Understanding Assisted Living Residency Agreements: Part Two

January 16, 2012 By Leave a Comment

In the previous post, we defined what an assisted living residency agreement is and the key tenets of such an agreement. We also worked our way through several basic sections of a sample agreement and highlighted questions to ask and language to look for in each section.

Let’s continue walking through the sections of a sample residency agreement. For each section, we’ll provide some tips and advice on what to look for.

IX. Use of Unit
The purpose of this section is to clearly define how and for what the unit can be used. This section normally addresses issues like pets, parking, guests and storage of materials. The language in this section is usually specific, so make sure and ask questions about items you don’t see in the text.

Some common questions to ask:

  • Is parking included? If not, is there an additional fee?
  • Can your loved one have overnight guests? Are there restrictions to how many nights they can stay? Are there additional costs associated with it?
  • Are pets allowed? How many? Are there optional services available such as dog walking, grooming, etc? What are the additional fees associated with pets?
  • Can there be joint occupancy? This is particularly relevant if spouses want to live together in an assisted living community. How does this affect the cost? Is there a cost benefit to joint occupancy? How do the costs change if one resident leaves? For example, at my mother’s community, a resident’s wife spends the night several times a week, but maintains her own home down the street. How would a scenario such as this be treated under the agreement?
  • Are caregivers considered to be joint occupants? Are the fees or meal charges associated with live-in caregivers? At one local community, a monthly surcharge is assessed for caregivers, which is nearly $1,000.

XI. Termination
The termination section of the contract defines in what situations the contract may be terminated, what money is refunded after termination and what sections of the agreement continue after the end of the contract. Our sample agreement defines termination rules in a variety of scenarios, including: termination by the resident, termination by the community and termination in the event of closure.

Most communities will negotiate little on this section of the agreement, as it defines much of how their business is operated. You should still be aware the rules in each scenario so that you can plan accordingly. It never hurts to ask what can be changed negotiation, so give it a shot!

Some things to be aware of:

  • What are the resident’s termination rights? What notice is required? Thirty days is fair, but don’t let it be more than that, as you will lose your flexibility. Is there a shorter notice period in the case of death or health reasons, such as admission to a hospital or the requirement for extended skilled nursing care?
  • Ensure that you can terminate, with notice, without reason.

So what are the community’s termination rights?

  • Ensure the community can only terminate for cause rather than for any reason. Cause typically includes things like failure to pay rent, failure to meet residency requirements, intentional damage of the community, being a danger to other residents, etc.
  • In the event you are under threat of termination, attempt to negotiate a period of time to remedy the situation. Most contracts allow for thirty days to remedy contractual issues.
  • What is the appeal procedure if you feel you are being terminated or evicted unjustly?
  • The community may also terminate contracts in the event they lose their license or close. What happens in this case?

What happens when the contract is terminated?

  • How long does your loved one have to remove his or her belongings?
  • What should you expect in terms of refunds, e.g. security deposits, community fees or unused monthly fees? Depending on the amount of the community fee that was prepaid, you may be entitled to some type of refund.
  • Within how many days is the community required to issue these refunds?

Other Legal Stuff
Most contacts have several pages of standard legal language. Most of the time, these sections have no impact on the substance of your agreement. While much of this section is standard legal language, it does make sense to alert you to a few “gotchas” below:

  • Costs and attorney’s fees. If there is a provision that resident shall bear all costs and fees (including attorney’s fees) to enforce the agreement, try to remove that language. Attorney’s fees can become quite costly and these fees should be part of the community’s cost of doing business.
  • Insurance and liability. First, most communities will require the resident to maintain their own insurance to cover personal property. You’ll likely be unable to change this, but you should get insurance if it is not provided. Second, the community will likely try and disclaim all liability. You want to try and negotiate this such that the community is at least responsible where the community or its staff has acted intentionally, recklessly or with gross negligence.
  • Assigning or subletting. Most agreements will not allow you to sublet the unit to someone else. However, in the event the community does this, you may still be responsible financial. In other words, make sure you protect yourself in the event of subletting so you are not on the hook for damages, rent and other expenses. Read this section carefully.
  • Arbitration. Arbitration is a clause put into contracts so that disagreements are resolved by a third party and not in court. Arbitration can be conducted anywhere, and many companies would like to have arbitration close to their corporate offices. In the case of a residency agreement, you want to make sure the arbitration location is near your home. You don’t need to incur additional expenses should the need for arbitration arise.
  • Entire agreement. Make sure the residency agreement presented to you represents the entire agreement. You have a right to review all auxiliary materials referenced in the contract, including documents, handbooks or verbal representations.

Residency agreements are not very complex. In fact, they usually very clearly articulate what happens in what scenario and what fee will be assessed. Some key things to remember:

  • Ask questions
  • Negotiate
  • Walk away if you are not comfortable

Photo credit: Waponi

Filed Under: Assisted Living, Legal & Financial Tagged With: ,

Understanding Assisted Living Residency Agreements: Part One

January 9, 2012 By Leave a Comment

One of the most daunting tasks of a transition to assisted living is the signing of the residency agreement. Similar to a rental agreement or lease on an apartment, the residency agreement governs cost, services and termination options for your loved one’s stay in assisted living.

It always struck me as odd how little families pay attention to these agreements. We spend hours test driving cars or strolling through the mall, but oddly, very few people read these agreements in detail. And even fewer take them to an attorney for review.

What is a Residency Agreement?

If you Google search “assisted living residency agreement,” you will find many agreements from state or local agencies or assisted living communities. For the purposes of this blog, I’ll be walking through a standard residency agreement from a typical assisted living community. While many agreements may be smaller, this particular agreement is relatively thorough, easy to read and provides a great example for discussion. And with the consolidation occurring in the industry, it makes sense to start there.

Core Components of a Residency Agreement
A residency agreement has many specific sections, but they can be grouped for the sake of discussion into several topics. They are:

  • Accommodations and Term. This topic deals with the actual unit being rented and the duration of the residency agreement.
  • Fees, Core Services and Meals. This topic sets the fee schedule and identifies both included and extra costs. This topic also discusses the “what, when, where, how” of meal service.
  • Residency Qualifications. This topic discusses the qualifications required to be admitted to the community and maintain residency.
  • Maintenance and Use. This topic communicates the service levels regarding building and unit maintenance, and identifies how the rented unit is to be (and not be) used.
  • Termination, Legal Stuff and Arbitration. This topic sets how the agreement can be terminated and includes a lot of standard legal language. One important item discussed in this section it arbitration.

Always remember with contracts that many things are negotiable, so don’t hesitate to ask. This is especially true if the community has many vacancies.

Now we will look at each section of the sample agreement and provide tips, concerns, items to be aware and suggestions to negotiate. I recommend you have an attorney review any contract that is presented to you.

I. Living Accommodations
This section of the contract describes the unit and common areas to be leased by the resident. The language in this section is fairly self-explanatory. Some things to be aware of include:

  • Confirm the exact unit identified in the contract is the unit you’ve agreed to rent
  • Confirm that your loved one, his/her friends and your family have the right to use common areas. These are areas of the community that are freely available to residents, although some communities put restrictions on who other than residents can use them.

II. Term of Residency Agreement
This section of the contract defines the term of the agreement and what happens at termination. Several things are defined: the resident’s rights to ownership (there are none), the length of the agreement, and the “what do to” at termination and with personal property. Things to be aware of in this section include:

  • The length of the agreement should preferably be monthly. Be cautious of longer agreements, especially if you have no termination rights in the event your loved one is no longer able to live there.
  • No auto-renewal. In the event you agree to a term longer than monthly, ensure there is no auto-renewal clause. As you may imagine from its name, auto-renewal automatically renews the contract for a specified period of time, unless you notify in writing your desire not to renew. If the term is monthly, then auto-renewal doesn’t matter as much as you’ll only have 30 days exposure financially.
  • Limit obligations at vacancy. Whether it is due to health or death, inquire about your obligations in the event your loved one is no longer able to reside in the community. Some examples include: How long are you obligated to pay after your loved one has left? How long do you have to remove his or her belongings?
  • Reasonable notice. Ensure your loved one is provided reasonable notice before the community shows your unit to a potential resident. 24-48 hours is reasonable in most situations. Try to avoid anything that doesn’t require notice, as this can be stressful to your loved one.

These sections are fairly standard, but the above tips will help you ask the right questions and negotiate where you feel necessary.

VII. Residency Qualifications
This section is designed to protect both your loved one and the assisted living community. Why? Assisted living communities are only licensed and staffed to provide certain types of care. By defining the qualifications of residency, the community ensures they have the staff and resources to take care of your loved one. There are also requirements to protect other residents such as those requirements around contagions like tuberculosis.
Some things you should be aware of:

  • Review the minimum requirements carefully and make sure your loved one meets these requirements. It’s important to be honest with yourself, as you don’t want to be in a situation where you’ve violated the agreement within the first week.
  • Does the contract state what happens in the event your loved one ceases to meet these requirements? For example, will they be forced to move out and with what notice? Is there an appeal process to dispute whether your loved one meets the requirements? How does that process work?
  • Some communities may require the presentation of medical records or results from a recent medical exam. Make sure the contract ensures the results of the exam are kept confidential except as released by you or your loved one.
  • Some communities may require a pre-admission assessment in which a nurse and community executive conduct an interview and/or medical exam. Make sure to understand in advance the purpose of the exam and what will be covered.

Skilled Nursing Transfers
My mother came to assisted living from a skilled nursing community. In her case, the assisted living community did not conduct a pre-admission assessment. However, they did require medical records from the skilled nursing community and had a lengthy conversation with the head nurse.

In this case, you should follow up with both parties to ensure consistency of the results. The goal here is to avoid any inconsistencies during the admission process. While this part of the contract may in some cases appear intimidating, it is important to realize that it benefits both parties.

VIII. Maintenance, Repairs and Alterations
This section defines the rules to be followed regarding redecoration, alterations and basic housekeeping. It also defines to what extent the assisted living community will be responsible for maintenance and repairs, as well as the resident’s responsibility for damages.

I think most people will find this section to be reasonable and consistent with renting a house or apartment. However, you should read it closely to be sure there are no unreasonable requirements in the contract.
Some things to be aware of:

  • You and your loved one will likely want their unit to feel like home, and therefore may want to redecorate. While our sample agreement provides for things like paint and wallpaper, you should ask specifically if you intend to do something not mentioned. If the community agrees with your request, get it in writing during the contract negotiation. Similar, if you are already a resident, all redecorations should be pre-approved in writing before the project begins.
  • Similar to redecorating, should you wish to make structural or non- structural alterations to the unit, make sure you get written permission during the contract negotiation. Usually, the cost for non-structural alterations like fixtures, toilet items and shelving are the responsibility of the resident. If your loved one is handicap or disabled, the community should make reasonable efforts to accommodate their needs. In our sample agreement, this language is very vague. Make sure you articulate your loved one’s needs and get in writing the community’s intent to provide those alterations. You should also insist that these alterations are completed prior to your agreed up move-in date.
  • Most communities provide some housekeeping services and things like routine carpet cleaning. Some communities charge extra for additional housekeeping. If you intend to have an outside housekeeper visit your loved one’s unit, make sure this is allowed for in the agreement.
  • Damages are often ambiguous in many lease agreements and residency agreements are no different. Ask the community to define damages versus normal wear and tear and to give examples. Some questions to ask: Who conducts the repairs? Are costs based on actual material cost or does the resident pay for asso-ciated labor as well? How do residents resolve situations in which repair costs appear to be abnormally high? If the resident can repair the damage on their own, how much time do they have to complete the project?

Stay tuned for part two of this post next week, where we’ll continue to work our way through the sections of a sample residencey agreement.

Photo credit: Orin Zebest

Filed Under: Assisted Living, Legal & Financial Tagged With: ,

A System for Selecting an Assisted Living Community

December 19, 2011 By 5 Comments

As you have likely learned through reading our blog posts and your own life experiences, the transition to assisted living is a stressful and emotionally charged period of your life. It’s also likely an incredibly scary and uneasy part of your loved one’s life.

In previous posts, we’ve shared information to help prepare you for this moment – the time when you and your loved one will select an assisted living community.

Visit our previous posts for resources on what to look for when researching and touring assisted living facilities. This information can help to convert a chaotic and often panic-filled situation into a calm, thoughtful and logical decision making process.

Now let’s discuss how to select the right assisted living community for your loved one:

Comparing the Finalists
By now you should have collected detailed information on several assisted living communities. You’ve had good and bad first impressions of communities, people, insurance companies and all the things that run hand-in-hand with this transition. For reasons both known and unknown to you, you’ve probably also excluded several communities.

When trying to find a community for my mom, my sister and I looked at many communities before ultimately making a decision. We struggled to find a technique that enabled us to make a decision that satisfied three criteria:

1. Compare all communities across the same attributes

2. Give some attributes more weight than others

3. Deliver an objective, measurable final selection

Why were we so formal? Because we knew that we had put every ounce of our souls into finding the best community we could. We didn’t want to ruin a decision by injecting too much bias into it..

Choosing Attributes
We decided on six attributes on which to make our community selection. They are:

  • Location: the geographic location of the community; proximity to family, friends and shopping; amenities of the community and size/ layout of the apartment.
  • Staff: experience of the executive team; friendliness of the dining room staff; staff treatment of residents and their observed interactions.
  • Activities: activities calendar; personality and demeanor of the activities director; amenities related to activities including transportation, game rooms and other entertainment.
  • Quality of care: the experience of the nursing staff; proximity to fire, hospital and emergency services; rehabilitation rooms and quality of the therapists.
  • Cost: total monthly cost of community at the level of care required for my mother.
  • Gut feeling: you have instincts for a reason. Use them.

Over the last several years, I’ve shared this list with many people and validated that it addressed the vast majority of families. Now that you have a group of attributes against which you can measure your finalists, let’s add a measure of importance to each one.

Weighing Attributes
Different things are important to different people, and you’ll likely have strong feelings about the relative important of one attribute over another. This is called weighting.

Weights are applied by giving each attribute a percentage from 0-100%. Those attributes you deem most important receive the highest percentage weight. The total of all attributes must equal 100%.
It’s important that you apply weights to the attributes before you begin ranking your community finalists. This will enable you to minimize unnecessary bias before the score process.

Ranking Final Communities
Now that you have removed the unnecessary bias from your decision, you can score each community against the others. The score will occur for each attribute above. You will likely find communities will be a leader in some attributes and a follower in others. This is normal.

Armed with this system, you will be able to sift through all of the information you’ve gathered and decide on a community that will meet your loved one’s and your family’s needs.

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New Gallup Research Profiles Caregivers in the U.S.

December 12, 2011 By 3 Comments

Have you ever wondered whether there are other people out there like you, balancing caregiving for an elder or disabled loved one with a full or part-time job?  New Gallup research sponsored by Pfizer and ReACT (Respect A Caregiver’s Time) provides demographic information about U.S. workers who are also caregivers.

To answer the question above, you are not alone. An estimated 17 percent of U.S. workers do double-duty as caregivers for elderly or disabled loved ones or friends. Overall, 16 percent of working men and 20 percent of working women are also caregivers. The majority of these caregivers (22 percent) are between the ages of 45 and 64 years old. The age group least represented as both workers and caregivers are 18 to 29 years old.

Infographic from Gallup Management Journal.

 

Caregivers are represented in every major demographic group, with 17 percent of  working whites, 21 percent of working blacks and 20 percent of working Hispanics also providing care. The research shows a correlation between income, education and caregiving. As income level and education level increase, the propensity for a worker to also be a caregiver decreases.

What is the Cost of Caregiving?
The intention of the Gallup research is to highlight how effective U.S. employers are in addressing caregiver needs and what the hidden costs of caregivers missing work are to those employers.

Infographic from Gallup Management Journal.

Below are some findings about the types of benefits working caregivers receive and the cost of caregiving:

  • Less than half of U.S. employees have access to assistance programs where they can discuss any emotional stress that comes along with balancing caregiving and their jobs.
  • Only 27 percent of U.S. workers who are also caregivers have access to support groups or health counselors who can answer any questions about providing care.

Gallup also takes a look at how each type of initiative, from vacation days to flex time and counseling, can impact caregiver absenteeism. Organizations that provide counseling to discuss caregiving options such as assisted living and nursing homes, may see an improvement of 1.2 fewer work days a year missed by caregivers. Support groups will reduce caregiver absenteeism by 1.1 days a year, and paid vacation by one day a year. All of the other options, including unpaid vacation, sick leave and flex time, will make an impact of less than one day per year in a caregiver’s schedule.

Conclusions
Studying ten benefits for caregivers who work full or part time, Gallup finds that if U.S. employers offer at least 8 of these 10 caregiver benefits, it can reduce the cost of caregiver absenteeism by 23 percent of its current level, or $5.8 billion dollars.

The research concludes by offering suggestions for small, medium and large businesses about caregiver initiatives that can have the most positive impact on employees and the bottom line. To review the complete findings, visit Gallup’s Management Journal.

Photo credit: Images_of_Money

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An Elder Care Conversation About Senior Activities Done Right

November 28, 2011 By Leave a Comment

During my research on assisted living communities and elder care, I met a woman whom I consider to be the model activities director. Her name is Terri Glimcher and she is the Life Enrichment Coordinator for Emeritus Senior Living. In addition to her duties at Oak Park Assisted Living in Clermont, Florida, she also serves as a trainer for many other local communities. If her techniques were universally adopted, this chapter would be completely unnecessary.

I’ve spoken to Terri several times during the course of my research, as she is a true expert in her field. She gets it!

To reword our discussion would not serve her great work justice, so I’ve included the entire transcript of our discussion.

RYAN: Thanks for spending the time with me, Terri. The work you’ve done at Emeritus has been amazing.
TERRI: Thanks for the kind words.
RYAN: Let’s go ahead and get started. What is your role at the company?
TERRI: I am the Life Enrichment Coordinator for Summerville at Oak Park Assisted Living, an Emeritus Senior Living property in Clermont Florida. I am also on the marketing team here at Oak Park.
RYAN: Sounds like a lot of hats! Being a marketing guy from a previous life I know what you’re going through. I’d like to focus on the activities portion of your responsibilities. Would that be okay?
TERRI: Sure.

RYAN: What is the role of “activities” in an assisted living environment?
TERRI: Great question! Activities play a very important role in assisted living. It is very important to keep the mind and body challenged and stimulated throughout the day. More importantly, however, is the socialization that comes with activities. It is very important for your loved one to feel connected in their new residence. Activities will help to do this. Activities also help the resident continue to enjoy many things they used to do. This consistency helps with the overall transition to assisted living.

RYAN: That makes a lot of sense. I know it was tough for my mom to transition to assisted living, because she was so active before.
TERRI: What did she do?
RYAN: She was involved in women’s club, some charities and card parties with her lady friends. She missed all that when she got into assisted living, as she remembered what is was like before her stroke.
TERRI: That sounds tough.

RYAN: It was. Anyway, let me ask you another question. What do most assisted living communities do wrong with regard to activities?
TERRI: I only know from many that I have observed that they do not meet the needs of ALL residents. They focus on the mainstream population and often have activities that people with special needs such as physical, visual or hearing cannot participate in. In my community, we make sure that adaptive equipment is in place so that all residents can participate in any activity.
RYAN: That great to hear…
TERRI: I also firmly believe that the residents should have choices in their schedule, which is why a resident council should be in place. This is their home and activities should be available at all times for residents to participate in as a group or individually. That piece lacks in many communities. Another important factor is that the assisted living community should be connected to the local community. Many times residents feel isolated because their whole world revolves around the community. The community is very open to seniors and it is a great way to keep them connected.

RYAN: Your approach sounds really unique. What have you planned that is unique?
TERRI: I really believe that most of my activities are unique in that age never plays a role in what I plan. We are always involved in a community service project of some kind. My knitting class made baby hats for the neonatal unit at our local hospital. We donated 150 hats. They were also involved in the Give a Kid a Backpack Program here. The residents hand-craft a beautiful teddy bear to go in each backpack received by the children. We have made soldier caps that were sent to Iraq, we raised money for breast cancer awareness and many more. Seniors enjoy giving back. They feel a part of a bigger picture.

RYAN: That’s really amazing. This is the kind of thing that probably makes a big difference to the residents. It seems like having a purpose is often missing for many of the assisted living residents I’ve met.
TERRI: Absolutely. In talking with the residents, I learned that not working and not having responsibilities was the hardest part for them. In hearing that, I came up with a list of jobs within our building and held a huge job fair for the residents. Each resident who wanted a job came down dressed up, filled out an application for the position, and was interviewed by me. This gave them a chance to tell me about their former careers and what it was like to work when they were growing up. It was wonderful. They all got the jobs they applied for — floral committee, taking statistics, welcome committee, sending get well cards, watering plants etc. I can tell you that for three years, every one of them has taken their job very seriously. We are a family here, and it takes a family to make it work. They receive $100.00 a week funny money and shop at our General Store.

TERRI: I also started the Bridging the Generations program with all the local high schools. This is ongoing for three years now. The high school kids come to Oak Park and are paired up with the residents. They do projects together, cook together, etc. We celebrate holidays with the students. I bring the residents into the high school so that students learn about the aging process. The students play their instruments for the residents and work on their science fair projects with them. The residents are truly mentors for these students. We have been recognized by the Orlando Sentinel many times for outstanding programs here. One of our greatest activities was “Biker Day” at Oak Park. A local merchant brought their Harley’s to Oak Park. Each resident dressed up in leathers with headbands and posed for pictures on the bikes. We sent pictures to the families saying “And you thought your loved one was at home knitting!” We got a huge response of laughter from all involved. It was a blast!

RYAN: (Laughs) That sounds incredible. You really owe yourself a pat on the back for such great work! Can you please send me a picture of Biker Day? That sounds awesome!
TERRI: Sure, no problem.
RYAN: So, in your opinion, how have the residents benefited from those unique activities?
TERRI: The residents feel a part of the community. They truly see that they make a difference. They are loved and respected by so many people in this community. The merchants come here to do activities with them. The local florist does flower arranging, Home Depot does workshops with them, Ritters Frozen Custard makes sundaes here, and we have a merchant that sets up a fruit stand in our lobby with fresh fruits and veggies that the residents can choose at no charge. They feel very connected. It’s not just being part of their residence, but still maintaining a sense of community. That is important factor in maintaining good emotional health.

RYAN: Very cool. How do you mix physical and cognitive activities?
TERRI: I do a lot of physical and cognitive activities. I run a cooking class. We have measuring, kneading, peeling, cutting, those are all good ways to combined both physical and cognitive. We bowl and golf both in the community and out. The residents keep the score. We play twister with word games. Scavenger hunts, walking club, following a map to the destination. Most of the activities have both components as a part of it.
RYAN: I really appreciate your spending so much time with me. I am learning so much. I have a couple more questions if that is okay?
TERRI: Sure, happy to spend the time with someone who’s so passionate about it.

RYAN: Thanks! Ok, so what would you recommend from an activities perspective to readers evaluating assisted living communities?
TERRI: I think it’s very important to ask a lot of questions. You want to make sure that there are activities going on all day that include, physical activities, crafts that include a product that the residents can take to their rooms, outings, and cognitive activities. You want your loved one to be able to make choices in his or her schedule. A big component is to find out how they will help your family member connect when they first come in to the community. “What can you do to help my mom or dad connect if they do not want to come out of their room?” You should also make sure that there are outings outside of the community and that there is community involvement consistently. If people are sitting in the lobby with no activity, chances are that is the way it will be when your loved one lives there. Look for resident participation – talk to the residents. They are the best indicators of what truly goes on in the assisted living community. They will tell you if they are active or not. Stimulation is very important. If you don’t use all your faculties, you begin to lose them. Make sure each and every part of your loved one is being challenged daily.

RYAN: Last question. Do you have any other advice for the readers?
TERRI: Take the time to look around at different communities. Talk to residents; request a report from the Department on Aging for the state survey of the community. You can request it from the community as well. They have to show it to you. That is the law. This will give you the information on any violations the community has had. It covers resident care as well as dietary issues. This is an important piece of information to have. There are agencies that are able to help with the cost of assisted living. If you are a spouse of a veteran or a veteran yourself, there are ways to receive help. Look in to all options before making your decision. Remember, this is your family member’s home. It should not have a community feel but the feel of being home.

Terri’s activities plan is not the norm, although I wish it were. However, it should serve as an example of the kinds of things available to your loved one.

Unfortunately, many assisted living communities follow our typical day example rather than the fine example Terri has described. Do not be lazy about finding a community with good activities. It is a major social and emotional outlet for your loved one.

Photo credit: visual.dichotomy

Filed Under: Assisted Living, Quality of Care Tagged With: , , ,

Senior Care and The Importance of Staying Physically and Mentally Active

November 21, 2011 By 9 Comments

Before Mom got sick, she was an active lady. By active, I don’t mean she walked every morning. Rather, she was involved in almost every woman’s club in town, dedicated time to fundraising and countless local charities and took a deep level of interest in her family’s lives.

I vividly recall the first community I visited. As the admissions director walked me through the amenities during the tour, I drifted thinking about whether my mom would be bored there. I asked the admissions director what their most unique activity was. She responded: “armchair exercises.”

She proudly told me about the activity and suggested that I stay 30 minutes for the start of the next session. I was intrigued, so I stayed.

Slowly a few residents arrived, most of them with the help of a community caregiver and a wheelchair. Once seated in a semi-circle, the activities coordinator began walking the residents through a number of arm and leg motions.

The concept was solid. The problem: the activities director either didn’t notice or didn’t care that the residents weren’t participating. Many residents had a scowl on the face, evidence of the fact that they did not want to be there. Others went through the motions as best they could.

I remember thinking to myself when I left the community: armchair exercise is not an activity!

The point of my story is not to be sarcastic, but rather to illustrate something important. Activities represent an important part of your loved one’s day. They should be engaging both physically and mentally.

Being physically active can prevent and help treat many of the most common chronic medical conditions associated with old age. Physical activity is one of the most important steps older adults can take to maintain physical and mental health and quality of life. Yet today, more than 60% of older adults are inactive – and this number is probably much higher for residents of assisted living communities. Many are sedentary, physically unfit, and experience disability from chronic medical conditions as they age.

Community administration and staff members hear many reasons from residents as to why they are not active:

  • It’sboring.
  • It doesn’t feel good.
  • It makes my arthritic joints hurt.
  • It takes too much time.

However, they need physical activity more today than they care to admit. In fact, without physical exercise they will continue to suffer the loss of strength and stamina.

Walking groups and physical activity programs can help residents become and remain active.

Strength training is recommended for all adults, but it is a vital link to health for older adults. The reason is that strength training prevents sarcopenia, the muscle deterioration that comes with aging, and also helps maintain bone mass. “Stronger people have better health outcomes,” noted Dr. David Buchner, Chief of CDC’s Physical Activity and Health Branch and renowned Gerontologist. However, some elderly people avoid physical activity and become sedentary out of fear of falling and fracturing a bone. Dr. Buchner added that emerging data indicate that physical activity can prevent falls by improving strength, balance, and endurance.

Keeping Young at Heart aerobic activity, which is cardiorespiratory or cardiovascular endurance activity, is also important. It keeps the heart strong, lowers blood pressure, and relieves anxiety and depression. Even when the activities in a program such as this one are too strenuous, older adults can obtain significant health benefits with moderate physical activity, such as walking or gardening.

“We need to make physical activity part of the daily routine for older adults,” said Dr. Buchner. To that end, you should search for a community that has an active, diverse fitness program. Or, should the community you select have less-than-desirable physical activity programs, become instrumental in developing them.

What about Mental Fitness?

A large-scale study of women aged 65 and older found that cognitive decline was least common in those who were most physically active, while a large-scale study of men aged 71 and older found that those who walked less than a quarter of a mile a day were nearly twice as likely to develop dementia as those who walked more than two miles a day.

Basically then, aerobic exercise appears to improve higher cognitive functions (planning, organization and working memory) in the elderly. Another way physical training may help cognitive function in the elderly is by increasing their confidence in their abilities.

A small 14-day study found that those following a memory improvement plan that included memory training, a healthy diet, physical exercise, and stress reduction, showed a better performance on a cognitive measure controlled by this brain region, and participants reported that they felt their memory had improved.

The memory training involved doing brainteasers, crossword puzzles and memory exercises. Diet involved eating 5 small meals daily (to prevent fluctuations in blood glucose levels) that were rich in omega-3 fats, low-glycemic index carbohydrates (e.g., whole grains) and anti-oxidants. Physical exercise involved brisk walking and stretching, and stress reduction involved stretching and relaxation exercises.

Photo credit: brad montgomery

Filed Under: Assisted Living, Quality of Care Tagged With: , , , ,

3 At-A-Glance Guides for Assisted Living

November 14, 2011 By 1 Comment

There are many details involved in choosing an assisted living facility that will work for your loved one. The process involves navigating the terminology and verbiage of health insurance policies and also figuring out what a day-in-the-life would be like at a facility.

Here are three at-a-glance guides to help illustrate what long term care insurance is, clarify key insurance terms and show what a typical day at an assisted living facility should look like.

1. Long Term Care Insurance

You may hear a lot about long term care insurance, but how do you know if it is the right choice for your family? Below we’ll outline the target market indicators for long term care insurance, to help give you a better sense if these types of policies would be a good fit for you.

Who needs long term care insurance?

  • People who have assets they want to protect
  • People who want to maintain their financial independence.
  • People who are concerned about having a choice in the quality of care they will receive in the future.
  • The average age of people who buy long- term care insurance is about 65.
  • Married people with assets of above $100,000 (not including a house).
  • Single people with assets above $ 50,000. Otherwise a client would probably deplete their assets before the insurance kicks in, making them eligible for Medicaid.
  • Since women live longer then men,they have a greater chance of ending up in a nursing home. According to a 1997 study by the Health Insurance Association of America, half of all women who live to age 65 will need a nursing home at least once during their life, compared to about one- third of men.

2. Key Health Insurance Terms

Insurance is a major factor in today’s eldercare system. I advise you to contact an insurance advisor who specializes in working with older adults and their families. Here are some basic terms you’ll need to be familiar with:

  • Medicare: A federally-funded health program administered by the Department of Health and Human Services. It is available to all Americans over the age of 65. It is made up of two parts.
  • Part A: This is available to everyone, and covers inpatient care and some aspects of in-home care.
  • Part B: This is optional and requires a monthly premium. It covers many outpatient services.
    Both Part A and B include deductibles and co- payments, and exclude certain services. You may choose to purchase Medigap insurance to cover the “gaps” in coverage by Medicare.
  • Medicaid: This is also known as Medical Assistance, and covers health care services for low-income Americans. Funded by federal, state and local governments; this program requires that applicants meet stringent income and asset requirements. While it covers some inpatient services in hospitals or certified institutions, it rarely covers in-home care.
  • Secondary Insurance: Purchased privately, these policies do not cover long-term health care costs, and rarely cover long-term in-home care. This insurance is designed to supplement Medicare.
  • Long-Term Care Insurance: Such a policy covers both in-home and residential services (including nursing homes) over an extended period of time. Often prohibitively expensive.

3.  A Typical Assisted Living Schedule

When you begin to tour assisted living communities, pay attention to the daily schedule of activities, as physical and mental stimulation will help keep your loved one happy and well.

Planned correctly, activities will become the cherished part of your loved one’s day. To set our frame of reference, let’s look at a typical assisted living day from the perspective of the resident:

  • 6:45 – 7:30am: Have breakfast and receive assistance for a shower from the aide that I’m already comfortable with
  • 7:30 – 9:00am: Make my way down to breakfast. An aide will assisted me to the dining room if necessary, and the medication technician will provide my medications for the day.
  • 9:30 – 10:30am: Morning exercises in the activity room include some stretches, leg lifts and rubber band exercises.
  • 10:30 – 11:30am: Choice of a scenic drive or reading a book by the fireplace. If I take the scenic drive, the van will be wheelchair-accessible.
  • 11:30 – 1:00pm: Lunch and return to my apartment to rest for a while.
  • 2:30 – 4:30pm: Different things happen on different days. During a week, I’ll usually see education presentation, musical performances or craft demonstrations. Nothing is required if I am tired.
  • 4:30 – 6:00pm: Dinner.
  • 6:00 – Bedtime: Evenings can bring visits from family and friends, outings in the community van, or quiet time at home.

Photo Credit: Jan Krömer

Filed Under: Assisted Living, Legal & Financial Tagged With: , , , , ,

People to Meet on Your First Community Tour

November 7, 2011 By 3 Comments

Meeting new people has never been a problem for me. But when I arrived in the parking lot of the first community, I found myself very nervous. I spent many hours on the Internet looking for the right questions to ask, the right people to meet, what safety metrics to ask about, etc. I met with the admissions director, took a tour and was back in my car 60 minutes later. I saw the entire community and even met a few of the staff members. I still had no idea of why that community was better or worse than any of the several I was planning to visit.

While I summarized our plan in the last blog, it makes sense to add more detail regarding the people you need to meet during each of your initial community visits. Your first community visit will be overwhelming. Assisted living is just like any other business. In the world of assisted living, beds are products and the goal of the admissions department is to sell that product.

Unless you arrive prepared, you’ll leave with nothing but a sense of completion and a shiny new brochure. What you won’t leave with is any useful information that will help you either eliminate that community from contention or move it on to the next round of consideration.

Try visiting during the week so you can get a feel for the full staff level. When you visit your short-list a second time, you can validate the weekend team.

Who You Need To Meet

When you set up your appointment, make it clear to the admissions representative that you’d like to meet with several members of the staff. I’ve listed below the ones I believe are crucial to meet on your first visit.

Admissions director: The admissions director will likely be your primary contact at the community. At many communities, this person is also responsible for sales and marketing. As such, you should expect an upbeat conversation with little or no negativity. The admission director’s primary role is to fill the beds (product) in the community, but they more than likely care a great deal for the people they place in the community. That being said, expect to get the pros, but not a complete picture of the cons during your discussion. I do recommend that you leverage this person’s knowledge of the staff to learn more about their backgrounds.

Activities director: The job of the activities director is to provide entertaining and stimulating activities for the residents. The demeanor and attitude of this person is tremendously important. Their patience, creativity and tenderness can make a world of difference in residents’ daily lives. Find a grumpy one, and your loved one could be looking at days of old movies and bus rides. The following chapter discusses the right way to implement an activities program.

Registered nurse: Assisted living communities are not required by law in all states to have a registered nurse (RN) on staff during some portion of the day. The RN will likely be the one to follow up with your doctor if your loved one is not feeling well, and they’ll also be the one to call an ambulance. Spend some time with the RN to clearly understand his/her hours. Get a feel for their philosophy. At all costs, avoid those who have that “tough it out” attitude.

Medication manager: The medication manager (also called a “med-tech”) is responsible for getting all medications to your family member on schedule. In assisted living, residents are usually not allowed to keep medications in their rooms – over-the-counter or prescription. Spend some time with the medication manager to understand their experience and communication skills. Make sure the night shift med-techs have the same training and language skills as the day shift.

Physical therapist: Depending on your family member’s ambulatory skills, the physical therapist may, or may not be, of value. Aside from my mom herself, the physical therapist had the most impact on her recovery and ongoing mobility.

Most communities have a therapy room, and you should visit it. If you time your visit in the morning or early afternoon, you’ll likely get to see the therapist with one of the residents. Speak to the therapist to get a feel for the experience they have working with seniors. If you family member has a specific condition, make sure they have successfully worked with that condition. In the case of my mom, it was important the therapist have experience helping stroke victims learn to walk.

Head chef: The head chef is responsible for planning the menu and managing the chefs who cook it. Look at the menu and ask how they plan for sodium, cholesterol and sugar-restricted diets. It always struck me as odd that with many older people suffering from heart disease and diabetes that chefs would serve food that I wouldn’t eat myself.

Executive director: The executive director has ultimate authority over all aspects of the community. They are also the one responsible for passing on and maintaining records for state health inspections. The executive director should have a deep and profound connection to helping the residents. You’ll run across executive directors that are all business. While it’s obviously important to take a business approach to the community, make sure this demeanor doesn’t come at the expense of the patience and compassion required to make the residents happy.

Don’t Forget the Residents

The biggest barometer of a community is the residents themselves. Pay close attention to the way residents interact with each other and with other residents. If you notice a group of residents in front of the TV with no real engagement in the show, ask questions. This could be a sign of a disengaged activities director.

It is also perfectly reasonable for you to speak to the residents. As I mentioned, you’re unlikely to get honest answers about the quality of the community. In fact my mom has told me on several occasions that residents feel pressure (perceived or not) to not speak negatively about the community. So, take their words to heart, but with that proverbial “grain of salt.”

Photo credit: Sahaja Meditation

Filed Under: Assisted Living Tagged With: , , , ,

Interviewing Assited Living Administration and Staff

October 31, 2011 By 5 Comments

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

 

Filed Under: Assisted Living Tagged With: , ,
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