Solving the Senior Living Puzzle
One of the most important and emotional choices senior citizens make in their golden years centers on where they should live. A wrong choice can split families, wreck budgets and even ruin lives.
So many questions need to be considered:
- Is the senior able to remain at home, perhaps with additional help from a home-care agency?
- Is the right move to a retirement community, and if so, what kind?
- Is a nursing home called for? If so, which level of care and options are the best fit?
Fortunately, organizations are out there to help navigate these often complex and sensitive matters.
“Many organizations have checklists to help you get familiar with, ‘What am I looking at?’” says Amy Goyer, an AARP family and caregiving expert.
Nine out of 10 seniors want to remain in their own homes, Goyer says, and that avenue should be exhausted before all others. The first step in deciding whether that is an option is getting a thorough evaluation of the senior’s needs and abilities.
To help you get started on how to do this, Goyer suggests downloading her free book, “Juggling Work and Caregiving” at aarp./org.caregivingbook and her blog at blog.aarp.org/author/amygoyer. AARP’s Caregiving Resource Center at aarp.org/caregiving also provides a comprehensive listing of links, tools, articles, videos and blogs.
In addition, Goyer says caseworkers at your local Area Agency on Aging can come to the home to evaluate the situation. You can also hire a geriatric case manager to locate in-home services and manage those services.
Should the decision be made to place a loved one in a long-term care facility, Goyer has a few tips to consider. She suggests talking to family members of the people living there, eating meals there, checking safety issues such as evacuation procedures and evaluating the overall quality of life offered.
“Just because your loved one’s 85 doesn’t mean they’re automatically going to be interested in playing bingo,” Goyer says. “Maybe that’s not their thing. Maybe another facility has activities that are much more engaging for them.”
Also, look for obvious signs of things awry.
“If it smells bad, you want to turn around and walk out the door,” Goyer says.
Once you select a place, she stresses that the senior should be visited every day, even if the facility has a good reputation. So pick a place close to your home or office.
“If you can’t be there every day, you need to make sure that someone is,” Goyer says. “Therefore, the location is really important.”
Johnson County Area Agency on Aging
Johnson County’s official website has myriad information on services for seniors, including housing options (hsa.jocogov.org — look for "senior services" under the "health" tab). For example, the Johnson County Area Agency on Aging offers a single point of entry for information and referral services. Information and assistance specialists can locate resources such as in-home services, congregate and home-delivered meals, transportation, legal assistance, insurance, housing and more.
For starters, Ed Schulte, aging information specialist, offers in an email some tips:
• Look at options. If you are looking at nursing-home care in Johnson County, a CARE assessment (Client Assessment, Referral and Evaluation) can be arranged by calling (913) 715-8857. The assessment considers a person’s need for nursing facility placement and alternate options. The agency can provide an overview of choices.
• Talk to people you can trust such as family, friends and health professionals to help you make good decisions.
• In narrowing down your options, consider availability of beds, skill levels of the staff and their numbers, and Medicaid coverage availability should private pay funds deplete.
Kansas Advocates for Better Care
Still another resource is Kansas Advocates for Better Care —(800) 525-1782; kabc.org. The non-profit group advocates for more than 90,000 Kansans who require long-term quality care in Kansas.
KABC does not designate a listing of top nursing facilities because things can change very quickly with new ownership, management and cuts to staff, but it does provide consumer information reports on individual nursing homes covering such topics as state enforcement actions, occupancy rates, hours of licensed nursing care and staffing ratios.
Mitzi E. McFatrich, KABC executive director, poses the following questions to consider:
• Do you need nursing-home level of care 24/7?
• If you choose a facility, do you need a specialized type of care — Alzheimer’s, tracheostomy care, wound care? If so, you want to assure that the facility has staff trained in the specialized care and that are available 24/7 and that their training is updated each year for the new information related to improving care for the specialized need.
• Is there frequent turnover of management, staff, nursing care providers or has there recently been such a change? Change sometimes is for the good, but it can also result in something less than optimal for persons living there. If a facility that has had stable management and staffing begins to have turnover of ownership, management or nursing staffing, it often has a significant impact on how well things go for individual residents.
• Are there enough nurses and aides to assist residents when help is requested? A minimum of four hours and 26 minutes is required daily to prevent unnecessary injury, illness and death. Make sure there is always an adequate nursing and nurse aide staff to provide the care needed. Ask residents who live in the facility if they have to wait for assistance after they request it and if so, how long do they wait. Ask visiting family members about their level of satisfaction with the nursing facility’s care. Ask what the facility does best. Ask what could be improved upon.
• Read the public copy of the most recent health survey inspection or look at it on-line for nursing facilities only. The state does not post inspection results for other types of senior centers.
• Review the quality measures for the facility on Medicare’s Nursing Home Compare website. (See sidebar). Quality measures and nurse staffing are self-reported by the facility and not audited by the state, but they do give some indications of quality, such as pressure ulcers/bed sores, loss of bowel or bladder continence, falls, and how the facility compares to national averages reported.
• Read the contract. If it is not in the contract, you have fewer or no protection or recourse should there be a problem.
• Make sure that all the care you need is listed in your Care Plan (revised every 90 days).
Missouri Coalition for Quality Care
KABC’s counterpart in Missouri is the Missouri Coalition for Quality Care — mcqc.com; (888) 262-5644. It also does not keep a listing of the best or worst nursing homes in Kansas City or Missouri. But its website lists violations by nursing homes in the state by region.
Dave Damico, MCQC president, offers the following advice on what to look for in a nursing home or long-term care facility:
“On our website we have a checklist of what to look for and questions to ask. We encourage individuals to visit several facilities, speak with the administrator, the head nurse, dietitian, social worker and other staff. Take a tour of the facility. Ask for references. Talk to the residents while you are there. Check our website to see if the facility has had violations and, if so, ask how they corrected the problem.
“Check to see of the facility has sprinkler system and smoke detectors throughout the facility. What is their plan for a fire, tornadoes and other emergencies? If there is an emergency with your loved one, what hospital do they take them to? Find out what the staffing levels are during the day, the evening and overnight.
“Also the nursing home costs — do they accept Medicare or Medicaid? Once they have placed someone, make sure to visit on a regular basis, but vary the times and days. Go when they are serving breakfast. Go for lunch or dinner, and sometimes in the evenings to see what they do to prepare residents for bed. Always go on different days. Do not set a pattern of when you visit. Be active at the home. See if there is an ombudsman and talk to them about the facility. We encourage them to speak up if they feel things aren't right. Have regular meetings with the head staff and administrator to go over the treatment plan for their loved one and to bring up any issues they may have.”
What’s It All Mean?
In one of her AARP blog posts, Amy Goyer, a family and caregiving expert, breaks down the different levels of care and options when it comes to senior living facilities.
Residents have their own apartments and live independently, with some services provided such as meals, housecleaning and activities. Some, but not all, have security and others offer some personalized services that they charge for on an a la carte basis, meaning you pay for each additional service on top of the base fees. These services may include medication reminders, help with bathing, laundry, etc. There may not be any medical professionals on staff. There is usually very little supervision because residents are able to live independently. Many residents in this type of facility may still drive, work and go out on their own.
This is a step up in care from independent living, but services and costs offered can vary greatly. Personal services may be included in a flat fee, but they are often offered on an a la carte basis. Assisted living offers just that — assistance and not much more. Generally, staff will provide assistance in the morning and evening with bathing and dressing as well as medication management, meals, some activities and there are varying levels of supervision at other times. Don’t assume someone will be checking on the resident all day or that staff will be at the resident’s beck and call. A resident can have a call-button to get help, but response times will vary. It’s not 24-hour, hands-on care or attention. For most facilities, residents can still come and go as they please, so don’t assume someone will know if your loved one wanders off.
Often referred to as “nursing homes,” residents in these facilities require a higher level of medical care. They offer meals and activities like other levels of care but more supervision (at least in theory). Residents’ capabilities will vary; some will be bedridden, others will be up and about. Residents have call buttons, but again, response times are not always quick. They are often short-staffed (even if they meet state standards) and may not be not able to provide as much attention to your loved one as you might like.
Many facilities have a special program for those with dementia. They offer meals, activities, assistance with bathing, dressing and medications, and there is generally a higher staff-to-resident ratio and more supervision. The most important features here are security measures to ensure no one can leave the grounds and get lost. But again, don’t expect your loved one will have someone constantly by their side unless you hire a private-pay aide.
Continuing Care Retirement Communities
These usually, but not always, include all of the previous levels on one campus. Residents can move between levels of care as needed. These facilities often offer some extra services to those in independent living because they do have nurses and other staff on the campus.
Group Homes or Board and Care Homes
A neighborhood home setting is one in which several people are cared for by the homeowner or staff who live there. The services offered vary greatly in reality, but they offer meals and usually help with bathing, dressing and medications. Some activities may be offered. They may offer more one-to-one care because they are smaller; however, they may offer less because they have fewer staff. The attention your loved one receives may vary a great deal from home to home.
Medicare has on its website, medicare.gov, a useful tool called Nursing Home Compare that allows consumers to compare information about nursing homes. It contains quality-of-care information on every Medicare and Medicaid-certified nursing home in the country, including more than 15,000 nationwide.
It should be noted that nursing homes are not included on Nursing Home Compare if they aren't certified to participate in Medicare or Medicaid. Those nursing homes can be licensed by the state. For information about nursing homes not on this website, contact your state survey agency.
photos: Tatjana Alvegard