Before you can even begin the process of evaluating assisted living, it’s im- portant to familiarize yourself with all the terms. There are many types of care ranging from skilled nursing to senior living. They all vary based on the level of assistance required by the resident. What is the difference? Let’s find out.

Senior Communities

Senior housing is designed for high-functioning elders, defined as those not requiring assistance with ADLs. Senior communities are usually neighborhoods or towns (consider Sun City, the nation’s “first and finest” senior community) that are limited to people of a minimum age. They are designed for active seniors and have a variety of social clubs such as golf, arts and crafts and cards.

While some senior communities offer additional levels of care, many are not equipped for individuals who require assistance with ADLs. Some senior communities require the resident move on, should they require this level of care.

Continuing Care

Continuing care communities are sometimes called “step care” or “progressive” care facilities. They offer a wide range of options, all the way from independent living to special care. Residents are usually admitted when they live independently. As their needs increase, they are guaranteed vacancies in the lower level of care. An entry fee is often required, making this option quite expensive.

Assisted Living

Assisted living offers the elderly a place to live outside of their own home, where they can receive basic assistance in one or more of the following areas: housekeeping, meal preparation, 24-7 monitoring, shower assistance, toileting, medication assistance or reminders, transportation, eating, dressing, activities or socialization.

In assisted living, your loved one will likely have their own apartment, unless you or your loved one consents to sharing a room with someone. A private bathroom is most often in the apartment to allow for privacy and dignity. Most facilities will have a kitchenette in the apartment with a sink, microwave, refrigerator, and cupboard space. Each apartment will likely be climate controlled individually. There will be access to common areas such as a TV room, an activity room, dining room, library, and communal sitting areas.

Assisted living facilities are designed for people who need help with complex ADLs on a daily basis. If you remember from the previous chapters, basic ADLs include eating, bathing, dressing and hygiene. More complex ADLs include cooking, shopping and money management. Assisted living aims to be the mid- point between independent living and long-term care.

Most assisted living facilities have a dining room decorated like a restaurant as well as a variety of activities. Most assisted living facilities are not licensed to administer IVs, requiring patients who need IVs to temporarily relocate to a skilled nursing facility.

Board and Care

Board and care is similar to assisted living in terms of care, although some group homes work with lower functionality seniors than those found in assisted living. A woman I spoke with recently had placed her mother, suffering from Alzheimer’s disease, in a board and care facility, sometimes known as a ‘group home.’ This is usually a single-family dwelling which has been converted into a residence for elderly and disabled residents. The monthly rent paid commonly includes room, three meals a day, laundry services, and some transportation – in addition to a 24-hour staff person. While basic medical care can be attended to, residents who have serious medical conditions will be expected to move into a more suitable facility.

Skilled Nursing

Skilled nursing (also called SNF or “sniff”) is the first level of care that is licensed to administer medical treatment with nurses. In fact, there are strict regulations that require nurses to be on duty and to regulation the nurse-patient ration.

As the name denotes, such a facility offers extensive nursing services for the residents. Admission must be initiated by a person’s physician, who recommends that a patient enter either ‘rehab care’ or a ‘special care’ facility.

• Rehab care. Located in hospitals or nursing homes, rehab care programs are sometimes called “Level 1” or transitional care. They provide intensive medical care for patients who are expected to regain functional capacity and return home in a relatively short time.

• Special care. There are two types of special care facilities: those involved with unique medical issues (sometimes called “Level 2” care), and those which manage behavioral problems that may arise from dementia.

Many patients are admitted to skilled nursing to address an acute condition such as rehabilitating a broken hip, or treating an infection with IV antibiotics.

Many skilled nursing facilities have a portion of their residents who are long- term care patients. These are patients who require the treatment capabilities of a SNF, yet their condition requires that level of care permanently. Long-term care includes nursing supervision, but it is custodial in nature – focused on maintenance as opposed to curative care. Here the condition is not expected to improve, and the nursing activities are focused on keeping the person healthy and safe. The table below summarizes the differences between the levels of care and residential options.

This table is an updated, compiled version of those found in both offline and online sources, many of them listed in the resources section, the Book Club listings or 2008 Long-Term Care Cost Study, The Prudential Insurance Company of America, 751 Broad Street, Newark, NJ 07102-3777.

Photo Credit: gilbert928.

Ellen Dunnigan combines dementia care with a 360-degree home care philosophy to provide a unique option for families struggling with dementia or Alzheimer’s. The Sollievo model is one of many unique care models that are emerging as we grapple with how to care for our elders. What I found interesting about Ellen’s approach is her keen attention on serving the seniors AND providing stress relief to the family.
How Ellen Describes Sollievo

Sollievo is a care management network for families caring for an aging parent. We provide expert answers and relief to the daughters and sons who have taken on the exhausting caregiving of a parent who has been diagnosed with Alzheimer’s or a related dementia.

Typically we guide daughters who are trying to be both SuperMom and SuperDaughter, doing one job all day and then coming home in the evening to start the even tougher job.

They are stressed out, tired of being tired, and feeling guilty; consumed with trying to be the “answer” to everyone including their siblings in other states. They wish someone else could help them without getting in the way. And they need just-in-time resources to safely keep their mother or father at home longer.

Our process begins with a three-pronged assessment of the living environment, the well-being of the person diagnosed with dementia, and the burdens placed on family caregivers. We supply education and clarify expectations. We tailor strategies to make the days and nights better. Our 24/7 helpline is always answered live to address their immediate concerns. And most importantly we deliver the “just right” answers and network of services the first time, and every time.
About Ellen Dunnigan

As a strategist healthcare product development, and a Speech-Language Pathologist, Ellen Dunnigan has produced several healthcare product lines including Alzheimer’s care, Geri-psych programs, diabetes care, traumatic brain injury programs, and others. She has developed a balanced model of Alzheimer’s care for the long-term care segment which guides caregivers to exceptional results in patient care and meaningful resident days. Additionally, she has initiated a first-of-its-kind community model for the coordinated care of families caring for an aging parent diagnosed with dementia.

Ellen has a Masters degree in Speech-Language Pathology, certification in gerontology and case management. She is the author of several best practice clinical and operational methods in Alzheimer’s care and speaks internationally. She founded Alzheimer’s Care Group in 2002 and has grown it to a nationwide consulting firm specializing in healthcare strategy. Alzheimer’s Care Group has five associates and operates in care settings in 30 states. Their community resource network is called “Sollievo” and operates throughout Indiana, with plans to expand to neighboring states.
Contact Information

Sollievo office: 317-218-5111
24-hour Helpline: 317-753-7447

Info@BeHomeLiveLife.com

www.BeHomeLiveLife.com

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.

Culture Change (also known as person-centered care or resident-directed care) transforms the traditional long-term care model from medical facility to a supportive home environment.  This movement is designed to change the overall mindset and environment of nursing homes into personal communities.  Culture change is designed to nurture the human spirit of aging residents as well as take care of their medical needs.  Its focus is on both quality of care and quality of life as guiding forces for improved life experience and life expectancy.

Within the culture change model, seniors have more privacy and choices, much like they would in their own homes.  They are given more control over their daily lives including meal and bed times and the caregivers are given more autonomy to care for residents in this flexible environment.  Residents’ needs and preferences come first, and care community operations procedures are shaped by this perspective.  Even the physical structures are changing from large hospital-like units to smaller communities resembling more of a group-home atmosphere in which they are cared for by a dedicated team of caregivers.

10 Benefits of Culture Change

1. Respects the right of the resident to make their own decisions and honors their need for control over choices in their daily lives.
2. Reduces boredom and helplessness in residents.
3. Improves mental health (reduces loneliness, depression, behavioral issues).
4. Encourages a personalized home atmosphere by allowing residents to create their own living style in their rooms.
5. Increases enjoyment and life expectancy of the patients.
6. Focuses on using person-centered language that respects and honors the patient by putting the person first and then the characteristic second.  For instance, instead of a wheelchair-bound resident, the description is modified to a person who uses a wheelchair for mobility and instead of a feeder the patient is referred to as someone who needs assistance with dining.
7. Focuses caregivers on person-centered care, rather than completion of tasks.
8. Individual care focusing on personalized needs and preferences of the staff and the residents creates a supportive environment that puts people first, over the facility.
9. Promotes a dedicated team approach rather than rotating assignments for staff thereby creating personal connections and familiarity for the residents.
10. Creates a team-building environment for the staff based on consistency of staff teams.
11. Reduces employee turnover which in turn keeps a steady team of familiar faces rather than the need for temporary staffing agencies with training needs and learning curves.

The essence of culture change is about transforming philosophies and management style so that aging is no longer synonymous with decline and illness.  The principles of culture change are founded in a new way of caring and being cared for that is based on choice, creativity, and flexibility.  The future of culture change lies in the commitment to improve resident and staff quality of life through empowerment.

For more information on the culture change movement, visit the Pioneer Network.

Photo credit: K?vanç Ni?

Whether you are a family member trying to choose the right home care company for your loved one, or you are a provider interviewing potential applicants, background checking is critical.

Eldercare abuse comes in many forms: financial, emotional and physical.  Being proactive about the selecting a home care provider can help you avoid worry, heartache and financial and potential legal action.

Example: Check-Cashing Fraud

Within months of hiring an in-home caregiver for her two aging parents, a woman in San Diego was notified by the Sheriff’s Department that the caregiver had opened 30 credit card accounts in the parent’s name and purchased three vehicles worth $50,000 with those credit cards. In addition, the caregiver had also convinced the elderly couple to provide her with power of attorney and then managed to have them sign over ownership of their house, valued at $650,000.  Further investigation of the individual revealed she had prior convictions for check-cashing fraud 10 years ago.  However, the background check only covered the prior 7 years of criminal history.

Knowing your home care provider does background checks is just the beginning. Not all background checks are the same and not all companies exclude potentially dangerous applicants based on the same criteria.

Questions to Ask Your Home Care Provider

• How many years back in the person’s history does the check cover?
• Does the check reflect both criminal and civil records?
• Does the company check licensing status across state jurisdictions?
• Are credit reports run?
• Are Department of Motor Vehicles records obtained?
• Are gaps in employment history verified?
• Do they make the phone calls to references or are they outsourced?
• Is evidence of education provided and confirmed?
• What criteria does the company use to deny employment?  What offenses are tolerated?

Choose the provider with the most stringent background checking protocol.  If the provider cannot answer these questions, find another provider.

New Federal Database of Dangerous Caregivers

More than two decades ago, Congress demanded that a national database be available for hospitals to check for disciplinary actions taken throughout the country against nurses, pharmacists, psychologists and other licensed health professionals.   The database became available as of March 1^st but there is some skepticism regarding the thoroughness and accuracy of the records.  When the information on this federal list was compared to the individual state records, they did not match up.  The reason for this inconsistency is due to the fact that some states filed incomplete records.

Although both the state and federal agencies continue to push for strong regulations of home care providers, you need to take an active role in making sure the right questions are being asked and the screening process is up to your standards.

Photo: ivers

“Holidays are coming, holidays are coming, holidays are coming … watch out, look around, something’s coming, coming to town, coming to your town, holidays are coming, something magical, can you see it shining bright? Tis the season …”

These are the lyrics from Coca Cola’s famous “Holidays are Coming” advertising that has been around for decades and usually runs to announce the soon to arrive holiday season.

Here we are again at the beginning of another such season, with Halloween, Thanksgiving and Christmas on the doorstep. A time for family and friends to visit and share the warmth of the season together – that is assuming our homes are “visit-able.”

Visit-ability, a trend that has been gaining more and more support starting in the mid-80s is a movement/philosophy that seeks to insure that all homes are at least partially accessible to people with mobility impairments, even though those in fact might not be the owners of the homes but rather occasional visitors.

The importance of this simple philosophy can be seen even more when one realizes that America’s 50-plus population is likely to exceed 100 million by 2010. Ten thousand people will reach the age of 50 every single day and this 50-plus consumer base will account for more than one-quarter of all new home sales in the future. One can argue that making a home visit-able may even have a direct positive impact on its resale ability.

In fact, back in 2006 the National Association of Home Builders stated that “Our visiting parents aren’t getting any younger (and neither are we). Visit-ability in entry doors, barrier-free showers and non-stoop dishwashers show buyers you care” were in their list of emerging trends. Visit-ability modifications also make homes easier for people who might develop mobility limitations to still visit friends and family, rather than have to turn down invitations or not be invited at all. Therefore, visit-ability can even act as a first step towards a fully universally-designed home.

These features provide basic universal access and allow currently able-bodied people to remain in their homes if they do in fact develop a disability, and as such to start to age-in-place, rather than to be forced to do expensive renovations, relocate to a different house, live in an inaccessible home which endangers their health and safety, or move from the community they love and feel safe and oriented in into a care facility prematurely.

Many of us baby boomers are also taking care of parents, and parents are visiting their children’s homes or living with us even now, so maybe we should look at the upcoming holiday season as a magical opportunity to prepare our homes to match the warmth of our hospitality through their visit-ability.

So how do we go about making these necessary changes to be able to entertain our families regardless of their individual impairments you ask? Well, some of these modifications can be temporary and barely cost you any money at all.

We’ll cover some of these specifics in Part Two.

About the Author: Raad Ghantous is the principal of Raad Ghantous & Associates and is an expert in luxury hospitality, wellness centers, and medical & day spa developments.  He is also the owner of Your Home For A Lifetime, an A.D.A/ Barrier-free/ Universal design/Aging in place, full service design/build firm with over 15 years of experience  specializing in developing integrating elegant and seamless designs/modifications to new or existing structures.

There was a very interesting article on MSNBC this weekend. While there is much discussion about the pros and cons of assisted living versus home care, one rarely hears about children who have taken their parents’ care into their homes.  This article adds color to that discussion.

SEATTLE – New census data shows a record number of elderly parents are now living with their adult children. In the past seven years, the number has surged by 62 percent.

Higher housing costs, the economy and the cost of medical care all play a role in the trend. And caring for an elderly parent isn’t easy, especially when you’re trying to hold a job. Forty percent of caregivers who work full time report missing work on a regular basis as they try and meet the needs of an elderly loved one.

“I want her at home,” said Lucille Shaffer, who has suddenly become caregiver to her 84-year-old mother, Maria.

Maria was diagnosed with dementia just a few months ago. That’s when Shaffer insisted her mother come to live with her and her husband.

“I love her,” said Shaffer.

The love is strong, but the transition is difficult. Caring for her mother while holding a full time job is a staggering task.

“I felt just very saddened and burdened because I didn’t feel I could care for mom completely,” said Shaffer.

Eighty percent of caregivers like Shaffer report emotional strain. And more children than ever are caring for their elderly parents at home.

According to U.S. Census Bureau data, 2.3 million elderly parents were living with their kids in the year 2000. By last year, the number had jumped to 3.6 million.

Suzie Huard is now lending a helping hand. Hired through Senior Helpers, she arrives each day to prepare dinner and keep Maria company.

“I know that I’m giving her daughter a break and that she is safe and well cared for,” said Shaffer.

For Shaffer, Huard is more than a helper. She’s a savior.

“I can take a deep breath because I felt a huge sense of relief,” said Shaffer.

Shaffer wants to share her experiences. She plans on starting a support group for adult children caring for their parents on the first of the year.