Tuesday, September 30, 2014

VARIETY sums up today's assisted living choices

If your parent needs assisted living today, and he or she lives in a city or suburbs, there's one word that describes what you'll see.  Variety.  Take Bellevue, Washington, for example.  The following assisted living communities differ in size, ambiance, pricing and care.  In many US cities, you'll find similar range of offerings.

The Bellettini--Situated in the heart of the city, this posh building is home to approximately 150 to 170 residents.  High ceilings, chandeliers and huge windows add to the hotel-like ambiance. The daily schedule rivals that of a cruise ship and includes outings, travelogues, exercise classes, personal trainers, art shows and culinary demonstrations. Speaking of food, dining options include two restaurants, which are open to the public.  In The Panini, a bistro, residents can watch the chef prepare their food to order.  The Bellettini caters to people who enjoy gracious living.  They tend to be independent, but have the reassurance they can receive more care if they need it.  Apartments range in size from the compact studio to the spacious penthouse.  There's a big range of pricing, too.

The Gardens at Town Square--Gracious living is a good way to describe this community, owned by Era Living.  For more than 20 years, Era Living has partnered with the UW School of Nursing to produce active aging and wellness programs.  Residents at The Gardens at Town Square can hear up-to-the-minute research on timely topics relating to health and other subjects.  Those might range from history to horticulture, from geneaology to astronomy, all delivered by experts in the field. The UW connection also extends to the Department of Social Work.  Residents here can join support groups and receive counseling with transition issues, thanks to this program.  One favorite feature of Era communities is the quarterly art show, showcasing work of residents and local artists.  When memory issues become challenging, care is provided in a specialized memory care unit. 

Evergreen Court--Homelike.  Friendly.  Affordable.  Those words describe Evergreen Court. This community features lots of trees, and every resident has personal access to the outdoors by either a patio or a deck. A long time ago Leisure Care, a national retirement community chain, owned the building.  But now it's owned by a not-for-profit called DASH (Downtown Action to Save Housing). Independent residents at Evergreen Court meet income qualifications to live here.  Apartment rents are the lowest in the city, and they come with three meals a day, weekly housekeeping, and a wonderful activities program.  With 84 total apartments, everyone knows everyone else.  Residents are active in helping plan programming, and they volunteer as they can.  Assisted living is offered in a section of the building, and there are some Medicaid-funded apartments.

Variety is the spice of life?  In assisted living, it appears to be just that.

  

Tuesday, September 16, 2014

Decisions, Decisions: How to Help Your Aging Parent Make Them

Giving up the car?  Moving to an assisted living community?  Eating a healthier diet? Whatever the decision your aging parent faces, there's ambivilance. Through a process called "Motivational Interviewing," you can help your parent resolve the vacillation and commit to change.

"There are pros and cons for every decision we make," Carilyn Ellis says.  Ellis uses motivational interviewing in her work with veterans who are grappling with issues including drug and alcohol abuse.  Some are seniors. She contends that the same principles she uses as a clinician can be used by family members and others in helping seniors make decisions.

In a nutshell:  "Motivational Interviewing is collaborative conversation that strengthens someone's own motivation for and commitment to change."

Words that describe the process, according to Ellis:

  • Collaborate--rather than confront or be authoritative.  You let go of the outcome, but focus on your parent and how you can work together.
  • Evoke your parent's motivation--Discover what he or she wants, rather than attempting to persuade him or her of  your point of view.
  • Honor your parent's independence and autonomy in making decisions for their own lives.
Principles of "Motivational Interviewing":
  • Express empathy.  Use phrases like "This is really concerning to you."  "It's a hard decision."  And if your parent dismisses the difficulty, say something like "I know what you're saying.  I still think it is hard."
  • Normalize their feelings.  You can say something like "What you're going through is normal. To think about what's important to you is always OK."
  • Summarize their words.  You might say, "I think I'm hearing you say...Am I right?  Please correct me if I'm wrong."
  • Support self-sufficiency.  They need to believe they're able to make the change.  You can help by validating the steps they've already taken or validate their successes in life.  Remind them of how they overcame obstacles.
  • Roll With Resistance.  Don't argue.  If a tug of war ensues, go back to empathy.
Developing Discrepancy:  
  • The goal is for your parent to initiate the "change talk."  How can you recognize this "change talk?" Instead of using phrases like, "Living in a retirement community is good for some people," he or she might say, "I want to visit one to see what it's like." 
  • Ask evocative questions.  Some possibilities: "Let me ask you, what if you chose not to..."  Or "What if you decided to continue..."  Or "On a scale of 0 to 10, where 0 is absolutely not and 10 is absolutely committed, where would you put yourself right now?" If he or she answered, 5, you could ask, "What would it take to move you from a 5 to a 6?"
  • Ask, "What are your top three values and why?"  How does your current situation/behavior fit with these values?  Since you know your parent well, you probably won't have to ask his or her values, but say something like, "You know I know you well, and it seems to me like family (or saving money, or friendship, or...) is a huge value for you.  Right?" 
Use a gentle, supportive tone, Ellis advises.  

Much of this information was taken from Carilyn Ellis' presentation to the Certified Senior Advisors.  It was entitled "Motivational Interviewing:  Tools for Fostering Improved Motivation in Your Clients to Make Decisions and Achieve Their Goals."

Tuesday, September 9, 2014

Medicaid Myth: Spend Down Your Money and Presto! Instant Medicaid

A note to you regarding your aging parent: Running out of money doesn't necessarily translate into Medicaid eligibility.

A few weeks ago an Executive Director of a nearby retirement community emailed me.  A woman in his community we'll call Sally had lived there at least five years.  She was nearly broke.

The community had a "spend down" policy of allowing people to convert to Medicaid funding after four years of private pay.  Since Sally had lived there more than that length of time, she'd be eligible for Medicaid, right?

Wrong.  Medicaid eligibility is two-fold:  financial and medical.  Sally is totally independent, taking her medications, dressing and bathing herself, and managing her activities of daily living.

Unfortunately, she has no medical need and flunks the Medicaid test.  Sally will need to leave her current community and find low-income housing.  Unfortunately, that option generally involves long waiting lists.

The moral to the story?  Don't assume that if your parent exhausts his or her funds,  Medicaid is assured.
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