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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. .

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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.
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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

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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.

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“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.

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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.

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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.

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“Prepare for your loved one’s transition from the hospital to a long-term care community.”

Four years ago, my mom, who is 88 and a registered nurse, had a triple bypass with a valve replacement. The hospital staff informed me that their transitional care unit was full and I would have to find a rehab community for her. As I was searching, I asked myself, “What if something goes wrong and she can’t return home?” As I narrowed my search to three options, I was mindful to choose places that could accommodate her needs long term.

As it turned out, a bed opened up in the transitional unit. She completed several days of her rehab. Then she complained it was too noisy, disagreed with the staff over her course of treatment, called my sister to take her home, and had herself discharged. So much for my worries about her returning home.

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People often ask for my opinion of the 5-star nursing home rating system that was instituted approximately two years ago by the Center for Medicare and Medicaid Service. The system is a comparative tool that assigns nursing homes composite rankings from 1 (below average) to 5 (above average). Rankings can be viewed on www.Medicare.gov. The scores are determined by a combination score based upon three items:

  1. The results from the annual inspection from the Illinois Department of Public Health
  2. Quality measures
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“Be certain that a community’s definition of “assisted living” meets your loved one’s needs.”

Greetings and best wishes for a wonderful summer! I’ve been blessed with a lot of assisted living and nursing home placements, completing my National Guardianship Certification, fishing, and playing some fun golf games, although at times my game is truthfully awful!

While there may or may not be much hope for my golf handicap these days, it is good to know that there is plenty of help available for making good senior placement decisions. However, when it comes to choosing the right assisted living community, please be very mindful of the community’s definition of “assistance.” According to the Assisted Living and Shared Housing Establishment Code in the State of Illinois, an assisted living community needs to fulfill three criteria:

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