Be aware that “Assisted-Livings” — from multi-bedroom houses to 50+ apartment residences — serve the needs of able seniors to a limit. Thereafter, some seniors may need more help with their daily activities that Assisted-Livings are unable, not willing, ill-equipped or just not licensed to provide. And while some Assisted-Livings may “offer” the services of their “assistants” or “aides” for an extra cost, or offer to place your loved one with Alzheimer’s in a “dementia unit” or in a “higher level of care,” the new, increasing fees may approach and even exceed those of a Licensed Skilled Nursing Home for services that are not certified as effective, safe, skilled and comprehensive. Additionally, Assisted-Livings “aides” are Home Health Aides, whereas Licensed Skilled Nursing Homes are required to use “Certified Nursing Assistants or CNAs” who are trained and certified to provide effective, safe, skilled and comprehensive care. Also, Assisted-Livings “dementia units” may not be licensed or qualified to provide safe, stimulating and memory-appropriate care to residents with Alzheimer’s. Unlike Assisted-Livings, for example, Licensed Skilled Nursing Homes use fall monitors for residents with a high risk of falling. If your loved one starts falling down often, it’s a sign that she should be moved to a Licensed Skilled Nursing Home before she has a serious injury.
To complicate matters even more, the Assisted-Living administrator may ask you to move your loved one back home or to another place when their monies run out because many Assisted-Livings are not Medicaid approved or do not have a Medicaid bedroom available at that time. What do you do then? “This happens all too often,” says Mr. John E. Kasarda, Administrator of Little Brook Nursing and Convalescent Home in Califon, NJ. “The best thing to do is to move your loved one to a Licensed Skilled Nursing Home that provides certified skilled care as soon as the need for specialized care arises or when they reach the point where they have only six months of funds left for a Licensed Skilled Nursing Home since that is minimally the amount of time needed to get Medicaid approval to move into a the Licensed Skilled Nursing Home. That way your loved one is settled and fully cared for.” The 3 signs that it’s time to leave your Assisted-Living situation are:
Sign #1: BEWARE of Care Not Meeting Needs
If either the type or quality of care that your loved one needs is not being provided by their Assisted-Living, then seek out a Licensed Skilled Nursing Home that can provide it immediately! A Licensed Skilled Nursing Home can coordinate and tailor the care your loved one requires for their unique and changing needs; the staff will monitor their health and vital signs, manage their medications, provide physical therapy and restorative nursing programs, and help toilet, bathe, clothe and feed your loved one.
Look for a Licensed Skilled Nursing Home that:
(a) INDIVIDUALLY Coordinates and Tailors Care. Seek a Licensed Skilled Nursing Home that will provide your loved one with the best skilled care including assistance with activities of daily living (i.e., dressing, bathing, eating, etc.), attending social functions and activities, moving safely throughout the home, eating three healthy, diet-tailored meals daily plus snacks, living in a comfortable environment, etc. There are many things that Assisted-Livings do or don’t do that can pose problems for seniors. For example, not helping seniors with incontinence can result in deadly infections or poor hygiene and appearance;
(b) CONTINUALLY Monitors All Health Vitals. Find a Licensed Skilled Nursing Home for your loved one who has complex medical conditions requiring regular monitoring – for instance, those who have diabetes require regular testing to track their sugar levels. Assisted-Livings do not provide much health care, if any; that’s just not their role or license. Assisted-Livings typically do not have medical professionals on staff 24/7, so there is no possible way for them to provide “round-the-clock” health care to residents. This is why many Assisted-Living residents are continually in and out of hospitals for conditions that could be treated within a Licensed Skilled Nursing Home;
and (c) PROPERLY Administers Medication. Assisted-Livings only have “medication aides” to help administer medications, unlike Licensed Skilled Nursing Homes which are required to use Licensed Nurses who have extensive training to give the right dose, of the right medicine, to the right resident, at the right time to avoid the risk of residents being under-medicated or over-medicated. “For many seniors, good health and well-being require daily professional medical attention,” says Mr. Kasarda.
Sign #2: BEWARE of Steadily Increasing Fees
Beware of rapidly increasing fees for servicing needs, as these fees may escalate and exceed that of a Licensed Skilled Nursing Home. Many Assisted-Livings offer “higher levels of care” for an extra cost which may exceed the levels of care they are qualified to provide. Furthermore, many Assisted-Livings ask the resident to pay privately for a one-on-one “aide” or “companion” as their health care needs increase; too often once the resident’s monies run out, residents are told that the Assisted-Living can no longer meet their needs. If you’re paying $6,000 monthly or more, then just compare the benefits versus the cost. While these increasing fees may appear to be associated with your loved one’s increasing needs, they may not be receiving certified effective, safe, skilled and comprehensive care for those additional fees. Mr. Kasarda suggests “that one determine whether a Licensed Skilled Nursing Home is a better option at least six months to a year before all the monies run out.”
Sign #3: BEWARE if Asked to Hand Over All Your Wealth
If your loved one is asked to commit everything to “Age in Place,” DON’T !!! “Don’t ever, ever liquidate and commit their entire estate (i.e., monies, stocks, properties, etc.) to any facility,” says Mr. Kasarda. Although it may seem enticing to “Age in Place,” that is, to continue living your life through a progression of residences on the same site, one never knows what fate has in store. What about if your loved one becomes unhappy or is not receiving the skilled care they require and wants or needs to move? What if the facility has to close down due to a catastrophe like Hurricane Sandy? Being tied down to one facility could become more of a hindrance than a convenience. So, if the Assisted-Living’s management is asking that your loved one commit their entire wealth, be very leery and don’t sign any documents until you’ve discussed this with your family and attorney. Not only will you and your loved one commit yourselves to this situation, but because the finances are encumbered so too will your loved one’s lifestyle options be restricted.
Assisted-Livings serve the needs of able seniors to a limit. BUT, when a senior’s needs increase and the fees start rapidly escalating be sure to get the best, certified skilled care for the cost, and get it sooner than later. “A senior’s golden years should be about living in peace, happiness, dignity, comfort, safety and good health. Your loved one deserves skilled care that is both excellent and comprehensive!,” says Mr. Kasarda.
Editor: Dr. JP Hampilos of Senior Care Focus, LBHI
Excerpts from an interview with John E. Kasarda, Administrator, Little Brook Nursing and Convalescent Home on Paula Span’s 2011 adapted article entitled “Assisted Living or a Nursing Home?”
Senior Care Focus, Issue No. 16, Late Fall 2014