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Senior Housing Solutions

Since 2004, Tiffany Wise has been empowering families with their search for senior housing and care needs in her role at A Place for Mom. Tiffany understands that selecting senior care and housing services can be a very emotional and overwhelming process for seniors and their families, and is happy she can provide expert service to help them find appropriate care for their individual needs and budget. A Place for Mom offers resources to guide families through the search process and provides information and options to empower them in making informed and confident decisions.
Mike Campbell has been an advisor and consultant to the senior housing and care industry for more than 18 years. More than 10 years ago, Campbell formed Campbell Consulting Services, LLC and has visited hundreds of senior housing and care communities across the country, seeing the best and worst that this industry has to offer. In his new book, When Mom and Dad Need Help, he shares and advises on what he’s learned in nearly two decades of research and experience. With more people educated about how to find quality long-term care options, he hopes his efforts will ultimately result in an improved long-term care system nationwide.
Q:

What is the difference between Green House Homes and implementing the Eden Alternative?


Ellen from IL
A: Answered by Tiffany Wise

The Eden Alternative and Green House Project are two separate organizations with similar goals; to provide seniors the opportunity to be cared for in a non-institutionalized environment.

The Eden Alternative focuses on partnering with nursing homes to help them change their culture, environment, and approach to care to “create a habitat for human beings rather than facilities for the frail and elderly.” Many assisted living communities were founded on similar principles.

The Green House Project focuses on helping companies and individuals convert or build residential homes that can provide high levels of care for individuals who do not wish to be a in a nursing home setting. Some of the homes are licensed as nursing homes and others as assisted living communities. You can read more about both initiatives by clicking the links below:

http://www.ncbcapitalimpact.org/default.aspx?id=146
http://thegreenhouseproject.org
http://www.edenalt.org/
 

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Q:

What are some of the commons warning signs that it may be time for my parents (or me) to look at alternative living arrangements?


A: Answered by Tiffany Wise

Sometimes you can see that parents are simply not doing well, but it is hard to put your finger on why. Here are a few things I look for when I visit with families.

  1. Loneliness and isolation. If a senior can no longer drive, their world changes dramatically as they no longer have as much freedom. They can’t make a quick run to the store, drive to the barber or hairdresser on their own, or easily meet their friends for lunch. And, often, at a certain point of life, most of their friends have passed away, which can lead to depression and a lack of interest in normal, everyday activities. Retirement communities can actually increase independence as they can provide transportation and increase socialization.
  2. Confusion or Increased forgetfulness. Look for signs of weight loss and ask your parent/s questions to make sure they’re remembering their meals. What’s in the cupboards? Does it seem normal? Is mail beginning to pile up in a big, disorganized mess? Are bills not being paid on time? If you noticed your loved one is losing things, forgetting doctors’ appointments or forgetting to attend events, like church, that they typically attend—there’s probably a problem.
  3. Changes in Physical Appearance. Sometimes they don’t look like themselves… It might look like they haven’t showered. It might be that their clothes are dirty or they were wearing the same clothes yesterday. It might be that they have lost weight. And while you’re looking, take a look at their pets too. Do their pets look like they have been cared for?
  4. Not eating right or taking medications correctly. Problems taking medication are a big warning sign that something is wrong. Some medications are critical to get right, such as blood thinners. Sometimes they forget to take medications all together, or forget to take them right. Another problem is not eating to accommodate medications, which can relate to further problems or medication symptoms and can affect the medication working properly.

Asking neighbors and friends and scheduling a routine doctor check-up is also a good idea to make sure nothing is out-of-the-norm. Remember that it is common for people to have a tendency to remember parents how they once were—not see the problems of today.

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Q:

How am I going to talk to my parent about moving to senior living?


A: Answered by Tiffany Wise

This is a five-pronged process:

  1. Do your homework first. Take some time to visit a few senior living communities before you have the conversation with mom or dad. This way you’ll be familiar with the different types of communities that are available, such as retirement communities and assisted living communities. Also, keep in mind the question: Why do you think that your parent should consider senior living? Are there specific things that you think they could use assistance with on a regular basis or do you think they would benefit from the socialization?
  2. Ask communities about the resources and guidance they offer. What distinguishes senior living communities are the people that work there. After all, a community is only as good as their nurses and staff. The best communities do not always have the prettiest chandeliers or newest building, for example; the best communities have people that will take the time to listen to your concerns and provide you with resources and guidance for your specific situation. When touring, look for a community that offers support and guidance on how to talk to your parent. Consider working with a Senior Living Advisor who can provide you with resources and education to help you through this journey, as well.
  3. Create a quiet, comfortable ambiance for the discussion. It’s important to create an environment where your parent does not feel threatened or belittled. If you have siblings, you may want to discuss it with your siblings first to make sure that everyone is in agreement. Decide together when and where the discussion should take place. Start by asking if they have ever thought about moving to a senior living community. Have they ever visited one? If they have, ask them what they liked and didn’t like about the community they visited. Let them know that you understand this may be a difficult conversation for them and that it is difficult for you, too.
  4. Ask if they would be willing to go with you to have lunch at a community. Learning and exploring senior living options together can help you assess the situation and find the best accommodations for your parent. Let your parent know that you understand that moving today might not be the right answer. Encourage them to visit communities with you now so that you will know which communities they like (and why) in case an emergency was to happen and you had to make a decision on your own.
  5. Recognize that moving to a community can actually give your parent more independence. Most people fear that moving to a senior living community means they’re giving up their independence. In actuality, moving to a community should help increase their independence as many communities offer drivers, day trips, socialization, and more. Look for communities that foster independence by creating customized care plans allowing the senior to be as independent as possible.

When planning for this conversation, it might help to know that most of us, as we age, think that we can do what we could do about 15 years ago, which is, unfortunately not accurate as we lose not only our energy level, but also our ability to function at our prime level. And if someone has dementia, they almost always don’t evaluate themselves clearly.

If your loved one is adamant about not moving, ask them why. Sometimes they think they can’t afford it. Help them to explore rates at different communities. Many seniors are Veterans or widows of Veterans and there are some great programs from the VA that can help financially. Medicaid will also help pay for assisted living in some states. Learn more about how to pay for senior care.

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Q:

Do you know of any senior living communities that are doing things differently than the life-care model?
 


Amy from CA
A: Answered by Mike Campbell

This is a great question. I’m sure you’re already aware that most Continuing Care Retirement Communities (CCRCs) not only offer life-care contracts, but also “modified” and “fee for service” contracts. For the benefit of everyone reading this, residents, in exchange for a one-time initial entrance fee and monthly service fee, are guaranteed a lifetime of housing, supportive and health care services for the rest of their lives. The entrance and monthly service fees vary depending on the type of contract a person executes with the CCRC. There are primarily three types of CCRC contracts: an extensive or “life-care” contract, a modified contract with a specified or limited amount of health care and a fee for service or “rental” contract that makes residents responsible for all costs of additional health care services as needed. Because of the life-care concept and its provisions, people who want to live in a CCRC must meet certain physical and financial requirements. Prospective residents must be able to function independently at the time of their admission and demonstrate the financial resources to meet the CCRC’s initial and monthly fee requirements. A CCRC, for the most part, is an option that requires a significant upfront financial investment, which many Americans cannot afford to pay.

Now let me expound upon what I’ve been hearing and seeing recently in the industry. With 78 million baby boomers beginning to retire this year, many senior housing and care companies are recognizing the overwhelming need for more affordable senior housing options. What I’m seeing is a focused shift toward developing more affordable independent living units complete with supportive services and senior-friendly design features that allow its residents to remain independent and age in place for a longer period of time.

Affordable housing with supportive services is a key component to our nation’s long-term care continuum. The US Department of Housing and Urban Development (HUD) Section 202 Supportive Housing for the Elderly Program funds affordable housing for low-income seniors and enables seniors to “age in place” with the help of supportive, community-based services. Today there are over 300,000 Section 202 units throughout the United States and an estimated ten seniors that are waiting for each Section 202 unit that becomes available. The other problem is many of the existing affordable housing units were built in the late 1960s and early 1970s. These accommodations were originally designed for seniors in their 60s and early 70s. Today these units are occupied by older, frailer seniors who are oftentimes well into their 80s and even 90s. These living units lack many of the state-of-the-art senior-friendly design features that make these accommodations safer and more comfortable for an aging adult. What you need to look for are features that help our seniors maintain their independence for a longer period of time and providing them a better quality of life. Some of these senior-friendly design features to look for include overall building designs that are completely stair-free, wider doorways and hallways for better accessibility, location of countertops, cabinets and shelving to lower heights for easier accessibility, drawers instead of kitchen cabinets to hold pots and pans for easier access, lever handles on doors, cabinets and faucets instead of knobs for ease of use and shower stalls with molded pull down seats instead of tubs to help prevent frequency of falls.

For an expanded version of this response, please go to the feature, www.parentgiving.com/elder-care/older-population-growing-need-more-senior-housing/


 

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Q:

Have you seen any cross-generational housing where people live in their own cottages and have the support of other generations around them. It's a win-win for all. Does something like this exist? I work with families using the interrelated arts (performing, visual, culinary, and literary) and meditation tools to support the whole family in well-being. What would the best senior housing look like?  


Elizabeth from CA
A: Answered by Mike Campbell

Thank you for your question. I have not been exposed to any cross-generational housing where the senior has the support of the younger tenants living around them. I think this is a fantastic idea. With the aging tsunami heading our way (i.e., 78 million baby boomers), we need some progressive thinkers to think "outside the box" and come up with some viable solutions that provide a quality of life at an affordable cost. I think you may be on to something here. I do know this is happening more and more with related family members renovating their house, making it senior friendly and then having their elder family members reside with them under one roof. The high cost of long-term care has made this a more common solution. If anyone is going to consider this for their family, the cottages/homes must be have a senior-friendly design. If you're interested, I have an article out on my blog titled "28 Home Remodeling Tips to Make Your Home More Senior Friendly!” You can access this article at http://www.iffenwen.com/blog.html
 

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Q:

I am a caregiver for my mom, 85, with dementia for 6 years now. I am trying to find out how I can open a family care home in my town. I was told to contact housing authority, but they said it wasn’t through them. I am interested so that I can open a not-for- profit care home to help seniors not spend all they have saved. I would like some assistance if you can direct me where to start. 


Jodi from NC
A: Answered by Mike Campbell

Jodi, you will need to start with the adult services section of your local county department of social services. Here is a link that provides all the requirements and contact information you will need to get started.

http://www.ncdhhs.gov/dhsr/acls/flofch.html

Very truly yours,
Mike Campbell
 

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Q: What happens if my parents run out of money to pay the rent?
A: Answered by Mike Campbell

Most communities will financially qualify your parents before allowing them to move in. There have, however, been instances in which people have lived at a community for an extended period of time and, as a result, have depleted their assets to a level where they can no longer afford the rent. What happens then? Will the administration help your parents apply for Medicaid? What happens if the state where your parents reside doesn’t have a Medicaid Waiver program for assisted living housing? Will they be forced to move out? These are the types of questions you’ll want to ask the marketing director before signing a residency agreement with the community. Make them give specific answers. Most residency agreements specify when a community has the right to terminate a person’s residency, including lack of funds.

Each resident of an assisted living community is required to execute a residency agreement prior to occupying an assisted living apartment. What exactly is a residency agreement? A residency agreement is a legal, binding contract between your parents and a community. It outlines the various terms of the contract including the payment of monthly fees, the services provided, refund provisions (if any) and when the community has the right to terminate your parent’s agreement. The residency agreement should provide specific examples as to when the community has the right to force a resident to move out. For example, the agreement should be clear as to how much care the community can provide and, upon reaching specific higher levels of care, when the resident must move out. It should also outline what action the community will take if your parents can no longer pay the required monthly fees. Will your parents be required to move out? It’s imperative that you and your parents review this agreement carefully with your parent’s attorney or eldercare consultant before signing anything. These agreements are fairly standard, however it’s always better to be safe than sorry.

Some communities, especially not-for-profit communities or communities with not-for-profit sponsors, will have resident benevolent funds established to help residents that are no longer able to pay their monthly fees. These benevolent funds are typically funded by charitable contributions made by the more affluent existing residents, resident family members, former resident estates, as well as supporting members and trustees of the not-for-profit organization or sponsor. The funds allow residents that are no longer capable of paying the required fees to continue to live at the community for as long as they desire.

Note that in addition to financially qualifying for admission to an assisted living community, your parents will also have to qualify physically. Before being allowed admittance, your parent will typically have to undergo a health evaluation by both an independent medical professional and the medical director employed at the assisted living community. As long as your parents are not bedridden or incontinent, they should qualify for admission to most assisted living communities. It really depends on the assisted living community and the amount of care they’re capable of providing there. The initial health evaluation or care assessment will also allow the community to determine what level of assistance your parents need, which will also determine the size of the initial monthly fee.

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Q: Who is responsible for paying for assisted living for elderly parents?
A: Answered by Mike Campbell

Assisted living services are not covered by Medicare. If, however, your parents’ income and assets are minimal, and depending on which state they live in, they may qualify for admission through the state’s Medicaid Waiver program. To find out if your parents live in a state with a Medicaid Waiver program for assisted living services, call your local Area Agency on Aging, the State Department of Health and Human Services or the State Medicaid Agency as most states have a separate agency to administer these programs.

Some private long-term care insurance policies provide a daily benefit for services that occur in an assisted living community. If your parents have a long-term care insurance policy, make sure to review it with your parent’s attorney or eldercare consultant to determine if assisted living services are covered.

Based on the available payment options noted above, unless your parents have a private long-term care insurance policy to help them pay for a portion of their daily fee, your parents are probably going to pay for their assisted living services out of their own private funds.

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