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In this very informative article, author Dawn Reiss has done a great service ed o seniors and their caregivers, including my many ADSLA clients. As a Care Manager Certified & founder of Andrea Donovan Senior Living Advisors, I was delighted to offer insights on the challenges and questions faced by ‘Sandwich Caregivers,’ and pleased to see Ms. Reiss highlight the resources we can help make available to families:http://chicagocaregiving.com/sandwich-caregiving/?mc_cid=b807c04904

When I was hired by the Ellisons, who are the family featured in this article, the son explained to me that his mother was 72 years old and had a diagnosis of Lewy body dementia.  She lived in the garden apartment of the building he owned. When I met Barbara, she completely different than how I had envisioned her.  She was extremely independent and traveled to all of her medical appointments in an Uber.  I was hired to attend her Dr. appointments with her.  Although her thinking was mostly coherent, she had issues with speech ephasia, and I had to complete her thoughts for her.  She would arrive in the Uber and I would meet her at every appointment she had. We had a very happy, fun relationship.

One of the tasks that was assigned to me was to look over her medication system to be certain she wasn’t missing any doses.  I was shocked to find that she had a three-tiered, color coded medication box that even I couldn’t have imagined.  I asked her if she ever missed any doses, and she said only once, but she took it right away when she realized she missed.   Her kids arranged to have all of her meals delivered to her.  She enjoyed babysitting for her grandchildren.  She was capable of going to Walgreen’s to pick up her prescriptions.

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Andrea Donovan Senior Living Advisors Celebrates 20 Years! Two Decades Strong – and Still Not Collecting Commissions from the Communities Where I Place Seniors

Anyone who has faced the herculean task of choosing the right senior living option knows the feelings all too well: stressed, confused, and overwhelmed. That is why someone might succumb to the temptation to use one of the well-publicized, “free” senior housing placement services, which match seniors to independent living, assisted living, memory care, and skilled nursing communities. What makes these organizations appealing is that they seek no fees from the families served.

These organizations’ efforts come at a price, however: the community wherein the senior is placed pays them a fee or commission that is linked to their housing costs. Some of the fees may be in the amount of as much as one or two month’s rent, a sum built into the organization’s bottom-line expense and borne by the residents and their families. This arrangement, a practice that dates back to the year 2000, raises questions about objectivity. If you were in the shoes of one of these “free” senior placement services, wouldn’t you perhaps be tempted to steer people to communities that offer more lucrative commissions, rather than those that pay a lower finder’s fee?

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This might be the saddest story in ADSLA’s 20-year history. Around this time last year, an Elder Law attorney approached me with a case. Her client was terminally ill and the woman had a brother who was in a local supportive living community. I was told there were no other relatives. Therefore, I was asked to become the secondary Power of Attorney for both health care and finances/property for the brother in supportive living, in case the gravely ill woman did not outlive him. As it was explained to me, the man was paying privately and would continue to do so until his funds were depleted, then the supportive living facility would apply for Medicaid for him.  Note: Supportive living is a type of assisted living that is supported by Medicaid. I was also told that, should the man’s sister pre-decease him, 10% of the proceeds from the sale of her house would be willed to him for his care.

Nothing happened on this case for almost a year. Then in mid-December 2025, I received a call from the terminally ill woman, telling me that she was not expected to live past Christmas. I made an appointment to meet with her in the hospice facility where she was residing.

Sadly, I found myself speaking with this woman while she was literally on her deathbed. She told me that administrators at the supportive living community had asked her brother to leave because they couldn’t provide the level of care that he now needed. We telephoned the director of nursing at the community, and she told me that the man now had a catheter that was being serviced by a home healthcare agency. Nevertheless, her staff was constantly finding him in his room, flat on the floor, and he had often defecated on himself and in his bed. I was also told he was unable to take any direction. Generally aware of a prior dementia diagnosis, I asked why he wasn’t being considered for the memory unit in the supportive living community. I was told there was a two-year wait list and he was beyond what they could handle from a caregiving standpoint. His records had already been sent to other nursing homes in the area. When I heard the names of those institutions, I immediately recognized that he was probably a candidate for public aid. Therefore, I cut right to the chase and asked his sister how much money her brother had remaining. She told me he had $40,000 left in his bank account.

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Happy New Year to one and all!

As many of you know, I act as seniors power of attorney for healthcare and property and finances when s/he are deemed no longer able to make decisions for him/herself. The senior appoints me on a legal document when they have no one else to act for them or they don’t care to have a family member act for them.

Recently, I have had several situations come up that have been complicated. The first situation involves two women who are both in their nineties. One still has her faculties, and the other has dementia. I am not their power of attorney, but I literally do everything for them. They were powers of attorney for each other, and that was all right at the time the documents were prepared. Now that they have aged, the woman with dementia cannot make any decisions for herself or anybody else. The other woman is capable of making decisions for herself. Their home had been on the market, and I perceived the dementia was going to cause an issue with the transactions and with many other issues I won’t mention here. I called the lawyer who had drawn up the documents and he told me I needed to have them both psychologically evaluated to have the secondary power of attorney move into the primary position.

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What Does a Geriatric Care Manager/Aging Life Care Professional Do? Read On and You’ll Find Out

Real Life Story

I was introduced to two new clients, ages 90 and 94, by a senior living community representative. He had met them when they attended an event at the community four years ago and remained in touch with them. But the two elderly women repeatedly insisted they were not ready to move because they “didn’t need the care.” That changed drastically, however, after several crises that eventually compelled one of the seniors to call the sales representative.

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In the early days of ADSLA, most of my clients were the same age as me – that is, the adult children of senior parents. Now I am in my 60s and most of the clients who seek ADSLA services for their loved ones are in their 40s and 50s. That being said, I have never sensed any sort of bad attitude toward me for this reason. I guess it’s because clients know I have been around the block a few times during the past 20 years. Clients and their older loved ones actually appear relieved when they see I am not a kid.

While not a kid, and often only 5 or 6 years younger than the senior for whom I am providing services, I do strive to stay young by dancing and playing the harp in my free time and by working hard on behalf of my clients. I pride myself on the fact that I was taught the right way to do things in a Catholic continuing care retirement community. I was trained by a taskmaster 10 years younger than me, and I worked under the scrutiny of nuns who wanted to do it their way, which was the same way as when the community opened in 1950. Now, being closer in age to my elder clients, it sometimes puts things into a totally different perspective for me.

The client I have in mind as I share these thoughts is a 72-year-old woman who has been diagnosed with Lewy Body Dementia. As the Mayo Clinic explains, Lewy body dementia is the second most common type of dementia after Alzheimer’s disease. Protein deposits called Lewy bodies develop in nerve cells in the brain. These deposits affect brain regions involved in thinking, memory and movement. Mental abilities in persons with Lewy body dementia gradually get worse over time. The afflicted senior might see things that aren’t there (i.e., have visual hallucinations) or experience symptoms akin to those of Parkinson’s disease: rigid muscles, slow movement, and tremors. Unfortunately, as Lewy Body Dementia progresses, the person with the disease exhibits behaviors that are erratic and can even become violent.

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I have recently completed many phone calls with prospective clients. The first question that most ask me is, ”How much will the different senior living options cost?” When I provide the answer, new and prospective clients are absolutely overwhelmed. That’s why, if you are in the process of looking for senior living for yourself or a loved one, you need to be aware of current costs. I share below a summary of costs according to each level of care:

Independent living – The senior can basically function on his or her own, but may need a little help with meal preparation and housekeeping. Costs can start at $4,000 a month for a one-bedroom apartment. Please note, this is what independent living is supposed to be; the senior should need only a little help with meal preparation and housekeeping. Many communities insist that residents at the independent living level adhere to this description. There are other communities that will allow seniors who need more than minimal help to rent an independent living apartment and move in with a part-time or full-time caregiver. This is a matter of personal preference, or there may be some cost savings involved.

Assisted living – The senior needs some stand-by or hands-on assistance with his or her activities of daily living, meaning bathing, dressing, toileting, transferring, walking and eating. Costs can run anywhere between $5,000 and $6,000 base price for a studio unit. This covers basic room and board and three meals per day. Then there will be an additional incremental charge of $400 to $2,300-plus for increasing levels of standby or hands-on care provided to the resident. What formerly was provided at the intermediate level of nursing home care has been absorbed at the assisted living level. What I am finding is that many assisted living communities take on cases that they are not equipped to handle. That is something to be aware of, and why evaluation by ADSLA is always advised.

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Every year at holiday time, I try to share an uplifting story. This year my story is about a client who is in his late seventies. Over the past 20 years, he has had 3 kidney transplants. He also has suffered urinary tract infections (UTI) that have often landed him in the hospital.

I became the care manager for this gentleman and his wife over a year ago because his wife needed help conducting his Telehealth appointments, arranging transportation, and monitoring his care at the nursing home where he resided. It was clear from the outset that my client longed to leave the nursing facility and go home. His wife objected to that idea because of his complicated medical needs and because home care was tried once before and failed. I worked diligently to see if there was an assisted living community that might accept him, but, alas, none would.

During one of his stays in the hospital for a UTI, my client’s nephrologist conducted some tests and determined that the third kidney he had in his body was “dead.” The nephrologist recommended that it be removed. As the couple’s care manager, I quickly made arrangements to have the surgery done, including all pre-operative tests and other time-sensitive and follow-up arrangements. The surgery to remove the dead kidney went extremely well and my client’s UTIs finally stopped.

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I was pleased to offer insights to author Cathy Cassata and readers of Chicago Caregiving magazine in the Summer/Fall 2024 issue (vol 5; issue 1) regarding post-hospitalization or sub-acute care for an older or disabled loved one. My professional advice includes investigating staff-client ratios at any potential facility, avoiding the mistake of being “taken in” by attractive decor when visual aesthetics may or may not indicate quality of care, and asking key questions to illuminate whether the facility can meet your loved one’s needs. To read more about those questions and tips, read Cathy’s article at https://chicagocaregiving.com/after-hospital-discharge/