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Long Term Care – Let The Buyer Beware!

I recently had a very interesting conversation with an Admissions Director of a well-respected Chicago skilled nursing home. We made the observation that due to the poor economy, many Chicago assisted living homes* are accepting residents whose medical needs cannot be met. In other words, the resident belongs in a skilled nursing home.** Being a former Admissions Director and with my current position as a Chicago Senior Living Advisor, I thoroughly understand the current market conditions.

The Admissions Director is the most important contact at a long-term care community. He or she is responsible for attracting and residents, while maintaining a high census. Many Admissions Directors also act as marketing liaisons. They provide your first impression of a long-term care community, and often are a direct reflection of the care your loved one is going to receive. They are also responsible for the initial assessment of the type of care that is appropriate for the senior. It is important to bear in mind that Admissions Directors are often commissioned salespeople. They are accountable to, “the powers that be,” for maintaining a high census. I can remember the terrible pressure that was exerted upon me by the management in order to keep filled the continuing care retirement community where I was working. Scarcely was a bed emptied before pressure came to fill it. The passing consolation that the seniors, “were called home by God,” just didn’t cut it in terms of lightening the pressure for quick turnarounds. I know that with a bad economy, the pressure is even worse.

My point is this. Don’t let someone “sweet talk” you into thinking they can take care
of your loved one in an assisted living community when he or she really needs skilled nursing care. Many assisted living Admissions Directors will play up the aesthetics their community has to offer, as well as the absence of the stigma associated with placement in a skilled nursing home. The savings ($4,500 is the the average cost per month for assisted living in the Chicago metro area vs. $6,000-$9,000 for skilled nursing care) may be attractive in the short run. But you will only be placing your loved one at risk and facing another move when things don’t work out. In addition, keep your loved one’s long-term financial realities in mind. Assisted living communities are mostly private pay*** and don’t offer the advantage of Medicaid support, as do skilled nursing homes. I have heard many assisted living representatives say, “We can take care of your loved one from admission to the point of bringing in hospice.” Of course they can, at a cost that is equal or more than what you pay for skilled nursing care. Read on and find out what happened in this month’s real life story.


My clients were the children of an 89 year-old senior. The mother had been living in an independent living community, with a full-time caregiver. The caregiver was helping her with all of activities of daily living. She had 5 chronic conditions that required her to use a wheelchair at all times. She enjoyed being taken to the independent living dining room each day where she socialized with the other residents. She also had the signs of early onset dementia. The costs of maintaining this lifestyle became exorbitant. The caregiver was released. The Admissions Director at the community convinced the family that their assisted living program could fulfill all of her needs, including those being provided by the caregiver, at a much lower cost than a nursing home. I was hired by the family to look into skilled nursing communities for her, as her funds were beginning to be depleted.

I always require that I see a client before I make my recommendations for placement. During my assessment, I found her sprawled out in bed, on her side, and unable to lift her head which was resting on her shoulder. While I was there, 2 certified nurses assistants entered to dress her and place her in a wheelchair. Normally, this is the kind of assistance you would witness in a skilled nursing home. There was a commode next to the bed due to the difficulty of getting her to the bathroom. Even though she had been in the assisted living area for four days or more, all of her boxes remained unpacked.

I called the family and said, “Your Mother needs to be in a nursing home.” One daughter asked, “Why do you think my mother needs to be in a nursing home?” I replied that she was sprawled out on the bed, couldn’t lift her head, and needed help with all of her activities of daily living. I was instructed to look into two nursing homes, “because these would be the only two Mother would consider.”

Unfortunately, one of the nursing homes had financial requirements that were above the woman’s means. I explained that to my clients upfront. The second home had some financial stipulations regarding her acceptance. My third recommendation was a skilled nursing home that provided great care and cost a bit more than her current assisted living arrangement. But, this home also offered the benefit of Medicaid when her funds ran out. In the end, the family held off choosing any of them because, “A move like this would just kill her, and she is currently doing well in her new surroundings.”

Here is the moral of the story. “A move like this would just kill her.” That is mere speculation, whereas as care that does not meet her needs is almost sure to have the same effect in the long run.

Just a tip: when you see your loved one’s funds can be used to pay privately for a year in a skilled community, that’s the time to make the move. And you can also use my assistance in judging the Admissions Director’s intentions.

For all you loved one’s senior living needs please contact Andrea Donovan at (708) 442-7174 or email us. Visit our website at Watch the video and learn how our process works and what some clients have to say.

*Assisted living is normally standby assistance with bathing, dressing, walking, toileting, transferring and eating. It isn’t hands-on assistance unless it is a very high end community where they are practicing nursing home care in the resident’s apartment.

**A skilled nursing community provides 24-hour nursing care with total assistance with some or all activities of daily living. The resident normally has some sort of health condition besides which requires 24-hour nursing care.

***Most assisted living communities are private pay except for Supportive living which is standby assistance supported by Medicaid.