Interviewing Assited Living Administration and Staff

Unfortunately, my mom was very weak and sick when she moved to assisted living. As such, she was unable to participate in the selection of an assisted living residence. While many will have their loved one with them during the selection process, the process is still the same.

My older sister Teresa, whom I deeply admire and trust, came out from Baltimore to evaluate potential communities and add some emotional stability to what I knew would be a draining process.

I had several high-level criteria in moving my mom to assisted living:

  • Close enough to visit regularly and quickly respond in the event of an emergency
  • Physical and occupational therapists who would aggressive rehabilitate my mom from her stroke, muscle loss and weakness
  • Community administration who had extensive experience and low staff turnover
  • A clean community with amenities that would provide my mom pride in residency
  • A first impression that residents were happy and well cared for

While our final decision had much more detail that you’ll identify on your own, we used these five objectives as screening tools for the 10+ properties we visited.

For the first round of visits, we followed a pretty simple plan that we felt would expose us to the above criteria in a time-efficient manner. We took the following plan of action at each community:

  • Met with the admissions coordinator to get a tour of the community, activities calendar and price schedule.
  • Toured the community to verify amenities, cleanliness and get an overall impression of the happiness of the residents.

(NOTE: Since then, I’ve heard from many in the industry that many residents are afraid to say anything bad about staff or a community due to fear of retribution. You may find this technique less than beneficial for getting good feedback.)

  • Spoke personally with the physical therapist and occupational therapist in the therapy room to understand the course of treatment they would take with my mom. The physical and/or occupational therapist(s) must have several years of geriatric experience.
  • Spoke personally with the nurse to verify medication management and basic procedures in place in the event a resident becomes ill. This includes verifying the medication room was clean and organized, as we wanted to avoid medication mix-ups.
  • Spoke personally with the executive director to verify experience, staff turnover, hiring procedures with background checks and to validate the health and safety inspection record.

It took us several hours per community to follow our above plan above and validate whether the community met our high-level criteria. With each new community we visited, we picked up some little detail that we applied to the ones we’d already visited.

We narrowed the list down to three communities which we felt satisfied our criteria, ranked in order of preference. For each of those three communities, we did the following:

  • Visited the community during lunch or dinner to check the quality of food and observe the residents in a more casual environment. We paid close attention to the interaction between residents and staff and residents and each other.
  • Shared my mom’s medical records with the admissions staff to ensure they had the capabilities to support my mother’s specific issues.
  • Had unscripted discussions with the admissions director and executive director to get a better impression of the staff and their ability to provide for my mom.

After this round of investigation, the decision became clear. All three communities met our criteria. But through longer conversations, we ultimately developed a sense of trust with the admissions director and executive director at one of the communities. They had a sense of emotional attachment to the residents that I didn’t feel at the other communities.

When I laid down that night, I was calm. I knew that we had executed a thoughtful plan.

Photo Credit: TheBusyBrain

 

More Tips for Finding Assisted Living Communities

In a previous blog post, I discussed some of the early steps you can use to start creating a list of potential assisted living communities for your loved one.

Here are some more tips for finding potential communities and narrowing down the list to the right facility that your loved one can call home.

A recommendation from a friend or other reliable source about a community can go a long way in this early screening process. Don’t hesitate to ask around. After all, you’re about to begin a long and detailed journey – one that ultimately affects the happiness and general well-being of your loved one. It’s best to tap every resource you can!

As you begin to tour communities, your head will be racing with questions, reactions and things you notice from one community to the next. I recommend you buy a spiral notebook, writing questions and comments before and after you tour each community.

Deciding on the Right Assisted Living Community

After you tour a few communities, you’ll find the details blend together and your memories cease to different each tour. Some will eliminate themselves quickly. Some will make the final cut. In the end, you’ll need to rely on initial impressions and your notes to make that all-important decision on the community best for you and your family. Choosing the right assisted living community is a challenging task. Whether you are searching for yourself, a family member or a friend, you’ll want to make sure that the assisted living community is able to meet the physical and safety needs of the prospective resident.

At the time of her stroke, mom lived in North County San Diego – about 50 miles from me in Orange County. For almost 6 months after her original discharge, she went back and forth between skilled nursing and the hospital. At the time, it seemed like a good idea to keep her close to friends who could come and visit her while I was as at work. I was down to visit 4-5 times a week, mostly after what was a 50-60 hour work week.

Choosing the location of an assisted living community will likely be the most important decision you make. For anyone, a move away from familiar surroundings can be stressful experience. Combine that with the emotional drain of accepting assisted living, and it’s easy to imaging the challenge your loved one is facing. You’ll likely be leaned upon frequently during this difficult adjustment period.

Here are a few things to consider as you choose the location of the community:

Make the commute easy. During the first weeks and months of assisted living, you will likely be the closest friend and confident for your loved one. If at all possible, choose a location that is close to your home and/or other family members that can regularly visit without negatively impacting their own responsibilities. Your loved one will look forward to your visits – even count on them. Make sure you are close enough to stop for a quick visit – even if it’s a short one.

Don’t ignore the “nice” neighborhoods. It would seem that nicer neighborhoods would charge a premium. While it may be the case in some places, don’t take this for granted. I called or visited almost every place in a 15 mile radius of my house and all were about the same price. On a whim, I called a beautiful community near the beach – complete with ocean view – and it turned out to be the exact same price as communities in some of the less desirable neighborhoods in the county. Don’t let your lack of a phone call cause you to miss a great opportunity.

Match town size and options. Your loved one likely came from an independent environment where they could come and go as they please. Whether it was shopping at the mall, dining out or playing cards at the Senior Center, they had options. Make sure you locate them in an area that has a similar set of options to the area they came from. The transition will be less of a contrast and it will be easier to get them back into the swing of things.

Always remember what Andrea Arambula told me: “people rise to the challenge.” Because of our situation, I was faced with the need to make a quick decision: should I put my mother in a skilled nursing community or assisted living? In skilled nursing, she’d be by far the most advanced of any of the patients, though she still needed a lot of physical therapy. In assisted living, she’d be the least mobile, but would be on par socially with far more residents. With some encouragement from the admissions director, my mom and I chose the latter. She’s a fighter, and neither of us has ever regretted the decision. She certainly rose to the occasion.

Photo Credit: stevendepolo

Save Money for Elder Care! 5 Tips to Put an End to Family Mooching

no senior care lendingAs the elder (and financially stable) member of your family, you may get a lot of requests for money.  After all, your home is paid off, your kids are grown, you have fewer living expenses, and even though you’re on a fixed income, it’s not like you really need the money, right?  At least, that seems to be the mentality of your kids, grandkids, and possibly even great-grandkids.  While you’re happy to help your family when you can, you’re starting to feel like an ATM!  Besides that, the fact that you’ve paid your dues and entered retirement means that you now have the leisure time and savings needed to start the business you’ve always dreamed of or begin crossing international cities off your bucket list.  But how can you say no when your family members come looking for a handout?  Here are a few tips to stop the mooching so you can once again look forward to seeing your family.

  1. Adopt a “no loan” policy.  If you say no to one family member, you really have to say no to all of them (in order to avoid the jealousies that spring up from favoritism).  In order to avoid rifts with family members over lending to some but not to others you simply have to adopt a no-loan policy that allows you to treat everyone the same.  This will ensure that no feelings get hurt and that you’re not constantly bombarded with requests for money.
  2. Give a one-time gift.  If you feel that you do have plenty of cash on hand to loan out but you don’t want to set a precedent that makes your family think you have an open-door policy where lending is concerned, then offer a one-time gift.  This way you don’t have to worry about whether or not your loved one will pay you back and you can quickly and firmly close the door on future monetary requests.
  3. If you can’t afford it, say so.  You have your own expenses and future to worry about, with no real chance for income down the road.  You need to consider that each time someone asks you for money.  By making your position clear to family members who ask for handouts you can hopefully keep your relationships intact and ensure that your family is aware of your financial standing.
  4. Be honest.  Saying no to the ones you love can be difficult and you might be tempted to tell a little white lie in order to make yourself feel better about letting them down.  But people often see through these deceptions and then they end up feeling bad, which you obviously don’t want.  Honesty is always the best policy and you’ll find that simply telling family members up-front that you’re starting to feel used will probably result in an end to the many requests for money.
  5. Make relationships the priority.  Lending money can be a recipe for disaster where personal relationships are concerned.  Simply let family members know that you are available to listen to their problems and offer advice and moral support, but that preserving the relationship means keeping money out of the equation.

About the Author: Elizabeth Retton writes for Senior Living Atlanta where you can find assisted living in Alpharetta.

Tips for Finding Assisted Living Communities

Recall that assisted living communities offer your loved one a place to live where they can receive basic assistance, while retaining a measure of their privacy and independence. This assistance could be housekeeping, meal preparation, 24-7 monitoring, shower assistance, toileting, medication assistance or reminders; transportation and help with eating, or dressing. The amenities of assisted living should also include interesting and engaging activities, as well as opportunities for social activity.

Assisted living communities vary in size. In a small assisted living community, you will have 16 or fewer apartments/rooms (much like a residential home). In a large community, you will have over 17 apartments/rooms and up to over 100 apartments/rooms.

You can locate local assisted living communities through a number of means. I’ve found both the Medicare tool and several public web sites will cast a wide net for you to start your search

Medicare’s Long-Term Care Planning Tool

The Internet is playing a growing role in caregiving and healthcare. One such tool worth mentioning here is Medicare’s Long-Term Care Planning Tool. The stated goals of Medicare’s Long-Term Care Planning tool are to help you understand:

  • What long-term care services are available
  • How much you can expect to pay for long-term care
  • What financing options are available to support your long-term care costs

This tool will ask between twelve and twenty questions and will then provide you with the long-term care results you need by comparing your answers to those of individuals with similar profiles.

For those that want a quick snapshot of communities, the tool only requires a few questions. However, if you have specific care needs, financial constraints or care needs, the tool enables you to indicate those requirements.

While the results of this online tool are general in nature, and certainly not intended to replace comprehensive financial and other long-term personal planning, they will give you important insights.

An initial recommendation can be provided from only a few basic questions. By answering optional questions, the user can further narrow the list of recommendations. Here’s a tip: be sure to check out the Resources tab while you’re on the site. There’s a wealth of links to various government programs and agencies

Other Ways to Search

In addition to the Medicare online tool just mentioned, I’ve got some tips to get you started on choosing the right assisted living community for your loved one. First, you’ll want to know all of the options in the area in which you are interested. To get a full list of the communities near you, you can:

  • Visit or call your local senior center
  • Use Google to find the listings for assisted living in your area or zip code
  • Get a list from a local hospital or skilled nursing community
  • Or Go “old-school” and look in the Yellow Pages

Assisted living communities aren’t always easy to find, and many are nestled in between neighborhoods. While there are many sites on the Internet that list assisted living options on a regional basis, such as the ones listed above, the three that I found most useful are noted below. They’re good places to take a broad view of what’s available. Write down the ones closest to you. As you work your way through the process,  you’ll want to narrow this down to a short-list to choose from.

My favorites:

Snap For Seniors
Snap for Senior is a great resource for senior care communities and has the largest database of senior resources in the country.  I’ve met the co-founders Derek Preston and Eve Stern and they are fantastic people with a high-degree of integrity.  I would start my search there.

Senior Housing Net
Senior Housing Net is a fee community located from Move.com. Through this site, you can find local assisted living communities as well as prepared for your loved one’s move.

ElderCarelink
ElderCarelink is an internet-based referral service–free to consumers–that specializes in eldercare case matching for elders and their families. ElderCarelink assists families in finding a multitude of services, including assisted living, nursing homes, adult day care, private duty nursing, care management and homecare.

Stay tuned for part two of this blog post next week with more tips and suggestions on finding assisted living communities.

Photo Credit: maureen lunn

Long-term Care And Financial Considerations

As you’ve seen, long-term care is expensive. Even a temporary stay in an assisted living facility can derail years of careful financial planning. Although costs may vary significantly depending upon where you live, a family’s assets can be quickly depleted.

According to the U.S. Department of Health and Human Services, one year of care in a nursing home (based on the 2006 national average) will cost over $62,000 for a semi-private room. One year of care at home, assuming someone needs periodic personal care help from a home health aide (the average is about three times a week), could cost almost $16,000 a year. I’ve seen folks spend close to $100,000 per year on 24-hour in-home care.

When my father died in 1989, my mom invested what he left her and did well. She thought she had planned for everything, including adjusting her expenses to be comfortable for many years. The one thing she didn’t plan for was an illness that required long-term care, where all expenses are paid privately. While she was fortunate that my father planned for her, the growing expenses continue to be a growing burden. Each year, the financial-related stress increases.

I’ve spoken to many people in similar situations. Those who don’t have the financial ability to pay for their assisted living solution, through asset allocation or long-term care insurance may find themselves forced to depend on their family to pay their bills – and that can be devastating.

It is imperative that you assess where the money can be found to implement any forthcoming decision regarding a specific assisted living location and I urge you to do so early on in the process.

What are the costs of long-term care?

And costs for long-term residential care services vary greatly depending on the type and amount of care, the provider, and in which state your loved one resides.

It is a surprise to some that ordinary health insurance policies and Medicare usually do not pay for long-term care expenses. I repeat: ordinary health insurance policies and Medicare do not pay for long-term care expenses.

Medicare pays only about 2% of all nursing facility costs, and nothing at all for residential care. Medicaid, a federal/ state health insurance program, will only pay for long-term care if the person has already spent most of their savings or other assets, and Medicaid pays nothing at all for assisted living or residential care facilities.

The average stay in a long-term care facility, according to the government findings, is about three years.

Private Long-Term Care Insurance

According to the U.S. Department of Health and Human Services (2007), at least 60 percent of people over age 65 will require some long-term care services at some point in their lives. The Department estimates that about 12 million Americans over the age of 65 will need long-term care services by the year 2020. This same study found a person may need long-term care services at any age: Forty percent of people currently receiving long-term care are adults 18 to 64 years old.

At costs ranging from $60-100,000 a year, you can easily see why Long Term Care insurance is of interest to many Americans – but as you age, it can become prohibitively expensive. According to Dianne Duva, Certified Financial Planner and Senior Financial Advisor for the JWS Group, Merrill Lynch, there’s a ‘sweet spot’ for purchasing this coverage: that optimal age where you’re not so old that such coverage is prohibitively expensive, and not so young that you’re paying needlessly for insurance you won’t use for many years.

Policy Parameters

Benefit Amounts: Policy benefits may be paid on a daily, weekly, monthly, annual or other basis. For example, a policyholder may receive $100 per day to cover their nursing home costs or $350 per week for home health care. It is important to know the average cost for nursing home care in the area before selecting a benefit amount for your loved one’s policy.

The Elimination Period: Most policies include an elimination period of 20, 30, 60, 90 or 100 days. This means that a policyholder will not receive benefits until after the elimination period has passed. Policies with longer elimination periods cost less than policies with shorter elimination periods.

The Benefit Period: This is the length of time that benefits will be received from the policy. Benefit periods can range from one year to life.

Lifetime Maximum Benefits: Most plans have a total maximum benefit paid over the length of the policy’s duration.

Inflation Protection Rider: Without inflation protection, policy benefits may be much lower than what is actually needed down the road to maintain your loved one’s standard of living.

Naturally, your loved one may not have had the opportunity to purchase such a policy. After all, we’re talking about “at-need” situations, not “pre-need.” If your loved one needs assisted living right now; paying for it has become a major issue in the present.

What’s next?

It’s time to look closely at your loved one’s assets and income. When families get together to talk about money, emotions can run rather high; it may prove useful to bring in the family attorney, accountant, or other objective third party to assist you.

You’ll quickly discover (unless your loved one has been extremely attentive to these details) that the financial and ownership records you’ll need are to be found in different places: safety deposit boxes, checking or savings accounts in different banks, stock portfolios held by different brokers; pension records, mortgage documents, deeds of trust. It’s time to get them all organized and accounted for.

Photo Credit: Images_of_Money

People Rise to the Challenge

I want to share a story that serves as an important lesson that many of us already know, but we’d likely forget under the stress of caring for a loved one. The story starts with a single sentence that forever changed my mom’s life: “People rise to the challenge.”

This isn’t my quote. To be fair, I heard these words for the first time after visiting many, many skilled nursing facilities. The source of the quote was a woman by the name of Andrea Arambula, and she was the admissions director at Belmont Village (formerly Crown Cove). It is to Andrea that I owe an enormous debt of gratitude. Andrea, if you are reading this, thank you!!!

Rewind back to December 2005. My mom had been in skilled nursing for more than five months. As dicussed in the previous blog post, skilled nursing is a mix between a hospital and an apartment. Patients usually share a room, and nearly all require treatments from a registered nurse. While my mom was there, one of her roommates passed away and several others were taken to the hospital. They did not return. While some are in skilled nursing for a short stay, many have declined to the point where it is required.

After driving 120 miles round trip, 4-5 times a week, usually after a full day at work, I decided to move my mom closer to me. I asked the head nurse for a care recommendation. She recommended skilled nursing.

She went so far as to tell me that my mom would likely be permanently bedridden, and that I should explore hospice. At the time, I was 34 years old and knew no better than to take her advice at face value. I started looking for skilled nursing facilities closer to my home in Orange County.

By chance, I called one assisted living facility and a woman answered the phone. It was Andrea.
She convinced me that my mom had no medical necessity for skilled nursing. Sure, she had problems walking, but that was a physical therapy issue. She told me something repeatedly, and I’ll always remember the words. People rise to the challenge. You just have to let them.

So I reviewed my mom’s medical records with her doctor, the assisted living community, the physical therapist and Andrea. It was a go! My mom was going to need a lot of help, but I was convinced that she would rise to the challenge.

I’ll always remember the ride there. Since my mom needed to be lifted (yes, lifted) into a wheelchair, driving my car was not an option. So I rented a shuttle, and my mom and I rode a little over an hour in the back of a wheelchair- accessible Super Shuttle (yes, the ones you take to the airport).

She was scared. I was scared. But in my heart I knew she could do it. When she first entered assisted living, she couldn’t walk. In fact, she couldn’t roll herself out of bed. She needed two people to literally pick her up and put her in a chair.

Within a year, she could walk the hallways with a walker, walk to dinner, come over to my house for BBQs, get in and out of a car, and resume some normalcy in her life. In fact, she even got featured in her physical therapist’s brochure. I guess she’s a testimonial for hard work and good physical therapy.

Each time my mother passed a new milestone, I thought of the skilled nursing recommendation and urging to explore hospice. And each time I smiled about the progress my mom made.

Why the long story? The details of the story are important. It’s human nature to fight, struggle and be determined. And regardless of your age, most people respond to the challenges they face. In the case of my mom, it was walking. In the case of your loved one, it may be something else.

So while I learned from Andrea that people rise to the occasion. I learned from mom that you have to let them.

So trust in your loved one. Trust in yourself. And I know you’ll find that you can both rise to the occasion. Perhaps – and most likely — there will be tears along the way, but there will be many wonderful moments of warmth and laughter, too.

Photo Credit: Vick the Viking