Articles Posted in Skilled Nursing Homes

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20171031_141154-2-300x225How in the world are busy professionals who also have growing children supposed to find the time to handle their aging parents’ issues – both health and living arrangements?

More and more of them are turning to experienced professionals who have experience in the field and can assist with everything finding the most cost effective and person-centered elder care, to interviewing potential home caregivers, to dealing with legal and financial specialists, to acting as a liaison to Medicare and long-term care insurance companies and even to paying bills.

Chicago Senior Living Advisors, based in Inverness, provides personalized Geriatric Care Management which is designed to assist family members or other unpaid people who are caring for an elderly or cognitively impaired loved one, according to Andrea Donovan, president.

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As I have mentioned in the past, the lines between the levels of care provided by long-term care communities have become very blurred. As the number of assisted living communities providing specialized memory care seems to increase every week, here are some of the things you need to look out for if you are contemplating moving a loved one to one of them:

Last month, I was hired by a family to advocate for their grandfather who had recently turned 100 years old. He was living in an assisted living community that specialized in memory care. Please note that the level of care offered was assisted living only and did not include a third higher level of care, i.e., skilled nursing. When he entered the community a year ago, he had been totally ambulatory and able to take care of all of his activities of daily living with cueing. Shortly after he entered, the community physician decided to take him off of all of his memory-related medications (without the consent of the family), because the doctor felt the medications were adversely affecting the patient’s kidneys. The grandfather went into withdrawal and ended up in a wheel chair needing total assistance with all activities of daily living.

In addition, the absence of using one of the dementia medications made the grandfather combative. The staff at the community claimed that he was at times in need of a three-person assist. Normally, a two-person assist and beyond indicates that person should be in a nursing home. The staff requested that the family look elsewhere for a new community for their grandfather. The staff also requested that the family hire a private caregiver to assist Grampa with his activities of daily living and prevent him from getting out of bed. The cost of his care in assisted living was $8,300 a month, just as much as a nursing home, plus the cost of a caregiver. Since the grandfather was already 100 years old, the grandchildren did not want to move him. Upon the request of the grandchildren, I was asked to attend the quarterly care plan meeting (attended by the Administrator and representatives of dietary maintenance, social work and nursing). Here is what happened:

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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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Many seniors have a tendency to keep private their financial realities. However, if your senior loved one purchased long-term care insurance to cover the costs of a stay in a community or to hire non-medical home care, you will want to ask if you can look at it. I say this based on the experience I had with my mother, and I share our story lest you should have the same experience.

My mother purchased a long-term care policy 25 years ago. I was amazed that the insurance carriers were able to underwrite her at age 70. Thankfully, she was well enough to pass the underwriting since she had no serious medical issues at the time. However, the agent who sold the policy to her (and who had bragged that she was the number one producer at her company) was not exactly prudent when designing the structure of the plan for a claim that could occur in the far future. The plan that was sold to my mother included a 90-day waiting period before any benefit would be paid. Such waiting periods are common. The plan maximum paid up to $100 per day. That, too, was all right for a plan that was purchased 25 years ago. However, the agent neglected to sell my mother her an inflation guard benefit which would increase her plan’s benefit by 3-4% per year. If an inflation guard benefit had been included, the benefit she would receive would be much more in line with the currents costs charged by her senior living community. The bottom line is, based on the plan purchased 25 years ago, my mother will receive a benefit that will cover $3,000 of her $6,000 monthly cost.

While I am thankful she had the policy, it would have been more valuable if the inflation coverage had been included at its inception. If you know or suspect your aging loved one has purchased a long-term care policy, ask if you can sneak a peek at it!

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Here are five easy steps to help convince your loved one who needs to move:

1. Enlist the child, sibling, or friend who is closest to the senior to initiate the conversation. The senior needs to hear the message from the right person.

2. ​Plant the seeds in very short, non-threatening messages. For example, “Gee, I noticed that you are having a little trouble getting yourself dressed. Don’t you think you would benefit from a little help?” Change the message at the right moment at the next attempt. “I noticed you have been eating a lot of cold cereal instead of a meal. Wouldn’t it be nice to have someone cook your meals for you?” Space out the messages and deliver them at the opportune times. It may take months for a senior to decide you are right.

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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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When you have completed the daunting task of choosing the right senior living community for your loved one, your next mission will be to prepare for his/her move. It is very likely that the senior will be moving to an apartment or room that will be much smaller than his/her current living arrangement. Decisions will need to be made as to which items the senior will discard, donate or keep. All of us tend to have difficulty parting with “keepsakes” to which we have emotional attachments; accordingly, it may be a wise decision to utilize the services of a professional organizer when your senior moves.

Sue Becker is a Certified Professional Organizer in Chronic Disorganization. She has worked side by side with my senior clients (including those with dementia) to help them with the highly emotional task of sorting through years’ worth of keepsakes and papers and deciding which items to keep.

Keepsakes: Turn Your Muddled Mess into Meaningful Memories

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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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The recent CBS investigative report regarding the cases of alleged neglect at a national assisted living chain held no surprises for me. I began my career in the elder care industry fifteen years ago when assisted living provided only “stand by,” assistance with activities of daily living (ADLS = bathing, dressing, toileting, transferring, walking, and eating). Several years ago, I made the observation that many of the assisted living communities were offering more “hands on” care to their residents. At the same time, I also observed that they were accepting residents who really belonged in intermediate nursing care or a skilled nursing community*. Being a former Admissions Director and with my current position as a senior living advisor, I thoroughly understand the current long term care 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.

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