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When I started serving in the senior living industry over 15 years ago, all communities included three meals in the rent. Three meals were just part of the senior’s care package, whether the level of care be independent living, assisted living, or skilled nursing home.

While that still holds true today for assisted living or nursing home care, the meals/food picture has changed in the independent living landscape. Most independent living communities are offering one main meal per day, with the choice of paying for 2 extra meals on an ala carte basis. Other independent living organizations are offering “flex dollar” arrangements, where the senior is given a fixed dollar stipend on a monthly basis. The flex dollars can be used to purchase meals, haircuts in the salon, or other amenities the community has to offer.

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About one-half of the clients who engage me for my services do so after they have already selected a community for a loved one. Then, when a problem arises, they call me to help fix the problem. Unfortunately, no one has a crystal ball and can anticipate some of the unusual circumstances that can arise. Most of the time, clients are so pre-occupied with fixing the senior living problem that exists now, they do not consider what can happen in the future. Clearly no one is to blame, as it is always what we do not anticipate that causes a problem.

Real-Life Story

My clients were the children of a senior aged 78. She had been placed at a Continuing Care Retirement Community (CCRC) that offered Independent Living, Assisted living, Assisted living with a memory care unit, and Skilled Nursing care. She had a lovely apartment in the independent living area that required an entrance fee of more than $200,000 when she moved in.

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Many seniors have a tendency to keep private their financial realities. However, if your senior loved one purchased long-term care insurance to cover the costs of a stay in a community or to hire non-medical home care, you will want to ask if you can look at it. I say this based on the experience I had with my mother, and I share our story lest you should have the same experience.

My mother purchased a long-term care policy 25 years ago. I was amazed that the insurance carriers were able to underwrite her at age 70. Thankfully, she was well enough to pass the underwriting since she had no serious medical issues at the time. However, the agent who sold the policy to her (and who had bragged that she was the number one producer at her company) was not exactly prudent when designing the structure of the plan for a claim that could occur in the far future. The plan that was sold to my mother included a 90-day waiting period before any benefit would be paid. Such waiting periods are common. The plan maximum paid up to $100 per day. That, too, was all right for a plan that was purchased 25 years ago. However, the agent neglected to sell my mother her an inflation guard benefit which would increase her plan’s benefit by 3-4% per year. If an inflation guard benefit had been included, the benefit she would receive would be much more in line with the currents costs charged by her senior living community. The bottom line is, based on the plan purchased 25 years ago, my mother will receive a benefit that will cover $3,000 of her $6,000 monthly cost.

While I am thankful she had the policy, it would have been more valuable if the inflation coverage had been included at its inception. If you know or suspect your aging loved one has purchased a long-term care policy, ask if you can sneak a peek at it!

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I remember fifteen years ago when I started as an Admissions and Marketing Director in the senior living industry, my future boss took me on a complete tour of the community. Or so I thought.

The community included independent living, where most of the seniors were well off mentally and ambulated with, at worst, a cane. The next level of care was assisted living, which at the time was an extension of independent living. But, the residents at that level received “standby” assistance with bathing, dressing, toileting, transferring, eating, and walking. At worst, seniors there ambulated with the help of a walker. No wheel chairs were allowed. Last, there was nursing home level, or the dreaded fifth floor that was reserved for residents who could no longer function at the independent living or assisted living level. Most were in wheel chairs and needed total assistance with their activities of daily living. Or, some suffered memory impairment and were at risk for wandering. The fifth floor was equipped with a security code for the elevator and an alarm for those residents who might attempt to leave unattended.

When my boss conducted the tour, he showed me the independent living and the assisted living areas, both of which were places where the residents appeared to be happy. However, after I began working there, I was sent to complete a task on the fifth floor where the residents needed total assistance with everything. Being new to the industry, I was like many of my clients taking a tour of a nursing home for the first time. I was nervous and terrified! I rushed down to my boss’s office and told him that I was exceedingly upset that I was not told that the fifth floor existed. As time went on, I grew to love the residents on the fifth floor. There we were encouraged to take a break from the regular tasks of the day, attend scheduled activities, or just talk.

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Last week, I received a phone call from a prospective client who was in panic mode. The client’s parent, who has dementia, had moved in with him on a permanent basis. The parent had been spending several days a week with three adult children. A family disagreement, the details of which were not disclosed to me, had occurred. As a result, the senior was not allowed to return to the other two children’s homes. My client was now responsible for the parent’s care on a 7-days-a-week basis and was not able to cope with the situation. In addition, his spouse was having issues with her own health. I quickly went out to assess the senior’s physical and mental condition.

When I arrived, I found a very healthy 88 year old. The senior could not, however, tell me what day of the week it was, his date of birth, or who the President is, which are all typical questions that are asked on a mini-mental examination. The senior’s ambulation was very good. The senior was an excellent prospect for assisted living with memory care.

After I completed my assessment, which included analysis of the senior’s financial realities and the family’s location preferences, the client told me that he wanted my recommendations completed in 2 days. The next morning, I sent him spreadsheets that included information regarding three senior communities that fit his specifications, and I immediately set up appointments for tours. I advised my client to obtain the senior’s medical history and physical form from the senior’s physician. I also told him to collect the senior’s financial information.

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Here are five easy steps to help convince your loved one who needs to move:

1. Enlist the child, sibling, or friend who is closest to the senior to initiate the conversation. The senior needs to hear the message from the right person.

2. ​Plant the seeds in very short, non-threatening messages. For example, “Gee, I noticed that you are having a little trouble getting yourself dressed. Don’t you think you would benefit from a little help?” Change the message at the right moment at the next attempt. “I noticed you have been eating a lot of cold cereal instead of a meal. Wouldn’t it be nice to have someone cook your meals for you?” Space out the messages and deliver them at the opportune times. It may take months for a senior to decide you are right.

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Only two things in my life have terrified me. The first was laying my husband of 33 years to rest after watching him suffer dreadfully from cancer of the appendix. I can at least take some comfort in the fact that I know he is at peace. The second thing was having to place my mother in a long-term care community.

You might be surprised and be asking yourself, “Why was she terrified? She does that sort of work as a beloved Calling and for a living!” My reply to such a reasonable question is this: As a highly trained and experienced professional, I have absolutely no problem dealing with my clients’ parents or loved ones. But when it comes to one’s own mother, the process takes on an added dimension that is – as you can imagine – very personal and emotional.

My mother is 95 years old and has lived on her own up until this point. Our family was fortunate enough that one of my siblings took on the role of companion and “go to” person for her. But my mother suffers from a rare blood disorder, severe arthritis, and heart issues, to name but a few. She has been prescribed 17 different medications, none of which she was taking correctly. She was not eating properly and had fallen on several occasions. She would only accept very minimal help with bathing and dressing.

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I want to share a story that may prove helpful to you my readers one day. I serve as the Power of Attorney for Health Care for one of my clients who has severe issues with her memory. She was recently transferred from the assisted living memory care unit of her current community to the skilled nursing section due to failing health. When I went to the nursing home to complete her admission papers, the social worker informed me that there was no completed DNR/POLST form in my client’s file, and I needed to complete one.

In order to accurately describe the form, I am quoting a description from POLST.ORG which reads, “The POLST Paradigm was developed to improve the quality of patient care and reduce medical errors by creating a system that identifies patients’ wishes regarding medical treatment and communicates and respects them by creating portable medical orders. While the POLST Paradigm supports the completion of advance directives, clinical experience and research demonstrate that these advance directives are not sufficient alone to assure that those who suffer from serious illnesses or frailty will have their preferences for treatment honored unless a POLST Form is also completed.”

Although I serve as Power of Attorney for several of my clients, most of them are not nearing the end of life at this point. When I looked at the form (, and admittedly I had seen it before, I was a little overwhelmed. Seeing the form is one thing. Comprehending the reality associated with it is another. I told the social worker that my client’s POA for Health Care clearly stated that she did not want her life prolonged if the “burdens of treatment outweigh the benefits.” I was informed that without the completion of the POLST form, she would be a “CODE 3,” meaning that she would be resuscitated even if the POA form stated otherwise. Hence, the POA form was not sufficient in the absence of a POLST form on file.

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Many of us, including our loved ones, have terrifying memories of visiting Grandma or Grandpa at a nursing home. We have visions of the residents sitting slumped over in wheel chairs, the dismal aesthetics, unpleasant odors, terrible food, a dying roommate and the ever popular bingo game as the daily activity. These sorts of thoughts, whether exaggerated or fully accurate, will deter a loved one from considering a move to a retirement community.

Yesterday’s nursing homes focused on taking care of the sick. In contrast, the CCRCs of today not only seek to offer lovely aesthetics but also seek to maintain a senior’s independence by offering many a la carte services that allow the senior to stay in his/her independent living apartment. For instance, a senior may be independent for all practical purposes, but might feel more psychologically secure if someone stood by while he or she is taking a shower. These types of a la carte services can help delay a premature move to a higher level of care and allow a senior to remain in his/her own apartment for as long as possible. However, if a senior needs more care in the future, a true CCRC will offer assisted living and skilled nursing to address future health care needs without moving. Thus the senior and his or her family will avoid the trauma of a second move and the loss of friendships the senior has cultivated.

From the financial aspect, many CCRCs have shunned the typical rental arrangement and converted to Life Care Contracts, meaning that if a resident is at some point unable to meet the financial obligations of paying his/her monthly fee, the senior’s care will be subsidized by the rest of the residents. In other words, care is guaranteed “for life.” Here is a brief, oversimplified, explanation as to how it works:

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My client whom I will call “Marie” for the purposes of this story, was a 71 year old woman who had serious respiratory issues. Until recently, Marie lived at home with her mother. They had spent their entire lives together. A sudden illness caused Marie’s mother to be hospitalized and subsequently sent to a nursing home for rehabilitation. When it became apparent that my client’s mother was not going to recover, Marie brought her home and arranged for hospice services. There, my client Marie, a 70-something senior, continued to help tend to her mom, who eventually passed away.

As I had been hired by Marie previously, I was recently contacted by her trust officer, and was informed that Marie had been ill. It was requested that I act as her geriatric care manager. I went to the hospital in order to assess her situation. At that point in time, the trust officer knew very little about Marie’s physical condition.

When I arrived at the hospital, I was very surprised at how much Marie had deteriorated. She had been a feisty, quick witted woman. Despite her breathing issues, she had always been a fighter as evidenced by her devotion to her mother. At first, Marie didn’t recognize me because she was taking medications. Then in a matter of a few minutes, she confessed to me that the combination of taking care of her mother and the breathing issues landed her in the hospital, then in a rehab. community for respiratory therapy, then back in the hospital again. She said, “Andrea, I am convinced that taking care of my mother worsened my health. But, I loved her, and I would never change what I did. But, now that she is gone, I really have nothing to live for.” The hospital’s plan was to send Marie home with hospice care. She told me she was impressed with the hospice team that had taken care of her mom, and wanted the same people to take care of her.