COVID-19 Update: How We Are Serving and Protecting Our Clients

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I recently had a heartbreaking experience with a family that made me very upset. Two adult sons hired me to help place their father in assisted living memory care. Their father was in a second marriage and living in his home with his second wife. The sons were not Power of Attorney for Health Care or Property. As it was explained to me, the second wife persuaded their father to sign his Powers of Attorney over to her when he had very early signs of dementia but was still well enough to sign. I was also told that the woman was aware of her husband’s ample finances and allegedly had stolen money from him.

When I first met with the family (the 2 sons and new wife), I sensed some very uncomfortable dynamics in the room among the family members. At our first meeting, they explained to me that they had a homecare agency coming into assist their father. He had previously been in a new assisted living memory care community that was part of a brand-chain I didn’t respect. Because of the poor care he received there, his new wife brought him home. The sons hired me to place him in a different community because his constant pacing and refusal to bathe made it difficult for him to stay at home. I investigated options and arranged for his placement at a superior assisted living community that also had skilled nursing care available whenever he might need it.

The clients took my advice and everything went very well. Then, the man’s dementia progressed and he was moved to the skilled care area of the assisted living community. When his wife saw the bills for the skilled care area, she claimed the costs were too high and stopped paying them. However, the sons assured me that their father had plenty of funds to pay and to pay privately (i.e., personal versus Medicaid funds). The community where he was living issued an eviction notice to the wife for non-payment. I told the boys to fight the eviction because moving a person with dementia too many times can lead to serious behavioral issues. The sons took the new wife to court, and their father was allowed to stay.

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My clients were a fascinating professional couple from South Africa. I say fascinating because they told me stories of how they had hidden Nelson Mandela in their home for 2 weeks while they were living there. The couple hired me to find the right senior living community for them because, unfortunately, the wife had memory issues, and the husband had terminal cancer that was expected to claim his life within a year. Both were ambulatory and extremely intelligent.

They had looked at several places on their own. However, none of the places had an assisted living memory unit, which would be critical for the future since the husband was not expected to live beyond another 12 months or so. When he died, the wife would have no one nearby on a daily basis to help with her memory issues. When I pointed this out to them, they had no idea there was no memory care available at the communities they had been considering. Can you imagine if they had moved to such a community, based on their limited assessment? They hired ADSLA just in time!

My clients’ major criteria for choosing a community was proximity to their two sons, both of whom have disabilities and do not drive. A member of the extended family confided to me that the parents had provided condominiums for their adult sons and, effectively, routine transportation as well, even though both men are capable of using publicly available transportation.

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I have repeatedly been asked in recent weeks whether a move to a senior living community at this time is “safe.” My answer? No, it is not as safe as we would hope, given the prevalence and the uncertainties of the coronavirus, CoVID10. While reported nursing home deaths related to CoVID19 may be at times inflated or otherwise erroneous, we do know that at least 20,000 and possibly more than 40,000 senior Americans have died in nursing homes during the pandemic, as the sudden onslaught of CoVID19 left many providers and public leaders ill-prepared. Certainly, most senior living facilities are doing their very best to ensure the safety and health of their residents and staff, and are working diligently to follow official public health guidelines for disease prevention. At this time, however, heightened concerns about CoVID safety call for careful evaluation of each and every senior housing option, as some placements must continue out of sheer necessity.

While long-term care facilities are following standard public health guidelines to protect residents as much as possible from CoVID and other ailments, at this time each long-term care community is conducting new admissions a bit differently. Here are some varied examples I have encountered thus far:

1. My client is only 60 years old and has some very serious health issues that render her bedridden. I was hired to find short-term rehabilitation that could also keep her for long-term placement after a stay in a specialty hospital. This objective was a terrible challenge because of her age and her funds being rather limited. Many of the communities rejected her, I suspect because they held the perception that a Medicaid claim would be looming from this client within a short period of time as her limited funds dwindled. The rate of reimbursement for a Medicaid recipient is significantly lower than what a community would receive if a person were paying privately.

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The CoVID19 crisis has brought home crucial lessons for all of us who care about older loved ones and America’s senior citizens. Often, a senior has to be placed in a nursing home because of his or her medical conditions or financial circumstances. By their very nature as communal facilities that house older and infirm individuals, nursing homes are natural “hot spots” for both seasonal influenza and Coronavirus. Residents may contract Coronavirus due to their proximity to other residents who have it, or exposure to a staff member required to give hands-on care, or from some other disease vehicle. In this pandemic both public policy and a lack of emergency planning by nursing homes share blame for the high incidence of infection and death.

For example, some state governors (including, ironically, some who refer to seniors as “our most vulnerable population”) ordered nursing homes to readmit residents who had been in the hospital. In New York, this included seniors still ill with CoVID19! Ordering a resident to be readmitted to a nursing home often sets them up for failure because many homes are poorly staffed to begin with. Most of the time, the ratio of certified nurse assistants to residents is 1:12 or higher. This means that one nurse aide is responsible for caring for a dozen or more residents.

Some nursing homes have sequestered residents with CoVID symptoms to specific areas and required them to quarantine in a private room for seven to 14 days, which is extremely difficult for seniors deprived of human contact. Elsewhere, such sequestration is a safety measure that many homes cannot provide due to bed availability and spacing issues.

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I was pleased to have been asked by ABC Channel 7 journalist John Garcia to provide professional comment on the Corona Virus outbreak in Illinois nursing homes. The link to the news segment appears below.

https://abc7chicago.com/coronavirus-deaths-fatalities-nursing-homes-illinous/6113728/

As I explained to this interested ABC reporter and Chicago area viewers, the current CoVID19 “Shutdown” is a heartbreaking situation because the CDC guidelines do not allow nursing home residents to have any visitors. The only individuals allowed in the buildings are those deemed as “essential employees,” i.e., personnel who are involved with end of life care or legal decisions.

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Many of my clients ask me, “Andrea, is it ever too early to plan for a senior’s future care?” My answer is, “It is never too early.” Approximately, 90% of my clients contact me when there is a crisis with a senior loved. That includes situations where there was a life-changing event with the senior, or the children of the senior made an incorrect decision about the senior’s type of care. In light of the Coronavirus pandemic, I can only imagine how many people wished they had contacted a senior living professional to create a care plan for a loved. Despite the fact that the Center for Disease Control has issued guidelines that suggest that no one be allowed to visit senior loved ones except for essential employees, I would be less stressed knowing that my loved one was being cared for in a safe environment. Picture a situation where the senior may be living at home alone. The children may experience stress because they don’t know if the loved one is safe, receiving the right care, and eating properly. With the emphasis on social distancing, the tasks that the child must perform on behalf of the senior become all the more difficult. If the right plan of care was in place and acted upon prior to the pandemic, the stress involved with a crisis could be alleviated.

Most of the long-term care communities, including independent living, assisted living, memory care, and the skilled nursing homes have been abiding by the guidelines issued by the Center for Disease Control. Some of the senior living communities have elected to stay open, continue to do tours, and admit new residents. And while it is painful  not to be able to see a senior loved one face-to-face, those communities that have abided by the guidelines have innovative ways of connecting the senior to his/her family. Many of the activity directors have gone door to door, arranging virtual meetings via Skype, Facetime, or Zoom between the seniors and their families. Don’t forget that if your loved one is in a skilled nursing home, you always have the right to request a care plan meeting with the nursing home staff to ensure that your loved one is receiving the appropriate care. If you have a special relationship with a Certified Nurses’ Assistant, you can ask him/her to connect you with a senior loved one via a cell phone.

At Andrea Donovan Senior Living Advisors, our process always includes a face-to-face assessment of the senior to determine his/her physical and mental capabilities. We will discuss whether placement in a senior living community or help at home is appropriate. The cost of senior care is astronomical so you cannot afford to make a mistake. That’s where we come in. Since we have toured and evaluated over 450 senior communities in the Chicago metropolitan area according to cost and method of payment, level of care, quality of care, staffing, food, and cleanliness, we direct you to no more than 3 or 4 senior housing options that fit your senior’s big picture! And since we are Certified Geriatric Care Managers, we will create and implement a care plan if the senior is to remain at home. And most importantly, we don’t accept any commissions from the communities or services that we present as options. We work for you and your loved one. Please stay safe!

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Five weeks ago, I went to a long-term care community for a meeting. When I signed in at the reception desk, I noticed there were signs warning there was a respiratory illness circulating on specific units. The units were located in the nursing home. My meeting wasn’t going to take place on any of the affected units; but, I took what I thought was a precautionary move: I told the receptionist where I was going and confirmed that the illness wasn’t circulating in the unit where I was going. She assured me it was not. So I proceeded to the locked memory unit, where the meeting was being held. I used my covered elbow to push the elevator button. And I waited for a certified nurse’s assistant to open the door to the unit. The meeting lasted no more than 40 minutes.

The next morning when I woke up, I had chest congestion, a cough, and a sore throat. Strangely enough, I did not have a high temperature or nasal congestion. I thought I had caught a common cold, but whatever illness I had acquired rendered me so fatigued that I slept for close to three days straight! The only exception I made to resting was to walk my wonderful golden retriever. By re-tracing my own steps, I don’t think I had been any place where I could have picked up a respiratory problem, although I have no absolute proof.

After a week, I realized that my cough and chest congestion were not subsiding. I decided to go to an immediate care center and see a doctor. The doctor, who was very kind, listened to my breathing and told me there was no sign of pneumonia, but that I had chronic bronchitis. It is now a month later, and I still haven’t been able to shake the cough completely.

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I worked very closely with a wonderful woman in her mid-eighties as her power of Attorney for Healthcare. After she had been hospitalized for an elevated white blood count, I transferred her to a short-term rehabilitation community, then to assisted living for a respite stay, before I took her home. The return home occurred in early December.

Two weeks before I took her home, I met with a licensed home care agency representative to arrange for a live-in caregiver until my client would be able to function on her own. I had good luck with this agency in the past and trusted the owner. But, like anything else, the situation can change overnight. I was aware that the holidays were approaching. I resigned myself to the fact that staffing my client’s case was probably going to be tough because, like anyone else, caregivers want time off during the holidays.

As it was explained to my client and me, she would have two caregivers. One would stay for four days of the week, and the other would work for three days. It was supposed to be the same two caregivers for the duration of my client’s care. While we were told by the agency in detail how the first four days would be covered, what would happen during the remaining three days remained a mystery.

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My father always told me there is “No such thing as a free lunch!” That’s why I was very wary when I received a phone call from my client’s Medicare Supplement insurance company representative. (I serve as Power of Attorney for health care for my client.) The insurance representative was very excited when she informed me that my client ‒ who is 99 years old, has advanced dementia and lives in a nursing home under Medicaid ‒ was eligible for a new program that would not only broaden her health care coverage, but also add dental insurance free of charge. As a former insurance broker, my antennae went up immediately: More coverage, free of charge? Here are stipulations of the policy:

Podiatry Services – 4 visits

Vision Services – $300 every 2 years toward lenses and frames

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Fifteen months ago, I was hired by a charming, alert, 85-year-old woman to act as her Power of Attorney for Healthcare and, if necessary, Geriatric Care Manager. I remember the first day I met her. She was running around her 2-bedroom ranch house like someone had fired her out of a cannon. I made my usual assessment, asking about her medical issues (surprisingly, she had many), list of medications, and how to help carry out her wishes when she was alive and near end of life. She was somewhat skeptical as to why she would need my Geriatric Care Management services. I explained that, since she had no relatives or friends who could handle the job if she needed help, she would need to have a plan in place. She went along with my suggestion.

Three months ago, I received a call from a skilled nursing home where she had been taken for rehab. My client had called 911 after falling. Unfortunately, her hospital was on bypass because the ER was so busy, so she was taken to the next closest hospital where none of her physicians were on staff. The hospital treated her for a heart problem and sent her to a rehab. community. I went to visit her and was astonished at how badly she had deteriorated. She said the food at the rehab facility was horrible and she felt like she was losing weight. She was a good cook and ate very healthy.

Upon developing a second health issue, my client was transferred back to the hospital where her doctors were on staff. She was treated for a high white cell count and was again ready for release to rehabilitation. She insisted on being transferred to a home that was owned by her hospital, thinking her doctors would follow her. I explained to her many times that her current physicians would not follow her unless I took her to see them myself. She was pretty unrelenting at this request, so I chose the best rehab. community available within the hospital system. I was right: Her current physician wouldn’t follow her and she was seen by the medical director at the home. While the therapy was good, she complained vehemently about the food and continued to lose weight (20 pounds).