Articles Posted in Assisted Living

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This year marks the 60th anniversary of Older Americans Month, as President Biden wrote in his recent presidential proclamation on the occasion. Thirty-three years ago, President George Bush, Sr., observed that Americans age 85 and older constituted one of the fastest growing segments of our population and that 1 in 5 Americans would soon be age 65 or older. Indeed, several years ago, I observed some of my friends retiring. Although they seemed happy to do so, I hoped and prayed that I still had many years of working ahead of me. Deep down, I felt that there was a chapter of my life that had not yet been written. I wasn’t certain what the story and adventure might be, and I thought about it for a number of years.

I have been a harp student ever since my husband’s untimely death from cancer in 2015. I had played the harp as a child and yet, as life-responsibilities grew, I had taken a hiatus for many years. Following the loss of my husband and my parents, I decided to take up the hobby again to divert my thoughts and to avoid escaping my grief by watching TV reruns at night. One day, a dear friend asked me to play the harp for her daughter’s wedding. Then, leaders of a retirement community asked me to play for an event for their residents. As the idea started catching on, the pandemic halted the possibility of playing more places. But, as things improved, I eventually was asked to play at more retirement homes, community events, and dance recitals, etc. Voila! I had found the pen to start writing the next chapter of my career by adding harp performances to ADSLA’s menu of services.

As President Bush wrote in 1990, “millions of older Americans are now remaining in the work force past the traditional “retirement age.” Indeed, many are pursuing second careers, while others continue to enrich our communities and country through volunteer work – and/or by quietly devoting their time to family and friends. Not long ago, U.S. News & World Report noted that many older workers move into a new field before retiring. The national magazine listed 15 “In-Demand Jobs for Seniors,” and I was delighted to see musician listed among them.

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I was contacted by a therapist to provide an assessment of one of his senior clients. When I spoke with the senior’s son, he told me that his mother was receiving terrible care at an assisted living community. He claimed that the care that had been promised had not been delivered and his mother’s apartment was not being kept clean. I set up an appointment to meet the son and his mother in person to evaluate the situation.

The woman met us at the door of her apartment thoroughly unkempt – clad only in a shirt and a diaper that was falling off. I observed a terrible rash down the back of her legs. She told us to sit down while she finished dressing. The apartment was a mess with boxes of sugary snacks and drinks crowding the small counter of the kitchenette. An odor of urine and feces permeated the air. A chair appeared to be nearly obliterated. While we waited, the son informed me that his mother was diabetic and was not attending any communal meals in the facility. Instead, she was ordering unhealthy grocery deliveries to the apartment and eating in the room. She also had serious issues with incontinence.

The senior emerged 25 minutes later. During my conversation with her, I found out that she was a college educated professional and had been involved in the teaching profession. I asked her if she was getting the care she expected in the community, and she admitted to me that she wasn’t going along with the program. She was honest in admitting she had too much pride with having the caregivers help her and was turning them away when they came to shower her and help her toilet. She admitted to me that she could not feel a bowel movement coming, thus the bad condition of the chair. In addition, she said she wasn’t attending communal meals because, in her words, the other residents were “snotty.”

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No one ever likes the idea of placing their loved one in a senior living community. But sometimes an observation from a non-family member and unbiased third party like ADSLA can bring another perspective into light.

My client was a child of elderly parents in their very late 80s and mid-90s, respectively. One parent had issues with dementia and needed serious help with toileting and bathing, including lifting. The more independent spouse, who had health issues too, insisted upon completing these tasks for reasons that I have heard many times before: e.g., “We don’t want in-home care because we do not want anyone in our house.” Or “I don’t want my spouse placed in a senior living community when I can do this.” And “Money is an issue.” While sympathetic to such common reasons and the spirit of love and commitment behind them, I observed that the caregiving spouse was very small in stature and looked tired and frail. I had no idea how they were completing the caregiving tasks without getting hurt. Needless to say, something needed to be done for both parents’ well-being.

My client had arranged for me to meet the couple via a Zoom call. When I observed the senior with dementia, I found that by engaging them in conversation that they loved to talk about their hobbies and seemed to be thrilled to have someone to talk to. The senior was very talkative and social. In contrast, the person doing the caregiving looked very fatigued and frail. In addition, I learned there was another adult child living with the couple who supposedly sat with the person with dementia (PWD) but wasn’t engaging in any of the caregiving. When I suggested that it might be a good idea to hire a caregiver who could engage in conversations with the PWD about their beloved hobbies, I received pushback from the resident child who said, “I can do that.” I also pointed out that a hired caregiver could provide an opportunity for the caregiving spouse to take time for respite and freely do whatever they wanted to do for several hours each day. Again, the caregiving spouse objected, claiming “I really don’t need that.”

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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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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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Even in the best of circumstances, the holidays can feel like a Keystone Kop comedy or a carousel spinning at a high rate of speed as each of us tries to keep up with shopping, cleaning, cooking, traveling, and engaging in social events and religious observances. When caring for an elderly relative, especially a person with dementia (PWD), the sense of fatigue – and sometimes farce – can feel almost double-fold. That is why I wish to share a few tips for surviving the holidays. Indeed, these tips are valuable no matter what one’s age or circumstances might be!

First, a tip borrowed from the commercial airlines: Be sure to put on your own oxygen mask before attempting to assist others. Self-care is an essential part of being able to help a person with dementia: At this hectic time of year, be sure that you are getting enough sleep, good nutrition, exercise and emotional support as you tend to the needs of your loved one with dementia. The commandment to “Love thy neighbor as thyself” implies that there is such a thing as a just love of self — no, not selfishness, but a proper regard to maintaining the strength and equilibrium that you will need in order to share those gifts with others. Prioritize what really matters, and don’t sweat the small stuff. Take breaks when you need them, and call on friends and other family members to pitch in and help when you feel overloaded. Often, others are happy to have the opportunity to assist.

When communicating with a person with dementia, recognize that emotional reactions and a tendency to judge are naturalhuman. However, they need not control you or a situation. As a PWD’s ability to verbalize deteriorates, he or she often will rely on body language to convey his or her emotions and wants and — conversely – to assess your mood, intentions andor sincerity. Ask yourself, what is their body language saying? What is yours saying? Clues to reading another’s mood and intentions include the following:

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I recently helped a client move to a supportive living community, which is assisted living supported by Medicaid. The term Medicaid refers to the Federal and state programs that fund long-term care for people who cannot afford to pay privately. Supportive living provides the senior with standby assistance for activities of daily living, meaning bathing, dressing, toileting, transferring, walking, and eating. The senior lives in his or her own apartment and enjoys oversight provided by a nurse, three meals a day, and options for activities.

The following is a checklist of items needed for application and approval for long-term care covered by Medicaid, whether it be for supportive living or a nursing home:

Red, white and blue Medicare card

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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.