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One of the facts that I always impress upon my prospective clients is that the aesthetics of a community do not necessarily reflect the quality of care that’s delivered by its staff. Recently, several of my clients indicated that they thought aesthetics and quality of care are directly related to one another. This correlation is not necessary true. Appearances can be deceiving, which is why I am privileged to serve families at their time of need.

Choosing an appropriate alternative living option for a senior loved one is a process that must be conducted with compassion and vigilance. At times, the decision must be made in a rush due to a life-changing illness or event with the senior. There is often guilt involved on the part of the relative or friend who has to make a placement decision. Of course, they will want the community to look attractive and inviting.

Because you are often in a rush when an elder crisis occurs, you need to carefully scrutinize costs and method of payment, quality of care, level of care, housekeeping, location, activity/ transportation schedules, and personal preferences like food and religious preference. This is a lot to analyze in a 30-45 minute tour. Do not let the smell of potpourri or the sight of pretty wallpaper distract you from making a rational decision. The ability of the community to meet your loved one’s medical demands, programming needs, and financial realities need to drive your decision. What you want for your loved one and what is available may also be two different stories. Please try not to judge the book by its cover.

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Here is a snapshot of the long-term care options available and their approximate costs. Not only can Andrea help you place your loved one in a facility that meets your needs, she can also evaluate your friend or loved one to determine what type of care is appropriate.

Independent Living Communities – The senior can function on his or her own, but may receive help with housekeeping and meals. The cost runs about $1,500 to $3,000 per month, depending upon the community.

Assisted Living – The senior needs help with some of his or her activities of daily living (ADLs). This includes help with bathing, dressing, toileting, transferring, eating, escorting and assistance with medications. The estimated cost is $3,800 – $6,000 per month. It is not “hands-on” care; it is “standby” assistance.

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My client had travelled to Florida to bring her parents back to Chicago to live. On the way home, my client’s elderly father suffered a heart-attack in the car and died in a hospital in Tennessee. To make matters worse, this happened over the Thanksgiving holiday.

My client’s mother has mid-stage Alzheimer’s disease. My client had no idea how much her father had been doing for her mother until she moved her in with her family. After a while, the tension started to mount. My client’s mother would often ask to be sent back to Florida or ask to move to a retirement community. At her mom’s request, they looked at one community and liked it. But they wanted a second opinion and hired me.

Upon visiting with my client and her mom, I realized that the community they visited would be inappropriate for her in the long-run. It didn’t offer any activities that were geared toward mid-stage Alzheimer’s disease. The choice was either to attend the activities for the regular assisted living residents or participate in the activities offered in the locked unit where she eventually might have to move. There was nothing offered for those residents who fell in between those two categories. I was able to place her in an assisted living community that offered a structured program geared toward mid-stage Alzheimer’s. The program is much like adult day care with mind-stimulating activities. These are conducted under the guidance of a team leader. But, unless you have thoroughly investigated the available programs, the average consumer would never be aware of their existence. If my client’s mother needed to move to the facility’s more secure, higher level of care section, there would be no change in price. I was also able to negotiate a two-year rate guarantee.

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My client is 85 years old and a former resident at an independent living community that fits his very limited budget. He is ambulatory with a cane, but uses a scooter when he becomes tired. He takes medication for depression. He is fortunate to have a very devoted nephew, who religiously visits him several times a week and takes him fishing (weather permitting). This nephew noticed that his uncle’s physical appearance was deteriorating, and he wasn’t keeping himself or his apartment clean. His personality, which was normally pleasant and gracious, was becoming cantankerous.

One evening during a bingo game at the independent home, my client was involved in a disagreement with another resident. An argument developed, and they began to threaten each other with their canes. The police were called, and my client was issued a ticket for disorderly conduct. He was also given a letter of dismissal from the management.

His nephew didn’t know what to do. He and his wife both work and didn’t have the time to research and find an appropriate community. He informed me about his uncle’s declining physical appearance and the disorderly conduct incident. I told the nephew that it sounded like his uncle just needed some help with taking his medications, bathing, and dressing. I was able to find three supportive living communities within reasonable distance of the nephew’s home. I arranged for a determination of needs screening through the appropriate senior agency, which is a requirement for support through the Medicaid program. The family chose a home that was within five miles of the nephew’s home. When I checked back with the nephew to see how things were going, he told me, “He’s very happy, the care and staff at the home are great. Your services were worth every penny!”

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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

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Prospects will often call me and open the conversation by saying something like, “My mother needs some assistance.” A statement such as this one can mean anything. Assisted living actually means the next level of care that is necessary when the senior is no longer completely independent. Specifically, he/she needs some help with activities of daily living: eating, bathing, dressing, walking, transferring, and toileting. This is not hands-on care. It is stand-by assistance. For instance, the aide will not give a loved one a full bath or shower. The aide will stand by and watch the senior take their shower. The aide will hand the senior the soap and towel. The assistant will not scrub the person down. People have a lot of misconceptions as to what “assisted” really means.

According to the Assisted Living and Shared Housing Establishment Code in Illinois, the personnel requirements to qualify for assisted living are:

  1. There must be someone age 18 on the premises for 24 hours
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I attended a networking breakfast that was organized for professionals involved in different areas of the senior industry. I was asked by the leader to share the greatest challenge that I was currently experiencing with my business. I didn’t have to think too long to respond.

Over the past year or so, I have witnessed my nursing homes engage in the process of converting entire floors to short-term rehabilitation units. Short-term rehabilitation costs are covered by Medicare. Without going into great detail, Medicare covers the first 100 days of short-term rehabilitation after a three night qualifying stay in the hospital. It doesn’t cover long-term custodial care, which many people don’t understand. Short-term rehab is where nursing homes are currently making their money. The tendency is to admit the senior and rehabilitate him or her until a plateau on the therapy is reached. The senior is then discharged and it’s on to the next person.

So what is the impact of facilities converting entire floors to short-term rehab? Many of the nursing homes making this change are not currently accepting any long-term residents. The long-term residents who currently live in the community are slowly being transitioned from their current floors and moved to another floor. So now there is a shortage of long-term beds at selected communities. The certification change to short-term beds results in not only a smaller number of long-term beds, but fewer beds that are certified for Medicaid (public aid).

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As a former Admissions Director of a continuing care retirement community (CCRC),* it was my responsibility (along with the community nurse) to assess prospective residents for placement in the appropriate level of care. During many consultations with my clients, I’ve found that people often don’t understand the different definitions of the levels of care that are offered by long-term care communities. Here are some very basic, broad definitions:

Independent living – The senior can perform all of the activities of daily living** on his or her own. S/he may want/need some assistance with meal preparation and housekeeping.

Assisted living – The senior needs help with some of the activities of daily living. It isn’t “hands on” care. It is normally stand by assistance. For example, a senior may need some assistance with a bath or a shower. However, the aide will hand the senior the wash cloth and soap and perhaps help wash any part of the body the senior cannot reach. It isn’t a full scrub down shower like those provided in the nursing homes. However, I will place a caveat on this definition. There are some assisted living communities that are based on a medical model where more “hands on” help is offered; e.g., the person needs total assistance getting in and out of bed. The presence of a nurse and his/her functions will vary according to each assisted living community.

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A Real Life Story

I am currently advising an elderly couple who recently chose a beautiful apartment in a continuing care retirement community. The items on their retirement community “wish list” included the following:

  1. The apartment had to be no less than 1000 square feet.
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During the latter stages of Alzheimer’s disease, it is common for individuals who are bilingual to revert to speaking and understanding only their original, native language. An event such as this can present challenges as described in the following Real Life Story.

Real Life Story

My clients are the daughters of a seventy-two year old woman with the latter stages of Alzheimer’s disease. The daughters live in Chicago, another U.S. city, and a city overseas. Their mother is a native Spaniard who is totally ambulatory and incontinent.

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