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Real-Life Story

I recently had a preliminary meeting with the adult son of an 82 year old senior who was diagnosed with dementia. The senior had been living with him for a number of years and was having issues with wandering, falling, and incontinence. In order to alleviate the stress of having the senior in the adult child’s home, a part-time caregiver was hired during the day to meet the senior’s care needs. During our meeting, my client did not want me to meet the senior in order to avoid unnecessary agitation. His mother was not born in this country and spoke a limited amount of English. After learning some facts about the senior’s behavior and financial realities, I informed my client that the senior was a candidate for assisted living with memory care. But, the catch was she needed to be in a Continuing Care Retirement Community that would keep her once her funds were exhausted. Or, she could move to an assisted living that offered memory care. Then, she could be moved to a nursing home that accepted Medicaid when she still had enough funds to move to a decent community.

Right after Christmas, my client called me and said his mother had fallen. The rehabilitation community where she was receiving therapy had set a release date for the following week. My client asked me to come and assess the senior and make suggestions for a long-term care community.

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Real-Life Story

My client was 102 years old and had lived in the same independent living community for more than 12 years. She had moved there with her husband when the community was a homey retirement home. After her husband’s death, she remained there with 2 part-time caregivers who provided total assistance with bathing, dressing, escorts to the dining room via wheelchair, and transporting her on errands. She was alert.

When I went to assess the client, I was greeted by 5 family members who were gathered in her lovely 2 bedroom apartment. As they explained to me, the community had been purchased by another organization that was turning it into a glamorous, high-priced, marble-clad independent living community. As I was listening to them, I noticed a baby grand piano occupying the corner of the room. And at one point during the conversation, the caregiver assisted my client with being seated at the piano. She delighted me by playing a wonder rendition of George M. Cohan’s work, “Give my regards to Broadway.” She could still play despite needing help with other activities of daily living!

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As a Certified Guardian, I am often asked to act as a senior’s Power of Attorney for Health Care when s/he doesn’t have a family member who is willing or fit to act for him/her. Simply stated, the Power of Attorney for Health Care grants the designated “agent” control over the senior’s decision-making, including end-of-life decisions if the senior lacks the capacity make the decisions on his/her own. As a Power of Attorney For Health Care, you should be thoroughly familiar with a senior’s personal, financial, and medical history before accepting this serious responsibility. Please read the following real life story that makes my point.

REAL LIFE STORY

Five years ago,  I was called at the last minute to act as Power Of Attorney (POA) For Health Care for an 85 year-old  woman.  It was the day before she was to move to independent living at a retirement community. Independent living used to mean that the senior can basically function on their own with some assistance with meal preparation and housekeeping. Now there are a lot of ala carte services that can be brought to the senior’s independent apartment, allowing him/her to remain there without changing to the assisted living level of care. The woman’s former POA had moved out of state and had written her a formal letter of resignation. A trust company had been appointed to act as her Power of Attorney For Finances.

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My client was the son of a 72 year-old woman who had suffered a stroke within the last six months. She had been placed at an excellent assisted living community that I had used for several clients in the past. After the stroke, she needed some help with her activities of daily living. Her son had indicated that he wanted to move her due to the high price being charged at the community. He was bearing most of the expense. He asked that I come and visit with her in order to hear her side of the story.

When I went to assess her in the lobby of the current community (at the son’s request), I found a well-dressed woman who was totally independent and had all of her faculties. When I asked her why she was in assisted living, she told me about the stroke. The physician who practiced at the community originally would not release her to the independent living level of care.  She felt the woman needed medication supervision.  But, my client proved her wrong. Then on review of my client’s case, the physician reversed the decision and approved her her to live in the independent living area.

However, my client didn’t want to remain at the current community. She had met a boyfriend there, and he had recently moved to a competing independent living community. She wanted to move there too.  As the conversation developed, she shared that her boyfriend wanted her to move in with him because his memory was getting bad, and he wanted someone to take care of him.

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“There’s no place like home for the holidays,” sings Perry Como in the Christmas classic composed by Robert Allen and recorded in 1954. But despite the wonderful lyrics of writer Al Stillman, sometimes you can (and maybe even should) reconsider what best constitutes “home sweet home.” For a senior whose health or faculties are failing, or who would benefit from greater socialization and/or daily living support, the holidays can be a good opportunity for family members to bring up life planning for the new year. It is, after all, one of the few times of the year when loved ones gather and may pause to converse leisurely around the kitchen or dining table.

Here are three tips to consider this holiday if you are trying to convince a senior to move or even simply trying to bring up this often delicate subject:

Do not use words such as “nursing home” or “facility” or “institution” during a conversation with the senior. Instead, use the words “retirement community,” “continuing care retirement community,” or “alternative living option.” A lot of seniors have awful memories of a loved one living in an old-time nursing home, with few to no amenities, and little sophistication with regard to geriatric needs. Your older loved one might not realize how senior living communities have changed. They are not your Grandma’s nursing home anymore!

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20171031_141154-2-300x225How in the world are busy professionals who also have growing children supposed to find the time to handle their aging parents’ issues – both health and living arrangements?

More and more of them are turning to experienced professionals who have experience in the field and can assist with everything finding the most cost effective and person-centered elder care, to interviewing potential home caregivers, to dealing with legal and financial specialists, to acting as a liaison to Medicare and long-term care insurance companies and even to paying bills.

Chicago Senior Living Advisors, based in Inverness, provides personalized Geriatric Care Management which is designed to assist family members or other unpaid people who are caring for an elderly or cognitively impaired loved one, according to Andrea Donovan, president.

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I recently enrolled in the Certified Dementia Communications Specialist program offered by two of my colleagues in the senior living industry, Tami Neumann and Cathy Braxton of the Silver Dawn Training Institute. As a senior housing consultant and Certified Geriatric Care Manager, I am almost always hired by the children of the senior. The senior is usually a Person With Dementia (PWD). The child of the senior often asks me to interact with his or her loved one, particularly if the senior needs to be convinced that it is time to move to a long term care community.

What I found invaluable about the Silver Dawn Institute Program is that it is based upon the basic rules of improv, which are: 1) relinquishing your agenda; 2) making your partner look good; 3) Using “Yes…and”; and 4) the gifts.

I recently used the rules of improv to assist the adult child of a person with dementia. Here is what happened:

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As I have mentioned in the past, the lines between the levels of care provided by long-term care communities have become very blurred. As the number of assisted living communities providing specialized memory care seems to increase every week, here are some of the things you need to look out for if you are contemplating moving a loved one to one of them:

Last month, I was hired by a family to advocate for their grandfather who had recently turned 100 years old. He was living in an assisted living community that specialized in memory care. Please note that the level of care offered was assisted living only and did not include a third higher level of care, i.e., skilled nursing. When he entered the community a year ago, he had been totally ambulatory and able to take care of all of his activities of daily living with cueing. Shortly after he entered, the community physician decided to take him off of all of his memory-related medications (without the consent of the family), because the doctor felt the medications were adversely affecting the patient’s kidneys. The grandfather went into withdrawal and ended up in a wheel chair needing total assistance with all activities of daily living.

In addition, the absence of using one of the dementia medications made the grandfather combative. The staff at the community claimed that he was at times in need of a three-person assist. Normally, a two-person assist and beyond indicates that person should be in a nursing home. The staff requested that the family look elsewhere for a new community for their grandfather. The staff also requested that the family hire a private caregiver to assist Grampa with his activities of daily living and prevent him from getting out of bed. The cost of his care in assisted living was $8,300 a month, just as much as a nursing home, plus the cost of a caregiver. Since the grandfather was already 100 years old, the grandchildren did not want to move him. Upon the request of the grandchildren, I was asked to attend the quarterly care plan meeting (attended by the Administrator and representatives of dietary maintenance, social work and nursing). Here is what happened:

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I recall having a conversation 5 or more years ago with a colleague who was an Admissions director of a high–end assisted living community.   It was around the time when I observed assisted living communities were going beyond providing “stand-by” assistance with activities of daily living (ADLs = bathing, dressing, toileting, transferring, walking and eating) and providing “hands on” care to residents in need.  Hands on care typically had been handled at the intermediate nursing care level, when a resident needed 24-hour supervision and “hands on” care with ADLs.  My colleague looked across the desk at me and said, “Andrea, the days of skilled nursing as you and I know it are dead.”  I remember that my immediate, gut reaction was, “You are crazy. Nursing homes will never disappear.”

A recent article published in Crain’s Chicago Business (August 21, 2017), titled “Out with nursing homes, in with home health care,” showcased the fact that Northwestern-owned Lake Forest Hospital, located in the affluent suburb of Lake Forest, Illinois, has plans to replace its hospital but will not include plans for building a new long-term care unit.  The reasons cited were that the “Northwestern Medicine may have found the one market where investment in long–term care has not paid off.” A spokesperson from Northwestern’s partner law firm said that “Only the sickest patients end up in nursing homes.  People 65 and up tend to find home health care and assisted living more comfortable.”

Given such trends, nursing homes may start to diminish in a community as wealthy as Lake Forest.  But nursing homes will probably always exist in one form or another.  I have to admit that among the many senior housing placements that I have completed in the past few years, the number of assisted living placements is way up, and the number of nursing home placements has decreased.   I recently reviewed some pricing for assisted living in a northwest suburb that featured help with ostomy or catheter care (a service the assisted living communities wouldn’t touch a few years ago because it was considered a skilled nursing service), hands on service with ADLs, a 2 person assist in transferring, medication assistance including help related to diabetes, chemo or radiation therapy or dialysis, and assistance with a feeding tube.  The price for this kind of care in a studio assisted living apartment is under $6,500 a month.  That pricing is well under the price of nursing home care, which on the lowest end can start at $7,000-$8,000 per month in the Chicago metro area.  So why wouldn’t someone opt for assisted living in the comfort of a private apartment vs. a semi-private room in a nursing home setting?

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My father suffered a stroke at the age of 86. He had received diagnoses of Parkinson’s and Alzheimer’s at the age of 84. As the diseases can have similar symptoms, it was very difficult to pinpoint which disease was causing his behaviors. At times he was depressed, moody, lethargic, and verbally abusive.

After the stroke, he required skilled nursing home care.  That prevented my mother from bringing him home. My mother felt an obligation to place him at a nursing home that was owned by the hospital where he had practiced as a physician for many years. That was our first mistake. We assumed that since he practiced at the hospital well into his 80’s that he would have decent care. Much to our family’s dismay, it was quite the opposite.

My story is no different than anyone else’s nursing home nightmare. But at the time, I was not yet in the eldercare industry and didn’t know any better. I didn’t know that checking the ratio of the staff to residents, observing the staff’s attitude, and watching for possible language barriers were critical components in the selection of a community.

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