Archive for the ‘Assisted Living’ Category

Assisted Living vs. Nursing Home Care


As a family caregiver you may find yourself limited in the level of care you can offer your aging loved one. It’s not uncommon for caregivers to find at some point that they can no longer provide the emotional, physical or social support their loved one needs and deserves on a daily basis. But, deciding where the next best place for them to go is can be difficult. Here’s a few things to consider about assisted living facilities and nursing homes (also known as skilled nursing facilities).

Know What They Don’t Offer

While assisted living facilities are supervised communities that offer services such as meals, social activities, and assistance with activities of daily living (e.g. bathing and dressing), one focus at these communities is to provide a healthy social environment so that elders don’t become socially isolated.

“Assisted living by definition is a lesser level of care [than a nursing home] and typically a more home-like environment often looking like an apartment. It is for someone whose prior living arrangement is no longer adequate,” says Jan L. Welsh, an Aging Life Care Manager and owner of Special Care for Older Adults, in Cincinnati, Ohio.

Because assisted living communities are considered non-medical facilities and are not licensed by Medicare or Medicaid to provide skilled care, they are not required by law to have a licensed nurse on staff. Even if a nurse is employed by the assisted living facility, which is often the case, the nurse cannot give residents hands-on skilled nursing care, which is defined by the federal and state governments and includes dressing wounds, administering insulin and oxygen, and more.

Assisted living facilities do not have the same safety or administrative requirements as a skilled nursing facility, and they are prohibited from providing any types of care they are not licensed to give.

“Some assisted living programs offer enhanced services, so you can receive a similar level of care that a nursing home would offer, as long as the family can pay for the services in addition to the room and board,” says Nancy E. Avitabile, who, like Jan, is an Aging Life Care Manager and owner of Urban Eldercare, LLC​​​, a care management practice based in Manhattan. “With this option, as the person becomes more immobile and eventually bedbound he or she could continue living there.”

Is Skilled Care a Must?

Nursing homes are set up like hospitals and staffed with registered nurses, licensed practical nurses, and certified nursing assistants who are licensed to provide skilled care. Skilled nursing facilities are regulated by the Department of Health and can bill Medicare and Medicaid for skilled nursing care, so they must comply with many complex legal regulations and requirements. For elders who need round-the-clock supervision, or who may need that level of monitoring in the near future, a nursing home may be the best option.

“When a caretaker can no longer provide what’s needed for their loved one, for instance, if the person needs ongoing dialysis or is bed-bound or needs a ventilator, those are appropriate times to consider nursing home,” says Avitabile.

While a senior’s health will inevitably decline over time, knowing which type of care your loved one will need in the future is hard to predict, adds Avitabile.

One thought is that your loved one may choose an independent living community first, then assisted living and then move to a nursing home when more advanced care is needed.

“That order works well for some people, but some people don’t necessarily have to enter assisted living even if they’re chronically ill,” says Avitabile. “We get conditioned to think that ‘OK, now my parent is older and becoming more frail and they can’t fully take care of themselves so now let’s move to assisted living.’ That’s not always the next step. Sometimes it’s less expensive to have an elder stay in their home and provide services for them there.”

Welsh adds that sometimes a person’s health actually improves when they are placed into a facility because they are in a more stable or healthy environment and at other times it declines. If a person was missing medications or eating poorly, those things can be easily stabilized in a nursing (or assisted living) environment. On the other hand, if the facility care is less than the care the person was receiving at home, or the person has a difficult time adjusting, they can go downhill quickly, she notes.

Major Factors for Nursing Home Placement 

Determining whether a loved one should move into a nursing home will be based on several factors unique to each individual. However, Welsh says the following are major indicators:

  • Increase in falls and wandering around dangerously
  • Medication management becomes complicated
  • Incontinence
  • Family fears the risks of being responsible for the aging loved one
  • When aging loved ones become victims of phone, mail or door-to-door scams
  • Sudden change in health (particularly diabetes, stroke, etc.) and independence of the aging person
  • Diagnosis of dementia or Alzheimer’s disease
  • The senior’s personal preferences, whether expressed in Healthcare Power of Attorney documents or based on prior life style

Think Long-Term

Before deciding on a long-term residence, think about the long run.

“Moving is stressful. Moving an older adult who then decides they don’t want to be there is incredibly stressful for them. If you’re interested in a place, after looking at several and meeting with staff, I’d suggest having your loved one stay for a weekend, or at the least a whole weekday to get a sense of how it is day to day,” notes Avitabile.

Besides the health and lifestyle care your loved one will need, Avitabile says consider the following before making a decision:

  • Cost
  • Flexibility
  • Proximity to family
  • How easily your loved one will acclimate in the environment
  • How easily your loved one connects with new faces and other people

No matter where your loved one lives, Avitabile says to keep the following in mind. “It’s very important that family finds ways to engage with the elder and arrange for visitors,” she says. “You can’t assume anything. Nursing homes have improved over the years, but the more present family members, aging care coordinator or caregivers are, the more the nursing home is aware that other people are looking out for your loved one.”


7 Questions to Ask When Looking for an Assisted Living Community


There are lots of important factors to consider when choosing an assisted living community for yourself or your loved one. You’re looking for a place that’s an ideal fit, and that means researching everything about the community, from cleanliness and ambiance to management activities and costs.

But it doesn’t have to be as daunting of a task as it might seem. Knowing what to look for – and which questions to ask – will help you make the best choice. Read on for some key questions to ask during your search.

  1. Where is the community located?

It’s convenient if the facility is a short drive from your home, of course, but experts advise against choosing a community based on convenience alone. Nonetheless, a community’s location is important for a variety of reasons, and some things you should consider include:

  • Is the neighborhood considered safe?
  • Is it close to doctor’s offices, pharmacies and other important places?
  • If the community isn’t near your home and doesn’t allow overnight guests, are there hotels nearby for when you visit your loved one?
  • Is it conveniently located for other family and friends to visit?
  1. Have you visited?

The importance of visiting the prospective assisted living community cannot be overstated. Likewise, it’s a good idea to visit at different times of the day, particularly during mealtimes. While there, take the time to talk to residents and staff to get a firsthand sense of the community’s features and atmosphere. Here are other key questions to consider:

  • Are hallways well lit and easy to navigate?
  • Are the common spaces clean, pleasant and appealing? Can you imagine your loved one using these common spaces?
  • Do most residents have a private or shared room?
  • Does each room have its own private (and handicap-equipped) bathroom, or is there one shared bathroom?
  • Is there enough closet and storage space?
  • Is the lighting good?
  1. How much will it cost?

The cost of assisted living can seem prohibitive since Medicare does not cover it for many seniors. That said, do your research to find the true costs, since fees can vary depending on your loved one’s needs. Also ask:

  • Are there move-in fees, or fees for services (such as laundry)?
  • How is the community funded? Is it non-profit or for-profit?
  • Is there a charge for transportation to and from doctor’s offices?
  • Will the costs go up in the future and why?
  • What payment options are available?
  1. What services are provided?

Be sure to ask what services the assisted living community provides, and whether those services are included in the overall price or will mean additional costs.

  • Is housekeeping provided and included in the price?
  • Are there religious services at the facility, or nearby?
  • Are barber and beauty services provided and are they included in the price?
  • Are pets allowed?
  • Are there visiting hours, or are guests allowed to visit residents at any time?

5. Is there a written care plan?

Knowing the specifics about your loved one’s care and having those details listed in a customized written care plan is important.

  • Who’s involved in developing the care plan?
  • What types of specific care are available?
  • Who handles medication management?
  • Is the facility associated with a hospital or nursing home if additional care is required?
  1. Is the staff well-trained, friendly and stable?

The staff’s attitude and approach toward residents is of utmost importance; after all, they’ll be taking care of your loved one on a daily basis. Observe several staff members and how they interact with residents.

  • Do they listen and make eye contact with residents?
  • Is there a nurse or licensed practical nurse on staff?
  • How many people are actually involved in your loved one’s care?
  • Are they friendly and patient while taking care of residents?
  • How much training do staff members receive?
  • Have staff members undergone background checks?
  • What’s the staff turnover rate?
  1. What’s in the admissions agreement?

Take your time to read the admissions agreement carefully. In particular, make sure you understand the move-out criteria – in many cases there’s language that requires a 30-day notice to stop billing for services even if the resident has died.

  • Is there a negotiated risk agreement?
  • Is there a liability waiver?

Experts suggest that liability waivers may indicate that the facility may not have the resources or ability to meet your loved one’s needs.


12 Tips for a Better Visit with an Elderly Loved One

Senior Doing Needlepoint With Younger Woman

Visiting an elderly loved one in a senior living facility can sometimes feel awkward or stressful. Many people make only brief visits, or avoid visiting altogether because of the challenges these visits present, but it’s important to remember that loneliness and lack of contact with loved ones can lead to major health issues for the elderly.

Here are some tips to make the most of visits with your elderly loved ones:

  1. Consult with the Staff

Your loved one may have certain dietary restrictions either due to their own health issues or facility guidelines, so it’s important to check with staff before the visit if you’re planning to surprise them with food.

  1. Set the Right Tone

Put yourself in the place of the person you’re visiting and think of how you would want to be greeted. Maintain eye contact, give a warm hug or handshake, and don’t stand stiffly in front of them but sit down so you’re at their level.

  1. Respect Their Privacy

Always knock first before you enter your loved one’s room, and step out into the hallway when they’re being given personal care by a staff member such as toileting, dressing or bathing. This way, they won’t get the feeling that you’re treating them as a child. Showing that you respect your older loved one’s privacy helps them retain their dignity and pride.

  1. Time Your Visit

The best time to visit depends on when your loved one’s energy and alertness are at their highest. For many seniors, this tends to be in the morning or after a midday meal. It may even be best to plan to share a meal with them.

  1. Keep Things Positive

It can be tough to keep up a cheerful attitude when a senior is being argumentative, depressed, or is in pain. Nonetheless, make it your goal to keep a positive, upbeat attitude throughout the visit. Avoid arguing with them and always talk to them with respect.

  1. Keep it About Them

Visits with elderly loved ones can sometimes bring feelings of sadness and grief, but it’s important to set your own feelings aside. Focus on the positives of their day; remember, they may feel sad or awkward, too. Additionally, focus on the “real” person inside of then, not the person whose outer appearance and health may have changed considerably.

  1. Keep Visits Intimate

You may be tempted to coordinate your visit with other family members or friends, but this isn’t always a good idea. A large number of people may be overwhelming for your loved one, and it’s always best to ask first if you can invite other people to visit with you. And if you bring children, make sure they’re well behaved and understand the rules of the facility.

  1. Change of Scenery

Visiting your loved one in a place other than their room can be a mood-booster for both of you. There may be a courtyard or garden at the senior living community, or you might consider leave the premises and taking a drive to check out some local scenery together.

  1. Bring Props

You can take some of the pressure off of yourself – and your loved one – as well as liven up the visit by bringing along meaningful objects such as a family photo album, some of your loved one’s favorite music, collectibles, etc.

  1. Shorter Visits Are Often Better

The length of your visit will often be determined by your loved one’s health and energy level, as well as how the visit is progressing. But, oftentimes, shorter visits are better. A half-hour of warm connection will be treasured more than a couple hours of silence and awkwardness.

  1. Communicate Clearly

Nearly half of people aged 75 and older have hearing problems, making it crucial for you to communicate clearly. You may have to raise your voice – but not shout – and it’s helpful to turn off the radio or other background noise while you’re talking with your loved one.

Also, keep your faces at the same level and be aware of your non-verbal communication, such as checking your phone every few minutes – which your loved one may interpret as a sign that you’d rather be someplace else.

  1. Promise to Visit Again Soon

Letting your loved one know that you’ll visit again soon will boost their spirits and help keep them from feeling lonely or down when you have to leave. Like most people, you probably lead a busy life, but a good rule of thumb is to visit your loved one at least once a month.

Will VA Benefits Pay for Senior Care?

Veterans Saluting

If you’re a U.S. military veteran who is planning for your own long-term senior care or the care of an aging loved one who is a veteran, you’ve probably considered whether VA benefits could help cover the costs of that care. If this is the case, you’re in good company. According to a 2012 census figures, more than 12.4 million veterans over the age of 65 live in the U.S.. With the average annual senior care costs ranging from $17,680 to $92,378 for care ranging from adult day health care to private nursing homes each year, financial help is essential.

What Are Aid and Attendance Benefits?

The costs of long-term care add up quickly. VA benefits like the Aid and Attendance Benefit can help significantly, even if the veteran’s income is above the limit for a pension. For eligible veterans and their spouses, the Aid and Attendance Benefit can help cover the costs of a variety of types of senior care, including assisted living, in-home care, and nursing home care.

The VA pays Aid and Attendance Benefits to a veteran in addition to monthly pension benefits. These benefits are also paid to survivors of veterans who have been collecting death pensions. Aid and Attendance Benefits may add $700 each month for veterans and $500 per month for survivors. This type of benefit is available for veterans who have served 90 days or more, one of those days being during a time of war.

Who is Eligible for Aid and Attendance Benefits?

These benefits are set aside for individuals who require assistance to perform daily activities, including bathing, feeding, dressing, and getting out of bed. It is also available for patients in nursing homes, those who are blind, and those who are undergoing treatment for a disability. Eligibility depends on whether the veteran is receiving a VA pension or if the veteran’s survivors are receiving a death pension. Either party must provide a primary doctor’s report as evidence of a qualifying condition.

How to Apply for VA Benefits

Applying for veterans’ benefits starts by contacting the regional office for the VA where the veteran previously applied for a pension or the survivor filed for a death pension. The VA will place the veteran into a priority group and make contact when the claim has been filed.

Unfortunately, all too many veterans and their loved ones don’t know that there are benefits available to help pay for the costs of senior care. With these rates rising every year, VA benefits can make a significant difference in the type of care that aging veterans can afford. Housebound seniors and those who require consistent assistance should be aware that they may be eligible for these additional VA benefits.



How Your Parent Can Test Out Assisted Living

Nurse Pushing Old Man On Wheelchair In Hospice

Committing to an assisted living community is a big decision. And chances are, your parent isn’t jumping at the opportunity, even if you think it’s their best move. The good news? Today there are a number of options that allow your mom or dad to test-drive communities to get a feel for how each place runs and to figure out whether it’s a good fit for them. Below are a few ways to test the waters.

Take a Tour

After you’ve pinned down some communities that seem like a good fit financially, you should tour the communities yourself without your parent, says Lisa Mayfield of Washington-based geriatric care management company Aging Wisdom.

“This way you can narrow it down to the top two places you like rather than dragging your parent all over the place, which can be exhausting and hard for them to remember one community from another,” said Mayfield. “Also, if you take them along initially, and the first place you go to is a bomb, then it can be discouraging and reinforce their hesitations.”

After you’ve determined your own top picks, it’s time to take your parent on a tour.

“It’s necessary for the parent to tour. They’ll see things differently than you will and you want them to want to move there,” says Debbie Feldman, a geriatric care manager in Buffalo Grove, Ill.

Typically, the visits last an hour and a half to two hours, and you can expect a marketing or salesperson from the community to tell you about the pricing structure, activities, and meals before you tour the different apartment options, dining room, and activity rooms.

Make sure to tour during a mealtime. “Not only do you want to taste the food, but everyone is assembled in the dining room, so it’s a good time to observe the type of people who are living there–if they’re cognitively and functionally similar to your parent,” says Mayfield.

Here are some other things to check off your list during tours:

  • Ask if the community will refund the admission fee, if your parent decides to leave.
  • Request to meet the nurse. “I think the nurse is the most important person in the building. Talk to her about any special needs your parent has and ask her how long she’s worked there,” Mayfield recommends.
  • Meet the community’s activity director and ask to see a calendar of activities, as well as observe an activity.
  • Pay attention to the ambiance. “Is the lobby active and are families in and out or does it feel like a ghost town?” says Mayfield, noting that while the condition of the building is important, most seniors aren’t sold based on whether it’s new and fancy. “Most older adults live in homes they haven’t changed or updated in years and they’re living modestly. They may not feel comfortable in a glitzy, brand new building. Find a match suited for your parent — not what you would want,” she says.
  • Take pictures of the outside of the building and inside the apartments, so you can remember each place after you leave.

Try Out Respite Care

Many assisted living facilities offer temporary stays, of up to a few days to several weeks. This option is referred to as respite care and gives your parent the chance to stay on the premises and try out everything the facility has to offer.

During respite stays, your parent will typically be billed for rent and services for the time he or she stays, but won’t have to pay the onetime admission or community fee of permanent residency, which can cost as much as $3,000 or more.

While some adjusting will take place, Mayfield says, “they’ll use the facility’s furnished apartment, so it’s more like staying in a hotel, which is a little easier and less stressful than having to move their own stuff in.”

Feldman notes that respite care is different from adult day care, which is usually not set in an assisted living community. “Adult day care is really set up for people who have dementia and other cognitive issues, and whose caretakers need a place for them to go during the day,” said Feldman. “This kind of environment is intended to engage elders during the day, so that when they go home, they tend to eat better and sleep better.”

Stay for the Short-Term

Many assisted living communities offer month-to-month lease arrangements in addition to long-term contracts. This offers similar advantages to respite care.

“The hope it that your parent realizes it’s not as bad as they thought,” says Mayfield. “However, there is a chance that if they stay and hate it, then they may not ever want to consider assisted living again.”

With this in mind, Mayfield recommends short-term stays only for people who are really reluctant to make the move. “It can take three to six months or up to a year to adjust to a community, so short periods of time aren’t enough to really get acclimated,” she said.

However, if circumstances require that your parent move into a facility immediately, a short-term stay can prevent you from having to choose a community based solely on what’s available–many popular assisted living communities have wait-lists for certain types of rooms or for the entire facility.

In the long run, this option may also make more sense financially. While month-to-month rates may not seem like the best deal, if you’re forced to move your parent into assisted living on short notice, going with a short-term stay can buy you the time you need to make a full assessment of your financial situation and choose a community that your family can afford.

While moving your parent to another facility could cost you to lose the community fee, Mayfield notes, “at most places that is pretty nominal in relation to the big picture.”