COVID-19 Update: How We Are Serving and Protecting Our Clients

Articles Posted in Skilled Nursing Homes

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I have repeatedly been asked in recent weeks whether a move to a senior living community at this time is “safe.” My answer? No, it is not as safe as we would hope, given the prevalence and the uncertainties of the coronavirus, CoVID10. While reported nursing home deaths related to CoVID19 may be at times inflated or otherwise erroneous, we do know that at least 20,000 and possibly more than 40,000 senior Americans have died in nursing homes during the pandemic, as the sudden onslaught of CoVID19 left many providers and public leaders ill-prepared. Certainly, most senior living facilities are doing their very best to ensure the safety and health of their residents and staff, and are working diligently to follow official public health guidelines for disease prevention. At this time, however, heightened concerns about CoVID safety call for careful evaluation of each and every senior housing option, as some placements must continue out of sheer necessity.

While long-term care facilities are following standard public health guidelines to protect residents as much as possible from CoVID and other ailments, at this time each long-term care community is conducting new admissions a bit differently. Here are some varied examples I have encountered thus far:

1. My client is only 60 years old and has some very serious health issues that render her bedridden. I was hired to find short-term rehabilitation that could also keep her for long-term placement after a stay in a specialty hospital. This objective was a terrible challenge because of her age and her funds being rather limited. Many of the communities rejected her, I suspect because they held the perception that a Medicaid claim would be looming from this client within a short period of time as her limited funds dwindled. The rate of reimbursement for a Medicaid recipient is significantly lower than what a community would receive if a person were paying privately.

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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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I was pleased to have been asked by ABC Channel 7 journalist John Garcia to provide professional comment on the Corona Virus outbreak in Illinois nursing homes. The link to the news segment appears below.

https://abc7chicago.com/coronavirus-deaths-fatalities-nursing-homes-illinous/6113728/

As I explained to this interested ABC reporter and Chicago area viewers, the current CoVID19 “Shutdown” is a heartbreaking situation because the CDC guidelines do not allow nursing home residents to have any visitors. The only individuals allowed in the buildings are those deemed as “essential employees,” i.e., personnel who are involved with end of life care or legal decisions.

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I recently helped a client move to a supportive living community, which is assisted living supported by Medicaid. The term Medicaid refers to the Federal and state programs that fund long-term care for people who cannot afford to pay privately. Supportive living provides the senior with standby assistance for activities of daily living, meaning bathing, dressing, toileting, transferring, walking, and eating. The senior lives in his or her own apartment and enjoys oversight provided by a nurse, three meals a day, and options for activities.

The following is a checklist of items needed for application and approval for long-term care covered by Medicaid, whether it be for supportive living or a nursing home:

Red, white and blue Medicare card

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A lively discussion about gun control with friends and siblings brought back a memory about an instance a case where an adult with dementia and other psychiatric issues endangered the life of his spouse of over more than 50 years.

My client hired me because her husband had been hospitalized at one of the local geriatric-psychiatric units. He had a habit of wandering away from the house unbeknownst to his wife, only to be re-directed home by one of their neighbors. He abused his wife verbally and threatened her.

My client’s husband had been a gardener and a gentle man who enjoyed engaging in outdoor activities. This included chopping firewood in the backyard. During one of his tirades at home, he chose to go into the garage, find his wood chopping axe, and threatened to kill his wife with it. Fortunately, his children intervened and at that point he was taken to the psychiatric facility for observation.

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After I have completed the task of finding the perfect senior living option for a senior loved one, many of my clients are faced with selling the senior’s property. I have asked my colleague, Senior Real Estate Specialist (SRES) Roz Byrne, to offer advice on that subject:

It’s an age-old question, and as we age it gets even trickier to determine how much work or money we should put into our homes.

When it’s time to sell the family home, seniors’ homes tend to present themselves in one of three ways:

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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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At the request of the Illinois Chapter of the Huntington’s Disease Society of America, I was recently asked to give a presentation at their annual meeting on, “How to choose a nursing home”. Had I been asked to speak about how to find a nursing home for a person with Huntington’s disease, the task would have been much more challenging.

For those of you who are not familiar with the disease, here are some very general characteristics of the disease:

1. It is a neurodegenerative disease that causes deterioration of the brain cells. It can strike as early as the age of 30 and progress for several decades. It can also strike children and the elderly. The disease is hereditary. Its victims exhibit inappropriate behaviors that can sometime be violent.

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Real-Life Story

I recently had a preliminary meeting with the adult son of an 82 year old senior who was diagnosed with dementia. The senior had been living with him for a number of years and was having issues with wandering, falling, and incontinence. In order to alleviate the stress of having the senior in the adult child’s home, a part-time caregiver was hired during the day to meet the senior’s care needs. During our meeting, my client did not want me to meet the senior in order to avoid unnecessary agitation. His mother was not born in this country and spoke a limited amount of English. After learning some facts about the senior’s behavior and financial realities, I informed my client that the senior was a candidate for assisted living with memory care. But, the catch was she needed to be in a Continuing Care Retirement Community that would keep her once her funds were exhausted. Or, she could move to an assisted living that offered memory care. Then, she could be moved to a nursing home that accepted Medicaid when she still had enough funds to move to a decent community.

Right after Christmas, my client called me and said his mother had fallen. The rehabilitation community where she was receiving therapy had set a release date for the following week. My client asked me to come and assess the senior and make suggestions for a long-term care community.

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Real-Life Story

My client was 102 years old and had lived in the same independent living community for more than 12 years. She had moved there with her husband when the community was a homey retirement home. After her husband’s death, she remained there with 2 part-time caregivers who provided total assistance with bathing, dressing, escorts to the dining room via wheelchair, and transporting her on errands. She was alert.

When I went to assess the client, I was greeted by 5 family members who were gathered in her lovely 2 bedroom apartment. As they explained to me, the community had been purchased by another organization that was turning it into a glamorous, high-priced, marble-clad independent living community. As I was listening to them, I noticed a baby grand piano occupying the corner of the room. And at one point during the conversation, the caregiver assisted my client with being seated at the piano. She delighted me by playing a wonder rendition of George M. Cohan’s work, “Give my regards to Broadway.” She could still play despite needing help with other activities of daily living!

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