Articles Posted in Assisted Living

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Elder abuse is a crime. It can occur whether your loved one is at home, attending adult day care, or living in a senior living community. And like any other crime, you have an obligation to report it. This month, I have asked one of my trusted partners, Mike and Mary Doepke of Home Helpers Home Care of Hinsdale, to share some information on Elder Abuse:

From all outside appearances, 80-year-old Shirley seemed well cared for by the niece who had moved in with her a few months earlier. She even told her friends how she was enjoying the company and the help around the house.

Shirley had always been frugal with her credit cards, using them only when needed. So when the bank called to ask her about some recent, unusual charges on her account, she was alarmed. She was even more surprised to find out that the purchases were made by the niece she had welcomed into her home.

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This week, I was overjoyed when a former client called me to tell me about her mother’s progress. Her mother was a young 70 when they became my clients less than a year ago. When I first met the elder during an assessment, she was at a short-term rehabilitation community and was covered under Medicare. She had been living in an independent living community with a 24-hour caregiver. A stroke had left her unable to use her left side. Then, the caregiver dropped her while she was transferring her in the bathroom and broke my client’s leg. That is how she ended up in a nursing home receiving short-term rehabilitation.

My client’s 100-day allotment under Medicare rehab was coming to an end, and she soon would have to begin paying privately. Although the care was satisfactory at the current community, she wanted a private room. This nursing home didn’t offer any private rooms. She did have the personal funds to pay privately for quite a while, even though the rate for a private room was over $300 per day. I knew, however, that since she was a young 70, and the cost of nursing home can run $9,000 and above for a private room, she would need the safety net of Medicaid if her money ran out. Because the stroke and the broken leg had left her totally disabled, she had to be transferred in and out of bed, bathroom and shower with the use of a Hoyer lift. I sent the senior’s adult children to tour a half dozen selected communities with the needed equipment, but nothing seemed to pass muster in their eyes. Either the rate for a private room was way too high, they didn’t like the Admissions Director, or the aesthetics were not what they wanted. They were being very specific about their location preference. Finally, I identified a community that was half-way in between for both daughters and had several Hoyer lifts available for the residents’ use. I was also very selective about the physical therapy that would be available to my senior client, as the daughters stated that she may want to pay privately for additional therapy. The therapists at the community were actually employees of the nursing home, not a separate agency. As a result, I knew she would have a better chance at receiving therapy from the same therapists.

When I recently spoke to the daughter, she said, “I have been meaning to call you. My mother has been moved from the nursing home (needing full assistance with bathing, transferring, toileting, dressing, walking and eating) to the assisted living area (some hands-on assistance with the aforementioned activities) of the nursing home. She can transfer in and out of bed and bathroom without the assistance of the Hoyer lift. The cost of her care was also reduced! And it is all because the therapists at this community worked so closely with her to improve her condition. Thank you!”

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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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When you have completed the daunting task of choosing the right senior living community for your loved one, your next mission will be to prepare for his/her move. It is very likely that the senior will be moving to an apartment or room that will be much smaller than his/her current living arrangement. Decisions will need to be made as to which items the senior will discard, donate or keep. All of us tend to have difficulty parting with “keepsakes” to which we have emotional attachments; accordingly, it may be a wise decision to utilize the services of a professional organizer when your senior moves.

Sue Becker is a Certified Professional Organizer in Chronic Disorganization. She has worked side by side with my senior clients (including those with dementia) to help them with the highly emotional task of sorting through years’ worth of keepsakes and papers and deciding which items to keep.

Keepsakes: Turn Your Muddled Mess into Meaningful Memories

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Assisted living communities that have a memory care unit are supposed to be adequately staffed with assistants and aides who are educated to deal with the behaviors of dementia residents. The habits of these residents can often be repetitive and endanger the resident if they are not closely watched. Many residents “sundown” in the evening, meaning they may often become more confused and agitated at this time. In my opinion, the caregiver ratio in these sorts of units at night should be no less than 1 aide to 8 residents, when residents with dementia, whether ambulatory or not, can become very agitated and even combative. The “powers that be” at some senior living communities will dispute my ratio, contending that they only need to staff according to long-term care regulations. This month’s real life story will outline the consequences of understaffing.

Real-Life Story

I was recently hired by a client who was forced to place her memory-impaired relative in an assisted living community’s memory unit. The relative had been living in another retirement community that was not equipped to care for residents with memory issues. When the staff at the original community witnessed the relative dragging a bag of laundry up the hallway in the wee hours of the morning, the staff arranged to have her taken to the local hospital’s behavioral unit for evaluation. Apparently, this had not been the first incident of questionable behavior. When the evaluation of the relative was complete, my client was informed that the retirement community could not handle the relative’s behaviors. Therefore, my client had to place the relative in an assisted living community that had a bed available in its specialized memory unit.