When Is It Time? Making The Difficult Decision to Move a Family Member to Assisted Living or Memory Care

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When Is It Time? Making The Difficult Decision to Move a Family Member to Assisted Living or Memory Care

March 30th, 2016 by

Suzy Murphy debra levy

special contribution by Susy Elder Murphy, BA, CMC
owner, Debra Levy Eldercare Associates

One of the most difficult decisions that any family faces is making the decision about when, or if, moving a family member to assisted living is the right thing to do. As Aging Life Care™ Managers, this is often when we are called on, whether to schedule an office consult with concerned adult children to discuss options or to meet with a spouse in their home and assess whether or not their husband or wife can still be safely cared for there. It is nearly always an emotionally fraught decision. Sometimes adult children promised their parents that they would “never put them in a home,” whatever that may mean in today’s world where some skilled nursing facilities actually more closely resemble a Hilton Garden Inn with nurses, and long before being faced with the realities of a difficult diagnosis, such as Lewy Body Dementia. When I meet with couples who may have been married for 60 years or more, they are often wracked with guilt because they feel that they have in some way not fulfilled their wedding vows to care for their spouse “in sickness and in health,” promises made decades before the diagnosis of a chronic and progressive illness such as Parkinson’s Disease has begun to take its toll on the strongest of marital bonds.

I give talks on this subject at assisted living communities in our area and they are always well-attended by adult children and spouses who have the same questions for me: What are the options and how can we afford to pay for this care? More of us have long term care insurance which may cover most or even all of the cost of care, but many families are dipping into hard-earned savings, or looking to government benefits to help cover the costs. I recently met with a brother and sister who live in this area and were concerned about their parents who live in Florida. They began trying to look at different communities on their own and quickly realized that they needed the guidance of an Aging Life Care Manager to help them understand the alphabet soup of categories of care that their aging parents might need. As members of the Aging Life Care Association (ALCA), we do not have a financial relationship with any community or resource that we refer our clients to, and our recommendations are based on our clients’ needs and our experience in the geographic area we serve.

To use the “Smith” family as an example, mom is age 85 and takes a few medications for chronic conditions such as hypertension and thyroid imbalance, but has had noticeable memory loss for the last several years. Dad, 89, also has some memory issues, but has also recently been diagnosed with congestive heart failure, including a hospitalization to treat that condition. Mom and Dad are both happy in Florida and have some extended family there, as well as many friends and activities they enjoy, although both of their adult children live here. “Don” and “Amy” wanted to know if they should continue to travel back and forth to Florida to deal with intermittent health crises such as their dad’s recent hospitalization, or, whether it would be better to bring their parents closer to them here.

We began with a discussion of finances. The Smiths have modest income of about $3500 per month, and are not eligible for the Aid & Attendance benefit through the VA, since neither parent served in the military. They have savings of about $50,000 and a condo worth about $100,000, which is fully paid off. They currently live within their means and cover their out of pocket medical expenses and living expenses out of their monthly income, usually with some left over at the end of the month. My first suggestion was that they get a more comprehensive assessment of their parents’ medical condition, particularly their dad’s congestive heart failure and their mom’s memory impairment. They plan to have a comprehensive assessment by a geriatrician of both of their parents, and I was able to refer them to an ALCA member in Florida who could assess how they are actually functioning at home. My colleague in Florida could assess if their memory issues are causing them to forget to take medication, compounding their other medical issues, and also identify what local resources they could tap into to support their continued care in their familiar home as an option that might be sustainable for another year or two.

At the same time, we explored different housing options in this area. I suggested that they look at communities that offer independent living (a private apartment with a full kitchen and a congregate dining meal plan of 1 -3 meals daily and weekly housekeeping) with the possibility of a subsidy, as well as the availability of ala carte services such as medication management, and assistance with bathing, as a way to stretch their savings out for as long as possible. Some of these communities also offer assisted living options (a private apartment but with only a kitchenette and 3 meals and snacks daily, as well as weekly housekeeping and laundry) with more comprehensive nursing oversight, as well as possible subsidies. In the event that one of them needs skilled nursing care, possibly Mr. Smith due to his advanced age and congestive heart failure diagnosis, I explained how Medicaid would come into play to pay for most of his care, and referred them to an elder law attorney who specializes in Medicaid for additional guidance. In the event that Mr. Smith predeceases Mrs. Smith, we also explored the possibility of a small group home to meet her care needs, due to her memory deficits and the strong possibility that she might have early to mid-stage dementia. Group homes offer private bedrooms, shared meals in a communal dining room and a less institutional setting than a skilled nursing facility, for about half the cost.

At the end of our 90 minute meeting, Don and Amy had a short list of communities near their homes in the metro DC area that could meet their parents’ medical and financial needs, as well as a referral to the Aging Life Care Manager in Florida to help them understand what options are available to their parents there, as well as to get a more complete assessment of their needs. We will remain in touch as they explore the options and, as a family, make the decision about when it is time to move their parents.

Susy Elder Murphy is the owner of Debra Levy Eldercare Associates, an independently owned and operated Aging Life Care Management practice founded in 1988. She is also President of the Mid-Atlantic Chapter of the Aging Life Care Association. She can be reached at smurphy@care-manager.com

What’s Wrong with Old?

February 17th, 2016 by

Close your eyes and imagine someone who is “old.” What images does this word conjure up?  Do you see frailty, sadness, or people with memory loss? For most Americans these are the images they see. But why?

Getting older isn’t the end of one’s life; it’s a chance to embrace more of life. Aging should be seen as a grand adventure, not a slow march toward death.

Geriatrician Dr. Bill Thomas believes our attitudes toward aging exacerbate some of the problems the senior community faces. He sees seniors as entering a new phase of life, something he calls “post-adulthood.” Thomas argues that the senior years can be vital years of self-discovery and adventure, given the chance.

But embracing your age also means that aging Americans have to stop chasing their youth.

‘You’re as young as you feel, and I feel like I’m 22 years old.’ That’s not good, that’s not right ... and the reason it’s wrong is it doesn’t allow you to be who you are,” Thomas explained to TheWashington Post. Instead of seniors pretending to be in their 20s, Thomas wants seniors to embrace their true age with the same energy and enthusiasm that would be expected of a 22-year-old.

Thomas points out that believing old age is a bad thing can lead to dementia, depression, and other maladies. The key to aging, in his mind, isn’t denying what’s happening, but refusing to view age as a burden. There are 80-year-olds who run marathons. There are 90-year-old grandmothers who make Christmas dinner each year.

Another culprit of the negative aging stigma are the very institutions we use to offer assistance to seniors. According to Thomas, American nursing homes are regimented against seniors, making them feel useless, and are designed for the convenience of the staff, not the benefit of the patients.

Whether you’re running marathons at 80 or need a little help with mobility, aging is nothing to be ashamed of. By embracing our age and celebrating seniors, we help build a stronger, happier elderly community.

Don’t Get SAD; Get Better

February 11th, 2016 by

Winter can be a bit of a downer.

Snow, ice, unsafe driving conditions, bitter cold—all of these factors can make winter seem depressing. But winter blues are more than just a passing notion; each year some people get SAD, or Seasonal Affective Disorder. SAD is a clinically diagnosable form of depression that can result in overeating, fatigue, difficulty concentrating, and loss of interest in daily activities. Scientists theorize that SAD is brought on not only by the drop in temperature, but the reduced amount of daylight. In essence, our bodies respond to the change in season by slowing us down physically and emotionally.

For seniors, SAD can be especially debilitating. The National Alliance on Mental Illness reports that more than 6.5 million Americans over the age of 55 experience depression. To make sure that seniors are not suffering from SAD, caregivers and loved ones should keep an eye out for crucial signs. If seniors seem to have lost interest in activities they typically enjoy, isolate themselves from friends and family, or spend inordinate amounts of time sleeping, caregivers should consider intervention.

Unlike for many forms of depression, for SAD there is a simple, non-pharmaceutically based treatment: the sun. Exposing SAD sufferers to sunlight can help energize and cheer most patients. If you suspect a senior is suffering from SAD, bright, sunny areas of the home are the best way to elevate their mood without the use of chemicals. Light box therapy is another effective option—filling a room with artificial sunlight to help minimize the effects of SAD. Sunlight therapy lamps, which are inexpensive, might also be an intelligent addition to your home décor. Even those who aren’t suffering from full-blown SAD will get a natural boost from the simulated sunlight.

Whether you’re worried about a senior who seems down or trying to cope with the effects of the season yourself, no one has to be SAD. Stay mindful of the signs, and seek help if any SAD symptoms present to eliminate this highly treatable form of depression.

How Smart Is Your House?

November 17th, 2015 by

Can your house tell you if your mother took her morning pills? Does it notify you with concerns about your father’s mobility? In a few years, it won’t just be phones that are “smart.” A team of researchers is working on a smart-house program that will monitor and adapt to seniors as they age.

Washington State University’s Center for Advanced Studies in Adaptive Systems has created a “smart home in a box.” The system involves 30 sensors installed throughout the house. The house can then monitor movement, temperature, times that doors are opened or closed, and changes to habit patterns.

The machines are more than just data collectors. The system was designed to learn and recognize repetition of actions. This means that pets, visitors, and other outside stimuli won’t warp the system’s data. With the “smart house,” seniors can live independently while their loved ones get real-time data on activities, household business, and the basic abilities of their seniors as assessed by the house’s program. The “smart house” can even tell the difference between an accidental fall and a senior willingly getting on the floor, so it won’t offer false alarms.

At Capital City Nurses, we believe that offering seniors a sense of self-sufficiency can help them remain vital. Until your home has the IQ to monitor your loved ones, consider the human touch. Capital City Nurses’ hand-picked nurses aides and the exceptional independent caregivers they can refer  are  equipped to help aging loved ones with everything from running weekly errands to regaining mobility. Patient care is paramount to us, and we work with seniors to make sure they are aging successfully.

If you’d like your loved one to live in a “smart house” that’s available now, consider The Cottage at Curry Manor. Capital City’s first foray into Refined Residential Living, The Cottage offers five-star accommodations and an attentive medical staff. We can help any resident achieve their mental and physical potential with a program tailored to enrich their life according to current mental and physical abilities. We offer gourmet food, exciting classes, afternoon tea, and community activities.

Whether you’re interested in transforming your home into a Shangri-la of digital security for your loved one or you simply want to ensure they are living life to the fullest, Capital City Nurses can help. Call us to learn how we can help you and your aging loved one enjoy the years to come.