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I recently had the wonderful opportunity to be interviewed on the Silver Solutions Radio show. It airs on WMRN 1410 AM in Elgin, Illinois. It is hosted by Jeanette Palmer, Jim Wojchiechowski, and Kathleen Wetters, who each independently own a Right At Home non-medical home care agency. During the interview, they graciously gave me a chance to explain how I started my career in the senior housing industry as the Admissions and Marketing Director of the St. Andrew Life Center (Now Glen St. Andrew) in Niles, Illinois. It was a faith-based community that offered three levels of care, including independent living, assisted living, and a nursing home on one campus. I was receiving so many telephone calls (mostly from the children of seniors who were calling me from the Yellow pages) from people who didn’t know how to solve their senior loved ones’ problems. I saw a niche for a consulting business. So in 2006, much to my husband’s dismay, I opened Andrea Donovan Senior Living Advisors in 2006.

I started my senior housing placement consulting business by touring and evaluating over 150 senior living communities in the Chicago metro area. I looked at cost and methods of payment accepted, levels of care, staffing, and quality of care. Then I also evaluated quality of life factors such as cleanliness, menus, activities, and apartment and room layouts. So, when a family needs my services, I make a face to face evaluation of the senior, their financial realities, and the location preferences of the family. Then, I select the options that fit the senior’needs so families aren’t wasting time touring places that simply won’t work long-term.  At this point I have toured and evaluated close to 500 senior communities in the Chicago metro area.

We also shared a very frank discussion about the costs of placement in a senior living community versus the costs of staying at home in the Chicago metro area.  We talked about the advantages and disadvantages of each option.

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My clients were a very pleasant, alert, 90 year old woman and her son. The son had been gainfully employed by a major corporation and had been transferred to a state out west. He liked the new location very much and remained there once he was retired. His mother had lived here in the Chicago area all of her life. When she could no longer take care of herself, the son chose to move her to an assisted living community here. She had lived in the suburbs all of her life and wanted to be in close proximity to the cemetery where her husband was buried. She had an excellent support system here, consisting of many personal friends who visited her and members of her church who came to give her communion at least once a week. In addition, the son hired me to act as her advocate for several hours a week. His long-term plan was eventually to find a senior living community for her out west where he was living. In the interim, he wanted me to monitor the visits from the nurse who was tending to a wound on his mother’s leg, ensure that her hearing aids were charged, make certain she arrived at her ophthalmologist appointments, and see that her mind was being occupied by decent activities and going outside.

At first my elderly client was rather wary of me. But we developed a wonderful relationship. She was very frank with me with regard to the staff at the local community. She was in the assisted living area of a Continuing Care Retirement Community (CCRC), including independent, assisted, and nursing home living, because she needed standby assistance with bathing, dressing, and putting in her hearing aids. On occasion she needed to use a wheel chair for long distances, and was in need of 24-hour supervision. However, she complained of long waits when she pushed her wrist pendant for summoning help. She said that when she did get help, some of the staff members were nice and others were not. She often mentioned to me that the activities were not very interesting. She told me she didn’t complain to staff or to her son because her son tried so hard to do a good job. She did mention that the food was wonderful. Overall, I got the impression that she was just putting up with things and would like to be happier with better staffing and activities.

The son eventually contacted me and said he found a new community for his mom out west and gave me the dates of her departure. I met with the son and his mom to say good-bye. The son told me that his mom was going to be living in an independent living/assisted living/memory care community. He explained to me that the independent living and assisted living residents lived in the same area in the new community because state law prohibited them from being separated. He expressed concern over the potential wait time involved when she pushed her pendant button. I asked him if he had asked what the ratio of staff to residents was and he replied “No.” I asked if he had checked the activity schedule for the types of things that might make his mom happy. I did not receive a clear affirmative answer. Since his mother loved the food at her original, local community, I asked if he had tried the food at the new community out west. Again, the answer was no. When I asked why he went with a community that lacked a nursing home component, he said he was told that any of the services she needed could be brought into her apartment. I’m not certain he was aware of how astronomical the costs of ordering ala carte services into an assisted living apartment can be.

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In this month’s newsletter, I share with you advice from my colleague Renee N. Duba, a certified financial planner with Sonder Private Wealth Management. Inc. In a recent article about the impact of inflation on purchasing power, authors at Sonder observed that, in 1916, nine cents could buy a quart of milk. Fifty years later, nine cents would buy only a glass of milk. Now, more than 100 years later, nine cents will buy only about 7 tablespoons of milk. That’s a different and yet very vivid way of looking at long-term cost increases, of which we’re all aware. For details on how inflation affects seniors, in particular, I have invited Renee to share with us the following information about retirement and Medicare.

While the United States has not seen skyrocketing prices for basic goods and services for many years, it is important for families to understand how inflation affects long-term financial security. Most adults recognize that rates of inflation for education and healthcare run much higher than the overall rate of inflation in our economy, as measured by the Consumer Price Index (CPI). Yet, while the funding of education for our children is a finite endeavor, funding our healthcare needs is not. Like an old car that has ever-increasing repair needs, our bodily health tends to require ever-increasing health care consumption as we advance in years.

Healthcare costs in the United States are the highest in the developed world. For example, the U.S. pays more for doctors and drugs than in 10 other developed nations. On average, Americans spend $1,443 per person on pharmaceuticals, compared to a global average of $749. As a certified financial planner, I wish to enlighten ADSLA’s readers specifically about Medicare Parts B and D, their long-term impact on your retirement income, and how you can best plan now to achieve financial security during your retirement years.

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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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Being older CAN have its advantages. Among them are these potentially money-saving tips from the IRS, for those of you who have not already done your taxes.

If you and/or your spouse are 65 years old or older, you can get a higher standard deduction amount if you do not itemize your deductions. And if either you or your spouse is blind, you can get an even higher standard deduction amount.

One suggestion I would add about the Standard Deduction for Seniors: If you are unsure which path is better for you, prepare your taxes both ways: Both with itemizing deductions and without itemizing deductions and compare your results. Naturally, you’ll want to choose the path that reduces your tax burden or increases your Refund.

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I recently enrolled in the Certified Dementia Communications Specialist program offered by two of my colleagues in the senior living industry, Tami Neumann and Cathy Braxton of the Silver Dawn Training Institute. As a senior housing consultant and Certified Geriatric Care Manager, I am almost always hired by the children of the senior. The senior is usually a Person With Dementia (PWD). The child of the senior often asks me to interact with his or her loved one, particularly if the senior needs to be convinced that it is time to move to a long term care community.

What I found invaluable about the Silver Dawn Institute Program is that it is based upon the basic rules of improv, which are: 1) relinquishing your agenda; 2) making your partner look good; 3) Using “Yes…and”; and 4) the gifts.

I recently used the rules of improv to assist the adult child of a person with dementia. Here is what happened:

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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!