Articles Posted in Real Life Story

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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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My client is a 72 year old, Eastern European woman who had been living in an apartment. She ambulated with a walker. She is diabetic, suffers from anxiety, and has difficulty with her vision. She had contracted an infection in her back due to a fall and had refused to go to the hospital for treatment. She had a part-time unlicensed caregiver who assisted her with errands, bathing, and meal preparation. The caregiver came to help out for several hours a day during the week, but my client was alone at night and on the weekends. I was hired initially to assist my client with making her cremation arrangements, review her paperwork and pay bills, and assess the need for senior living options. Although my client and I have a fairly strong bond, I sensed that the bond between her and the caregiver was much stronger, as they were both from the same country of origin.

After working with my client for a month or so, I told her that I didn’t feel that her apartment was safe for her to be alone. She even confessed to me that the shower didn’t work properly, and the caregiver was filling a bucket and dumping the water over her head in the bathtub in order to bathe her. I suggested calling the landlord.

As time went on, my client named me as her Power of Attorney for Health Care and Property. Her financial advisor, attorney and I had repeated conversations with her (together and apart) regarding the need for her to move. As the saying goes, the conversations fell on deaf ears.

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Hearing loss can lead to auditory deprivation, dementia, and emotional problems.  I have asked my respected colleague, Audiologist Kelly O’Malley, to share some facts about each consequence:

Auditory Deprivation:

When the hearing nerve and the area of the brain responsible for hearing are deprived of sound, they atrophy. Microscopic hair cells in your inner ear vibrate with sound and send signals to your brain. When those hair cells are damaged, they can’t transmit the sound properly to your brain. This results in hearing loss at certain frequencies. Prolonged untreated hearing loss may cause your brain to forget how to interpret auditory impulses, like an unused muscle becomes weak over time. Damage to the hair cells in the inner ear is permanent. Even if these areas are stimulated again through amplification, the brain may no longer be able to interpret the incoming signals clearly. In other words, “use it or lose it” applies to your hearing as well.

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At the request of the Illinois Chapter of the Huntington’s Disease Society of America, I was recently asked to give a presentation at their annual meeting on, “How to choose a nursing home”. Had I been asked to speak about how to find a nursing home for a person with Huntington’s disease, the task would have been much more challenging.

For those of you who are not familiar with the disease, here are some very general characteristics of the disease:

1. It is a neurodegenerative disease that causes deterioration of the brain cells. It can strike as early as the age of 30 and progress for several decades. It can also strike children and the elderly. The disease is hereditary. Its victims exhibit inappropriate behaviors that can sometime be violent.

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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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Real-Life Story

My client was 102 years old and had lived in the same independent living community for more than 12 years. She had moved there with her husband when the community was a homey retirement home. After her husband’s death, she remained there with 2 part-time caregivers who provided total assistance with bathing, dressing, escorts to the dining room via wheelchair, and transporting her on errands. She was alert.

When I went to assess the client, I was greeted by 5 family members who were gathered in her lovely 2 bedroom apartment. As they explained to me, the community had been purchased by another organization that was turning it into a glamorous, high-priced, marble-clad independent living community. As I was listening to them, I noticed a baby grand piano occupying the corner of the room. And at one point during the conversation, the caregiver assisted my client with being seated at the piano. She delighted me by playing a wonder rendition of George M. Cohan’s work, “Give my regards to Broadway.” She could still play despite needing help with other activities of daily living!

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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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A client who heard me speak a number of years ago decided to hire me for an interesting project. He and his wife live in a large beautiful older home (estimated over 5,000 square feet with three floors). The couple was wondering what the potential future costs of staying in the home would be if one or both of them became ill. I generated a report for them based upon three case examples. Although I didn’t know what the current costs of maintaining their home are, I included places in the report to “fill in the blanks.” I gave the couple some general ideas of what they might need to consider in the future. Many of the future costs would vary by the dimensions of their home and the models of safety equipment chosen (e.g., stair lifts, as they had three floors). The report was meant only to give them ideas of what the costs might be, and what they might need to think about for future safety. I ended the report with a ball park comparison of what it might cost to move to one of the higher end senior living communities. Here are the results:

Case Examples

Client M had been healthy until recently when s/he was diagnosed with a serious heart condition. The client was ambulatory, but now needs a walker. Because the disease has left the client very weak, s/he needs help with meal preparation, bathing, dressing, and standby assistance with toileting. In addition, the caregiver must run errands, provide medication reminders, do laundry, and light housekeeping. All of the necessary help can be obtained through a private caregiver from a licensed non-medical home care agency. The current cost for care of the individual would be $22 per hour. The non-medical home care agency estimated that the client would need at least 8 hours of care per day, 7 days a week so as not to exhaust the spouse. Therefore, the cost of the care would be $176 per day, and $1,232 per week. The total annual cost for the caregivers would be $64,064. In addition, the bedroom was on the second floor, so the stairs would need to be modified in order to accommodate a lift, the cost of which would start at $1,600. The bathroom needed to be outfitted with grab bars, and the shower needed to be modified to a walk-in model, with the addition of a raised toilet seat. A ramp needed to be fitted to the back door, with access to the driveway. Additional support had to be hired to keep the ramp and other areas free from snow and ice. The house needed to be canvassed for tripping hazards and slippery floors.

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Elder abuse is a crime. It can occur whether your loved one is at home, attending adult day care, or living in a senior living community. And like any other crime, you have an obligation to report it. This month, I have asked one of my trusted partners, Mike and Mary Doepke of Home Helpers Home Care of Hinsdale, to share some information on Elder Abuse:

From all outside appearances, 80-year-old Shirley seemed well cared for by the niece who had moved in with her a few months earlier. She even told her friends how she was enjoying the company and the help around the house.

Shirley had always been frugal with her credit cards, using them only when needed. So when the bank called to ask her about some recent, unusual charges on her account, she was alarmed. She was even more surprised to find out that the purchases were made by the niece she had welcomed into her home.

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