assisted living

Moving Mom and Dad – or your spouse.

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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.

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Long-term care facility heartache.

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More often than not, a senior citizen moving into a long-term care (LTC) facility is doing so under duress.  “My kids said they’re not comfortable with me living on my own anymore.  Well I’m not comfortable living in this old folks home!”

SENIOR CITIZENS FIND THAT NEW ULM, MINNESOTA, ...
(Photo credit: Wikipedia)

Sound familiar?  It should.  I am a LTC Ombudsman in Washington State and I can’t tell you how often I hear residents who provide nothing but negative comments about their living conditions.  Regardless of how good the building; regardless of how fabulous the food; regardless of all the fun activities in which the residents participate, they are still not happy because the overriding dissatisfaction of not being in control of where they want to live colors all that they do.

And I agree with them.

Losing control and losing independence – a natural outcome of getting older?  Gosh, I hope not.  For the most part, a person moving into a long-term care facility has been in charge of their life – managing finances, choosing when and where they want to drive in their vehicle, eating whatever they want, whenever they want – in short, doing whatever they damn well please!  Suddenly someone else, regardless of how well-meaning, takes those freedoms away and those choices because they’re not comfortable leaving mom and/or dad alone in their own house.

English: Alarm clock Polski: Budzik

In my article: “Adjustment disorder: a long-term care facility side-effect,” I talk about the difficulties that befall the elderly as they endeavor to acclimate to senior living.  Think about it!  Going from a schedule-free life to a regimented one is difficult – whether you’re a young adult going into the military, or a senior citizen moving into an institutional living situation.  Both generations suffer greatly during this adjustment period but the adjustment takes longer when you’re in your late 70’s and upward.  And don’t forget, if the senior citizen wasn’t the one making the decision – choosing to move out of her home and into a senior housing community – the adjustment period will take longer still.

How can the adjustment period be made easier?

As advocates for residents in long-term care living situations, LTC Ombudsmen  emphasize and promote a resident’s right to make choices about pretty much everything that goes on in their new “home.”  What a novel idea!  Some of the choices that we know are important to residents are:

  • Choosing the clothes they want to wear.
  • Choosing what time they want to go to a meal.  Even if the resident wants breakfast after posted dining room breakfast hours, the culinary staff must make reasonable accommodation and provide some sort of breakfast item for that resident.
  • Choosing which activities – if any – in which the resident wants to participate.  No one should be forced to go somewhere against their will – that’s called coercion.  “Come on sweetie, you’ll like it once you get there.”  No!
  • If the resident is on some sort of care plan in the facility, the resident has the right to refuse care, even if it might be to that resident’s detriment.  When she was living in her own home, she had that right – nothing’s changed – only her environment.
  • The resident can even choose to move out of the long-term care facility if she chooses.  Don’t forget, it wasn’t her decision to move there anyway.  Long-term care housing isn’t a prison – she can leave if she wants to, even if doing so goes against the wishes of the family, and against the advice of her physician.

The bottom line is that residents in long-term care facilities aren’t children who need someone else to make decisions for them.  Granted – some residents with major cognitive decline may rely on others, such as a Power of Attorney (POA), to make decisions for them – but even then, that POA should be making decisions that the resident would have made if he/she were still capable of doing so.

Put yourself in your parent’s or grandparent’s shoes.  How would you feel if your opinions, wishes, and rights were dismissed?  Feels lousy, doesn’t it?

How to Break the News When It’s Alzheimer’s

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How to Break the News When It’s Alzheimer’s.

It’s so unfortunate that Alzheimer’s, and other dementia, have become the new condition to avoid and/or not acknowledge.  A dementia diagnosis is SO difficult for everyone – including the one with the disease.  I think this article is very well done and provides a perspective of which many need to be aware.  Dismissing, or using euphemisms for this disease e.g., my wife has some memory problems – won’t make it go away.  Helping others to understand – not necessarily accept – this diagnosis is a very worthwhile endeavor.

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

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Duct-tape Moving Van

Think of a moving/relocating experience you’ve had with all of its inherent tasks of purging of items, packing what remains, and leaving all that is familiar as you move into uncharted territory.  In your new neighborhood you’re starting all over again to find: new friends;  a new supermarket with the best deals; perhaps the best school(s) for your children; a new church; and new ties to the community.  Not exactly an enjoyable experience.  It took you some time to adjust to your new community and feel that you fit in, didn’t it?

Now imagine doing the same thing as someone who is at least 70 years old with failing health, no family nearby, and perhaps with a compromised cognition level.  Vulnerable adults move into a long-term care (LTC) housing environment because of a condition, or combination of conditions, that make living independently no longer an optionBecause of this disruptive move, another disorder – adjustment disorder – makes their move a perilous one.

A loss of context in a new environment.  In my work as an advocate for vulnerable adults, I had the privilege of hearing a wonderful speaker, George Dicks.  At the time, Mr. Dicks supervised the Geriatric Psychiatry Service clinic at Harborview Medical Center in Seattle, WA.  He was also a contracted instructor for the University of Washington, teaching courses on Gerontology, Psychiatric Consultation, and Mental Health.  He emphasized that residents living in nursing homes and assisted living facilities struggle to look for context within their new environment.  For example, context is hard to come by when your daily bath occurs at 2:00 in the afternoon instead of in the morning or evening as was the case prior to the move.  And forget about finding comfort in routine because the demands on LTC staff are such that caring for numerous residents on their shift can’t possibly assure a routine on which the residents can rely.

Just providing care doesn’t mean that a staff person is caring.  Everyone who moves into a long-term care facility will have difficulties, but those who are cognitively impaired face an especially arduous adjustment.  As I previously mentioned, staff are hard pressed to provide individual care to their residents, and oftentimes are poorly prepared to handle the disorders that walk through the door.  Just getting through their daily shift is troublesome so trying to learn the habits and routines that are so vital for quality of life of the resident with dementia is a very time-consuming task.

a hand holding unidentified white pills
(Photo credit: Wikipedia)

Quite frequently, the only contact a staff person has with a resident is when they are making demands of that resident: “time to take your medicines Mrs. Jones;” “let’s get that soiled clothing changed Mr. Smith;” “open your mouth Mrs. Clark so I can feed you.”  Providing for  basic needs is not providing care.  Why?   Because the staff are requiring something of the resident.  There is no connection.  When a staff person interacts with a resident, absent a provision of care, that’s a better definition of care.

How to lessen the effects of adjustment disorder.  Those living in a long-term care housing situation oftentimes feel as though they left all their power, and all of their basic human rights, at the door.  They are constantly surrounded with reminders of their condition – all those other residents who look as lost and helpless as they do – and it seems that the only time anyone pays attention to them is when someone is demanding something of them in the form of providing some sort of assistance with their care needs.  If every staff person spent just five minutes of non-task-oriented time with each resident during their shift, those residents just might start feeling better about themselves.

  • Walk with a resident for a few minutes by simply accompanying them in the hallway and reassuring them along the way.
  • Play music the residents like in the common areas and in their rooms – and don’t assume that you know what they like to hear.  Take the time to find out what gets their feet tapping.
  • When you walk past a resident, greet them, smile at them, just as you would if you were in a social environment instead of a clinical environment.  Again, do so even when you’re not providing a care service.  Your friendly, heart-felt greeting may just make their day.
  • Start a dialogue with residents that allows them to open up to you about who they are; what their lives were like prior to arriving at the facility.  If you need to jot down some of their stories so you’ll remember them later, do so and continue the dialogue the next time you see them.  Wouldn’t it be a pleasant surprise to a resident when you asked them, “Tell me more about your grandson Charlie.  He seems like a real character!”  Wow – you were actually listening, and it shows.  Now you’re connecting with the resident.

If you are a staff person in a long-term care facility, can you put your grandma or grandpa’s face on your patients/residents faces thereby having a greater incentive to connect with those receiving your care?  Or if that doesn’t work for you, do what you must in order to add an element of care to those you serve.  Just because you’re helping the resident perform a task, doesn’t mean that you’re providing the care that they really need.

Long Term Care Insurance scares me.

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insurance, n. A thing providing protection against a possible eventuality.  Concise Oxford English Dictionary, 11th Edition; 2004.

Result of a serious automobile accident
Image via Wikipedia

Auto insurance, home or renters insurance, and health insurance – we understand these policies and know that more likely than not the need for the aforementioned insurance policies will rear its ugly head in the near or distant future so we pay the premium for said policies, hoping we won’t need it, but sleeping better at night because we have it.

Why is purchasing long-term care insurance such a difficult step to take for me and my husband?

  1. Unquestionably, it’s expensive;
  2. Fearfully, companies who offer this product are going out of business left and right and may leave us holding an empty bag;
  3. Definitely, it’s a real difficult type of policy to understand; but
  4. Undeniably, the financial need for it can outweigh the cost of purchasing it.
New Orleans, 1942. Doctor at Marine Hospital p...
Image via Wikipedia

My husband and I have still not made an effort to look into it further.  Here are my two reasons based on family experience – both of which tend to contradict each other:

My father’s long-term care insurance policy.  My father had a long-term care insurance policy for which he paid premiums for at least 20 years – no small amount of money to be sure.  He was diagnosed with Alzheimer’s at the age of 84 and died five years later.  His care needs at the retirement facility in which he had lived for 13 years didn’t meet the insurance reimbursement threshold until his final month of life.  As with most policies, the insurance holder’s care needs must meet a defined level of care before the insurance company kicks in their assisted living care reimbursement payments.  When that happens, the insurance holder no longer pays any more premiums.  Twenty years of paying premiums for one month of reimbursement benefit.

My sister-in-law’s long-term care policy.  My brother and sister-in-law purchased their long-term care insurance policies when they were in their late fifties.  Less than a year later my sister-in-law was diagnosed with early-onset dementia and approximately two years later drew benefits from her policy.  A couple of years of paying premiums for what will be years of reimbursement benefit.  If that isn’t the good news/bad news of long-term care insurance I don’t know what is!

I have no excuse. I know the devastating costs of long-term care because in my past professional life I worked for a senior housing provider and they represented the Champagne & Chandelier variety of assisted living.  But even the generic assisted living providers charge high rental rates and as ones’ care needs increase, so do the care fees.  This isn’t avoidance behavior on my part and I’m not squeamish about the subject of health and ones’ eventual death.  I’m just finding it hard to take this leap into signing up for insurance, even though it holds the assurance of fending off the potential of total personal financial collapse without it.

How are you Baby Boomers dealing with this subject?  If you finally bit the bullet and purchased a policy – how did you finally take that leap of faith?

I AM NOT LOOKING TO BE BOMBARDED BY SELLERS OF INSURANCE AS A RESULT OF THIS BLOG ARTICLE SO PLEASE DON’T GO THERE.  But I welcome other constructive feedback for those of us on the brink of making this difficult decision.

Avoiding the pitfalls of selecting Senior Housing.

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You’re patting yourself on the back, congratulating yourself for:

  • finally deciding that it’s time to move into Senior Housing; and
  • deciding which type of long-term care (LTC) option suits your needs.

Now what?  You’re scared to death because of the abhorrent negative press you’ve read regarding certain types of Senior Housing.  Good for you – you should be!  There are ways to make your selection a more trustworthy one.  What follows will hopefully weed out the bad eggs, but there is absolutely NO guarantee the decision you make is 100% sure.

WORD OF MOUTH

Chances are that those similar to you in age – your friends, work associates, neighbors – have looked into or are currently looking into Senior housing options and they can be a very worthwhile resource.  Don’t be afraid to ask them to share their experiences with you and you’ll certainly do the same with others as their needs become known to you.  Better yet – if you know of someone who already lives in a LTC facility, visit them to discern what they think about their own choice.

HOUSING SEARCH RESOURCES 

Where will your path take you?
  • Check out your state’s Aging & Disability Services Administration department (linked here is Washington State’s ADSA.)  You really can’t go wrong checking out your State’s services for the Senior population.  These resources usually have links to long-term care facility research tools, such as the Assisted Living section of my local state’s ADSA.  No doubt your State’s Aging & Disability department will have similar links.  If you’re looking for retirement communities that involve totally independent living, or a Continuing Care Retirement Community (CCRC), an all-care type of residential model mentioned in my previous blog “Selecting a Senior Housing Community”, your search will be less informational because most States do not license retirement communities.
  • STATE INSPECTION SURVEY.  All licensed facilities in the United States are inspected/surveyed every 12 – 18 months.  This survey is quite thorough and covers absolutely EVERY aspect of a facility’s operations.  When you tour a facility, always ask to look at a copy of that building’s latest State Survey.  By law they must make it available to anyone who asks.  I don’t think I would ever consider a Senior housing option without reading the building’s State Survey.  You’ll find minor or major citations which will be very telling as to how the building is run and how the Administration or Owner of the building responds to such citations.

LONG-TERM CARE OMBUDSMAN PROGRAM (LTCOP)

Every state must have a long-term care ombudsman program in place.  These programs are mandated by the Federal Older Americans Act and are intended to improve the quality of life for people who live in long-term care facilities.  A call to the LTCOP intake line in your state is a call worth making.  Let’s say you’ve narrowed down your housing search to a few options.  You ask the LTC Ombudsman’s office about the types of complaints that have been filed against those facilities and this office will provide worthwhile information to help you make your housing decisions.  The National Long-Term Care Ombudsman Center  will help you locate your local LTC Ombudsman program.

SENIOR HOUSING LOCATORS

You’ll notice that I’ve placed this type of resource at the bottom of my list.  There are numerous housing “finders” out there and they can certainly be helpful.  You tell them what you’re looking for; what area of town you prefer; what type of care you need; and what you’re willing to pay; and they’ll come up with some options for you.  Please keep in mind, however, that these senior housing finders have an inventory of housing clients that may or may not be representative of all that is out there.  They may come up with some very good options for you but their list will most likely not be an exhaustive one.

Regardless of what/who you use to locate a LTC facility, I hope you’ll go through the previous options I’ve listed above to discern the appropriateness of any facility you’re considering.  Perhaps a Senior Housing Locator has provided what appear to be some great options for you and you’ve even toured them and feel comfortable with what is offered.  Prior to making your final selection, at the very least go through your State’s Long Term Care Ombudsman to discern whether or not any recent actions or citations have been placed against that facility.  And when touring any housing location, be certain to ask for the facility’s latest State Inspection Survey so you can see what the State thinks about that facility.

My father & I on a picnic a year before he died.

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

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Even if you think you will never move into a Senior housing facility you should at least do some research so that in an emergent situation, you’ll be well-enough informed to start moving forward with a plan.  This is not the time to be making snap decisions.  Your well-being, or that of a loved one, deserves more attention than that.  Making an advanced decision, and thinking ahead regarding future living circumstances, will afford you the opportunity to make a decision that you want, not what others have decided for you.  What follows may be too basic for those who are already familiar with Senior housing options, but for many, this blog entry will serve as a first step primer towards getting ones’ feet wet.

INDEPENDENT LIVING – sometimes called After 55 Housing.

These complexes are designed for adults who want an independent lifestyle in which they can relinquish yardwork and house maintenance tasks to someone else.  Now you’re talking!  If the independent complex has a common dining room they will either provide meals in a restaurant setting (ordering off the menu) and/or buffet-style selections.  Depending upon the particular independent community you’re considering, other amenities such as housekeeping, transportation and on and off-site activities may also be available to its residents.  It’s important to know that although these communities may offer wellness programs in which you can become involved, e.g. exercise or nutrition classes, there are typically no care options offered unless the community is licensed as a residential care facility for the elderly.

ASSISTED LIVING.

This category of facility promotes independence while also offering personal assistance for specific care needs such as bathing & toileting, dressing, walking assistance, and/or medication assistance.  These needs are called Activities of Daily Living (ADLs).  Assisted living communities may be a stand-alone building or an extension of an independent residential community.  If an assisted living facility is also licensed to provide dementia/memory care, a resident could readily move from general assisted living care to dementia care in the same facility.

GROUP HOME/ADULT FAMILY HOME (AFH)

An Adult Family Home is typically a single family home with a State-imposed maximum allowable number of residents – in Washington State, this number is six.  These residences offer assistance with ADLs.  This is a desirable option for those looking for a residential situation that is more home-like than facility-like.  Many adult family homes also provide specialized care for those with dementia.

ALZHEIMER’S/DEMENTIA CARE.

These facilities provide all the expected assisted living services plus specialized services that meet the needs of the memory impaired adult and is usually always a secured unit to protect a resident who might be a wandering risk.  By secured, I mean that in order to exit to a public hallway or common area, such as a lobby, a person would need to punch a code into a keypad that one with dementia would most likely not be able to navigate.  A secure dementia care unit can exist as a stand-alone building or can be found within an assisted living complex, a nursing home complex, or a continuing care retirement community.

NURSING HOME/SKILLED NURSING FACILITY/REHABILITATION FACILITY.

This facility provides 24-hour medical care on a short-term or long-term basis.  Additionally, rehabilitation programs are offered.  If someone living in an assisted living community has orthopedic surgery, he would probably undergo a certain amount of rehabilitation at a nursing home and then return to his previous residential situation.  A nursing home can sometimes become a permanent care option for those requiring a higher level of care.  Since assisted living and dementia care facilities have certain limits on the level of care they can provide, a nursing home may be necessary in order to receive the advanced care needed by a resident.

CONTINUING CARE RETIREMENT COMMUNITY (CCRC)

A CCRC has all levels of Senior living – therefore it’s usually quite expensive: independent, assisted, dementia care and nursing home care.  The benefit of a Continuing Care Retirement Community is that you can age in place regardless of your growing medical or cognitive needs.  This type of community exists on a larger campus that truly does provide an entire spectrum of care.  You can move into a CCRC totally independent – without any care needs whatsoever – and gradually move through the campus property without leaving your friends and without greatly changing your surroundings, thus assuring a continuum of experience for many years to come.

Housing for Seniors is addressed in the attached Federal Seniors Resource website that provides an extensive list of pertinent resources.  I hope you’ll find it helpful – not just for senior housing information but for many topics about which you may have an interest.

My wonderful dad and I taking a stroll in 2006.

What challenges have you faced – or what concerns do you have about either your future or the future of a loved one who might need Senior housing?  Let’s talk about it – let us hope that what each of us contributes benefits those tuning into this blog.