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During a recent presentation to a group of independent seniors, a gentleman asked me if there were any rating systems available for Continuing Care Retirement Communities. Here are the some resources that I find helpful:

If you are looking into the financial strength of a Continuing Care Retirement Community (CCRC), the Fitch Ratings are helpful. Lest this recommendation sound too “money oriented” to some readers, here I note that it is only natural – and prudent – to want a senior living option where the community has both the resources and the stability to ensure a high quality of service to its clients, and for years to come. Fitch Ratings were founded over 100 years ago by the Fitch Publishing Company, a provider of financial statistics. The ratings are comprised of credit rating scales that give a snapshot of the organization’s potential to honor its financial obligations. This could include repayment of principal, interest, dividends or insurance claims.

Basically, Fitch Ratings are credit rating scales that indicate an organization’s potential for honoring its financial obligations to its investors. (In one sense, seniors “invest” when they select a CCRC). Grades ranging from ‘AAA’ to ‘BBB’ (described as investment grades) are assigned to those operations that fall into the low to moderate risk category. Grades of ‘BB’ to ‘D’ are assigned to operations with “speculative grade” or a greater level of credit risk. Some operations carry a grade of “NR,” which indicates they have not been rated by Fitch.

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The recent CBS investigative report regarding the cases of alleged neglect at a national assisted living chain held no surprises for me. I began my career in the elder care industry fifteen years ago when assisted living provided only “stand by,” assistance with activities of daily living (ADLS = bathing, dressing, toileting, transferring, walking, and eating). Several years ago, I made the observation that many of the assisted living communities were offering more “hands on” care to their residents. At the same time, I also observed that they were accepting residents who really belonged in intermediate nursing care or a skilled nursing community*. Being a former Admissions Director and with my current position as a senior living advisor, I thoroughly understand the current long term care 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.

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As the former Admissions Director of a retirement community that offered independent living, assisted living, and intermediate nursing care, I often had to convince the senior that it was time for him/her to move. Some of the seniors (and their children) knew that it was time to move. Other seniors were extremely resistive. One circumstance stands out in my mind that may offer you some tips on how to convince the senior to move. As a senior living advisor and Certified Care Manager, I find my past experiences to be invaluable to share with my clients.

Real Life Story
My prospect for the retirement community was a seventy-eight year old senior who I will call Mary. Mary was living alone in her own home. She had Parkinson’s disease but could perform all of her activities of daily living on her own. She was the perfect candidate for independent living! The house was located in a changing neighborhood. Her daughter, Lynn, brought her to the home for a tour because Mary’s home had been burglarized. Mary was mugged during the burglary.

During the entire tour and interview, Mary cried piteously and kept repeating that she didn’t want to leave her home. The daughter and I kept insisting that Mary’s safety was at risk. Lynn was also the only relative in the Chicago metropolitan area, and lived in a suburb that was over 25 miles from where Mary lived. I also stressed during the interview that Mary’s Parkinson’s disease would become worse at some point in time. The community would offer additional assistance as well as being closer to Lynn.

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I was sad to read that the search for victims who perished in a Quebec retirement community fire had ended. At least twenty eight seniors were killed when the wood-framed building caught fire and was destroyed in less than an hour.

In the fifteen years that I have been involved in the elder care industry, I have never been asked how a senior would be evacuated from a building during a fire or other disaster. In light of current tragedy in Quebec, it is a question that should be addressed when assessing senior living communities.

Before I opened Andrea Donovan Senior Living Advisors, I was the Admissions Director of a retirement community that offered Intermediate nursing care (as well as independent living and assisted living) to its residents as part of the continuum of care. We were bound to act according to the Illinois Administrative Code for Skilled Nursing and Intermediate Care Facilities, Section 300.670 on Disaster Preparedness. This meant the staff had to adhere to extremely rigorous guidelines in case of a “disaster.” A disaster meant, “an occurrence as a result of natural force or mechanical failure such as water, wind or fire, or a lack of essential resources such as electric power, that poses a threat to the safety and welfare of residents, personnel, and others present in the facility.” The requirements were as follows:

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My client whom I will call “Marie” for the purposes of this story, was a 71 year old woman who had serious respiratory issues. Until recently, Marie lived at home with her mother. They had spent their entire lives together. A sudden illness caused Marie’s mother to be hospitalized and subsequently sent to a nursing home for rehabilitation. When it became apparent that my client’s mother was not going to recover, Marie brought her home and arranged for hospice services. There, my client Marie, a 70-something senior, continued to help tend to her mom, who eventually passed away.

As I had been hired by Marie previously, I was recently contacted by her trust officer, and was informed that Marie had been ill. It was requested that I act as her geriatric care manager. I went to the hospital in order to assess her situation. At that point in time, the trust officer knew very little about Marie’s physical condition.

When I arrived at the hospital, I was very surprised at how much Marie had deteriorated. She had been a feisty, quick witted woman. Despite her breathing issues, she had always been a fighter as evidenced by her devotion to her mother. At first, Marie didn’t recognize me because she was taking medications. Then in a matter of a few minutes, she confessed to me that the combination of taking care of her mother and the breathing issues landed her in the hospital, then in a rehab. community for respiratory therapy, then back in the hospital again. She said, “Andrea, I am convinced that taking care of my mother worsened my health. But, I loved her, and I would never change what I did. But, now that she is gone, I really have nothing to live for.” The hospital’s plan was to send Marie home with hospice care. She told me she was impressed with the hospice team that had taken care of her mom, and wanted the same people to take care of her.

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And old saying observes that “Beauty is only skin deep,” but I believe both beauty and better health begin inside and out. Here’s one example why.

I serve as a Geriatric Care Manager for a woman in her late 80s who has no family. Although I regret to take her outside during the cold weather, her medical appointments are a necessity that cannot be avoided. I’ve thought about how tough the frigid Chicago weather can be on anybody’s skin. Since I know my client’s medical history, I keep the following things in mind as part of her elder care planning:

Since she is over 85 years old, her skin is very fragile and rather thin. Therefore, she is subject to two skin conditions:

1. Seborrheic Dermatitis, a skin inflammation that is characterized by areas of dry, itchy flakes that are normally found in oily areas such as the scalp. The condition becomes worse during the cold weather. The condition is caused by yeast that activates skin irritation in cold weather.

2. Psoriasis, another skin condition that appears like a red outbreak with a dry patch on the top. It can appear just about anywhere on the body, but emerges mostly on the elbows, knees, and scalp. I have often seen the psoriasis flare on my client’s legs, and during the dark winter weather, it is much harder to clear up. It is much easier to get the outbreak to diminish when the skin is exposed to some light. The dermatologist treats the outbreak with a combination of topical steroids and an ointment called Calcitrol.

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A friend and I were having a casual conversation regarding the costs of hiring a 24 hour caregiver. Her sister was having difficulty caring for a spouse with dementia. I told her that in the western suburbs of Chicago Illinois, the figure I was quoted was somewhere in the area of $230-$240 per day. Someone overheard me and said, “Oh no, you can get a live in for much cheaper than that. When I hired a caregiver for my parents, they only paid $120 per day.” My response was, “The arrangement you made for them was not through a licensed agency. Trust me, you probably talked to a staffing agency who found you the person that fit your needs. There is a big difference.”

If you are considering home health care for a loved one, the agency should be a member of the Home Care Association of America (formerly the National Private Duty Association). Without going into a lot of detail, the agencies who are members of the association In Illinois hold a license. They adhere to a code of ethics. A licensed agency, in opposition to an independent contractor or staffing agency (as the person I referenced was talking about), is responsible for the screening, training, and back round checks of the staff among other things. Some choose to test test for drug and alcohol use. If you choose to hire an unlicensed caregiver you will be assuming all the responsibilities of an employer, and may have no recourse if something goes wrong. What may appear as savings in the short- term may have long term repercussions as exemplified in the following Real Life Story.

Real Life Story
The client was a woman in her late 60’s. She had a diagnosis of a debilitating disease that left her bound to a wheelchair, and needed assistance with all of her activities of daily living (ADL). That is, eating, bathing, dressing, toileting, transferring, and walking. She needed total assistance from a sit to stand position, a feat that was well-accomplished by one caregiver. She lived in her own home with two full-time caregivers. One caregiver assisted her from the late afternoon into the evening, and supposedly held a nursing degree at one point in time. Yet, she was no longer licensed. The other was an unlicensed caregiver who assisted her from mid-morning until late afternoon. Thus, there was a gap in care from the late evening to the next morning. The caregiver who had the nursing credentials was being paid three times the amount of the unlicensed caregiver. Both caregivers were employed by her for over ten years.

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I have never had a circumstance arise where the wishes outlined in my client’s Power Of Attorney For Healthcare were not carried out by a community where s/he was residing. I am sharing the facts regarding a recent incident that occurred lest it happen to you and your loved one.

I was hired by the child of an elderly loved one who was living in a rehabilitation community (religious affiliated) under Medicare benefits. The child lived out of state and told me that I was to identify the best long term care communities of the same religious affiliation for the loved one. The current community typically did not have a lot of long term care beds available. Placement was to occur once the loved one’s rehabilitation was completed. Spirituality was exceedingly important to this particular senior. The ability to attend religious services was a mandatory prerequisite.

After preparing the necessary research on the communities that fit the family’s criteria, I was instructed to arrange transportation to accompany the senior on the tours of the various communities.

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Happy Holidays to you and your loved ones!

While the holidays can be a time of joy, they are also a time when extended family gatherings may provide us with occasion to notice that an older loved one’s health is deteriorating. As families reunite, celebrate the season, and take stock of the year gone by, they sometimes reflect on the passage of time – and begin to recognize how it might be affecting a senior member.

A sense of fear or worry — exacerbated, perhaps, by the darker winter weather – can then lead families to make rushed and hasty decisions about senior care or senior living options. Later, they hire me when they realize they have made an error.

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According to the National Institute on Aging (NIA), Alzheimer’s Disease is now the most common form of dementia among older persons. Dementia is marked by serious decline of one’s cognitive abilities — that is, the ability to think clearly, remember information, and engage in critical reasoning. More than the occasional “slip of the brain” that all of us experience from time to time (like forgetting where we placed our house keys or when a friend’s anniversary is coming up), Alzheimer’s Disease involves significant damage to the brain itself.

As the NIA explains, the brains of persons with Alzheimer’s Disease will exhibit abnormal tissue clumps (known as amyloid plaques) and/or tangled bundles of fibers (known as neurofibrillary tangles). A third main characteristic of the disease is the loss of connection between neurons, or nerve cells, in the brain.

The US Centers for Disease Control and Prevention report that as many as 5 million Americans suffer from Alzheimer’s Disease. More than half of all Americans know, or know of, someone with Alzheimer’s. The disease is believed to affect some 35 million people worldwide. According to the Global Burden of Disease Study, worldwide deaths from Alzheimer’s disease and other dementias more than tripled between 1990 and 2010. This may not be altogether surprising, as nations advance and more and more people live longer lives.

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