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When I placed my mother in a long-term care community at the age of 95, the cost of her care in assisted living was about $6,000 per month. That was over 3 years ago. Now the cost of assisted living can run between $6,000 to $9,000 per month depending upon how much help a person needs and which community is chosen. Skilled nursing care can run $9,000 to $17,000 per month depending upon the community.

My mother purchased her policy in the 1980s when long-term care insurance was a newer product on the market. She asked me if I thought the purchase was a good idea, and I said, “Absolutely!” What she purchased was a policy that paid $100 per day, up to a maximum of $143,000. She had a 90-day waiting period, which meant she had to pay the first three months of her care out of her own pocket, or $18,000. She didn’t purchase an inflation guard rider, which would have increased the benefit by several percentages on an annual basis in order to keep up with inflation. Therefore, the policy covered a little over half of what her care cost on a monthly basis. She had to pay the balance of $2,500 a month out of her pocket.

Now, there are different types of long-term care insurance available. Some are traditional like the policy my mother bought. Others are hybrid products that consist of life insurance products with a long-term care rider. In any event, trying to self-fund a stay in a long-term care community can be devastating. Illinois is one of the toughest states in which to obtain Medicaid, which is the federally funded and state administered coverage for people who do not have the funds to pay for long-term care. Because the State of Illinois is so far in arrears with reimbursing nursing homes for Medicaid recipients, many nursing homes have de-certified the number of Medicaid beds they have available. Many nursing homes are also look for a resident to pay between 1 to 2 years privately before filing a Medicaid application. Therefore, Medicaid isn’t a resource to be relied upon for long-term care. In addition, Medicare only covers short-term stays in a rehabilitation skilled nursing community.

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A lively discussion about gun control with friends and siblings brought back a memory about an instance a case where an adult with dementia and other psychiatric issues endangered the life of his spouse of over more than 50 years.

My client hired me because her husband had been hospitalized at one of the local geriatric-psychiatric units. He had a habit of wandering away from the house unbeknownst to his wife, only to be re-directed home by one of their neighbors. He abused his wife verbally and threatened her.

My client’s husband had been a gardener and a gentle man who enjoyed engaging in outdoor activities. This included chopping firewood in the backyard. During one of his tirades at home, he chose to go into the garage, find his wood chopping axe, and threatened to kill his wife with it. Fortunately, his children intervened and at that point he was taken to the psychiatric facility for observation.

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My client is the lovely granddaughter of a woman who was 99 years old when we met. They are of the Jewish faith. The granddaughter had contacted me over concerns that her grandmother was running out of money while living at home and paying for 24-hour caregiver services. The services were primarily for companionship, as she could handle on her own most of her activities of daily living (i.e., bathing, dressing, transferring, toileting, walking, and eating). The woman’s financial advisor had given her several warnings that she needed to move before her funds were depleted. We made arrangements for me to meet my client’s grandmother to do an assessment.

During our meeting, the grandmother insisted that she didn’t want to be in a Jewish retirement community. Apparently, she had been in a Jewish organization for rehab. once before and the stay didn’t end well. Grandma told me her plan was to stay at home until her 100th birthday. Home was located in a far south suburb. The location of her home made it very difficult for her granddaughter to visit, as she lived in the north side of Chicago. She didn’t have a car and had to rent one every time she visited her grandmother. Every time I mentioned a potential move, Grandma would swing the conversation toward one of the many artifacts she had collected during her life’s travels. During our conversation, she also said she wanted to remain out south because she wouldn’t know anyone if she made a move up north. She insisted upon moving to a particular community she had in mind. However, it was not a good idea from a safety standpoint, as the neighborhood was changing – and not for the better.

I went to work and narrowed the options to three assisted living communities that were close to the granddaughter. She toured all three, and narrowed the options to 2 places that she felt could work for her grandmother. I arranged a tour for the grandmother at one of them. Grandma seemed rather stoic and resistant during the tour. After the tour, we went to the famous Superdawg drive-in for hot dogs which we proceeded to consume in my car. While we ate in silence, I decided to ask her, “Well, what did you think of the place?” Grandma look at me and said, “It was a little to goy for me,” which I loosely interpreted to mean that it was too non-Jewish. The granddaughter and I looked at each other since Grandma had previously insisted that a Jewish community wasn’t important to her. She also told us both nicely that she had no intentions of moving until her 100th birthday was over.

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I lost my husband to cancer of the appendix in April of 2015. I had been a member of the local chamber of commerce in Riverside, Illinois, and chose a funeral director that I knew because he was president of the chamber. When I called him at 6 A.M. the morning after my husband’s death.  It was pretty obvious that I woke him up. Yet, he was cheerful. He told me to come over any time after I was showered, and he would have coffee waiting for me. From the moment that I explained the type of arrangements that I wanted, he didn’t ask me any questions. He took the entire awful process out of my hands, and everything went very smoothly. When my parish priest refused to accommodate the time I was requesting for the ceremony, he even called another Catholic church and arranged to have the ceremony there.

As part of the services offered by Andrea Donovan Senior Living Advisors, I often have arranged funerals for my clients if I am named as the senior’s Power of Attorney for Health Care. In a case I was involved with recently, my client had pre-arranged her own funeral, but was very confused as to what she had purchased. I called the funeral home and asked a representative to come out to explain the contract. I shared the contract number with her and asked her to be prepared to explain any charges that still needed to be paid, and to bring the necessary paperwork.

The funeral director showed up half an hour late to the meeting, claiming that she thought it was a half an hour later. In addition, she muddled through some kind of explanation as to why my client needed to sign some burial insurance form in order for the contract to pay, then proceeded to tell me she brought the wrong paperwork. Faxed or scanned documents were unacceptable, so this resulted in having to set another meeting to sign them.

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I recently had the wonderful opportunity to be interviewed on the Silver Solutions Radio show. It airs on WMRN 1410 AM in Elgin, Illinois. It is hosted by Jeanette Palmer, Jim Wojchiechowski, and Kathleen Wetters, who each independently own a Right At Home non-medical home care agency. During the interview, they graciously gave me a chance to explain how I started my career in the senior housing industry as the Admissions and Marketing Director of the St. Andrew Life Center (Now Glen St. Andrew) in Niles, Illinois. It was a faith-based community that offered three levels of care, including independent living, assisted living, and a nursing home on one campus. I was receiving so many telephone calls (mostly from the children of seniors who were calling me from the Yellow pages) from people who didn’t know how to solve their senior loved ones’ problems. I saw a niche for a consulting business. So in 2006, much to my husband’s dismay, I opened Andrea Donovan Senior Living Advisors in 2006.

I started my senior housing placement consulting business by touring and evaluating over 150 senior living communities in the Chicago metro area. I looked at cost and methods of payment accepted, levels of care, staffing, and quality of care. Then I also evaluated quality of life factors such as cleanliness, menus, activities, and apartment and room layouts. So, when a family needs my services, I make a face to face evaluation of the senior, their financial realities, and the location preferences of the family. Then, I select the options that fit the senior’needs so families aren’t wasting time touring places that simply won’t work long-term.  At this point I have toured and evaluated close to 500 senior communities in the Chicago metro area.

We also shared a very frank discussion about the costs of placement in a senior living community versus the costs of staying at home in the Chicago metro area.  We talked about the advantages and disadvantages of each option.

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The holidays can be a profoundly stressful time for a Person With Dementia (PWD) and his/her family members. To avoid even more stress and any potentially awkward or embarrassing situations, family members who don’t know about the PWD’s diagnosis should be made aware of it. That way, you will avoid any shock and/or inappropriate remarks when your Uncle Fred decides to pipe up and exclaim, “Hey, why are you acting so weird?!”

Many years ago, I was driving my parents to Wisconsin to visit my maternal grandmother. My dad was sitting in the front seat of the car with me. He used to read the daily newspaper from cover to cover. So, I wasn’t surprised to look over and see him reading the paper during our trip. Dad also had a marvelous sense of humor. So, when I glanced over and saw him reading the newspaper with his sunglasses on, and upside down, I giggled and said, “Very funny, Dad!” But then I saw that he really wasn’t comprehending what I was saying. When we arrived in Wisconsin, I noticed that he needed a lot of help to get out of the car and eventually to the hotel room. I addressed my mother indignantly and asked, “When were you planning on telling me about this?” She replied, “I just didn’t want you to worry.” So, what would have been a better approach? Was it better to cover up the situation and let it rear its ugly head at a time when I didn’t expect it? Or should she have told me?

This season, if you intend on taking your Person With Dementia to a holiday party, plan to keep the visit short. Parties with a lot of people, flashing lights, noise, and kids, etc., can be very overwhelming. It is a good idea to have a family member assigned to stay with the PWD so that he or she stays engaged and does not withdraw. Look for a quiet room where the person can retreat to if he or she becomes overwhelmed. Or you may want to avoid parties all together and have family members visit the person at home in smaller numbers. If you have recently moved your loved one to a long-term care community, it probably is not advisable to take the PWD out of the environment to which he or she is just getting accustomed. All of the communities will have some sort of holiday get-together that family members can attend. Dementia is an unpredictable disease, so it is best to avoid behavioral issues from the get-go.

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The worst part of my business is that I sometimes have to say “Good-bye” to my favorite clients. In the past several weeks, I have had two favorite clients pass away, and one move out of state to be closer to her son. Today, I am going to share a story about one of my clients, whom I am going to call “M.”

“M” was in his early 70’s. He was a former states attorney, who was hired personally by the late Mayor Richard J. Daley. M was extremely eccentric and opinionated, and some of the things he said made me laugh so hard that I cried. He had opinions of politicians no matter which party they belonged to. He had been educated by Jesuits from high school through law school and hated everything that happened in the Catholic Church after Vatican II. He had never married, lived with his recently deceased mother, and cherished an overweight, 6 year old Dachshund that was not housebroken. (Therefore, the dog did its business anywhere in the house). He told me that if anything were to happen to him, the dog was to be taken to a woman who ran an animal shelter in her home up the street. He didn’t put this in writing. His estate was left to a charity. He had named a trust company as his Power of Attorney for Property. I was referred to this gentleman because he had very bad experiences with a non-medical home care agency. After a stroke in spring 2017, he amassed a bill for more than $200,000 in charges for 24-hour care provided by the agency. After reviewing the bill, I found some of the charges to be extremely excessive. I was hired in January of 2018 to help find a new home care agency for him and pay his bills. After bringing in 2 agencies for him to interview, he confided that he had hired some caregivers privately at a much lower rate.

As I put together M’s big financial picture, I found that his money was at a bank in a number of CDs valued over $500,000. He had checking accounts in two banks, an IRA, a pension, and a vacation property in Wisconsin. He had a habit of running down his checking accounts to the last penny, even though he had plenty of money. When I suggested that a financial advisor should be called to “pull everything together and maximize earning potential,” M replied, “No, because they will make me sell the property in Wisconsin.” Please note that M was not in any physical condition to be using a vacation home. Nevertheless, I backed off. However, when I would give him advice, he would acknowledge me with a traditional, “Yeah, I know.” As time went on, M trusted me more and more. Eventually, he asked me to attend his doctor appointments with him and become his advocate. He had signed a Power of Attorney for Health Care with another entity in 2017 that never had any contact with him, or knew anything about him. I was named, however, as Power of Attorney for Property at only one of the banks where his CDs were placed and came due. I would then cash them in. In other words, I was effectively the only person who knew what was going on in his life. Did he have relatives? Yes, but he wanted nothing to do with them!

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My clients were a very pleasant, alert, 90 year old woman and her son. The son had been gainfully employed by a major corporation and had been transferred to a state out west. He liked the new location very much and remained there once he was retired. His mother had lived here in the Chicago area all of her life. When she could no longer take care of herself, the son chose to move her to an assisted living community here. She had lived in the suburbs all of her life and wanted to be in close proximity to the cemetery where her husband was buried. She had an excellent support system here, consisting of many personal friends who visited her and members of her church who came to give her communion at least once a week. In addition, the son hired me to act as her advocate for several hours a week. His long-term plan was eventually to find a senior living community for her out west where he was living. In the interim, he wanted me to monitor the visits from the nurse who was tending to a wound on his mother’s leg, ensure that her hearing aids were charged, make certain she arrived at her ophthalmologist appointments, and see that her mind was being occupied by decent activities and going outside.

At first my elderly client was rather wary of me. But we developed a wonderful relationship. She was very frank with me with regard to the staff at the local community. She was in the assisted living area of a Continuing Care Retirement Community (CCRC), including independent, assisted, and nursing home living, because she needed standby assistance with bathing, dressing, and putting in her hearing aids. On occasion she needed to use a wheel chair for long distances, and was in need of 24-hour supervision. However, she complained of long waits when she pushed her wrist pendant for summoning help. She said that when she did get help, some of the staff members were nice and others were not. She often mentioned to me that the activities were not very interesting. She told me she didn’t complain to staff or to her son because her son tried so hard to do a good job. She did mention that the food was wonderful. Overall, I got the impression that she was just putting up with things and would like to be happier with better staffing and activities.

The son eventually contacted me and said he found a new community for his mom out west and gave me the dates of her departure. I met with the son and his mom to say good-bye. The son told me that his mom was going to be living in an independent living/assisted living/memory care community. He explained to me that the independent living and assisted living residents lived in the same area in the new community because state law prohibited them from being separated. He expressed concern over the potential wait time involved when she pushed her pendant button. I asked him if he had asked what the ratio of staff to residents was and he replied “No.” I asked if he had checked the activity schedule for the types of things that might make his mom happy. I did not receive a clear affirmative answer. Since his mother loved the food at her original, local community, I asked if he had tried the food at the new community out west. Again, the answer was no. When I asked why he went with a community that lacked a nursing home component, he said he was told that any of the services she needed could be brought into her apartment. I’m not certain he was aware of how astronomical the costs of ordering ala carte services into an assisted living apartment can be.

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In this month’s newsletter, I share with you advice from my colleague Renee N. Duba, a certified financial planner with Sonder Private Wealth Management. Inc. In a recent article about the impact of inflation on purchasing power, authors at Sonder observed that, in 1916, nine cents could buy a quart of milk. Fifty years later, nine cents would buy only a glass of milk. Now, more than 100 years later, nine cents will buy only about 7 tablespoons of milk. That’s a different and yet very vivid way of looking at long-term cost increases, of which we’re all aware. For details on how inflation affects seniors, in particular, I have invited Renee to share with us the following information about retirement and Medicare.

While the United States has not seen skyrocketing prices for basic goods and services for many years, it is important for families to understand how inflation affects long-term financial security. Most adults recognize that rates of inflation for education and healthcare run much higher than the overall rate of inflation in our economy, as measured by the Consumer Price Index (CPI). Yet, while the funding of education for our children is a finite endeavor, funding our healthcare needs is not. Like an old car that has ever-increasing repair needs, our bodily health tends to require ever-increasing health care consumption as we advance in years.

Healthcare costs in the United States are the highest in the developed world. For example, the U.S. pays more for doctors and drugs than in 10 other developed nations. On average, Americans spend $1,443 per person on pharmaceuticals, compared to a global average of $749. As a certified financial planner, I wish to enlighten ADSLA’s readers specifically about Medicare Parts B and D, their long-term impact on your retirement income, and how you can best plan now to achieve financial security during your retirement years.

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After I have completed the task of finding the perfect senior living option for a senior loved one, many of my clients are faced with selling the senior’s property. I have asked my colleague, Senior Real Estate Specialist (SRES) Roz Byrne, to offer advice on that subject:

It’s an age-old question, and as we age it gets even trickier to determine how much work or money we should put into our homes.

When it’s time to sell the family home, seniors’ homes tend to present themselves in one of three ways:

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