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I recall having a conversation 5 or more years ago with a colleague who was an Admissions director of a highend assisted living community.   It was around the time when I observed assisted living communities were going beyond providing “stand-by” assistance with activities of daily living (ADLs = bathing, dressing, toileting, transferring, walking and eating) and providing “hands on” care to residents in need.  Hands on care typically had been handled at the intermediate nursing care level, when a resident needed 24-hour supervision and “hands on” care with ADLs.  My colleague looked across the desk at me and said, “Andrea, the days of skilled nursing as you and I know it are dead.”  I remember that my immediate, gut reaction was, “You are crazy. Nursing homes will never disappear.”

A recent article published in Crain’s Chicago Business (August 21, 2017), titled “Out with nursing homes, in with home health care,” showcased the fact that Northwestern-owned Lake Forest Hospital, located in the affluent suburb of Lake Forest, Illinois, has plans to replace its hospital but will not include plans for building a new long-term care unit.  The reasons cited were that the “Northwestern Medicine may have found the one market where investment in longterm care has not paid off.” A spokesperson from Northwestern’s partner law firm said that “Only the sickest patients end up in nursing homes.  People 65 and up tend to find home health care and assisted living more comfortable.”

Given such trends, nursing homes may start to diminish in a community as wealthy as Lake Forest.  But nursing homes will probably always exist in one form or another.  I have to admit that among the many senior housing placements that I have completed in the past few years, the number of assisted living placements is way up, and the number of nursing home placements has decreased.   I recently reviewed some pricing for assisted living in a northwest suburb that featured help with ostomy or catheter care (a service the assisted living communities wouldn’t touch a few years ago because it was considered a skilled nursing service), hands on service with ADLs, a 2 person assist in transferring, medication assistance including help related to diabetes, chemo or radiation therapy or dialysis, and assistance with a feeding tube.  The price for this kind of care in a studio assisted living apartment is under $6,500 a month.  That pricing is well under the price of nursing home care, which on the lowest end can start at $7,000-$8,000 per month in the Chicago metro area.  So why wouldn’t someone opt for assisted living in the comfort of a private apartment vs. a semi-private room in a nursing home setting?

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My father suffered a stroke at the age of 86. He had received diagnoses of Parkinson’s and Alzheimer’s at the age of 84. As the diseases can have similar symptoms, it was very difficult to pinpoint which disease was causing his behaviors. At times he was depressed, moody, lethargic, and verbally abusive.

After the stroke, he required skilled nursing home care.  That prevented my mother from bringing him home. My mother felt an obligation to place him at a nursing home that was owned by the hospital where he had practiced as a physician for many years. That was our first mistake. We assumed that since he practiced at the hospital well into his 80’s that he would have decent care. Much to our family’s dismay, it was quite the opposite.

My story is no different than anyone else’s nursing home nightmare. But at the time, I was not yet in the eldercare industry and didn’t know any better. I didn’t know that checking the ratio of the staff to residents, observing the staff’s attitude, and watching for possible language barriers were critical components in the selection of a community.

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An article posted in National Real Estate Investor has predicated that active senior living communities and Continuing Care Retirement Communities will be the most profitable in the future senior housing market.

I was trained in a faith-based, Continuing Care Retirement Community (CCRC) that offered independent living, assisted living, and a nursing home all on one campus.  A CCRC will allow the senior to move between the various levels of care without having to move out of the building or complex, thus saving the senior and his/her family the stress and heartache of having to move a second time.  In the case of a couple, if a husband or wife requires a different level of care, placement at a CCRC will allow them to remain together in the same home.  If a resident needs short term rehabilitation, most of the skilled nursing areas of CCRCs are certified by Medicare.  The necessary rehabilitation programs are offered right there without having to temporarily move to another community.  Therefore, I wasn’t surprised to see the posted article’s author predicating that CCRCs will be one of the most profitable options for senior housing.

REAL LIFE STORY

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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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I remember fifteen years ago when I started as an Admissions and Marketing Director in the senior living industry, my future boss took me on a complete tour of the community. Or so I thought.

The community included independent living, where most of the seniors were well off mentally and ambulated with, at worst, a cane. The next level of care was assisted living, which at the time was an extension of independent living. But, the residents at that level received “standby” assistance with bathing, dressing, toileting, transferring, eating, and walking. At worst, seniors there ambulated with the help of a walker. No wheel chairs were allowed. Last, there was nursing home level, or the dreaded fifth floor that was reserved for residents who could no longer function at the independent living or assisted living level. Most were in wheel chairs and needed total assistance with their activities of daily living. Or, some suffered memory impairment and were at risk for wandering. The fifth floor was equipped with a security code for the elevator and an alarm for those residents who might attempt to leave unattended.

When my boss conducted the tour, he showed me the independent living and the assisted living areas, both of which were places where the residents appeared to be happy. However, after I began working there, I was sent to complete a task on the fifth floor where the residents needed total assistance with everything. Being new to the industry, I was like many of my clients taking a tour of a nursing home for the first time. I was nervous and terrified! I rushed down to my boss’s office and told him that I was exceedingly upset that I was not told that the fifth floor existed. As time went on, I grew to love the residents on the fifth floor. There we were encouraged to take a break from the regular tasks of the day, attend scheduled activities, or just talk.

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Many of us, including our loved ones, have terrifying memories of visiting Grandma or Grandpa at a nursing home. We have visions of the residents sitting slumped over in wheel chairs, the dismal aesthetics, unpleasant odors, terrible food, a dying roommate and the ever popular bingo game as the daily activity. These sorts of thoughts, whether exaggerated or fully accurate, will deter a loved one from considering a move to a retirement community.

Yesterday’s nursing homes focused on taking care of the sick. In contrast, the CCRCs of today not only seek to offer lovely aesthetics but also seek to maintain a senior’s independence by offering many a la carte services that allow the senior to stay in his/her independent living apartment. For instance, a senior may be independent for all practical purposes, but might feel more psychologically secure if someone stood by while he or she is taking a shower. These types of a la carte services can help delay a premature move to a higher level of care and allow a senior to remain in his/her own apartment for as long as possible. However, if a senior needs more care in the future, a true CCRC will offer assisted living and skilled nursing to address future health care needs without moving. Thus the senior and his or her family will avoid the trauma of a second move and the loss of friendships the senior has cultivated.

From the financial aspect, many CCRCs have shunned the typical rental arrangement and converted to Life Care Contracts, meaning that if a resident is at some point unable to meet the financial obligations of paying his/her monthly fee, the senior’s care will be subsidized by the rest of the residents. In other words, care is guaranteed “for life.” Here is a brief, oversimplified, explanation as to how it works:

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My client whom I will call “Marie” for the purposes of this story, was a 71 year old woman who had serious respiratory issues. Until recently, Marie lived at home with her mother. They had spent their entire lives together. A sudden illness caused Marie’s mother to be hospitalized and subsequently sent to a nursing home for rehabilitation. When it became apparent that my client’s mother was not going to recover, Marie brought her home and arranged for hospice services. There, my client Marie, a 70-something senior, continued to help tend to her mom, who eventually passed away.

As I had been hired by Marie previously, I was recently contacted by her trust officer, and was informed that Marie had been ill. It was requested that I act as her geriatric care manager. I went to the hospital in order to assess her situation. At that point in time, the trust officer knew very little about Marie’s physical condition.

When I arrived at the hospital, I was very surprised at how much Marie had deteriorated. She had been a feisty, quick witted woman. Despite her breathing issues, she had always been a fighter as evidenced by her devotion to her mother. At first, Marie didn’t recognize me because she was taking medications. Then in a matter of a few minutes, she confessed to me that the combination of taking care of her mother and the breathing issues landed her in the hospital, then in a rehab. community for respiratory therapy, then back in the hospital again. She said, “Andrea, I am convinced that taking care of my mother worsened my health. But, I loved her, and I would never change what I did. But, now that she is gone, I really have nothing to live for.” The hospital’s plan was to send Marie home with hospice care. She told me she was impressed with the hospice team that had taken care of her mom, and wanted the same people to take care of her.

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I remember fifteen years ago when I started as an Admissions and Marketing Director in the senior living industry, my future boss took me on a complete tour of the community. Or so I thought.

The community included independent living, where most of the seniors were well off mentally and ambulated with, at worst, a cane. The next level of care was assisted living, which at the time was an extension of independent living. But, the residents at that level received “standby” assistance with bathing, dressing, toileting, transferring, eating, and walking. At worst, seniors there ambulated with the help of a walker. No wheel chairs were allowed. Last, there was nursing home level, or the dreaded fifth floor that was reserved for residents who could no longer function at the independent living or assisted living level. Most were in wheel chairs and needed total assistance with their activities of daily living. Or, some suffered memory impairment and were at risk for wandering. The fifth floor was equipped with a security code for the elevator and an alarm for those residents who might attempt to leave unattended.

When my boss conducted the tour, he showed me the independent living and the assisted living areas, both of which were places where the residents appeared to be happy. However, after I began working there, I was sent to complete a task on the fifth floor where the residents needed total assistance with everything. Being new to the industry, I was like many of my clients taking a tour of a nursing home for the first time. I was nervous and terrified! I rushed down to my boss’s office and told him that I was exceedingly upset that I was not told that the fifth floor existed. As time went on, I grew to love the residents on the fifth floor. There we were encouraged to take a break from the regular tasks of the day, attend scheduled activities, or just talk.

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If you are considering non-medical home care for your loved one, you should be aware of some changes in this segment of the senior living industry.

When I started in the senior living industry over 15 years ago, things were very simple. “Assisted living” meant nothing more than “stand by,” assistance with activities of daily living. Now, the industry has changed. “Hands on” care is available at the assisted living level, which allows the senior to remain in his/her assisted living apartment so much longer. In the same way, the licensed, non-medical home care agencies have undergone many changes. I have asked Mike O’Brien, owner of Independence-4-Seniors, and Legislative Chairperson, Illinois Chapter of the Home Care Association of America to tell you about them.

Illinois Legislation and Regulatory Changes in Private Duty Homecare

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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.