Published on:

Family Consensus Should Play A Part In The Selection Of A Long Term Care Option

I am often confronted with some interesting family dynamics when a family hires me to consult with them. At times, the children are willing to accept my advice without reservation. Sometimes, there is often one child who wants to prove that s/he can “do this on her/his own.” While there is usually one child who emerges as the spokesperson for the family, the choice of the right care should be the result of a family consensus and not the persuasive skills of a ringleader. Consensus should be coupled with careful comparison of cost and methods of payment, level of care needed, staffing considerations, location, and quality of care involved with all the senior living options. Please read the following “Real Life Story,” that exemplifies my point

Real Life Story
One of my clients who did not follow my initial advice contacted me last week. She was unhappy with the care that her Mother was receiving at an assisted living community that specializes in memory support.

When the daughter and two sons had contacted me initially, their Mother was ambulatory and living at home alone. The Mother was experiencing severe short term memory issues. At times, she didn’t recognize her daughter. However, at the time that I assessed her she was having a “good day,” during which she proudly showed me many artifacts (mostly religious in nature) from her native country. The children were taking turns with staying overnight when the part-time caregiver wasn’t there to watch her. The stress of working and part-time caregiving was taking its toll on everyone. Hiring a 24 hour caregiver was too expensive.

At the time when I was hired, the Mother’s finances were at the point where I could place her in a Continuing Care Retirement Community (CCRC) that included an assisted living unit with memory support. But, when her funds were exhausted, she could transfer to the skilled community and apply for Medicaid. The Mother’s religion was very important to her. I arranged for a tour of the CCRC that was of the Mother’s religious affiliation. They also had a benevolence fund that stipulated that if a loved one paid privately for a number of years, a resident would not be asked to leave if their funds were exhausted. The community was in a location that was convenient for all three children.

On the night of the tour, one of the sons who vehemently opposed the mother entering a community decided not to show up. This caused a certain amount of consternation amongst his siblings. But, we continued with our tour. After the tour, the other two children kept taking their Mother back to the community on a weekly basis for religious services. Yet, they failed to commit to moving her because the other son was in opposition to the move.

I had made them aware of another local assisted living community that specialized in memory support. However, it did not have a skilled nursing community that was, “Medicaid friendly.” Since my client was in her early seventies at the time and her house was not sold, the availability of Medicaid was an issue. I had also observed several other weaknesses, including lack of programming. I also questioned the training of the staff. As a senior living advisor, I make my clients aware of the viable options and give reasons as to why they may or may not work. I informed the children I was not in favor of this option.

The brother who was in opposition to his Mother’s move decided to tour the assisted living community and the CCRC on his own. He thought that the layout of the assisted living community was favorable to the CCRC because it had an enclosed outdoor area and a layout that was like a college dormitory . Although I had pointed this out to the other children, they assured me these features would not be important to their decision because she rarely went outside. . The brother persuaded his siblings to move her to the assisted living community and not to the CCRC.

Last week, I received a call from the daughter who reported that their Mother had been at the community for over a year and was failing rapidly. She was a total assist for most of her activities of daily living She feared the staff was inadequately trained. She told me that several of the staff members told her brother they had received no formal training, even though they were told otherwise. She was also distraught because her mother had found a boyfriend (a fellow resident) and had caught them engaging in inappropriate behavior prior to her mother’s decline in health. When she confronted the staff, they claimed that sort of behavior was “healthy and normal.” The man was moved to another area. Yet, my client observed him consorting with another woman.

The fortunate part of this story is that my client’s home has sold and the Mother is not under stringent financial constraints. The unfortunate part is that because my initial advice wasn’t followed, we are consulting together to find a new nursing home community. And, they are back at square one.