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My father always told me there is “No such thing as a free lunch!” That’s why I was very wary when I received a phone call from my client’s Medicare Supplement insurance company representative. (I serve as Power of Attorney for health care for my client.) The insurance representative was very excited when she informed me that my client ‒ who is 99 years old, has advanced dementia and lives in a nursing home under Medicaid ‒ was eligible for a new program that would not only broaden her health care coverage, but also add dental insurance free of charge. As a former insurance broker, my antennae went up immediately: More coverage, free of charge? Here are stipulations of the policy:

Podiatry Services – 4 visits

Vision Services – $300 every 2 years toward lenses and frames

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Fifteen months ago, I was hired by a charming, alert, 85-year-old woman to act as her Power of Attorney for Healthcare and, if necessary, Geriatric Care Manager. I remember the first day I met her. She was running around her 2-bedroom ranch house like someone had fired her out of a cannon. I made my usual assessment, asking about her medical issues (surprisingly, she had many), list of medications, and how to help carry out her wishes when she was alive and near end of life. She was somewhat skeptical as to why she would need my Geriatric Care Management services. I explained that, since she had no relatives or friends who could handle the job if she needed help, she would need to have a plan in place. She went along with my suggestion.

Three months ago, I received a call from a skilled nursing home where she had been taken for rehab. My client had called 911 after falling. Unfortunately, her hospital was on bypass because the ER was so busy, so she was taken to the next closest hospital where none of her physicians were on staff. The hospital treated her for a heart problem and sent her to a rehab. community. I went to visit her and was astonished at how badly she had deteriorated. She said the food at the rehab facility was horrible and she felt like she was losing weight. She was a good cook and ate very healthy.

Upon developing a second health issue, my client was transferred back to the hospital where her doctors were on staff. She was treated for a high white cell count and was again ready for release to rehabilitation. She insisted on being transferred to a home that was owned by her hospital, thinking her doctors would follow her. I explained to her many times that her current physicians would not follow her unless I took her to see them myself. She was pretty unrelenting at this request, so I chose the best rehab. community available within the hospital system. I was right: Her current physician wouldn’t follow her and she was seen by the medical director at the home. While the therapy was good, she complained vehemently about the food and continued to lose weight (20 pounds).

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I was lucky enough to be engaged by Jocelyn Newhall of Arbor Terrace (Naperville) to teach a dance class to the residents in the Evergreen assisted living memory unit. I’m not sure who had more fun…the residents or I!

I conducted a one-hour class that was divided into short segments of ballet, tap, and jazz dance. I started each section with a short stretching exercise and warm up, followed by some brief steps that were set to some of their favorite music.

There were between fifteen to twenty enthusiastic residents who attended the class. Some were ambulatory but most of them participated in the class seated in chairs. Although they worked through the ballet exercises patiently, many of them were anxious to get on into the tap portion of the class. I had them doing shuffles and flaps, along with simple flap heels set to Frank Sinatra’s, ”New York, New York.” When I turned the music on, most of them began to sing so loudly that you couldn’t hear the recording. Several of the residents chose to leave their seats and improvise.

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My colleagues in the long-term care industry are all aware of the fact that once a senior enters a long-term care community, s/he will probably not maintain a relationship with his/her personal physician. The general public may not necessarily be aware of this fact. Most long-term care communities have arrangements with certain doctors who come there and see the patients on site. The exception to the rule is, if a senior’s doctor becomes credentialed with the community and agrees to physically visit in order to see the patient, then the physician-patient relationship can be maintained. That does not normally happen, however. Sometimes if you are within a certain health system that has affiliations with certain long-term care communities, your loved one may be lucky enough to have his/her personal physician credentialed at the place where the senior moves. Let me share some experiences that you may encounter once your loved one moves.

Real-life Story

Last summer, I was hired as Power of Attorney for Healthcare/Geriatric Care Manager for a very active 84-year old woman. She had all her faculties, was ambulatory and gainfully employed until she retired. Two months ago, I received a call from a long-term care community informing me that she had been taken there to complete rehab. She had developed severe bouts with sweating and was diagnosed with a high white blood cell count. In addition, she had suffered heart problems, loss of appetite and low potassium. When I heard about which community she had been taken to, I wasn’t impressed. Unfortunately, when the emergency occurred, I wasn’t contacted immediately. The 911 hospital, which happened to be her regular hospital, was on bypass during the emergency. She was taken to the closest hospital, treated for the heart problem, and released to the rehab community.

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I am often amazed at the number of clients who call me and say they are looking to place a loved one in a senior living community because their loved one is falling. When it comes to senior falls, please remember the following very general guidelines:

No senior living community provides one-on-one care. Placement in a senior living community is never a guarantee that an older loved one won’t fall. If a senior is in independent living, that level of care is not licensed. There are no nurses or nurses’ assistants. If a senior falls in independent living, 911 will be called to help the person stand or to take them to the nearest hospital. When a senior resides in assisted living or a nursing home, there will not be enough staff to prevent the senior from falling unless the staff witnesses the fall taking place and they can act on time. Don’t forget that your loved one will be sharing a certified nurse’s assistant with many other residents.

The use of full bed rails is not allowed in Illinois. They are considered to be a restraint. They can only be used if a doctor writes an order for them. The most that can be used without a doctor’s order is a half rail. A resident cannot be restrained with chemicals without a doctor’s order. There are grab bars available that attach to seniors’ beds to help them steady themselves when they rise. Many times, a mattress is placed close to the floor to lessen the distance of any potential fall.

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Real-life Story

My clients were the sons of a 94-year-old gentleman. One son lived in town, and the other lived out of state. At the time they contacted me, their father was living at home, could ambulate with a walker, and was having short-term memory issues. He needed assistance with meal preparation, hands on help with bathing and dressing, and a lot of cueing. But his biggest issue was that his body retains a lot of fluid due to medical issues. He has a catheter that has to be emptied at least four times a day. While he is capable of inserting the catheter on his own, the sons had been setting up the catheter and lubricating the tip for him. They also had an aide from a non-medical home care agency helping him several times a week for four hours at a time. Because their dad needed 24-hour supervision, the sons were taking turns watching him for 2-3 weeks at a time. Both were exhausted: One is still working full-time, and they told me they just couldn’t manage his care anymore.

The catheter immediately presented an issue because assisted living licensing does not allow assisted living communities to provide catheter care. Those services must be provided by an outside agency licensed to do so. Unfortunately, the cost to provide the needed service, four times a day, would be an additional $100 per day. Therefore, the cost for the catheter care would be an additional $3,000 a month on top of the $6,000 to $8,000 base cost for assisted living. This gentleman is not yet ready for a nursing home.

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When I am asked to place a couple that is looking for a 2-bedroom apartment in assisted living, I often cringe.  That is because when the assisted living areas of many of the communities were built, the plans just didn’t include many 2-bedroom options.  The majority offer only studios or one-bedrooms.  Some communities offer nothing but studios.  Those places that offer the option of a 2-bedroom apartment assisted living usually are full with a waiting list.  In one instance, the Administrator at a senior living community went as far as knocking down a wall between 2 studios in order to accommodate my clients (a couple) so they could stay together.  Timing and luck play a huge part in finding a 2-bedroom in assisted living, as illustrated in my Real Life Story.

Real Life Story

My clients were a couple in need of two different levels of care.  Although both individuals had significant health issues, one was able to remain at the independent living level of care.  The spouse had experienced several hospitalizations and needed assisted living. The couple hired me at the suggestion of their children.  This was a second marriage for both members of the couple.

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I have vivid memories of the seniors picking on each other many years ago while I was an Admissions Director at a Continuing Care Retirement Community. If they weren’t fighting over the seats at Bingo that had been “saved,” they were sniping at each other in the line for flu shots at the nurse’s office. A vicious gossiper could get another resident sequestered to sitting alone at a table in the dining room by starting a rumor. There was a certain independent resident who was constantly poking fun at the assisted living residents, not realizing that one day she would be in assisted living herself. I just took it with a grain of salt.

However, there was another notorious independent living resident Bully who I will refer to as Dee. Dee had a reputation of bullying just about everyone, and was feared by every resident. One of my favorite residents was a t former Chicago policeman who was tough as nails and had a mouth like a drunken sailor. Dee even posed a problem for him. She tried to bully me by asking all sorts of intimidating questions and telling me, ” I do not like the people you are letting in here.” She harassed the wait staff horrifically by complaining about the food and the manner in which they served it.  Several of the servers were often in tears. She had endless insulting conversations with the Director of Dietary that often didn’t end well. If she didn’t care for something that another resident was doing, she would literally tail them up the hallway with her purse dangling and calling out insults after them.

At one point, I admitted a very attractive older woman who I will refer to as Lee. She was well dressed, personable, and the rest of the residents liked her. She befriended one of the male residents, who I will simply refer to as Jay. After dinner every night, Jay and Lee would get together in Jay’s room. The door was always open, and they would talk late into the night, sometimes until one o’clock in the morning. Dee had this terrible habit of walking the hallways late into the night. The other residents told me that the fact that the two residents were talking late into the night didn’t bother them. The weren’t making any noise and the door was always open so they knew nothing was happening. Apparently, Dee didn’t have the same reaction. She was often seen on the third floor walking back and forth in front of Joe’s room.

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When I placed my mother in a long-term care community at the age of 95, the cost of her care in assisted living was about $6,000 per month. That was over 3 years ago. Now the cost of assisted living can run between $6,000 to $9,000 per month depending upon how much help a person needs and which community is chosen. Skilled nursing care can run $9,000 to $17,000 per month depending upon the community.

My mother purchased her policy in the 1980s when long-term care insurance was a newer product on the market. She asked me if I thought the purchase was a good idea, and I said, “Absolutely!” What she purchased was a policy that paid $100 per day, up to a maximum of $143,000. She had a 90-day waiting period, which meant she had to pay the first three months of her care out of her own pocket, or $18,000. She didn’t purchase an inflation guard rider, which would have increased the benefit by several percentages on an annual basis in order to keep up with inflation. Therefore, the policy covered a little over half of what her care cost on a monthly basis. She had to pay the balance of $2,500 a month out of her pocket.

Now, there are different types of long-term care insurance available. Some are traditional like the policy my mother bought. Others are hybrid products that consist of life insurance products with a long-term care rider. In any event, trying to self-fund a stay in a long-term care community can be devastating. Illinois is one of the toughest states in which to obtain Medicaid, which is the federally funded and state administered coverage for people who do not have the funds to pay for long-term care. Because the State of Illinois is so far in arrears with reimbursing nursing homes for Medicaid recipients, many nursing homes have de-certified the number of Medicaid beds they have available. Many nursing homes are also look for a resident to pay between 1 to 2 years privately before filing a Medicaid application. Therefore, Medicaid isn’t a resource to be relied upon for long-term care. In addition, Medicare only covers short-term stays in a rehabilitation skilled nursing community.

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I lost my husband to cancer of the appendix in April of 2015. I had been a member of the local chamber of commerce in Riverside, Illinois, and chose a funeral director that I knew because he was president of the chamber. When I called him at 6 A.M. the morning after my husband’s death.  It was pretty obvious that I woke him up. Yet, he was cheerful. He told me to come over any time after I was showered, and he would have coffee waiting for me. From the moment that I explained the type of arrangements that I wanted, he didn’t ask me any questions. He took the entire awful process out of my hands, and everything went very smoothly. When my parish priest refused to accommodate the time I was requesting for the ceremony, he even called another Catholic church and arranged to have the ceremony there.

As part of the services offered by Andrea Donovan Senior Living Advisors, I often have arranged funerals for my clients if I am named as the senior’s Power of Attorney for Health Care. In a case I was involved with recently, my client had pre-arranged her own funeral, but was very confused as to what she had purchased. I called the funeral home and asked a representative to come out to explain the contract. I shared the contract number with her and asked her to be prepared to explain any charges that still needed to be paid, and to bring the necessary paperwork.

The funeral director showed up half an hour late to the meeting, claiming that she thought it was a half an hour later. In addition, she muddled through some kind of explanation as to why my client needed to sign some burial insurance form in order for the contract to pay, then proceeded to tell me she brought the wrong paperwork. Faxed or scanned documents were unacceptable, so this resulted in having to set another meeting to sign them.