Moving Mom Into A Nursing Home

In elder or dementia caregiving, one of the hardest decisions to make is to move your loved one out of his or her home (or your home) and into a more institutional setting.  Making the move bearable for your loved one may not always be possible.  They may stand firm… They’re staying put, and that’s that!

It may help with the transition if you can remember some significant changes from your own life:

Questions to consider before moving mom into a nursing home:

  • What did it feel like to you as a child when your family moved to a new home in a new location?  Think about those first few days of trying to find your things, especially if some of them had to be left behind.  Try to recall what your emotions were when you went to the new school the first time—all those strangers and you didn’t know anyone.  Did your parents’ logical explanations and promises that “everything will be alright” make any impact on how you felt?
  • What did it feel like as an adult when you went to a new job for the first time?  Managing to learn a lot of new names in a short period of time was stressful, wasn’t it?  The same was probably true of learning new work rules—written and un-written—so that you weren’t creating problems right off the bat.
  • Can you remember what it felt like to give up control of your life when you went into the military or other organization?  You know, when someone else told you what to do and how to do it… You were probably a bit resentful, even if you managed to comply.  Most of us find small ways in which to act out that rebellion—sneaking a forbidden treat, making jokes about the people in charge, etc.

“For emotional preparation, the prospective resident should be involved in as much of the decision-making as possible. Fear of the unknown can make an admission more difficult. Both the caregiver and resident should be able to spend some time in the facility, with the staff, other residents, and other family members until some kind of comfort is developed.”  Peter Silin, MSW, RSW

I think you get the point.  Moving your loved one puts them into the emotional pool I’ve just asked you to swim in.  By answering these questions, you can begin to experience some of what your loved one is experiencing.  This sense of loss of the familiar, confusion in the new place with new people, and new regimes is especially heightened if your loved one is suffering from dementia.

Stretch your imagination far enough to strategize ways to ease the transition and AND the emotional upset it will engender.  There’s a terrific article by Peter Silin, MSW, RSW entitled “Moving Into a Nursing Home: A Guide For Families“.  Take a look at it if you’re in the process, or if you can see this in your future down the road.  It can be a big help in easing the stress for you and your loved one.

Blessings, Joanne

*Photo: Bardaga via flickr

Downsizing To Community Living- What To Bring With You

The Senior Resource Network is a leading placement and referral agency in Portland Oregon.  Amie Clark (owner/operator of The Senior Resource Network, and co-founder of The Senior List) wrote a helpful post entitled “Downsizing To Community Living- what to bring and what to let go”.  It contains some valuable tips that we’d like to share with you here on The Senior List.  Here is a list of what to bring with you.  For the list of what to leave behind, click through to the original article.

What to bring to your new senior community:

  • Bed- Generally, beds are not furnished (the exception would be an adult care home), unless your insurance is paying for a hospital bed.  Depending on the size of the bedroom, a twin, double, or full-sized mattress is best.  You want to make sure there is plenty of room around the sides of the bed to maneuver safely, especially if other furniture is in the room.  A foot-board and headboard may be desired, depending on the space.
  • Chairs and Sofa
  • Shower curtain and rings- Most communities supply the rod.
  • Towels- Several (2-3)complete sets of towels.  If housekeeping is done weekly, this should be plenty.
  • Sheets- At least two sets, unless the bed is changed frequently, most housekeeping is weekly that includes laundering sheets.
  • Bedspread, blankets, and pillows
  • Laundry Basket
  • Garbage cans- In a retirement or assisted living setting, a small garbage in the bathroom(s) and kitchen area are handy.
  • Clothes Hangers
  • Personal Items & Toiletries- toothpaste, toothbrush, denture products, comb/brush, soap, shampoo, shaving products, incontinence supplies*, glasses, hearing aids.
  • Clock, personal photos, and decorative items- familiar items in your new home, like curtains, artwork, and houseplants can make a world of difference to make your new accommodations feel more like home.
  • Telephone (optional)
  • TV/ Radio
  • Dresser/ Nightstand
  • Clothing- Garments that are washable- commercial washing machines can be very harsh on clothing, I would limit dry clean items, and comfortable for everyday use.  Perhaps a few dressy items for special events.

*Some communities will assist in ordering incontinence supplies as they may be able to purchase in bulk at reduced prices.

For a list of local placement and referral specialists in your community, check out the agency listings on The Senior List Eldercare Directory.  Be sure to look for ratings and reviews as they can be a helpful tool when deciding who to work with.

The Cost of Eldercare

Here at The Senior List we often field calls from clients and other professionals about the cost of care across the nation. I am thrilled to share an incredible tool I recently discovered to help answer those questions! The Cost of Care Map has been developed by Genworth Financial, a leading financial security company.

Genworth Financial map image

The Cost of Care Map provides an overlay of each state, citing yearly costs for Nursing Homes, Assisted Living, Adult Day Health Care, Home Health Aide, and Homemaker Services. Some states are even called out by metro region, allowing the user to compare metro areas within particular states. What struck me was the vast differences in costs not only across the states, but even within specific states themselves! The tool is very user friendly and serves as a cold dose of reality to the rising costs of care in all settings.

Here is an example for the state of Oregon:

 Oregon cost of care map

What is a Retirement Community?

What Is A Retirement Community?

Retirement Communities and/or Independent Living Facilities are most appropriate for seniors who can manage their health care needs on their own or with assistance from family in an apartment type setting. Independent Living does not offer health care services or assistance, but may offer a monthly meal plan, housekeeping, social activities, and transportation.

Some communities will partner with an In-Home Care Agency to provide some services to residents. Services may include Medication Management, Bathing and Grooming Assistance, or Incontinence care. If additional care services are being provided, at some point the cost of the apartment and care will equate that of an Assisted Living Community. Some Independent Facilities are located on a campus where other levels of care are offered should one need them in the future.

Independent Living costs range from $1000-$2500 per month, depending on apartment size, amenities, and meal plan. Some Independent Facilities will provide one to two meals per day and may offer a meal plan if a resident prefers to cook occasionally.

Only private pay is accepted at Independent Facilities. Medicaid does not cover housing costs for Independent living. Long Term Care Insurance typically does not cover Independent Living, but may cover the cost of outside in-home care services.

What are the advantages of a Retirement Community?

  • Nutritious Meals, Activities, and Housekeeping offered
  • Maintain Independence in a social setting
  • No upkeep or utilities to manage (except personal phone and cable)

What should I look for when searching for a Retirement Community?

  • I personally prefer retirement communities to be adjacent to another level of care, most commonly, an assisted living or residential care facility. If a move occurs in the future, it is much easier to move across the courtyard instead of the other side of town.
  • What amenities are offered? Are the activities varied? Is an exercise program offered?
  • If your loved one is driving, is there reserved and covered parking available for residents?
  • Are pets allowed? Is smoking allowed on campus?
  • How involved is the management staff in the lives of the residents? Will they notify you if they see changes in your loved one?
  • How often are meals served? Is there a flexible meal plan option? Is the cost of meals included in the overall price?
  • How is the food? Invite yourself for lunch (most will offer)- observe staff interacting with the residents. Is there a social atmosphere in the dining room or are residents keeping to themselves. Do residents seem happy? Do the staff know the residents by name? The dining room is a great indication of the “mood” of the building.
  • How does the physical building look? Is it well kept? Are repairs needed? Ask about the maintenance response time. How available are they for minor repairs for the resident’s apartments (light bulbs, hanging pictures, etc…)?

When is it time to transition to higher level of care? First, I would suggest that if a resident requires care to begin with, a retirement community will only be a temporary solution. If a resident has lived in a retirement community and is requiring more supervision, can’t safely manage daily activities, and requires frequent checks from staff, a higher level of care is needed.

Assisted Living- The Good, Bad and the Ugly

Assisted Living: Facts and Figures

There are almost 35,000 Assisted Living Facilities licensed and operating in the US today. Thousands of these assisted living facilities are already included in The Senior List eldercare directory.  These communities range widely in size, price and amenities and are all fiercely competing for your businesses. The real trick is finding the one the suites your needs, life-style, and pocketbook.

What is Assisted Living?

The typical Assisted Living model is based on apartment style living with care services built in. This model encourages independence and autonomy while providing supervision and daily assistance with care needs. Meals are typically served in a main dining area with the intent of a social gathering while enjoying meals selected by the residents. Activities will be offered, including outings, scenic bus rides, and trips to the grocery store, bank, and doctors visits on designated days of the week.

What type of care is provided?

Assisted Living provides custodial care, not medical care.

  • Bathing, Dressing, Toileting, Grooming, Mobility, Medication Management
  • Cooking, Housekeeping, Transportation, Laundry

What can I expect to pay for Assisted Living?

Most Assisted Living facilities structure their costs on an “ala carte” system. You will be quoted a “base cost” or “room and board cost” ranging from $1500-$3000 per month, depending on geography, size of apartment, and amenities offered. Expect to see additional costs added on right away. Based on an assessment of your care needs, the price will increase accordingly. This price can vary from month-to-month, especially if care needs drastically improve or decline over time.

What are the advantages to Assisted Living?

  • Less expensive than nursing home care
  • Private apartments to optimize privacy, autonomy, and independence
  • Three meals a day served in a social dining atmosphere
  • Security and call bell systems
  • Designed with accessibility in mind (roll-in showers, etc)
  • Exercise programs
  • Care Services available- to be used as little or as much as you require
  • Activity programs designed to keep residents active, social, and healthy
  • Most have a beauty parlor on site

What are the limitations of Assisted Living?

  • Despite staff presence and encouragement, some residents can become isolated
  • Most do not allow residents to cook, for safety reasons
  • Assisted Living can not accommodate residents who are wandering or exit seeking
  • Minimal staffing requirements in most states. On average, expect to see 1 caregiver for every 30 residents during peak hours, and much less at night
  • While facilities tout their abilities to care for residents through the end of life, many will ask families to hire private caregivers or transfer to a higher level of care if the residents needs are beyond the scope of their staffing levels

What do I look for in an Assisted Living community?

  • Ask to see the latest survey
  • Invite yourself to lunch (most will happily invite you first). Do you have menu options? Can family or friends join you for a meal? What is the cost for guest meals?
  • Do the other residents interact well with each other? Are the staff friendly and kind? Do they know the residents by name?
  • What is the caregiver-to-resident staffing ratio for each shift?
  • Is a nurse available? What hours is the nurse in the building?
  • Does the facility have a comfortable atmosphere? Is it clean? Are there any noticeable odors? What safety features are available?
  • Is transportation available? Is there an additional cost?
  • How often is the care plan reviewed? Is the resident or responsible party involved in the review? (they should be)
  • What is the turn-over rate for staff? *Note* Most facilities have a high turn-over rate. It’s a huge problem. What is the facility doing to keep current staff and attract new quality caregivers?
  • If you have a pet, ask about any fees you will be expected to pay for your pet. Typically, an additional move-in fee and cleaning deposit will be incurred.
  • What cost of living increases can be expected? (we have noticed 3-6% yearly for most communities)
  • If the community can no longer meet your needs, how much notice will you receive and what assistance will be available to relocate to another level of care?
  • Trust your instincts!!!

Who pays for Assisted Living?

  • Private Pay (you)
  • Long Term Care Insurance- Check your policy for coverage, waiting periods, etc…
  • Medicaid- If you already qualify for Medicaid, or will qualify in the near future, make sure the facility you are considering has a Medicaid contract- many do not. You can check with the facility or your local Agency on Aging office for a list of contracted facilities in your area. If a facility does have a contract, chances are they are trying to balance Medicaid v.s. private pay in the building. Some will have a waiting list for Medicaid, so plan ahead. Do not wait until a crisis to start your search!!!
  • MEDICARE DOES NOT PAY FOR ASSISTED LIVING

If you are just starting your search for an Assisted Living Community, you may consider working with a geriatric care manager or placement and referral agency to guide you. These professionals will know the communities in your area and save you valuable time and energy.

Senior Housing Options- So many choices!

What do you need to know about senior housing options?  Probably a lot more than you know right now, but at least you’re searching for the answers!

So… You just started a search for Senior Housing Options, and your not sure where to start?  Let’s begin with the basics… What are the generally accepted senior housing options out there?  Let’s answer these questions in this blog post.

Senior-Housing Options can vary widely in services, amenities, and levels of care offered, and geographical location. Some states may not have Adult Care Homes, for example.  Below are brief descriptions of each level of care.

Assisted Living Facilities offer private apartment style living for those who may need assistance with daily living activities, supervision, health-related services, and social activities.

An Adult Care Home is a single family residence that offers a home-like setting for seniors needing care. Adult Care Homes are very family oriented and care for five or six residents at a time.

Skilled Nursing Facilities offer the highest level of care (Custodial Care) for those who may be dependent on others for their health care needs. In addition, many of these facilities offer Rehabilitation (Skilled) Services to those needing short-term care after a severe illness or injury.

Retirement Living Facilities are for those 55 and better who require no assistance with Activities of Daily Living or personal care services. Transportation, Meals, and Activities are usually offered. These communities are generally not licensed.

Alzheimer’s/ Dementia Care offers a specialized level of care for those who have been diagnosed with Alzheimer’s disease or a Dementia related illness. These facilities are typically secured (locked) and have specially trained staff to work with the unique needs of their residents.

Residential Care Facilities can be similar to Assisted Living Facilities. Generally, the difference is in the structure and design of the building. You will find both shared and private rooms, as well as shared and private bathrooms in Residential Care. Memory care facilities may also be licensed as Residential Care.

If you have anything to add, please comment below!

I Found the Perfect Place for Mom and Dad- Now What?

You have most likely just navigated some very important decisions regarding the care of your loved one. You now have several additional decisions to make about their new home and lifestyle changes. This following suggestions are designed to help you “organize” your thoughts and help you plan for the next steps.

Senior Housing Tips: What to do when you after you find a care home

Is there a home to sell? If your loved one owns a home, planning and preparation for selling the home must begin soon, especially if the funds from the sale of the home will be used to finance new living accommodations. The first professional you need to talk with is a Seniors Real Estate Specialist. These Realtor’s have received specific training and education to address the needs of home buyers and sellers 50+. You can locate an agent by browsing The Senior List category of “Real Estate Services” in your city and state or visit the SRES website.

Is the home filled with years of personal and meaningful possessions? Does the task of packing, deciding what to keep and what to give away seem overwhelming? Most of us have a lot of stuff: furniture, kitchen accessories, clothes, hobbies, linens, and everything else that we accumulate throughout our life-time. There are a variety of services available to assist with organizing belongings and helping with the tedious task of deciding what to keep, what to pass on, what to donate, and what to simply throw away. Again, check the listings on The Senior List.com for local Senior Move Managers in your area, or visit the official National Association of Senior Move Managers site.

Is there a car or two? Most care communities have transportation available for the residents. If your loved still drives, they only need one car, if that. If you are concerned about driving abilities or safety, now is the perfect time to encourage your loved one to let go of the wheels. You may be able to find a non-profit in your area that will accept donated cars and your loved one will benefit from the tax credit.

Prior to move-in to any care community, they will be requesting copies of your loved one’s advanced directives, power of attorney documents, and any other health directives. If these documents are already in place, now is a great time to review them with your loved one to ensure they are up to date and accurately reflect their wishes. If these documents are not in place, you must have them before move-in takes place. In fact, everyone, regardless of age, should have these documents. If you need assistance with these legal forms, I recommend you contact an elder law attorney. You can find these specialists on The Senior List Eldercare Directory, or visit the National Academy of Elder Law Attorney’s.

These are tough decisions and tasks for any individual to complete on their own. These resources will alleviate stress and anxiety for families and seniors alike during this difficult transition time.

Adult Care Homes- Personal Care Homes- Board & Care… What’s the Difference?

What’s the difference between Adult Care Homes, Personal Care Homes, and Board and Care?  As it turns out, there are many differences, AND as many similarities.

What is an Adult Care Home?

Adult Care Homes are single family residences that are licensed to provide care services for frail seniors and adults. In some cases, the homes do not have to be licensed at all.

The number of residents per home ranges from 1-6, depending on the state licensing requirements. Care services at this level can vary, but typically fit a higher level of care than can be provided in assisted living communities, but don’t require full 24 hour nursing care. The advantages of this level of care are consistent caregivers, home-cooked food, high staff to resident staffing ratios, and a home-like environment. Typically the costs are less than other levels of care that provide the same services.

Disadvantages of an Adult Care Home:

While Adult Care Homes are a great option for many residents, there are some disadvantages. Due to the small number of residents, it is difficult for providers to maintain a full activities program for the residents. The care home may not provide the same social aspect as an assisted living or residential care community. They may not be able to provide transportation, hair-care services, or visiting podiatrists.  Care homes are operated by individuals, not corporations who have specific policies and procedures for staff to follow. Many care homes are not able to provide night-time care, as the caregivers are sleeping during the night as well. This is not to say that care homes can’t assist toileting at night or be available for emergencies, but consistent, extended night-time care is difficult to maintain. Care homes may also have great difficulty with a resident who is actively exit-seeking.

The Senior List.com explores the care home options in Oregon, Washington, and California.

Oregon Adult Care Homes: What you need to know

Oregon: Adult Care Homes: Must be licensed by the state who provides inspections on a yearly basis. Homes may provide care for up to five residents in the home. Homes are licensed and classified on three levels, from one to three depending on the level of care provided, number of caregivers, and experience of providers. There are even homes that are licensed to provide care for residents on ventilators. The cost for an adult care home in Oregon ranges anywhere from $2000-$4000. Medicaid does pay for some adult care home costs.

Washington Adult Care Homes: What you need to know

Washington: Adult Care Homes, Adult Family Homes: Must be licensed by the state, very similar to Oregon expectations and regulations, yearly inspections, etc… May have up to six residents per home. Levels range from 1-4, depending on the level of care required. Most Adult Family Homes have a Medicaid contract. In addition, the state of Washington requires any home that contracts with Medicaid to carry additional liability insurance. The costs seem a bit higher than Oregon, $2800-$4500 for most residents, $3000-$5000 for homes with licensed providers (RN, PT, etc…) and heavy care (hoyer-lift, hospice, end of life). Adult Family Homes in Washington may also be licensed for one adult day care resident in addition to six full-time residents.

California Board & Care Homes: What you need to know

California: Board and Care: Must be licensed by the state and are inspected. There are a variety of sizes of homes in California and rooms can be shared or private. Homes can receive specialized waivers to provide care for those on hospice, Alzheimer’s disease and ventilators. Board and Care homes in California can be secure (locked) to provide care for residents who wander. The cost for a Board and Care home range from $1200-$6000 per month, depending on location in the state and amenities offered. Few Board and Care homes accept Medi-Cal.

Many thanks to contributors of this article:

Bobbi Trifon, ElderHomeFinders
Claudia Belindean, A Caring Choice