​Okay, this is really hard to believe. But it’s coming from the federal Centers for Disease Control and Prevention (CDC), so it must be true.
 
Here’s the scoop: According to a CDC report issued in 2015, up to 75% of antibiotics administered to skilled nursing facility (SNF) residents are either unnecessary or prescribed incorrectly in terms of drug, dose or duration. 
  
How can this be?
 
One cause appears to be overzealous diagnosis of urinary tract infections (UTIs) based solely on confusion or bacteria in urine, according to the Wall Street Journal. Apparently that doesn’t always mean a UTI. And apparently it’s difficult to counter the knee-jerk reaction of prescribing antibiotics in these cases, primarily because of staff turnover, physicians not actually seeing their patients, and patients who may have a hard time describing their symptoms.
  
Overuse of these drugs is no minor problem. It contributes to the flourishing of antibiotic-resistant bacterial strains that are difficult or impossible to treat.
 
So what can you do to protect loved ones in long-term care from falling prey to antibiotic abuse?
 
A good place to start is with the facility’s Director of Nursing. Find out what policies are followed to ensure the appropriate use of antibiotics – and if you’re not satisfied with the answer, consider looking elsewhere.
 
I asked Cheryl Johnson, R.N., Director of Nursing for Care-age of Brookfield, about her facility’s approach to this problem.
 
“We have in place antibiotic stewardship policies that guide us in the judicious and appropriate use of antibiotics,” she said. “That means using them only when they’re really needed, and then using the right antibiotic at the right dose for the right duration.”
 
It starts with an accurate diagnosis, she added.
 
“We are of course in compliance with both CDC and State of Wisconsin recommendations on, for example, identifying specific clinical manifestations that warrant antibiotic use – and, whenever necessary, running additional tests to determine precisely which antibiotic will best treat that particular infection.”
 
When antibiotics are deemed necessary, don’t hesitate to ask questions. What are your loved one’s symptoms and clinical signs? Why is an antibiotic needed? How soon should relief be expected? And if the symptoms don’t go away, what’s the next step?
 
“This is a growing problem in our world,” Johnson said. “It’s important for families of nursing-home residents to be aware of the potential for antibiotic misuse, and to educate themselves about the bigger threat of antibiotic-resistant infection.”
 
For details, visit www.cdc.gov. 

Let’s get one thing out of the way up front: No nursing home is perfect.  

It won’t surprise you to hear that money is a primary reason that many fall short of the ideal. On the one hand, states are adding more stringent and costly regulations every year because – well, because that’s what bureaucrats do. On the other hand, as nursing homes’ expenses continue to climb, Medicaid reimbursements are plunging, so that these facilities are actually losing money, day after day, on residents who have run out of their life savings.  

This is why many nursing homes now promote themselves as short-term rehabilitation centers for people recovering from illness or injury; the higher reimbursements paid out by insurers, both public and private, help them make ends meet. But even then, the numbers are tricky, and every nursing home has to do more with less these days. There will inevitably be times when something or someone falls short of expectations. 

Nevertheless, even in this environment, there are some real gems out there in the world of nursing homes/rehab facilities. I’d like to introduce you to my favorite, Care-age of Brookfield, in Brookfield, Wisconsin. 

Disclaimer 

My Christian mother lived at Care-age for seven years, dying there in May of 2000. I’m not proud of that – we could have taken her in, but I was a feminist atheist then and, much as I loved her, it would have been too much of an inconvenience to have her living here, too much of a distraction from my all-important work. (Talk about idols – but that’s another subject entirely) 

After she died, in my despair, I began volunteering at Care-age, visiting a growing list of elderly women every week – at first, because they each reminded me in some way of my mom, and later, because I’d investigated the possibility that her imaginary Friend in the sky might have been the real deal, and had discovered that, once again, she had been right. 

In a nutshell: I became a Christian myself. The love of God gripped my heart, and has made hanging out with my “old ladies” the joy of my life.   

The difference: Christ

I believe that it’s this divine love pervading Care-age of Brookfield that makes all the difference in the quality of residents’ lives.

It’s not a Christian facility, and I do hope I’m not getting anyone in trouble by saying this. I’ve never met the owner and have no idea where he stands on this question.

But I’ve visited and volunteered at other nursing homes, and the difference is palpable. From the top down, so many of the staff members are born-again Christians that love, patience, kindness and extraordinary service seem to dominate. 

Just yesterday, for instance, I saw a wonderful young singer lifting up his Savior in beautiful song for a huge group of residents; he concluded his performance by giving everyone a free copy of the gospel of John. 

I found one aide patiently, and with great good humor, helping two residents figure out how to put on a (very confusing) new pocketed shawl. 

I watched another employee leading a dozen especially disabled men and women in a hymn sing, complete with five-star devotional readings; she does this a couple times a week, doing the hard work of gathering these residents herself. 

And I witnessed an entire flock of nurses taking the time to talk and laugh with an elderly man who was beaming with joy at the hilarity his jokes were generating.

These are just a few snapshots of what I see around every turn at Care-age – staff members delivering peace, joy and love to assuage the challenges, heartaches and disappointments of debilitating disease and old age.

The proof: people want to live here

Like I said, no place is perfect. Sometimes the food is less than gourmet. There can be staffing shortages on some shifts, especially among those who do the hardest work. Sometimes a resident has to wait too long for help getting to the bathroom, or is treated with disrespect by a renegade employee. And no one can fill the void left when children are just too busy to visit for weeks or months on end. 

But get this: One of my dearest friends at Care-age – let’s call her Lucy -- could be living with her daughter, who regularly begs her mother to pack her bags and come home. 

But Lucy doesn’t want to. 

“There, I’d be alone so much of the time, while my daughter does her thing, visiting friends or shopping or fixing up the house and yard. Here, I’m around people my own age. We have the same interests and memories, and there’s always something going on in Activities. And the staff is so nice – I just love them, and I love this place. It’s one big happy family and I’m here for the duration!”  

And Lucy isn’t the first one who has expressed such feelings to me over the years.

On the flip side, I have a wonderful and very fragile old friend who lives with one of her children – a child who loves her very much and seems to treat her with great affection and tenderness. The trouble is, she’s alone most of her waking hours (the child works, of necessity) and she has no other companionship. Visitors are rare, outings even rarer. Having spent a good deal of time at Care-age herself as a volunteer, she knows she’d be happy there. But nursing homes are expensive, and her kids don’t want her to spend her money on one. Case closed.

Finding your own Care-age  

It’s apparently difficult to find a place of this caliber. Unfortunately, a beautiful building and luxurious amenities don’t reveal much about the character of a place, or how you’ll be treated there. 

If I were looking for a home for myself or a loved one, and Care-age had disappeared, I would begin by asking everyone I know for input, and then doing thorough internet searches for comments, reviews, ratings and awards. (Care-age has been ranked among America’s top nursing homes by US News & World Report for five years running now, and has repeatedly earned Medicare's maximum five-star rating.)  

I would check with the state group in charge of nursing-home regulation. In Wisconsin, it’s the Department of Health Services; you can find out a lot about individual facilities from a resources such as this.   

Having narrowed down my search through investigations like these, I’d visit the top three or five on my list. I’d arrive armed with a list of questions of personal import and would seek permission to ask those questions of several residents – in private, if at all possible (I don’t know if that would be legal, let alone permissible – but I would make the request). I’d take a close look at their activities calendars. And I’d ask if they had any testimonials or thank you letters on file. 

If the need wasn’t particularly urgent, I might pop in at a few different times, if I could, just to see what’s going on and how content people seem and how clean the place was over time.

After all of that, I would listen to my heart: Which facility seemed like a place that I’d like to call home?  

If you’re in need of finding a great long-term care facility, today or years down the road, I hope that you’ll find a treasure just as wonderful as the one I call my home away from home! ​

Updated from a 1/4/14 post

I don't know who enjoys nursing-home visits more -- visitors or visitees. But I do know that there's an easy way to keep the memories you're making alive until you return. And that's bringing flower arrangements that you've custom-made for each resident you visit – silk flower arrangements, to be precise, since they look as lovely on Day Seven as they did on Day One.   

I get most of my containers at Good Will stores, usually for $3 or less apiece, and often find bunches of unused silk flowers there, too. Great buys can also be had at the end-of-the-season sales at local garden centers and craft stores.

But there's nothing better than amassing donations from friends. A few cases in point: the wonderful vintage planters above and to the left, recently contributed to the cause by Tess; the beautiful basket shown below left, handcrafted by Brenda; and the blooms in the four-legged bowl on the right, contributed by Linda.

Of course, if you want to do this in any volume, it takes quite a collection of both containers and silk flowers. To accommodate mine, my husband was kind enough to build me a wall of shelves in the garage. And he usually manages to bite his tongue as the scene gets more and more chaotic between spring cleanings, spilling over into the basement -- not to mention the kitchen, which becomes my washing-and-arranging workroom on the weekend.  

But I guarantee that it's worth it. My elderly friends look forward to their new arrangements each week, as you can see from this photo of my late friend Leona, holding a copper-clad tub that arrived on our doorstep one Christmas stuffed with Honeybell oranges.

​Just as important: Between visits, they're reminded that someone is not only thinking about them, but is making something special just for them. 

Adapted from a 10/20/14 post