Articles Posted in Assisted Living

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I am often amazed at the number of clients who call me and say they are looking to place a loved one in a senior living community because their loved one is falling. When it comes to senior falls, please remember the following very general guidelines:

No senior living community provides one-on-one care. Placement in a senior living community is never a guarantee that an older loved one won’t fall. If a senior is in independent living, that level of care is not licensed. There are no nurses or nurses’ assistants. If a senior falls in independent living, 911 will be called to help the person stand or to take them to the nearest hospital. When a senior resides in assisted living or a nursing home, there will not be enough staff to prevent the senior from falling unless the staff witnesses the fall taking place and they can act on time. Don’t forget that your loved one will be sharing a certified nurse’s assistant with many other residents.

The use of full bed rails is not allowed in Illinois. They are considered to be a restraint. They can only be used if a doctor writes an order for them. The most that can be used without a doctor’s order is a half rail. A resident cannot be restrained with chemicals without a doctor’s order. There are grab bars available that attach to seniors’ beds to help them steady themselves when they rise. Many times, a mattress is placed close to the floor to lessen the distance of any potential fall.

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I was fortunate enough to be interviewed for a blog post by my colleagues at Lexington Square regarding caregiving tips for a spouse. I would like to share them with you.

When it comes to caregiving to a spouse, there may come a time when additional help and support are needed.

In this helpful Q & A with Andrea Donovan of Senior Living Advisors of Inverness, she offers expert insight on how to best handle this situation, how to overcome caregiver guilt and how to create a social and wellbeing experience for both the caregiver and spouse.

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My client is the lovely granddaughter of a woman who was 99 years old when we met. They are of the Jewish faith. The granddaughter had contacted me over concerns that her grandmother was running out of money while living at home and paying for 24-hour caregiver services. The services were primarily for companionship, as she could handle on her own most of her activities of daily living (i.e., bathing, dressing, transferring, toileting, walking, and eating). The woman’s financial advisor had given her several warnings that she needed to move before her funds were depleted. We made arrangements for me to meet my client’s grandmother to do an assessment.

During our meeting, the grandmother insisted that she didn’t want to be in a Jewish retirement community. Apparently, she had been in a Jewish organization for rehab. once before and the stay didn’t end well. Grandma told me her plan was to stay at home until her 100th birthday. Home was located in a far south suburb. The location of her home made it very difficult for her granddaughter to visit, as she lived in the north side of Chicago. She didn’t have a car and had to rent one every time she visited her grandmother. Every time I mentioned a potential move, Grandma would swing the conversation toward one of the many artifacts she had collected during her life’s travels. During our conversation, she also said she wanted to remain out south because she wouldn’t know anyone if she made a move up north. She insisted upon moving to a particular community she had in mind. However, it was not a good idea from a safety standpoint, as the neighborhood was changing – and not for the better.

I went to work and narrowed the options to three assisted living communities that were close to the granddaughter. She toured all three, and narrowed the options to 2 places that she felt could work for her grandmother. I arranged a tour for the grandmother at one of them. Grandma seemed rather stoic and resistant during the tour. After the tour, we went to the famous Superdawg drive-in for hot dogs which we proceeded to consume in my car. While we ate in silence, I decided to ask her, “Well, what did you think of the place?” Grandma look at me and said, “It was a little to goy for me,” which I loosely interpreted to mean that it was too non-Jewish. The granddaughter and I looked at each other since Grandma had previously insisted that a Jewish community wasn’t important to her. She also told us both nicely that she had no intentions of moving until her 100th birthday was over.

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I recently had the wonderful opportunity to be interviewed on the Silver Solutions Radio show. It airs on WMRN 1410 AM in Elgin, Illinois. It is hosted by Jeanette Palmer, Jim Wojchiechowski, and Kathleen Wetters, who each independently own a Right At Home non-medical home care agency. During the interview, they graciously gave me a chance to explain how I started my career in the senior housing industry as the Admissions and Marketing Director of the St. Andrew Life Center (Now Glen St. Andrew) in Niles, Illinois. It was a faith-based community that offered three levels of care, including independent living, assisted living, and a nursing home on one campus. I was receiving so many telephone calls (mostly from the children of seniors who were calling me from the Yellow pages) from people who didn’t know how to solve their senior loved ones’ problems. I saw a niche for a consulting business. So in 2006, much to my husband’s dismay, I opened Andrea Donovan Senior Living Advisors in 2006.

I started my senior housing placement consulting business by touring and evaluating over 150 senior living communities in the Chicago metro area. I looked at cost and methods of payment accepted, levels of care, staffing, and quality of care. Then I also evaluated quality of life factors such as cleanliness, menus, activities, and apartment and room layouts. So, when a family needs my services, I make a face to face evaluation of the senior, their financial realities, and the location preferences of the family. Then, I select the options that fit the senior’needs so families aren’t wasting time touring places that simply won’t work long-term.  At this point I have toured and evaluated close to 500 senior communities in the Chicago metro area.

We also shared a very frank discussion about the costs of placement in a senior living community versus the costs of staying at home in the Chicago metro area.  We talked about the advantages and disadvantages of each option.

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The holidays can be a profoundly stressful time for a Person With Dementia (PWD) and his/her family members. To avoid even more stress and any potentially awkward or embarrassing situations, family members who don’t know about the PWD’s diagnosis should be made aware of it. That way, you will avoid any shock and/or inappropriate remarks when your Uncle Fred decides to pipe up and exclaim, “Hey, why are you acting so weird?!”

Many years ago, I was driving my parents to Wisconsin to visit my maternal grandmother. My dad was sitting in the front seat of the car with me. He used to read the daily newspaper from cover to cover. So, I wasn’t surprised to look over and see him reading the paper during our trip. Dad also had a marvelous sense of humor. So, when I glanced over and saw him reading the newspaper with his sunglasses on, and upside down, I giggled and said, “Very funny, Dad!” But then I saw that he really wasn’t comprehending what I was saying. When we arrived in Wisconsin, I noticed that he needed a lot of help to get out of the car and eventually to the hotel room. I addressed my mother indignantly and asked, “When were you planning on telling me about this?” She replied, “I just didn’t want you to worry.” So, what would have been a better approach? Was it better to cover up the situation and let it rear its ugly head at a time when I didn’t expect it? Or should she have told me?

This season, if you intend on taking your Person With Dementia to a holiday party, plan to keep the visit short. Parties with a lot of people, flashing lights, noise, and kids, etc., can be very overwhelming. It is a good idea to have a family member assigned to stay with the PWD so that he or she stays engaged and does not withdraw. Look for a quiet room where the person can retreat to if he or she becomes overwhelmed. Or you may want to avoid parties all together and have family members visit the person at home in smaller numbers. If you have recently moved your loved one to a long-term care community, it probably is not advisable to take the PWD out of the environment to which he or she is just getting accustomed. All of the communities will have some sort of holiday get-together that family members can attend. Dementia is an unpredictable disease, so it is best to avoid behavioral issues from the get-go.

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My clients were a very pleasant, alert, 90 year old woman and her son. The son had been gainfully employed by a major corporation and had been transferred to a state out west. He liked the new location very much and remained there once he was retired. His mother had lived here in the Chicago area all of her life. When she could no longer take care of herself, the son chose to move her to an assisted living community here. She had lived in the suburbs all of her life and wanted to be in close proximity to the cemetery where her husband was buried. She had an excellent support system here, consisting of many personal friends who visited her and members of her church who came to give her communion at least once a week. In addition, the son hired me to act as her advocate for several hours a week. His long-term plan was eventually to find a senior living community for her out west where he was living. In the interim, he wanted me to monitor the visits from the nurse who was tending to a wound on his mother’s leg, ensure that her hearing aids were charged, make certain she arrived at her ophthalmologist appointments, and see that her mind was being occupied by decent activities and going outside.

At first my elderly client was rather wary of me. But we developed a wonderful relationship. She was very frank with me with regard to the staff at the local community. She was in the assisted living area of a Continuing Care Retirement Community (CCRC), including independent, assisted, and nursing home living, because she needed standby assistance with bathing, dressing, and putting in her hearing aids. On occasion she needed to use a wheel chair for long distances, and was in need of 24-hour supervision. However, she complained of long waits when she pushed her wrist pendant for summoning help. She said that when she did get help, some of the staff members were nice and others were not. She often mentioned to me that the activities were not very interesting. She told me she didn’t complain to staff or to her son because her son tried so hard to do a good job. She did mention that the food was wonderful. Overall, I got the impression that she was just putting up with things and would like to be happier with better staffing and activities.

The son eventually contacted me and said he found a new community for his mom out west and gave me the dates of her departure. I met with the son and his mom to say good-bye. The son told me that his mom was going to be living in an independent living/assisted living/memory care community. He explained to me that the independent living and assisted living residents lived in the same area in the new community because state law prohibited them from being separated. He expressed concern over the potential wait time involved when she pushed her pendant button. I asked him if he had asked what the ratio of staff to residents was and he replied “No.” I asked if he had checked the activity schedule for the types of things that might make his mom happy. I did not receive a clear affirmative answer. Since his mother loved the food at her original, local community, I asked if he had tried the food at the new community out west. Again, the answer was no. When I asked why he went with a community that lacked a nursing home component, he said he was told that any of the services she needed could be brought into her apartment. I’m not certain he was aware of how astronomical the costs of ordering ala carte services into an assisted living apartment can be.

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After I have completed the task of finding the perfect senior living option for a senior loved one, many of my clients are faced with selling the senior’s property. I have asked my colleague, Senior Real Estate Specialist (SRES) Roz Byrne, to offer advice on that subject:

It’s an age-old question, and as we age it gets even trickier to determine how much work or money we should put into our homes.

When it’s time to sell the family home, seniors’ homes tend to present themselves in one of three ways:

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While “age 55 and older” seems to be the general definition of an American “senior,” I have never allowed my age to deter me from enjoying two of my favorite activities: tap and jazz dancing. As a senior living advisor and former part-time children’s dance teacher, I am pleased to see so many senior living communities offering dance therapy classes to their residents. I have also taught tap and ballet on a voluntary basis in several senior centers and in some of the assisted living communities that specialize in dementia care. When I was teaching, I was made aware that several of the participants in my class with dementia also had Parkinson’s disease.

Exercising even just several times a week can boost a person’s immune system and make him or her feel better physically and mentally. That is in large part because of the endorphins that are released. Exercise classes provide fun and fellowship while encouraging seniors to move all of their muscles and body parts. If a person moves his or her limbs, it increases hand-to-eye coordination, strengthens the core, and helps balance.

I approached teaching my senior dance classes as I would have any other basic level: I included combinations and repetition to Frank Sinatra and Bobby Darin songs, among others. I found that most of my “students” found ease in doing the tap warm ups, grape vines, and some jazz movements, even if a participant was confined to a wheel chair. Many of the participants said that their joints felt better, their overall movement improved, and, most importantly, their spirits had been lifted. After the class had finished, I always served my students a snack and we’d talk for a while. Some of the residents with dementia would reminisce about where they used to go to dance with their spouses. One resident in particular spoke about a church in Evanston, Illinois that had a Scottish affiliation and offered Scottish dance lessons. She even went so far as to quote me the exact street address. The repetition of certain exercises helps people with Parkinson’s to concentrate on movements that have become difficult for them, such as doing two things at once. People who have suffered a stroke are able to express themselves by moving to the music even though they can’t talk. Sometimes seniors’ medications stop working for them and yet the classes gave them relief from their symptoms.

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Real-Life Story

I recently had a preliminary meeting with the adult son of an 82 year old senior who was diagnosed with dementia. The senior had been living with him for a number of years and was having issues with wandering, falling, and incontinence. In order to alleviate the stress of having the senior in the adult child’s home, a part-time caregiver was hired during the day to meet the senior’s care needs. During our meeting, my client did not want me to meet the senior in order to avoid unnecessary agitation. His mother was not born in this country and spoke a limited amount of English. After learning some facts about the senior’s behavior and financial realities, I informed my client that the senior was a candidate for assisted living with memory care. But, the catch was she needed to be in a Continuing Care Retirement Community that would keep her once her funds were exhausted. Or, she could move to an assisted living that offered memory care. Then, she could be moved to a nursing home that accepted Medicaid when she still had enough funds to move to a decent community.

Right after Christmas, my client called me and said his mother had fallen. The rehabilitation community where she was receiving therapy had set a release date for the following week. My client asked me to come and assess the senior and make suggestions for a long-term care community.

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As a Certified Guardian, I am often asked to act as a senior’s Power of Attorney for Health Care when s/he doesn’t have a family member who is willing or fit to act for him/her. Simply stated, the Power of Attorney for Health Care grants the designated “agent” control over the senior’s decision-making, including end-of-life decisions if the senior lacks the capacity make the decisions on his/her own. As a Power of Attorney For Health Care, you should be thoroughly familiar with a senior’s personal, financial, and medical history before accepting this serious responsibility. Please read the following real life story that makes my point.

REAL LIFE STORY

Five years ago,  I was called at the last minute to act as Power Of Attorney (POA) For Health Care for an 85 year-old  woman.  It was the day before she was to move to independent living at a retirement community. Independent living used to mean that the senior can basically function on their own with some assistance with meal preparation and housekeeping. Now there are a lot of ala carte services that can be brought to the senior’s independent apartment, allowing him/her to remain there without changing to the assisted living level of care. The woman’s former POA had moved out of state and had written her a formal letter of resignation. A trust company had been appointed to act as her Power of Attorney For Finances.

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