Articles Posted in Real Life Story

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This month, I am celebrating the 11-year anniversary of the opening of Andrea Donovan Senior Living Advisors. I am hoping that I have at least another 11 years of rewarding work ahead of me. I have to chuckle because I have had so many unusual requests over the past decade, not to mention finding that special apartment for the senior who has the 90 pound Labrador that must continue to attend its current doggie day care, requests for caregivers who speak a special dialect of Indian or Farsi, accommodations for religious preferences, transportation to senior symphony practice for a senior cellist, and finding a nursing home that would allow my senior loved one with dementia to store and play her piano in her room. I figure that I have evaluated more than 450 senior communities in the Chicago metro area over the past decade and completed over 6,000 hours of research. I know that sounds like an insanely large number of hours, but how else would I be able to get the answers for my clients? Admittedly, in some cases there may only be one right answer, as I share in this month’s REAL LIFE STORY.

Real-Life Story

My clients were the child (and her husband) of a 94 year old gentleman. He had been a white collar professional, an avid musician (stringed instruments) and recently lost his spouse. He underwent some very serious cancer surgery several years ago and had recovered very well. He and his late wife had been living in a luxury condo owned by the child. Since it was located in the middle of the downtown area, it allowed them easy access to their doctors, the symphony, and shows they deeply loved. After the death of his wife, he remained in the condo with several caregivers who came in at 2 different intervals during the day. He remained in the condo alone in the evening. However, the child told me he had recently been hospitalized with pneumonia, wasn’t drinking enough fluids or eating 3 meals a day, and had fallen. The child no longer wanted him to live in the condo alone. I was also told that the senior was “putting on a good act,” and that his need for more help was being well hidden. I was told that I would need to duplicate his environment in order for a move to occur. The environment could not have an “assisted living or nursing home feel.”

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This week, I was overjoyed when a former client called me to tell me about her mother’s progress. Her mother was a young 70 when they became my clients less than a year ago. When I first met the elder during an assessment, she was at a short-term rehabilitation community and was covered under Medicare. She had been living in an independent living community with a 24-hour caregiver. A stroke had left her unable to use her left side. Then, the caregiver dropped her while she was transferring her in the bathroom and broke my client’s leg. That is how she ended up in a nursing home receiving short-term rehabilitation.

My client’s 100-day allotment under Medicare rehab was coming to an end, and she soon would have to begin paying privately. Although the care was satisfactory at the current community, she wanted a private room. This nursing home didn’t offer any private rooms. She did have the personal funds to pay privately for quite a while, even though the rate for a private room was over $300 per day. I knew, however, that since she was a young 70, and the cost of nursing home can run $9,000 and above for a private room, she would need the safety net of Medicaid if her money ran out. Because the stroke and the broken leg had left her totally disabled, she had to be transferred in and out of bed, bathroom and shower with the use of a Hoyer lift. I sent the senior’s adult children to tour a half dozen selected communities with the needed equipment, but nothing seemed to pass muster in their eyes. Either the rate for a private room was way too high, they didn’t like the Admissions Director, or the aesthetics were not what they wanted. They were being very specific about their location preference. Finally, I identified a community that was half-way in between for both daughters and had several Hoyer lifts available for the residents’ use. I was also very selective about the physical therapy that would be available to my senior client, as the daughters stated that she may want to pay privately for additional therapy. The therapists at the community were actually employees of the nursing home, not a separate agency. As a result, I knew she would have a better chance at receiving therapy from the same therapists.

When I recently spoke to the daughter, she said, “I have been meaning to call you. My mother has been moved from the nursing home (needing full assistance with bathing, transferring, toileting, dressing, walking and eating) to the assisted living area (some hands-on assistance with the aforementioned activities) of the nursing home. She can transfer in and out of bed and bathroom without the assistance of the Hoyer lift. The cost of her care was also reduced! And it is all because the therapists at this community worked so closely with her to improve her condition. Thank you!”

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When I started serving in the senior living industry over 15 years ago, all communities included three meals in the rent. Three meals were just part of the senior’s care package, whether the level of care be independent living, assisted living, or skilled nursing home.

While that still holds true today for assisted living or nursing home care, the meals/food picture has changed in the independent living landscape. Most independent living communities are offering one main meal per day, with the choice of paying for 2 extra meals on an ala carte basis. Other independent living organizations are offering “flex dollar” arrangements, where the senior is given a fixed dollar stipend on a monthly basis. The flex dollars can be used to purchase meals, haircuts in the salon, or other amenities the community has to offer.

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I want to share a story that may prove helpful to you my readers one day. I serve as the Power of Attorney for Health Care for one of my clients who has severe issues with her memory. She was recently transferred from the assisted living memory care unit of her current community to the skilled nursing section due to failing health. When I went to the nursing home to complete her admission papers, the social worker informed me that there was no completed DNR/POLST form in my client’s file, and I needed to complete one.

In order to accurately describe the form, I am quoting a description from POLST.ORG which reads, “The POLST Paradigm was developed to improve the quality of patient care and reduce medical errors by creating a system that identifies patients’ wishes regarding medical treatment and communicates and respects them by creating portable medical orders. While the POLST Paradigm supports the completion of advance directives, clinical experience and research demonstrate that these advance directives are not sufficient alone to assure that those who suffer from serious illnesses or frailty will have their preferences for treatment honored unless a POLST Form is also completed.”

Although I serve as Power of Attorney for several of my clients, most of them are not nearing the end of life at this point. When I looked at the form (http:www.idph.state.il.us/public/books/dnrform.pdf), and admittedly I had seen it before, I was a little overwhelmed. Seeing the form is one thing. Comprehending the reality associated with it is another. I told the social worker that my client’s POA for Health Care clearly stated that she did not want her life prolonged if the “burdens of treatment outweigh the benefits.” I was informed that without the completion of the POLST form, she would be a “CODE 3,” meaning that she would be resuscitated even if the POA form stated otherwise. Hence, the POA form was not sufficient in the absence of a POLST form on file.

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Assisted living communities that have a memory care unit are supposed to be adequately staffed with assistants and aides who are educated to deal with the behaviors of dementia residents. The habits of these residents can often be repetitive and endanger the resident if they are not closely watched. Many residents “sundown” in the evening, meaning they may often become more confused and agitated at this time. In my opinion, the caregiver ratio in these sorts of units at night should be no less than 1 aide to 8 residents, when residents with dementia, whether ambulatory or not, can become very agitated and even combative. The “powers that be” at some senior living communities will dispute my ratio, contending that they only need to staff according to long-term care regulations. This month’s real life story will outline the consequences of understaffing.

Real-Life Story

I was recently hired by a client who was forced to place her memory-impaired relative in an assisted living community’s memory unit. The relative had been living in another retirement community that was not equipped to care for residents with memory issues. When the staff at the original community witnessed the relative dragging a bag of laundry up the hallway in the wee hours of the morning, the staff arranged to have her taken to the local hospital’s behavioral unit for evaluation. Apparently, this had not been the first incident of questionable behavior. When the evaluation of the relative was complete, my client was informed that the retirement community could not handle the relative’s behaviors. Therefore, my client had to place the relative in an assisted living community that had a bed available in its specialized memory unit.

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One of my current clients is a former medical professional who has decided to donate her body to science upon her death. She therefore enrolled as a member of a local anatomical gift association. As her Power of Attorney for Health Care, I was assigned the task of pre-arranging for the disposition of her body. My client’s enrollment card stated that arrangements needed to be made in advance with a funeral director to transport the body to the location of the anatomical gift association when the time comes.

Upon making a telephone call to a local funeral home to get a price for transportation of the body, I was shocked to be quoted a price for more than $1,600, along with a $350 cremation fee. Since the quote sounded high, I called the anatomical gift association to be certain that I understood all of the stipulations. When I had a discussion with the association’s representative, I was informed that every funeral home has the right to charge differently for its services. I was also informed that if the anatomical association accepts the body, then cremation of the remains is free. If the body is not accepted, i.e., is diseased or in unacceptable condition, the association would charge $370 for the cremation of the remains. The association’s representative gave me the name of two other funeral homes and recommended that I get quotes from them.

When I called the second funeral home, I was informed that the cost to transport the remains would be $1,150, with a $350 cremation fee. Although the price was better, the funeral director’s demeanor was so unfeeling that I wrote him off immediately. The second funeral director quoted me a fee of $850, and there was no cremation fee whether the anatomical society accepted the body or not. The deal sounded a little too good, so it made me wary. Last, I contacted the funeral director who handled by late husband’s services, because he was a very easy going man who made my life easier during a very difficult time. His price was $650, plus a $350 fee for cremation if the body was rejected. While his transportation quote was even lower than $850, I knew that I need not be wary based on my firsthand knowldege of his services and demeanor.

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There is always danger involved with the choice of hiring a non-licensed caregiver. This time, a disaster occurred right in my own backyard. The choice to hire a private caregiver directly instead of through an agency may have cost a North Riverside man his independence. Charlie Matuska, who is 79 years old, followed the advice of a neighbor (and friend) and hired David Kowalsky as a private caregiver.

Mr. Kowalky had cared for Mr. Matuska once before, prior to some hip surgery. At that time, Mr. Kowalsky had been employed by the Visiting Angels, a non-medical home care agency in Brookfield, Illinois. (Non-medical homecare agencies, like Visiting Angels, hold a license with the State of Illinois. Licensed agencies are responsible for the employer-employee relationships with their caregivers, conduct backround checks, adhere to a code of ethics, and participate in ongoing training). When it became apparent that Mr. Matuska needed to have a caregiver help him on a full-time basis, the friend assisted him with hiring Mr. Kowalsky on a full-time basis, but not through Visiting Angels.

Please note that this sort of hiring takes place all the time. If a caregiver starts out caring for a client through an agency, the client often hires them directly at a cost that is significantly lower. For instance, it was reported in the Landmark Newspaper, that Mr. Kowalsky was being paid $700.00 a week to care for Mr. Matuska. As a Certified Care Manager, I know the price of a 24-hour caregiver can cost $220-$240 a day in the western suburbs of Chicago. And by hiring a caregiver directly, a client will also forgo the supervision of agency management ie., the unannounced check-ins that are performed by a person of supervisory capacity to see the client is being cared for appropriately.

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In my opinion, Medicare Advantage plans were never a smart purchase. That’s because many people don’t understand they are not a Medicare product. They are programs that are underwritten by private insurers. The claims are adjudicated by the private insurer as well. Upon purchasing a “Medicare Advantage” plan, the insured waives the right to have his or her claims paid by Medicare. Yes, the private insurers do have to follow all of the rules of Medicare. But, the private insurers can offer different plan designs, including different deductibles and out of pocket limits that are the insured’s responsibility.

I worked in the health insurance business as both a broker and company representative selling group health insurance to medium and large size corporations. I remember the company underwriters would cringe when they saw a group submission that contained more than 20% retirees on the census. Elderly people tend to be sicker and submit more claims than younger folks, so a large proportion of retirees on a census sent out signals that the case wouldn’t be profitable. So what was the solution? Many companies removed the seniors from the group plan and purchased Medicare supplements for them and their spouses. I saw many major corporations buy Medicare Advantage plans for the retirees due to the cost savings offered by the plans at that time. Today, so many companies have discontinued covering retirees that any coverage is a gift.

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As the former Admissions Director of a retirement community that offered independent living, assisted living, and intermediate nursing care, I often had to convince the senior that it was time for him/her to move. Some of the seniors (and their children) knew that it was time to move. Other seniors were extremely resistive. One circumstance stands out in my mind that may offer you some tips on how to convince the senior to move. As a senior living advisor and Certified Care Manager, I find my past experiences to be invaluable to share with my clients.

Real Life Story
My prospect for the retirement community was a seventy-eight year old senior who I will call Mary. Mary was living alone in her own home. She had Parkinson’s disease but could perform all of her activities of daily living on her own. She was the perfect candidate for independent living! The house was located in a changing neighborhood. Her daughter, Lynn, brought her to the home for a tour because Mary’s home had been burglarized. Mary was mugged during the burglary.

During the entire tour and interview, Mary cried piteously and kept repeating that she didn’t want to leave her home. The daughter and I kept insisting that Mary’s safety was at risk. Lynn was also the only relative in the Chicago metropolitan area, and lived in a suburb that was over 25 miles from where Mary lived. I also stressed during the interview that Mary’s Parkinson’s disease would become worse at some point in time. The community would offer additional assistance as well as being closer to Lynn.

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I was sad to read that the search for victims who perished in a Quebec retirement community fire had ended. At least twenty eight seniors were killed when the wood-framed building caught fire and was destroyed in less than an hour.

In the fifteen years that I have been involved in the elder care industry, I have never been asked how a senior would be evacuated from a building during a fire or other disaster. In light of current tragedy in Quebec, it is a question that should be addressed when assessing senior living communities.

Before I opened Andrea Donovan Senior Living Advisors, I was the Admissions Director of a retirement community that offered Intermediate nursing care (as well as independent living and assisted living) to its residents as part of the continuum of care. We were bound to act according to the Illinois Administrative Code for Skilled Nursing and Intermediate Care Facilities, Section 300.670 on Disaster Preparedness. This meant the staff had to adhere to extremely rigorous guidelines in case of a “disaster.” A disaster meant, “an occurrence as a result of natural force or mechanical failure such as water, wind or fire, or a lack of essential resources such as electric power, that poses a threat to the safety and welfare of residents, personnel, and others present in the facility.” The requirements were as follows:

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