Articles Posted in Continuing Care Retirement Communities (CCRC)

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Couples who want to remain together but require different levels of care always present some very complicated challenges. One person may want to stay in the home, the other may not. A member of a couple may develop health challenges that may necessitate a move to a nursing home due to medical and financial reasons. I always show people the costs of both stay-at-home care and moving to a community. The problem with the latter is that many communities are not set up to accommodate different levels of care. A community’s capacity to handle multiple levels of care depends upon the way its apartments are licensed. Some communities are capable of handling residents who are on the independent level and who need assisted living (standby care and some hands on care with bathing, dressing, eating, toileting, transferring, and walking), often referred to as “swing apartments” because they are licensed to accommodate people at both levels. The situation becomes more complicated when one person needs nursing home care and the other remains at the independent or assisted level. Nursing home care requires yet another level of licensing which doesn’t allow couples to remain together unless their health issues require it. (For example, a person who is independent cannot occupy a nursing home room with his/her spouse unless s/he too needs the care). I recently worked with a couple who needd help sorting through these issues, as exemplified in the following real life story.

REAL LIFE STORY

My clients were the children of parents in the Chicago metro area who were in their early seventies (clients who were much younger than those I normally work with). Their parents were living in a lovely home with an urban setting. Their mother had been suffering from a disease that caused recurring seizures every few years. The latest bout with the disease caused her to be sent home with a full-time, non-medical caregiver who was costing them $350 per day. Their mother needed help with most of her activities of daily living, but could feed herself and walk with a walker. Their father, on the other hand, was independent. The caregiver was also preparing their meals, doing light housekeeping, and running errands. The children hired me because they lived in a suburb more than 20 miles away from their parents and were busy with their own families. They wanted their parents to move to the same suburb. In addition, they were uncomfortable with the existing home care arrangement because they felt there was no ongoing support system in case their mother became more ill. They were not comfortable with the “live in” situation and preferred to order a lesser number of hours if possible. The cost of maintaining the home plus the home care services was becoming prohibitive. The parents had been married for 50 years and wanted to remain together as long as possible. The dad was not social and wanted to “do his own thing.” During rehabilitation, the mom had enjoyed art therapy classes, such as water color painting, and music appreciation classes. I was instructed to find a community that would allow the couple to continue their current living situation, with a continuing care support system, in the kids’ suburb, with opportunities for socializing for their mom. I was able to come up with three options in their requested location.

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If you carefully scrutinize the activity schedule at a long term care community and correlate it to the seniors needs, his/her independence could be enhanced.

I was the Admissions Director of a Continuing Care Retirement Community located in Cook County near the Chicago metropolitan area. Many of the children who came to tour the home told me they were concerned that their loved one would lose their independence if they moved to a retirement community. It used to amuse me that after expressing this concern, the children would spend so little time studying the activity schedule. Instead they would remark, “Oh this is great! They have bingo, baggo, and bunco!” I used to refer to it as the “three Bs!” While it is important to many seniors to have bingo available, you will have to be more thorough when assisting them with finding the right retirement community if you aim to preserve their independence. Studying the activity schedule to ensure that a community is providing serious mental stimulation for seniors is a task that shouldn’t be taken lightly. As a senior living advisor who has evaluated hundreds of long term care communities in the Chicago area, I can share some activity tips with you.

I have seen many of the retirement communities offer brain fitness programs in order to keep their residents mentally fit. Some of the homes will allow your loved one to participate in their brain fitness programs as a non-resident of the community. I enrolled in one of the classes at a local retirement community because I was curious to see what the programs had to offer. They were offering the brain training program created by Posit Science, that can help anyone exercise their memory and enhance the ability to focus. Although the program is computer based, the senior doesn’t have to be computer literate. They only need to operate a mouse. There were many independent seniors who were taking the course to enhance their driving skills. One of the programs simulated a fictitious car ride where dangers such as a child chasing a bill into the street popped up on the screen. The program requires the driver to react quickly in order to avoid having an accident.

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As a senior living advisor, I recommend that my clients who are at the independent living or assisted living level take a trial stay at a long-term care community before they make a commitment to move in. This will allow a senior to sample the food, try the activities, socialize with potential fellow residents, and decide if they like congregate living.

Sometimes the communities will not allow a trial stay. At other times, it may be required that the senior stays for at least 30 days. Personally, I am in favor of the 30 day requirement, because a stay of two days or a week isn’t going to give the senior the ,”big picture,” of retirement community life.

A short stay or “respite” at a senior living community is normally treated like a regular admission. The senior may have to submit a medical history and physical form from their primary care doctor, along with the results of a TB test that is negative. This information ensures that a community can meet the resident’s medical needs. I recommend that my clients request the medical information several weeks prior to the anticipated admission. Collecting the information from a physician’s office can be extremely slow and often delays the admission process. Many physician’s will not complete the forms unless they have seen the patient recently. The homes also will not accept medical information that is too old.

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My client is one of a large number of siblings who were searching for a high end continuing care retirement community for their mother. Mom was in her early seventies, living independently, and driving. She owned a second home where she lived during the winter months. She could afford an entrance fee in the range of $800,000, and a monthly fee of $5,000 per month. The requirement expressed to me was at least 2 bedrooms, multiple dining venues with one being alfresco, room to entertain her friends, and a busy suburban setting. She needed to be able to reach one of the expressways and have access to the downtown Chicago area.

Her children had already chosen two places that they wanted her to seriously consider. My job was to identify a third option and compare their selections. I identified a third community that fit their requirements (one that would have been my selection for their mother). After dealing with my client, I found that the family was already leaning heavily towards one of the previously identified options. It was a newer community that fit all of their criteria, including every bell and whistle available to its independent residents (pool, masseuse, bar, postal service, concierge, health club). Those initial impressions had the family enamored. However, the community was not the real deal with regard to the advanced stages of care. Frankly, I felt the siblings’ decision had been made before I even began my work.

The daughter had made some comparisons of what the two places had to offer from an independent living standpoint. But, she failed to compare the communities from the viewpoint of location and layout, a compassionate staff, and what would happen if her mother needed more care down the road. Although I had been in all three of the communities, I set up appointments to “secret” shop them in order to fine tune my recommendations. I found that the family’s favorite community had some serious flaws behind its mask of sophistication. Here are some, just to name a few:

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I recently had a very interesting conversation with an Admissions Director of a well-respected Chicago skilled nursing home. We made the observation that due to the poor economy, many Chicago assisted living homes* are accepting residents whose medical needs cannot be met. In other words, the resident belongs in a skilled nursing home.** Being a former Admissions Director and with my current position as a Chicago Senior Living Advisor, I thoroughly understand the current market conditions.

The Admissions Director is the most important contact at a long-term care community. He or she is responsible for attracting and residents, while maintaining a high census. Many Admissions Directors also act as marketing liaisons. They provide your first impression of a long-term care community, and often are a direct reflection of the care your loved one is going to receive. They are also responsible for the initial assessment of the type of care that is appropriate for the senior. It is important to bear in mind that Admissions Directors are often commissioned salespeople. They are accountable to, “the powers that be,” for maintaining a high census. I can remember the terrible pressure that was exerted upon me by the management in order to keep filled the continuing care retirement community where I was working. Scarcely was a bed emptied before pressure came to fill it. The passing consolation that the seniors, “were called home by God,” just didn’t cut it in terms of lightening the pressure for quick turnarounds. I know that with a bad economy, the pressure is even worse.

My point is this. Don’t let someone “sweet talk” you into thinking they can take care

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As a former Admissions Director of a continuing care retirement community (CCRC),* it was my responsibility (along with the community nurse) to assess prospective residents for placement in the appropriate level of care. During many consultations with my clients, I’ve found that people often don’t understand the different definitions of the levels of care that are offered by long-term care communities. Here are some very basic, broad definitions:

Independent living – The senior can perform all of the activities of daily living** on his or her own. S/he may want/need some assistance with meal preparation and housekeeping.

Assisted living – The senior needs help with some of the activities of daily living. It isn’t “hands on” care. It is normally stand by assistance. For example, a senior may need some assistance with a bath or a shower. However, the aide will hand the senior the wash cloth and soap and perhaps help wash any part of the body the senior cannot reach. It isn’t a full scrub down shower like those provided in the nursing homes. However, I will place a caveat on this definition. There are some assisted living communities that are based on a medical model where more “hands on” help is offered; e.g., the person needs total assistance getting in and out of bed. The presence of a nurse and his/her functions will vary according to each assisted living community.

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I’m pleased to introduce my monthly newsletter, “Senior Living Moments–Words to the Wise.” My clients, contacts and associates have suggested that I provide tips on how to demystify what can be a daunting task: dealing with the issues of an elderly relative or friend.

“Boomer Bind”

More than 44 million Americans help to care for or support an elderly loved one, and many of these caregivers are employed. Not everyone is easily able to cope with what I call the “Boomer Bind,” juggling a job, personal life, and caring for an elderly person. It’s never easy when the children live far away; there aren’t enough siblings to share in these responsibilities, or there is no firm caregiving plan in place.

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