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.
When I arrived for the assessment, the senior was exhausted from the morning’s physical therapy. However, she was persistent in trying to get up and walk to the bathroom. She was very unsteady on her feet, and wobbly from a sit to stand position. She knew enough English to express to me that she did not want to remain permanently in a nursing home.
I began putting together my recommendations for some long-term care communities. Then, the son called me and told me his mother developed a condition that caused her to be admitted to the hospital. There was another stint in a rehab community. However, the senior’s behaviors had become so precarious that the rehab community required the child to hire a 24-hour caregiver to sit with her. For example, she repeatedly tried to get out of her wheel chair and walk, despite her prior fall and high risk of falling again. State and federal laws stipulate that nursing home residents have a right to remain chemical- and physical-restraint free; thus they will not use a wheel chair alarm that buzzes whenever its occupant tries to get up. My client was told that if she was to remain permanently at the nursing home, the 24-hour caregiver would have to continue to take care of her. The cost of the nursing home plus the caregiver would approach $15,000 per month.
As a result, my client said that he was considering sending his mother back to her native country where the cost of care would be about $3,000-$4,000 per month, and her funds would last her close to 10 years. The downside was that her Medicare would not be accepted there and he would have to buy her private insurance. The son would also have to incur the cost of transporting her on a long flight (especially with a person who has dementia). Several family members would have to accompany him on the flight. There was only a distant cousin residing in the foreign country who could check in on her. Otherwise, my client would hardly see his mother.
After approaching a number of nursing homes, the consensus from most of them would be that the 24-hour caregiver would need to be maintained. My biggest concern involved what would happen once the senior achieved Medicaid status and couldn’t afford the private caregiver? The general answer I received was that once the senior ran out of money, she would be placed in a community that could deal with her behaviors. I was livid with that answer. If a decent community wouldn’t accept her with adequate funds without the private caregiver now, where in the world would she be placed later?
After I continued to work on the case, I found two communities that assured me there was adequate staffing to deal with her behaviors, and she will move to one of them tomorrow, at a cost of $7,000. Stay tuned.
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