For Black Elders, Improving Miss. Care Homes Involves Hopes and Prayers

For Black Elders, Improving Miss. Care Homes Involves Hopes and Prayers

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Photo: Willora “Peaches” Ephram, left, age 90, listens as a local official reads a proclamation honoring the 50th Anniversary of her Peaches Restaurant. (Alice Tisdale/Jackson Advocate)

First of two articles. Read Part 2 here.

JACKSON, Miss.--A nursing home stay can be temporary. Roderick Ephram couldn’t be happier about that. His mother, Willora Ephram, better known as “Peaches,” returned home recently from Trinity Mission Health and Rehab in Clinton, Miss., after recovering recently from pneumonia.

Peaches Ephram, age 90, is considered the matriarch of Jackson, renowned for having operated Peaches Restaurant in the Farish Street Historic District for over 50 years. It was her establishment where Barack Obama made a campaign stop in 2007, in his run for the White House.

“I couldn’t give her the care she needed at home,” said Roderick. “She was very weak. It took three months for her to recover and get the rehab she needed.”

Only 20% Earned State’s Top Rating

Trinity Mission is one of 34 nursing homes within 50 miles of Jackson, Miss. Only 11 received an overall rating of five stars from the federal Centers for Medicare and Medicaid Services.

In the Mississippi Delta, the percentage is even bleaker. Out of 33 nursing homes, only three received five stars. Facilities in Greenwood have the highest marks across the board.

Housing for elders needing continual care begins to describe what a skilled nursing facility provides. Most nursing homes have at least one registered nurse available for at least eight straight hours a day and at least one licensed practical nurse on duty round the clock.

However, among most African Americans, there remains a stigma attached to relocating an elder family member to a nursing home, or more frightening, a convalescent home, a rest home or the old folks’ home, which are usually permanent.

Yet, more and more adult children of aging parents are making the tough decision whether or not to manage their loved ones at home or begin the challenging, if not painful, process of filling out an application for nursing home residency.

Sometimes the decision is made for them following hospitalization or diminished capacity associated with dementia, such as Alzheimer’s disease.

Trinity Mission provides a wide range of services for both short-stay recovery, often following hospitalization, as well as ongoing supportive services for individuals requiring long-term care. The facility offers orthopedic, neurological, cardiac, pulmonary and wound care services, as well as interventions for other medically complex diagnoses.

“I thank the Lord for being back home; he is my strength,” said Peaches, who also survived triple-bypass surgery last year.

What Peaches likes best about returning home is no surprise to her pastor, Richard Lind of Morning Star Church in Utica. “I like being able to get up on Sunday morning and get dressed to go to church,” she said. Pastor Lind didn’t wait until Sunday to see his faithful churchgoer. He stopped by her home for an evening bible study, along with her son and four nieces.

New Medicaid Rules

In addition, she benefited from Medicaid rules enacted in recent years. Peaches spent 90 days in rehab. Under rules implemented in 2010, nursing home residents who have been in a facility for over 90 days are asked whether they want to talk to someone about returning to the community. If a resident is interested, the facility must help the senior get more information on a potential move.

Medicaid’s Money Follows the Person program, which Congress passed in 2005, and extended by the 2009 Affordable Care Act (ACA), had overseen tens of thousands of moves from institutions to home or other non-institutional community settings in 41 states.

This demonstration program encourages more flexible use of Medicaid funds, allowing that money to "follow" beneficiaries to the home or community setting they choose.

As the population ages, and baby boomers live longer, the number of nursing homes and related facilities will continue to rise in the inner cities and rural communities. And as the needs of seniors change, nursing homes will need to adapt.

For instance, years ago, nursing homes provided simple care such as room and board, monitoring of medications, personal care (dressing, bathing, toilet assistance), 24-hour emergency care and some social and recreational activities.

Today, facilities are charged with offering physical, occupational, infusion and speech therapies, as well as specialized care for dementia and other chronic conditions.

New terminology, such as “person-directed care”—allowing patients to pay a family member or friend to care for them--and “culturally specific care,” help to define new frameworks to address the care of elders or people with disabilities.

Enhancing Patients’ Well-Being

While the nation continues to focus on insuring people for basic health care, it is the areas of long-term care or end-of-life care that are developing new ways of enhancing well-being for patient and their families.

Health care workers are developing various models to improve everyday situations addressing the needs of elders. Often they are using creative solutions to empower individuals to live full and positive lives.

There is also a movement to decrease nursing homes’ reliance on psychotropic medications, often merely to quiet residents so they don’t demand much limited staff time. Again, recent federal nursing home regulations are helping bring about these changes.

At the top of the Mississippi nursing homes list are those with a rating of five stars from the federal Centers for Medicare and Medicaid Services for their overall performance in health inspections, nurse staffing and quality of medical care. About one Mississippi nursing home in five have earned the top rating.

But the success of kinds of improvements in health care rules and practice will depend on how well they are able to support senior’s ability to remain close to home.

As Peaches put it, “The love of my family really picked me up. I wake up at night and think about how good God has been to me,” Peaches said. “Thank God I have a home and so many people who love me.”

This article is adapted from a series Alice Thomas-Tisdale wrote for Mississippi’s Jackson Advocate, where she is publisher. She developed the series supported by a MetLife Foundation Journalists in Aging Fellowship organized by The Gerontological Society of America and New America Media.