Don’t complicate things by giving yourself unreasonable deadlines on getting the entire house cleared out. Do one or two areas each week. Get friends and family to help you.
Below is a printable list of suggestions on the process of downsizing. I hope you find it helpful.
How to Start the Process of Downsizing
If you would like professional help, please contact me at Seasoned Life Transitions. The email is seasonedlifetransitions@gmail.com . The toll free number is 866-653-9669.
This past weekend, my sister and I sorted through 2.5 closets and a few cabinets of Mom’s. We had a pile of shopping bags that was 8 feet wide and 3 feet tall. Mom oohed and aahed over almost every item, but she made the hard choice to let go of 90% of those purchases. After about 3 hours of this sorting process, it began to hit her how out of control her buying had been. She had never pulled it all out and looked at the quantity of items. The amount of money that she had spent was also starting to hit her. $20 here and $50 there. It adds up to a great deal of money. Money that she can use now for her expensive long term care.
My sister and I spent two solid days pulling out things from these 3 closets, two china cabinets, shelving in laundry room, and the shop. I filled up the back of the pickup truck twice with trash. All of these purchases, many of which are still brand new with the price tags still attached, will be sold in a Seasoned Life Event Sale in June. They filled up the counter spaces in the shop. It truly looks like a retail store! The hard thing to grasp is that all these items were new purchases. We haven’t even started on her storeroom that contains bins after bins of the Christmas decorations she used year after year! These will be the things of which she has the most emotional attachment. She has to reduce “the keep” holiday items to 5 bins.
The next hard thing to grasp is that these are just holiday items. We have not even started on household items, such as china, glassware, decorative pieces, and clothing. I have so far spent over 40 hours sorting and cleaning out spaces in her home. Most of this has been the most cluttered areas, such as the closets and shop. I am guessing that it will take over 100 more hours to finish clearing out the house completely. Some of that time will require professional movers and other family members to pitch in. My body is aching and bruised, but I will keep going. It has to be done.
Hopefully, all of this information will set off a light bulb or warning light to other seasoned life people who need to downsize. Do not put this type of burden on your loved ones! I do this for a living. They do not. The task is too overwhelming and time consuming for the average person. They will tend to take the easier downsizing path, which includes, hauling it off to the junkyard, donating it, or selling it off for cheap in a garage or estate sale. Future blogs will take you through the Seasoned Life Transitions process and show you what we do and the results.
My career was split into two phases. The first phase was as a salesperson for Plustar, Inc. The second phase was the owner of Tape Solutions, Inc. Running my own business was definitely challenging at times, but far more rewarding.
I could not have been successful in either phase without the support of customers, vendors, employees, and co-workers. There are hundreds of people who were loyal to me for many years. I have to thank a few.
Byron Barlow and George Marvin, the founders of Plustar; June Finlay and David Mahon, co-workers at Plustar; multiple customers, including Bill Birch, Eric Hoover, Casey Gonzales, Darryle Woods, Anthony Flores, Bruce Mansfield, Ralph Rodriguez, Angie Aragon, Pete Moreno, Les Miller, David Hall, and so many more; former employees, Jeff Heath, Rosalinda Talkmitt, Elizabeth L. Melvin, Walter Colson, and Kevin West; and vendors, Shurtape; Packsys; ATP; Electro Tape; Decker Tape; Cantech; and many more were all key components to my success. Thank you all from the bottom of my heart.
I look forward to the new venture, Seasoned Life Transitions. I hope to help many people and believe this is now my life’s purpose.
When a few weeks were left prior to the 100 day mark of Mother’s skilled nursing stay, a care meeting was called to discuss her future plans. It was during this meeting that I learned the real truth about the financial end of long term care.
In a previous blog, I discussed average costs of long term care. (average in the State of Texas for the rate to be $140/day + extras) I was told that for her to stay in this facility, she would go on self-pay after 100 days at a rate of $165/day + extras. For a 30 day month, that comes to $4950 + extras. I was a bit relieved to hear that number, because I had seen the statements from the insurance company and the figures they were charged were immensely higher. Below is the actual amounts from the statements:
May 2016 – Medicare was billed $26,706.15 by the skilled nursing facility. That is the amount they paid, less a deductible from Mom’s secondary insurance (about $4400). During the month of May, Medicare was also charged for a doctor’s visit from three different doctors for $280-$336/ea. Medicare paid a very reduced amount in the range of $160 to each doctor. Medicare was also charge for 9 visits by a nurse practitioner for $270/ea, of which they would actually pay about $116/ea.
June 2016 – Medicare was billed $24,998.29 by the facility and they paid that less a smaller deductible from the secondary insurance. The doctor charged for 2 visits this month, 11 visits by the nurse practitioner, and 4 other services/doctors billed Medicare for the same numbers of the previous month per visit.
July 1-19 – Medicare was billed $15,606.06 by the facility. There were no doctors visits, but 7 charges by the nurse practitioner. Two additional charges by other services.
When I asked the administrator of the skilled nursing facility why the rates were over $800/day previously, she was stunned that I knew this information. She replied, “We charge the maximum amount that Medicare will pay.” You are probably asking, “What difference in care do you get for $165/day versus $800?” If you haven’t read my blogs from day 3 and 4, I will tell in brief – not much!
I have probably looked at those reports 4-5 times in the last few months and I get just as angry every time! Mom was not getting proper care in numerous ways during that time and had to eventually be hospitalized to recover from her ailments. She supposedly was visited and treated by a doctor and nurse practitioner several times each month and she was not getting better. I did meet the doctor one day when Mother was so ill and asked her if she had actually examined Mother. She told me, “No.” She had just observed her progress during a therapy session. I asked her to please physically examine Mother and she said she would. She told me to ask the nurse’s desk a few days later for doctor’s notes on her findings. I did and the nurse told me that there were no doctor’s notes of an exam – just orders that Mother needed to be changed every 4 hours.
I also tried to call the nurse practitioner from the phone number listed on the insurance documents. It was not a working number. I tried googling her name and could not find any office for her. I asked the nurses about this nurse practitioner and was told she comes in really early (before her office hours) to visit patients. Often before 7 a.m. I found that odd, since there was no office that I could find for her. I asked them for her phone number and was told that they don’t give out that information, but they would give her a message to call me. I never once received a phone call from this woman who was charging Medicare and insurance for 10 visits a month!
I am not suggesting that all skilled nursing facilities are bad. Many are not though and that is the truth of the matter. If you plan on putting a loved one into a place like this (or yourself), it is crucial that you have good insurance and a trusted family member who can look out for your best interest. Ask the hard questions and be persistent. There are agencies that can help, if you have problems. DADS with the State of Texas is one. There are also ombudsmen with the city in which your facility is located that can help mediate.
For many of us, there exists an emotional attachment to many of these things. We have a fondness for the memories that are associated with the item or how it was acquired. Many of our parents and grandparents lived during the Depression or other times of hardship. They began accumulating things because they hated going without or being poor. Many of these people look at having things as comforting and sign of status and accomplishment.
There are some extremes of people who get an adrenaline rush from the thrill of buying something and cannot control the urge. Many of them also have difficulty throwing things away. This behavior can be extremely problematic and lead to hoarding. In those extreme cases, a trained psychologist would be necessary to help these people understand they have a problem and get the counselling necessary to get control over the situation.
The younger generations have not typically gotten as attached to things as us “seasoned life” people . The millennials and Generation X group have a minimalist attitude. They desire freedom and seek the thrills in the here and now. Being tied down by stuff is not desirable. If it doesn’t fit in a backpack or compact car, it isn’t their cup of tea. They enjoy a more spontaneous lifestyle. If the seasoned life generations think that our kids and grandchildren want all of our stuff, we are grossly mistaken.
Don’t assume that those cherished items you have collected all these years will be loved and appreciated by other family members. If you think it is overwhelming to sort through and make decisions about your things, try to imagine what it must be like for someone else to be put in the situation to do it for you. Divorce, illness, accidents, or death can occur to anyone anytime. These events can shift the burden of responsibility to a loved one.
If you have been reading my series of blogs, you know that this is my situation. It actually goes back even before Mother’s stroke. My father had varied interests and hobbies, which resulted in a large collection of items. When he became ill, Mom and I both tried to convince him he should take control of selling off his collection while he still could. No one knew the value and history as well as he – nor had the connections. He refused to let them go. When he passed away, my mom was now left in the position to take care of it. It took a while, but with the help of my brother and some of his knowledgeable friends, she was able to sell almost all of his collection.
You would think that from this experience, my mom would be more agreeable in downsizing some of her things. Not the case! I tried for years to get her to cut back on continuing to acquire more of the things for which she had a weakness. It didn’t happen. She would laugh it off and say that I can get rid of them after she is gone. Every closet, cabinet, storage room, and nook in her home was crammed with this collection.
Now that she has made the decision to move into my new home, the amount of stuff she can bring will be limited. Due to her physical condition, the work of sorting, packing, moving, selling, and discarding her things will be left to me and my siblings. Of course, Mom will be involved in much of the process, but I know it will not be easy for her to decide. The downsizing process begins this weekend.
This interested buyer came in for a visit in August and we came to an agreement on price in September. The due diligence process was excruciatingly slow. It is during this process that many deals fall apart. Much of the delay was due to the buyer’s loan process. Over three months went by before an actual closing date was set.
During this time, I had many discussions with Mother about our options after the business was sold. I knew she would be happier nearer to her friends and I, too, had friends in the Dallas area. I had lived there for 17 years prior to moving to Austin. Mother was aware that she was not likely to ever be able to live on her own again. She was quite happy to move to Dallas. She would just say, “I want to go wherever you are going.” When I asked her if she would rather find another assisted living facility near where I bought a home or live in the new home with me with the assistance of in-home caregivers. She said, “I need the think about it.”
While all this was going on, I started my business plan for the new company. There was much research to do and I was having great difficulty deciding on a name. I also wanted credentials, so I enrolled in an on-line course to become a certified antique appraiser. I was doing my best to lay the ground work for the next few months.
About a month before the closing on the sale of my business, Mother told me that she had made a decision. She wanted to try living at home. She wanted to have more freedom and feel more independent in her daily activities. She wanted to be proactive with her therapy in hopes that she could still improve her speech and movement. She was tired of doing the same thing every day. She was bored in the assisted living facility and needed more variety. She missed socializing with her friends and hoped she could resume playing in some of her bridge clubs. It was up to me to make it happen.
The business closing went through in the middle of February. I had agreed to a 3 month consulting agreement to help with the transition of the business ownership. That gave me a few months to finish my plan and start building a network of professionals to help me in the overwhelming process of downsizing and consolidating two homes, listing the homes for sale and coordinating the timing of all of it. It should be a snap, right? After all, that is a big part of what I am going to be asking people to hire me to do.
The next blog will start explaining the process of downsizing….
I found it especially helpful to attend a family support group the first couple of months that Mother was in assisted living. The responsibility and guilt that family members go through can be overwhelming. It was interesting to hear about everyone’s story and experience. Although everyone was different, much of the issues were the same: a spouse that feels so guilty about leaving their loved one behind, the stress of being yelled and cussed at for putting them in this place, and the financial responsibility of paying for two different residences.
Mother understood where she was and why she was there. She had to warm up to participating in activities. I encouraged the social directors and caregivers to make sure she was involved in the various activities. It was important that she develop a routine of getting out of bed every morning, getting dressed with full makeup and jewelry, eating meals in the dining room, and socializing. Attempting to get her life as normal as possible, I felt, was of great importance in Mom’s recovery. One small thing that meant a great deal to her was to get her hair done in the salon every week.
She also began another 6 weeks of therapy. It was a goal to keep the momentum of improvement she had started at the acute care rehab.
Scooting across a bed or bench, standing up and maintaining her balance for 10 minutes, keeping her paralyzed right arm and hand flexible, working her brain in order to improve her speech, and improving her ability to read and write were important in her recovery. After that round of therapy, she had shown great improvement.
As the holidays approached, decisions needed to made in regards to how we could celebrate them with Mother. We requested and were approved to get a couple more weeks of therapy to train myself and one of Mother’s granddaughters on transfers. We wanted to be able to take Mom out and that meant learning how to move her from wheelchair to car and back. We also had to learn how to get her in and out of bed and in and out of the bathroom.
After about three weeks of twice-a-week training, I took Mom out to lunch in a restaurant. She was so excited and was waiting at the door when I arrived! We had a nice afternoon of shopping and lunch. The next big event was to bring her home for an overnight stay. We did that on Thanksgiving night. I will not say that it was easy. There were definite challenges and it is a lot of work. I took me two hours to get her up, showered, dressed, and hair done. Due to all this, the family decided to hire an in-home caregiver at Christmas. (In a later blog, I will discuss in-home caregivers.)
As the next few months go by, Mother’s verbal improvements were great. She was happier and we were able to reduce her medications in half. This was very important to Mom. She was put on an anti-depressant medication within a couple of weeks of admission in the skilled nursing facility. She complained that it was making her “foggy” and she objected to taking it from the very beginning. I refused it at first, but the nurses and therapists insisted that it was necessary. The ability for Mom to get out and do normal things also helped her improve. Her verbal accuracy was over 80% at the 8th month mark.
The cons of the living situation for Mom was that she was getting extremely bored with the mundane and repetitive routine day after day. She would often cry and express her desire to spend more time away with me. She missed her friends and her social life. When her physical therapy ended, her exercise was reduced to almost nothing. She began to lose some of her strength. Also, once Mother was up and dressed, she could move about on her own with little assistance within the facility. Due to this fact, the caregivers would mostly ignore her much of the day. More dependent residents got their attention. If Mother didn’t want to wear her brace or put her armrest on her chair, which was important to maintain her flexibility, the caregivers didn’t insist. The result was a slight regress in her condition.
All of this help lead me to the conclusion that talking to Mother about living at home with me, with the assistance of in-home caregivers, might be in her best interest. Stay tuned on her reaction and what happened next ……
As I tried to get her dressed, she began questioning me about where she was going. She had apparently forgotten the details I had previously shared with her about the new place. She had been happy at St. David’s. She was confused and thought I was taking her back to the old skilled nursing facility. She got very upset and it took much assuring to calm her down.
The ambulance attendant arrived a little early with a gurney. I questioned him as to the need of a stretcher, and he said that was what they were told was necessary. A wheelchair transfer would have been less expensive, but that was not what was requested. He wanted to know about the responsible party for payment. That subject had never come up before. I had expected that the transportation to the assisted living facility would be complimentary with the prices they charged. That was not the case! Mom did have to pay for that ambulance ride, which cost about $800.
Since we are talking about costs, it would be important to point out here that assisted living places do not provide beds and wheelchairs. The social workers made arrangements for Mom to have an adjustable bed and a wheelchair with accessories delivered to her new room. Medicare will pay for this type of equipment; however, they will only rent them. You cannot just buy one outright unless you pay for it yourself. An adjustable bed from a medical supply place typically rents for about $135/mo. and a wheelchair for about $75/mo. You will own them after about 12-18 months of rentals. If you do the math, the end cost of the adjustable bed costs $1620 – $2430 and the wheelchair costs $900 – $1350 . If you go online, one can buy a similar bed for $700-$1200 and the wheelchair for $120. This is why any government supported medical programs are in a crisis. In a later post, I will tell you more about the charges to Medicare from the skilled nursing facility. It will blow your mind!
Once Mom was on her way to the new place, I went ahead to meet her there. I had expected a whole team of people to greet her as she arrived. The reality was exactly the opposite. I had to chase down someone to help direct us and soon discovered that they were not ready for her. Her bed and wheelchair had not been delivered and no one had any idea of their status. The ambulance attendants placed Mom in a chair in the common area and left. An hour or so later, we were told that some of the items ordered for Mom had been back-ordered. The bed was on a truck and should be arriving that afternoon. They found a wheelchair she could use temporarily and suggested we go into the main dining hall and have lunch while we waited. Two hours later, her bed arrived.
In the next blog, I will tell you more about life in assisted living. The pros and the cons.
After three days in the hospital, Mother was becoming more like herself. She was feeling better and communicative. The doctors were pleased with her progress and felt she could be ready to be released in a couple of days. St. David’s had an acute care rehabilitation hospital that had an excellent reputation, so I began working with the social worker to try to get Mom approved as an inpatient.
The rehab facility will send a representative to do an evaluation, as well as, review the medical records and previous therapy notes (if any). I cannot stress enough how important it is that a family member attend these evaluations, especially if your loved one is a stroke victim. These reps that perform the evaluations could be a head nurse, therapist, or another social worker. They will put the prospective patient through a battery of tests and questions. You want to make sure they get accurate information.
Since it was not an option to me for Mom to go back to that skilled nursing rehabilitation facility, I felt I had to be an advocate for Mom. A week or so before she was hospitalized, I had tried to get her approved in a different acute care rehab facility that I had toured. I was not present when she was evaluated. I was just informed by the therapists at her current facility that she had not been approved. The acute rehab place based their decision solely on her records and her current condition (which at the time was not good). I was determined to not let that happen again. I requested to the social worker of the St. David’s rehab facility to please have the decision maker talk to me before they made a final decision. They honored my request. I used every bit of my sales ability to convince them that Mom was capable of doing the work and did have obtainable goals. She was approved!
She was transferred via ambulance two days later. Due to the MRSA, she was still under restrictions. All attendees, doctors, nurses, therapists, and visitors had to wear the protective garments. She had been approved to stay the maximum allowed time which was about 3 weeks. It was time to get to work and Mom said she was ready. She was much more like herself. It was obvious she was happy to be there. She liked her private room and she smiled and cracked jokes, which was such a relief to her family.
After a similar admission evaluation, the therapy began. She was on a strict schedule of when she was to be up and dressed, ate meals, had speech therapy, occupational therapy, physical therapy, and rest. She had at minimum of 3 hours of therapy per day. I tried to be there for as many of her therapy sessions as possible. This meant as much as 2 hours at the hospital some days, but I felt it was important. I could see her progress and what things the therapists were having Mom do. She settled in and was responding to the therapy. She was able to stand and with the help of an aid, she could transfer from bed to chair without the need of a lift or second person. She was communicating better and her accuracy was getting better than 50%. She was even able to walk down the halls with the aid of a therapist pushing her still paralyzed right leg forward and shifting her weight to step with her left leg. Towards the end of her stay, she had undergone another swallow test and was approved to go back to a normal diet, with the exception of thickened liquids.
During the three weeks that she was in rehab, I had to start searching for a more permanent living situation for Mom. I had been told about a gentleman who offered a service to people looking for long term care places. He worked much like a real estate agent. He would take you to tour facilities that were in the geographical area and assist in the decision process. It was free to the client. The long term care facility paid him a referral fee. I toured three different assisted living facilities and heard about their services and fees. Mom had exhausted her threshold with Medicare for long term care, so she was going to be faced with a self pay situation.
The places I toured varied in cost. One place, that had many less amenities, charged about $3500/mo. + prescriptions and incontinence fees. A second place charged about $6000/mo. + prescriptions. These were not private rooms and neither one offered any type of rehab services. The third place was new and was a “memory-care” assisted living facility. It was very impressive and boasted a ratio of 1 caregiver for every 3-5 residents. They had on staff nurses and activity personnel. While I was there, a dance troupe was performing in the main dining room. The residents seemed to be enjoying themselves. They also had a therapy room and therapy services. There were no private rooms available. I was told there was a long waiting list to get one. A semi-private room cost $235/day + incontinence fees of $450/mo. Prescriptions and doctor visits would be filed with insurance. You could also sign up for in-house hair salon services, which would be extra. Transportation to doctor’s offices or outings would be charged by the mile. If you do the math, this added up to over $7500/mo. To top all of that, each place required a reservation fee of anywhere from $2000 to $4000 (non-refundable unless the patient was not approved).
I felt Mom would get the best care at the third place and enjoy the atmosphere and activity. It was important to get her back into socializing. She had gotten used to isolating herself in her room or in bed for hours every day. I signed the documents and paid her reservation fee in hopes that she would get approved. There were some obstacles to overcome. Assisted living is different that a skilled nursing facility. Even though they have caregivers and nurses, they only are allowed to do certain things. Assisted living facilities have different regulations and less restrictions than skilled nursing facilities. Mom had to be completely off the feeding tube and eating on her own. She had to be able to transfer without the aid of a lift. She had to be retested for MRSA to ensure it was no longer active. Since it was a “memory care” facility (which means they cater to residents who suffer from alzheimer’s and dementia), she had to get approved due to her aphasia. Since aphasia often leads to memory issues, it was likely to get approved.
The social worker and head nurse from the memory care assisted living facility worked with St. David’s Rehab in order to make sure Mother was capable of meeting the criteria. A few days before her discharge from the acute rehab, Mom was approved. The next post will tell the story of assisted living ………
One of things I have learned to trust is my instincts. Customers have told me hundreds of times over the years that I must be psychic. I don’t believe that it is quite that powerful, but I do sense when patterns are disrupted. I also pay attention to nuances and small details. I never doubted that Mother’s illness was serious. The doctor’s at St. David’s confirmed that she needed to be hospitalized.
Once she was admitted and receiving treatment, I went back to SOS Skilled Nursing Facility (again, a fictitious name) and retrieved all of mother’s belongings. I told them she would not be coming back. I had no idea how long she would be in the hospital, but I planned to use that time to get her accepted into an acute care rehabilitation facility.
When I returned the hospital the next day, I found a sign on the door to Mother’s room stating that the area required face masks, gloves, and protective gown before entering. I was advised that Mother had tested positive for MRSA.* They explained that it was customary for this test to be ordered after someone was admitted from another hospital or skilled nursing facility. It is taken very seriously in hospitals due to the fact that it can spread so easily.
The doctor also said that they were ordering another swallow test. They suspected that the fluid in Mother’s lungs could have come from her aspirating her food and drink (it goes down the wrong path). They also added that she had all kinds of issues that needed to be cleared up that included a third bladder infection, continued hemorrhoids, congestion that had built up in her mouth and throat, bed sores, and cracked skin on her legs and feet.
After a few days, Mother started feeling better; however, the results of her swallow test were not great. She did show a tendency to pocket food on the side of her mouth that suffered from paralysis. She was only correctly swallowing fluids sometimes. This result caused them to come to the conclusion that her pneumonia most likely was brought on by her aspirating her fluids. They ordered her to go back on a modified food plan with only thickened liquids to drink.
I was happy to know that we had answers and that Mom was getting better, but I was furious at SOS Skilled Nursing and blamed them for Mom’s condition. MRSA in itself is very serious and had to be reported. I wrote a letter to the administrator of this skilled nursing hospital and copied it to the liaison at their corporate office and the Texas Department of Aging and Disability (DADS). I listed out all the things that this facility did (or didn’t do) to contribute to my mother’s condition and requested that they do what is necessary to correct the problems before someone else suffers in the same way. I never received a reply from the administrator or their corporate office. I did; however, receive a phone call from a representative at DADS. They assured me that they would open an investigation.
I tell you all this because all these issues that happened occurred even though I was there almost every day. Can you imagine how bad it must be for those residents who do not have someone to look out for their best interest?
The next blog will spell out what happened in the next stage when Mom was ready to be released from the hospital…..
*http://www.mayoclinic.org/diseases-conditions/mrsa/basics/definition/con-20024479
