Diabetes is a big deal in Senior Living. When I first got into the Senior Living industry I was stunned to learn how many seniors suffer from diabetes. The statistic is that over 25% of people over 65 live with diabetes. Let’s explore some of the considerations surrounding diabetes management and Senior Living placement.
Most of the time in Senior Living diabetes isn’t a particularly difficult problem. Some people are able to handle their diabetes with simple dietary changes, the loss of weight, and/or the addition of exercise. Most communities have diabetes-friendly menu options, including no-sugar desserts, which can help considerably. Most seniors manage their diabetes with pills, the most common of which is Metformin. However, unmanaged diabetes can lead to bigger problems and health issues.
Where diabetes management becomes particularly tricky is when insulin shots are required. If the resident with diabetes can manage the insulin regimen, this isn’t a problem. But diabetes management gets complicated when the resident needs help with injections because insulin shots require finger-pricking and injections with various types of syringes. Sliding-scale insulin injections are the most complicated to deal with.
Here is the challenge: because we’re piercing the skin, regulatory oversight comes into play. By regulation, only licensed nurses can give injections. The single exception to this rule in Assisted Living and Memory Care is with diabetes shots, where a trained caregiver can give shots under “nurse delegation” rules. However, nurses who delegate their authority are putting their license at risk if something goes wrong, so few nurses are willing to delegate this task, which brings us back to the original bottleneck that only nurses can give shots.
This isn’t a problem in Skilled Nursing, where there are, by regulation, nurses 24/7. Assisted Living and Memory Care however are “custodial care,” where nurses are typically in the building only 40 hours a week at best, and not necessarily on weekends. For this reason, the large majority of Assisted Living and Memory Care communities can not assist residents with insulin injections.
So what to do? Fortunately, some alternatives do exist.
1. There are approximately 11 Assisted Living and Memory Care communities that have nurses in the building 24/7. I say “approximately” because this number occasionally varies as some communities change management and their policies evolve. Buildings with nurses 24/7 are the most reliable option for diabetics requiring help with their injections.
2. Some buildings have nurses available enough of the time that they can handle certain injection regimens. Not every diabetic needs injections four times a day, and not every diabetic needs to have his finger pricked every day. So sometimes there are instances where a community without nurses 24/7 can handle diabetic shots. This is of course situation dependent and can change if something about the resident or his required diabetic regimen changes.
3. There are instances where a person from outside the community can come to the community and give shots. This would usually be a relative. Home Health companies can send a nurse for shots, but Medicare will usually only cover this service for a very short time period if at all. You can pay privately for visits from Home Health, but this usually costs in the neighborhood of $100 per visit and is, therefore, cost prohibitive. Occasionally Veterans benefits will cover the cost of sending someone to take care of diabetic shots, but this can be very tricky to arrange.
4. Creative solutions can sometimes be found. This sometimes involves changing from an “optimal” diabetes management regimen to a “good enough” regimen. Of course, this is situation dependent and must be done in close consultation with your doctor. For example, I have seen cases where instead of getting three finger pricks a day plus three customized doses from an insulin pen, a patient might instead get one insulin shot a day of a consistent amount that is evaluated weekly under a doctor’s direction. Another example is when someone is put on sliding scale insulin in a hospital or Nursing Home, where they are trying to optimize whatever they can control. In some cases, these patients may be able to return to pills after their convalescence. And as mentioned, sometimes with weight loss and the better-managed eating habits available in community living, someone’s blood sugars may not swing as widely and a person may be able to switch back from shots to pills for their diabetes management. So with a careful evaluation of a person’s changing situation, sometimes a doctor is willing to change a diabetic regimen away from shots.
Environmental factors can play a role too, especially in Memory Care. Diabetics with dementia pose a special challenge, and not only because they can’t give themselves shots. Sometimes these people eat inappropriately, which wreaks havoc with their insulin. Some communities have snacks freely available, such as potato chips or candy. Memory Care residents have been known to eat compulsively from such always-available foods, so sometimes these snacks must no longer be made so easily available.
At any rate, an obvious point to this discussion is that it helps to work with a Senior Living Locator when exploring Senior Living options for a loved one with diabetes. If you live in the Austin, Texas area and are looking for help with the question of where to place your loved one, please call Michael Gill at (512) 630-7133.