The Intentional Caregiver » caretaker

Will Assisted Living Facilities Become the Next Dinosaur?

The Intentional Caregiver — Wed, 13 Jan 2010 00:19:11 +0000

This past couple of years, I’ve noticed many new assisted living facilities being built in the area in which I live. These are gorgeous properties with beautiful amenities throughout that have been placed there by designers hired to make them look like “home”.

It wasn’t until I began looking at them as a means of respite care placement for my father that I learned of their costs. In my father’s case, the daily respite cost was $220 but the monthly cost would have been over $5000.00 for a semi-private room. This rate did not include medications or transportation to medical appointments. (Rates seem to vary between $4000.00 and $7500.00 per month depending upon the residence.) None of these facilities accepted Medi-Care and private insurances don’t cover such things. A couple of them stated that if a person were 2 guarantee private payment for 3 years, then they would not “evict” the resident once their money was gone. At that time, they would then accept Medicaid reimbursement.

Recently I have read several articles about assisted living facilities being available mostly in areas of higher income. In areas of lower income, rural areas and in areas where minorities live (and all 3 of these are equivalent to areas of lower mean income), there are less available assisted living facilities.

In a study at Brown University, a conclusion was made that hispanics would be more likely to use nursing homes than assisted living facilities because they at more likely to be at the lower end of the socio economic scale and did not have the money. Because of lack of money, they were more likely to be placed in nursing homes with less than desirable facilities, receiving less than adequate care which sent them back to the hospital and began a downward spiral.

I think that another reason that there are fewer assisted living facilities in areas where hispanics live is that their culture has the tradition of elder care being handled by the adult children of the family in a home setting. My best friend’s mother took care of both her mother and aunt in her home until she was physically unable to do so anymore.

Assisted living facilities vary tremendously; they can contain a myriad of amenities and consist of private apartments with a nurse on duty 24 hours a day or at the other end of the spectrum, they can be closer to a nursing home environment with semi-private areas that consist of 2 beds in a room with a television set.

Assisted living homes are not the right choice for everyone. Unless a facility has a special unit (and many are opting to include these), dementia patients should not be placed there. Sometimes patients have medical conditions that are too complicated for this type of living arrangement, as well.

Nursing homes don’t have much variation. In MY words, they are simply sad places where lonely people live out their final days.

In between, there are skilled nursing facilities, but in most instances, these are temporary placements until the “patient” can either be returned home or to a more permanent placement in a different facility.

I’m concerned about what will happen when the aging population runs out of money to pay for these expensive assisted living homes. At between $ 50,000 and $90,000 per year, who will be able to live there long? Our elders were a little more prepared but I don’t believe that the baby boomer generation has prepared themselves well enough to be able to cover even a year of living there. And now that many boomers are upside down on their mortgages, selling their home won’t help to pay for that care. Not many of us have long term care insurance either. (And in reality, how can long term care insurance continue to exist when almost ALL of us will need it at some point?)

I also think that with health reform, more families are going to be responsible for the care of their elders. Hospitals will discharge elder patients sooner and before they are able to care for themselves. This is happening even now ! I literally had to beg that my father be admitted to help remove the 12 pounds of fluid that had accumulated in his legs due to congestive heart failure. Sure…..they’ll put a defibrillator in an 86 year old man with dementia (because insurance will pay for THAT) but when it comes to managing the care of that man post procedure, they’ll leave it to the family. (And they won’t discuss end-of-life care…but that’s a whole other issue.)

Already, a big portion (17% of employees in south Florida, according to a recent study)* are having to leave the work force in order to care for their aging loved ones and another 15% have cut their hours.

During the past year, as we have experienced a financial crisis, more family members are gathering together under one roof in order to make ends meet. Do you think that we will return to the days of Leave it to Beaver and Father Knows Best where Moms become the caregivers for the family while Dads return to providing the financial contribution?

walk-in bath tubs: a review

The Intentional Caregiver — Tue, 10 Mar 2009 22:32:07 +0000

My father, who lives with me, has his own bathroom here. Unfortunately, it was a bathroom that contained a combination tub/shower with a glass door. Because my father has difficulty with his balance and also has some neuropathy, we knew we needed a different set-up for him. It was dangerous for him to step over the side of the tub and I also had visions of him falling through the glass door. Changing the tub into just a shower would require major plumbing changes, so we looked into and purchased one of the newly advertised walk-in bath tubs.

These bath tubs are advertised as being great for elderly, disabled or mobility-impaired individuals. They are made of fiberglass or acrylic, are found in sizes ranging from 48″ X 28″ to 60″X32″ and are said to fit any bathroom. If the bathtub area is too big, there is an “extension kit” which essentially adds a shelf area to the tub. They each have a seat installed and there is also the option of choosing one that is complete with a hydrotherapy unit (we chose this option because my father has both arthritis and leg muscle cramps). The cost for these units can be in the thousands, so it is a fairly expensive purchase but can be one that enables a person to continue to live at home rather than in an assisted living facility.

Having experienced the walk-in tub for over 6 months, I am going to say that it was not the right choice for my father, but it may be a good choice for other senior citizens.

The positive aspects of it were the built-in anti-slip seat, the anti-slip tub floor, the low-level entry, the temperature control (it does not allow the temperature of the “hot” water to be hot enough to burn), the height on the sides of the tub which helps to keep my father from falling, the ease of cleaning the “unit” and the hydrotherapy.

The negative aspects of it are that it is an almost claustrophobic bathing experience when using the shower curtain, as the bathing area is very small. Additionally, if your bathroom is such that an extension (or shelf) is required, the shower curtain must sit on the inside of the tub making an even smaller bathing area.

This is definitely not a product that will enable a person with dementia to have more independence. It’s much too technical. Once entering the tub, there is a special lever that must be pulled in order to make the tub water-tight. My father is confused by the hand-held shower sprayer (doesn’t realize that it can be left hanging in its casing) and several times, I have heard him turn on the hydrotherapy jets without having any water in the tub (is a burnt-out motor in our near future?). He also forgets (with short-term memory, that means 2 minutes later) that the shower curtain must be on the inside of the tub itself, so very often, we are sopping up water from the floor after his shower (water on the bathroom floor contributes to slipping, as well.)

It is also NOT conducive to caregivers helping with the showering of the patients or loved-one. The sides are too high, thus contributing to back strain and the water does not stay in its designated area. If a caregiver was helping their loved-one to bathe (rather than shower), it would be fine.

I think this is probably a great product for those in their late 60s and 70s who may be “a little wobbly” and could use the extra support and also benefit from the hydrotherapy. I don’t think it’s a good product choice at all for those with dementia who are trying to continue to bathe on their own.

Your thoughts?

Please see our YouTube video on this subject for more information.

I’m Asking for Your Advice

The Intentional Caregiver — Mon, 02 Mar 2009 19:00:56 +0000

My father has dementia that has progressed to a point between the 2nd and 3rd stages. As such I have been granted conservator/guardianship over him and his affairs. (Conservator/guardianship means that I have control of all his medical, financial, life decisions).
As you know, with dementia, there are periods of seemingly complete lucidity ….and then there are the rest of the times. My father doesn’t understand the implications of the conservator/guardianship. He just knows that I’m “taking care of his things now.”
Like most men, my father is in the habit of carrying a wallet with him containing money, credit cards, health insurance enrollment cards, identification, etc. I have been told by various experts in the field of dementia that he should not carry ANY type of credit or debit card and no more than $20.00 in cash. It was easy to convince him to hand over the health insurance information and identification cards, but I am having difficulty obtaining the credit and debit cards. No….. “difficulty” is not a strong enough term…in fact, he REFUSES to hand them over. My father has always been willful and stubborn. As I am usually at his side when he is out of the house, I felt it was one of those battles that I would choose not to fight. It hasn’t been a problem until recently when he went out of state to visit family and insisted on taking his bank cards with him. Because I thought that he would be spending most of his time in the family home, I wasn’t too concerned, but as it turns out, whenever someone is leaving the house, he asks them to take him to the bank because “he needs some money” or “he wants to check on his money”. Several times, family members have succumbed to his wishes and chauffered him to the local branch of his bank. Because his accounts are now in my name, he cannot “check on his money” but he can use his bank card to make a withdrawal…which he has done.
My concerns are two-fold: that he’ll lose his cards, and that he’ll buy unnecessary items (did I mention that when I was still working, he bought a truck and had it delivered to the house – that was AFTER he lost his driving priviledges)?

I have handled having to take away the driving priviledges, restricting use of power tools, eliminating coffee maker and coffee-pouring activities but taking away the items he has carried with him since becoming “an adult” is something I can’t seem to get past. It’s like taking away that LAST bit of independence . In our society, we are almost synonymous with the “bartering power” or money that we have.
Can you offer any advise?