Articles Posted in Real Life Story

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A recent article published in the Chicago Tribune entitled “Refund sought; ‘every little dime would help’ emphasizes two important points. First, the media has provided only the complainer’s side of the story. There are so many facts about this case we don’t know. Second, it points out the true pitfalls of having a neighbor of 47 years, and someone who is inexperienced at navigating the long term care health system calling the shots for an elderly person. As a senior living advisor who acts as Power Of Attorney for several of my clients, I cannot express the importance of having an experienced individual take on this serious task.

According to the article, the elderly person had fallen and spent over three months in a rehabilitation facility beginning in November. If the elderly person spent over 100 days in rehabilitation after a three night hospital stay, it is likely she had exhausted her Medicare benefit period. The costs to remain at the same rehabilitation community as a private pay client would have been prohibitive. I have in many cases, seen clients released to a lower level of care (before they are ready) in an effort to avoid paying higher costs. The Supportive Living community mentioned in this case provides only stand by assistance with bathing, dressing, transferring, toileting, walking and eating. There is no nurse present on a 24 hour basis. After living at the Supportive Living community for six weeks, the resident was sent back to a skilled nursing community after developing an infection in her heel. According to Doctors, the source of the infection was unknown and treated with an IV, which is a type of care Supportive Living communities are not licensed to deliver. After the diagnosis of infection, the resident was placed back in a skilled nursing home (which is the same level of care she was receiving during rehabilitation). I wouldn’t have allowed my client to make that sort of transition unless they were really ready.

The article also documents that the elderly woman’s Power Of Attorney tried to obtain a refund of a $2,500 move in fee. As a senior living advisor, I am unaware of very few move in fees that are refundable. Off hand, I can think of only one community that offers a refundable move in fee. But, that is one item that you need to be clear on before you move a loved one into a community. This Power Of Attorney insisted that the money be returned because the resident was only there six weeks. Needless to say, she still moved in.

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I recently had a situation occur that I’d like to share, lest the same circumstances arise for you.

My client’s were a family whose Mother was living in an independent living retirement community with a full-time caregiver. Her health issues had escalated to the point where she could no longer perform any activities of daily living on her own. She was approaching the point where she was a two-person assist. The cost of two full time caregivers plus the independent living rent was prohibitive. Therefore, the family retained me as a senior living advisor and certified care manager to find a nursing home for her.

I actually anticipated that the placement was going to be fairly easy. They wanted a private room for their Mom, with specific location parameters, and a certain religious affiliation if possible. Sounds easy, right?

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I just turned 55 on my last birthday. Although some people consider 55 as the official age of becoming a senior, I have never allowed my age to deter me from participating in my hobby of tap and jazz dancing. As a senior living advisor, (and a former, part-time children’s dance teacher of 13 years, hobby only) I am also pleased to see so many of the senior communities offering dance therapy classes to their residents. I have also taught tap and ballet on a voluntary basis in some of the assisted living communities that specialize in dementia care and several senior centers. I was made aware that several of the participants also had Parkinson’s disease.

Exercise that is performed several times a week can help to elevate a person’s immune system and make them feel better about themselves. That is because of the endorphins that are released. The exercise classes provide camaraderie while encouraging seniors to move all of their body parts. If a person moves their limbs, it increases hand to eye coordination, strengthens the core, and helps balance.

I approached the classes as I would have at any other basic level. I included combinations and repetition to Frank Sinatra and Bobby Darin songs. I found that most of my “students,” found ease in doing the tap warm ups, grape vines, and some jazz movements, even if they were 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 them 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 peoples’ medications stop working for them and the classes give them relief from their symptoms.

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A recent, nationally publicized tragedy involving a woman with memory issues emphasizes the fact that a senior with dementia (even in the early stages) should never travel alone. The woman’s family was aware of the fact that she was having memory issues. Yet, they allowed her to fly from Barbados to Washington alone (flight time approximately four and one half hours) with a layover in Miami. The article states that the family was concerned about her memory issues and planned to have her checked once she arrived back in Washington. It seems to me that she should have been checked prior to doing any travelling. In addition, the woman had poor vision. She walked past an airline agent who was carrying an electronic sign with her name on it. He was to escort her to the baggage area where the daughter was waiting. Her physician would have advised against her travelling alone and the tragedy could have been prevented.

As a senior living advisor, I always tell my clients that a senior with dementia should never travel alone. Here are some other tips that I offer to ease the stress of travelling with a senior who has dementia:

:-Always stay with the person in the airport. Do not turn your back on him/her.

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I am often confronted with some interesting family dynamics when a family hires me to consult with them. At times, the children are willing to accept my advice without reservation. Sometimes, there is often one child who wants to prove that s/he can “do this on her/his own.” While there is usually one child who emerges as the spokesperson for the family, the choice of the right care should be the result of a family consensus and not the persuasive skills of a ringleader. Consensus should be coupled with careful comparison of cost and methods of payment, level of care needed, staffing considerations, location, and quality of care involved with all the senior living options. Please read the following “Real Life Story,” that exemplifies my point

Real Life Story

One of my clients who did not follow my initial advice contacted me last week. She was unhappy with the care that her Mother was receiving at an assisted living community that specializes in memory support.

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When I am hired by a family whose loved one has Alzheimer’s or some other form of dementia, my thoughts immediately turn to my Father. My Mother, who is a registered nurse, insisted upon caring for him at home until his medical conditions forced his transfer to a nursing home. He had been one of the charter physicians who helped open a major hospital in the 1960’s. Because of this fact, my Mother felt obligated to place him a nursing home that was owned by the hospital. It was centrally located for most of my family members, except for my husband and me. We would travel 25 miles every night after work so that I could visit him. The commute exhausted both of us. The poor care resulted in my Mother making a decision to move him to a nursing home that was closer to her, but even further away from us. The care and compassion that he received at the new nursing home was the difference between night and day. I just had to resign myself that I was going to see him less. As a senior living advisor, I always tell my clients that location is important but it shouldn’t be the sole factor in choosing a long term care community.

REAL LIFE STORY

My clients were an 82 year old woman and her children. Their Father was at home with two caregivers who took care of him in 12 hour shifts. He was diagnosed with Alzheimer’s disease. His behavior was becoming very difficult to the point where he was a two person assist. The family was in favor of placing him in a long term care community. There was one child who volunteered to move him into her home. Her intent was hire a number of caregivers to accommodate the two person assist.

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During the week, I was presenting my “Senior Living Myths Unmasked – Separating Fact From Fiction,” to a group of business owners. As a senior living advisor, I told them that I always make certain that a skilled nursing community is certified for Medicare and Medicaid and to understand any stipulations relating to both. The response from several members of the audience was “Do you mean some aren’t?” Therefore, I would like to share an unusual incident that encourages exercising due diligence in understanding your loved one’s terms of permanent admission.

For the past several weeks, I have been assisting a woman whose husband was at home with a 24 hour caregiver. This arrangement had been in place for a number of years and the cost was becoming prohibitive. As much as she wanted to keep the current arrangement in place, she needed to move him in enough time to afford placing him in a top notch skilled nursing community. There were enough assets to pay privately for a number of years. But like many seniors, he would need to file a Medicaid application once his funds were depleted.

When I sat down with the wife, she gave me some location parameters. I immediately came up with a suggestion for a community that I felt would be perfect for him. My client was pleased because her husband’s primary care physician happened to be the community’s Medical Director. Although she was elated with my suggestion, she wanted to look at other communities for the purpose of comparison. I went home and chose 2 other communities to present to her.

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The firestorm controversy regarding the refusal of a retirement community nurse to administer CPR to an 87 year old resident of its independent living section has been fueled, in part, by faulty media coverage. On the morning of March 4, 2013, I heard a reporter on a local news radio station in Chicago refer to the Glenwood Retirement Community in Bakersfield, California as a “nursing home,” which is a mistake. Many national news announcers made the same mistake. The more accurate terms would have been “senior retirement community” and “independent living.”

The distinctions do make a difference — not necessarily for the moral and ethical implications of the case (which are gravely serious and merit solemn discussion in a nation founded on life-affirming Judeo Christian values), but for the majority of Americans who might not understand the wide range of senior living options.

Glenwood Gardens is a community that offers independent living. The independent living unit where the decedent lived does not require any sort of licensing. Glenwood’s licensed assisted living units and nursing home are located on adjacent property. The independent living facility is not unlike a regular apartment building. Its residents are supposed be able to function with very little assistance except, perhaps, for some meal preparation and housekeeping help. Therefore, during the widely reported incident, the Glenwood nursing staff member was following business protocol when she called 911. Her choice not to administer CPR to the resident who later died is something that she will have to live with for the rest of her life.

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I remember when my 91 year old mother was admitted to the hospital after a mini-stroke (TIA), I was not caught off guard. She has had a history of having TIA for many years. As a senior living advisor, I have toured and evaluated over 400 senior living communities in the Chicago metropolitan area on the basis of cost and method of payment, level of care, staffing, quality of care, and other quality of life factors such as food and housekeeping. Therefore, I was prepared when it came time to choose a rehabilitation community for her. However, the institution of the 30 day readmission rules for Medicare recipients has made me more vigilant with watching as to whether she is admitted as an inpatient or under observation.*

The following story may not necessarily be directly related to the 30 day readmission rule, but it makes for some very interesting food for thought as you monitor your senior loved ones’ admissions, re-admissions, and discharges.

During a recent hospital stay, my husband was in a semi-private room because it was otherwise full. Due to the fact that he and his roommate were separated by nothing but a curtain, I overheard the situation involving his roommate’s admission. The man was a gentleman who was in his late seventies. He had been living at home, suffered a heart attack, and had broken his neck in some sort of fall or other incident. Most recently, he was placed in a senior community and was assigned to some rehabilitation. He was not cooperating with the therapists and was sent back to the hospital. His re-admission occurred at 1 A.M. Later that morning a social worker was in the room at 9 A.M. telling the gentleman that he was set for release that day. However, he was not able to go home alone; and, his daughter felt she was incapable of taking care of him.

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The prospects of alternative living options for people with dementia who are under the age of 65 are not plentiful. Although there are assisted living communities offering memory support for prospective residents under the age of 65, the pay source is strictly private. I have been faced with situations where the prospective resident has been in their early 50s and had severe Alzheimer’s disease. Unfortunately, the family lacked the funding to pay privately at an assisted living community. I had no other option except to assist the family with placing the individual in a nursing home that would accept Medicaid.

As a senior living advisor, I must persuade my customer’s to accept options that are less than optimal because there is nothing else available. In the following Real Life Story, I had the long term solution to my prospect’s problem, but the individual is still contemplating other arrangements.

REAL LIFE STORY My client’s sibling is only 51 and has early onset dementia. The individual was living alone in an apartment quite far away from the rest of the family. The person had worked at the same job for many years until it was apparent that the symptoms caused poor job performance. The person was dismissed from the job. The person had a monthly income of less than $900. The person also had a 90 pound dog that needed to be cared for. Yet, the individual could perform all of the activities of daily living. A recent neuropsychological report stated the person was capable of holding down a job with repetitious tasks. However, her sister was worried about her care on a long term basis and safety issues.

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