Category: Diary of a Seasoned Life Articles

The story of a life in transition that, hopefully, will help someone else learn and understand how to deal with life changes that are and are not planned.

Diary of a Seasoned Life – The Transition from Independent Living to Dependent

Making the decision to move yourself or a loved one into some type of dependent care or assisted living facility is one of the most difficult things to do. You want to do what is best for all concerned.  Often this decision does lie on the shoulders of a spouse or child, so it can be difficult to find the best way to help the individual warm up to the idea and understand the reasons why they need to be there.  Mother understood the reasons and agreed, but I knew that it was the last place she wanted to be.  Even though she had owned and operated a nursing home for decades, she had told me for years that she never wanted to live in one.  She also did not ever want to be a burden to her children or grandchildren.  She accepted the idea as a temporary place for her to heal and get better.  She was also comforted in the fact that her granddaughter and I would be able to come and see her every day. This type of arrangement might not be possible for other families, but I cannot stress enough the importance, not only to your loved one’s well-being and happiness, but also to keep an eye on the level of care they are receiving.

In the previous post, I mentioned the caregiver to patient ratios.  It is not an exaggeration that in almost any type of dependent care facility, the ratios are terrible.  The best I have seen it anywhere is 1 caregiver for every 7-8 patients.  If even just 50% are not able to do most of their personal care without the aid of another person, it is an overwhelming task.  These caregivers often work long shifts with little pay.  The facilities will tell you that the turnover for these employees is high.  They will also tell you that they know they are “stretched to the limits, but they keep on staff the ratio that the health department suggests as the minimum number and that is all they can afford.”

This comment leads me to discuss the costs.  Different places will charge different rates, but none of them are lower than independent living.  It is probably average in the State of Texas for the rate to be $140/day + extras. These extras include medications, physical therapy, doctor’s visits, lab tests and incontinence supplies.  For those seasoned life people who are 65 and older that qualify for Medicare, you will be covered as a patient in a skilled nursing facility for up to 100 days.  Medicare paid a great portion of Mother’s expenses, but not all.  This is where supplemental insurance is crucial.  This second insurance will pick up most of the other costs up to the limits within your policy.  Mother had also planned ahead and purchased hospital income insurance and prescription insurance.  What is difficult is what do you do when you or your loved one needs to be in a place such as this for more than 100 days or you do not qualify for Medicare?  There are several options, but you need to plan ahead for these or it can break the bank and fast.

Long Term Care insurance is the number one thing I would recommend everyone obtain.  It is expensive, but is way less of a cost to you if you ever find yourself in a similar situation. Without insurance, self pay is an option, but be prepared for expenses of $7000-$8000/mo.  You can get a caregiver service to come to your home or assisted living facility, but be prepared to shell out $30-40/hr.  If you are a veteran or wife of a veteran, you should be able to get some assistance in paying for long term care, but it can take some time to apply and the amount they pay may be based on your income.  In the State of Texas, lower income people can apply for Medicaid.  Elder care attorneys can assist for applying for assistance with these agencies; however, they in themselves charge hefty fees.  I was told $10,000 for one I talked to on Mom’s behalf.  I chose not to hire one.  These elder care attorneys will also tell you about “strategies” to re-allocate your money and income in order to help an individual qualify that would not ordinarily qualify.  These strategies made me skeptical, but I imagine they are legal.

I also learned more about hospice care services in this stage, as well.  I think most people, like me, thought that hospice care is for people who are on their death bed.  I learned that they offer services to individuals and families who just need help with an ill loved one.  It is not full time assistance, but they can help a few times a week with certain things.

In the next entry, I will share more about what happened in this skilled nursing facility ……

Diary of a Seasoned Life – Evaluating Skilled Nursing Facilities

After touring the facilities on my list, I needed to make a decision on the place I thought would be best for my mom.  Mom was still very early in her stroke recovery and it was a big question mark as to how much she would improve. I tried to consider what I believed she wanted, since she was really unable to communicate to me in this stage. I was needing to choose between what seemed to be two very different options.

The first place seemed to be a homey environment with a small wing dedicated to stroke patients.  There were only 8 rooms in this wing with 2-3 caregivers and one nurse.  There were 3 beds in each room.  They did have a therapy room, but it was about the size of a small bedroom and had a couple of pieces of gym equipment inside.  No one was in therapy at the time and no therapists on the premises to meet.  The facility was older and it had not been updated in years. The vast majority of the residents in the entire facility were mentally-impaired or severely disabled and the range in age was from adolescents to seasoned life people. I walked away from this place thinking that Mom would probably get good care there and be comfortable, but unsure how much she would be able to improve and recover from her stroke.

The second place was a large, updated facility with three wings.  There was a nice porch out front where you could find residents sitting and enjoying the outdoors. You walked into a big reception area and then a large living room where the residents and family can sit and visit, watch TV, play games, eat, or participate in social activities.  The nurses station was the central hub between the three wings.  Two were for long-term care residents and one for short-term rehabilitation residents.  There were probably about 120 beds in this facility. (Two beds in a room.)  Each wing had one nurse and 2-3 caregivers.  If you do the math, you will figure out that that was about 1 caregiver responsible for 15-20 residents.*  They had a very nice therapy room and a large staff of therapists that provided physical, occupational, and speech therapy. The rehabilitation aspect of this facility was impressive. I did talk to a nice gentleman who said he had suffered a stroke and was brought in there in almost the same condition my mother was in at that time.  He said he had been there a couple of months and he was walking, talking, and showed very little signs of his stroke trauma. He was hoping to be released in a few weeks, he said.

I knew that, in all likelihood, this last place was a good option for Mom’s recovery due to the rehab capabilities, but I was very concerned about the quality of care she would receive.  I saw residents sitting in the wheelchairs in the common areas, unattended, and sleeping or just existing. I heard the call buttons buzzing at the nurse’s station constantly and seeming to go unanswered for long periods of time.  After discussing all these findings with my family, we collectively agreed that we thought we should send Mom to a place that would have the best therapeutic services.  We wanted her to recover as much as she could.  We had hoped, like the gentleman I met, she would only have to be there for a few months.  I thought that if I was able to be present everyday and keep an eye on her, I could make sure she was getting the proper care.

I told the social worker at the hospital that we had selected option two, which I will call “SOS Skilled Nursing Rehab”. (This is not the real name.) The social worker at the hospital then contacted the facility and sent them the medical records and documents needed to get her approved.  Within a day, she was approved and we scheduled the transfer from Dallas/Ft. Worth to Austin via private ambulance.  Due to mother’s condition, feeding tube, IV’s, and paralysis, this was the only option.  (FYI, Medicare does not pay for private ambulance transfers.  Get bids.  I got quotes from $1800 to $3500.)  Exactly one week from her stroke, she was on her way to the skilled nursing rehabilitation facility in Austin.  I was there waiting for her arrival…..

*If you would like more information on the staffing ratios, check out this website: http://www.texasbabyboomers.com/texas-nursing-home-staffing-ratios/ .

Diary of A Seasoned Life – Checklist for Evaluating a Nursing or Assisted Living Facility

It is important for readers to know that both my grandmother and my mom owned and operated a private nursing home in East Texas.  I grew up with an understanding of these places and saw how a well run facility functions and looks. I learned what inspectors want and do not want to see. The industry has changed substantially in recent decades.  Most of the changes have been through increased regulations and the fact that very few facilities are private-owned anymore.  They are part of a corporation, hospital, or chain. They are profit-driven. It would not be a stretch to say that a large number only do the minimum amount needed to pass state standards in order to keep getting Medicare or Medicaid. There a few good ones, but even the best have their issues.

Below is a checklist you can print out and take with you, if you ever find yourself in the position of making a decision to move yourself or a loved one into a skilled nursing facility, retirement home, assisted living facility, memory care facility, acute rehabilitation hospital, or a nursing home.

Checklist for Evaluating a Nursing Facility or Assisted Living Facility

There are three key things I would suggest you keenly observe during your tour:

  1.  Are there plenty of common areas for socializing and activities? Are they occupied with patients, care-givers or hospitality personnel? What are they doing? Do the patients look like they are having a good time? I would even find a person who lives there that might be willing to talk to you. Ask them if they like living there. Listen to what they have to say. If they have a visiting family member present, ask them about their experience.
  2. As you are walking down the halls, observe the cleanliness of the rooms, floors, and common areas. What does it smell like? It is normal to run across bad odors sometimes, but not everywhere or all the time. Cleanliness and avoiding “a hospital smell” was always important to my mom in her nursing home. She made sure the floors were spotless and shined.
  3. As you go by the nurse’s station, listen for whether the button calls from patients are being answered timely. If you hear constant buzzing that is not being answered within a couple of minutes, that is a sign that there is a slow response to needs. Most facilities have lights above the doorways into the patient rooms.  If these lights are lit, it means they have pushed the call button and are waiting on someone to respond. Observe how long they stay lit.

There a many other things of which you should inquire and observe, but if you see problems in any of these three things, I would give it great consideration in your decision. Other things would be:

  1. Menu/Food – Is it nutritious and tasty? Do the patient’s get a choice?
  2. How many caregivers per patient?
  3. Observe the rehabilitation area. What kind of equipment do they have? How many therapists? How much time per day do they spend with patients?
  4. What are the residents doing?  Are they active and participating or just sitting in their chairs sleeping or unattended?

The next post will go over what happens after you pick a place and guidelines for getting the best possible care for yourself or loved one.

Diary of a Seasoned Life – The Importance of Legal Documents

One thing of which my parents did do in planning ahead was to prepare wills and a power of attorney.  Twenty years ago, my brother, sister, and I had been informed by Mom and Dad their wishes and they explained the reasons for their decisions. Their hope was to avoid misunderstandings down the road. I was aware that my parents designated me as the executor and POA (power of attorney).  This made the process and decision-making less complicated.  A POA can give one the ability to make medical decisions and, basically, do everything on behalf of the disabled or ill family member.

Due to the fact that I was the one who had the ability to sign for Mom and had a little more flexibility in taking time from work to deal with her affairs, the decision was made to find her a place near me in Austin for the time being. Now to find one…..

What is the difference between acute rehabilitation and skilled nursing rehabilitation?  How do you locate and select these places?  These were the pressing questions.  The good news is that hospitals provide social workers to help explain the process, answer questions, provide information and resources to help make decisions, and aid in making the arrangements.  I will do my best to answer these questions in layman’s terms.  An acute rehab facility is for patients who have suffered some type of disability due to illness or accident and they have the ability to withstand several hours per day of physical and occupational therapy, as well as, speech therapy, if needed.  These places want the patient to be somewhat able to do some things on their own and have goals for recovery.  A skilled nursing rehab facility is basically a short term nursing home that offers physical, occupational, and speech therapy to patients who require a substantial amount of care in order to do basic activities. Mom needed a skilled nursing facility because she needed assistance to eat, dress, bathe, and move.  She was bed-ridden and had been given a feeding tube in order to get nourishment.

With the help of my sister, I reviewed skilled nursing facilities in my area and tried to narrow them down based on the type of rehabilitation services they provided.  Not all facilities cater to stroke patients.  Once I had a list of places that specialized in stroke recovery, I used the website from Medicare, https://www.medicare.gov/nursinghomecompare/search.html? , to investigate the ratings of these places and any complaints or issues from their inspections. The social workers discouraged giving consideration to reviews on the internet for these places, because, “One person may have had issues that they wrote about when many more had a good experience and didn’t write about it on these sites.”  My advice is read it all and consider it all.  We selected about three places that had decent scores and comments that were nearby my business to go in-person to check out.

It is very important to visit these places in-person first.  Of course, they want you to schedule an appointment in advance, but I suggest going in when they are not expecting you.  You are most likely going to see an “unproduced” version of the way the place looks and what goes on there regularly.

The next post will give you a checklist of things to evaluate when visiting a long term care or short term care facility.

Diary of A Seasoned Life – Life Events and Transitions

“The only thing that is constant is change.” is a saying from Heraclitus of which I have heard all my life.  Change is uncomfortable for many.  We become complacent and comfortable or set in our routine. It is easier. Change is hard and so many of us avoid it by hiding our heads in the sand. Many of us also try to predict or plan life that often is unpredictable.

When I turned 55, I started my “five year plan”.  I owned a business that was 15 years old and began putting together an exit strategy. I knew my widowed mother would be turning eighty in a few years and I worried about being so far away from her.  What if something happened? A year later, I signed a 5 year agreement with a mergers and acquisitions firm to begin marketing my business for sale.

 

Ten months into the process, I received a late night call that my mother had suffered a stroke and was taken by ambulance to a hospital. My mother, who was living independently and was a strong, vibrant woman had a stroke?  How could that be? I was unaware of heart disease in her history or family. She had two sisters in their mid-nineties!

As the next few days past, I learned she had been taking high blood pressure medicine for a while.  She had been recently treated for hypertension.  She never told me about that stuff. As most mothers would say, “I didn’t want you to worry.”

The result of the stroke was full right side paralysis, aphasia, and swallowing issues. After 4 days in the hospital, I was told she needs to be moved to a skilled nursing rehabilitation facility.  They stressed that it was NOT acute rehabilitation, but must be a skilled nursing.  You have 3 or so days to find one and make arrangements to transfer her.

to be continued ……