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

Articles Posted in Assisted Living

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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.

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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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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 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.