Feed: The Senior List - AggScore: 85.6

You have most likely just navigated some very important decisions regarding the care of your loved one. You now have several additional decisions to make about their new home and lifestyle changes. This following suggestions are designed to help you “organize” your thoughts and help you plan for the next steps.

Is there a home to sell? If your loved one owns a home, planning and preparation for selling the home must begin soon, especially if the funds from the sale of the home will be used to finance new living accommodations. The first professional you need to talk with is a Seniors Real Estate Specialist. These Realtor's have received specific training and education to address the needs of home buyers and sellers 50+. You can locate an agent by browsing The Senior List category of "Real Estate Services" in your city and state or visit the SRES website.

Is the home filled with years of personal and meaningful possessions? Does the task of packing, deciding what to keep and what to give away seem overwhelming? Most of us have a lot of stuff: furniture, kitchen accessories, clothes, hobbies, linens, and everything else that we accumulate throughout our life-time. There are a variety of services available to assist with organizing belongings and helping with the tedious task of deciding what to keep, what to pass on, what to donate, and what to simply throw away. Again, check the listings on The Senior List for local Senior Move Managers in your area, or visit the official National Association of Senior Move Managers site.

Is there a car or two? Most care communities have transportation available for the residents. If your loved still drives, they only need one car, if that. If you are concerned about driving abilities or safety, now is the perfect time to encourage your loved one to let go of the wheels. You may be able to find a non-profit in your area that will accept donated cars and your loved one will benefit from the tax credit.

Prior to move-in to any care community, they will be requesting copies of your loved one's advanced directives, power of attorney documents, and any other health directives. If these documents are already in place, now is a great time to review them with your loved one to ensure they are up to date and accurately reflect their wishes. If these documents are not in place, you must have them before move-in takes place. In fact, everyone, regardless of age, should have these documents. If you need assistance with these legal forms, I recommend you contact an elder law attorney. You can find these specialists on The Senior List or visit the National Academy of Elder Law Attorney's.

These are tough decisions and tasks for any individual to complete on their own. These resources will alleviate stress and anxiety for families and seniors alike during this difficult transition time.

Amie Clark, Co-Founder, The Senior List.com

You are traveling. Your mom is in an assisted living community. She isn't sleeping well or taking her medications. You have three sisters, who also lead busy lives. You are constantly playing phone tag between flights and meetings to find out the most recent update about her health and in turn, call each of your sisters to keep them up to date. Sound familiar?

Communication with care providers continues to be a full time job for many family members who are the primary contact for their loved one. As a family liaison myself, I am all too familiar with the time-sucker of phone tag, waiting on hold, and talking to several caregivers before I can get to the bottom of the issue for my clients. "Medications need refills, didn't eat lunch, won't take a shower, wants to go out for lunch, yelled at table mate, didn't sleep well, having a good day, needs new undershirts" were all separate phone calls I fielded during the course of a week for one client. Once I received the information from the care providers, I was then in charge of notifying the family and care team. I estimate that in one week, I spent at least an hour per issue between talking with the care providers, dealing with the issue, and reporting back to family members. So, you can imagine how thrilled I am to write about a company that will solve my communication woes.

Connect for Healthcare, in very simple terms, improves communication between care providers and families. How? Connect for Healthcare allows families to choose their preferred method of contact, email, text, or through a very well designed, easy to use, web portal. The founder, Neil Moore created the service after dealing with his own communication issues while his father resided in an assisted living facility.

"Connect for Healthcare is an inexpensive, easy-to-use, subscription-based web service that uses modern technologies - the Internet, e-mail and text messaging - to create and maintain a new and vital link between families and their loved ones in long-term care. It enables care providers to easily give regular, proactive, specific wellness updates to family members and loved ones no matter where they might be in the world. The family benefits by staying better informed and feeling more connected, their loved ones in long-term care benefit because the better informed and more engaged the family is, the better care they can receive, and the provider benefits by having a simple, one-step method of giving families what they really want."

What I like most about Connect for Healthcare is that each family member can be notified through their preferred method of communication, without any work from the primary family communicator. The family web portal allows families to not only establish their preferred contact method, but to designate what they would like to be notified about. Each client profile is tailored specifically to the client, family, and care provider.

For care providers, using Connect for Healthcare as a tool to communicate with families will save staff time, decrease communication errors, and in many cases, will simplify documentation and charting. Many long term care providers are offering Connect for Healthcare to the families they serve as an additional feature of their community. Families may also request Connect for Healthcare to be set up for their loved one, costs range anywhere from $15-$37 per month. To find out more about pricing or to view a tutorial of the program, visit www.connect4healthcare.com.

Amie Clark, Co-Founder, The Senior List

As it turns out, there are many differences, and as many similarities. These homes are single family residences that are licensed to provide care services for frail seniors and adults. In some cases, the homes do not have to be licensed at all. The number of residents per home ranges from 1-6, depending on the state licensing requirements. Care services at this level can vary, but typically fit a higher level of care than can be provided in assisted living communities, but don't require full 24 hour nursing care. The advantages of this level of care are consistent care givers, home-cooked food, high staff to resident staffing ratios, and a home-like environment. Typically the costs are less than other levels of care that provide the same services.


Lets explore the care home options in Oregon, Washington, and California.



California: Board and Care:
Must be licensed by the state and are inspected. There are a variety of sizes of homes in California and rooms can be shared or private. Homes can receive specialized waivers to provide care for those on hospice, Alzheimer's disease, and ventilators. Board and Care homes in California can be secure (locked) to provide care for residents who wander. The cost for a Board and Care home range from $1200-$6000 per month, depending on location in the state and amenities offered. Few Board and Care homes accept Medi-Cal.


Many thanks to contributors of this article:

We often field calls from clients and other professionals about the cost of care across the nation. I am thrilled to share an incredible tool I recently discovered to help answer those questions! The Cost of Care Map has been developed by Genworth Financial, a leading financial security company. The map provides an overlay of each state, citing yearly costs for Nursing Homes, Assisted Living, Adult Day Health Care, Home Health Aide, and Homemaker Services. Some states are even called out by metro region, allowing the user to compare metro areas within particular states. What struck me was the vast differences in costs not only across the states, but even within specific states themselves! The tool is very user friendly and serves as a cold dose of reality to the rising costs of care in all settings.

Amie Clark, Founder, TheSeniorList.com
www.theseniorlist.com

The Senior List was recently reviewed by a well known and highly respected PR professional. We think Marilynn hit the nail on the head when she wrote about our site... "what's more, those of us in the "sandwich" appreciate the convenience, efficiency, transparency, and objectivity of peer reviews, so to speak. And we love to share what we learn. I predict we are the ones who will build and use this site most effectively."

Thank you Marilynn and to all who have contributed to our growing site thus far. The seniors in our lives are better for it.

By: Marilynn Mobley,
Find her blog at: http://babyboomerinsights.typepad.com/my_weblog/

"Over the past year, my husband and I have each had the responsibility of finding services for our aging parents, who still live independently. My parents live in Waycross, Georgia, in the home my father built 57 years ago, while my mother-in-law lives in St. George Village, a lovely retirement community in Roswell, Georgia.

Now, I consider myself pretty savvy when it comes to research. I not only know how to find things online, I'm quite familiar with the Yellow Pages and I even know how to use a card catalog. So you'd think it wouldn't be too hard to find senior services by letting my fingers do the walking. But, I've been surprised at how difficult and frustrating it can be!

There's certainly no lack of information, but pulling it together, making comparisons and trying to figure out what is hype and what is transparent information isn't always easy or even possible. Most of the time, we've resorted to asking people we trust for their recommendations. In the case of Ralph's mother, when we needed to hire someone to help her with daily chores and errands after she returned home from rehab, we turned to the folks at St. George for advice. But for my parents, that wasn't an option. We relied on word-of-mouth from friends and neighbors.

That's why I was delighted to learn about www.TheSeniorList.com. Co-founders Chris and Amie Clark describe it as a national online resource that helps match people with senior-related services in their communities. By visiting The Senior List and clicking on a state, users can browse, add, or rate their local businesses. It's a great place to find everything from quality housing to in-home care to support services.

Already, there are over 8,000 businesses in the database, but for it to realize its full potential, businesses need to list themselves and consumers need to rate the services they use so that others can benefit from their experiences. Businesses that don't consistently receive at least three stars (of a possible five) from consumers are dropped from the site.

Beyond aggregating information service providers, the site also offers learning resources, such as expert articles and links to useful sites.

Launched about a year ago, I believe this site has the potential to be very powerful. Boomers, especially women, frequently turn to the Internet to do research. What's more, those of us in the "sandwich" appreciate the convenience, efficiency, transparency, and objectivity of peer reviews, so to speak. And we love to share what we learn. I predict we are the ones who will build and use this site most effectively."

Marketers: pay attention to this trend. Boomers and Seniors want trustworthy resources, not "messaging" about your products and services. My daddy used to tell me, "It's easier to ride a horse in the direction it's already going." My recommendation is to look for horses that are already out of the gate, rather than building a whole new racetrack!

In my work with families who are placing a loved one in a care community, I am often asked about the future of long term care. Many people I talk with are uncomfortable with the concept of long term care for themselves but think it’s adequate for their parents. I have good news and bad news: There is an alternative to long term care options known as Elder cohousing, but don’t expect it to show up in your neighborhood anytime soon.

The cohousing model was adopted from Denmark and migrated to the US in 1988. Initially conceived as multi-generational cohousing, neighbors adopted rules and built structures that allowed them to live supportively with one another, sharing common facilities and incorporating non-hierarchical decision-making, two of the six main characteristics that all cohousing communities share. Now, a similar concept, Elder cohousing, is becoming more popular with the 50 and older crowd in the US. Elder cohousing is an environmentally sustainable alternative to the existing models of housing for boomers and elders alike who yearn for their independence within a supportive community environment.

There are three elder cohousing projects that have been completed in the US. The three lucky states are Virginia, California, and Colorado. To date, there are eight elder cohousing projects actively underway according to Eldercohousing.org. Some communities are spearheaded by a group of friends or neighbors; others are formed by a few members who then recruit other future “neighbors” for investment and participation.

Studies suggest that people remain healthier and may live more independently if they have strong community ties. Cohousing fits this prescription perfectly as each member of a cohousing project has duties and contributions they are expected to provide. In one cohousing community, members’ professions included the following:
* Architect and Project Manager
* Technical illustrator/painter/sculptor
* Librarian
* Builder/Developer
* Teacher
* Retired English professor
* Financial planner
* Ombudsman
* Psychotherapist
* Retired businessman
* Social services for youth in prison.

If a member of an elder cohousing project needs care at some point in their journey, they continue to live at the site for as long as possible. Members are expected to help provide for one another; some will hire in-home care or employ caregivers for those who are in need. In the event that a member needs to live in a long term care community, members of the elder cooperative will continue to remain a part of the member’s life. This allows members to age in place for as long as possible, decreasing the financial, psychosocial, and health burden of the individual.

If you would like to learn more about elder cohousing, or how to form your own cohousing project, visit www.eldercohousing.org.

Amie Clark, Founder, The Senior List
www.theseniorlist.com

You find your mom on the floor in her bathroom at home. She complains of hip pain and has been there for a few hours. You make the call and a few hours later she has been admitted to the hospital with a hip fracture. Now what?

Insurance: If your loved one has Medicare or a HMO that manages Medicare benefits, the hospital stay is mostly covered. Medicare recipients will pay a $992 deductible for 2007 for hospital stays of 1-60 days. If a HMO is involved, check with the benefits administrator for specific deductibles or co-pays.

Legal Documents: If you haven't done it already, now would be a great time to have legal documents prepared for health care decisions. The most widely used form is called the Advance Directive for Health Care. This form allows your loved one to appoint someone to make decisions about health care if they are unable to do so, as well, this form also addresses end-of-life decision making. While you are helping your loved one with this document, fill one out for yourself!

Your mom has been in the hospital for two days now, and the discharge planner is telling you that she needs to leave the hospital in two days! To top if off, you have been presented with a list of in-patient rehab centers for discharge and you are expected to pick one!

Skilled Nursing Facilities (SNF): Medicare and HMO's will cover rehab centers- with a catch. Medicare recipients must have a three night hospital stay and receive a doctor's order to receive 'skilled' care in order to qualify for admission to rehab. The doctor will make a decision based on several aspects of a patient's rehab potential. HMO benefits vary greatly, check with the benefits administrator for specific requirements. .

Medicare has a great website for users to compare rehab centers based on their yearly state inspection results and other quality indicators, www.medicare.gov/NHcompare. You will also find helpful checklists to assist in your search. Select a few; go for a tour. Talk to health care professionals who can share their experiences with these facilities.

The 100-day myth: Many families leave the hospital believing their loved one will be able to stay in the rehab center for a full 100 days. It is a rare case that a resident uses their full 100 days of Medicare during a rehab stay. Medicare does not cover long term care, it is simply an insurance benefit. Medicare will cover a rehab center as long as your loved one continues to benefit from the skilled services they are receiving. Medicare does not have representatives that make this decision, instead, the decision to continue with rehab from one day to the next, is decided by the interdisciplinary team at the rehab center working with your loved one. In the case of HMO recipients, the HMO does employ case managers who keep in close contact with the rehab centers and decide when a resident is no longer eligible for skilled benefits. In either case, once it has been determined that your loved one no longer qualifies for skilled benefits, you will be presented with a Notice of Medicare Provider Non-Coverage aka, a denial letter. By law, Medicare beneficiaries must have 72 hours notice of non coverage; HMO's vary between 48-72 hours depending on the HMO.

Appeals: Once your loved one has been presented with a denial letter, several options are available. If you do not agree with the non-coverage decision, you can appeal it. You will find appeal information within the Non-Coverage letter, specific to the Medicare insurance provider. If you do agree with the non-coverage decision, it is time to make decisions about the next move for your loved one. Hopefully, you and your loved one have been discussing the plans to return home after the rehab stay. The rehab social worker can help you arrange for equipment and services to ease the transition of returning home. If returning home is not an option for your loved one, you now face a myriad of options for community based care.

Amie Clark, Founder of The Senior List
www.TheSeniorList.com

There are almost 35,000 Assisted Living Facilities licensed and operating in the US today. These communities range widely in size, price and amenities and are all fiercely competing for your businesses. The real trick is finding the one the suites your needs, life-style, and pocketbook.
What is Assisted Living?

The typical Assisted Living model is based on apartment style living with care services built in. This model encourages independence and autonomy while providing supervision and daily assistance with care needs. Meals are typically served in a main dining area with the intent of a social gathering while enjoying meals selected by the residents. Activities will be offered, including outings, scenic bus rides, and trips to the grocery store, bank, and doctors visits on designated days of the week.

What type of care is provided in Assisted Living?

Assisted Living provides custodial care, not medical care.

• Bathing, Dressing, Toileting, Grooming, Mobility, Medication Management
  
• Cooking, Housekeeping, Transportation, Laundry

What can I expect to pay for Assisted Living?

Most Assisted Living facilities structure their costs on an "ala carte" system. You will be quoted a "base cost" or "room and board cost" ranging from $1500-$3000 per month, depending on geography, size of apartment, and amenities offered. Expect to see additional costs added on right away. Based on an assessment of your care needs, the price will increase accordingly. This price can vary from month-to-month, especially if care needs drastically improve or decline over time.

What are the advantages to Assisted Living?

• Less expensive than nursing home care
• Private apartments to optimize privacy, autonomy, and independence
  
• Three meals a day served in a social dining atmosphere
• Security and call bell systems
  
• Designed with accessibility in mind (roll-in showers, etc)
• Exercise programs
• Care Services available- to be used as little or as much as you require
  
• Activity programs designed to keep residents active, social, and healthy
• Most have a beauty parlor on site

What are the limitations of Assisted Living?

• Despite staff presence and encouragement, some residents can become isolated
• Most do not allow residents to cook, for safety reasons
• Assisted Living can not accommodate residents who are wandering or exit seeking
• Minimal staffing requirements in most states. On average, expect to see 1 caregiver for every 30 residents during peak hours, and much less at night
• While facilities tout their abilities to care for residents through the end of life, many will ask families to hire private caregivers or transfer to a higher level of care if the residents needs are beyond the scope of their staffing levels

What do I look for in an Assisted Living community?

• Ask to see the latest survey
• Invite yourself to lunch (most will happily invite you first). Do you have menu options? Can family or friends join you for a meal? What is the cost for guest meals?
• Do the other residents interact well with each other? Are the staff friendly and kind? Do they know the residents by name?
  
• What is the caregiver-to-resident staffing ratio for each shift?
• Is a nurse available? What hours is the nurse in the building?
• Does the facility have a comfortable atmosphere? Is it clean? Are there any noticeable odors? What safety features are available?
• Is transportation available? Is there an additional cost?
• How often is the care plan reviewed? Is the resident or responsible party involved in the review? (they should be)
• What is the turn-over rate for staff? *Note* Most facilities have a high turn-over rate. It's a huge problem. What is the facility doing to keep current staff and attract new quality caregivers?
• If you have a pet, ask about any fees you will be expected to pay for your pet. Typically, an additional move-in fee and cleaning deposit will be incurred.
• What cost of living increases can be expected? (we have noticed 3-6% yearly for most communities)
• If the community can no longer meet your needs, how much notice will you receive and what assistance will be available to relocate to another level of care?
• Trust your instincts!!!

Who pays for Assisted Living?

• Private Pay (you)
• Long Term Care Insurance- Check your policy for coverage, waiting periods, etc...
• Medicaid- If you already qualify for Medicaid, or will qualify in the near future, make sure the facility you are considering has a Medicaid contract- many do not. You can check with the facility or your local Agency on Aging office for a list of contracted facilities in your area. If a facility does have a contract, chances are they are trying to balance Medicaid v.s. private pay in the building. Some will have a waiting list for Medicaid, so plan ahead. Do not wait until a crisis to start your search!!!
• MEDICARE DOES NOT PAY FOR ASSISTED LIVING

If you are just starting your search for an Assisted Living Community, you may consider working with a geriatric care manager or placement and referral agency to guide you. These professionals will know the communities in your area and save you valuable time and energy.

Amie Clark, Founder of The Senior List
www.TheSeniorList.com

In Home Care is designed to support those who do not desire or need to leave their homes, but do require assistance with one or more of their daily activities. Care in the home can take on a variety of shapes and sizes and can incorporate family, friends, and professional assistance. I think most people, given a choice, would prefer to receive assistance from someone they know, family or friends. There are certainly situations, however, that family or friends providing care is not appropriate, or does not appeal to everyone, including the family and friends. If professional support needs to be hired, here are a few considerations and questions to ask the agencies you are interviewing.

1. Most In-Home Care agencies have hourly minimums, usually 2-4 hrs. If a shift does not meet these minimums, the client may still have to pay for the full shift.
2. Make sure the agency you are considering is licensed, and caregivers are bonded and insured.
   
3. What kind of training and orientation do the staff participate in?
4. Is there a nurse to oversee the caregivers and provide training?
5. What is the process if a caregiver is sick or does not show up for a shift?
6. What are the fees? Do you pay less for longer shifts? Does the agency bill monthly or weekly? Do they provide transportation to doctor appointments, grocery store, etc...?
7. Does the agency have access to other resources in the community should you need them?
8. Check inspection results at medicare.gov.
   
9. Ask to see references and testimonials. You can review online ratings from other consumers.
   

What is the advantage of hiring my own private caregiver?

• generally less expensive than working with an agency
• caregiver is your employee, they work for you.
• may be able to exchange care services for room and board, this works well for students

What is the advantage of hiring an agency?

• agency pays taxes, insurance, etc... No liability on your part, less risk
  
• shift will always be covered
• agencies are regulated and must pass inspections to operate
  

What type of Assistance can a caregiver provide?

• Bathing/ Grooming
  
• Light Cleaning
• Shopping
• Laundry
• Meal Preparation
• Toileting
• Dressing
• Mobility
• Night care
  

How Much Does In-Home Care Cost?
I have seen quite a range for costs, anywhere from $12-$22 per hour, depending on geography and duties of the caregiver. If the caregiver is a CNA, the cost will typically increase due to training that the individual has received.

Who Pays for In-Home Care?

• Private Pay (you)
• Long Term Care Insurance- check your policy for restrictions and make sure agency is able to accept payment from Insurance provider
• Some Health Insurances- check your policy
• Medicaid- offers limited in-home care programs for those who qualify

Amie Clark, Founder of The Senior List
www.TheSeniorList.com

Retirement Communities/ Independent Living Facilities are most appropriate for seniors who can manage their health care needs on their own or with assistance from family in an apartment type setting. Independent Living does not offer health care services or assistance, but may offer a monthly meal plan, housekeeping, social activities, and transportation. Some communities will partner with an In-Home Care agency to provide some services to residents. Services may include Medication Management, Bathing and Grooming Assistance, or Incontinence care. If additional care services are being provided, at some point the cost of the apartment and care will equate that of an Assisted Living Community. Some Independent Facilities are located on a campus where other levels of care are offered should one need them in the future.

Independent Living costs range from $1000-$2500 per month, depending on apartment size, amenities, and meal plan. Some Independent Facilities will provide one to two meals per day and may offer a meal plan if a resident prefers to cook occasionally.

Only private pay is accepted at Independent Facilities. Medicaid does not cover housing costs for Independent living. Long Term Care Insurance typically does not cover Independent Living, but may cover the cost of outside in-home care services.

What are the advantages of a Retirement Community?

• Nutritious Meals, Activities, and Housekeeping offered
• Maintain Independence in a social setting
• No upkeep or utilities to manage (except personal phone and cable)

What should I look for when searching for a Retirement Community?

1. I personally prefer retirement communities to be adjacent to another level of care, most commonly, an assisted living or residential care facility. If a move occurs in the future, it is much easier to move across the courtyard instead of the other side of town.
2. What amenities are offered? Are the activities varied? Is an exercise program offered?
3. If your loved one is driving, is there reserved and covered parking available for residents?
4. Are pets allowed? Is smoking allowed on campus?
5. How involved is the management staff in the lives of the residents? Will they notify you if they see changes in your loved one?
6. How often are meals served? Is there a flexible meal plan option? Is the cost of meals included in the overall price?
7. How is the food? Invite yourself for lunch (most will offer)- observe staff interacting with the residents. Is there a social atmosphere in the dining room or are residents keeping to themselves. Do residents seem happy? Do the staff know the residents by name? The dining room is a great indication of the "mood" of the building.
8. How does the physical building look? Is it well kept? Are repairs needed? Ask about the maintenance response time. How available are they for minor repairs for the resident's apartments (light bulbs, hanging pictures, etc...)?
   

When is it time to transition to higher level of care?
First, I would suggest that if a resident requires care to begin with, a retirement community will only be a temporary solution. If a resident has lived in a retirement community and is requiring more supervision, can't safely manage daily activities, and requires frequent checks from staff, a higher level of care is needed.

Amie Clark, Founder of The Senior List
www.TheSeniorList.com