Eldercare Q-A: Assisted Living, Memory Care, Which does Dad Need?

A client is asking:

My 85-year-old dad has been healthy until now.  He's beginning to shuffle which I know can be a sign of Parkinson's or Alzheimer's.  His  younger brother has Alzheimer's and lives in a Memory Care Community.  Dad hasn't been eating, he no longer drives and he lives in an isolated community near a mountain pass.

I want to know:  What's the difference between assisted living and memory care?

My answer:  

In Washington State, assisted living communities, including memory care communities, are authorized by law to do heavier care than in most states.  However, the level of care here varies.  Here's what I mean:

Light to moderate care assisted living--These communities focus on activities and provide light care such as medication management, help with bathing and dressing, and cueing.  Residents with dementia can live here as long as they have no behaviors which would potentially endanger themselves or others.  No exit-seeking, wandering into other resident's apartments, or socially inappropriate behavior.  In addition, these light to moderate care communities usually can't care for people who need a lot of help in the day or night.  If a person has a diagnosis of dementia, they might need to move to memory care in another building later. 

A building with both assisted living and memory care in the same building.  This type of building has separate areas for assisted living and memory care.  Alternately, there are two buildings--and two programs--side by side on the same property.  The memory care residents have a program specially designed for their needs.  It is a quieter setting with higher staffing than in assisted living.  It is secure so residents can't leave the building.  In memory care residents are able to receive care that includes feeding and behavior management.  People often will move into the assisted living area and move to memory care when their dementia advances.  

Stand-alone memory care communities--A resident in this type of community must have a dementia diagnosis.  Generally residents have varying degrees of dementia. Some are pleasantly confused.  Others have significant dementia.  Like other memory communities, and many assisted living communities, residents can generally stay through end of life. 

A little complicated?  I sent this brief explanation with examples to my client so we can discuss which type of community he would prefer.  Families have different priorities.  Some absolutely don't want Dad to move twice.  Others want a great fit now and if necessary will move Dad later.  Touring several communities may help spotlight the one that works best.

What experience do you have with memory care?  Has it been positive?

Eldercare Resource: 'Nancy's Lifts' does more than give rides to seniors.

Nancy Balin, owner of Nancy's Lifts

Nancy Balin owns a business, to be specific, a transportation network company.

It's called Nancy's Lifts. She drives seniors and others to places they need to go:  doctor's offices and hair stylists, meetings and outings. And even to the airport.  Many of her clients are debating on whether to give up driving altogether or to adapt to a new lifestyle that requires minimal driving, so they are relieved to have as an alternative a safe, known driver like Nancy.

There's more to this story:  a year ago Nancy worked as a lawyer while heading a fledgling not-for-profit organization called Family Jewels Foundation.  Its mission was to save young men's lives by alerting them to the symptoms of testicular cancer, the number one cancer in the 15 to 44 age group.  Nancy had been personally affected when her 20-year-old son died of the disease.  Early detection likely would have saved his life.

Speaking about testicular cancer and fundraising for her foundation  takes lots of time.  So Nancy retired from the lawyering and launched the driving business, to help pay the bills. 

First she passed an extensive  defensive driving course, got her business license and met the other state requirements.

Why do her clients--seniors and others--choose her?  Nancy has lived in the Bothell/Woodinville area--her main service area--for over 15 years. She is well acquainted with Western Washington.

"I'm local. I know how to navigate.  I speak English well, and I have references," she says.

"I have elderly parents.  So I treat my senior passengers like I'm driving with my parents."  That means reminding them about packing the C-Pap Machine, their ID and their medications.  It means Nancy putting the belongings and luggage into the car herself.  It may mean pulling the walker out of the trunk and escorting the senior into the doctor's office instead of dropping them off at the curb.  

Often her passengers will ask her about the rest of her life, and she says, "I'm doing this to help me be able to save young men's lives."  She often asks people, 'Do you have any males in your life ages 15 to 44 whom you care about?' Many of them do."  So Nancy educates them about testicular cancer, in the hopes that their families won’t have to suffer the way hers has.

Nancy is giving seniors and others a lift while working to save the lives of young men.  For more information about Nancy's Lifts, call 206-550-9570.

One Woman's Story: For the Love of Dad, She Did the Near Impossible

'Tis the season for cheerleaders.  Not always the ones waving pom poms and working the crowds at football games

Take a Boomer named Dianne.  A week ago she called me in a panic.  Her father's significant other had died just two days earlier.  Dianne's dad had dementia, and she was his only living relative.  She'd already been riding a roller coaster of emotions in the light of the recent loss when she found an elderlaw attorney a few days later.  The attorney gave Dianne my name and I found myself helping her sorting out the details that would put her dad's life back together.

1.  Step One:  Finding the money for her dad.  Dianne wanted to find an adult family home for Dad within an hour's drive of her home  But how to pay for it?  All she had was a checkbook, and credit cards with debt.  She needed a current bank statement.  And her name wasn't on the account.  So she went to the bank and pleaded their case.  Her dad was able to tell him this was his daughter and he wanted her to handle his money.  One down.

2.  Step Two:  Finding a new home.  With an accurate statement of assets--a bit more than Dianne had thought--and a statement of monthly income, Dianne was able to approach the adult family home that I had helped her find.   She and her dad visited the home and met the residents--all men.  And Dianne's dad struck up a conversation with one of them.  They liked the home.  Best of all, the owner would allow him to convert to Medicaid funding after six months.  The owner contacted the doctor and began arranging for admission.  Two down.

3.  Signing the power of attorney.  That document was needed for Diane to assume responsibility for her dad's move-in and other financial, legal and medical matters in the future.  So she set an appointment with the elderlaw attorney she had talked to a few days earlier. Her dad was losing competency, but knew her and could agree in front of the lawyer that he wanted his daughter to take care of him.   Three down.

What an amazing daughter!  She should be named "Daughter of the Year!"  Her dad will move into his new home in two days, and the whole process took eight days from start to finish.   I'm so impressed and proud to have been part of her team.

Silver Age Referrals: When High Tech and High Touch Meet, Families Win

What does a great database have to do with helping find the best assisted living and adult family homes?  What does an amazing database do for people searching for what could be their loved one's final home on earth?

Plenty. At Silver Age Housing & Care Referrals, where I work, we have a team of professionals who love to help families.  While our primary job is to work with people finding housing and care, we bring to the work an incredible array of skills and experience including occupational therapy. caregiver support, administration, finance and marketing.   We share information.  We help each other as we work with families in King, Snohomish and North Pierce Counties.  And all of us
have personal experience with helping our family member or members with a difficult transition.

Did I forget to mention our extra team member?  It's a super database, without which we'd be lost, frustrated or at the very least hampered in our efforts.  And while the database isn't human, it gives us the information we need to seem superhuman.

In King County alone, there are 1100 adult family homes, plus several hundred assisted living communities.  We're able to update records on our 600-plus partnering organizations, and search for so many categories.  We can find an adult family home in Bellevue where caregivers speak Japanese.  And other homes with experience in Huntington's Disease, Multiple Sclerosis and more.

We know which adult family homes can take Medicaid funding immediately.  I wish there were more!  And homes that take Medicaid after a certain number of months or years.

It's so gratifying for us to find just the right fit for a person's unique needs.  Even if someone has the same diagnosis as another client, they each have a different combination of needs.  This summer we celebrated 10 years of serving seniors, and we are still finding this to be true.

How did we get such an incredible database?  Our owner, Abby Durr, founded Silver Age in 2008.  After a year or two of working with spreadsheets, she realize she needed something more sophisticated to track all the vital information.

Hence the fancy data base.  She got some help, big time, from her husband, an IT specialist.  We like to call him our 12th Man. And while the work of Silver Age is high touch--we meet face to face or voice to voice with people whenever we can--the high tech feature can't be beat.

Senior communities: For profit? Not-for-profit? The Kenney tells the story well.

When it comes to eldercare, be it retirement and assisted living  or home care, many people choose the not-for-profit model.

I'm on the Board of Directors for The Kenney, a continuing care retirement community in West Seattle.  I've also been employed by three other not-for-profits since I began working in the eldercare field in 1994.   Here's what I've discovered:

What sets not-for-profits apart?

1. Not-for-profits are mission-driven and accountable to the community at large. Many are connected with a church or a hospital, and their responsibility to the broader community is well defined. Their tax exempt status presupposes the practice of "giving back." That's certainly true of The Kenney, a faith-based community.  If residents run out of money, or outlive their money, a benevolence fund through The Kenney Foundation may be available to help them pay their monthly fees.  This allows them to stay and continue to live a purposeful lifestyle.  The Kenney also gives back to West Seattle.  Groups including the West Seattle Pastors Group, Tiny Tots and West Seattle Chamber of Commerce meet here regularly. The Kenney Foundation will soon be sponsoring a fundraiser for veterans.

2. Corporate investors don't set the organization's policy. Boards of directors, who are community volunteers, work with management and administration to make the key decisions which are in line with the community's mission. At The Kenney, as in other not-for-profits, board members are experts in their respective fields of finance, education, health care and ministry.  Another difference: extra dollars go, not to stockholders or owners, but back into the organization, to improve staffing ratios, train employees and build innovative programs that make seniors smile.

2. 3. In general, not-for-profits do a better job of retaining their high quality employees. I've watched the senior communities I've worked in do many things--big and small--to attract excellent caregivers and other employees and to keep them. In-services, scholarship opportunities and specialized training build staff morale and increase tenure. So do simpler things like the monthly staff meetings where all departments can set common goals and celebrate those with five years of service, ten years, etc.  At The Kenney, many staff in the dining services and caregiving staff have worked there more than 15 years.  The Kenney has a staff member celebrating 34 years of service this month!  The big plus?  She knows every resident by name.

For more information on not-for-profit eldercare organizations, contact their national association, Leading Age.

Certified Senior Advisors Offer Ethics Plus Knowledge to Their Clients

"Are you a nurse?"

I'm asked that question from time to time.  My answer:

"If I were a nurse, all the patients would die the next day."

I have a fair amount of medical knowledge, most of it acquired through osmosis by working in a nursing home for 12 years with seniors and their families.  But I'm not a nurse.  I have great respect for nurses, though, and I work alongside of them as our company Silver Age Referrals  helps families find assisted living and adult family homes for their loved ones.

I'm not an elderlaw attorney, either, yet I refer people to those experts in the law on subjects including Medicaid.  Neither am I a physical or occupational therapist, yet I know how valuable these professionals are to what Washington law calls "vulnerable adults."

From the organizers/planners, to the Realtors specializing in working with seniors, to the Geriatric Care Managers who oversee the care of elders on behalf of families, professionals helping seniors run the gamut. 

In the best of worlds, we work together, pooling our skills and expertise to benefits seniors.

If my client needs help I can't provide, I refer to a professional.  But how do I know that this person will have, in addition to knowledge and expertise, the ethics needed to work with "vulnerable adults" and their families?

One helpful factor is the CSA alongside the professional's name.  That stands for Certified Senior Advisor.  It means membership in a national organization called the Society of Certified Senior Advisors.

Members study and pass a test on a broad-based curriculum that includes senior-related topics including:  Trends in Aging, Physiological Changes in Aging, Mental Health, Grief and Loss, Caregivers and Caregiving, Chronic Illness, Cognitive, Aging, End of Life Planning, etc.  There are also segments on Estate Planning, Financial Choices, Long-term Care Coverage, etc.

The organization requires continuing education, as well.  One of the most important aspects of the Society is its strong emphasis on ethics.  If members get into trouble ethically, there's a process which can lead to censorship or ousting from the organization.

I'm delighted when I can refer to a professional who is a CSA.  Not because they're perfect, but because they know how to treat seniors and their families ethically.  They know how to do the right thing.

Help for the Caregiver, Family: A Calendar & Friends

As a little girl, I attended more funerals than most adults today do in their lifetime.  A pastor's daughter in the Midwest, I sat in the front row with my little sister, while Mother sang a solo and Daddy preached the sermon.  Mostly I remember the food:  Jello salad, fried chicken, mashed potatoes.  Yes, and cookies, pies and cakes.

Community, so important in the 50s,  has waned.  Yet the needs, not just during the time of death, but during extended illness, are still there.  How do we cobble together a caring community which allows us, in the words of Scripture, to "bear one another's burdens?"  How do we help caregivers get a break from the important work they do so they can be revived?

Care Calendar is a great help.  This program organizes needs so others can meet them. The recipient lists needs:  meals, visits, light housework, transportation to medical appointments, etc..  Friends and family sign up on the calendar for the tasks they choose.  The program also sends reminder emails a day ahead of the assignment. And each group of helpers has a leader to keep things running smoothly.

My friend Lupe is our recipient.  She is fighting cancer and needs all her strength for the battle. I do what I can when I can do it.  So far, it's been bringing a cooked meal and visiting with her.  Others fill in other gaps.  They clean her house, drive her to chemo appointments and stay with her.

Care Calendar was born when a mother of nine children had a serious illness, and her husband needed a simple, organized way of telling the family's story and the needs of each family member.
It has so many applications, however, but particularly for the caregiver and the person in need.

What do you think of the CareCalendar idea?  Could it help you or your friends?

Caregiving, illness and stress: sharing the load

Are  you overburdened?  Or do you live or work with someone who is?  Aging parents, or aging, period, can bring overwhelming stress to all.

I've been thinking a lot about this subject, so I turned to the Bible.  It turns out that in Galatians 6, in the New Testament, there are two references to burdens that may at first seem contradictory.

"Bear ye one another's burdens" in v. 2 seems to indicate that we are to help others who are overwhelmed by life. Yet in v. 5, the command is that "every man should bear his own burden."  Which is it?  Or can it be both?

There are actually two different Greek words for burden.  Baros in v. 2 refers to an overloaded ship, with cargo so full that it's in danger of taking in water and sinking.  Picture a person or a family in that situation.  Their physical and emotional resources are shot.  They don't know where to turn.  They have taken on so much cargo, otherwise known as baggage, that they feel they're sinking.  They need help!

The other Greek word for burden, found in v. 5, is Phortion.  Another nautical word, it refers to the normal load a ship is designed to carry. If a ship is to sail properly, it needs a certain amount of cargo.  If it's empty, it cannot set full sail and make full speed, and it tosses and pitches violently in rough seas. The analogy works in life, too.  We need some stress to produce and to feel alive.

In another explanation of the burdens, the one  mentioned in v.2 is like a bolder that no one can roll up a steep hill.  And the other burden in v. 5 is like a backpack that we can strap on and navigate through life.

Bottom line, we all have burdens from time to time, and we're given strength to carry them or to allow others to help us.  And we can reach out and assist others whose burdens are otherwise unbearable.

Another blog post soon will cover a way people can team together to help families facing illness.  Stay tuned.

Moving from Rehab to a New Home is Easier Said than Done

Six professionals, all working in the senior care field, gathered around a table for a general discussion.  One of them, Susan, recently stepped into an unfamiliar role, a role that was fraught with obstacles.

Susan's mother had been living independently when suddenly, due to illness, she landed in the hospital and then in rehab. The doctor's verdict was that she could no longer live independently.  Assisted living, or possibly an adult family home, seemed the best answer.

Susan started the search but found that finding a great place for her mother was easier said than done.  Yes, she had experience working with seniors and their families.  But she needed more than the list the social worker gave her.  Another issue:  the social worker had little time to help people. 

Speaking of "the list," Susan said, it was difficult to work with.

"Assisted living communities and adult family homes were grouped alphabetically by city.  But some cities are so spread out that it takes a lot of effort to find these places.  The list had facilities that no longer existed.  Pricing was missing from the list, as was any kind of description regarding the care provided.  And there was nothing about availability."

After many calls and some visits Susan finally found a new home for her mother.  Yet she realizes there has to be an easier way.  Perhaps hiring a geriatric care manager?  Or working with a good referral agent?  Both those options can make the job easier.  Speaking of referral agencies, Silver Age Referrals can help. 

Beneath the Surface, Seniors Want to be Seen

Texts, emails, Facebook?  With seniors and their families, these communication modes have limits.  They're great for conveying simple information like dates and times, and yes and no.  However, when we want to learn about the "real person," and want them to learn more about us, we need to go face to face or at least voice to voice.  A simple telephone call or visit can reveal our client's likes and dislikes, distinct personality and sense of timing.

I learned about face to face or voice to voice contact at a young age.  My father was a minister in a small church of between 100 and 150 members.  One of his goals was to make 60 or 70 monthly personal visits to families.  That number seems staggering, but he did it!  He knew the family with the sick grandpa living far away and the one with the teething toddler.  He knew about rebellious teens and out-of-work dads.  I remember him talking down an alcoholic by phone in the middle of the night, and leaving our house to visit the dying.

Decades later, I still value the idea of voice to voice.  Personal contact allows us to see the person, inside and out, if you will.  And with seniors especially, that's very important.  I've made assumptions about elders by hearing statements from their loved ones, such as "My mom is you know, like any other 85-year-old lady with a walker, grey hair and glasses."  When I actually laid eyes on the woman, I got a completely different picture.

Today I read a newspaper article by Hannah Brencher, author of "Come Matter Here."  In it she talks about a simple prayer she uses to direct her life, one word at a time.  It's "Reduce me to love."  She shares a story of a disheveled homeless man who enters their church, starts playing his harmonica in the foyer, and says to Hannah, "Look beneath the surface.  Beneath the surface, we all just want to be seen."

I think that especially applies to seniors.  Beneath the surface, like all of us, they all just want to be seen.