Articles Posted in Non-Medical Home Care

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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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If you are thinking of hiring licensed non-medical home care for your loved one, you should be aware of some changes that have arisen due to the pandemic. My Real-life Story will outline what they are.

Real-life Story

My client is an 84 year-old man. He is still an avid skier, and flies a glider plane. His wife who is only 72 years old is well in the latter stages of Alzheimer’s disease. Although she is ambulatory, she cannot bathe or dress herself. Previously, she had prepared all of the couple’s meals. Since my client doesn’t cook, meal time was a huge challenge. He told me that getting his wife dressed and fed in the morning and putting her in bed at night were the hardest parts of the day for him. Yet, he admitted that he wasn’t ready to place her in a nursing home. But, he also told me that her condition prevented him from getting out to ski or fly his plane. It was taking a toll on him and he was increasingly conflicted and in need of both a listening ear and informed, professional advice.

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The CoVID19 crisis has brought home crucial lessons for all of us who care about older loved ones and America’s senior citizens. Often, a senior has to be placed in a nursing home because of his or her medical conditions or financial circumstances. By their very nature as communal facilities that house older and infirm individuals, nursing homes are natural “hot spots” for both seasonal influenza and Coronavirus. Residents may contract Coronavirus due to their proximity to other residents who have it, or exposure to a staff member required to give hands-on care, or from some other disease vehicle. In this pandemic both public policy and a lack of emergency planning by nursing homes share blame for the high incidence of infection and death.

For example, some state governors (including, ironically, some who refer to seniors as “our most vulnerable population”) ordered nursing homes to readmit residents who had been in the hospital. In New York, this included seniors still ill with CoVID19! Ordering a resident to be readmitted to a nursing home often sets them up for failure because many homes are poorly staffed to begin with. Most of the time, the ratio of certified nurse assistants to residents is 1:12 or higher. This means that one nurse aide is responsible for caring for a dozen or more residents.

Some nursing homes have sequestered residents with CoVID symptoms to specific areas and required them to quarantine in a private room for seven to 14 days, which is extremely difficult for seniors deprived of human contact. Elsewhere, such sequestration is a safety measure that many homes cannot provide due to bed availability and spacing issues.

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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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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.

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The worst part of my business is that I sometimes have to say “Good-bye” to my favorite clients. In the past several weeks, I have had two favorite clients pass away, and one move out of state to be closer to her son. Today, I am going to share a story about one of my clients, whom I am going to call “M.”

“M” was in his early 70’s. He was a former states attorney, who was hired personally by the late Mayor Richard J. Daley. M was extremely eccentric and opinionated, and some of the things he said made me laugh so hard that I cried. He had opinions of politicians no matter which party they belonged to. He had been educated by Jesuits from high school through law school and hated everything that happened in the Catholic Church after Vatican II. He had never married, lived with his recently deceased mother, and cherished an overweight, 6 year old Dachshund that was not housebroken. (Therefore, the dog did its business anywhere in the house). He told me that if anything were to happen to him, the dog was to be taken to a woman who ran an animal shelter in her home up the street. He didn’t put this in writing. His estate was left to a charity. He had named a trust company as his Power of Attorney for Property. I was referred to this gentleman because he had very bad experiences with a non-medical home care agency. After a stroke in spring 2017, he amassed a bill for more than $200,000 in charges for 24-hour care provided by the agency. After reviewing the bill, I found some of the charges to be extremely excessive. I was hired in January of 2018 to help find a new home care agency for him and pay his bills. After bringing in 2 agencies for him to interview, he confided that he had hired some caregivers privately at a much lower rate.

As I put together M’s big financial picture, I found that his money was at a bank in a number of CDs valued over $500,000. He had checking accounts in two banks, an IRA, a pension, and a vacation property in Wisconsin. He had a habit of running down his checking accounts to the last penny, even though he had plenty of money. When I suggested that a financial advisor should be called to “pull everything together and maximize earning potential,” M replied, “No, because they will make me sell the property in Wisconsin.” Please note that M was not in any physical condition to be using a vacation home. Nevertheless, I backed off. However, when I would give him advice, he would acknowledge me with a traditional, “Yeah, I know.” As time went on, M trusted me more and more. Eventually, he asked me to attend his doctor appointments with him and become his advocate. He had signed a Power of Attorney for Health Care with another entity in 2017 that never had any contact with him, or knew anything about him. I was named, however, as Power of Attorney for Property at only one of the banks where his CDs were placed and came due. I would then cash them in. In other words, I was effectively the only person who knew what was going on in his life. Did he have relatives? Yes, but he wanted nothing to do with them!

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My client is a 72 year old, Eastern European woman who had been living in an apartment. She ambulated with a walker. She is diabetic, suffers from anxiety, and has difficulty with her vision. She had contracted an infection in her back due to a fall and had refused to go to the hospital for treatment. She had a part-time unlicensed caregiver who assisted her with errands, bathing, and meal preparation. The caregiver came to help out for several hours a day during the week, but my client was alone at night and on the weekends. I was hired initially to assist my client with making her cremation arrangements, review her paperwork and pay bills, and assess the need for senior living options. Although my client and I have a fairly strong bond, I sensed that the bond between her and the caregiver was much stronger, as they were both from the same country of origin.

After working with my client for a month or so, I told her that I didn’t feel that her apartment was safe for her to be alone. She even confessed to me that the shower didn’t work properly, and the caregiver was filling a bucket and dumping the water over her head in the bathtub in order to bathe her. I suggested calling the landlord.

As time went on, my client named me as her Power of Attorney for Health Care and Property. Her financial advisor, attorney and I had repeated conversations with her (together and apart) regarding the need for her to move. As the saying goes, the conversations fell on deaf ears.

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The child of an elderly loved one will undoubtedly face terrible stress when trying to care for him/her.  My respected colleague, Kurt Hjelle, owner of Safe At Home Health Care, a non-medical home care agency specializing in live in caregivers,  does a wonderful job of describing the realities of caring for an elderly loved one:

Every single week, I am contacted by a family member — typically the son or daughter of a senior citizen — who is looking for help.

Their parent (or parents) are starting to have some struggles, and it’s taking its toll on the entire family.

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A client who heard me speak a number of years ago decided to hire me for an interesting project. He and his wife live in a large beautiful older home (estimated over 5,000 square feet with three floors). The couple was wondering what the potential future costs of staying in the home would be if one or both of them became ill. I generated a report for them based upon three case examples. Although I didn’t know what the current costs of maintaining their home are, I included places in the report to “fill in the blanks.” I gave the couple some general ideas of what they might need to consider in the future. Many of the future costs would vary by the dimensions of their home and the models of safety equipment chosen (e.g., stair lifts, as they had three floors). The report was meant only to give them ideas of what the costs might be, and what they might need to think about for future safety. I ended the report with a ball park comparison of what it might cost to move to one of the higher end senior living communities. Here are the results:

Case Examples

Client M had been healthy until recently when s/he was diagnosed with a serious heart condition. The client was ambulatory, but now needs a walker. Because the disease has left the client very weak, s/he needs help with meal preparation, bathing, dressing, and standby assistance with toileting. In addition, the caregiver must run errands, provide medication reminders, do laundry, and light housekeeping. All of the necessary help can be obtained through a private caregiver from a licensed non-medical home care agency. The current cost for care of the individual would be $22 per hour. The non-medical home care agency estimated that the client would need at least 8 hours of care per day, 7 days a week so as not to exhaust the spouse. Therefore, the cost of the care would be $176 per day, and $1,232 per week. The total annual cost for the caregivers would be $64,064. In addition, the bedroom was on the second floor, so the stairs would need to be modified in order to accommodate a lift, the cost of which would start at $1,600. The bathroom needed to be outfitted with grab bars, and the shower needed to be modified to a walk-in model, with the addition of a raised toilet seat. A ramp needed to be fitted to the back door, with access to the driveway. Additional support had to be hired to keep the ramp and other areas free from snow and ice. The house needed to be canvassed for tripping hazards and slippery floors.

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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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