Archive for the ‘Assisted Living’ Category

Facility Living: Empowering Ideas For Better Care

Posted on August 20th, 2015 by karen

How to get better care in facility

by Karen Keller Capuciati

“Feeling of defeat: When you realize the place where you have moved your loved one gives less than desirable care and there is no place better to go to. I had to accept that this was as good as it gets.”

This comment was written by Martha in a recent post to In Care of Dad.  She had done her due diligence, checking all the memory-care facilities in a 50-mile radius surrounding her home, eventually locating the very best place for her father. But she is frustrated because the care her father is receiving doesn’t match up with her expectations for the facility.

Martha explained that all the personalized care details that she communicated at intake — her father’s food likes and dislikes, his special skin care needs, etc. — are not being communicated to the folks who are caring for him. Furthermore, the activities provided by the facility are not engaging.

So Martha’s question is, what can be done?

I asked some professionals in the field of geriatric care for ways to help a person in Martha’s situation. Here are some of their suggestions:

Joan Blumenfeld, a geriatric care manager:
I’d like to have some help with this myself. Even “good” places often fall short of our expectations and their promises. Sometimes our expectations do not jibe with reality and that’s frustrating. So we have to make some adjustments to our expectations.

Consider the following:

  • Pick your battles and set priorities. Not everything is worth a confrontation.
  • If there is an issue of health or safety, speak to nursing or administration, not to the aides. Facilities are hierarchical. Power to fix, change or adjust comes from the top.
  • Visit regularly and randomly, so you can see what is really going on.
  • If you can afford it, a part-time private duty aide might be of service, though it may create conflict between staff and the private aide.
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Transforming A Life One Room At A Time

Posted on June 17th, 2015 by karen

smooth ALF transitioning

by Karen Keller Capuciati

After one of the meetings I have every month with a group of geriatric care professionals, Kathryn, a gerontologist, was telling me what she had done for a client named “Rosie,” who had recently transitioned from post-operative rehab, where she was recovering from a femoral fracture, into an assisted-living facility.

Kathryn described how she had transformed an empty room at an ALF into a home for her client. I was touched by the lengths that Kathryn had gone to — in my opinion, she went above and beyond the normal bounds of her profession in making sure that Rosie’s new home was as nice and comfortable as it could possibly be.

“Rosie loves the outdoors,” Kathryn told me, smiling at the recollection. “So I loaded the big picture window with flowering plants, and colorful vases that I filled with flowers. Then I bought a brightly colored flowered quilt, a high-back chair and ottoman that is really cozy — in blue, Rosie’s favorite color. I also brought over some of Rosie’s artifacts and knickknacks to have in her new space.” Kathryn smiled again. “It’s a real joyful room.”

Kathryn couldn’t bring too much from Rosie’s home, but she took what she thought was important, such as the antique secretary desk. Rosie had worked her whole life as an administrative assistant, so Kathryn figured that having her desk in the new home, with lots of shelves and compartments and stacked drawers, would be a point of familiarity and comfort for Rosie. Kathryn knew intuitively that Rosie would enjoy sitting at her desk, reading the newspaper, writing cards and letters to friends. It would give the room a point of warmth and familiarity.

Kathryn was detailing the Rosie situation because of an earlier group discussion about how long it often takes new residents to get acclimated to an unknown facility. It’s no surprise really — imagine being moved into a building full of strangers, sometimes against your wishes, sleeping in an unfamiliar bed, eating in a dining room while surrounded by faces you’ve never seen, being given a routine that’s wholly different from the one you’ve been living for years. It feels like the comfort of home has been ripped away from you.

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Transitioning To Assisted Living: A Work In Progress

Posted on March 4th, 2015 by karen

Transitioning to assisted living takes time

by Joan Blumenfeld, MS, LPC

My 85-year-old client, Henry, lives alone as he always has. He retired long ago from his lifetime career as a history professor. He never married, has no family presence locally and is fiercely independent.

Although his health is generally good and remarkably stable for his age, Henry shows signs of frailty. His mind is quite sharp and he is very charming, but his memory lapses are alarming. He uses a cane to help steady his walk and, although he is still driving, his vision is certainly not up to snuff. He admits to being lonely since his few friends have moved away or died.

Henry has difficulty managing money and paying bills on time. He can barely take care of his marketing, cooking, laundry and housekeeping, but sees no need for help with any of it. He often doesn’t make or keep medical appointments and frequently forgets or misplaces his medications.

Henry is the perfect candidate for assisted living!

I aroused his curiosity about such facilities by telling him stories of how well some of my other clients have fared in them. The idea of eating three well-prepared and nicely served meals a day in a hotel-like dining room was especially appealing to Henry. Having nurses on staff to respond to medical emergencies and aides to assist with personal care seemed reasonable (only if absolutely necessary, of course). And people to talk to and play bridge with actually sounded like fun.

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Life With Pop: The Lost Watch

Posted on November 19th, 2013 by karen

Pop's lost watch

An excerpt from the book, Life With Pop: Lessons On Caring For An Aging Parent, by Janis Abrahms Spring, Ph.D., with Michael Spring.  


January 5, 2002

Seven-ten, Saturday morning. The phone rings. It’s Pop.

“I can’t find my watch,” he declares. “The girl must have taken it. What’s her number?”

I can hear the anxiety in his voice. The “girl” is Ann, his caretaker — the devoted nanny who comes in weekday mornings for an hour to get him up and running. She’s a responsible, intelligent woman in her midthirties, with a warm olive complexion that rivals Halle Berry’s. If Ann is dishonest, then Dad is a 007 agent.

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In Praise Of The “Therapeutic Fiblet”

Posted on November 7th, 2013 by karen


by Joan Blumenfeld, MS, LPC

We all agree that lying is awful. It’s rotten and reprehensible. People lie to escape punishment for doing something they know is wrong or for manipulating others to their own advantage. But a therapeutic fiblet — now that’s another matter altogether! A therapeutic fiblet is kissing cousin to a white lie and delivers a partial truth, something to guide another person in a direction that is deemed to be good for them, even when they would prefer to be left alone.

At first, the very concept of a “therapeutic fiblet” really went against my grain. But over time I’ve learned that it can be quite a useful tool, especially when working with people who have dementia, and when the full, unvarnished truth would only escalate their agitation and resistance.

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Looking For A Nursing Home: The Essential Search Protocol

Posted on June 6th, 2013 by karen
Santo and his granddaughter Cece, June 2011

Santo and his granddaughter Cece, June 2011

by Karen Keller Capuciati

I often seek out my friend, Elaine, when someone I know is looking for a nursing home in our area. Elaine has done a lot of research on the topic, and I know she will have detailed answers for all the important questions that come up. Elaine also has a lot of handy tips to enhance a loved one’s nursing-home experience. For example, when I spoke with her on the phone this week, Elaine told me how she had made a special effort to get to know everyone — administrators, aides, nurses, etc. — at the nursing home where her father-in-law became a resident.

“I introduced myself and told them that Santo was my father-in-law. I made a point to ask them their first and last names, and then repeated each one back to them in order to get it right and to remember it well.”

“I find you get better care that way,” she explained. “Santo definitely got VIP attention, and that was because they saw how important he was to his family.”

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When Home Alone Is No Longer Safe

Posted on January 31st, 2013 by karen

by Ed Moran, LCSW

I don’t think I can pinpoint the exact moment I first noticed my mother was getting older. Sure, I know on an intellectual level that Mom, like everyone else, gains a year with each birthday, but I’m talking about the physical changes that accompany aging. They were so subtle at first that I hardly took note. Though Mom is still very active at 75 and sharp as a tack, I’ve begun to wonder what life will be like for her in five or ten years. Can she stay in Florida, or should I try to bring her to Connecticut to live with family? Should she sell the house? Will she need home care? Will she need assisted living? Will she want any of these things? And what if she doesn’t want them? What will I do then? You may have noticed already how my anxiety over Mom’s advancing age is beginning to color my thought process, which is not necessarily a bad thing, if kept in moderation. Understanding our own feelings about our aging parents — anxiety and all — is crucial for making the best decisions about their care.

My mother has been very good about communicating her wants and needs, as well as discussing pertinent “what ifs.” If additional care were ever needed, I think my siblings and I would have a great chance of being on the same page with each other, as well as with Mom. But what about the situations where an aging parent is resistant? Naturally we all worry about our parents, especially if they’re alone. We see signs that living independently is becoming increasingly difficult, yet the parent denies the need for help. The situation becomes even more complicated when one parent accepts the need for change while the other parent resists.

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Save Your Pennies!

Posted on November 15th, 2012 by karen

by Joan Blumenfeld, MS, LPC

In Connecticut, if a person can pay for nursing home care out-of-pocket for several months, or in some cases show enough assets to pay privately for a year, they can select the facility they want and reduce waiting time. If they have spent down their assets and are subsequently accepted by Medicaid, then Medicaid will select the facility, depending on wherever there is a long-term bed available. Thus, setting aside money to privately pay for nursing-home care allows people to make crucial choices they cannot otherwise make.

My 72-year-old client, Sylvia, was outliving her money. And her worst nightmare was inexorably unfolding.

Sylvia was recovering from a stroke and was about to be discharged from rehab when I was hired by the court-appointed conservator to manage her care. Sylvia desperately wanted to return to her nine-room home in one of Connecticut’s lovely shoreline suburbs, but she was ill-equipped to do so.

As a result of the stroke, her walking was impaired, though she could ambulate unsteadily with a walker. One arm and hand were weakened. Sylvia had already been experiencing some dementia, which was exacerbated by her stroke, leaving her judgment and ability to manage her money, her meals, her medications — her life in general — severely diminished. She also struggled with an unrelated life-long mental illness that resulted in hallucinations and delusions, which impaired her relationships with others and required careful medicating.

From a Geriatric Care Manager’s point of view, Sylvia was a challenge!

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The Crisis Is The Solution

Posted on January 17th, 2012 by karen

phone pad 911

by Joan Blumenfeld, MS, LPC

Lily, 92, lived alone in a huge house in Greenwich, CT, with no family nearby.  Her middle-aged daughter, Sue, lived in New Mexico, and her adult grandson, Charlie, lived in Georgia.  Both had been very worried for some time about Lily, who was becoming increasingly frail, but they simply could not convince her to move nearer to one of them or to accept help at home.  Lily had been widowed for many years and managed perfectly well for a long time, thank you very much.  She saw no need for change even though she had recently given up driving and was using a walker to get around.

Although falling was constant danger, Lily would not consider a stair lift to help her get to her bedroom on the second floor because that would spoil the décor of her home.  Nonetheless, the house was getting noticeably rundown — she could not attend to the considerable upkeep required to maintain it.  But she did not share financial information with her loving family because she considered money a private matter.  As a result, Sue and Charlie were in the dark as to whether there were sufficient assets to take care of Lily.

One day a shocked housekeeper found Lily lying on the floor in the kitchen and called 911.  Lily was rushed to the hospital where she stayed for almost a week.  No one knows exactly what had happened or how long Lily lay there waiting for assistance.  After numerous tests, she was diagnosed with a urinary tract infection, pneumonia, dehydration and anemia.

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Calculating The Cost Of Care

Posted on November 14th, 2011 by kim

Genworth Financial map

by Kim Keller

Here’s a fabulous resource: The Genworth Cost of Care Survey, which provides the costs for various home care providers, adult day health care centers, assisted-living facilities and nursing homes.  The survey notes the lowest, highest and median costs of these services by state (including the District of Columbia), as well as the median annual costs of care by city.

Here are the national median costs for:

Homemaker (Personal Care Assistant or Companion): $18/hour

  • For someone who lives at home and needs additional household help, such as housecleaning, cooking, running errands, companionship
  • No personal or medical care provided
  • Price is based on a non-Medicare, licensed agency
  • Most agencies require a 4-hour minimum
  • Genworth notes that the lowest hourly rate is $9 and the highest is $34
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