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

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Five weeks ago, I went to a long-term care community for a meeting. When I signed in at the reception desk, I noticed there were signs warning there was a respiratory illness circulating on specific units. The units were located in the nursing home. My meeting wasn’t going to take place on any of the affected units; but, I took what I thought was a precautionary move: I told the receptionist where I was going and confirmed that the illness wasn’t circulating in the unit where I was going. She assured me it was not. So I proceeded to the locked memory unit, where the meeting was being held. I used my covered elbow to push the elevator button. And I waited for a certified nurse’s assistant to open the door to the unit. The meeting lasted no more than 40 minutes.

The next morning when I woke up, I had chest congestion, a cough, and a sore throat. Strangely enough, I did not have a high temperature or nasal congestion. I thought I had caught a common cold, but whatever illness I had acquired rendered me so fatigued that I slept for close to three days straight! The only exception I made to resting was to walk my wonderful golden retriever. By re-tracing my own steps, I don’t think I had been any place where I could have picked up a respiratory problem, although I have no absolute proof.

After a week, I realized that my cough and chest congestion were not subsiding. I decided to go to an immediate care center and see a doctor. The doctor, who was very kind, listened to my breathing and told me there was no sign of pneumonia, but that I had chronic bronchitis. It is now a month later, and I still haven’t been able to shake the cough completely.

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I worked very closely with a wonderful woman in her mid-eighties as her power of Attorney for Healthcare. After she had been hospitalized for an elevated white blood count, I transferred her to a short-term rehabilitation community, then to assisted living for a respite stay, before I took her home. The return home occurred in early December.

Two weeks before I took her home, I met with a licensed home care agency representative to arrange for a live-in caregiver until my client would be able to function on her own. I had good luck with this agency in the past and trusted the owner. But, like anything else, the situation can change overnight. I was aware that the holidays were approaching. I resigned myself to the fact that staffing my client’s case was probably going to be tough because, like anyone else, caregivers want time off during the holidays.

As it was explained to my client and me, she would have two caregivers. One would stay for four days of the week, and the other would work for three days. It was supposed to be the same two caregivers for the duration of my client’s care. While we were told by the agency in detail how the first four days would be covered, what would happen during the remaining three days remained a mystery.

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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.