Articles Posted in Assisted Living

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As a senior living advisor, I recommend that my clients who are at the independent living or assisted living level take a trial stay at a long-term care community before they make a commitment to move in. This will allow a senior to sample the food, try the activities, socialize with potential fellow residents, and decide if they like congregate living.

Sometimes the communities will not allow a trial stay. At other times, it may be required that the senior stays for at least 30 days. Personally, I am in favor of the 30 day requirement, because a stay of two days or a week isn’t going to give the senior the ,”big picture,” of retirement community life.

A short stay or “respite” at a senior living community is normally treated like a regular admission. The senior may have to submit a medical history and physical form from their primary care doctor, along with the results of a TB test that is negative. This information ensures that a community can meet the resident’s medical needs. I recommend that my clients request the medical information several weeks prior to the anticipated admission. Collecting the information from a physician’s office can be extremely slow and often delays the admission process. Many physician’s will not complete the forms unless they have seen the patient recently. The homes also will not accept medical information that is too old.

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A recent article published in the Washington Post portrays a very biased picture of assisted living communities. The writer is a former Zen monk and journalist. I encourage you to read the article and take note of the facts that were left out of his side of the story.

The author writes the he, “decided,” to move out of his home at age 53 to an assisted living community because he had Parkinson’s disease. He neglects to mention the reason as to why he made the decision to move. Did he move because he wanted the socialization of being with other people? Was his condition becoming too complex to be handled at home? Were his funds being depleted? Could his caregiver have been experiencing “burn out?”

The article states that he knew his future fellow residents were going to be much older. Yet, he complained about watching his table mates, “waste away,” and die.

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I have been hired to find an assisted living community with a memory care component for a client in southern Cook county or Will County in Illinois. Defined in general terms, assisted living with memory care is an extension of assisted living that caters to individuals with Alzheimer’s disease or other dementias. This form of care is a wonderful alternative for individuals who have dementia but are not yet ready for a nursing home. The communities with memory care provide the resident with heavy cueing to remind him or her to begin the activities. The staff is trained to handle the behaviors that often accompany the diseae. For example, activities are provided on a structured, 12-hour basis including the residents’ activities of daily living in order to keep them mentally stimulated and occupied.

During my research, I compared nine communities on the basis of cost, staffing, activities, living areas, and and the attitude of the person conducting the tour. Here is what I found in each catagory:

As far as what you can expect to pay for your loved one’s care at one of these communities, the cost for a studio will range from $4,500 to $6,800 per month depending upon whether the charges are on a tiered or package basis.

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The cost long term care can be exorbitant. Aside from the typical ways of paying for long-term care (private pay, long-term care insurance, Medicare, Medicaid; some of which may not apply to all of the above), there is a little known benefit provided by Department of Veterans Affairs. It is called the VA Aid and Attendance benefit. It can provide up to $1,056 to $1,949 per month to the Veteran and/or his or her surviving spouse if they qualify. Basic qualifications for the Veteran include:

  • Served at least one day during the War Time period
  • Served 90 consecutive days on active duty
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My prospects were a 45 year old baby boomer and her mother. Her mom lived in her own home where the neighborhood wasn’t changing for the better. The mother was 78 years old, totally ambulatory, mentally alert, and had Parkinson’s disease. The daughter lived in a suburb that was a 45 minute drive from her mother’s home.

When they came for a tour at the community where I worked at the time, the mother was already crying piteously, exclaiming that she didn’t want to leave the home where she had lived with her husband for 50 years. In almost the same breath, she told me she had been mugged in her home and wasn’t socializing, taking her medications, or eating properly. She and her daughter argued about issues regarding the safety of the neighborhood, the mother’s physical and mental well-being, and the need for more care once the Parkinson’s disease had progressed. We completed the first tour, Mom crying the entire time while I showed her the beautiful chapel, the dining room, and the exercise class where the independent residents were having a wonderful time. As they left, I doubted that I would see them again.

Two months later, they reappeared for a second tour. I invited them to stay for lunch, a suggestion I make to all my clients since the food needs to agree with your loved one. The scenario was a repeat of the last trip, including arguments regarding the mother’s safety at home, her reluctance to move from her home of 50 years, and her fear of losing her independence.

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Here is a snapshot of the long-term care options available and their approximate costs. Not only can Andrea help you place your loved one in a facility that meets your needs, she can also evaluate your friend or loved one to determine what type of care is appropriate.

Independent Living Communities – The senior can function on his or her own, but may receive help with housekeeping and meals. The cost runs about $1,500 to $3,000 per month, depending upon the community.

Assisted Living – The senior needs help with some of his or her activities of daily living (ADLs). This includes help with bathing, dressing, toileting, transferring, eating, escorting and assistance with medications. The estimated cost is $3,800 – $6,000 per month. It is not “hands-on” care; it is “standby” assistance.

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I recently had a very interesting conversation with an Admissions Director of a well-respected Chicago skilled nursing home. We made the observation that due to the poor economy, many Chicago assisted living homes* are accepting residents whose medical needs cannot be met. In other words, the resident belongs in a skilled nursing home.** Being a former Admissions Director and with my current position as a Chicago Senior Living Advisor, I thoroughly understand the current market conditions.

The Admissions Director is the most important contact at a long-term care community. He or she is responsible for attracting and residents, while maintaining a high census. Many Admissions Directors also act as marketing liaisons. They provide your first impression of a long-term care community, and often are a direct reflection of the care your loved one is going to receive. They are also responsible for the initial assessment of the type of care that is appropriate for the senior. It is important to bear in mind that Admissions Directors are often commissioned salespeople. They are accountable to, “the powers that be,” for maintaining a high census. I can remember the terrible pressure that was exerted upon me by the management in order to keep filled the continuing care retirement community where I was working. Scarcely was a bed emptied before pressure came to fill it. The passing consolation that the seniors, “were called home by God,” just didn’t cut it in terms of lightening the pressure for quick turnarounds. I know that with a bad economy, the pressure is even worse.

My point is this. Don’t let someone “sweet talk” you into thinking they can take care

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Prospects will often call me and open the conversation by saying something like, “My mother needs some assistance.” A statement such as this one can mean anything. Assisted living actually means the next level of care that is necessary when the senior is no longer completely independent. Specifically, he/she needs some help with activities of daily living: eating, bathing, dressing, walking, transferring, and toileting. This is not hands-on care. It is stand-by assistance. For instance, the aide will not give a loved one a full bath or shower. The aide will stand by and watch the senior take their shower. The aide will hand the senior the soap and towel. The assistant will not scrub the person down. People have a lot of misconceptions as to what “assisted” really means.

According to the Assisted Living and Shared Housing Establishment Code in Illinois, the personnel requirements to qualify for assisted living are:

  1. There must be someone age 18 on the premises for 24 hours
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As you can imagine, I’m often asked how to convince a loved one who has dementia to move out of a home when she or he has refused. The issue is further complicated when someone is ambulatory, somewhat functional, but safety is a concern. If your loved one refuses to move, it is unlikely that you’ll be able to talk him or her into moving anywhere. It isn’t worth bringing up the subject. The person may become upset and dig his/her heels in deeper. The disease prevents the individual from rationally understanding the situation. While each case is different, here are some basic ideas I have seen work for my clients.

  1. Once a community has been selected on behalf of your loved one’s best interests, have his/her physician write orders saying that the person should be admitted for general care and management of a medical condition. The move should be presented as a temporary situation that has nothing to do with your loved one’s mental capacity. Remind your loved one that life for all of us is best lived One Day at a Time, and that nothing is ever written in stone. The move is a step, taken with his/her safety in mind. It is not an “end.” Hopefully once the person is settled, s/he will adjust well and forget prior objections.
  2. Convince the person that the home or apartment is unfit for habitation due to physical problems and have them “temporarily” relocate to the chosen community.
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I often have seniors and their families hire me to find the right community because the senior is lonely and wants to socialize with people his/her own age. The feeling of being isolated and depressed while eating alone is often a major cause for concern. While I empathize with such concerns, I always encourage the senior to sample the food and the “communal dining experience” before signing on the dotted line at a new home. The senior could be eating one to three meals a day at the community depending on the level of care and type of dining program offered. If a senior could be spending up to 30% of his or her time eating, the food better be good. Couple that with table mates who have personality clashes and you could be headed into a situation that spoils the whole retirement experience.

Most of the time, admissions directors are more than happy to have a prospective resident and his or her family members sample the food. However, I recommend that the sampling be conducted during an ordinary meal, rather than during a special event. The food at an event won’t be reflective of a meal that is typically served. I also recommend that the senior be seated with some of the residents during the sample meal. That way, s/he will always get truthful opinions of what the food is really like on a daily basis. It also allows the senior to sample the social setting and resident personalities. Some communities have unassigned seating. Others will purposely mix the residents to prevent cliques from forming at meal time.

Please be advised that independent living and assisted communities may not have a dietician on staff. Many of them note “heart healthy” and sugar free foods on their menus. Then, it’s up to the senior to behave. If your loved one needs a special diet like pureed or mechanical, ask if that can be accommodated. I have even arranged for my nursing home clients who are lucid and contemplating a change in nursing homes to travel to the proposed new home via Medicar to take a tour and sample the food.

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