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5 Ways assisted livings prevent dehydration in elderly residents

5 Ways assisted livings prevent dehydration in elderly residents

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Dehydration in the elderly is a serious health risk. It’s a common cause of hospitalization. Especially during the hot summer months.


As a precaution, most senior living communities have a Hydration Program. Of course, some do a better job than others.


That's why it's important to understand the risk factors, signs of dehydration, and prevention strategies. Then you can assess the program in your loved one's assisted living.

Why are elderly more prone to dehydration?

Assisted living providers understand the risk factors for older adults of becoming dehydrated.  You can partner with your mom’s community when you too know what’s involved.

Diminished thirst

As we age our sense of thirst diminishes and we don’t recognize we need fluids. So older adults get severely dehydrated before they even realize they’re thirsty. 

Mobility

Frail elders may find it difficult getting out of chairs and recliners. Getting a drink of water doesn’t seem worth the effort.

Overactive bladder and incontinence

Liquid in, liquid out. Many older adults avoid fluids because of incontinence worries. They get tired of frequent and urgent bathroom trips.

Misdiagnosed and undiagnosed

Many early signs of dehydration are easily confused with other medical and natural conditions. Things like dry mouth, fatigue, dizziness, and muscle cramps.

Too many diuretics

Many older adults avoid water and drink a lot of coffee instead. While coffee, tea, and soda are okay in moderation, they shouldn’t be the only fluids consumed.

Medications

Older adults often take several medications. Some of these meds act as diuretics. They may also cause increased sweating leading to dehydration.

Decreased kidney function

Aging bodies have aging kidneys that are less able to conserve fluids.

Illness

Vomiting and/or diarrhea can quickly cause dehydration in the elderly.

What are the signs of dehydration in a elderly?

Caregivers are trained to watch for the following signs of dehydration – especially during hot weather. Collaborate with your dad’s caregivers in keeping him safe by also recognizing the signs.

  • Confusion
  • Low energy
  • Difficulty walking
  • Dizziness or headaches
  • Dry mouth
  • Sunken eyes
  • Inability to sweat or produce tears
  • Rapid heart rate
  • Low blood pressure
  • Low urine output
  • Constipation

You can also check an elderly person’s skin for turgor (plumpness of the skin cells). Pull up on the skin on the back of the hand for a few seconds. If it doesn’t return to normal almost immediately, they’re dehydrated.


If you notice these signs in your loved one, call the nurse right away. He or she can assess if your elder should go to the hospital.

What are Hydration Programs in assisted living?

elderly couple drink beverage

Most assisted living facilities start a Hydration Program during hot weather streaks. These programs prevent dehydration by surrounding residents with opportunities to drink fluids. Here’s what Hydration Programs could include:

Caregiver training

Caregivers should get frequent reminders about symptoms of dehydration. And daily review residents at greater risk – such as loners and those with dementia.

Resident Education

Seniors themselves need education about their risk of dehydration. They should be encouraged to drink, even when they don’t feel thirsty. Urge them to keep several water bottles around: by the bed, easy chair, or dining table. Kick off a Hydration Program with special branded water bottles.

Body weight monitoring

Elders can lose 2-4 pounds of water weight when they’re dehydrated. Daily weight monitoring is critical for folks with renal failure and cardiac issues.

Mealtime choices

Staff should routinely serve water and juices at every meal. Along with encouragement and reminders. Soups should regularly be on the menu. Also, meals should include a wide variety of fresh fruits and vegetables.

Social hours

Activity directors can include popsicles, fruit infused water, and fresh melons at all social gatherings. They can place water stations throughout the building. Especially in areas where residents naturally gather. Meanwhile, encourage your loved one to attend events.

How can you partner with your parent's assisted living?

young woman visits with elderly lady

In case you're rating the Hydration Program at your parent's facility, a high score would include all the above. But keep in mind, your parent’s facility might not need all the above. Every community is different – every mix of residents is different.

Over all, what do you think? Is your facility doing a great job? Wonderful! Be sure to compliment the staff and say, “Thank you.”

On the other hand, could the program use a little boost?

First, encourage your own loved one. Make sure they have plenty of water bottles.

Second, talk to the administrator and ask about their program. They may be doing things you don’t see. Check the Activities Calendar.

Third, ask how you can best help. Perhaps you could volunteer to join the social hours and help serve refreshments.

In conclusion

Keeping our elders healthy and safe is a team effort. It takes collaboration of family advocates and their loved one's assisted living.

The best outcome for your elderly family member is to know about dehydration. Especially the added risks for elderly. Know the signs of dehydration and some prevention strategies. 

Leave a comment below. Tell us how you partner with your assisted living community.

Wondering about Assisted Living in your area? 

Contact  An  OSRAA  Referral  Agent

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How to avoid Medicaid spend down stress: One family’s experience

How to avoid Medicaid spend down stress: One family’s experience

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elderly woman with caregiver

Medicaid spend down takes pre-planning and knowledge. Get 13 insights about choosing a care home when planning a Medicaid spend down.

Avoid the stress this family experienced.

A Medicaid spend down plan – you think you’re doing it right

A family friend called. Four years ago, she and her siblings found an adult care home for their aging mother. They agonized over making the right decision until they found one that seemed like a perfect match. The peer group, location, and care level fit their mom's needs.

The oldest son, Jeff, handled mom’s finances. She had money in the bank from the sale of her home and property. Mom was physically healthy but pleasantly confused. He knew she’d out-live her assets and would need Medicaid to pay for her care in the future. To qualify for Medicaid, she had to spend all her money on care and medical costs first until it was almost gone.

Jeff asked all the right questions and was honest with the provider about how much money his mom had.

The care provider assured them that when their mother ran out of money, he would accept Medicaid. The owner didn’t have a Medicaid contract at the time but said he’d be willing to sign one when the time came.

My friend’s family is large so every day someone visited mom in her beautiful new home. They enjoyed the birthday parties and outings the caregivers hosted for the residents. Families were always welcomed. The caregivers treated their mom with love and kindness.
My friend and her siblings sighed with relief, grateful for the care their mom received.

Jeff thought the monthly rate of $7500 was high but worth it. And besides, he believed mom could stay in the home on Medicaid. The owner had verbally promised.

Mom spent down. It's time to apply for Medicaid.

care provider says no to Medicaid

Now, after living in the home for 3 ½ years, Jeff told the owner he was applying for Medicaid soon. Mom was running out of money. They had spent $315,000. Only $25,000 was left in mom’s account. He reminded the owner that he'd promised to open a Medicaid contract.

Right away the owner began making excuses. He said the timing was bad for him. He wanted to open a second care home and couldn’t afford a Medicaid resident. He didn’t want to hassle with the extra Medicaid oversight and paperwork.

At one point, the owner hinted he’d consider a Medicaid contract if the family paid the difference. (Medicaid reimbursement is much lower than private pay open market rates).

My friend and her family panicked. They started searching online about what to do. They talked to friends, social workers, and the visiting nurse. Could they enforce the verbal Medicaid spend down agreement with the provider? If they could, should they? Would the providers become angry and treat mom poorly? How could they find a new home on such short notice? Were there any nice homes that would take Medicaid right away?

Jeff called a family meeting to discuss the situation. His brother yelled about the deceiving, cheating owner. His sisters cried. They worried about how to tell mom that she was moving. How would she react to a new home? Would another move cause more memory loss? 

Get help choosing a care home that takes Medicaid

I recommended they call a registered local referral agent for help.

The referral agent understood all their concerns. She reassured them that there were available options. In fact, within a few days she had homes for them to visit.

All the care homes she referred were pleasant and clean. Perhaps a little more modest than mom’s current home. But the providers were friendly and had good references. Most importantly, they already had a Medicaid contract. So a short Medicaid spend down wouldn’t be an issue.

The good news! - my friend’s mom transitioned to her new place without any problems. She’s even made friends with another resident on her first day. Her family is grateful for that.

But they wonder how this stressful situation could have been avoided. How could the Medicaid spend down planning work better? They don’t want other families to go through this stress. 

What is Medicaid and how do you qualify?

Doctor writes Medicaid
  • Medicaid is a Federal and State program for low income elders who need care. One must qualify and meet the criteria for both income and care levels.
  • When an elder qualifies, then Medicaid pays for housing, care, supplies, and medical costs.
  • Find OSRAA Medicaid & Elder Care Resources Here

Read more:   Oregon Medicaid Eligibility: 2019

How do you plan for Medicaid?

Medicaid takes a lot of pre-planning - the devil is in the details. Don’t find yourself disqualified, with no money, and needing care. Work with a Medicaid case worker at the Department of Human Services.

It’s also recommended you work with an elder law attorney to properly spend down. 

Read more about Medicaid spend down planning: NW Estate Law

Do all care homes accept Medicaid?

  • Homes are not required to contract with the State in accepting Medicaid. They must disclose if they have a contract or not
  • If a home has a Medicaid contract, they cannot ask a current resident to move out when the resident qualifies for Medicaid.
  • Conversely, if a home has a Medicaid contract, they are not obligated to accept new residents already on Medicaid. Also, if someone will qualify within a few months, a home may deny admission.
  • Do the math. Be clear about how much money your loved one has before they’ll need Medicaid. Be honest with prospective providers.
  • Never rely on a verbal promise for Medicaid spend down. Get it in writing. Make it part of the written contract.
  • Some families purposely choose a private pay only care home for spend down. They think these facilities are “better” and want an upscale setting for as long as possible. These families anticipate another move.
  • If you choose this plan, keep in mind that your options will be limited. Providers who accept Medicaid need private pay funds for as long as possible. Medicaid reimbursement is much lower than market rate.

How to choose a care home when planning a Medicaid spend down?

  • If you think you’ll need Medicaid in the future, select a home that has a current Medicaid contract. Or at least has had a contract in the past. Some homes really do honor their word. They open a Medicaid contract for long-term residents who need it. (get it in writing)
  • Never agree to “making up the difference” between private pay market rate and the Medicaid reimbursement. This is illegal Medicaid fraud. If a provider suggests it, file a complaint with DHS.  Read more about filing complaints with Oregon DHS
  • Check with your referral agent about any past complaints or negative experiences with a care home. One benefit of working with a referral agent is their experience and all the networking they do. Word gets around when providers make “false promises”.
  • Situations do change. Some care homes have cancelled their Medicaid contracts with the State. They decided to accept private pay residents only. All the residents on Medicaid had to move out of the home. This doesn’t happen often but it’s something to be aware of.

What you can do when a provider makes false promises:

In a situation like my friend's, filing a formal complaint with the State won’t have much effect. There’s nothing a licensor can do about verbal agreements.

But you can file a complaint with OSRAA.  Here's our Contact Us page

If you have a negative experience with a provider making false promises, we want to know. Our members will be cautious in referring that home. Especially to someone needing future Medicaid.

Finding the right care home for a loved one is stressful enough. Avoid the type of situation my friend and her family faced. Follow the advice above. Work with a registered OSRAA referral agent member.

Find an OSRAA member Referral Agent:  Member Directory

Did you find this article helpful?

Let us know in the comments below. 

You might also like this article and companion video:

Medicare vs Medicaid

There's a lot of confusion about Medicare and Medicaid. In this article we explain the differences between the two. Find out who qualifies for each program, what services are covered, and the qualifying steps needed to get started.