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“When choosing a long-term care community for your loved one, make sure his/her care-level needs and financial realities are appropriately assessed.”

Greetings!

As part of my services, I always meet and get to know the person I’m about to place. My past experience as an admissions director of a continuing care community (one offering Independent living, assisted living, and a nursing home on a single campus) taught me how to assess an individual’s mobility and cognitive impairment (if any). An assessment also affords me the opportunity to meet family members, see the person’s current living conditions, and find out the person’s financial realities. All of these factors play an important part in the options I present to my clients. As families who “go it alone” and clients of other service providers have sometimes discovered too late, a mistake in assessing any one of these factors can result in misplacement of a client. This, in turn, can lead to a rapid decline in a senior’s well-being, more serious adversities, and even yet another move – a heartache and inconvenience that no resident or family should ever have to endure. This month’s real life story emphasizes that fact.

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Greetings!

The holidays are a cherished time for families to be together – a time to make new memories and to celebrate the past. The holidays are also a time when family members might notice that an older loved one is declining physically or mentally. For example, the onset of winter weather might make a senior’s physical limitations more evident or more worrisome. Gradual changes that were not obvious to nearby family members over the past year might be very apparent to a visiting relative. Suddenly, family members might be aware that they have entered yet another new season in life: a season of care-giving and or long-term care planning. This is when I can help.

Over the past four years, I’ve been blessed to be able to help many families place their elderly loved ones in a community that matches their medical needs and financial realities.

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Three weeks ago, my mother had what appeared to be a stroke, followed by a TIA, and a urinary tract infection. She was taken by ambulance to the nearest hospital, which in the case of an emergency is required by law. Her primary care physician was not on the staff at that hospital. Due to her frail condition and lack of a private room (my mom’s request) at her regular hospital, we did not move her. After she had been staying in the hospital for two weeks, I arranged for her transfer to a skilled nursing community for rehabilitation. I must admit, I felt uneasy and alone because her primary care physician was not in command of her health care.

When you move your loved one to a skilled nursing community for rehabilitation or a long-term stay, be prepared for the possibility that his or her primary care physician will not, or will not be able to, follow them. Your loved one will be giving up a long-term emotional and psychological relationship with his or her physician. Most of my clients don’t seem to be concerned with keeping their loved one’s physician. You should be concerned!

Luckily, my mother was in a community where the Medical Director was on site every day. When she did not see my mother, the doctor had a nurse practitioner who would follow up with her patients. Some of the physicians in other communities do not visit the patients more than once a week. Many of the physicians on nursing home staffs visit less than once a week. The new doctor’s routine, bedside manner, and educational background may not be in accordance with what your loved one is used to, resulting in patient dissatisfaction.

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“Prepare for your loved one’s transition from the hospital to a long-term care community.”

Four years ago, my mom, who is 88 and a registered nurse, had a triple bypass with a valve replacement. The hospital staff informed me that their transitional care unit was full and I would have to find a rehab community for her. As I was searching, I asked myself, “What if something goes wrong and she can’t return home?” As I narrowed my search to three options, I was mindful to choose places that could accommodate her needs long term.

As it turned out, a bed opened up in the transitional unit. She completed several days of her rehab. Then she complained it was too noisy, disagreed with the staff over her course of treatment, called my sister to take her home, and had herself discharged. So much for my worries about her returning home.

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People often ask for my opinion of the 5-star nursing home rating system that was instituted approximately two years ago by the Center for Medicare and Medicaid Service. The system is a comparative tool that assigns nursing homes composite rankings from 1 (below average) to 5 (above average). Rankings can be viewed on www.Medicare.gov. The scores are determined by a combination score based upon three items:

  1. The results from the annual inspection from the Illinois Department of Public Health
  2. Quality measures
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“Be certain that a community’s definition of “assisted living” meets your loved one’s needs.”

Greetings and best wishes for a wonderful summer! I’ve been blessed with a lot of assisted living and nursing home placements, completing my National Guardianship Certification, fishing, and playing some fun golf games, although at times my game is truthfully awful!

While there may or may not be much hope for my golf handicap these days, it is good to know that there is plenty of help available for making good senior placement decisions. However, when it comes to choosing the right assisted living community, please be very mindful of the community’s definition of “assistance.” According to the Assisted Living and Shared Housing Establishment Code in the State of Illinois, an assisted living community needs to fulfill three criteria:

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Over half of my clients are children of seniors who are already living in a community. The children are looking to move them because the senior needs a higher level of care or they are dissatisfied with the care the senior is receiving. But the most common reason clients contact me for my services is the senior is depleting his or her finances and cannot stay at the current community.

Most senior housing placements occur as the result of a crisis in the senior’s health. The unfortunate reality is that people don’t plan for this sort of crisis. The immediate reaction is to put a bandage on the problem to solve it short term without examining the senior’s long term financial realities. People often choose a community because it has name recognition or “it looks like a really nice place.” Yet, when people are in a rush, they fail to ask common sense questions such as “Does your community accept Medicare or Medicaid?” Or, “What happens when my mother or father runs out of money?”

We are now living in a society where people are living longer. We need to take that fact into account when searching for the right senior living alternative whether it be home care or community living. We plan for disasters and accidents by purchasing insurance. Many of us have pre-planned our funerals. Why not take some time to think about what will happen if your loved one needs to enter a community and outlives his or her finances? This month’s real-life story will supply you with some food for thought.

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When I deliver the assisted living segment of my group presentations, the audience is often unaware that Medicaid offers a program that pays for assisted living. It is called the Supportive Living Program. Assisted living is the next highest level of care above independent living where the senior needs some help with his or her activities of daily living: bathing, dressing, walking, eating, transferring, and toileting. It is stand-by assistance not hands-on assistance. If a senior is paying privately for assisted living, the costs can range from approximately $3,800 to $6,000 a month. The Supportive Living Program is a wonderful alternative for low-income seniors who cannot pay privately for the assisted living level of care and are not yet ready for nursing home placement.

Here are the requirements for admission to supportive living:

  1. The senior must be at least 65 years old.
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During my years of work as a retirement community executive, I had many opportunities to observe the residents file to their Bingo, Baggo, and Bunco games on a weekly basis. I would often hear them complain about the routine, boredom, and a lack of variety with the activities. I thought to myself, “What a terrible waste! These men and women have worked all of their lives to enjoy retirement. Why shouldn’t it be accompanied by a sense of fulfillment and maybe some adventure?”

Have you really taken a step back and thought about what you’d like to do during your retirement? While it’s OK to sit back and enjoy that Bingo game, you may want to consider something more challenging from a physical (if you can) and mental standpoint. It might be time to do a bit of soul searching and re-visit a hobby that you were passionate about, or find a new one.

I “retired” from my hobby of tap dancing for 20 years. Eleven years ago, I returned to it because I was forced to participate in a mandatory employee talent show at the retirement home. I can’t pull rabbits out of a hat or tell jokes, so I returned to the only thing I knew well. After resuming my lessons, my teacher encouraged me to enter my first competition at age 43. I won a gold medal! At age 49, I won my first platinum medal while competing against 25 women who were less than half my age. I was named by the judges as the overall winner out of 300 contestants. Competing was tiring from a physical and mental standpoint. Yet, I felt a sense of satisfaction from the challenge. During the same year, I was cast in a small part in The Nutcracker. I’m 51 years old and teach tap and ballet to children on a part-time basis. I watch my students compete with the same sense of pride (and an occasional tear) as when I was competing. I was able to realize a dream that subconsciously I didn’t know I had. I now teach tap and ballet to Alzheimer’s residents.

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“Delaying a loved one’s move to a long term care community might not be a good decision in the long run.”

The decision to move a senior to an assisted living community or nursing home can be an unpleasant experience. Because our parents took care of us, it is a decision laden with guilt. Children often enter a state of denial with thinking the parent is “doing just fine.” Reality may be the opposite situation. Deferring the decision seems to be a good short-term decision; but, in actuality, it may be placing the loved one’s health and finances in jeopardy. It never hurts to do some thinking or pre-planning about what may happen down the road.

While I’m not an advocate of moving a senior before they are ready, let me share some experiences that I’ve encountered with my clients:

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