On this West Virginia Morning, more effectively treating trauma and moving a loved one into a nursing home
On this West Virginia Morning, Randy Yohe spoke with Christie Eastman, the Cabell Huntington Hospital Counseling Center manager, who is on a mission to train West Virginia mental health professionals in more effectively treating trauma.
Also, many families have to move a loved one into a nursing home because of dementia. The experience often comes with grief and loss and a sense of failure. For his series Getting Into Their Reality: Caring For Aging Parents News Director Eric Douglas spoke with Julia Smythe, the dementia program director and Natalie Petty, the director of Admissions and Marketing, for the Marmet Center nursing home with a memory care program for people with dementia.
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Work on a veterans nursing home in Beckley is set to begin, the second one in the state.
Work on a veterans nursing home in Beckley is set to begin, the second one in the state.
Initial funding for the 120-bed facility was awarded in 2021, with more money from the state’s general budget going towards the project last year. The initial investment included $30 million from the state and $15 million in federal funding.
The home is set to be built on a 12 acre plot of land next to the Jackie Withrow Hospital.
Gov. Jim Justice announced during his regular briefing Thursday that design and engineering work would begin on the project.
“We should be proud, proud, proud of who we are as West Virginians to the contribution that all of us have made and all the great folks in the military have made to make this nation what it is today,” Justice said.
Of the beds available, 20 will go towards nursing veterans with Alzheimer’s or dementia. It’s also planned to include private rooms, community spaces, fully accessible kitchens and a central common area, as well as recreational and health care services.
“My staff and I have worked tirelessly on making this facility a reality,” Department of Veterans Assistance Cabinet Secretary Edward Diaz said in a statement. “We understand that this architectural and engineering agreement is only one step toward construction of the new nursing facility, but it is a huge, critically important step.”
There is currently one other veterans nursing facility in the state, located in Clarksburg.
Many families face the question of what is the best place for an aging family member to get the best care in their later years? In-home care? Nursing home? And, how do you pay for it?
Many families face the question of what is the best place for an aging family member to get the best care in their later years? In-home care? Nursing home? And, how do you pay for it?
This interview has been lightly edited for clarity.
Douglas: One of the things that I’ve dealt with — what other people I’ve talked to have dealt with — how do I, as a caregiver, make the decision that it’s time for mom or dad or my family member to go into a facility?
Braley: Yeah, that’s the million-dollar question. I have a lot of families that have come to me over the years, and they’ve asked when is it time? And I think it’s really an individual account based on the personal situation. What I counsel families on is looking at, “What’s the safety issues?” When you get to the point with an aging parent or spouse, what kind of safety issues are you dealing with? Are they ambulatory? If they are, are they forgetting where they are in their home and not recognizing that? And are they trying to get out and in their mind going to their home, maybe to their childhood home.
In the field, we call that an elopement risk. Obviously, that can be a very serious safety issue, because the individual with dementia in that moment, when they’re in their house, they may not realize it. For 23 of the 24 hours that day, they did recognize it, but then at that moment — that you can’t predict as a caregiver — it’s a strange place, and they’re trying to get out. That can be very challenging for the caregiver in that moment, whether it’s family or a private caregiver, trying to de-escalate that situation and redirect because in that person’s mind, they’re terrified. They don’t recognize it, they’re trying to get out and they’re going to do whatever they can to get out.
When they get a little more confused, when they get frustrated, are they becoming aggressive? How are they handling the behavioral strategies that the caregiver is trying to de-escalate the situation? Are they getting physical? That becomes very challenging, especially for an aging caregiver. Statistically, the caregiver that is providing care for someone with dementia can have a higher risk of mortality.
Douglas: Most caregivers are not trained in all those de-escalation techniques. I’ve definitely seen that.
Braley: We quite often see that they’re maintaining, and all of a sudden, for whatever reason, whether it’s a medical issue or something else with the disease progressing, it’s like they fall off that kind of cliff and now the parameters you had in place to care for them don’t work. It puts families in crisis.
Douglas: I’ve heard it said it’s easier for somebody to go into a nursing facility from a hospital, rather than just calling up and trying to get mom or dad in a facility, right. Explain that process for me.
Braley: Typically, if you have someone in the hospital, then there’s been a crisis. There’s been a situation that occurred, whether it was due to their dementia, and maybe they became a little more aggressive, and they had to go to the hospital to have behavioral health work with them and adjust medications. Or perhaps they fell, they harm themselves, and they’re in the hospital recovering from that. That crisis allows them to be able to transition from a hospital into whether it’s a nursing home or maybe rehab services, or into assisted living, because the family has realized it’s probably time for long-term care.
That can be a little easier than on the flip side where they’re at home and maybe there’s not a crisis, but the family sees what’s coming, and they want to try to be proactive. But the one with dementia is going to probably struggle a little more with that. And also, I think, when a family is not in crisis in that moment, that guilt just hammers so much more. And that’s a whole other aspect of dealing with talking about the grief that families go through in this.
Douglas: I think that’s an important thing, too. It’s a grief process, but it’s a really slow burn grief process.
Braley: When you dissect grief, there’s stages. And the other interesting aspect to this is, typically there’s more than one person in that family. You can have different family members in different grief stages. And that creates a whole other ball of wax. And in dealing with that, you could have someone who is in the anger stage, you could have somebody who’s in the denial stage, you could have someone reaching acceptance. A lot of times you’ll see the ones that are dealing with the person on a day-to-day basis, that are the primary caregivers, they’re going to be more likely to be closer to that understanding and acceptance than a family member who lives in another state and only talks to mom or dad on the phone and can’t quite recognize what’s going on.
Douglas: What are the differences, assisted living versus skilled nursing homes. What are the differences between those types of facilities?
Braley: A nursing home is going to be, is more geared toward a skilled need. And that’s the way that nursing homes were designed initially, that someone who just has a skilled medical issue, maybe they need a feeding tube, or they have a wound that is something that requires more nurses and doctors to be paying closer attention to it. Whereas assisted living will have nurses and can have a doctor come into the facility and has CNAs and caregivers, but it’s more geared toward helping that individual on their daily activities and needs.
But then when you take memory care, and look at assisted living, at least for me and my memory care, we’re focused on the dementia aspect. That’s what our staff are trained on, what we do every day. We’re a smaller facility so it allows us to have that one-on-one attention to give to the resident with dementia attention. In a larger facility, whether it’s a large assisted living or a large nursing home, they just can’t give that individual attention all the time.
Douglas: As I understand it, private pay facilities run anywhere from $5,000 to $10,000 a month. How do you pay for that?
Braley: Some people have prepared and they have what’s called Long-Term Care Insurance. But most people don’t have that. There are some VA benefits if the individual is a veteran, or their spouse is a veteran, that can help pay for long-term care and can help pay for in-home care. Of course assets, retirement, things of that nature that unfortunately people have to then tap into in order to pay for the care.
Douglas: I’ve heard many stories of people who’ve have to sell the family house and effectively watch any inheritance just kind of evaporate as they’ve had to pay for care.
Braley: I strongly encourage families to consult with an elder law attorney, that really can help. They can help the family weave through that, because that is the horror story. From my understanding, there are some aspects with Medicaid that you don’t necessarily have to sell your house and those kinds of things. So you definitely want to consult with an attorney in that area.
Douglas: When it comes to Medicaid and Medicare, for Medicaid to kick in, you have to have liquidated assets down to below $2,000, right?
Braley: This is kind of a soapbox of mine with Medicaid. The reality is, there are a lot of people in our country, and especially in our state, that can’t afford private care. And the only way they can get 24-hour care, because they don’t have the funds and they are eligible for Medicaid, is to access that Medicaid for a nursing home. But they don’t necessarily, maybe, have that skilled need. They could probably benefit better in a more focused memory care facility.
Right now, unfortunately, in West Virginia, Medicaid doesn’t pay for assisted living care, it only pays for nursing home care. But there are other states where it’s opened up a little more and Medicaid is trying to adjust more to assisted living care, because the reality is, assisted living care is less expensive than nursing care.
There is what’s called a DHHR supplement, which is closely connected to Medicaid that West Virginia will pay out but it doesn’t touch anything so no assisted living facility can accept that supplement. It’s just really not set up to be successful.
Douglas: What’s the process? Do you start making a whole bunch of phone calls? Where do you start?
Braley: That’s a great question. I think you want to be as proactive as possible. It’s best to start looking before you have to do it and start touring facilities, whether it’s a nursing home, or assisted living based on what you’re able to do. And start asking the questions. You’re interviewing them and taking tours and finding out how they did in their surveys with OHFLAC (Office of Health Facility Licensure and Certification) and things of that nature so you can make the best informed decision you can for your loved one. Also look for what in home services are available.
Four people have died due to COVID-19 at an assisted living facility in Mercer County, West Virginia.
The Bluefield Daily Telegraph reported that 12 of the 14 residents at Rockin’ Chair Residential Care in Lerona tested positive for the coronavirus, according to owner Airwana Arnett. Lerona is about 25 miles (40 kilometers) northeast of Bluefield.
One of the residents who died was in Hospice care, she said, and two had severe underlying medical conditions. “The other loss was a shock,” she told the paper. “He got sick and could not be revived.”
The other eight who caught the virus are recovering, in addition to four of the 10 staff members who became infected, she said.
She said six residents and “several” staff members had received the coronavirus vaccine. “The ones vaccinated did not get the bad symptoms,” she said. “The shot may have saved their lives.”
She said some staff and family members of residents refused to receive the vaccine. A pharmacy had offered the shots at the care center.
West Virginia, which has one of the oldest and most at-risk populations, rapidly deployed doses of the vaccine to nursing homes in December.
The Mercer County nursing home had not previously reported any deaths from the virus. Long-term care facilities have accounted for 801, or about 28%, of the state’s 2,872 virus-related deaths, health data show.
The facility is being tested twice a week. “We have got it under control,” Arnett said. “We are going to make it.”
West Virginia Gov. Jim Justice announced the start Wednesday of a new vaccine rollout plan aimed at the state’s senior population called Save Our Wisdom, or SOW.
“We can’t let the wisdom just die away,” said Justice in his Wednesday virtual press briefing where he addressed specifics on his vaccination plan rollout and concerns from educators over safety.
SOW will mainly focus on getting the elderly in West Virginia vaccinated, starting with people 80 and older.
“The very thing that we oughta all be the most concerned with, that I was preaching to the mountaintops, was age, age, age,” Justice said. “Because if we can vaccinate our elderly, that’s who I’m reading every day.”
Justice referred to the identities of the state’s latest COVID-19 victims, which he acknowledges in each media briefing by reading their age, gender and where they lived. The majority of those deaths have been people over 60.
The governor said his new SOW initiative will also prioritize “faculty and service personnel” who are 50 and above, but he did not specify exactly what kind of service workers they would be.
Ten vaccination clinics, starting Thursday, will be set up in partnership with county health departments. These counties include Berkeley, Kanawha, Mercer, Monongalia, Ohio, Raleigh, Wood and Wyoming.
The first vaccination sites announced this week as part of the Save Our Wisdom initiative are located here:
Berkeley County: Berkeley County Health Department 273 Martinsburg Drive Martinsburg, WV 25404 Thursday, Jan. 7 from 10 a.m. – 6 p.m. Saturday, Jan. 9 from 10 a.m. – 6 p.m.
Mercer County: Brushfork National Guard Armory 2915 Old Bramwell Road Bluefield, WV 25701 Thursday, Jan. 7, 9 a.m. until complete
Raleigh County Beckley Raleigh Convention Center 200 Armory Drive Beckley, WV 25801 Friday, Jan. 8, 9 a.m. – 3 p.m. NO APPOINTMENT NECESSARY
Monongalia County Morgantown National Guard Armory 90 Army Band Way Morgantown, WV 26505 Thursday, Jan. 7, 9 a.m. – 7 p.m. Friday, Jan. 8, 12 p.m. – 6:30 p.m.
Ohio County Wheeling-Ohio Health Department 1500 Chapline Street, #106 Wheeling, WV 26003 Jan. 7-14, 9 a.m. to 3:30 p.m. Call 304-234-3756 to schedule an appointment.
This first round of events will be only for people 80 years old and older, and most locations require scheduling an appointment.
Justice said more vaccines will be distributed each week to sites. As of Wednesday, the state had 109,000 vaccine injections available. About 61,000 West Virginians have been vaccinated so far. The governor also said that all nursing home staff and residents in the state have now been vaccinated and have started receiving the required second dose of the vaccine this week.
“West Virginia is the first in the country to provide both doses to the long-term care community,” said Todd Jones, president of AMFM Nursing and Rehabilitation Centers in West Virginia. “[That’s] a tribute to the plan that the [state’s coronavirus task force] have put together.”
Jones said several other states have not yet begun the process of vaccinating those who live or work in nursing homes.
Additionally, K-12 teachers and school service personnel 50 and older will have access to the vaccine beginning Thursday, Jan. 7. Vaccination sites vary per county. The first round of vaccinations for Jefferson County Schools, for example, will be administered at Jefferson High School.
Teachers have reported receiving emails from their county school system with more details about whether they are eligible this week or at a later time. Thursday will be the first time teachers and school service personnel will have access to the vaccine since rollout began.
Rollout, however, comes a little more than a week ahead of the state’s in-person schooling start-date.
When K-12 school resumed on Jan. 4 following the holidays, all students remained in remote-style learning. The governor has made it clear he wants kindergarten through middle school to resume full, in-person schooling on Jan. 19. High schools are expected to continue with remote learning only if that county is red on the Department of Health and Human Resources color-coded coronavirus map.
Up until this point, counties labeled red or orange were not permitted to teach face-to-face at any grade level.
“We have got to get our kids back in school,” Justice said in a virtual press briefing just before the new year. “During 2020 we learned that COVID-19 transmission rates in our schools during the first semester was 0.02 percent among students and 0.3 percent among staff. Our schools are safe when guidelines are followed.”
Justice said bringing kindergarten through middle school students back to brick-and-mortar buildings is not a mandate. County school systems have the flexibility to make decisions about how they want to hold school after Jan. 19.
The governor’s start-date also does not allow for all teachers and service personnel to receive the required two-dose injections ahead of returning to classrooms. Depending on the manufacturer of the vaccine, a second injection must be administered 21 or 28 days after the first.
Many educators are protesting the governor’s school reopening plan, including 2016 Berkeley County Teacher of the Year Jessica Salfia. Salfia is also a member of the American Federation of Teachers, West Virginia chapter.
“We will be opening schools when our infection rate is the highest it has ever been and during the post-Christmas and holiday surge that most scientists and medical professionals tell us to expect this month,” Salfia wrote in a statement shared on Twitter Monday night. “I know remote learning is difficult. I miss school. My children miss school. But if it means no deaths, no sickness, and teachers being vaccinated with both doses, then we can do it for one more month.”
Salfia called on her local school board to continue with remote learning only until all teachers and service personnel can be fully vaccinated.
AFT-WV President Fred Albert announced Monday that AFT-WV has filed a Freedom of Information Act request to receive all documentation collected showing school outbreaks. The union is also seeking virtual schooling data claiming over one third of students on remote or virtual learning are failing, as the governor has said.
“Everyone yearns to get back to normalcy,” Albert said in a statement. “But to get there, we need a plan that protects staff, students and vulnerable members of our community. It’s time the governor used the CARES Act money to implement an accelerated vaccination plan of school employees who wish to be inoculated.”
Many teachers around the United States are also expressing frustration at vaccine rollout plans. In Tampa, Florida, teachers said they aren’t being prioritized. In Chicago, Illinois, 40 percent of public school teachers didn’t report for in-person schooling Monday.
As of Wednesday evening, the West Virginia Department of Health and Human Resources reported more than 1,500 new cases of COVID-19 identified in the past 24 hours. More than 27,000 cases are active, and there have been 1,481 people who have died from the virus to-date.
More than 800 people in West Virginia are hospitalized, 217 people are in intensive care and 90 people are on ventilators.
Kanawha County is the latest to advance in the state’s color-coded map for community coronavirus spread in counties.
It moved into the orange zone from 9.7 average daily cases per 100,000 people on a rolling 7-day average Sunday, to nearly 12 on Tuesday.
“Nobody said this was going to be easy, and nobody ever said a pandemic would not be something that would be very difficult for all of us to deal with it,” Gov. Jim Justice said during a regularly scheduled, virtual press briefing Wednesday. “And we’re doing it and we’re doing a great job, but we got to get these counties out of orange. That’s for sure.”
Logan and Monroe counties were also in orange on the state’s color-coded map for community spread. That means state officials have tracked 10 to 24.9 daily cases in these counties per 100,000 people, either on the 7-day rolling average or a 14-day rolling average for counties with less than 16,000 people.
The state is using the map for school reopenings after the first day of in-person classes begins Sept. 8. The map also applies to after-school activities like sports and rules for nursing home visits and group activities.
If school was already in session, being in the orange zone on the map for Kanawha and the other two counties would mean mandatory face coverings for students in the third grade and older, no large group assemblies and a more concerted effort from local health and school officials to mitigate further disease spread.
For any county in the red, with more than 25 daily average cases per 100,000 people – this was Logan county until Tuesday – in-person classes would be suspended.
In all three orange counties and others currently marked yellow or green, the state was on Wednesday tracking 39 outbreaks in nursing homes and long-term care facilities. It was also monitoring 29 active cases of COVID-19 across four churches and more than 20 positive coronavirus results among prisoners at the Mount Olive Correctional Center in Fayette County.
Outbreaks in state jails, prisons and nursing homes only count as one person in the state’s color-coded map for community spread, except for infected employees, who the governor’s office said on Aug. 17 will count as whole individuals. State health officials have said this is because they fear outbreaks in congregant settings will skew results.
The map has been revised and tweaked at least twice since state officials first introduced it on Aug. 14. A similar, more stringent color-coded map from the Harvard Global Health Institute shows Monroe and Logan counties in the red.
West Virginia has had more than 9,500 cases of COVID-19 since March. More than 1,700 cases are still active, and there were 190 deaths from the coronavirus by Wednesday.
