Tag Archive | assisted living

Seeking a Higher Level of Care

By Cindy Sproles

 

Courtesy of http://www.pixabay.com and PICNIC_Fotografie

Parents are the foundational support of the family. They are the symbol of strength when we are children, caring and providing for us. Their goal – to assure their children grow to be happy and productive adults.

As we grow and take on families of our own, our parents welcome grandchildren into their arms likewise providing that special love and care a grandparent can only give. But what happens when the reality of an aging parent hits home?

No longer are we comfortable with leaving the grandchildren in their care. No longer are we sure they can care completely for themselves. A time comes when the roles must reverse. Our parents need assistance and it’s hard to accept.

Every situation lends itself to the specific needs of each individual parent. Therefore having a conversation about the future needs of their care is vital while parents are in good health and not in the throes of sudden illness.

It is important to know there are levels of care spanning from simple assistance to fully dependent care in a facility. Rushing to either degree is not something one takes lightly, rather it is one family members assess with great care.

*In-home non-medical caregivers – The first stage of higher care is the introduction of a caregiver who can come into the home for a few hours a week to help with the mundane skills life requires. Non-medical caregivers can prepare meals, assist with light housekeeping, and help with personal care and hygiene. Most aging parents can maintain their home for a number of years with just a few hours weekly from an outside caregiver. It is important to take into consideration the pros and cons of hiring a private caregiver, keeping in mind the need for backgrounds checks, and access to personal finances and properties must remain strictly limited and monitored. When hiring through a caregiver company, children can trust background checks are performed and workmen’s compensation insurance and liability insurance is in place to cover the caregivers. Please note, when hiring a private caregiver, families are responsible to pay taxes, provide a 1099, and assure there is workmen’s compensations available to protect both your parent and the caregiver. Check with your parent’s homeowner’s insurance to see what is covered and what is not via their homeowner’s policy. Families are stunned that coverage does not extend to cover private contracted laborers. Though private caregivers can be safe and dependable, families are best served to cover the bases of safety and security by considering a company’s assistance. Companies must meet strict standards of care and are monitored by their perspective states.

*Assisted living – When in-home care is not enough the next step of care is assisted living. Parents live in an assisted living community. Their independence is 100%, being allowed to come and go as they please, even drive if they are physically and mentally able. Assisted living offers full internal assistance if needs require. Facilities or communities provide meals, transportation if needed, and a physician, nurse practitioner, or RN on staff 24/7. The primary requirement for living in assisted living is to be independent enough to get themselves out of the building in the event of a fire or facility emergency. Otherwise, assisted living can help parents up until memory care or full care becomes necessary. Assisted living is far more affordable than families imagine. It’s important to know that when families close the parent’s home and turn off utilities, cancel insurances, and either rent or sell a home, those same funds can now be diverted to the cost of assisted living. On a personal note, our family rents our parents home through a realtor and all those funds go to defer the costs of assisted living. Between those funds and parental social security, the costs are met easily and there is no drain on our family. Of course, every situation is different, but it is wise for families to delve deeper into this option and have an open mind.

*Nursing home and end-of-life care – The circle of life continues despite our best efforts. Seek the assistance of an attorney early on to protect parent’s assets in a revocable trust, then when the time arises for full-time nursing, families are somewhat prepared. Do your homework. Seek out the facility that can best care for your parent and then take it upon yourself to be proactive. Visit frequently and at unexpected times so the facility staff sees you are actively involved in your parent’s care.

Write down the wishes of your aging parents and when the time comes for additional assistance, there will be no questions. Make the transition to assisted care easier by early preparation.

 

Photo Courtesy of http://www.pixabay.com and PICNIC_Fotografie

Making the Move – Home to Assisted Living

by Cindy Sproles

It goes without saying, the decision to move a parent into an assisted living or nursing home facility is both heart wrenching and guilt filled. There is no doubt parents are happier in their own environment. Ninety-nine percent of the time, they thrive much better from their homes due to this one simple thing: A sense of independence. But what happens when it is obvious a move must be made?
Many time aging parents are reluctant – even determined, they will not move into a facility and the one card they have to play, is the guilt card. “I’ve taken care of you all your life and you just want to put me away now?” Understandably, this is a normal response to the possibilities of losing your independence.

Even the most loving parent can dig into the depths and find something to make the decision harder. Despite our best efforts, the decision to make this move can tear a family apart. Your job, and the jobs of your siblings is to prepare in advance. Sometimes the best a child can hope for is cooperation, even if it’s begrudging.

There are ways to make the transition easier and they begin well before a parent needs the assistance:

*Have the discussion – Talk with aging parents early on and hash out scenarios that can be written down and placed into important papers. Address the what ifs. What if you fall and become unable to care for yourself? What if your memory becomes clouded and you cannot remember to eat, or bathe? What if your children are living in other states? There are lots of what ifs that your family can discuss. Address these things when parents are in good health and a bit more reasonable, then, many times the guilt of making this decision vanishes.

*Do the paperwork – Take time to make preparations for aging parents. Secure necessary power of attorney for health and durable power of attorney for daily living care. Check into setting up a revocable trust that parents can divert funds or their home into which remain untouched for their care. Seek the assistance of the bank to place one executer as an owner on all bank accounts, IRA and insurance policies (simply having your name on the signature card does not allow you access to necessary funds in the event of death or an emergency). Put a living will, as well as an after-life will, into play and have copies handy in the event of an emergency. Place insurance, doctor’s names and phone numbers, pharmacies, and even copies of prescriptions and medication lists into a 3-ring binder for easy access. Add copies of drivers licenses, social security card, insurance cards – any cards that you feel might be necessary as times progresses. Having these things in place saves chaos and confusion when they are needed.

*Visit facilities – Take time to visit facilities. See what each one offers. Check out costs, insurance coverages, and out-of-pocket expenses. Check with the families of other residents and see how the care stacks up with their loved one.

When the time arrives you feel a move is necessary for the health and safety of your parent, make a doctor’s appointment, first without the parent and then later with the parent affected. Ask your questions, express your concerns. Give the doctor a heads up on your loved one. Then schedule an appointment with the parent. Allow the doctor to do a fair assessment and testing, and if the medical professional deems it necessary, allow them to be the one to recommend a move. Many times, aging parents will listen to the doctor before they will listen to their children. Again, it’s the fear of losing independence. Have and exhibit a show of compassion for this blow to your aging parent. It hurts and honestly, it’s frightening, so try to roll with the punches.

Once the doctor has delivered the news, allow your parent some time to absorb the news. Don’t rush out of the office and into a facility. Offer your loved one some space to gather their thoughts and take in the reality of first – aging to this point; and secondly, releasing their independence. It is, after all, a life altering decision.

Making the Move

*Take time to sort through possessions as a family – A few weeks prior to moving your parent, take time to sift through belongings with them. Allow them to pick and choose what they need to take. Remember they, they have to mentally adjust to having their possessions dispersed. Help them choose the sentimental items they can take with them that will keep their family and sense of familiarity close. Allow aging parents to give certain items to particular family members.

elderly-handsA family recently moved their mother into an assisted living. Her great granddaughter had married a few months prior and grandmother was able to completely provide her granddaughter with all the necessities of homemaking – a new washer, dryer, refrigerator, stove, dishes, etc. It was a joy for this grandmother to give these items to her great grandchild knowing they would provide her with the same warmth and joy of housekeeping as they’d provided herself. The key to sorting through possessions with an aging parent is taking the time to reminisce as items are packed away. Once again, be compassionate.

*Purchase a new mattress – Though this can be costly, it’s worth the effort. It’s difficult enough to sleep in a strange surrounding, but making the most of rest is vital. It sounds silly, but a new mattress that is comfortable helps lull your loved one into a more restful sleep. And a good night’s sleep is worth the effort. Loved ones will rest better, eat better, and have a healthier attitude if they are well rested.

*Don’t forget to take the hobbies – If your mother is an active seamstress, take her sewing. If dad is an avid reader, make sure he has access to his reading. Try to make room for their favorite chair. It’s the little things that mean the most.

*Keep their routine – If you visit weekly prior to the move, continue to do so. Routine is important. If mom has her hair done weekly, keep the routine. Not only do these routines help maintain “normal,” they also allow a sense of independence to care for one’s self. Take parents shopping, to church, and on outings. Being pro-active is vital. Your job as a caregiver at home may have lessened but it has not ended. Remain in close contact with your aging parents. It will make all the difference in the world.

The decision to move into an assisted living or nursing home facility is hard but as a family, you can make the transition a joy and an adventure.

Adding a caregiver into the mix will help make the transition easier, especially in the evenings when family has gone home. Will there still be bumps in the road? More than likely. Will all transitions be an easy fix? Probably not. But if you make the effort to make the move as easy and natural as possible, the weight and guilt of the decision is easier.

Senior Beware – Ask, Get Informed, then Decide

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Aging parents will reach a stage in their lives where families begin to question if living at home is best or should their aging senior move into assisted living. It’s a valid question and one that deserves a lot of attention and consideration. But, before families make the decision to move their loved ones into a facility, there are definite questions that need to be sought out and answered.

What is assisted living?  Honestly, there’s not a real definition by industry standard. It varies from state to state. The best explanation for assisted living is a facility with limited care. Most are not licensed for medical care like a nursing home. It’s important to understand assisted living facilities are not medical care facilities. For lack of better words, we can dumb down the explanation to this: Assisted living is group home living where residents can perform all the necessary assisted daily living skills (ADLs) with minimal help. The general rule for assisted living is, that in the event of an emergency, a resident must be able to remove themselves from the facility (without assistance) within a small time frame. If they cannot, they do not qualify to stay.

Assisted living facilities perform levels of care for residents from those who simply need daily monitoring to those who require assistance with personal care. Residents rent a room or small apartment where they can either cook for themselves or join others in a dining room area for meals. There is usually an RN or LPN on staff in the event of an emergency and who, if the service is needed, will regulate and distribute medications to residents. Those who live in assisted living facilities are fairly mobile and are charged according to the needs.

For example, if you require house cleaning, you may be charged. If a resident needs a higher level of care, i.e. assistance with a bath or dressing, they may be charged a higher price. Should they need transportation, this is additional as well (however, it’s fair to say this service will vary from facility to facility. Some provide transportation as part of the basic package while others charge per month or even per ride.)

Independent care living – It’s important to understand the difference between independent care living and assisted living. The best explanation for independent care living is:  A group retirement facility or community – a  place where seniors in good health can retire to be with friends their own age. They generally pay a homeowners association fee so their home maintenance is provided. They are able to maintain their own care in its entirety, able to function and drive without help. Cook, clean, bathe – all the things they would do in their home on Maple Street.

Some “communities” allow seniors to purchase condos, small homes or even build within a gated community (this instance requires in-depth understanding of the rules of habitation). They can sell their dwellings to other seniors should they come to a point where their care moves to the next level. It’s important to read every line on independent care contracts and notice where the line is drawn in the sand as far as qualifications to remain living in the facility/community.

Many pre-built homes, duplexes, condos or apartments revert back to the owners of the facility/community upon the death or the need for the resident to move away. Wording can be misleading and so can the sale of the properties. Potential residents may be told they are “purchasing” an apartment, condo, or duplex when in fact, it’s a glorified way to say leasing or renting. The purchase may even resemble the purchase of a home with a down payment and monthly payments, and a closing). The greatest surprise may come when independent care facilities or communities see residents growing frail and begin to push residents out, informing them there is no refund or resale on the property. Instead it reverts back in its entirety to the facility or community. This happens more in independent living facility complexes with apartments or condos but it’s important to know, it happens all the time. Read the contracts in their entirety. Invest in a visit with an attorney to read and understand the jargon and wording so your aging parent is not surprised when their needs shift and they are asked to leave. If there are HOA fees, verify they are yearly and not an extravagant amount monthly. To live in an independent care facility, residents must be fully able to maintain their own care completely. If that changes, they will be asked to move.

Seniors BEWARE! – Assisted living, independent care living, and nursing home facilities are expensive. Unfortunately, insurance does not cover what families assume it will. There is no coverage for independent care living and often with assisted living, there is little to no coverage. Families cannot depend on receiving financial assistance from resources, i.e. Medicaid. If seniors have Long Term Health insurance purchased early in their lives, they will receive some payment here, but as a rule, most insurance companies will pay limited amounts on assisted living facilities but far more on nursing home facilities when their resident requires full medical assistance and care.

Facilities are beautiful. Their lobbies are adorned with lovely flowers, pretty furniture, and smiling faces but none of that bears any thought to what actually goes on behind closed doors. Pay attention to the staff. Make unscheduled visits. Does the staff know the residents names, are they interactive, kind, and attentive?  Talk to residents. Are they happy with their care? Seek outside references. Ask past resident’s families about hidden charges or unexpected financial surprises. If ever there was a time to be due diligent, this is it.

In fairness to facilities, it’s important to know there is a horror story for them all. There are few businesses who are incident free. However, 98% of these facilities are wonderful and provide great care. There are those residents and family members who are demanding and are simply unable to please.  You, however, can look at the overall picture and get a good feel. Bottom line. If you walk into a facility and your gut says no. Stick with your gut. Instinct follows us for a reason. Listen to the nudge should you feel it.

Elderly Hand Holding Cane

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In-Home Care – The question that rises within families is this:  “Why pay for an assisted living when we can get someone to stay at home with our folks?”

It’s a valid question and one that deserves an answer. It is a proven statistical fact that seniors thrive in their own homes. Their own home is familiar and it gives them a sense of holding on to some control in their lives when their cognitive and physical abilities begin to slip away. Educating yourself is still important.

Private caregivers are a dime a dozen. Many are wonderful. But few, if any, meet state and federal regulations for in-home care. There are a few pros. Family members, friends, or someone’s best friend may be willing to care for your senior for a reasonable hourly rate.  They will help manage the household chores, take seniors to appointments and provide companionship.

The cons:  Many private duty caregivers take pay without paying income tax. Senior’s families are required to provide a 1099 to the caregiver and to pay Social Security/Medicare taxes to the state. Families can be sued if a caregiver is injured because homeowners insurance does not cover paid employees. This injury falls under workman’s compensation. Caregivers can call out and leave families in a bind with no one to care for their parent when they are required to go to work. Eldercare abuse, elder scam and thievery are at a higher rate because no background checks are done. Medical procedures are performed (i.e. sugar tests, feeding tubes, wound care, or injections) with no supervision and limited training. Important warning: This not acceptable by most states governing authorities and families tread on dangerous ground when they allow these procedures to be performed by non-medical personnel.

In fairness there are many private duty caregivers who provide excellent care for aging parents. Either way, this is a job that is regulated by the State and if your caregiver is not licensed, paying the taxes due the government, and receiving continued training, then families and the caregiver run the risk of being called out by the state.

The truth:  Cheaper is not always better.

In-Home Care Companies – There is security in hiring a caregiver through a company. First and foremost, caregivers are screened with background checks, credit checks, and motor vehicle driving records to provide the safest care possible. Companies are regulated and licensed through the state. This forces the highest level of care possible. Should a caregiver be ill and need to call out, companies can provide a replacement so families are not left in a bind.

In-home companies provide workman’s compensation. They provide W-2’s, assure federal and state income taxes, Social Security and Medicare taxes are withdrawn. Companies have liability insurance, provide full background, credit checks and motor vehicle reports on all caregivers, and caregivers are bonded. When all is said and done, in-home companies allow aging parents to remain in their homes as long as possible with exceptional care provided. Cost comparison on a senior who requires 24/7 care runs slightly less to equal to assisted living.

All things said, when it’s time to consider living situations, be pro-active. Do not hesitate to research every aspect of the facility or company you are considering. Understand the cheapest route may end up costing you the most due to hidden fees and agendas. Do the homework and find the facility or company that best suits the needs and care level of your aging parent.

Be and “Elder” Elf

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By Cindy Sproles

The holidays have arrived. Christmas trees, decorations, parties, a flurry of friends and family, keep us filled with joy and fun. However, the fun does not always resonate with our seniors. There are a number of things that “put a damper” on such a festive season. It’s important to become sensitive to those things that may trigger hardship or sadness for our elders.

Despite the stumbling blocks the holidays bring, we challenge you to put on an elf hat and become an “Elder” Elf. What does an Elder Elf do? It’s simple. Make visits, calls, visit nursing homes and assisted living facilities. Make yourself available to those seniors who may be lonely or forgotten for the holidays.

Be aware of the following things and take action:

*Loneliness is a major source of depression – The holidays spur times of deep reflection for everyone. Fond memories of loved ones past swirl in our minds as we pull out the Christmas decorations. For aging parents, the loss of a spouse or even children, surface and the longing for times past rise. Be mindful of those elders who have lost their spouse. Invite them to spend time with you, call, visit, include them in your holiday activities.

*Take note of the things that cause stress – For some aging parents, the festive hoopla is confusing, i.e. Alzheimer’s patients, those with dementia. Festivities sometimes cause confusion and stress. Simply be mindful of those needs and adjust visits and interaction to fit their needs.

*Give seniors permission to NOT purchase Christmas gifts – It sounds a little harsh, but the truth is, many seniors will overspend their already slim budget, in order to purchase gifts for grandchildren and great grandchildren. Those gifts can sometimes number in the 50’s depending on the number of children. Be sensitive to the small retirement budget of elder parents and give them permission to stop the Christmas spending. Initiate a “name drawing” or a dirty Santa Christmas where only one gift is purchased rather than buying for every family member. It’s a hard habit to break but one that will relieve enormous stress from your aging parents.

*Note holiday safety – Scams will be on the rise, opportunity for robberies and even identity theft – Take the necessary precautions to firm up security for your aging parents. Be sure deadbolts are in place, windows and less used doors are locked. Encourage seniors to never give their social security or bank information to anyone over the phone. Place charge cards and debit cards in a secure location. Keep an eye on bills and if your aging parent has difficulty getting to the street for their mail, check with the Postal Service about adding a mailbox at the door of a parent’s resident. Safety is always first.

One other suggestion. If your aging parents have since passed, adopt a senior at a nursing home or hospital. Look in your church at seniors who may be alone and make them part of your Christmas season. Assisted living and nursing home facilities maintain a list of those who have no family. Make Christmas stockings by gathering items such as toothpaste, skid-free socks, lap blankets, short devotional books, fragrance free sensitive skin lotions, close-heeled house shoes, soft cookies to deliver to nursing homes. Something so small can make such a wonderful difference.

This Christmas, be an Elder Elf. It’s our job to care for our aging parents and friends. Put on the elf ears and become a senior’s special elf.

And So It Begins…

Children depend on parents. It’s how it’s meant to be. Couples marry, have children and raise them. Their rewards usually come in the form of grandchildren, which at times, means grandparent-dom becomes parenting all over again. The fact is society has changed its view of the family unit. Parents are needed when their children are young, used when their children begin to raise their own families and then become abandoned as the elderly.

It’s a sad fact but true, in the United States our elderly are considered a problem, lower class citizens. Eastern countries honor their seniors placing their care above all other things. Even poorer third world countries refuse to push their aging parents out to fend for themselves. What has happened in America?

Perhaps in our effort to better ourselves we’ve lost sight of the importance of family and the circle of life which bonds us. As a nation, we’ve worked hard to make ourselves independent of others not realizing the end result falls to greed, stubbornness and ultimately, loneliness. 2011 marked the first year Baby Boomers “came of age,” hitting age 65 themselves and though they have raised their own children they are grossly unprepared to care for their own aging parents.

A critical first step to aging parental care is having that first conversation, laying it all on the table. Baby Boomers have to ask the question, “Mom, Dad…what about your care?” No one said this would be an easy conversation. Let’s face it. Talking about our aging brings our immortality into reality.

Still this is not a conversation that should be put on hold until the day mom or dad finally concede to assistance. Mother has a heart attack or Daddy is 90+ and getting feeble. They need help. You need help helping.

The roles of parent and child reverse. The loving parent, the caregiver for 65 years of your life is now the one who needs care and you are now the caregiver. I’m going to walk you through some important steps to help you pull together a good quality of care for your parents. Within these pages you’ll find simple how-to’s, good solid advice and even tough love.

Take a deep breath and prepare for the golden years. Perhaps along the way, you’ll see the importance of having these same conversations with your own children.

So it begins….caring for an aging parent. Our goal – to help ease the transition, to award you a new and appropriate title for your position and to allow you to enjoy the end years of the ones who have loved and cared for you so faithfully.