Category Archives: Senior Housing

The Gift that Keeps on Giving – until it’s no longer needed.

Rev. Dale Susan Edmonds answers your questions about caregiving.

The above link, from a December 2012 NBC News report, addresses the conversations that many of us – well, many of you anyway – still need to have with your parents.  (My mother died in 1994, my father in 2007 – those conversations have long since taken place.)  In many respects, my brother and sister and I were fortunate because in our family, the topic of sickness and death seemed no different from discussing that night’s dinner menu – perhaps even easier.  That’s just how it was in our household growing up.  But I’m aware that universally, that is not the case.

In my article Cost of Dying: planning for a good death, from advance directive to talking with your family, I’ve attached an exceptional article about a few people’s experiences discussing how their loved ones want to die.  By now I may have lost some of you, but bear with me.  There’s a reason why I’ve chosen to address this topic.

presenting

(Photo credit: only alice)

GIFTS.  Who doesn’t like receiving gifts?  Most of us get a kick out of being handed a package with a fully wrapped surprise within and told to “open it!”  “What, for me?”  Yes – for you.  Perhaps the gift is something we didn’t expect, or we’ve sufficiently hinted our exact wishes and finally someone gifted us with that long sought after item.  Fun, isn’t it?  Someone cared enough to gift you with something you’ve always wanted or you receive something that you didn’t know you wanted, but it turns out, you do!!!

THE GIFT THAT KEEPS ON GIVING.  A few years ago, I succeeded in convincing my wonderful hubby that we needed to put together our “last wishes” which of course includes a Will, but more importantly, an Advanced Health Care Directive.  My husband is one of those who isn’t exactly comfortable sitting around the dinner table – or any table for that matter – talking about death.  I get that – I really do.  So I couched this discussion by talking about what a gift my parents, and his parents, gave their families by specifically outlining what to do when it came time to do something.

When your loved one is heading towards the great beyond, it’s comforting to already have his or her wishes on paper and ready to execute – no pun intended.  I’ll use my father as an example.  My father died at the age of 89 on October 13, 2007.  Official cause of death was prostate cancer but advanced Alzheimer’s was a huge factor in his death.  There is no way my father would have a) survived cancer surgery; and b) even wanted cancer surgery at that stage of his dying.  His Advanced Health Care Directive very clearly stated his wishes and us three siblings had copies of that document and respectfully went along with his wishes.  Dad saved us the stress of making an extremely difficult guesstimate of what he would have wanted in the midst of that situation.  His dying was already an emotional experience so I can’t imagine having some sort of discussion about when to stop treating his illnesses.

The legal document, drafted years earlier, was drafted for this specific time.  Even if dad had been conscious – and he was not – his dementia would have prevented him from making a well-informed decision.  If ever there was a time when dad’s gift was ready to be presented – this was it.  That gift allowed us to spend our last hours with him simply loving him; singing to him; and telling him how grateful we were to have him as our dad.  Beautiful.

You don’t have to wait until you are 50 years or older to put your wishes in print.  Old people aren’t the only ones dying who require some sort of affirmative decision-making.  Someone in their thirties could be in a horrific vehicle accident and end up lingering on the precipice of death.  A forty-year old person could have a stroke and be on that same precipice.  It’s never too early to do something about your exit from this world as we know it.  You can always change your mind later – you decide that you do, or do not, want hydration, so you revise the document.  That’s the beauty of word processing – it’s changeable, and once you get that revised version documented by witnesses, you’re good to go!  Literally.

If you choose to use an attorney, you can go through the local Bar Association for referrals or you can attempt the same outcome by doing it yourself.  Many office supply stores have boiler plate legal documents you can readily purchase – but be certain to purchase the forms that contain the required legal verbiage for your state or territory.  Additionally, organizations such as Compassion and Choices provides forms that you can download from their website, even a form that has a Dementia Provision.  Who woulda thunk?  Not me.

The Holidays may be over, but the season of gift-giving is not.  Won’t you consider giving your loved ones one more gift this year?

The Journey of Grief: A Personal Snapshot

The Journey of Grief: A Personal Snapshot.

Grief

Grief (Photo credit: Wikipedia)

Grief – when one experiences a loss, there is no way around this emotion.  It has no clearly defined end.  It manifests itself differently for every individual.  The writer of the above article shares the personal side of how this emotion presented itself in his own life in this continuation of his series of articles on grief.

This “personal snapshot” is a follow up to his first article in the series that addressed an event in ones life for which everyone’s grieving experience takes on a slightly different character.  I  hope you’ll read the article attached above, and his previous article – also available on his website.

Lighten up Mondays.

One evening, a family brought their frail, elderly mother to a nursing home and left her, knowing that after all the research they did to find a great place, she would be well cared for.

The next morning, the nurses bathed her, fed her a tasty breakfast of an omelet, sausages, and pancakes, and set her in a chair at a window overlooking a lovely flower garden.

She seemed okay, but after a while, she slowly started to lean over sideways in her chair.  Two very attentive nurses immediately rushed to her side to catch her and straighten her up.  Again, she seemed okay but after a while, she started to tilt to the other side.  The nurses rushed back, and once more moved her upright.  This went on all morning.

Later the family arrived to see how their mother was adjusting to her new home.

“So Ma, how is it here?  Are they treating you alright?”

“It’s pretty nice here,” she replied, “except they won’t let me fart!”

New roommate paradigm: adult children & their parents.

Historically, it’s the adult children who move back into the parents’ home, oftentimes because of financial issues.  Apparently that is no longer the sole definition of multi-generational living.

In a USA Today article, Who’s moving in? Adult kids, aging parents, Haya El Nasser writes, “(A)bout one in seven say they already have a ‘boomerang kid’ – an adult child who moves back home – or elderly parent living under their roof.”

This brings about two unexpected events:

  • The parents who enjoyed their empty nest and started to reestablish themselves as a couple, instead of just as parents, suddenly have an adult living with them who just happens to be the kid they gave birth to 30 years ago; or
  • The adult child who strove to establish his home with his spouse and their 2.5 kids suddenly have a parent living with them requiring just as much attention, if not more, than the young children they themselves brought into this world.

The USA Today article above focuses on a rising trend towards families deciding to purchase larger homes than they would have previously considered with the anticipation that it would be more economical to have other adult family members living in – and contributing to – the same household.  Talk about a paradigm shift!  Stephen Melman, director of economic services at the National Association of Home Builders says, “I remember when I was in college, no one wanted to be near their parents.”  That thought certainly resonates with me.  When I was single in my 20s and early 30s there was no such luxury of renting a place on my own and living-at-home was definitely not an option.  At one time I had two roommates so all three of us shared the same bathroom, kitchen and common living space.  Inconvenient and not as private as we would have liked?  Certainly – but the only way to afford housing and have the ability to put away money for our future was to split costs with other like-minded adults.

A Pew Research report earlier this year showed that “the share of Americans living in multi-generational households is at its highest since the 1950s.”  OMG!  As a Baby Boomer who was born in 1953, I just have to repeat, “OMG!!!!!”

My focus today is on the caregiving issue – that adult children and/or Baby Boomers find themselves with the added responsibility as caregiver to a loved one.  In my article Start your retirement – start your job as a family caregiver I address the caregiving aspect of Baby Boomer retirement which sometimes evolves into multi-generational living.  Our quality of life definition tends to change as family caregiving is added to our lives.  But it’s a fact of life for many of us and one that very few can escape.  But herein lies the problem…

Most of us aren’t prepared for that eventuality.  Those of us who are counting the days until retirement kid ourselves into believing that caregiving happens to others, not to us.  And our adult children find it difficult to wrap their minds around that type of living scenario whilst in the midst of their hectic career development and ever-changing family dynamics.

So what happens?  We find ourselves in an emergent situation that requires immediate action that may not be well-thought out because we don’t have the time to make a well-informed decision.  We all know that the worse time to make a life-changing decision is in an emergency.  There is a wealth of information available at our fingertips – the worldwide web is replete with helpful resources.  Even this website has many articles written on the subject.  As you browse through this website’s categories, be sure to enter a search term in the “Search My Site” box located at the right-hand side of each content page.

I’m not suggesting that you finalize plans that might not be implemented until many years down the road – or at all.  What I am suggesting, however, is that we all become aware that a) these issues exist and could very well happen in our own lives; and b) we’re going to do what we can now to make wise decisions later.

The Sunday Family Visit at an Assisted Living Facility.

Another Sunday Family Visit at the Assisted Living Facility.

This article, written by a fellow blogger, is beautifully descriptive and paints a clear picture – not just of the visual scene – but also of the emotions that exist in those who step into the world of their loved one with Alzheimer’s and other dementia.

The two poignant themes that resonate with me are: the development of resident boyfriend/girlfriend relationships within a memory care community; and the wonderful interaction between a great-grandson and his great-grandpa with cognitive difficulties.

I honor this blog author and her family for choosing to integrate a youngster into what could be a scary or challenging environment for a child.  One of my articles, “Alzheimer’s Heartache: young family members adjusting to a grandparent or parent with dementia,” addresses the difficulties that families oftentimes experience in long-term care (LTC) settings.  I can see that this family already figured out how to soften the hard edges to make the visiting experience beneficial to all.

Lighten Up Mondays.

A man moved into a nursing home.

He soon noticed that a woman was constantly staring at him.  After a few days, he approached her and asked,

“Ma’am, why have you been staring at me all the time?”

“You look just like my third husband,” she replied.

“Well, how many times have you been married?” he asked.

She answered, “Twice.”

Important Article on Hiring a Caregiver Privately

Important Article on Hiring a Caregiver Privately.

The senior care industry is a dangerous maze wherein even the well-educated and well-intentioned providers of care fail to put any “care” in their caregiving.  Whether at an assisted living facility or at home with private care, the path of least resistance is oftentimes the one taken and the accompanying attitudes reflect such feelings:  “Man, I just gotta get over this shift!  These people are driving me crazy!”  “I know, I’ll just stick her in front of the TV while I catch up on my Facebook posts/soap operas.”

Don’t worry everyone – I’m not saying that there are NO ethical, compassionate caregivers, there definitely are – but attention must always be focused on those who don’t provide stellar care because the vulnerable amongst us are at the mercy of their care people.  Those hidden in a private home are the most susceptible.  Why?  Because there are very few sets of eyes observing the day-to-day happenings.  At a facility, the existence of ongoing traffic – family members, visiting ministries, long-term care ombudsmen/advocates – provides some sort of monitoring that a private home does not and can not provide.

The attached article – link above – is quite thorough.  Please take the time to review it.

Baby Boomer gray divorce – I’m just not gonna take it anymore!

Kind of like the movie “Network” in the iconic scene where the actor Peter Finch, as Howard Beale, says, “I’m as mad as hell and I’m not gonna take this any more!”

Gavel (PSF)

(Photo credit: Wikipedia)

What is often left out from that quote is the statement made just prior, “I’m a human being.  My life has value.”  I think some spouses in their 50′s through their 80′s decide that after decades of a somewhat dissatisfying, or perhaps an abusive, marriage they realize that they have a whole lifetime ahead of them and decide that they deserve better.  In an article from the AARP June 2012 Bulletin, one of the reasons for a late-in-life divorce centers around the fact that longer lives mean more years with an incompatible spouse.   And even though the overall divorce rate in the United States has decreased since 1990, it has doubled for those over age 50.

Jay Lebow, a psychologist at the Family Institute at Northwestern University says, “If late-life divorce were a disease, it would be an epidemic.”

Wow!!!!  I had no idea! I’m fortunate in that my second marriage at the age of 47 is still one in which I am very happy now twelve years later.   There are those, however, with whom I am acquainted who stick to the dictum of “in sickness and in health, until death do us part” even through an abusive relationship (verbal, physical or otherwise)  and, because they’ve been in it for the long haul, e.g., 30 plus years, they feel that they have no choice but to stay.

Why do those with abusive spouses – both male and female – cling to their marriage?

As I mentioned above – one reason is certainly the commitment to vows that were made at the height of a romantic relationship.  And there are other reasons.  An excellent therapist with whom I am acquainted who leads support groups for the abused told me that over the years, as abuse has prevailed in the household, the one being abused adjusts to each added level or intensity of abuse and becomes acclimated to each added degree.  Added to this unwarranted commitment to their abusive spouse, they fear the unknown, even though it may bring about an abuse-free life.   And without the help of good friends and powerful resources, a spouse in an abusive relationship may not have the tools that will give them sufficient confidence to make a decision that will benefit them the remainder of their life.

Divorcing later in life can often result in less time to recover financially, recoup losses, retire debt, and ride the ups and downs of the economy.

Some Baby Boomers out there have relished the security that their spouse or significant other has provided them in the form of financial stability.  They’re thinking that perhaps it’s worth putting up with this person with whom I am incompatible to guarantee a comfortable enough life until one of us dies.  Well – certainly that is a factor – but I personally believe that an individual’s life contains far more value than any bank account can provide.  If someone is feeling devalued in their relationship, they have short-changed the remainder of their life.  And if someone truly craves, absolutely longs for greater self-worth, nothing will stop them from satisfying that need.  I guess you have to look at the options and determine if you’re willing to go with it:

living in a mortgage-free home without financial concerns with someone who tears you down, or renting a one-bedroom apartment with thrift store furnishings, that frees you from a relationship that has prevented you from being your true, and valued self.

But who will take care of me in my old age?

A 2009 National Alliance for Caregiving/AARP survey found that 66% of caregivers were female, with women providing on average 22 hours per week vs. 17 hours for males.  In a divorce situation, “older men may make out better financially than women, but they don’t fare so well at finding someone to take care of them when they’re older.  They often don’t have alternative care networks the way women do,” says Andrew Cherlin, a sociologist at Johns Hopkins University.  When asked who they will turn to when they’re older, single men often cite paid help – a pricey and somewhat difficult option to find.  Some older divorced people have children or other family members who can assume the caregiving role, but not everyone does.

Gray divorce is occurring and there are certainly many factors to consider.  I guess I’m of the belief that a bad marriage is not better than living alone.  Whether you’re a Baby Boomer – or of any other generational group – only you can decide what you’re willing to sacrifice in order to obtain your sense of personal value.  As far as I know, we’ve only been given this one life. This is not a dress rehearsal and there are no do-overs. 

Your thoughts?

Seattle Times: Seniors for Sale, Part 6

In yesterday’s post, a Seattle Police Detective defined elder abuse as:

  • sexual abuse
  • physical abuse
  • financial exploitation
  • neglect

In Part 6 of Seniors for Sale: Placement perils and successes, Michael Berens, Seattle Times reporter, delves into the senior housing placement industry, focusing on one placement company that placed a client in a Tacoma-area Adult Family Home (AFH) with a history of safety and health violations – elder abuse -  even a fatal event, but because the placement company had not done its research, it was not aware of the home’s previous infractions and kept placing unknowing vulnerable adults in the home’s care.

Many of these placement service companies operate state-wide and/or nation-wide, and believe that there is no way that they can help as many people as they do if they are required to visit each and every home/assisted living option available to the public that they are trying to assist.  These companies are oftentimes characterized as Bed Brokers – an industry that is growing exponentially without much scrutiny or State controls.

CAVEAT: Just as in every assisted living situation – there are good senior housing options and there are bad senior housing options – so too there exist reputable senior placement companies, and not-so-reputable placement companies.

I personally think that these companies can be helpful to those looking for a senior housing option that suits their, or their loved one’s, needs.  I caution those using these agencies, however, to understand that not every option out there is listed with placement companies.  If a senior housing company does not choose to be listed with a placement service company, that option will not be offered, even if that particular housing option might be the very best choice for some families: cost-wise, location-wise, and even service-wise.

In a news update, Michael Berens’ article, State gets tough on referrals for elder care, we see that attention is now being directed at these placement referral companies in the hopes that those they serve – vulnerable adults in need of some sort of daily care – are protected from those companies who are simply aiming to make a profit at the most vulnerable time in an elder’s life.

As I mentioned in previous articles found in my blog category, Senior Housing, there are numerous resources available for those looking for senior housing for themselves or a family member.  Please go to that category and type in a search term in the space located on the right-hand side of the page to find the topic that interests you most.

Seattle Times: Seniors for Sale, Part 5

Part 5, of Seniors for Sale: Hiding Harm: the human toll, is one example of the lack of reporting that goes on in some assisted living residential settings – in this case – an Adult Family Home (AFH).

When you watch the video link above, you’ll be shocked at how a particular accident happened – and its after effects on the victim -  and you’ll be horrified at how long it took before it was reported to the police.

Perhaps this statistic will provide a partial explanation:

only 16% of all incidents of elder abuse are reported.

The Seal of Washington, Washington's state seal.

The Seal of Washington, Washington’s state seal. (Photo credit: Wikipedia)

Not only are many caregivers not reporting incidents of abuse that occur; surprisingly, family members fail to get beyond the denial stage when they discover that their loved one just might be in danger in the very location entrusted to his/her care.  They can’t believe that the caregiving solution they found for their loved one has turned out to be disastrous in every way.

The police investigator for this case states the following:

We don’t tolerate domestic violence, but that’s not always the case with elder abuse.

The final episode of Seniors for Sale will be submitted tomorrow, Saturday.

Seattle Times: Seniors for Sale, Part 4

Seniors for Sale, Part 4: Suspicious Deaths

It doesn’t get much worse than the video attached above.  Two suspicious deaths are the focus of this episode of the Seniors for Sale series.  The two cases discussed in this video occurred at the same Adult Family Home (AFH), Houghton Lakeview, located in a very swank area of Kirkland, Washington.  It goes without saying that this Adult Family Home was shut down.

The Seal of Washington, Washington's state seal.

The Seal of Washington, Washington’s state seal. (Photo credit: Wikipedia)

Family members whose loved ones died at the hands of these caregivers speak out about how the abuse was discovered, and how the State of Washington did, or did not, effectively respond.

One of the family members whose father died at the hands of the caregiver/owner of the Adult Family Home poignantly stated:

It’s unfathomable to realize that we were paying these people to abuse our loved one!

Conviction results (attached) of one of the suspicious deaths was reported by the same Pulitzer Prize winner, Michael Berens, who wrote the series, Seniors for Sale.

Seattle Times: Seniors for Sale, Part 3

What Needs to be Done?  is the subject matter of Part 3 of  Seniors for Sale.  In this episode, the viewer is encouraged to do research about a facility, Adult Family Home or otherwise, prior to considering a move to that senior housing alternative.  In my article, “Avoiding the pitfalls of selecting Senior Housing,” I provide helpful resources that everyone can use in order to find out:

  • if any complaints have been filed against a particular home;
  • if the State issued any citations, and the nature of those citations;
  • if the Long-Term Care Ombudsman office received particular complaints and the nature of those complaints.
The Seal of Washington, Washington's state seal.

The Seal of Washington, Washington’s state seal. (Photo credit: Wikipedia)

No one has to go into this housing search blind.  Please view the very brief video provided in Part 3 of this Pulitzer Prize winning series by Michael Berens of the Seattle Times, then click on the attached article that I’ve provided for your assistance.  Although the links I provided relate to resources in the State of Washington, similar resources exist nation-wide.  Check with your State Ombudsman office or Department of Health and Social Services for your State’s equivalent.

Seattle Times: Seniors for Sale, Part 2

I provide Part 2 of Seniors for Sale – Janice and Elaine.

The Great Seal of the State of Washington

The Great Seal of the State of Washington (Photo credit: Wikipedia)

The attached link connects you to Part 2 of 6 of this Pultizer Prize winning series written by Michael Berens of the Seattle Times.  Please don’t give up hope.  Once all 6 of these episodes have been provided – one per day – I will provide you with story outcomes and repercussions in the Adult Family Home industry in Washington State.  Keep in mind – as I indicated in my first submission -  although this horrific situation took place in the State of Washington, this type of abuse goes on in other states, and countries as well – whether in group homes, nursing homes, assisted living facilities or similar senior residential settings.

Are there stellar Adult Family Homes (AFHs) in Washington state?  Absolutely.  But of the 2,900 AFHs in the state, 446 of those were cited for major violations since 2010.  The industry certainly was not regulated well enough to avoid such violations.  That is changing.

Seattle Times: Seniors for Sale, Part 1

My local newspaper ran an investigative report about the Adult Family Home (AFH) industry in Washington State.  Depending upon where you live, a similar  assisted living home may be called a Group Home.

The Seal of Washington, Washington's state seal.

The Seal of Washington, Washington’s state seal. (Photo credit: Wikipedia)

In Washington State, no more than 6 residents can live in an Adult Family Home.  These “businesses” popped up all over Washington State over the past several years as entrepreneurs realized how much money they could make taking in residents and charging thousands for rent and resident care.  At this writing, there are close to 2,900 AFHs in the state.  Since 2010, 446 of those were cited for violations of health or safety standards.  Caveat: there are many Adult Family Homes that are doing an extraordinary job, but it’s the bad ones that make the Headlines and that’s the way it should be.

June is Elder Abuse Awareness Month.  I thought it appropriate to provide Michael Berens’ series, “Seniors for Sale” in six parts this week, but I provide it with a warning that this Pulitzer Prize winning expose can be very difficult to read, and watch.  Nevertheless, awareness is key, so I hope all will benefit from his extensive work on this piece.  Whether you live in the United States, Singapore, the United Kingdom, or elsewhere globally, abuse occurs world-wide and it’s the vulnerable adults in this world who are its targets.

Seniors for Sale – I provide this link to Part 1 of the series – “Ann.”

Moving Mom and Dad – or your spouse.

Moving Mom and Dad – Leaving Home is an article from the June/July 2012 AARP Magazine.  Statistics on aging are astounding, and scary.  “By 2020 some 6.6 million Americans will be age 85 or older.”  That’s an increase of 4.3 million from the year 2000.  Time to celebrate – right?  We’re living longer – and in some cases – thriving in our older age.  The reality of the situation, however, is that eventually we’ll need some sort of assistance with our activities of daily living (ADLs) that might require a move to a care facility of some sort.

The stories presented in the attached article describe family instances where emergent circumstances warranted an emergent decision to move a parent into some sort of care facility.  The best case scenario, as this AARP article suggests is that you, “dig the well before you’re thirsty.”  Nice sentiment – but not always possible.

I have written numerous articles for my blog that address the difficulties the caregiver, and the one needing care, go through when making the decision to choose a long-term care (LTC) facility for a loved one.  Below are links to each of those articles.  I hope they prove beneficial to you.

Deathbed promises and how to fulfill them.

Caregiving: The Ultimate Team Sport.

Selecting a Senior housing community – easy for some, not for the rest of us.

Avoiding the pitfalls of selecting Senior Housing.

Adjustment disorder: a long-term care facility side- effect.

Be an advocate for your aging loved one.

Visiting a loved one at a long-term care facility.

Caregiver guilt.