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My friends and prospective clients who have parents who aren’t ready for senior housing placement often ask me questions about non-clinically licensed home health caregivers. The question I’m most often asked is, “Why can’t I just hire the nice lady from across the street to take care of Mom/Dad? It is much cheaper.” While I have seen that strategy work successfully for a lot of people, I do not make that recommendation to anyone.

If you are considering home health care for a loved one, the providing agency should be a member of the National Private Duty Association (NPDA). Without going into a lot of detail, agencies that are members of the NPDA in Illinois hold a license. They profess allegiance to a code of ethics. An NPDA-agency, in contrast to an independent contractor or staffing agency, is responsible among other things, for the screening, training, and background checks of staff members. If you choose to hire “the nice lady up the street,” you will be assuming all the responsibilities of an employer and may have no recourse if something goes wrong. What may appear as savings in the short-term may have long-term repercussions, as exemplified in this month’s real life story.

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Real-Life Story

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I recently worked with a family whose Dad contracted an infection in his foot. The infection lead to further complications coupled with the fact that he had mid-stage Alzheimer’s disease. He was using his Medicare days in a nursing home. His wife was very dissatisfied with the care he was receiving. When the family realized he probably wasn’t going to be able to return home, they hired me to find a better nursing home for him on a permanent basis.

1014575_war_veteran.jpgHis wife was in her 80’s and still working part-time. Monthly income was limited. When I sat down with the family to tell them the cost of his nursing home care would be in excess of $6,000 a month, tears began to flow from her eyes. Thank goodness this was a wonderful family. They insisted upon the best care for their father. The kids offered to chip in and pay for the best place possible. I suggested that they look into the VA Aid and Attendance benefit because their Dad was a World War II Veteran. Although the benefit isn’t huge, it lifted some of the financial burden from the kids, thus alleviating some personal and work-related stress.

Assistance may be available whether at home, in assisted living, or in a nursing home. There are specialists authorized to provide Veterans with assistance in filing a claim and interpreting the benefit. Please see the VA Aid and Attendance article or call me for details.

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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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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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