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I recently experienced one of the most difficult placements since the opening of my business in 2006. Members of a family contacted me to place their elderly relative who was diagnosed with Alzheimer’s and disruptive behavior disorder. My prospect was 88, frail, ambulatory, prone to slapping other residents at the current community, and demanding one-on-one attention from the staff. Medicaid was the payor source in this situation. After two admissions to different hospital psychiatric units, my prospect was asked to leave the community.

I was able to identify four communities that would be able to handle these sorts of behaviors and accept Medicaid as a payor source. The first two had no Medicaid beds available. The third option wasn’t optimal due to the floor layout. My client was a pacer, and the hallways in this community were excessively long. Placement at the end of a long hallway would not allow the staff to keep an eye on my client and would increase the risk of falling if my client became tired. The last option had a special care unit that included a trained staff and activity programming to suit the issues I mentioned previously. The residents were separated into high, middle, and low functioning groups for meals and activities. The home had a very good reputation for being able to handle these sorts of issues. The problem was that the unit was not aesthetically appealing, with the carpet, doors, and hallways showing a lot of wear and tear.

When the family toured the community, my expectations of their reactions were correct. Less pretty than others, the look of the place gave them some misgivings. However, we were up against a release date from the hospital. I was able to convince the family to give the new community a trial run since they had successfully dealt with these sorts of residents in the past. They were also able to accept Medicaid.

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One of my prospective clients asked me if any of my placements had ever not worked out. I responded, “Yes, only once–early on in the years I have been conducting placements.” Here’s what happened.

My client was a baby boomer whose part-time occupation required intermittent air travel during the week. Her mother, who had mid/latter stages of Alzheimer’s and ambulated with a walker and a wheelchair, was living with her. My client’s mom had a part-time caregiver. My client expressed that she wanted to work full-time, and that taking care of her mother was physically and psychologically exhausting. She wanted to place her in a community rather than have a caregiver on a 24 hour basis. Yet she told me that no one could take care of her mother better than she. In retrospect, that should have been a red flag to me.

I noticed that during my assessment the daughter gave her mom her undivided attention; i.e., bringing her water, placing the glass in her hand when she was capable of grasping it on her own, answering every call of her name and repetitious questions, and incessantly checking her diaper. The daughter also told me her mother’s bedroom was on the second floor and she was assisting her up the stairs on a daily basis. Since her mom was still ambulatory to some extent, the stairs presented a falling hazard..

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My client is one of a large number of siblings who were searching for a high end continuing care retirement community for their mother. Mom was in her early seventies, living independently, and driving. She owned a second home where she lived during the winter months. She could afford an entrance fee in the range of $800,000, and a monthly fee of $5,000 per month. The requirement expressed to me was at least 2 bedrooms, multiple dining venues with one being alfresco, room to entertain her friends, and a busy suburban setting. She needed to be able to reach one of the expressways and have access to the downtown Chicago area.

Her children had already chosen two places that they wanted her to seriously consider. My job was to identify a third option and compare their selections. I identified a third community that fit their requirements (one that would have been my selection for their mother). After dealing with my client, I found that the family was already leaning heavily towards one of the previously identified options. It was a newer community that fit all of their criteria, including every bell and whistle available to its independent residents (pool, masseuse, bar, postal service, concierge, health club). Those initial impressions had the family enamored. However, the community was not the real deal with regard to the advanced stages of care. Frankly, I felt the siblings’ decision had been made before I even began my work.

The daughter had made some comparisons of what the two places had to offer from an independent living standpoint. But, she failed to compare the communities from the viewpoint of location and layout, a compassionate staff, and what would happen if her mother needed more care down the road. Although I had been in all three of the communities, I set up appointments to “secret” shop them in order to fine tune my recommendations. I found that the family’s favorite community had some serious flaws behind its mask of sophistication. Here are some, just to name a few:

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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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My client had travelled to Florida to bring her parents back to Chicago to live. On the way home, my client’s elderly father suffered a heart-attack in the car and died in a hospital in Tennessee. To make matters worse, this happened over the Thanksgiving holiday.

My client’s mother has mid-stage Alzheimer’s disease. My client had no idea how much her father had been doing for her mother until she moved her in with her family. After a while, the tension started to mount. My client’s mother would often ask to be sent back to Florida or ask to move to a retirement community. At her mom’s request, they looked at one community and liked it. But they wanted a second opinion and hired me.

Upon visiting with my client and her mom, I realized that the community they visited would be inappropriate for her in the long-run. It didn’t offer any activities that were geared toward mid-stage Alzheimer’s disease. The choice was either to attend the activities for the regular assisted living residents or participate in the activities offered in the locked unit where she eventually might have to move. There was nothing offered for those residents who fell in between those two categories. I was able to place her in an assisted living community that offered a structured program geared toward mid-stage Alzheimer’s. The program is much like adult day care with mind-stimulating activities. These are conducted under the guidance of a team leader. But, unless you have thoroughly investigated the available programs, the average consumer would never be aware of their existence. If my client’s mother needed to move to the facility’s more secure, higher level of care section, there would be no change in price. I was also able to negotiate a two-year rate guarantee.

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My client is 85 years old and a former resident at an independent living community that fits his very limited budget. He is ambulatory with a cane, but uses a scooter when he becomes tired. He takes medication for depression. He is fortunate to have a very devoted nephew, who religiously visits him several times a week and takes him fishing (weather permitting). This nephew noticed that his uncle’s physical appearance was deteriorating, and he wasn’t keeping himself or his apartment clean. His personality, which was normally pleasant and gracious, was becoming cantankerous.

One evening during a bingo game at the independent home, my client was involved in a disagreement with another resident. An argument developed, and they began to threaten each other with their canes. The police were called, and my client was issued a ticket for disorderly conduct. He was also given a letter of dismissal from the management.

His nephew didn’t know what to do. He and his wife both work and didn’t have the time to research and find an appropriate community. He informed me about his uncle’s declining physical appearance and the disorderly conduct incident. I told the nephew that it sounded like his uncle just needed some help with taking his medications, bathing, and dressing. I was able to find three supportive living communities within reasonable distance of the nephew’s home. I arranged for a determination of needs screening through the appropriate senior agency, which is a requirement for support through the Medicaid program. The family chose a home that was within five miles of the nephew’s home. When I checked back with the nephew to see how things were going, he told me, “He’s very happy, the care and staff at the home are great. Your services were worth every penny!”

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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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