Articles Posted in Assisted Living

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Sometimes you must face the fact that you are in denial about your senior loved one’s needs. I am sharing the following Real Life Story with you to emphasize that point.

My clients are a family of ten children who attended my, “Senior Living Myths Unmasked,” presentation over three years ago. Their elderly Mother was living alone in a large home. At that time, she had been diagnosed with early onset dementia. The children were divided in their opinions on whether to keep their Mother at home with a caregiver or seek placement in a long term care community. After countless conversations with them, they decided to hire a caregiver on a part-time basis.

The family contacted me recently to advise them on their Mother’s situation which had changed dramatically. The caregiver was helping their mother on a full-time basis. Her finances had changed drastically. Reportedly, she was down to her last $30,000. She owed no money on her home, but the house was not on the market to be sold.

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The popularity of reality TV shows has brought about an overwhelming interest in the disorder of hoarding. I delivered a presentation on the subject this week and was overwhelmed myself by the number of people in the audience who thought they had the disorder themselves. As a senior living advisor and certified care manager who works closely with hoarders, here is a summary of what I shared with my audience.

Hoarding is a disorder that is comprised of three components. First, a person accumulates too many possessions. Second, the person fails to get rid of them. Third, the individual fails to organize the “stuff.” The bottom line is that living spaces that are intended for other uses are so cluttered that they can’t be used for the purpose for which they were designed. The result is that the hoarder suffers distress due to the hoarding.

Here are some of the signs of a chronic hoarder:

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The weather in Chicago has fooled us again! Last week, we suffered from the sweltering heat. For the past few days it has been like fall. Tomorrow, it will probably snow. Just as the weather can change on a dime, so can “Seasonal Affective Disorder (SAD) ,” cause depression in a senior at any time of the year.

What is Seasonal Affective Disorder? At is a form of depression that affects seniors (and other people) at the same time of the year every year. My Father started experiencing the symptoms at it at about the same time he was diagnosed with dementia. He had been a “sun worshipper” all of his life and spent hours outside during the summer months reading books. Once the winter months would set in and he was unable to spend time outside, he would experience depression, loss of interest in activities he enjoyed, sleepiness, anxiety, a heavy feeling in his arms and legs, weight gain, and social withdrawal. The symptoms would manifest themselves at the same time of the year. While most people suffer from SAD during the onslaught of fall and winter, some people actually exhibit symptoms in the spring and summer! People who have SAD during those months experience some of the reverse symptoms meaning weight loss, loss of appetite, insomnia along with anxiety, irritability, and agitation. As a Certified Care Manager, it makes sense that I observe so many seniors who (like my Father) experience the disease in the fall/winter. Inclement weather may inhibit a senior’s ability to drive, walk, and attend the activities that make him/her the most happy.

What causes SAD? As with other forms of depression, the causes are unknown. It is suspected that age is a factor along with the an individual’s genetics. Changes in the brain chemical or neurotransmitter, Seratonin, are also though to trigger SAD. This brain chemical affects mood. A reduction in sunlight may cause a drop in Seratonin which increases depression. When the seasons change, the levels of Melatonin may change as well. Melatonin is a hormone that helps with sleeping patterns. SAD is also diagnosed more often in women, but men often experience much more serious symptoms. People who have clinical depression or bipolar depression seem to be prone to SAD. If a person lives far north or south of the equator, the decrease in sunlight during fall or winter may increase the occurrence of the disease.

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The blistering Chicago heat arrived last week. That means it is time to review some tips to keep your senior loved one safe. Our elderly loved ones are more sensitive to the effects of heat and are more prone to dehydration. Remember that they do not adjust well to rapid switches in temperature. If they have a medical condition, it may change the way his/her body reacts to the heat. Prescriptions s/he may be taking also affect the way his/her body adjusts.

I am fortunate enough to have a brother who is able to check on my 91 year old mother on a daily basis, and another brother who stays with her at night. I am blessed and I don’t know what I would have done without either of them. If you aren’t as lucky as I am, you will need to designate a trustworthy individual to check in on you elderly loved one. Whether your senior lives at home or in a senior living community at the independent, assisted living, or skilled nursing level, the following are tips that you can use to cope with the heat:

-Try not to take a senior outside during the hottest parts of the day. This sounds like common sense but when you are under the duress of taking care of a senior and your own family, common sense flies right out the window!

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I was an advocate for “person-centered care,” long before it became part of elder care terminology. “Person centered care” simply means that a community, or another entity, adapts and delivers care or amenities according to the habits of the senior. As the former Admissions Director of a community that catered to residents at the independent, assisted, and intermediate nursing home level, I knew that flexibility was the key to keeping the place full. Most importantly, it kept the residents happy.

The organization that I represented had not changed much aesthetically or administratively since it was built in the early 1950’s. Consequently, I broke just about every rule in the book (often to the dismay of the religious order that had once reigned there in the past) in order to keep the place filled. At one point, I admitted a cheerful, boisterous, resident who asked me if he could bring his extremely loud, talkative, Cockatiel to live with him when he moved in. I said, “of course,” even though the community had a strict no pets policy. The bird absolutely delighted the residents and I often saw a group of them congregating in the owner’s room before dinner. Another resident’s daughter told me that her Father was a sports fanatic and that he often watched as many as six different events at the same time. Bear in mind, we are talking about events that occurred 15 years ago, and the building was not yet cable friendly. I said, “That’s no problem, we’ll just install a satellite dish outside his window.” You can imagine how many eyebrows I raised when the satellite dish company pulled up and started to hammer away.There was also a long-term resident who confided to me that she had an illness that would eventually cause her to need a feeding tube. She said that above all, she wanted to live out her final days at the community rather than be moved to a nursing home where they could accommodate her needs. I was very touched by her request. I approached the Administrator and asked if there was something we could do for her. He was able to petition the State on a one time basis to allow the feeding tube, and her request was granted! Thankfully, times have changed since then. As a senior living advisor, I have learned that some but not all of the nursing homes are delivering “person-centered care.”

Real Life Story

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A recent article published in the Chicago Tribune entitled “Refund sought; ‘every little dime would help’ emphasizes two important points. First, the media has provided only the complainer’s side of the story. There are so many facts about this case we don’t know. Second, it points out the true pitfalls of having a neighbor of 47 years, and someone who is inexperienced at navigating the long term care health system calling the shots for an elderly person. As a senior living advisor who acts as Power Of Attorney for several of my clients, I cannot express the importance of having an experienced individual take on this serious task.

According to the article, the elderly person had fallen and spent over three months in a rehabilitation facility beginning in November. If the elderly person spent over 100 days in rehabilitation after a three night hospital stay, it is likely she had exhausted her Medicare benefit period. The costs to remain at the same rehabilitation community as a private pay client would have been prohibitive. I have in many cases, seen clients released to a lower level of care (before they are ready) in an effort to avoid paying higher costs. The Supportive Living community mentioned in this case provides only stand by assistance with bathing, dressing, transferring, toileting, walking and eating. There is no nurse present on a 24 hour basis. After living at the Supportive Living community for six weeks, the resident was sent back to a skilled nursing community after developing an infection in her heel. According to Doctors, the source of the infection was unknown and treated with an IV, which is a type of care Supportive Living communities are not licensed to deliver. After the diagnosis of infection, the resident was placed back in a skilled nursing home (which is the same level of care she was receiving during rehabilitation). I wouldn’t have allowed my client to make that sort of transition unless they were really ready.

The article also documents that the elderly woman’s Power Of Attorney tried to obtain a refund of a $2,500 move in fee. As a senior living advisor, I am unaware of very few move in fees that are refundable. Off hand, I can think of only one community that offers a refundable move in fee. But, that is one item that you need to be clear on before you move a loved one into a community. This Power Of Attorney insisted that the money be returned because the resident was only there six weeks. Needless to say, she still moved in.

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I just turned 55 on my last birthday. Although some people consider 55 as the official age of becoming a senior, I have never allowed my age to deter me from participating in my hobby of tap and jazz dancing. As a senior living advisor, (and a former, part-time children’s dance teacher of 13 years, hobby only) I am also pleased to see so many of the senior communities offering dance therapy classes to their residents. I have also taught tap and ballet on a voluntary basis in some of the assisted living communities that specialize in dementia care and several senior centers. I was made aware that several of the participants also had Parkinson’s disease.

Exercise that is performed several times a week can help to elevate a person’s immune system and make them feel better about themselves. That is because of the endorphins that are released. The exercise classes provide camaraderie while encouraging seniors to move all of their body parts. If a person moves their limbs, it increases hand to eye coordination, strengthens the core, and helps balance.

I approached the classes as I would have at any other basic level. I included combinations and repetition to Frank Sinatra and Bobby Darin songs. I found that most of my “students,” found ease in doing the tap warm ups, grape vines, and some jazz movements, even if they were confined to a wheel chair. Many of the participants said that their joints felt better, their overall movement improved, and most importantly their spirits had been lifted. After the class had finished, I always served them a snack and we’d talk for a while. Some of the residents with dementia would reminisce about where they used to go to dance with their spouses. One resident in particular spoke about a church in Evanston, Illinois that had a Scottish affiliation and offered Scottish dance lessons. She even went so far as to quote me the exact street address.The repetition of certain exercises helps people with Parkinson’s to concentrate on movements that have become difficult for them, such as doing two things at once. People who have suffered a stroke are able to express themselves by moving to the music even though they can’t talk. Sometimes peoples’ medications stop working for them and the classes give them relief from their symptoms.

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I read the attached article, “Adult Children Ignoring Confucius Risk Lawsuits in China,” about the elderly having the option of suing their children if they don’t visit them enough while they are in a long term care community. I used to be the Marketing/Admissions Director of a large Continuing Care Retirement Community where I dealt with admitting seniors who were at the independent, assisted, or nursing home levels of care. The article made me reminisce about acting as, “manager of the weekend,” and some of the experiences I had with family members who were regular visitors. In other words, the families were the polar opposites of the “no shows” referred to in this article.

As manager of the weekend, each staff member at the community had to take a turn at watching over the place. This meant taking care of the needs of the residents, as well as meeting and greeting the family members who came to visit on the weekends. The manager was instructed to walk the hallways to observe cleanliness and anything that seemed out of the ordinary. Another assignment was to circulate in the dining rooms during meal times, ask the residents about the acceptability of the food, and to eat the food to make our own assessment. The best part of acting as the “manager of the weekend” was that I got to see all of the visiting family members that I had previously been involved with during the admissions process. However, I chuckled at the content of this article because some of the families didn’t deserve to be penalized because they didn’t visit enough. They deserved to be scolded for what they did while they were they visiting loved ones, particularly the seniors who were at the independent level. Let me share some of the events with you.

There was a woman who had lived at the community for a number of years and was practically a model resident. She never had a single hair out of place and was always dressed in the latest fashions with a hand bag to match. She had a son who lived in the neighborhood. He visited her each weekend without fail. One time I noticed a large bottle of liquor in her room. Residents at the independent level were allowed to keep liquor. Since independent living is just like an apartment building, there were no rules against it. I was told by another staff member that she kept it to offer her son a cocktail when he visited. The problem was that while I was walking the hallways after the son had left, I found her wandering the hallways half looped on several occasions. I had to escort her to the dining room to make sure that she ate. The same thing happened with another resident whose girlfriend picked him up on Saturdays to take him out for dinner.

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The prospects of alternative living options for people with dementia who are under the age of 65 are not plentiful. Although there are assisted living communities offering memory support for prospective residents under the age of 65, the pay source is strictly private. I have been faced with situations where the prospective resident has been in their early 50s and had severe Alzheimer’s disease. Unfortunately, the family lacked the funding to pay privately at an assisted living community. I had no other option except to assist the family with placing the individual in a nursing home that would accept Medicaid.

As a senior living advisor, I must persuade my customer’s to accept options that are less than optimal because there is nothing else available. In the following Real Life Story, I had the long term solution to my prospect’s problem, but the individual is still contemplating other arrangements.

REAL LIFE STORY My client’s sibling is only 51 and has early onset dementia. The individual was living alone in an apartment quite far away from the rest of the family. The person had worked at the same job for many years until it was apparent that the symptoms caused poor job performance. The person was dismissed from the job. The person had a monthly income of less than $900. The person also had a 90 pound dog that needed to be cared for. Yet, the individual could perform all of the activities of daily living. A recent neuropsychological report stated the person was capable of holding down a job with repetitious tasks. However, her sister was worried about her care on a long term basis and safety issues.

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I have been working with a lot of families who are not familiar with the differences between types of services that are provided at the independent living, assisted living, and nursing home care levels. The result is that they waste a lot of time touring communities that are inappropriate for their loved one. It is even worse when a loved one is placed in a community at the wrong level because it is cheap. I have seen instances where an admissions director often convinces an uneducated family that their loved one can survive at a level of care that is inadequate for their needs. Bear in mind, there are a lot of communities with low censuses and apartment/rooms that need to be filled. The bottom line is that if the senior cannot function at a level of care that is too low for them, s/he is the one who suffers!

A Real Life Story Continued From Chicago Senior Living Advisors Blog November 18, 2012

I had written a partial Real Life Story about this incident recently. Here is part two of the story. My client is an 86 year old woman. I am her Power of Attorney For Health Care. She has severe short term memory issues, is incapable of handling her finances and medications, and as of late needs standby help with her activities of daily living. Her former Power Of Attorney For Healthcare (who resigned from the position and resides out of state) placed her at the independent level because it was cheap. Independent living means the senior can function on their own, with some help with housekeeping and meal preparation. I was assigned to the position the day before she was supposed to move. She was already objecting to the move. It was too late and she really needed to be in an environment that had some semblance of supervision. In my opinion, she really needed to be in an assisted living community with a memory care unit. Memory care units provide structured activities, 24 hour supervision, and heavy cuing plus standby assistance with activities of daily living.

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