nursing homes, there is a Web site developed by Medicare that offers nationwide survey results and other relevant information. It can be viewed at www.medicare.gov/nhcompare. The federal government's new five-star rating system is also available on the site (see related story). Orchards received an overall three out of five-star rating, which is average.
Hagedorn says her situation at the nursing home has improved since she was first admitted. For the most part, the staff is friendly and accommodating.
"They try real hard to make it where I'm not considered elderly. Now they tell me when my appointments are and don't go through my daughter."
Although she dreaded spending her first Christmas in a nursing home, Hagedorn says it went better than expected. On Christmas Eve, she had take-out food from Applebee's and went to her daughter's house, where she visited with family members and opened presents. "It was actually pretty good."
She hopes someday she can live with family or in an assisted-living environment. Until then, she says it's the little things that make her happy, such as waking up every morning.
"I'm not one to really give up. I still haven't made my will out. I'm not going to accept it because I'm too young." ..Source.. by The Plain Dealer
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