Published on:

by

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.

Continue reading
Published on:

by

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.
Continue reading
Published on:

by

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.

Continue reading
Published on:

by

I had to chuckle because a national advice columnist was asked the following question about a senior who was in apparent need of assisted living services: “My mother-in-law was diagnosed with dementia over a year ago. She can no longer do anything for herself. She can no longer climb the stairs, get to her bed, shower or do laundry. She does nothing all day but watch TV and eat sweets. What can be done for an elderly person who obviously can’t take care of herself but “fakes” it so her kids won’t put her in a home?” The columnist’s answer was basically, “You have my sympathy. Convene a family meeting, and call the Alzheimer’s Association.” Frankly, I found the response to be an oversimplification and glib. While the associations for specific diseases will provide you with excellent sources to begin your research, they will not help you analyze and identify the appropriate option for your loved one. You will still have to complete all the legwork that comes with identifying the appropriate option for your loved one.

Since I’ve already completed the research, why not let me streamline this time-consuming and emotionally draining task for you?

My father had Alzheimer’s disease and was a master at “faking otherwise” when his baby daughter was there to visit, in order to keep her from worrying about him. He was so good at acting that at times I was in denial that anything was wrong with him. However, sometimes the person who has Alzheimer’s becomes so good at “faking it” that the results are detrimental. .

Continue reading
Published on:

by

As you can imagine, I’m often asked how to convince a loved one who has dementia to move out of a home when she or he has refused. The issue is further complicated when someone is ambulatory, somewhat functional, but safety is a concern. If your loved one refuses to move, it is unlikely that you’ll be able to talk him or her into moving anywhere. It isn’t worth bringing up the subject. The person may become upset and dig his/her heels in deeper. The disease prevents the individual from rationally understanding the situation. While each case is different, here are some basic ideas I have seen work for my clients.

  1. Once a community has been selected on behalf of your loved one’s best interests, have his/her physician write orders saying that the person should be admitted for general care and management of a medical condition. The move should be presented as a temporary situation that has nothing to do with your loved one’s mental capacity. Remind your loved one that life for all of us is best lived One Day at a Time, and that nothing is ever written in stone. The move is a step, taken with his/her safety in mind. It is not an “end.” Hopefully once the person is settled, s/he will adjust well and forget prior objections.
  2. Convince the person that the home or apartment is unfit for habitation due to physical problems and have them “temporarily” relocate to the chosen community.
Continue reading
Published on:

by

When I opened my doors in 2006, I began touring and evaluating communities under wrap; meaning, I didn’t volunteer to the admissions director at a community that I was a consultant. I did this because I wanted to see how an outsider would be treated during an unexpected “walk-in”, if the community was a mess from a housekeeping standpoint, and how long I would have to wait for someone to take care of me. All my findings have been duly noted, documented, and shared with my clients.

The practice of “walk-in” tours is a great strategy when you’re conducting your senior living search. In my opinion, your first tour should always be a confirmed appointment with the admissions director. The second tour (you’ll always want to take a second one to confirm your first impressions) should be unannounced. That way, you’ll receive an initial tour from the person who has expertise in the care, features, and amenities that a community has to offer. Many times, the admissions director will have marketing responsibilities that will cause him/her to be out of the building. If you choose to tour at a time when the admissions director isn’t available, you will be handed off to the activity, maintenance, or dietary director. At times, the “manager of the day” is responsible for conducting the tours on the weekends, another time when the admissions director may not be available. Unless that person has been thoroughly trained on how to conduct a good tour, you’ll be on the receiving end of a presentation that’s unsatisfactory. In the end, you may pass on a community that is totally acceptable as exemplified in the following “real life story.”

real-life-story200Real-Life Story

Continue reading
Published on:

by

I often have seniors and their families hire me to find the right community because the senior is lonely and wants to socialize with people his/her own age. The feeling of being isolated and depressed while eating alone is often a major cause for concern. While I empathize with such concerns, I always encourage the senior to sample the food and the “communal dining experience” before signing on the dotted line at a new home. The senior could be eating one to three meals a day at the community depending on the level of care and type of dining program offered. If a senior could be spending up to 30% of his or her time eating, the food better be good. Couple that with table mates who have personality clashes and you could be headed into a situation that spoils the whole retirement experience.

Most of the time, admissions directors are more than happy to have a prospective resident and his or her family members sample the food. However, I recommend that the sampling be conducted during an ordinary meal, rather than during a special event. The food at an event won’t be reflective of a meal that is typically served. I also recommend that the senior be seated with some of the residents during the sample meal. That way, s/he will always get truthful opinions of what the food is really like on a daily basis. It also allows the senior to sample the social setting and resident personalities. Some communities have unassigned seating. Others will purposely mix the residents to prevent cliques from forming at meal time.

Please be advised that independent living and assisted communities may not have a dietician on staff. Many of them note “heart healthy” and sugar free foods on their menus. Then, it’s up to the senior to behave. If your loved one needs a special diet like pureed or mechanical, ask if that can be accommodated. I have even arranged for my nursing home clients who are lucid and contemplating a change in nursing homes to travel to the proposed new home via Medicar to take a tour and sample the food.

Continue reading
Published on:

by

“When choosing a long-term care community for your loved one, make sure his/her care-level needs and financial realities are appropriately assessed.”

Greetings!

As part of my services, I always meet and get to know the person I’m about to place. My past experience as an admissions director of a continuing care community (one offering Independent living, assisted living, and a nursing home on a single campus) taught me how to assess an individual’s mobility and cognitive impairment (if any). An assessment also affords me the opportunity to meet family members, see the person’s current living conditions, and find out the person’s financial realities. All of these factors play an important part in the options I present to my clients. As families who “go it alone” and clients of other service providers have sometimes discovered too late, a mistake in assessing any one of these factors can result in misplacement of a client. This, in turn, can lead to a rapid decline in a senior’s well-being, more serious adversities, and even yet another move – a heartache and inconvenience that no resident or family should ever have to endure. This month’s real life story emphasizes that fact.

Continue reading
Published on:

by

Greetings!

The holidays are a cherished time for families to be together – a time to make new memories and to celebrate the past. The holidays are also a time when family members might notice that an older loved one is declining physically or mentally. For example, the onset of winter weather might make a senior’s physical limitations more evident or more worrisome. Gradual changes that were not obvious to nearby family members over the past year might be very apparent to a visiting relative. Suddenly, family members might be aware that they have entered yet another new season in life: a season of care-giving and or long-term care planning. This is when I can help.

Over the past four years, I’ve been blessed to be able to help many families place their elderly loved ones in a community that matches their medical needs and financial realities.

Continue reading
Published on:

by

Three weeks ago, my mother had what appeared to be a stroke, followed by a TIA, and a urinary tract infection. She was taken by ambulance to the nearest hospital, which in the case of an emergency is required by law. Her primary care physician was not on the staff at that hospital. Due to her frail condition and lack of a private room (my mom’s request) at her regular hospital, we did not move her. After she had been staying in the hospital for two weeks, I arranged for her transfer to a skilled nursing community for rehabilitation. I must admit, I felt uneasy and alone because her primary care physician was not in command of her health care.

When you move your loved one to a skilled nursing community for rehabilitation or a long-term stay, be prepared for the possibility that his or her primary care physician will not, or will not be able to, follow them. Your loved one will be giving up a long-term emotional and psychological relationship with his or her physician. Most of my clients don’t seem to be concerned with keeping their loved one’s physician. You should be concerned!

Luckily, my mother was in a community where the Medical Director was on site every day. When she did not see my mother, the doctor had a nurse practitioner who would follow up with her patients. Some of the physicians in other communities do not visit the patients more than once a week. Many of the physicians on nursing home staffs visit less than once a week. The new doctor’s routine, bedside manner, and educational background may not be in accordance with what your loved one is used to, resulting in patient dissatisfaction.

Continue reading