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My clients are a couple ages 78 and 80. The couple’s daughter had called me and tearfully related the story of how her parents were looking at senior living options, most of which would not fill their long-term needs. Like many of my clients, they had lost a significant amount of money in the most recent economic crisis, and they were living in a condominium where they could not afford to stay. The daughter feared that they would run out of money and be forced to move to a Medicaid community in the future. She pleaded with me to call her mother and set up an appointment to talk to them.

When I called, her mother curtly told me that they were still driving, had their faculties, and were able to evaluate the senior living communities on their own. Furthermore, they couldn’t afford services like mine. I assured her that I have lots of flexibility with the way my services are structured, and I could design a consultation that fit their budget. She said “no thanks,” and hung up.

When I relayed the situation to the daughter, she said that she would convince her parents to set up an appointment with me. To this day, I don’t know what the daughter said to her parents, but within a few days, I had an appointment set.

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Many times my stories revolve around the child of a senior who hires me to solve a parent’s senior living problems. The terms of my real life story are a little bit different this time.

My clients were a couple ages 80 and 78, respectively. They lived on the east coast, but grew up in the Chicago metro area. Like many grandparents, they wanted to move back to the Chicago suburbs to be closer to their children and grandchildren.

When I met with this couple, I was pleased to find two very polished, excessively independent individuals. One member was still working in an artistic capacity. They were more than open to sharing their financial realities with me. Their annual income was more than ample, and their net worth was well in excess of $1 million. They also had long-term care insurance.

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Assisted living communities that have a memory care unit are supposed to be adequately staffed with assistants and aides who are educated to deal with the behaviors of dementia residents. The habits of these residents can often be repetitive and endanger the resident if they are not closely watched. Many residents “sundown” in the evening, meaning they may often become more confused and agitated at this time. In my opinion, the caregiver ratio in these sorts of units at night should be no less than 1 aide to 8 residents, when residents with dementia, whether ambulatory or not, can become very agitated and even combative. The “powers that be” at some senior living communities will dispute my ratio, contending that they only need to staff according to long-term care regulations. This month’s real life story will outline the consequences of understaffing.

Real-Life Story

I was recently hired by a client who was forced to place her memory-impaired relative in an assisted living community’s memory unit. The relative had been living in another retirement community that was not equipped to care for residents with memory issues. When the staff at the original community witnessed the relative dragging a bag of laundry up the hallway in the wee hours of the morning, the staff arranged to have her taken to the local hospital’s behavioral unit for evaluation. Apparently, this had not been the first incident of questionable behavior. When the evaluation of the relative was complete, my client was informed that the retirement community could not handle the relative’s behaviors. Therefore, my client had to place the relative in an assisted living community that had a bed available in its specialized memory unit.

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One of my current clients is a former medical professional who has decided to donate her body to science upon her death. She therefore enrolled as a member of a local anatomical gift association. As her Power of Attorney for Health Care, I was assigned the task of pre-arranging for the disposition of her body. My client’s enrollment card stated that arrangements needed to be made in advance with a funeral director to transport the body to the location of the anatomical gift association when the time comes.

Upon making a telephone call to a local funeral home to get a price for transportation of the body, I was shocked to be quoted a price for more than $1,600, along with a $350 cremation fee. Since the quote sounded high, I called the anatomical gift association to be certain that I understood all of the stipulations. When I had a discussion with the association’s representative, I was informed that every funeral home has the right to charge differently for its services. I was also informed that if the anatomical association accepts the body, then cremation of the remains is free. If the body is not accepted, i.e., is diseased or in unacceptable condition, the association would charge $370 for the cremation of the remains. The association’s representative gave me the name of two other funeral homes and recommended that I get quotes from them.

When I called the second funeral home, I was informed that the cost to transport the remains would be $1,150, with a $350 cremation fee. Although the price was better, the funeral director’s demeanor was so unfeeling that I wrote him off immediately. The second funeral director quoted me a fee of $850, and there was no cremation fee whether the anatomical society accepted the body or not. The deal sounded a little too good, so it made me wary. Last, I contacted the funeral director who handled by late husband’s services, because he was a very easy going man who made my life easier during a very difficult time. His price was $650, plus a $350 fee for cremation if the body was rejected. While his transportation quote was even lower than $850, I knew that I need not be wary based on my firsthand knowldege of his services and demeanor.

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I was recently hired by a family whose loved one was taking an experimental drug for cancer. The cost of the drug was more than $8,000 a month. Because the drug is experimental, it is not covered by private insurance, Medicare, or Medicaid. The drug was being paid for by a grant that required re-application every year.

The senior was at risk for falling, had a catheter, and had been admitted to a rehabilitation community covered by Medicare. However, one of the children informed me that finding a community that would accept the loved one (due to the experimental status of the drug) was a challenge. Their first choice in rehabilitation communities declined to offer the senior a bed since the drug wasn’t covered by Medicare. The administration at the community did not want to incur any liability for absorbing the cost of the drug. The second choice in rehab. communities admitted the senior, but required the children to purchase the drug and bring it to the home for administration to the senior.

When the senior’s Medicare days were exhausted, it was time for me to find a permanent home for him. While a family member told me that it was probable that the grant would be re-issued to cover the drug for another year, I had to bear in mind that at some point the grant may stop paying for the prescription. Thankfully, this senior had enough money to pay for long term care, and the prescription for several years, before applying for Medicaid. However, all the communities that I approached for his placement required that the children would still have to pay for and deliver the prescription. Since the senior had progressed during rehabilitation, I was able to secure placement in a Continuing Care Retirement Community (CCRC) that offered high level, assisted living that was lower in cost than a nursing home, but could address issues with the catheter via their medical in-home care services. The senior eventually would be able to apply for Medicaid and transfer to the CCRC nursing home on the same property. However, should the senior convert to Medicaid status, the experimental drug will not be covered.

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There are many occasions when my clients hire me as a second set of eyes and ears once they have completed the first round of tours at senior living communities. Most of the time my clients are in emergency situations. Sometimes they have selected a community and are prepared to act upon their decision, but they use me as a sounding board for their concerns. Here are two example situations where my clients were unaware of the types of questions they should have been asking:

Real-Life Story 1

My client was looking to place a loved one in a Continuing Care Retirement Community (a community that has independent living, assisted living, and a skilled nursing home all on one campus). In my client’s opinion, the senior was currently at the independent living level. I had not yet met the senior, so therefore I was unable to verify that assessment. However, during our conversation, there were indications of some health concerns that made me suspicious that the senior was more appropriate for assisted living. The client had toured a large number of senior living communities and was leaning toward selecting one in particular. I indicated to my client that if the senior was to enter at the independent living level, that was fine. But, I had knowledge that the assisted living area had a ratio of Certified Nurse Assistants to Residents of 1 to 20. Such a ratio is not acceptable for a community that is delivering a large amount of hands-on care to its residents. I advised my client to question the Admissions Director about the ratio I shared with my client.

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During the past several months, several of my clients considered taking their loved one home rather than placing him/her in a long-term care community. After reviewing the costs of stair lifts ($2,500 to $16,000) and refurbished bathrooms, all of them opted to place the loved one in a community. That is because the loved ones would have required a 24-hour caregiver at a cost of at least $250 per day.

In contrast to these scenarios, my father-in-law had a stroke at age 85. After a stint in a nursing home, first with rehabilitation, then a short period as a nursing home resident, the family decided to renovate their father’s house for Disability access. I am going to share my sister-in-law’s thoughts as she recalls the situation:

As we saw in the months and year-or-more after Dad’s stroke, senior care giving is a continual learning process. My brother and I still sort of laugh (although it’s not really a laugh) about how Donovans put 50K into renovating the house for Disability access, but no one thought of certain details until those details hit us in the face.

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I worked with the adult child of an elderly couple who lived out of state. Their ages were in the late 80’s and mid-90’s. nineties. One parent had recovered from lung cancer surgery and was operating at 85% of normal capacity. The other parent had a diagnosis of Lou Gehrig’s disease (ALS) and was expected to decline rapidly in the upcoming over the next 6 months. Upon meeting the parents, I was delighted to find two happy seniors who were functioning (at this point) at the independent living level. However, the parent with Lou Gehrig’s disease needed to use a feeding tube at mealtimes (and mealtimes only). The parent was taking care of the feeding tube with no assistance. Otherwise, the parent walked freely without it.

At the request of the couple’s child, I completed a comparison of every Continuing Care Retirement Community (CCRC) near the northwest side of Chicago, and the western suburbs of Chicago, with my client’s the child’s wish being that mom and dad they would be admitted to independent living. The problem I ran into was since independent living is unlicensed, the only help the couple could obtain in an emergency would be to call to 911. They were not in need of any of the services provided in assisted living. Since maintenance of a feeding tube is a skilled service, it could not be taken care of in an area that was licensed for assisted living. Last, none of the skilled nursing homes within the CCRCs could provide a ventilator, which was a service the parent may need down the road.

So, what did I do? I knew the child of the seniors owned a condominium right in the midst of downtown Chicago where mom and dad they could attend the plays they so deeply loved, as well as enjoy a lovely view of the Chicago skyline. I suggested that the child hire me as the parents’ Geriatric Care Manager and move them to the condo downtown. I would arrange for a housekeeper, licensed non-medical home care agency and eventually a medical home care agency (nurse) to take care of their needs as their health declined. Since the funds were available, in this case, staying “home” made sense.

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Every once in a while I am confronted with a situation that requires me to think out of the box a little bit more than usual. Recently, I was asked to find placement for a “young” senior who had a traumatic brain injury. This case involved many calls to different social service agencies. Unfortunately, due to my client’s age, lack of need for hands-on care at this point in time, and certain cost factors involved, some of the information I obtained was not usable. I had to dig deeply beyond the options that first emerged.

Real-Life Story

My client is 63 years old. Unfortunately, my client was hit by a motorcycle when a teenager and suffered a traumatic brain injury. After rigorous rehabilitation, the client was able to lead a normal life. However, after a series of personal disasters including a fall, the client experienced a number of physical setbacks that resulted in needing to use a walker for ambulation and needing to move in with an elderly parent. The parent and the child shared a caregiver from a private, non-medical home care agency for standby assistance with activities of daily living. At this point, my client needed only standby assistance with dressing. The arrangement was only temporary for my client, as independence and socialization were major factors. My client was doing well from a cognitive stand point. Therefore, I was hired by the client’s Power of Attorney for Health Care to find alternate living arrangements for the client. Here are the results of my research:

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After a long and often gray winter, it is wonderful to start seeing green again – whether it is the lively colors of St. Patrick’s Day celebrations, the first signs of daffodils and tulips, or early Easter decorations.   Spring is rightly associated with fresh starts and new beginnings, and so it might well be a good time to discuss senior living options for the older individual or couple in your life.

Many families have seen a senior loved one’s health decline over the course of winter, or watched with concern as “the house seems to be getting away from Mom and Dad’s ability to keep up with it.”  Hence, spring might be the time to suggest a fresh look at senior living options available in your area.

Here are three tips to keep in mind if you are trying to convince a senior to move or are merely attempting to bring up this sometimes-delicate subject:

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