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I am often amazed at the number of clients who call me and say they are looking to place a loved one in a senior living community because their loved one is falling. When it comes to senior falls, please remember the following very general guidelines:

No senior living community provides one-on-one care. Placement in a senior living community is never a guarantee that an older loved one won’t fall. If a senior is in independent living, that level of care is not licensed. There are no nurses or nurses’ assistants. If a senior falls in independent living, 911 will be called to help the person stand or to take them to the nearest hospital. When a senior resides in assisted living or a nursing home, there will not be enough staff to prevent the senior from falling unless the staff witnesses the fall taking place and they can act on time. Don’t forget that your loved one will be sharing a certified nurse’s assistant with many other residents.

The use of full bed rails is not allowed in Illinois. They are considered to be a restraint. They can only be used if a doctor writes an order for them. The most that can be used without a doctor’s order is a half rail. A resident cannot be restrained with chemicals without a doctor’s order. There are grab bars available that attach to seniors’ beds to help them steady themselves when they rise. Many times, a mattress is placed close to the floor to lessen the distance of any potential fall.

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I was fortunate enough to be interviewed for a blog post by my colleagues at Lexington Square regarding caregiving tips for a spouse. I would like to share them with you.

When it comes to caregiving to a spouse, there may come a time when additional help and support are needed.

In this helpful Q & A with Andrea Donovan of Senior Living Advisors of Inverness, she offers expert insight on how to best handle this situation, how to overcome caregiver guilt and how to create a social and wellbeing experience for both the caregiver and spouse.

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Real-life Story

My clients were the sons of a 94-year-old gentleman. One son lived in town, and the other lived out of state. At the time they contacted me, their father was living at home, could ambulate with a walker, and was having short-term memory issues. He needed assistance with meal preparation, hands on help with bathing and dressing, and a lot of cueing. But his biggest issue was that his body retains a lot of fluid due to medical issues. He has a catheter that has to be emptied at least four times a day. While he is capable of inserting the catheter on his own, the sons had been setting up the catheter and lubricating the tip for him. They also had an aide from a non-medical home care agency helping him several times a week for four hours at a time. Because their dad needed 24-hour supervision, the sons were taking turns watching him for 2-3 weeks at a time. Both were exhausted: One is still working full-time, and they told me they just couldn’t manage his care anymore.

The catheter immediately presented an issue because assisted living licensing does not allow assisted living communities to provide catheter care. Those services must be provided by an outside agency licensed to do so. Unfortunately, the cost to provide the needed service, four times a day, would be an additional $100 per day. Therefore, the cost for the catheter care would be an additional $3,000 a month on top of the $6,000 to $8,000 base cost for assisted living. This gentleman is not yet ready for a nursing home.

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When I am asked to place a couple that is looking for a 2-bedroom apartment in assisted living, I often cringe.  That is because when the assisted living areas of many of the communities were built, the plans just didn’t include many 2-bedroom options.  The majority offer only studios or one-bedrooms.  Some communities offer nothing but studios.  Those places that offer the option of a 2-bedroom apartment assisted living usually are full with a waiting list.  In one instance, the Administrator at a senior living community went as far as knocking down a wall between 2 studios in order to accommodate my clients (a couple) so they could stay together.  Timing and luck play a huge part in finding a 2-bedroom in assisted living, as illustrated in my Real Life Story.

Real Life Story

My clients were a couple in need of two different levels of care.  Although both individuals had significant health issues, one was able to remain at the independent living level of care.  The spouse had experienced several hospitalizations and needed assisted living. The couple hired me at the suggestion of their children.  This was a second marriage for both members of the couple.

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I have vivid memories of the seniors picking on each other many years ago while I was an Admissions Director at a Continuing Care Retirement Community. If they weren’t fighting over the seats at Bingo that had been “saved,” they were sniping at each other in the line for flu shots at the nurse’s office. A vicious gossiper could get another resident sequestered to sitting alone at a table in the dining room by starting a rumor. There was a certain independent resident who was constantly poking fun at the assisted living residents, not realizing that one day she would be in assisted living herself. I just took it with a grain of salt.

However, there was another notorious independent living resident Bully who I will refer to as Dee. Dee had a reputation of bullying just about everyone, and was feared by every resident. One of my favorite residents was a t former Chicago policeman who was tough as nails and had a mouth like a drunken sailor. Dee even posed a problem for him. She tried to bully me by asking all sorts of intimidating questions and telling me, ” I do not like the people you are letting in here.” She harassed the wait staff horrifically by complaining about the food and the manner in which they served it.  Several of the servers were often in tears. She had endless insulting conversations with the Director of Dietary that often didn’t end well. If she didn’t care for something that another resident was doing, she would literally tail them up the hallway with her purse dangling and calling out insults after them.

At one point, I admitted a very attractive older woman who I will refer to as Lee. She was well dressed, personable, and the rest of the residents liked her. She befriended one of the male residents, who I will simply refer to as Jay. After dinner every night, Jay and Lee would get together in Jay’s room. The door was always open, and they would talk late into the night, sometimes until one o’clock in the morning. Dee had this terrible habit of walking the hallways late into the night. The other residents told me that the fact that the two residents were talking late into the night didn’t bother them. The weren’t making any noise and the door was always open so they knew nothing was happening. Apparently, Dee didn’t have the same reaction. She was often seen on the third floor walking back and forth in front of Joe’s room.

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When I placed my mother in a long-term care community at the age of 95, the cost of her care in assisted living was about $6,000 per month. That was over 3 years ago. Now the cost of assisted living can run between $6,000 to $9,000 per month depending upon how much help a person needs and which community is chosen. Skilled nursing care can run $9,000 to $17,000 per month depending upon the community.

My mother purchased her policy in the 1980s when long-term care insurance was a newer product on the market. She asked me if I thought the purchase was a good idea, and I said, “Absolutely!” What she purchased was a policy that paid $100 per day, up to a maximum of $143,000. She had a 90-day waiting period, which meant she had to pay the first three months of her care out of her own pocket, or $18,000. She didn’t purchase an inflation guard rider, which would have increased the benefit by several percentages on an annual basis in order to keep up with inflation. Therefore, the policy covered a little over half of what her care cost on a monthly basis. She had to pay the balance of $2,500 a month out of her pocket.

Now, there are different types of long-term care insurance available. Some are traditional like the policy my mother bought. Others are hybrid products that consist of life insurance products with a long-term care rider. In any event, trying to self-fund a stay in a long-term care community can be devastating. Illinois is one of the toughest states in which to obtain Medicaid, which is the federally funded and state administered coverage for people who do not have the funds to pay for long-term care. Because the State of Illinois is so far in arrears with reimbursing nursing homes for Medicaid recipients, many nursing homes have de-certified the number of Medicaid beds they have available. Many nursing homes are also look for a resident to pay between 1 to 2 years privately before filing a Medicaid application. Therefore, Medicaid isn’t a resource to be relied upon for long-term care. In addition, Medicare only covers short-term stays in a rehabilitation skilled nursing community.

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A lively discussion about gun control with friends and siblings brought back a memory about an instance a case where an adult with dementia and other psychiatric issues endangered the life of his spouse of over more than 50 years.

My client hired me because her husband had been hospitalized at one of the local geriatric-psychiatric units. He had a habit of wandering away from the house unbeknownst to his wife, only to be re-directed home by one of their neighbors. He abused his wife verbally and threatened her.

My client’s husband had been a gardener and a gentle man who enjoyed engaging in outdoor activities. This included chopping firewood in the backyard. During one of his tirades at home, he chose to go into the garage, find his wood chopping axe, and threatened to kill his wife with it. Fortunately, his children intervened and at that point he was taken to the psychiatric facility for observation.

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My client is the lovely granddaughter of a woman who was 99 years old when we met. They are of the Jewish faith. The granddaughter had contacted me over concerns that her grandmother was running out of money while living at home and paying for 24-hour caregiver services. The services were primarily for companionship, as she could handle on her own most of her activities of daily living (i.e., bathing, dressing, transferring, toileting, walking, and eating). The woman’s financial advisor had given her several warnings that she needed to move before her funds were depleted. We made arrangements for me to meet my client’s grandmother to do an assessment.

During our meeting, the grandmother insisted that she didn’t want to be in a Jewish retirement community. Apparently, she had been in a Jewish organization for rehab. once before and the stay didn’t end well. Grandma told me her plan was to stay at home until her 100th birthday. Home was located in a far south suburb. The location of her home made it very difficult for her granddaughter to visit, as she lived in the north side of Chicago. She didn’t have a car and had to rent one every time she visited her grandmother. Every time I mentioned a potential move, Grandma would swing the conversation toward one of the many artifacts she had collected during her life’s travels. During our conversation, she also said she wanted to remain out south because she wouldn’t know anyone if she made a move up north. She insisted upon moving to a particular community she had in mind. However, it was not a good idea from a safety standpoint, as the neighborhood was changing – and not for the better.

I went to work and narrowed the options to three assisted living communities that were close to the granddaughter. She toured all three, and narrowed the options to 2 places that she felt could work for her grandmother. I arranged a tour for the grandmother at one of them. Grandma seemed rather stoic and resistant during the tour. After the tour, we went to the famous Superdawg drive-in for hot dogs which we proceeded to consume in my car. While we ate in silence, I decided to ask her, “Well, what did you think of the place?” Grandma look at me and said, “It was a little to goy for me,” which I loosely interpreted to mean that it was too non-Jewish. The granddaughter and I looked at each other since Grandma had previously insisted that a Jewish community wasn’t important to her. She also told us both nicely that she had no intentions of moving until her 100th birthday was over.

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I lost my husband to cancer of the appendix in April of 2015. I had been a member of the local chamber of commerce in Riverside, Illinois, and chose a funeral director that I knew because he was president of the chamber. When I called him at 6 A.M. the morning after my husband’s death.  It was pretty obvious that I woke him up. Yet, he was cheerful. He told me to come over any time after I was showered, and he would have coffee waiting for me. From the moment that I explained the type of arrangements that I wanted, he didn’t ask me any questions. He took the entire awful process out of my hands, and everything went very smoothly. When my parish priest refused to accommodate the time I was requesting for the ceremony, he even called another Catholic church and arranged to have the ceremony there.

As part of the services offered by Andrea Donovan Senior Living Advisors, I often have arranged funerals for my clients if I am named as the senior’s Power of Attorney for Health Care. In a case I was involved with recently, my client had pre-arranged her own funeral, but was very confused as to what she had purchased. I called the funeral home and asked a representative to come out to explain the contract. I shared the contract number with her and asked her to be prepared to explain any charges that still needed to be paid, and to bring the necessary paperwork.

The funeral director showed up half an hour late to the meeting, claiming that she thought it was a half an hour later. In addition, she muddled through some kind of explanation as to why my client needed to sign some burial insurance form in order for the contract to pay, then proceeded to tell me she brought the wrong paperwork. Faxed or scanned documents were unacceptable, so this resulted in having to set another meeting to sign them.

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I recently had the wonderful opportunity to be interviewed on the Silver Solutions Radio show. It airs on WMRN 1410 AM in Elgin, Illinois. It is hosted by Jeanette Palmer, Jim Wojchiechowski, and Kathleen Wetters, who each independently own a Right At Home non-medical home care agency. During the interview, they graciously gave me a chance to explain how I started my career in the senior housing industry as the Admissions and Marketing Director of the St. Andrew Life Center (Now Glen St. Andrew) in Niles, Illinois. It was a faith-based community that offered three levels of care, including independent living, assisted living, and a nursing home on one campus. I was receiving so many telephone calls (mostly from the children of seniors who were calling me from the Yellow pages) from people who didn’t know how to solve their senior loved ones’ problems. I saw a niche for a consulting business. So in 2006, much to my husband’s dismay, I opened Andrea Donovan Senior Living Advisors in 2006.

I started my senior housing placement consulting business by touring and evaluating over 150 senior living communities in the Chicago metro area. I looked at cost and methods of payment accepted, levels of care, staffing, and quality of care. Then I also evaluated quality of life factors such as cleanliness, menus, activities, and apartment and room layouts. So, when a family needs my services, I make a face to face evaluation of the senior, their financial realities, and the location preferences of the family. Then, I select the options that fit the senior’needs so families aren’t wasting time touring places that simply won’t work long-term.  At this point I have toured and evaluated close to 500 senior communities in the Chicago metro area.

We also shared a very frank discussion about the costs of placement in a senior living community versus the costs of staying at home in the Chicago metro area.  We talked about the advantages and disadvantages of each option.