Tag Archives: Nursing Home

Las Vegas Getting New Nursing Home and Assisted Living Facility with its own shopping mall on the first floor.

 My first thoughts when reading this article were that would be great for families who could enjoy the mall and entertainment of the Las Vegas strip while visiting their loved one but then I thought the frail seniors might not get the same benefit if the families spent most of their time shopping and less of their time with the seniors.  While this is an exciting project I just wonder if the exciting mall and casio’s will at some level lead to less family and personal contact with the seniors who are in these Assisted Living and Nursing Home beds?  There is no easy answer and we need choices in Senior Care.  If the mall on the first floor is not for you there are many choices in Senior Care including ones that offer a family style of care instead of the business model of care with the mall on the first floor. Secondly, in all cases people provide the care in any care setting and you need to meet the individuals in the care team to know who you are getting. Advertising is just not detailed enough to begin to know who you are getting as the managers and caregivers and what relationships you can hope to develop in this last chapter of life.

Public subsidy to bring skilled nursing, assisted living center downtown Nursing-home

Here is the full Article

Public subsidy to bring skilled nursing, assisted living center downtown

Las Vegas strip just upgraded with a new high end, 150 bed nursing home, 140 Assisted Living Beds, and a new first floor mall.  This should help the many wealthy gamblers have a place to put mom close to the strip so there is easy access to the local entertainment for the family.

Will this help the poor long term care patients or is this targeted for the private pay nursing home and assisted living crowed and possibly the short term rehab that medicare pays so well for?



The article did not say if they would take Long term stay Medicaid  patients as opposed to private pay nursing home patients,  or what percentage of long stay, long term care, Medicaid patients they expected to care for in the facility.  The article implies that they will offer physical, occupational and speech therapy among other rehabilitation.  They did not clarify if that mean this will be preferentially for short term rehab only or mainly which in general are the high pay Medicare days and not for the low pay, long term, days Medicaid traditionally pays for.  That will be interesting to find out when we all learn more about how this will impact the long term care for the frail seniors of Nevada.

I know this distinction of Medicaid long term days and short term Medicare rehab days will be new form many but it is something you will quickly learn when any loved one starts to need assistance.  Also this is a distinction many find after they have spent down all of their savings and now get medicaid.  How medicaid and medicare work together is something you should discuss with your doctor who in effect uses these resources for you or on your behalf for you.   Here is the direct quote from the lvrj

“Saltzman said the skilled nursing center will be six or seven stories, with about 150 beds, and offer physical, occupational and speech therapy among other rehabilitation. The assisted living center will be eight stories, with about 140 units, and the parking garage will be five or six stories with 464 spaces, he said.”

This should be good from the sales space addition in that we will get more mall sales jobs and for the Assisted living and Nursing home sections we will get more jobs for those places.  We are happy that the investors could get that discount from 5-11 million which was the quoted value of the land in the article for 3.5 million for 3.3 acres in down two Las Vegas.  I hope the other tax revenues they note will pan out as well for Nevadans.

For those looking for new care alternatives that focus on the care and family style care we suggest you check out these care alternatives.

Fantastic alternatives to the Assisted Living and Nursing Home Rehab.  This is a family style care option to compare to more of the same nursing home rehab and Assisted Living.  If you look at the staff, staffing systems instead of the mall on the first floor the care you get are likely to be different.

These care settings offer custodial care but with day to day training, supervision, and support of a hands-on management with decades of medical and custodial care experience. Look for the care team to get the best Assisted Living, Residential Care, Home Care, Retirement Community, Hospice Care, Dementia Care, Alzheimer’s Care and Memory Care in any care setting.  Look beyond the setting label and find out who you are getting before you buy.

Tender Loving Care Senior Residence


Tender Loving Care Senior Residence, Costa Brava  –

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Dr Shawn McGivney


Assisted Living, Nursing Home, Home Care-If they only knew the value of continuity of care!

Choosing any care setting, Assisted Living or Nursing Home is difficult not because of the physical plant but because the care is delegated, there is not one responsible person or team and the care team changes every time the care needs change.  Indeed, the hospitalist does not talk to the pcp, the pcp never or rarely meets the caregivers, and the family is in the middle quite confused.

We are very biased because Tender Loving Care Senior Residence, Costa Brava are the standards of care based on Continuity of Care and Complete Care. While Great Authors like Paula Span write great articles it is clear to me she has never visited http://Tlcsr.com All that she writes is true for the industry. This great article is not exception. Assisted Living or a Nursing Home hits many good points. But in fact the most important fix is continuity of care and knowing the entire care team. Doctor, administrator, and care team throughout this difficult family journey.

Assisted Living or a Nursing Home.
Another Great NYT post by Paula Span.

Two great example to follow as standard of care and continuity of care.

Tender Loving Care Senior Residence – http://tlcsr.com


Tender Loving Care Senior Residence, Costa Brava – http://costabrava.tlcsr.com
Value continuity of care to get the best care and the most cost effective care.

Dr Shawn McGivney

Hospital and Nursing Home InActivity VS Exercise in Assisted Living

Hospital and Nursing Home Inactivity Vs Assisted Living

Is Nursing Home rehabbing the best exercise after the hospital or is Assisted Living with structured care and doing daily exercise a comparable choice? 

This NYT article raises a good question about activity in the hospital and by extension Nursing Home Rehab where you are on your feet 43 minutes a day.  They go on to point out that if you are allowed to walk more, provided an setting or support system that encourages twice or more a day activity that is better than less activity.  We add in questioning the definition of the phrase “rehab” since we believe that confuses many who would walk more, do more, if they were allowed to be in a setting that encouraged ambulation.  For example being on your feet more, walking to meals, doing day to day tasks that most people would do in a more supervised Assisted Living or structured care setting might give one more activity than in many hospitals or other nursing home type settings.

Trapped in the Hospital

Paula Span

http://www.tlcsr.com/blog/|nursing home word pic

Nursing Home Rehab vs Assisted Living that has adequate staff and continuity of care to do assisted activity with seniors


A nursing home, which is the most common form of senior rehab, might only have them on their feet for 43 minutes a day.  While the senior gets “rehab” from a licensed physical therapist  they don’t get a lot of walking and ambulation for the remaining 23 hrs a day.  If walking and ambulation are rehab then one might get more “rehab” or exercise in an Assisted Living or Residential Care home that focus on continuity of care and activity.

Just because the hospitalist doctor, who generally does not know you, and might have less  interest in your condition months later since he does not expect to see you,  suggests “rehab”, meaning nursing home rehab  don’t assume you will get a lot of exercise.   In fact, the system delegates your rehab to just the time you are in rehab which is not very long.  The staff do their jobs but the floor staff like the senior  to rest, and not get up, since they don’t have time to supervise that.

If you knew your doctor, your doctor participated in the care both in the hospital and after the hospital he might feel differently about your expected functional decline in nursing home rehab.  Now the NYT is confirming this view.

We caution that all Assisted Living Homes may not have adequate staff or systems set up to allow or encourage mobility but note that if your setting favors continuity of care and senior independence it might be a good alternative to Nursing Home Rehab.  All of these are speculative and each needs to discuss this with their doctor and health care team.

Free or paid by Medicare nursing home rehab  is not always the best care, most care, or most exercise.

We bring this point up since many hear that nursing home rehab is free or covered by Medicare for 100 days.  They want to use up this free resource.  At first glance saving a few bucks is a good ideas but when you consider that many my decline further and  not regain their previous community mobility with extended nursing home or hospital  stays and the inactivity that accompanies them.

All nursing homes are not the same. Some staff will get you up and walk with you but practically it is hit or miss. Also management will direct staff to stay on task and walking with residents takes time, time that staff could be doing something else. Also walking with residents is risky for the institution in that the patient might fall so they want to be extra safe.  Of course the senior wants to take that risk since to live a full life requires walking.  If they fall it wont be the first or last time and that is ok.  Aging and life are risky.

Example of a Assisted Living Care Option that probably does offer more exercise and supervision than many hospital and rehab settings.

At http://tlcsr.com we have a negotiated risk agreement with falls and encourage people to walk knowing that our encouraging then will encourage them to do more and when they do more they might not ask for help and fall.  That is an acceptable risk the patient and family agree to which is the negotiated risk agreement.  That should become a model for care.

Read this and share your comments.

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 Click for The Best, Most Cost Effective, Assisted Living and Senior Care Alternatives.

Tender Loving Care Senior Residence

TLCSR, Costa Brava

Dr Shawn McGivney


Read the two articles below and comment.
Assisted living vs. Hospice:  Who is in Charge?
Click on these links for the two articles from the NYT.

Assisted Living VS. Hospice:  Who’s in charge?


Managng the Assisted Living VS. Hospice Dilemma.


The New York Times is right on the money and we applaud them for discussing this.

To be fair we believe you need to add many players to the list of

 who is in charge ?

We would add Doctors, Your Doctor, and the financial entities that pay for your medical care and control to various degrees “your Doctor”  into the mix.

This is precisely the issue, no one, Doctor, Assisted Living, Hospice, Hospice Doctor, the Home Care aide or the office manager who runs the Home Care Company, Family Member, The Government, The Insurance Company — WANT TO BE RESPONSIBLE FOR THE VERY CHALLENGING AND EXPENSIVE TASK OF PROVIDING CARE TO A SENIOR.  When it comes to being “responsible” few want that job.  That is expected since it is a very difficult and under valued job.  While Medical Care use to have a high Value, much of the value came from relationships, continuity of care on both sides, “provider” and “Senior”.  However, we have seen a stead decline in the value both sides places on relationships and continuity of care which has gotten us to the assembly line, less personal, style of care we now see.   Why, How, that is a discussion we are ready to have and need to have as a society.

assisted living vs hospice nyt article pdf


The issue is lack of continuity of care.

 This is a lack of responsibility by the patient and the provider.  To have a responsible party you have to have a person, family, or patient who is participates and respects that responsibility.  If the Patient jumps to a new insurance company because a stranger, a sales lady, promises them something new they can’t expect to build and earn a trusting relationship.  We believe that health care requires that relationship especially as people age or acquire chronic illnesses for any reason.  30% of people on Medicare are less than 65 yrs old.  Accidents do happen, illness is not only for the old and all of us will need health care someday.  We need to value it, invest in a cost effective, humanistic, system of care and the basis of that will undoubtedly be Continuity of Care.

The power struggle is between financial entities, corporations trying to get your dollars and delegate the work and responsibility.   While that is a very good business system and works great when building inanimate cars or objects it fails miserably in dealing with people or providing Health Care which by definition has Emotional Health, Feeling, Depression, Satisfaction, and all the human emotions included in the service or product.  If we all were VCR’s then we can roll out care down the wide Assisted Living , Nursing Home, or Hospital Hall and go do to door making the patients wait until our assembly line was turned on.  However, in fact the bowl and bladder and entire body and mind work on their own time table making assembly line much less efficient  in providing high quality heath care.  Do not let the sales lady convince you that her best care, care she will not provide, care she has little interest in once she signs you up, will be as compassionate as care you get from someone you have a professional relationship with.  Look for continuity of care.

of course the ideal person to be in control is “your Doctor”.  They use to have more control but now have had that dissolve.  Families, insurance companies, politicians, have all come between the care providers, Doctors, RN, and Caregivers and the patients.  As those relationships were lost it stands to reason some care and caring went with them.  Now the financial institutions want to be “responsible” for your premium but want to delegate are to unknowing doctors.

By Shawn McGivney MD, RFA

By Kerry Mcgivney


Thanks for reading this post .  If you liked this post please help us by sharing the message of Care, Caring, and Continuity of Care by likeing, friending, and following our works on Facebook     (tlcsr.kerrymcgivney), Twitter ( TLCSRLasVegas), Youtube (TLCSRLV),  Joining our Email List and this Blog, and sending this to any sons, daughters, or seniors you know. Here are links to make it easy!

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Shawn McGivney MD, RFA




Continuity of care 10 31 12 Must Read Power Point Presentation.

Continuity of care 10 31 12 ( Great PDF discussion of Continuity of Care)

Please read the link to the power point presentation below and comment on it.  Continuity of care is needed in and across each care setting that claims to offer “Care” or “Assistance” including Assisted Living, Dementia Care, Alzheimer’s Care, Memory Care, Hospice Care, Home Care, Elder Care, Senior Care, Senior Living and many others.  Be sure to look for and value Continuity of Care if you want the best health care.

Great Continuity of Care Power Point Presentation!  Must Read.


Topic ( index of the above link)

Definition of “Continuity of care” ( COC) Types of care continuity Patient related impact of COC Physician- related impact of COC ( This is an important variable to consider.  One needs to consider  what, how and why the physician is affected.   The physician is the person you need to show that you trust, want, and respect them and the services they are offering.  Relationships take two — patient and doctor.)
What COC means for the older adult.Factors that disrupt continuity.Discharge planning The Patient – Centered Medical Home.

Areas to focus on:

It is not impossible to find a doctor willing to be an old fashioned doctor.

it is impossible to expect any insurance company who does not know you to offer you and everyone everything health care can offer.  That is just like paying for it yourself but having the insurance company take 20% off the top.  We do not expect cosmetic surgery paid for, Dental care paid for, and need to realize that things we all need like Senior Care cant be covered by insurance.  If we all use something it is easier to just let everyone pay for it.   However, if you value the doctor, and want a more individual, personal opinion on your own unique health care situation you can get a private doctor.  I liken it to getting the public defender vs hiring a private defense lawyer.   For a small fee you can choose a private doctor who is more responsive to your individual needs and offers the valuable continuity of care.  You may not know that a solo practice doctor needs that extra 2K per person per yr, or 166 / mo from each of you in addition to the 100 or so per visit to cover his overhead and stay in business.  The doctor has difficulty maintaining the office you and he use to provide the private medical opinion and continuity of care you want.   While many will initially think that 2K a year is a very high cost, that is $166/mo.  There are doctors who do that.  Be wary of doctor’s who charge more also.  Follow our Golden Rule of meet the doctor and his entire staff.  Just because they charge more per year or month does not mean they offer any extra Continuity of Care.   Also if the doctor is not involved actively in some forms of senior care, Home Care, Case management, Residential Care, Assisted Living, or even Nursing Home care it is less likely they can provide Continuity of Care as you age. That will reduce the value to most seniors and families to paying any premium for Continuity of Care.

Do not confuse Financial Continuity of Care, Continuity of the payment, with Continuity of care.  

This is a great pdf but we feel strongly that you need to say they do not distinguish continuity of the payment which insurance companies or Assisted Living Facilities provide in lieu of real continuity of the care.   Do not confuse Continuity of Care  which most big institutions claim to offer with Continuity of the Payment and little continuity of care which is what we usually see.  They are not the same at all!!  In a CCRC, Continuing Care Retirement Community, which offers independent living, Assisted Living, and Nursing Home care one might think there is also continuity of care when in fact it is more accurately continuity of the payment and sales force.  In general, you change rooms, staff, and friends each time you move but the money or payment goes to the same llc or chain of corporations.

For example Assisted Living Facilities or Institutions often suggest and claim that they can offer you continuity of care as you age, however, that is far from the truth.  In assisted Living Facilities when you move from Assisted Living to the Memory care you change room, staff, and sometimes doctors.  That is practically a move be it out of state or out of the building or to a new locked section far from your previous Assisted Living friends and care setting.  What is preserved is the financial structure receiving your payment.

A second, example of not confusion care is when we hear phrases like Obama Care!  In fact, we know that Barack has nothing to do with the care.  He might affect how much they pay for a given care item, or if they pay for it at all but when it comes to providing the care, answering the phone emergent at 2 am or knowing or caring for each individual we all realize when we think about it that the insurance company, or name sake of the financial structure does not provide the care.  We need to meet and come to our own financial agreements with the person who will provide the direct care. Unless we do it is hard to expect any care provider, administrator doctor, nurse, or care giver to do what someone else promises they will do with the same level of responsibility they will feel if they make the agreement themselves.  We all prefer to manage our own money, more of it, and to share less with the many levels of management in between who help us deposit our money in the bank.  Yes, I am a provider.  When you call you get me.


Seniors and any younger people with chronic illnesses benefit most from Continuity of care


While many will know at some level that any one who is older or who starts to develop more than one simple medical, social, financial or other problem will benefit from a highly informed and skilled person to assist in coordinating that care.  When you have just one problem it is easy to go to the ER or urgent care and describe your one simple, relatively easy to fix,  issue in a short period of time.  The ER staff doctor can quickly listen and respond.  However, as the history and story become longer, and includes many problems each with  no simple answers for treatment, one can see that just listening to that long history, or reading volumes of old charts or calling many places to get the old charts and then reading them will take more time than that quick care or ER staff can or will invest in that problem. Instead the ER doctor might tell you — you don,t “need” an hospital stay CALL YOUR DOCTOR when you get home.  What or Who is your doctor?    That is the point of reading and understanding this power point presentation.   Without Continuityof Care you practically do not have a doctor.   We want doctors, patients, family members and others to see what they might be missing by having a very loose relationship with “their doctor”.  We want to encourage all to invest in the doctor patient relationship so the patient can benefit.  Now more than ever Continuity of care is the care and caring we all want.


Younger people less than 65 and people with few clinically expressed Chronic Diseases need less Continuity of care.

 These are the people who are correct in the financial decision not to pay up for more continuity of care.  While these generally well people make the correct financial decision to get the cheapest insurance possible that decision does affect the rest of society who need care in that these people will undoubtedly get sick and then the payers of last resort will be stuck with paying for this very expensive care and the people who accepted premiums when they were well are let off the hook of providing the care they need when they need it.  That is exactly why basic health care needs to be a public service just like the military.

Basic, Public, Universal, Health Care – The only cost effective answer.

We can not each raise our private army and the same is true for health care, we cant have a doctor in each of the 50 states waiting for us to get in a car accident on our cross county trip, or can’t ensure our job wont move out of state and cause our health care system to change dramatically.  Society is so mobile we need public health care at a minimum.  Second is cost.  Health care is very expensive when you need it.  We need to have everyone pay, much like for military or taxes or social security so that when we get sick, or when bad things happen there is a safety net. That safety net lets each of us be individuals, lets us experiment with work, gives us choice because we know there is some acceptable minimum care, food and housing, we can get if our best efforts fail.  Creativity, and productivity are empowered by all having some minimum health care.  Third, Business will hire more people if they don’t have to be stuck with medical insurance.  Indeed, even if businesses offer medical insurance most will share costs with the employee and the employee will decline that coverage leaving them uninsured.  It is a public service and is only needed when you get sick so no one will pre pay for it when they are of moderate means.  This will improve jobs, hiring, and help reduce workers comp since you can get health care when you are working and do not need to fake a bigger disability injury.  Offering health care will also allow us to tighten monitoring for disability and to have a much stricter test for disability since you can get health care after work, before work, take one hour off during work and don’t have to just drop work and run up big unnecessary health bills to get minimal health care.  I can go on and would welcome doing so if comments by you blogger ask for more discussion.By Shawn McGivney MD, RFA and Kerry McGivney


Thanks for reading this post .  If you liked this post please help us by sharing the message of Care, Caring, and Continuity of Care by likeing, friending, and following our works on Facebook     (tlcsr.kerrymcgivney), Twitter ( TLCSRLasVegas), Youtube (TLCSRLV),  Joining our Email List and this Blog, and sending this to any sons, daughters, or seniors you know.

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Shawn McGivney MD, RFA