Articles Posted in Skilled Nursing Homes

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Many of my clients are surprised when they are told their senior loved one has “reached a plateau,” with his/her assessment for the appropriate level of care upon their release from the rehabilitation community is going to be key for your loved one’s long term plan of care. If your loved one requires two people to assist him/her with activities of daily living (bathing, dressing, eating, toileting, transferring, and walking) they are not suited for skilled nursing care. It is always in your loved one’s best interest to begin at a higher level of care and move them down (ie. from skilled nursing to assisted living) to a lower level of care.

2. While your loved one is partaking in their short-term rehabilitation, take a look at their long-term financial picture. Most of the nursing homes in the State of Illinois are requiring one to two years of private pay before allowing an application for Medicaid to be filed. It is taking the State of Illinois up to 14 months to reimburse the nursing homes for their public aid residents. That is the reason for the stringent qualifications. The temptation to place a loved one in assisted living in order to avoid the stigma of placement in a nursing home will be present. If your loved one needs the medical care, think with your brain and not your emotions.

3. When you are ready to begin tours of communities, remember there are advantages to making a confirmed appointment rather than taking a “walk in” tour. Then, you will have an opportunity to speak with the Admissions Director who is an expert on what the facility has to offer. Otherwise, you will be given a tour by whoever is available. This may result in a poor tour and cause you to discount a perfectly good community.

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If you carefully scrutinize the activity schedule at a long term care community and correlate it to the seniors needs, his/her independence could be enhanced.

I was the Admissions Director of a Continuing Care Retirement Community located in Cook County near the Chicago metropolitan area. Many of the children who came to tour the home told me they were concerned that their loved one would lose their independence if they moved to a retirement community. It used to amuse me that after expressing this concern, the children would spend so little time studying the activity schedule. Instead they would remark, “Oh this is great! They have bingo, baggo, and bunco!” I used to refer to it as the “three Bs!” While it is important to many seniors to have bingo available, you will have to be more thorough when assisting them with finding the right retirement community if you aim to preserve their independence. Studying the activity schedule to ensure that a community is providing serious mental stimulation for seniors is a task that shouldn’t be taken lightly. As a senior living advisor who has evaluated hundreds of long term care communities in the Chicago area, I can share some activity tips with you.

I have seen many of the retirement communities offer brain fitness programs in order to keep their residents mentally fit. Some of the homes will allow your loved one to participate in their brain fitness programs as a non-resident of the community. I enrolled in one of the classes at a local retirement community because I was curious to see what the programs had to offer. They were offering the brain training program created by Posit Science, that can help anyone exercise their memory and enhance the ability to focus. Although the program is computer based, the senior doesn’t have to be computer literate. They only need to operate a mouse. There were many independent seniors who were taking the course to enhance their driving skills. One of the programs simulated a fictitious car ride where dangers such as a child chasing a bill into the street popped up on the screen. The program requires the driver to react quickly in order to avoid having an accident.

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If your loved one requires a Medicaid bed in the Chicago metropolitan area and the payor source is Public Aid Pending (PAP), you may be in for a difficult encounter. What do I mean by Public Aid Pending? It means that an individual needs the support of the Medicaid program (Federal system administered by each state that grants assistance for long term care to people who can’t pay privately.), but his/her application is in the process of being prepared. Or, the application has been prepared, filed, but isn’t approved with a case number. Due to the implementation of the SMART Act (Save Medicaid Access and Resources Together), Illinois is now one of the toughest states in which to obtain Medicaid.

Right now, the nursing homes aren’t too willing to accept residents who are in PAP status. That’s because if a resident enters in this status, the nursing home receives no reimbursement for their care until the case is approved and stamped with a number. In addition, it can take up to three months or longer to get an application approved. Plus, many of the nursing home representatives that I deal with are reporting that reimbursement from the state is currently nine months or more in arrears. In total, you may be looking at a year before a nursing home receives payment for a public aid resident. Therefore, most nursing homes are asking that a resident has at least one or two years of funds to pay privately before filing a Medicaid application.

Here are some issues I have encountered while searching for Medicaid beds for my clients. many of the nursing homes are simply not accepting anyone in Public Aid Pending status because their censuses already have too many residents applying or waiting for approval. Please don’t panic. You will find a bed for your loved one, but it may not necessarily be at your first choice of communities. If your loved one is currently at a nursing home for a Medicare stay (That is the federal program for short term rehabilitation at a long term care community.), and you know there is no way the senior can return home permanently, begin your application process immediately. Ask the Admissions Director if there is a Medicaid bed available so your loved one can transition from Medicare to Medicaid. If a bed will not be available, use your loved one’s remaining Medicare days as a bargaining tool with another community that might have a Medicaid bed available. That way, your loved one can transfer and their new home can be reimbursed by Medicare while you are filing the Medicaid application. The Admissions Directors are more likely to help you if they know the community is going to get some payment from Medicare while waiting for the Medicaid application to be approved. I will also note that many of the nursing homes want the prospective residents to use their, “financial specialist,” to file a Medicaid application, rather than using an alternative source. If the resident uses their resource, the home is assured of collecting as much private pay from the resident as possible.

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I have been receiving a fair number of requests to assist families with the placement of loved ones who have psychiatric issues. Many of them have had episodes with violent behaviors. Unfortunately, there are no easy solutions to these types of placement problems, and under no circumstances do these placements resemble a typical nursing home placement. A nursing home is simply not a dumping ground for a senior who exhibits psychiatric behaviors. If you call a nursing home to inquire about a bed for someone who has bipolar manic depression, schizophrenia, or Alzheimer’s disease with disruptive behavior disorder, it is likely the response you receive won’t be positive. That is because there is a real lack of Geriatric-Psychiatric (“Gero-psych”) care available for seniors around Cook, Du Page, Will, and Lake Counties in Illinois. For instance, there are only about 6 nursing homes in Du Page County that can handle psychiatric illness effectively. There are more in Cook County. Most nursing homes don’t have the staff with training to accommodate the one-on-one type of attention seniors with mental health issues require. They may be a danger to themselves and their fellow residents.

Here’s what you can expect if you enter the senior psychiatric arena in the Chicago metropolitan area:

1. Most of the homes that handle mental illnesses (Institutions for Mental Disease or IMDs) are at the intermediate care level. The residents are often ambulatory and many are not elderly. The residents need their medications administered to them and sometimes need help with some of their activities of daily living. Depending upon the seriousness of his or her mental condition, the resident may be allowed to check in and out of the facility on a daily basis. There is a lack of locked units that treat psychiatric illnesses that many seniors who wander require.

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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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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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I have so many fond memories of my dad and his dry but delightful sense of humor. He wasn’t athletic and once managed to pitch a hard ball through a picture window while practicing baseball with my brother. He told my mom, “Well, I never told you that you married Sandy Koufax!” I used to bring him a Long John (no, not the underwear but a long chocolate, creme filled doughnut) everyday when I visited him at the nursing home. He had a terrible sweet tooth and my husband was continually coaxing him to eat. The doughnut was always wrapped in a paper doily. One time he told me, “Andrea, this is the best d__m paper I’ve ever eaten!”

It is also the memories of the poor staffing at the nursing home where he lived that makes me strive harder to place my clients appropriately. Here’s what happened:

Real-Life Story

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One of the facts that I always impress upon my prospective clients is that the aesthetics of a community do not necessarily reflect the quality of care that’s delivered by its staff. Recently, several of my clients indicated that they thought aesthetics and quality of care are directly related to one another. This correlation is not necessary true. Appearances can be deceiving, which is why I am privileged to serve families at their time of need.

Choosing an appropriate alternative living option for a senior loved one is a process that must be conducted with compassion and vigilance. At times, the decision must be made in a rush due to a life-changing illness or event with the senior. There is often guilt involved on the part of the relative or friend who has to make a placement decision. Of course, they will want the community to look attractive and inviting.

Because you are often in a rush when an elder crisis occurs, you need to carefully scrutinize costs and method of payment, quality of care, level of care, housekeeping, location, activity/ transportation schedules, and personal preferences like food and religious preference. This is a lot to analyze in a 30-45 minute tour. Do not let the smell of potpourri or the sight of pretty wallpaper distract you from making a rational decision. The ability of the community to meet your loved one’s medical demands, programming needs, and financial realities need to drive your decision. What you want for your loved one and what is available may also be two different stories. Please try not to judge the book by its cover.

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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 attended a networking breakfast that was organized for professionals involved in different areas of the senior industry. I was asked by the leader to share the greatest challenge that I was currently experiencing with my business. I didn’t have to think too long to respond.

Over the past year or so, I have witnessed my nursing homes engage in the process of converting entire floors to short-term rehabilitation units. Short-term rehabilitation costs are covered by Medicare. Without going into great detail, Medicare covers the first 100 days of short-term rehabilitation after a three night qualifying stay in the hospital. It doesn’t cover long-term custodial care, which many people don’t understand. Short-term rehab is where nursing homes are currently making their money. The tendency is to admit the senior and rehabilitate him or her until a plateau on the therapy is reached. The senior is then discharged and it’s on to the next person.

So what is the impact of facilities converting entire floors to short-term rehab? Many of the nursing homes making this change are not currently accepting any long-term residents. The long-term residents who currently live in the community are slowly being transitioned from their current floors and moved to another floor. So now there is a shortage of long-term beds at selected communities. The certification change to short-term beds results in not only a smaller number of long-term beds, but fewer beds that are certified for Medicaid (public aid).

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