This article is based on episode #11 of A Bridge To Wholeness podcast. You can listen to the episode on iTunes, Stitcher, and on our website.
Today is part two of the series When We Become Parents For Our Own Parents, and I’m doing this in two parts because there’s so much information to cover. Click here to read part one
As many of you know, I am a registered nurse. I’m also a certified whole health educator, and I also have quite a bit of personal experience in this area dealing with my own parents, and my in-laws as well. Over a period of many, many years. I have really been through quite an extensive amount of experience with this. I don’t know how else to put it, but I’m hoping to pass some of this information onto you so that if you’re beginning this process or even if you’re in the middle of it, maybe there are some things that you can take away from this podcast that will help you or help someone else.
In the first podcast we really addressed actually just looking at the care of our elderly parents or relatives and are they at that point where they really need care and what are the signs that we need to look for? How can we make sure that they stay safe in their environment? If they can’t stay safe in that environment, what is the next step? What do we look for? Today that’s exactly what we’re gonna talk about and there are some really interesting statistics that I would like to pass along to you. First of all, according to a 2009 report that was done advocacy and research organizations inside the assisted living industry, there’s an average length of stay that they have come to, and it’s about 28 months. When someone goes into assisted living, the average stay is anywhere I believe between 21 and 28 months. That’s something that you definitely want to consider when you’re looking or possibly thinking about a long term care facility. This is really, really interesting.
I found this also. According to the National Center for Assisted Living, 59% of all assisted living residents will eventually move to a skilled nursing facility. That’s something you may want to consider because in the assisted living world, there are places that the patient or the client can actually move through. They start maybe in an independent living facility in that community and then maybe they’re going to start needing a bit more care so then they move into an assisted living apartment inside that same community. Maybe they’re there for a year or two or three, but they become more feeble. They need more help. Maybe they’re suffering from cognitive impairment or they have a physical illness. Whatever it is. Then they have to move into a skilled nursing facility and the average stay in a nursing home is 835 days according to the national care planning council.
Those are a lot of statistics, but we can sit here and talk about statistics all day, but I think what we want to look at is really looking at the person and what that involves. What is this about? What happens when somebody really does need more help? Let’s say you have determined that your parent can’t stay at home by themselves anymore. There’s a few things you can think about. Can we have them work with an aide. Somebody that actually comes into the home and spends some time with your loved one. Maybe they need help in meal prep. You don’t want them near the stove anymore or near the oven. Maybe they have some mobility issues and that becomes more challenging for them. Having an aide come in and doing some light meal prep. Maybe they prepare breakfast and dinner and then lunch is on their own. They help with laundry. They maybe change the bedsheets. Do some light housekeeping. That is something that you can definitely look into and I would suggest that you carefully vet those people.
Now there are organizations you can go through that will help you to find someone to come in and help, but you can also look on Craigslist. You can look in the newspaper. You can do a Google search, but you do want to look at someone who is first of all used to working with elderly or really enjoys it. They have their own transportation. They can get there. They can get home. They’re dependable. They’re a good match for your loved one. You want to make sure that they’re going to get along. If you can do a background check on them, I would highly suggest that you do that. You want them vetted for sure. If you want to go through some type of an agency such as a nursing agency to get an aide for your loved one, you can also do that. It’s probably going to be more expensive, but at the same time, they are carefully vetted, they’ve had their background searches done. They are certified patient assistance. They’ve gone through training. They know what they’re doing.
You have a little bit of piece of mind. Also in that person becomes ill or can’t make it that day, you should be able to get somebody to replace them in that time. For my own father, we did use an aide through a nursing agency and we were extremely fortunate to have an absolutely wonderful gentleman come in and help my father with all kinds of things even when he was in independent living. For us, that worked out fairly well. If you’re at the point where you want or think that your loved one may need some more care, you might want to start checking into assisted living facilities. Now, they’re expensive. I’m not gonna lie to you. They’re expensive and the cost keeps going up. If cost is a consideration for you, you may have to weigh what it is to have your loved one come and live with you versus having an aide come into their place. Maybe an aide comes in to help in your home. There’s all kinds of things you can do.
Assisted living is not inexpensive. The cost I thing goes anywhere from probably $3 thousand a month up to $10 thousand a month and I think that depends on your location, what state you’re in. I’m sure there’s different various rules and regulations state to state. Do be prepared. It is sticker shock. Also there a lot of times the rules are that the more care they require, the more expense that you lay out per month. That’s the way it is. Now, when you go in and you’re looking around for an assisted living place, what do you look for? What are you supposed to be checking out? Let’s say you’re going to take a tour. Usually you set up a tour with a sales person and they’re goal is to sell you on the place. Let me tell you, they’re not selling the place. I mean, this is my personal experience and it’s my opinion and maybe I’m gonna get in trouble for it, but from just the experience I’ve had because I’ve had dealings with four to five different assisted livings over several years and I will tell you that they don’t sell to the client.
They’re not selling to the client. They’re selling to the child. I’m really convinced of that because we’re the ones that usually go in for the tours, the children. We’re usually the ones going in for the tours. Don’t get swept up in the aesthetics of the place because some of them are quite beautiful. I mean, wow. Who wouldn’t want to live there? When it really comes down to it, I found that the older my in-laws became and the older my parents became especially my father. My mother passed before we ever got to that point. The less they want. They don’t really, in my experience, they’re not concerned with so many aesthetics as they are … they just want to be in community. They want to be cared for and they want to see their families and their friends. That’s really what they want. When you go into an assisted living, you’ll often see a big swimming pool which I’ll be honest, all the places I’ve ever been in, I’ve never seen anyone in the pool.
That doesn’t mean they don’t use them, but I’ve just never seen anybody in the pool. They will usually have a couple of really nice dining rooms. Sometimes the assisted living client depending on their cognitive ability, if they’re in an independent living situation in a different part of the community, they may have their own separate dining room from the clients who are in assisted living that may have more ability issues or cognitive issues et cetera. Sometimes they keep them separated. Sometimes they bring them all together. Just depends on the price. You’ll see swimming pools. You’ll see dining rooms. You’ll see sometimes movie theaters. You will see libraries. Often times there’s usually a big community meeting room. You’ll see a piano in there and that’s where they do a lot of activities. Sometimes you see a separate activity room. You’ll often see some type of a chapel for religious services and they usually combine those or they may have separate ones.
Again, that really depends on your area and maybe what the main spiritual practice is in that area. There’s lots of different things that you’ll see. Think about it as almost like a resort feel because that’s what these communities are trying to do. They’re very self contained. You often will find beauty parlors. Maybe find a little store front for conveniences, things like that. The grounds are usually very beautiful. There’s places to sit outside. There’s usually quite a few places inside as well. You’ll see little separate dining rooms sometimes that you can rent or just sign up for if you just want a private dinner with your family. Then they have little areas to sit et cetera that you can go to. An assisted living room, the room where the client will sleep is usually small. It’s not an apartment sized per se, but will contain a bed, a chest of drawers, a closet, a handicap accessible bathroom. A lot of times it will have a very small kitchenette with a few cabinets, a very small mini fridge.
Just really basic necessities. Sometimes a microwave, sometimes not. They usually do not have a stove because they do want to encourage their clients to come down and have meals inside the community. What do you look for? What are you looking for that I think is really one of the more important things beyond the aesthetics in an assisted living place and that is, even in independent living, what is the client to staff ration? That is the question you should be asking because if you are considering putting your parent in an assisted living and the staffing is short, everybody suffers. That includes you parent, your loved one. It also includes the staff because when the staff is short handed, the people who are there are trying to work faster to take care of everybody. I can tell you from experience that you do not rush older people. They are in no hurry. You can try as much as you want, but they’re going to move at their own pace. That’s just the reality of it.
You need to find out what that staff ratio is and also what is the staff ration on a weekend or on a holiday because often times it goes down. If you have a three day weekend, look into that. That’s a question you need to ask. Is there a full time nurse on 24 hours a day? Is it in RN? Is it an LPN? Talk to them. Walk around and talk to the clients who live there. Ask them how they like it. Ask them if they receive enough help. If they ring the call bell, do they have to wait a long time or does somebody come right away to help them? Are the staff nice? Do they treat them with respect? Do they talk down to them or do they talk and really communicate with them on a personal level? Can the assisted living place that you’re considering, if your parent has a cognitive impairment or is beginning of Alzheimer’s or has some type of dementia, can the staff handle them? You really, really need to find this out because this is where a lot of communication breaks down and issues happen.
Often times it’s because the staff are not well trained or they don’t know how to handle certain situations. They don’t know how to diffuse the situation and I have been in this quandary. This is personal experience because I had a father who had cognitive impairment and eventually went to dementia. What are they doing to encourage really good communication with that patient? Are they able to really handle them? Are there certain staff members that should not be handling those patients and you have to make sure that they’re not doing that. Also one thing you want to check out, when you’re taking a tour through a place, you want to find out are the patients or clients, are they in there rooms or are most of them, a majority of them, in the community room participating in activities? Is that what you’re seeing? You really need to look at that because it you’re seeing about a 50/50 where half of the patients or clients, I keep saying patients, but they’re really clients.
If half of the clients are in there rooms, why is that? Why are they in there? They should be down participating in activities or at least sitting in the community room. That to me is a big red flag because that means they haven’t gotten the care they need that day or they’re not being encouraged to participate. Being a nurse, these are some of the nursing things that I really look out for. What does the place smell like? Are you walking in smelling urine? Foul odors? Are the rooms clean? Is the place clean? You may have to look at reviews on the place and really find out. Are they up to par with everything? Have they been dinged for something and has that been taken care of. You also want to consider what is the security in the place. If you do have a parent with a cognitive impairment, you want to make sure they’re not going to be able to just leave the premises and be found wondering around on the local roadways outside. Yes, this does happen once in a while. I don’t think it happens that often, but it does happen.
You want to make sure that they’re not able to get out of a locked door or if they are going to go outside, are they in an enclosed area such as a courtyard et cetera. Some other things that you want to check out is there a security deposit that you’re going to have to put down? Most likely there will be. Is there room for negotiation. I say this because we did this in one of these assisted livings where we put my mother-in-law. We actually were able to negotiate on the security deposit. They wanted a two month security deposit and we actually were able to negotiate a one month security deposit which was very helpful to my mother-in-law because that money was important. It’s not like she has a lot of money. Don’t think that negotiation is out of the question. You also want to find out what are the costs per month based on the level of care that your loved on will receive because in assisted living there are different levels of care. Some of them have just levels one, two and three.
Others go up to four. Some of them base their levels of care on how much medication they receive during the day so maybe patient A only takes four pills once a day but patient B might have eight to 10 pills three times a day. You’re probably going to pay a different fee. Those are things that you have to consider. You want to also think about as the care moves along and more care becomes necessary, how is that going to reflect in the cost increase. You want to be able to really sit down and financially play this out. What are some of the ways that you can think about planning out these things financially. If your parent owns a home, you can sell that home. Then you can take the proceeds from that home and you can use them to pay for the assisted living. You’re obviously going to have consider again the area you live in, how much money you would be able to get for that home, and then you want to be able to spread that out over so many years and I would say a minimum of five years.
You want to look at a minimum of five years of financial planning for assisted living and nursing care home. Those are things that you really do want to consider. You might want to sit down and speak to a health care attorney about that or a financial advisor, your accountant. Maybe they can run a spreadsheet for you so you can see hey, this is how much money mom or dad has. How long is this going to last? What are the increases going to be that we’re looking at? Now, if your parent or loved one has a long term care insurance policy, you definitely want to check into that to see if it covers assisted living or is it strictly nursing home? I know that the insurance care policy that my parents had only covered nursing home and that’s because they opened it way back in 1982 or 81 when these policies just came out.
I know that the policies now cover more and I’m sure there are variations of them so you may want to check into that because you want to make sure that if they do have a long term care insurance policy, can you use it immediately or do they have to wait till a certain amount of time? Some of them have a three or six month waiting period before they even kick in. Those are some of the things you have to consider. I know this is a lot of information, but this is from my own past experience from dealing with all of these things. There’s even more to this, but I want to give you a heads up so that you can start thinking about these things now so you’re not confronted with them and then have to make a decision in a very short amount of time. The more time you give yourself to look into this, the better prepared you’re going to be. You want to at least go to three different places and check them out because they really vary in what they offer.
Some of the more expensive places, I mean they offer everything. It truly is like resort living. Some of the smaller assisted livings that maybe only take eight or 16 or 20 clients in, they may have a very small place and they don’t offer a lot, but maybe that will work better for your parent. Maybe they want something that’s not so busy and large and confusing to them. Check a couple things out. Check some smaller ones out versus the really large ones and then maybe the ones in between. You also want to look into facilities that do move from independent living to assisted living and then have a nursing care facility all in the same area because if you have to move again, if you have to move that client suddenly and you’re out of state or you live a couple of hours away from mom and dad, what is that going to entail for you? All of those things really need to be taken into consideration.
We are going to have a podcast with a healthcare attorney and I think I said that in the first podcast and gonna talk. In that podcast, we will address more about the legal pieces of all of this because looking at medical powers of attorney, financial powers of attorney, advanced directives, what are your rights as a client or patient in a community like this? What do you do if you do have an issue? Where do you go? Who do you talk to? How do you get things resolved? All of those things. I thank you for tuning in today. If this information has been helpful to you, I’m really glad. We’re on iTunes and Stitcher. Please, please share this. This information is vitally important and as baby boomers continue to age and that population continues to grow, I think we’re going to see more and more places like this and we want to make sure that the care that our parents receive is the best, but also are there other alternatives beyond these communities. I think we need to address that in another podcast as well.
What’s outside of these communities that we could look into? In anyone has any suggestions or would like me to talk more about this topic in another way, please let me know. Thank you once again.
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