Assisted Living

Recommended Reading

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Parkinson’s Disease: 300 Tips for Making Life Easier

By Shelley Peterman Schwarz

An indispensable resource for patients, families, and caregivers

Filled with creative tips and techniques, this updated second edition of Parkinson’s Disease: 300 Tips for Making Life Easier contains a wealth of ideas and shortcuts for working, organizing, simplifying, and conserving time and energy while living with Parkinson’s disease. It includes:

  • Ways to make your home safe and accessible, your mealtimes more pleasurable, and your communications easier

  • Unique product suggestions that make daily living tasks less stressful

  • Extensive resources to help you easily locate items and services

Find it online on Amazon!

Seniors and Fraud Protection

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Seniors Need to Protect themselves from Fraud

We can all be vulnerable to fraud, whether it’s a phone call, a seemingly innocent email that we receive or even surfing the Internet on our computers.  It is always good time to brush up on some basic fraud protection. Unfortunately, there are many types of fraud schemes such as health care fraud, reverse mortgage fraud, counterfeit prescription drugs and even funeral and cemetery fraud. Here are a few pointers.

Do not give your credit card number to anyone over the phone. Is it Red Cross or your favorite charity calling? It is better to send a check in the mail than provide your credit card number on the phone. It is acceptable to ask the caller to send you something in writing and to ask for his name, phone number and business license number.
Do you surf the web regularly? Be an informed internet user and understand the basics of pop-up browser windows which may be malicious or the possibility of inadvertently downloading fake anti-virus programs.

Taking protective steps today can save you time, energy, and stress in the future!!

If I Get Dementia…

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On behalf of those who have the disease, a caregiver offers requests for how to treat people with dementia.
A woman who works with people with dementia knows how she would want to be treated if she had the disease and offers her own list of “16 Things I Would Want, If I Get Dementia.” Rachael Wonderlin, the director of Memory Care at Blue Harbor Senior Living, specializes in long-term dementia care. Her first request:
“If I get dementia, I want my friends and family to embrace my reality. If I think my spouse is still alive, or if I think we’re visiting my parents for dinner, let me believe those things. I’ll be much happier for it.”

— Rachael Wonderlin

She would also ask that you “ask me to tell you a story from my past” and wants you to know that she “still likes receiving hugs or handshakes.” Whatever you do, “don’t talk about me as if I’m not in the room.”

For a list of all 16 requests for how to treat people with dementia, visit the Alzheimer’s Reading Room.

Green Houses as an Alternative to Nursing Homes

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These small dwellings in residential neighborhoods provide a family environment with individualized care for the same price as an institution.

While surveys show that most older people want to live in their homes as they age, for many this is unworkable, as they face loneliness and lack of support for health and physical issues. Often, seniors don’t want to leave their homes because they fear losing their independence if they move into care facilities such as assisted-living or nursing homes.

That’s where the Green House Project comes in. For older adults who can no longer live on their own, this alternative nursing home provides shared living and 24-hour support, but with the ability to live as independently as you desire. A Green House (which is not green in color, doesn’t provide a place to grow plants and doesn’t refer to an environmentally progressive place) is a large house generally shared by seven to 10 adults (although some places have more). Each resident has their own room and bathroom, but shares a communal kitchen and living room.

The Green House Project describes itself as providing long-term and post-acute care. In the words of its founder, William H. Thomas, the Green House Project aims to create “a real home that provides care but also supports those seeking to redefine the worth and meaning of late life. [It] represents a massive shift toward the deinstitutionalization of older people. It generates human warmth, as opposed to institutional coldness, through its commitment to small size (seven to 10 residents in each house), its de-emphasis on hierarchy and its complete dedication to fostering a new expression of elderhood” (fromNext Avenue).

How It Started

Film Documents One Town’s Efforts

With a strong desire to take care of their elderly, a group of citizens in the small town of Sheridan, Wyo., went through a 12-year struggle to establish a Green House project. The effort involved finding land and funding, having to change the local laws to make this kind of care possible and raising millions of dollars during the 2008 economic crisis.

A documentary, Homes on the Range, captured the struggle and ultimate success: the only independent, not-for-profit, purely grassroots skilled nursing facility in the United States, not affiliated with or dependent on a larger corporation or hospital. Four cottages were opened in 2013, with 48 residents and 65 support staff, and plans are to add more houses, including cottages for veterans’ groups.

The film has been shown on PBS stations around the country, and is available as a DVD. A short clip is available from the Media Policy Center

Thomas, a geriatrician, international authority on elder care and author of four books on the subject, cofounded Eden Alternative in the 1990s. The nonprofit organization partners with nursing homes and other long-term care facilities with the aim of deinstitutionalizing them. In 2003, he started the Green House Project, also a nonprofit organization, which puts into reality the philosophy of the Eden Alternative. The Green House Project partners with the Robert Wood Johnson Foundation, which provided a $10 million grant in 2005, and Capital Impact Partners, which provides technical assistance and coordinates financing. The first Green House Project home was constructed in 2003 in Tupelo, Miss. In December 2008, the project reached its goal of completing 50 houses by 2010. As of February 2015 there are 174 Green House homes in 27 states with another 186 in development (Wikipedia).

How a Green House Works

Unlike traditional nursing homes, which can be huge institutions, Green Houses are literally homes, usually situated in a neighborhood. They are centered on a large living room, dining room and kitchen in one great room, which encourages communication and community. Rather than residents eating at different, smaller tables, they share one large table, emphasizing the sense of a family or community eating together. Each resident, called “elder,” can furnish and decorate their room and bathroom how they want (unlike institutionalized rooms with largely bare walls).

Residents can get up in the morning and to go to sleep when they want, which provides a lot of freedom and flexibility. In contrast, nursing homes enforce a strict sleeping and eating schedule. In Green Houses, residents can eat when they want, although meals are often shared.

To ensure quality, Green House homes are trademarked and built to strict certifications. These dwellings meet federal and state licensing requirements and operate within existing regulatory and cost frameworks.

How the House Is Staffed

Green House homes are staffed by a nurse 24 hours a day. Other staff include certified nursing assistants who perform all the duties found in a traditional nursing home, including dressing, bathing and toileting. Green Homes also provide physical, occupational and speech therapy, but often in a Green Home dedicated for that purpose. For example if an organization built six green homes, it would dedicate one to short-term rehabilitation, in order not to disrupt the routine of the main homes, according to Scott Brown, director of the Green House Project.

Residents with Alzheimer or other forms of dementia are integrated into the home, although some organizations have built homes specifically for those with Alzheimer’s. Although Brown was unable to provide a figure for the staff-resident ratio, he said the “time dedicated to direct care exceed ratios in traditional nursing homes.”

The relationship between the staff and residents is viewed as a partnership rather than the traditional nursing-home role of caretaker and patient. For example, the Eden Alternative’s definition of care is “that which helps another to grow. . . . It acknowledges that opportunities to give and receive are abundant and experienced by everyone involved in the care relationship.” Residents are encouraged to interact with staff and even develop personal relationships.

To emphasize the more informal relationship with residents, staff members are given playful names. The Shahbaz works with the clinical support team of nurses, therapists and dietary professionals to provide individualized care for each elder. The Guide is responsible for the operations of the home, while the Sage is a local elder who volunteers to be a mentor and adviser.

How Much It Costs

Despite the smaller residences, independent research has found that Green Houses cost the same or less to operate than traditional nursing homes, while delivering four times more personal and social contact (Next Avenue). One study found Green Houses cost $1,300 to $2,300 less in total Medicare and Medicaid costs per resident over 12 months than traditional nursing homes. At a Green House in Grand Rapids, Mich., a monthly stay is $10,230, comparable to a good nursing home (New York Times).

Organizations are making an effort to help low-income seniors get into Green Houses. Thanks to a $2.2 million loan through Age Strong, an initiative of the AARP Foundation, Capital Impact Partners and Calvert Foundation, a new Green House in Akron, Colo., plans to have 60 percent low-income residents who are covered by Medicaid. The Green House, expected to open this year, will replace an outdated traditional nursing facility.

Green House Project homes that are licensed as traditional nursing homes are eligible for the same Medicaid and Medicare reimbursements as a traditional nursing home. If the facility is licensed as assisted living, Medicaid reimbursement depends on the state’s assisted-living provisions. For Medicaid, the expenses are equivalent to the traditional Medicaid costs for nursing homes. For private pay, each facility determines its own cost structure.

What Research Has Shown

Several studies have favorably compared Green Houses to traditional nursing care. The Robert Wood Johnson Foundation Green House Workflow Study found that nursing home residents were hospitalized more often (more than 7 percentage points higher per resident over a 12-month period) than Green House residents. As such, annual Medicare hospitalization expenditures per resident were less in the Green House unit relative to traditional units.

A 2009 evaluation of the Green House Project’s care found it provided higher direct care (23–31 minutes more per resident per day) than traditional nursing homes and more than four times as much staff engagement with elders outside direct-care activities (Wikipedia). In a 2004 report presented to Congress, researchers from the University of Minnesota School of Public Health found that elders in a Green House Project home were able to perform daily functions longer than those in traditional nursing facilities. Among those living in Green House homes, there have been increased reports of mobility and social interaction, and fewer reports of weight loss and depression.

Sources

The Green House Project

“New Homes on the Range: Better Care for Elders,” Dec. 1, 2014, Next Avenue

“Homes on The Range–Change our elder care!“, Indiegogo

“GreenHouse in Akron, CO will offer homelike care,” Age Strong

“A Revolution in Life Beyond Adulthood,” July 31, 2012, Next Avenue

“Green House Project,” Wikipedia

“Culture Change Goes Mainstream,” May 2010, Robert Wood Johnson Foundation

Eden Alternative

“The Green House Project: The Next Big Thing in Long-Term Care?,” July 30, 2015, A Place for Mom

“Small Residences for the Elderly Provide More Personal, Homelike Care,” Nov. 20, 2015, New York Times

Blog posting provided by Society of Certified Senior Advisors
www.csa.us

Aging Stereotypes

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According to new research, stereotypical views on aging can negatively affect our hearing and memory skills, according to University of Toronto researchers.  In a study of 301 adults ages 56-96, scientists assessed each person’s view on aging, the perception of one’s memory and hearing abilities, and actual hearing and memory performance on tests.  Those with negative views about aging who believed they had hearing and memory challenges performed poorly on tests.  Dispelling stereotypes about aging could improve confidence in hearing and memory abilities, researchers say.

Medicare to Pay for End-of-life Discussions

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Under a new law, patients can discuss their medical options and goals in order to make an informed decision on the type of care they want.

For the first time, Medicare will pay this year for a conversation with your healthcare provider about your end-of-life care. When Congress attempted this coverage six years ago, it was met with charges that such conversations would result in “death panels.” Yet polls show that a majority of Americans want to talk to their doctors about their options and preferences as they approach the end of their lives. A recent Kaiser Family Foundation survey found that about 9 in 10 adults say doctors should discuss end-of-life care issues with their patients, yet only 17 percent of adults say they have had such a discussion.

Even though most adults (90 percent) say they would prefer to receive end-of-life care in their home if they were terminally ill, only about one-third of Medicare beneficiaries (age 65 and older) died at home (Kaiser Family Foundation). Conversations with healthcare provider about such wishes could guide you and your doctor to the kind of treatment that would ensure you die where you want.

Under the new rule, Medicare pays $86 for the first 30 minutes of “advance care planning” in a doctor’s office and $80 for the service in a hospital. In both settings, Medicare will pay up to $75 for 30 additional minutes of consultation. If the discussion takes place during your annual wellness visit, it is considered a preventive service and the patient’s coinsurance and deductible are waived. These voluntary discussions can take place at any time, not just when a patient is facing a serious illness or death.

Ideally, end-of-life conversations would cover a range of concerns, including understanding the patient’s prognosis and goals. Do you want everything done that would keep you alive—chemotherapy, CPR, tube feeding—even if it doesn’t meet your wishes for your end of life? Be specific about treatments and interventions you do and do not want.

Benefits of the Conversation

Far from forcing people to accept treatments that would shorten their lives, communication with your healthcare provider can help ease your fears, minimize pain and suffering and enable you and your family to experience a peaceful passing. Those who are dying often have many fears—of pain, indignity, abandonment and the unknown. By talking to your healthcare provider, your end-of-life care can become an experience of choice rather than passivity, of empowerment rather than powerlessness, experts say.

An end-of-life conversation allows your loved ones to know what to expect and know that you are receiving the care you desire. The new policy will help seniors “make important decisions that give them control over the type of care they receive and when they receive it,” the Centers for Medicare and Medicaid Services stated.

Studies have shown that advance-care planning improves the patient’s quality of care because it’s targeted to what the person wants. Directed treatments can reduce the costs of medical interventions that the patient either doesn’t want or doesn’t need.

 

This article comes from the Certified Senior Advisors March 2016 blog.  Corinne Auman with Choice Connections is your local Certified Senior Advisor.

 

Finding the Right Care is Confusing

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One of the questions that we here at Choice Connections get asked almost everyday goes something like this…”What is the difference between skilled nursing, assisted living, and memory care communities?”

If this question has crossed your mind, you are not alone!  Here is some clarification:

Assisted Living: Provides assistance with grooming, bathing, tolieting, and medication management, just to name a few!  In addition to providing these personal care services, assisted living communities also provide 3 meals a day, plus snacks, and offer a wide variety of activities that residents can participate in if they choose.

Assisted living communities are generally more aesthetically appealing that skilled nursing facilities, and they are also less costly.  However, not all accept Medicaid and even if they do, there is a income cap that must be met to qualify for Medicaid (also called Special Assistance).

Memory Care: Provides all the same services as an assisted living community, but also has staff specially trained to work with residents who are cognitively impaired.  Additionally, memory care buildings are secure, to insure that residents do not wander out the door and become confused about their surroundings.

Memory care communities are more costly than assisted living communities.  This is due, in part, to a lower caregiver-to-resident ratio.  Memory care residents require more hands on care an attention, and the price reflects that difference.  Some memory care communities do accept Medicaid, but there is also an income cap requirement that must be met to qualify.

Skilled Nursing Facilities: The majority of residents in a Skilled Nursing Facility are there for physical rehabilitation after a hospital stay.  These rehab stays are paid for by Medicare, but after the Medicare days are used up, the patient is responsible for paying for care.

Long-term residents of skilled nursing facilities are individuals who have a medical condition requiring 24-hour nursing care.  Examples would be a feeding tube or being bed bound.  Skilled nursing facilities are quite expensive, costing upwards of $70,000+ per year.  Medicaid will help pay for care, and there is no income cap, but your assets must be less than $2000.

If you have further questions about finding the right care, call Choice Connections today!

 

VA Aid and Attendance

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Did you know that the VA offers a benefit that can help pay for in-home-care as well as Assisted Living and Memory Care?  They do!

Aid & Attendance (A&A) and Housebound Pensions are stipends that may be added to existing pension amounts, meaning a veteran must first be pension eligible to receive these benefits. A&A and Housebound are mutually exclusive pension supplements, meaning veterans may not receive both at the same time—they either receive A&A or Housebound. As of 2015, a single veteran is eligible for up to $1,788 per month. A veteran with a spouse is eligible for up to up to $2,120 per month, and a surviving spouse may be eligible for up to $1,149 per month. A non-service-connected (NSC) pension is a financial stipend similar to social security that can provide for the needs of lower income veterans whose annual income is below a certain threshold. This will allow veterans who are receiving no or minimal social security income to increase their income to more of a livable wage. A disability is not required. All veterans may apply for VA benefits, and they are encouraged to apply for as many benefits as they need. It is not uncommon for a veteran to receive multiple benefits, such as pension income, home loans, and educational benefits, at the same time.

-Excperted from CSA Journal, number 63

By Carilyn Ellis

Dementia: One name, but many different illnesses

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One of the most common things primary care physicians (PCP) see seniors for is evaluation of cognitive decline.  Often PCPs do not refer the patient out, but instead enter a diagnosis of dementia in the patient record based on the family report and then give a prescription for Aricpet or Excelon, drugs that can treat the symptoms of dementia.

Many families are content with this process, as it confirms their suspicions.  However, a lot is missed in simply labeling cognitive decline dementia.  This would be similar to a dermatologist labeling all presenting problems as “rashes” and prescribing the same cream.

The term dementia encompasses a wide range of diagnoses and symptoms.  Where there are common symptom presentations across dementias, the specific diagnoses are unique and carry with them differing prognoses (expectations of lifespan and the nature of decline), treatments, symptoms, drug interactions and support needs for family members and caregivers.

Families often assume that dementia and Alzheimers’ are synonymous, and that all dementias follow a common course.  This is not true.  There is value in clarification of what kind of dementia a person has.

Common Changes Among All Dementias

Memory loss is the first and most common complaint in patients and families concerned about dementias.  All people with dementia experience loss of independence with Activities of Daily Living (ADLs), such as brushing their teeth, dressing, feeding themselves, and Instrumental Activities of Daily Living (IADLs), such as driving, taking medications, paying bills.  Additionally, across all dementias it is common to see “masking” behaviors, when people with a dementia are able to rally in the moment (usually at the doctor’s office!) and have a clear, thoughtful discussion that is quite different from their presentation when at home.  This can be quite frustrating for caregivers.

Different Types of Dementia

Alzheimer’s Disease.  This is the most common form of dementia, accounting for 60-80% of the diagnoses.  It is a slow progressing disorder, and ususally presents a memory loss, progressing to further impairment across cognitive domains.  Alzheimer’s dementia is one of the few dementias for which acetylcholinesterase inhibitors (ex. Aricpet, Excelon) and multi-receptor antagonist (Namenda) may actually slow symptoms.  It is important to note that these drugs are often prescribed to everyone who has a diagnosis of dementia.  However, they are only FDA approved to treat Alzheimer’s Disease.  It is unknown if they are helpful in treating other dementias.

Vascular Dementia.  This is a form of dementia resulting from vascular complications.  It can often be the result of a series of strokes.  It accounts for about 10% of dementias.  Unlike Alzheimer’s, vascular dementia often presents as impairment in judgment, reasoning, and executive functions (poor decisions) rather than memory loss.  Treating vascular dementia focuses on treating the underlying vascular conditions to slow decline.

Lewy Body Dementia.  LBD is a lesser-known, and therefore under-diagnosed, form of dementia.  It is characterized by cognitive changes in combination with problems with movement (issues with walking, tremors, stability) and visual hallucinations.  The importance of knowing the diagnosis of LBD is most significant when it comes to medications.  Up to 50% of patients with LBD who are treated with any antipsychotic medication may experience severe neuroleptic sensitivity, such as worsening cognition, heavy sedation, increased or possibly irreversible Parkinsonism, and other complications that can be fatal.  Given that many Alzheimer’s patients are treated with antipsychotics for behavioral and sleep problems, this difference is very important to know.

Parkinson’s Disease.  Today, PD is being combined with LBD due to their common foundations-protein deposits in the brain.  The difference between LBD and PD is mostly in the order of presentation of symptoms.  PD presents first as a movement disorder.  One of the pricipal treatments of PD is l-dopa, which is a synthetic drug designed to increase the amount of dopamine in the brain, which results in better movement.  Sadly, a common side effect is hallucinations, for which doctors often prescribe the neuoleptics that are very dangerous to LBD and PD patients.

Fronto-Temporal Dementia.  FTD results from degeneration of the frontal lobes of the brain (responsible for reasoning, decision making, impulse control, and some emotion regulation), and the temporal lobes (responsible for language and some aspects of memory).  There are 3 forms: behavioral variant (marked by personality changes, impulse control, and sometimes violence), semantic dementia (loss of verbal memory and understanding), and progressive non-fluent aphasia (changes in the ability to speak, read, write, and understand what others are saying.

Why Diagnosis Matters 

Due to the unique variations across types, one can begin to see the value of more specific diagnoses, whether it relates to medication planning, family education, and treatment considerations.  In some cases the difference can mean life and death!

Adapted from CSA Journal number 64, Autumn 2015

by Carilyn Ellis, PsyD

Holidays with Loved Ones in a Senior Community

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As the holidays approach, don’t forget about your loved one in a Senior Community!  All Senior Communities welcome family and friends to visit during the holidays, and often have special events going on just to welcome outside guests.  If you have a loved one in a Senior Community, be sure to check the activity schedule so that you can be part of all the celebrations!

Of course, it is always nice to get out and about, so if you can take your loved one to your home for the holidays this can also be a welcome change of pace.  Make sure that the Senior Community knows that your loved one is leaving the community for a while, so that they can prepare any medications that may need to be taken during the time away.  When your loved one returns to the community, be sure to notify the staff that he or she has returned.

Being in a Senior Community during the holidays can be very enjoyable.  Make sure to take advantage of all the events and hospitality!

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