Articles Posted in Non-Medical Home Care

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One of the facts that I stress to my clients is that skilled nursing is not one-to-one care. Other facts that a lot of my clients don’t take into account are how the costs of a 24 hour caregiver (which can start at $200 per day if they agency is licensed) are going to affect their loved ones’ long term financial picture. This usually occurs when the child is in a rush and s/he doesn’t have the time to research all of the options. Or, the child feels guilty about the stigma associated with placement in a long-term care community. Everyone’s circumstances are different. As a Certified Care Manager, I assist my clients with looking at all of the options, including staying at home. But, you have to keep the senior’s long term financial picture in mind. If a senior can afford to stay at home, that is the best place for him/her if their medical conditions don’t require the presence of a nurse and if the socialization with the caregiver is adequate. People hire me for my senior living advisor services once they have already hired the full-time caregiver and discover after a period of time that the loved one is running out of money.

Last November, a family hired me because their Mother had three, unlicensed caregivers who were taking care of her in shifts for the past ten years. The son told me she had easily spent over one million dollars on caregivers. When he and his siblings realized that she was going to run out of liquid cash in the next year, they hired me to find a nursing home for her.

When I arrived at her home, the place was spotless. My client was impeccably clean and every single hair on her head was in place. She was sitting in a cheerful kitchen where the caregiver had fed her breakfast. Although my client was a total assist with all activities of daily living including toileting, and had latter stage dementia, I saw her smile and try to respond to the caregiver’s kind tone of voice. It was obvious that my client had received excellent care. That observation was verified by her son, who informed me that he often stopped in on all three ladies unannounced.

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I am often confronted with some interesting family dynamics when a family hires me to consult with them. At times, the children are willing to accept my advice without reservation. Sometimes, there is often one child who wants to prove that s/he can “do this on her/his own.” While there is usually one child who emerges as the spokesperson for the family, the choice of the right care should be the result of a family consensus and not the persuasive skills of a ringleader. Consensus should be coupled with careful comparison of cost and methods of payment, level of care needed, staffing considerations, location, and quality of care involved with all the senior living options. Please read the following “Real Life Story,” that exemplifies my point

Real Life Story

One of my clients who did not follow my initial advice contacted me last week. She was unhappy with the care that her Mother was receiving at an assisted living community that specializes in memory support.

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For the first time in the seven years that I have been a senior living advisor, I actually told a prospective client not to move their loved one out of the current long term care community. About 50% of my clients come from the children of elderly loved ones who “did it themselves” the first time around. The result is often placement at the wrong level of care, or at a community that “looked nice,” but delivers poor care. This time, I actually discouraged my prospect from making a change.

The elderly loved one had been placed at a county facility and was paying privately. If I had done the initial placement, I probably wouldn’t have selected it as one of my top three choices. However, the community has a respectable reputation. The senior had begun rehabilitation in the short term rehab. unit. After the senior hit a plateau under Medicare, the decision was made to keep the individual in the long term care area.The family expressed concern over the fact that the staff was much smaller in the long term care area versus the staffing in the short term rehab. unit. Staffing is always better in the short term unit in opposition to the custodial care that the residents receive in the long term areas, a fact that the family was unaware of.

They also told me that they were disappointed that the staff appeared disinterested and was not “engaging with” their loved one. My answer was that most of the communities are understaffed. Nursing home care is not one-to one care, a fact that many of my prospects don’t understand until I explain it to them. On the average, a loved one could be sharing a certified nurse assistant with nine other residents, another fact they were unaware of. I explained if the expectation was to “engage” their loved one, they should hire a companion from one of the licensed home care agencies.

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As a senior living advisor and Certified Care Manager, I always conduct a face to face assessment of my client. This gives me an opportunity to evaluate him/her from a cognitive and functional standpoint. I observe the environment s/he is living in, talk with the family about the individual’s personal history, finances, and support system. That way, I can make an assessment of how I can improve the senior’s quality of life by recommending services that allow them to remain at home (That is, via the most economical and efficient services). Or, I can help them ascertain whether placement in a community would be more appropriate. In either case, I always include the senior in the care plan if they are able to participate. Just as I do my “in person” due diligence, you should do the same when researching senior living options. Here is what you should expect if you rely on the internet as a credible source of information:

1. I recently used Google to research the words “Chicago nursing homes.” I received over 44,000,000 returns. When you look at the websites for long term care communities, they rarely give you in depth information, and the prices are almost never listed.

2. Some of the websites will show the viewer the most newly decorated or beautiful areas of the property. They neglect to show the overall big picture. I have arrived at many of these organizations to find that the pictures on the site were no reflection of what the community was really like. Conversely, some of my clients have looked at the sites for the communities I have recommended to them. One my my clients reportedly logged on, and told me she was disappointed with how dingy and oppressive they looked. In truth, the facilities were beautiful and the pictures that were posted didn’t do them justice.

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This is a question that is asked of me and often causes controversy among the families that I serve. My goal is to find the best answer, and every situation is different. In the seven years that I have owned my senior living business, no two cases have been exactly alike. However, when a senior is still capable of making his/her own decisions, s/he almost always wants to remain in the home as long as possible. The only exceptions to the rule are if a senior is lonely and wants the socialization of being in a community, ot if medical issues no longer allow the senior to remain at home, or s/he can no longer afford the luxury of in-home care. Placement in a community is often the second choice to remaining in the home and normally arises when the senior is exhausting their funds. However, caution needs to be taken with this strategy, as many nursing homes are requiring a year or even two years of private pay before a person is admitted. This insures against the immediate filing of a Medicaid application, which can take up to a year for a resident’s reimbursement.

If you have a senior loved one who may need some help with his or her activities of daily living, I share below the ballpark figures for non-medical home care and long-term care community costs in the Cook, Will, Dupage, Lake. and Kane Counties in Illinois.

Non-Medical

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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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Many of my clients are surprised when they are told their senior loved one has “reached a plateau,” with his/her assessment for the appropriate level of care upon their release from the rehabilitation community is going to be key for your loved one’s long term plan of care. If your loved one requires two people to assist him/her with activities of daily living (bathing, dressing, eating, toileting, transferring, and walking) they are not suited for skilled nursing care. It is always in your loved one’s best interest to begin at a higher level of care and move them down (ie. from skilled nursing to assisted living) to a lower level of care.

2. While your loved one is partaking in their short-term rehabilitation, take a look at their long-term financial picture. Most of the nursing homes in the State of Illinois are requiring one to two years of private pay before allowing an application for Medicaid to be filed. It is taking the State of Illinois up to 14 months to reimburse the nursing homes for their public aid residents. That is the reason for the stringent qualifications. The temptation to place a loved one in assisted living in order to avoid the stigma of placement in a nursing home will be present. If your loved one needs the medical care, think with your brain and not your emotions.

3. When you are ready to begin tours of communities, remember there are advantages to making a confirmed appointment rather than taking a “walk in” tour. Then, you will have an opportunity to speak with the Admissions Director who is an expert on what the facility has to offer. Otherwise, you will be given a tour by whoever is available. This may result in a poor tour and cause you to discount a perfectly good community.

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There are approximately 44 million Americans who are caring for an elderly loved one. A recent article written by Terry Savage and published in the Chicago Sun Times cites that between one and two million people over the age of 65 have been abused by someone who cares for them. During the six years that I’ve owned my senior living advising business, I have never been witness to any suspected elder abuse until recently.

A respected colleague called me and said that a couple in their 80’s were in a very tenuous position, and asked if I would assess their situation with regard to recommending some senior living communities in the Du Page County area. When I called and spoke to one member of the couple, I was told that he and his wife weren’t interested in senior living communities, but would rather speak to someone who would help them integrate back into society via participation in activities at a senior center. He also expressed an interest in having a personal trainer come to the house and exercise with them. I told him I’d call back in several days with some contact information.

When I contacted him several days later with potential resources, his conversation with me headed in a drastically different direction. I felt that an onsite visit was in order, so I made an appointment with him.

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There are many seniors who prefer to stay in the comfort of their own homes rather than move to a retirement community. Non-medical home care agencies will send a private caregiver to your loved one’s home to assist with activities of daily living (bathing, dressing,walking, transferring, toileting, eating), light housekeeping, running errands, companionship, and meal preparation etc. The process of choosing a non-medical home care agency needs to be performed with due diligence.

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During the past several years, we’ve observed the number of these non-medical home care services have increased drastically in the Chicago metro area. We have assessed many of them. They are not all created equal. The owners’ backgrounds and levels of expertise vary. Some are licensed by the state of Illinois and operating as home care agencies. Others may not be licensed an operating as independent contractors. In the latter case, hiring the nice lady from across the street places you in an employer/employee relationship. You will have no recourse but to assume liability when the independent contractor makes an error.

At Andrea Donovan Senior Living Advisors, we have a systematic approach to assist you with hiring a non-medical home care agency. The process begins by selecting several candidate agencies with the appropriate credentials, longevity, and experience in the industry. Then, we guide you through the rigorous interviewing process by questions that may not have dawned on you to ask. The answers will ultimately determine which agency is a good fit for you and/or your loved one.

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My friends and prospective clients who have parents who aren’t ready for senior housing placement often ask me questions about non-clinically licensed home health caregivers. The question I’m most often asked is, “Why can’t I just hire the nice lady from across the street to take care of Mom/Dad? It is much cheaper.” While I have seen that strategy work successfully for a lot of people, I do not make that recommendation to anyone.

If you are considering home health care for a loved one, the providing agency should be a member of the National Private Duty Association (NPDA). Without going into a lot of detail, agencies that are members of the NPDA in Illinois hold a license. They profess allegiance to a code of ethics. An NPDA-agency, in contrast to an independent contractor or staffing agency, is responsible among other things, for the screening, training, and background checks of staff members. If you choose to hire “the nice lady up the street,” you will be assuming all the responsibilities of an employer and may have no recourse if something goes wrong. What may appear as savings in the short-term may have long-term repercussions, as exemplified in this month’s real life story.

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Real-Life Story

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