My Experience with Elder Care and Assisted Living

elder careEighty-four percent of Americans over the age of 50 expect an immediate family member to move into a senior living community within the next 10 years, while 24 percent over the age of 65 expect the same for themselves, according to a new national survey of American attitudes on assisted living released today by the Coalition to Protect Choice in Senior Living (CPCSL). The poll found just more than half (51 percent) expect their parents to live in a senior living community within 10 years, with 15 percent expecting the same for their spouse and 10 percent for a sibling.

My Story

I’d like to briefly share the story of the event that started me on this path. I imagine it’s similar to your own in that it begins with an unexpected phone call.

My wife and I had just returned from celebrating our engagement in Greece, and we were sharing stories over bowling with some good friends.

I was the product of a second marriage, and my mom and I had become quite close since my father’s passing while I was in high school. We spoke often, so I wasn’t surprised when my cell phone rang and the caller ID showed it was her.
I was surprised when I answered and it was the paramedics.

Apparently, my mother called 411 asking for my name and phone number as she could not remember it. The operator called 911, and in a matter of minutes, they had arrived, kicked down the door and called me.

My mother had a stroke. I was only 33, and totally unprepared for the depth of emotions, or the complexity of the decisions I was about to face.

That a 73-year old woman had a stroke is not unusual. My mom’s case was unique because of the series of complications that nearly killed her. In the eighteen months following her stroke, she endured major back surgery to remove a staph infection from her spine, a perforated intestine that required stomach surgery, several MRSA infections1 requiring IV antibiotics and a broken hip. She spent several weeks in the surgical intensive care unit recovering from her back surgery. Many of these nights, I feared the worst. But my mom is a fighter.

The medical system these days isn’t designed for long-term recovery. Hospital personnel are highly trained at treating acute problems and dealing with specific injuries and conditions. In fact, we have some of the most skilled doctors in the world.

But when you’re older and recovering from a serious illness, your options are usually to go home, or go to a skilled nursing facility – where staff can provide physical or occupational therapy, administer IVs and perform other functions requiring a registered nurse.

During this time, she spent nearly six months moving back and forth between the hospital and skilled nursing. In January of 2006, I moved Mom from San Diego to Orange County. She graduated from skilled nursing and was on her way to assisted living.

Trust, Hope and Hard Work

When Mom arrived in assisted living, she could not stand or walk and required a 24-hour caregiver. She could not eat or drink on her own and was in a deep state of depression.

While I found much advice on medical conditions and treatment, I found virtually nothing on understanding assisted living. Sure, there were some Websites that taught you the basics, like “make sure a nurse is on duty” or “make sure the kitchen is clean.” But this is my mom and I wanted far better for her. I wasn’t putting her away; I was playing a key role in her recovery.

Because of the lessons I learned – and a lot of hard work on the part of my mother – she is doing very well. In fact, we’ve become very close friends. She walks with a walker; her memories are clear and vibrant. She has a circle of friends and a packed calendar.

She even made it to my wedding. And she looked beautiful. I cried. They say your wedding toast is one of the most important speaking opportunities you’ll ever have. And I consider myself to be a good public speaker, routinely speaking at tradeshows and other events. But when I looked into the crowd and saw my mother smiling, I fell apart.

The joy I felt at seeing her on that special day was overwhelming. So was my commitment to her continued well being. It was my clear intention that she be given every opportunity in her assisted living situation to thrive, to grow, and to be fulfilled.

Recall the statistics at the beginning of the chapter. While I was shocked these numbers were so high, I completely agree. I did some homework. In an informal study of about 40 people, I sensed an almost inevitability about needing assisted living. I also found that financial issues and quality of care topped the list of concerns for both Baby Boomers and their children.

I followed up my informal study with a formal study of nearly 200 families. The Assisted Living Family Attitude and Preparedness Report showed that 75% of respondents believed a friend or family member would soon require assisted living. The report is free to anyone who wants to read it and can be accessed at the link above.

My goal is to share with you some of what I learned through my journey. My hope is that these lessons can make it easier for you and your mom, dad, relative or loved one. I assume you’re reading this blog because you or a loved is considering assisted living. Since you likely haven’t gone through it before, the decisions can be overwhelming. I’ve written this blog to help you make more informed decisions, and to be calm in what is likely to be an emotional storm. I sincerely hope I can help you avoid some of the pitfalls of learning the assisted living ropes.

While a move to assisted living may initially be seen as negative, I know first- hand that with some careful and thoughtful planning, you can make it a huge positive for all concerned. Over the last several years, my relationship with my mother has strengthened. She has become one of my best friends and an integral part of my life.

I hope you enjoy reading this blog and that I’m able to somehow make your journey a bit easier.

Photo Credit: andrewmalone.

Five Tips for Finding a Quality Home Care Provider

You and your family have decided that it is time to bring in outside help to assist with the care of a loved one in need. Because you want them to be able to remain safe, comfortable and independent in their own home for as long as possible, you have chosen to hire an in-home caregiver or home healthcare agency. The next step is choosing the best care provider for you and your loved one. But how do you know who the best is?

Here are five tips for finding a quality home care provider:

  1. Get recommendations. Talk to trusted professionals and community members. Your parent’s doctor, financial advisor, attorney, other medical providers, friends or family members may have familiarity and experience with local companies that do a good job. A list of providers is also available from your local Area Agency on Aging or hospital social work department. However, it is rare for these resources to make specific recommendations.
  2. Know your liability. Understand the possible liabilities and ramifications involved when hiring a caregiver privately. Consider issues such as taxes, insurance, liability and worker’s compensation, backup coverage, background checks/oversight and training.  If hiring through a nurse registry or employment agency, the family may end up being the official employer, responsible for pay, taxes and other obligations. On the other end of the spectrum, fully licensed private duty home health agencies offer more comprehensive services and protections as employers of the caregivers.  To learn more about state agency requirements and protections, contact your state licensing agency for healthcare organizations, or visit the National Private Duty Association at www.privatedutyhomecare.org.
  3. Consider innovation. Research how current their monitoring and communications technology is. How easy is it to monitor the care your loved one is receiving? Do they use technology like telephone clock in systems and scheduling software for quality assurance?  How quickly are they aware if a caregiver has not shown up to provide care?  What methods do they use to communicate with you?  Do they offer you conveniences such as online monitoring and paying bills online or via credit card?  Do they keep up to date with aging in place technology and can they provide you recommendations that may bolster care?
  1. Get to know who you’re hiring. When talking with an agency, get a feel for their process. Will they allow you and your loved one to interview potential caregivers? How do they handle replacing a caregiver that is not a good fit? What steps do they take to ensure coverage and accountability? How do they supervise, train and support staff? Do they strive for continuity or will your loved one have different staff each time?  How many caregivers will cover the shifts your loved one requires?  It is important to discuss your loved one’s specific diagnosis and needs, finding out the agency’s experience with similar situations and any special training and guidance they provide, for example training on working with clients with Alzheimer’s disease.  While regulations standardize licensed home care agencies to a degree, these are the things that will set one agency apart from another.
  2. Research involvement. Seek out providers who have a history in the community and the industry. Check if providers are involved with local and national associations such as the Alzheimer’s Association, the Area Agency on Aging and the National Private Duty Association. Their involvement demonstrates passion and dedication for their field. Management staff that has a history in the community and the profession demonstrates a commitment, stability and a positive reputation that they would want to protect.

Photo credit: familymwr

About the authors: Alex Chamberlain is executive director at EasyLiving, Inc. (http://www.easylivingfl.com), a fully licensed, private duty home health care company serving individuals and families in Pinellas and Pasco counties in Florida.

Shannon Martin, M.S.W., CMC, serves as Director of Communications for EasyLiving, Inc. and Aging Wisely, LLC (http://www.agingwisely.com). Shannon has worked for Aging Wisely, a professional geriatric care management and consultation firm, for over 8 years.

Finally, a Vision for Care Referrals That Will Improve Outcomes

Picture this: you’re one of millions of Americans who needs care at home either because of aging, dementia, recovery from surgery or other disabilities.  You’ve got a family—and often an unpaid caregiver who helps with your care.  They’re part of an elaborate team of caregivers, physicians, therapists and non-medical assistance.  I’ve lived this first-hand as I’ve cared for my mother, and I’ve spoken to literally hundreds of families in the same situation.

Insurance companies and other employee benefit programs often deliver these care recommendations.  They do the best they can considering maintaining these programs—and the underlying data—is not their primary business.  Unfortunately, they struggle to extend these programs across the whole company so that each member-facing group can leverage the same data to provide the best care referrals to their members. I’ve just assumed it was one of those “not-yet-solvable” situations, as healthcare technology is always a bit slower than other industries.  So we did the best we could and used what was not an ideal support system.

The Future of Care Referral Programs

I think I finally found a vision for the future.

I ran into a white paper from SNAPforSeniors that really caught my eye.  If SNAP can deliver on this vision—and if insurance companies, call centers and other providers have the vision and foresight to adopt it—it will dramatically change the outcomes of care coordination as part of the age in place movement.  More important, it will give families like mine the peace of mind that we are getting referred to the best matched providers for our care.

I know this vision may not concern some of you, but I highly recommend you check it out.  These types of ideas are the ones that are going to make the biggest impact. If you think your family would benefit from your insurer adopting programs like this, you should let them know.

Here’s the link to the paper – http://bit.ly/aPPsWU.

How to Choose a Caregiver

The title of caregiver is not as obvious as it may seem.  Caregivers can aid in eldercare on many different levels and depending on your needs their roles can provide key benefits.

Benefits of caregivers

Your eyes and ears: Whether you live close by or far away, a caregiver can observe and update you on areas of nutrition, hygiene, activity level, services and other daily issues.

A concierge: Scheduling and staying current with weekly and monthly activities such as doctor’s visits, shopping, hair appointments, and therapy requires phone calls and follow up.  Allow the caregiver to take some of this off or your mind and your to-do list.

An influencer: Communication and opinions by close family members are sometimes not seen as being objective or carry as much weight as a professional caregiver.  Therefore it may be easier on everyone if the caregiver steps in at times to advise the patient rather than a family member.

Finding a caregiver

Before you choose a caregiver, you should determine the range of services you want so that you are making a decision that covers your predetermined needs.  Consider the following:

Make a list of daily activities: By reviewing the activities of a typical day of the patient you will be able to determine the specific duties required.  It helps to create a timeline of activities so that you plan for meals, naps and regular appointments.

Assess the degree of specialty: If the patient suffers from any degree of dementia or physical disability make sure you look for a caregiver with appropriate knowledge and experience.

Determine the need for meal preparation: Not only should you make a choice for a caregiver on their ability to prepare meals if necessary, but also their understanding and ability to create diet-specific meal choices.

Once you have your specific needs list refined, go to the following resources to be connected to the appropriate pool of caregivers to begin your interview process.

Additional resources:

www.caregiverlist.com

www.caregiver.com

10 Caregiver Questions

To make the most of your time during the interviewing process, conduct preliminary interviews on the phone rather than starting with in-person appointments.  Describe the job in detail along with the required hours needed and wages available.  If you feel the applicant may be a good match based on their experience and ability to provide references, then schedule the in-person interview.  It is a good idea to have another family member or friend participate in the interview to provide an objective perspective.  Finding that great match may be easier with a second opinion.

In preparation for the interview, create a list of questions pertinent to the job description.  Ask questions relevant to the caregiver’s experience and expertise surrounding the daily activities list you previously created.

  1. Where have you worked before?
  2. What were your duties?
  3. What type of patient medical limitations have you worked with in the past?
  4. What is your experience cooking for other people (including dietary restrictions)?
  5. Is there anything in the job description that you are uncomfortable doing?
  6. Have you had to deal with a patient emergency in the past?
  7. Can you keep track of and administer medications?
  8. Would you be able to transfer someone from a wheelchair into a car or into a bed?
  9. How do you feel about caring for a disabled person? Or a person with memory problems?
  10. Can I contact at least two work-related and one personal reference?

If you need a template for a caregiver interview, download this form as a guide:

http://www.agis.com/Document/38/professional-caregiver-interview-form.aspx

Once you narrow down your field of applicants, make sure you observe the applicant’s interactions with your family member on a casual basis before making a decision.  If your family member is able, he or she should be included in the interview process and in making the final decision.

Consider the person most qualified for the job and with whom you feel most comfortable. Always check the references of at least two final applicants. Good applicants may have more than one opportunity at a time, so don’t wait too long before proceeding with an offer.

Your Senior Health Care Bill: $260,000!

I have always been a big fan of Howard Gleckman, author of Caring for Our Parents.  In fact, he was the very first person I interviewed for my Leaders in Elder Care series.  If you aren’t familiar with Howard’s blog, you’re really missing out on a complete play-by-play of how the health care debate is impacting the cost of senior care.

This morning, he shared some startling statistics about paying for elder care that I have quoted below.  In this article, Howard has links to some fascinating studies about the out-of-pocket costs for seniors, and it is shocking.  It is mind-boggling to me how financing elder care will be solved as we move forward. He wrote:

A typical couple would have to save nearly $200,000 to pay for their out-of-pocket medical costs from the time they are 65 until they die, according to an important new study by the Center for Retirement Research at Boston College. Add in nursing home costs, and they are likely to need $260,000.

But that’s only part of the story. About 5 percent of 65-year-old couples will face catastrophic medical and long-term care costs exceeding $570,000, according to researchers Anthony Webb and Natalia Zhivan.They estimate those expenses would have exhausted the total financial assets of 85 percent of all retirees even at the peak of the stock market in 2007.

As someone who has first-hand experience with out-of-pocket expenses and my Mother’s care, I was still so stunned by these numbers, that I could not write a conclusion to this article.  What do you say?

Obviously, I encourage you to check out Howard’s writing.  In the meantime, what are your thoughts about these big numbers?

Photo: bubble dumpster

Assisted Living Saved My Mom in Oregon

A couple weeks ago I had the pleasure of traveling to Oregon to speak at three assisted living communities across the state.  I posted some pictures of the event on the Inside Elder Care Facebook page at http://www.facebook.com/eldercare.  Brookdale brought me up from California to visit three communities—all from distinct areas within Oregon.  They were:

  • Albany – small towns set in an agricultural area just southeast of Portland
  • McMinnville – right in the center of Oregon wine country
  • Gresham – at the base of Mount Hood (yes, I was cold)

At each community, I gave a talk entitled Assisted Living Saved My Mom—a presentation communities ask me to give that provides an insider’s view about how to determine which assisted living community is best for your family.  Assisted Living Saved My Mom shares many techniques that uncover information you would never get from just speaking to an admissions director.  Brookdale provided a copy of my book to each who attended—something appreciated by the attendees.  Based on the large amount of feedback I received from attending families and people in the industry, the message really hit home and benefited many people.

Despite the obvious differences in the locations of each of these communities, I found a few things in common:

  • Warm and friendly: nearly every person I met—from the staff to the residents—were very welcoming and warm.
  • Pride: there is a strong sense of pride in the residents that carried over to their feeling that it was their responsibility to make new residents comfortable.
  • Camaraderie: I got the feeling that the residents genuinely enjoyed each other’s company. You could tell because they all knew each other’s little quirks and habits—something they found amusing.

One thing that came up repeatedly was the concern over “How do I pay for this stuff?” Many people were surprised there were other payment options beside just selling their house and paying cash.

When I wrote the By Families, For Families Guide to Assisted Living, I interviewed nearly 200 families to ask them about the concerns related to assisted living and elder care.  The issue of paying for elder care came up as a primary concern from almost three-quarters of those families.

The financial issues are the elephant in the room.  Most people don’t know how to solve them or even where to start, because there is no holistic guide for families on how to navigate these issues.  I am a month or two away from releasing my second book that gets into these answers—the feedback from those that have seen it has been really positive.  Stay tuned.

Taking Your Feet for Granted? Meet Ray Margiano, Founder of Foot Solutions and Leader in Elder Care

In this Leaders in Elder Care interview, I wanted to step back from residential and medical care and focus on something that many of us take for granted.  The simple fact is that for seniors, foot comfort and correctly-fitted shoes can make the difference between independence and comfort or pain and immobility.  As an athlete, I thought I knew a lot about shoes – the how and why the need to fit.  When you talk to Ray Margiano, CEO and founder of Foot Solutions, you quickly learn the mind-numbing depth of science that goes into shoes.   I’ve named Ray Margiano a Leader in Elder Care because of the passion he brings to his business and for the incredible impact that his work has on millions of seniors who want to keep moving forward.  Kudos, Ray!  And to the rest of our readers, I hope you enjoy the interview…with your shoes ON!

About Ray Magiano

Ray Margiano PhD, CEO and founder of Foot Solutions, established Foot Solutions at the end of 2000 with three employees and no funding, to provide custom orthotics and shoes to fit and provide proper support, and to address the individual foot health needs of a wide variety of consumers. By the end of 2008, he grew the company to more than 240 franchises worldwide and a corporate staff of over 50 people with sales around $100-million. Foot Solutions has already signed agreements in 16 countries with master developers and are projecting five new countries per year with a continuing growth rate of 50 new units a year.

Ray’s business philosophy is to give something back to the community and to be part of positive change and energy. As such, Foot Solutions provides many outreach programs donating time and money to organizations active in health and wellness, children’s obesity, diabetes and foot care. Ray also serves on the American Diabetes Association’s advisory board, is a member of the Board of Governors at University of New Haven and on the Board of Directors for the National Shoe Retailers Association.

Ray has received many awards in business throughout his career, including the 2008 Cobb Chamber Small Business of the Year, Small Business of the Year Atlanta 1994, Blue Chip Award Winner, and International Fran¬chise Award for International Excellence, University of New Haven Distinguished Alumni Award and Distinguished Bartels Fellowship Award University of New Haven, among others. He is a frequent speaker on franchising, the footwear industry, pedorthics and Balance Walking, a low-impact exercise using modified ski poles with wrist straps that increases circulation muscles and aerobic fitness.

Ray has a Bachelor of Science in Business Administration from the University of New Haven, a Masters degree in Computer Science from Rensselaer Polytechnic Institute and a PhD in International Business Administration from Canbourne University. Before founding Foot Solutions, Ray held high-level positions at Sikorsky Aircraft, Sybron and Textron and also founded Heel Quik, the world’s largest personal services franchise with over 700 operations in more than 30 countries. Ray is also the author of “Balance Walking”, which teaches about the physical benefits of Nordic Pole walking.

How Ray Margiano Described Foot Solutions

Foot Solutions is a leading multinational retailer of proper-fitting, comfortable, high-performance shoes, custom inserts and technology-driven health and wellness products to consumers across the globe. With more than 240 stores in 13 countries, Foot Solutions is the world’s largest health and wellness franchise dedicated to foot care.

CEO Ray Margiano PhD, founded Foot Solutions in 2000 after a 20-year career in the foot care and pedorthic industry to provide custom orthotics and shoes to fit and provide proper support, and to address the individual needs of a wide variety of consumers.

The company’s philosophy of better health through your feet is put in practice by providing a full line of quality shoes, arch supports and foot care accessories for all lifestyles. A key part of the Foot Solutions experience – and a core aspect of the company’s overall product and philosophy – is an individualized consultation for each customer to determine the proper shoe, orthotic or other foot care product for their specific needs.

Foot Solutions’ staff, versed in both foot pathology and properly fitting shoes, helps customers make choices that will support their foot care plan, accommodate foot problems, or simply offer both comfort and style. Foot Solutions offers foot care products specifically tailored to individuals with 18 health problems including heel and arch pain, diabetic foot disorders, arthritis, sports injuries, and back pain through expertly fitting footwear, arch supports and other foot pain relief products. It also provides shoes and other products designed to accommodate and alleviate foot injuries, products to optimize athletic performance, fitness and training aids, and corrective and occupational footwear, including nonslip shoes.

Part of Foot Solutions’ philosophy is to contribute in positive ways to the community on a local, national and global level. To that end, the company provides opportunities for its associates to participate in programs related to children’s obesity, diabetics, fitness, and retirement communities. Foot Solutions is also a consistent supporter of the President’s Challenge program for getting Americans back in shape and Soles for Souls, which donates shoes for flood, fire and the underprivileged.

Text from Obama’s Healthcare Speech That Addresses Seniors

For those of you who missed President Obama’s speech last night, below is the text of the section of the speech addressing seniors.  The speech was delivered on September 9, 2009, in a joint session of the US Congress.

In fact, I want to speak directly to America’s seniors for a moment, because Medicare is another issue that’s been subjected to demagoguery and distortion during the course of this debate.

More than four decades ago, this nation stood up for the principle that after a lifetime of hard work, our seniors should not be left to struggle with a pile of medical bills in their later years. That is how Medicare was born. And it remains a sacred trust that must be passed down from one generation to the next. That is why not a dollar of the Medicare trust fund will be used to pay for this plan.

The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies – subsidies that do everything to pad their profits and nothing to improve your care. And we will also create an independent commission of doctors and medical experts charged with identifying more waste in the years ahead.

These steps will ensure that you – America’s seniors – get the benefits you’ve been promised. They will ensure that Medicare is there for future generations. And we can use some of the savings to fill the gap in coverage that forces too many seniors to pay thousands of dollars a year out of their own pocket for prescription drugs. That’s what this plan will do for you. So don’t pay attention to those scary stories about how your benefits will be cut – especially since some of the same folks who are spreading these tall tales have fought against Medicare in the past, and just this year supported a budget that would have essentially turned Medicare into a privatized voucher program. That will never happen on my watch. I will protect Medicare.

Now, because Medicare is such a big part of the health care system, making the program more efficient can help usher in changes in the way we deliver health care that can reduce costs for everybody. We have long known that some places, like the Intermountain Healthcare in Utah or the Geisinger Health System in rural Pennsylvania, offer high-quality care at costs below average. The commission can help encourage the adoption of these common-sense best practices by doctors and medical professionals throughout the system – everything from reducing hospital infection rates to encouraging better coordination between teams of doctors.

Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan. Much of the rest would be paid for with revenues from the very same drug and insurance companies that stand to benefit from tens of millions of new customers. This reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money – an idea which has the support of Democratic and Republican experts. And according to these same experts, this modest change could help hold down the cost of health care for all of us in the long-run.