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Whether you are moving your loved one into a high end assisted living community or a nursing home that will eventually accept public aid, it is mostly a heartbreaking event that is stressful for the senior and their family. Because it is such an emotional event, you need to be careful with what you promise to your loved ones who are lucid. Please read the following Real Life Story and you will understand what I mean.

REAL LIFE STORY I was hired to coordinate the transfer of and elderly loved who had children in the south suburban Cook county area of Illinois and a child living out of state. They had filed an application at one the supportive living communities. They had experienced some communication problems with regard to the admission and asked me to step in and expedite the process.

I always do an assessment of every senior that I place. When I went to conduct the assessment, I found the senior was not appropriate for supportive living. Here is a quick review of the type of care the supportive living program provides:

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For the first time in the seven years that I have been a senior living advisor, I actually told a prospective client not to move their loved one out of the current long term care community. About 50% of my clients come from the children of elderly loved ones who “did it themselves” the first time around. The result is often placement at the wrong level of care, or at a community that “looked nice,” but delivers poor care. This time, I actually discouraged my prospect from making a change.

The elderly loved one had been placed at a county facility and was paying privately. If I had done the initial placement, I probably wouldn’t have selected it as one of my top three choices. However, the community has a respectable reputation. The senior had begun rehabilitation in the short term rehab. unit. After the senior hit a plateau under Medicare, the decision was made to keep the individual in the long term care area.The family expressed concern over the fact that the staff was much smaller in the long term care area versus the staffing in the short term rehab. unit. Staffing is always better in the short term unit in opposition to the custodial care that the residents receive in the long term areas, a fact that the family was unaware of.

They also told me that they were disappointed that the staff appeared disinterested and was not “engaging with” their loved one. My answer was that most of the communities are understaffed. Nursing home care is not one-to one care, a fact that many of my prospects don’t understand until I explain it to them. On the average, a loved one could be sharing a certified nurse assistant with nine other residents, another fact they were unaware of. I explained if the expectation was to “engage” their loved one, they should hire a companion from one of the licensed home care agencies.

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In this past week, I have had many clients approach me with long term care placements involving potential shortages of funds. All of them were approaching what I call the long-term care “black hole.” Let me explain exactly what I mean by that as it will vary according to the level of care your loved one needs.

If your loved one needs skilled nursing care the costs in Illinois run about $6,000 – $9,000 a month. Some of the Alzheimer’s or dementia units can cost more. Right now, It is taking Medicaid (The Federal program designed for those who cannot pay for long-term care and administered by each state) close to a year to reimburse the nursing homes for residents who are participants in the Medicaid program. Therefore, most of the nursing homes want to see a resident pay privately for a year before submitting an application for Medicaid. Even the nursing homes that deliver less than desirable care are not making access to public aid easy. So, the bottom line is, if your loved one going to need nursing care, you should try to set aside at least $72,000 for their care if you’d like them to enter a better nursing home . If your loved one has less than that, they are in the black hole. You should expect some difficulty with the placement.

In the case of skilled nursing care, the number for the black hole is much easier to quantify. If your loved one needs assisted living, the amount of funds needed is more difficult to pinpoint. That’s because you have no way of knowing how long your loved one will remain at that level of care. Assisted living in Illinois can run $3,500 to $6,000 a month. I have seen some of the memory care units run as high as $7,200. You will have to make some financial assumptions if your senior may need nursing home care down the road.

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I have been reading a number of articles that sing the praises of senior move management companies. During the past several years there has been a huge influx of people entering into this aspect of the senior living industry. These organizations don’t act as the actual movers. They are actually general contractors who will hire the moving company, sort out which items the senior will take to their new home, and donate the excess items to charity.

As a senior living advisor who has been in the business for seven years, I know which organizations are reputable. pleas be advised that there is currently no organization who grants accreditation to these organizations and there is no “good housekeeping seal of approval.” I encourage you to do your due diligence in researching these organizations lest you have an experience like the one I will relate in my Real Life Story.

Real Life Story

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I attained the designation of Certified Care Manager issued through the National Association of Certified Care Managers. I can help by acting as a neutral third party when difficult family issues involving a senior arise and connect people with appropriate medical and non-medical services.

Here are some of the services that I generally provide in order to assist the families of seniors:

1. I meet with the senior and their family in order to perform an assessment of the senior’s cognitive and functional capabilities. I also assess his/her physical environment and support systems.

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I was recently contacted to conduct a placement for a gentleman who has alcoholic dementia, also known as Wernicke-Korsakoff’s syndrome. The affect of years of chronic alcohol abuse causes loss of short-term memory. The disease usually affects men between the ages of 45-65 who have a history of heavy drinking. The disease affects women too, and the age group is normally younger than men.

You can’t actually diagnose the disease until after the individual quits drinking for a period of several weeks so that the affects of intoxication or withdrawal can subside. Normally, a number of tests will follow including those that are medical and psychological. If the condition continues to worsen, a diagnosis of dementia, such as Alzheimer’s may follow.

When you are faced with a crisis situation, like the instance I will share in my Real Life Story,

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As a Certified Guardian, I am often asked to act as a senior’s Power of Attorney for Health Care when s/he doesn’t have a family member who is willing or fit to act for him/her. Simply stated, the Power of Attorney for Health Care grants the designated “agent” control over the senior’s decision-making, including end-of-life decisions if the senior lacks the capacity make the decisions on his/her own. As a Power of Attorney For Health Care, you should be thoroughly familiar with a senior’s personal, financial, and medical history before accepting this serious responsibility. Please read the following real life story that makes my point.

REAL LIFE STORY

My client is an 85 year-old woman who had been living independently. I was called at the last minute to act as her Power Of Attorney (POA) For Health Care the day before she was to move to independent living at a retirement community. Independent living means that the senior can basically function on their own with some assistance with meal preparation and housekeeping. The woman’s former POA had moved out of state and had written her a formal letter of resignation. A trust company had been appointed to act as her Power of Attorney For Finances. All of this occurred about three months ago.

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As a senior living advisor and Certified Care Manager, I always conduct a face to face assessment of my client. This gives me an opportunity to evaluate him/her from a cognitive and functional standpoint. I observe the environment s/he is living in, talk with the family about the individual’s personal history, finances, and support system. That way, I can make an assessment of how I can improve the senior’s quality of life by recommending services that allow them to remain at home (That is, via the most economical and efficient services). Or, I can help them ascertain whether placement in a community would be more appropriate. In either case, I always include the senior in the care plan if they are able to participate. Just as I do my “in person” due diligence, you should do the same when researching senior living options. Here is what you should expect if you rely on the internet as a credible source of information:

1. I recently used Google to research the words “Chicago nursing homes.” I received over 44,000,000 returns. When you look at the websites for long term care communities, they rarely give you in depth information, and the prices are almost never listed.

2. Some of the websites will show the viewer the most newly decorated or beautiful areas of the property. They neglect to show the overall big picture. I have arrived at many of these organizations to find that the pictures on the site were no reflection of what the community was really like. Conversely, some of my clients have looked at the sites for the communities I have recommended to them. One my my clients reportedly logged on, and told me she was disappointed with how dingy and oppressive they looked. In truth, the facilities were beautiful and the pictures that were posted didn’t do them justice.

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I have been involved in two recent cases where I was hired to provide a second opinion to seniors who were seeking to move to a Continuing Care Retirement Community* (CCRC) in Cook County of Illinois. I wasn’t surprised to learn during my initial consultation that neither of them knew how to differentiate between the types of contracts that were available. I have listed a summary of each type of CCRC contract below and a broad definition of the entrance fee that grants access to them:

Entrance fee – An amount of money that allows a senior admission to the community and guarantees the future health costs of all the residents that reside there. A portion of the fee can be refunded to the individual or his/her estate if s/he moves out or passes away. The money is usually not refunded until the unit has been re-occupied, which is a fact that most people aren’t aware of.

Type A Contract -This is referred to as a “true” Life Care contract. Certain types of care are included in the CCRC’s contract for individuals who enter the community at the independent level (ie. the senior can care for themselves) and have passed the requirements of a financial application. Monthly fees don’t increase as a result of moving to a higher level of care such as assisted living or skilled nursing, except for the cost of extra meals and other personal expenses. If you have a member of a couple who requires the higher level of care, but the other does not, one can remain in the independent living area while the other moves to the higher level of care. The couple continues to pay only for the monthly fees charged for independent living. For example, a couple enters at the independent level and the monthly fee is $2,000 per person. One of them suffers a stroke and needs to move to the assisted living area. S/he is still only responsible for the $2,000 fee plus the cost of extra meals and expenses. The person remaining in independent living pays $2,000 as well. This is a wonderful contract as the costs of future care is predictable!

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This is a question that is asked of me and often causes controversy among the families that I serve. My goal is to find the best answer, and every situation is different. In the seven years that I have owned my senior living business, no two cases have been exactly alike. However, when a senior is still capable of making his/her own decisions, s/he almost always wants to remain in the home as long as possible. The only exceptions to the rule are if a senior is lonely and wants the socialization of being in a community, ot if medical issues no longer allow the senior to remain at home, or s/he can no longer afford the luxury of in-home care. Placement in a community is often the second choice to remaining in the home and normally arises when the senior is exhausting their funds. However, caution needs to be taken with this strategy, as many nursing homes are requiring a year or even two years of private pay before a person is admitted. This insures against the immediate filing of a Medicaid application, which can take up to a year for a resident’s reimbursement.

If you have a senior loved one who may need some help with his or her activities of daily living, I share below the ballpark figures for non-medical home care and long-term care community costs in the Cook, Will, Dupage, Lake. and Kane Counties in Illinois.

Non-Medical

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