End of life decisions are so difficult for an advocate to make for his or her’s senior parent. A few months ago, I had to make tough choices for my mom before she passed. A month ago, my husband and his family faced difficult choices for his dad.
My father-in-law, Bill, had been on home hospice with 24/7 care for about three months. He was frail (worn out from being a caregiver for his wife who had Alzheimer’s), had inoperable blockages in his heart, had four small strokes that my sister-in-law witnessed and was frustrated with early dementia.
He was reaching for the cat when he fell.
The hospital determined that his pelvis was fractured in multiple locations and his femur (thigh bone) was broken. So Bill would be bed ridden the rest of his life. Sigh…he was in so much pain.
They were turning Bill every two hours to prevent bedsores. He could only be on his back and the side without the broken femur. He was a two-person transfer.
The fall that sent him to the hospital was a non-hospice related incident so it was covered by insurance. With no hope of improvement the hospital determined that he was once again comfort care. So according to the hospital, he was a hospice patent who needed to move out of the hospital or pay privately.
The only skilled nursing care facility in the area was not an option (bad reputation). There were no hospice facilities in the local area.
So the only two choices were:
- Stay in the hospital for a cost of $48,000 a month.
- Go home with two around-the-clock caregivers for a cost of $32,000 a month (because he was a two person transfer). The going home option would require my sister-in-law to stay home (she works full time) and manage the caregivers. The family would have to reimburse her normal salary.
My wonderful but exhausted sister-in-law found a temporary solution, which she badly needed. It is called hospice respite care, which includes a 5-day stay. Medicare Part A will pay for up to five days of respite care for a hospice patent who is otherwise cared for in the home. It gives a break to the caregiver. It can be provided in a hospice facility, nursing home or hospital. So we started the 5-day clock and didn’t have to move Bill. He was so frail and moving him would have been horrible painful. He died about three days later, pain free, with family at his side.
He worked hard his whole life and the family agreed upfront to pay the $48,000 a month after the respite 5-day stay.
What if a senior does not have this kind of money or a home to sell?
My own 92 year old mother died in skilled nursing care on Medi-cal. It was in a caring compassionate 5-star rated skilled nursing community called Freedom Village in Lake Forest, CA. My mom was lucky. Many skilled nursing facilities that offer Medicaid assistance are not wonderful experiences.
Families need to research choices, advocate and make the best end of life decisions possible at the time.
Hospice Note: Our family’s goal was for Bill to die at home. My sister-in-law was fully prepared through hospice to make this happen. Bill’s devastating fall that required a two person transfer changed the situation. Just shifting him in his hospital bed was horribly painful. We could not imagine moving him in a ambulance at this point to any another location.
This situation is still very raw for me and it has taken me over a month to be able to write about this topic in my blog.
Your Senior Housing Options,” has a simplistic title, but what’s inside this new book can save a you months of research time. Hear Diane Masson’s interview of how her mother and in-law’s faced the pivotal decision to plan ahead or wait until a crisis. Learn the pitfalls from transitioning from your home to senior housing. Understand what questions to ask, insider tips and dirty secrets revealed. The decision to stay home requires caregivers. Prevent elder abuse by determining if a home care agency is reputable, before they move into your home. You are just not looking for today’s needs, but for your future care. Discover key differences between rental facilities vs Continuing Care Retirement Communities. Do you have enough financial resources if you need to be in a higher level of care for an extended period of time? For weekly tips join at: Www.Tips2Seniors.com
Diane Masson has worked in senior housing for 17 years and is the regional marketing director for two debt-free Continuing Care Retirement Communities in Southern CA (Freedom Village in Lake Forest and The Village in Hemet). Her first book “Senior Housing Marketing – How to Increase Your Occupancy and Stay Full,” is being utilized by senior housing professionals across the country. Both her first book and second book, “Your Senior Housing Options,” have a 5-star rating on Amazon.com.
Diane and Chris Flying 1000 Miles to Look for Affordable Memory Care for my Mother-in-law
My mother-in-law is currently in a secured memory care community. The price is very high – $6750 for 30 days of respite care. If we don’t move her within two weeks, the community fee for a permanent stay will be $10,000 and her monthly fee will be $9,000 a month. Are you kidding me? Who can afford this?
She was living in her own home six weeks ago, but a crisis you can read about HERE has left her adult children scrambling to find a permanent solution for my mother-in-law.
My husband, Chris, and I work in the senior housing profession, so who is better than us to evaluate the choices. We flew 1000 miles yesterday to be the experts on the ground in Seattle. We are going to visit three memory care communities today and one or two tomorrow. The best way to evaluate and compare retirement communities is in a short span of time. The crème always rises to the top.
We can’t base our decision on what the community looks like, the size of the rooms or the wonderful sales person. We are going to dig deeper and ask the following questions of each memory care community:
- What is the staff turnover? We want to see longevity of staff – particularly in the administrator, nurse, caregivers and possibly the chef.
- Do the staff and residents look happy? We will talk to some of each.
- What will be my mother-in-laws quality of life? What programming is offered? How often does live entertainment come in the building? How will they minimize her anxiety?
- How many hours does the nurse work per day? Twenty-four hours will always be the best answer, but you get what you pay for.
- What is the procedure if my mother-in-law falls? When my mom was in an assisted living community with dementia, every fall led to a terrifying emergency room (ER) visit that was stressful for her. If a nurse is on shift around the clock, it may save my mother-in-law from this stress. If the fall happens at 2:00 am and only a caregiver is on staff, the call to 911 will almost always lead to the terrifying ER visit.
- Do doctors come and visit my mother-in-law here or does she have to be driven to her doctor? Who will do that? Will someone accompany her? What are the costs?
- We will discuss my mother-in-law’s dietary needs and meet the chef. When my mother-in-law was in the hospital, she became incontinent. We hope it is not permanent and assume the diarrhea was from feeding her too many raw vegetables and fruit. She has not eaten those in years because of too much radiation after colon cancer. So it is important that we advocate for her in this regard. Just incontinence can cost an additional $1,000 a month.
- What is the initial community fee? What is the current monthly cost for room, board and care? What is the maximum cost it could potentially be? What are the additional costs? What have we not asked that could cost extra? What happens when someone is broke and can’t pay these hefty fees? We need to find out if the memory care community charges for my mother-in-law’s care by points, levels of care, or is all-inclusive. Pricing can be very grey and it is easy to be confused. Even us experts will have to see beyond the sales “smoke and mirror” answers.
- What is the history of their year over year monthly increases? We can’t just look at affordable costs today, but what if my mother-in-law lives for years?
- Is the room furnished? Do we just bring personal affects? Do we need to go buy a twin bed, TV or special chair?
- How do they handle hearing aids and glasses? My mother-in-law has two hearing aids that she has not used in six weeks.
- What is their procedure in contacting the family to give updates or let us know of a change in our loved one’s health?
- Is there anything that we should have asked but did not?
We will look at the entire memory care community space, her possible room and the outside walking area. I will keep you posted on our family evaluation and pricing for these communities. Hopefully, sharing my experiences and tips can help you too.
Diane Masson’s new guide book for seniors, “Your Senior Housing Options,” will be available next week on Amazon.com. If you sign up for my weekly newsletter on the right side of this blog, you will be notified when this valuable resource can be purchased. Check out my new website: Tips2Seniors.com or please follow me on Facebook.
Diane Twohy Masson is the author of “Senior Housing Marketing – How to Increase Your Occupancy and Stay Full,” available at Amazon.com with a 5-star rating. The book is required reading at George Mason University as a part of its marketing curriculum. Within this book, the author developed a sales & marketing method with 12 keys to help senior living providers increase their occupancy. Masson developed this expertise as a marketing consultant, sought-after blogger for senior housing and a regional marketing director of continuing care retirement communities in several markets. She has also been a corporate director of sales and a mystery shopper for independent living, assisted living, memory care and skilled care nursing communities in multiple states. Currently, Masson is setting move-in records as the regional marketing director of two debt-free Continuing Care Retirement Communities in Southern California – Freedom Village in Lake Forest and The Village in Hemet, California. Interestingly, this career started when she was looking for a place for her own mom and helped her loved one transition through three levels of care.
© Marketing 2 Seniors| Diane Twohy Masson 2015 All Rights Reserved. No part of this blog post may be reproduced, copied, modified or adapted, without the prior written consent of the author, unless otherwise indicated for stand-alone materials. You may share this website and or it’s content by any of the following means: 1. Using any of the share icons at the bottom of each page. 2. Providing a back-link or the URL of the content you wish to disseminate. 3. You may quote extracts from the website with attribution to Diane Masson CASP and link http://www.marketing2seniors.net For any other mode of sharing, please contact the author Diane Masson.
How many of you have worked with a senior who clearly needs to make a move into a senior living community? Maybe she is lonely, not eating nutritiously, no longer driving or desires the social connectivity of liked-minded seniors. The senior is one visit away from selecting an apartment and putting down a deposit. A daughter has already consented that her mom needs the support of your community and is emotional exhausted from helping her mom. The son/brother is coming to town and they want him to put his stamp of approval on this move.
Suddenly, the senior and the daughter become uncommunicative with you. The family is a no-show for the scheduled tour at your retirement community. Your phone calls to reach out to them are unanswered. What happened? Are they okay? Did something happen and maybe the senior is in the hospital?
Most likely the son came into town and sabotaged the deal. “Mom is fine. She does not need to move into an old folks home. It is too expensive. Just keep helping her sis.” Maybe this son is in denial or maybe he is worried that mom might drain his inheritance. Either way, it is a sad circumstance for the mom who will lose out on a better quality of life and the sister who is tired of taking care of mom while raising her own children.
What can you do? How can you handle this situation in the best possible light?
Here is my suggestion: Next time, prepare the mom and sister for the brother’s visit. I would say, “I would love for your son/brother to come see this community and the apartment that you are considering. Just remember, when you tell him that you are thinking of moving here, he might believe you are moving to an old folks home filled with hospital beds. He won’t be able to imagine the lifestyle you will have living here. I think he will be blown away when he sees the 5-star dining room, live entertainment schedule and all the classes that you want to partake in. Let him know that you understand it is hard to believe and ask him to come see it for himself. Let him know how excited you are and that you want him to support your decision.”
Please share in the comment section below how have you handled this situation in the past.
Diane Twohy Masson is the author of “Senior Housing Marketing – How to Increase Your Occupancy and Stay Full.” It is rated by Amazon Editors as one of the best books of 2014 and readers have given it a 5-star rating on Amazon.com. This award winning book is required reading at George Mason University as a part of its marketing curriculum. Within this book, the author developed a sales & marketing method with 12 keys to help senior living providers increase their occupancy. Masson developed this expertise as a marketing consultant, sought-after blogger for senior housing and a regional marketing director of continuing care retirement communities in several markets. She has also been a corporate director of sales and a mystery shopper for independent living, assisted living, memory care and skilled care nursing communities in multiple states. Currently, Masson is setting move-in records as the regional marketing director of two debt-free Continuing Care Retirement Communities in Southern California – Freedom Village in Lake Forest and The Village in Hemet, California. Interestingly, this career started when she was looking for a place for her own mom and helped her loved one transition through three levels of care.
© Marketing 2 Seniors| Diane Twohy Masson 2014 All Rights Reserved. No part of this blog post may be reproduced, copied, modified or adapted, without the prior written consent of the author, unless otherwise indicated for stand-alone materials. You may share this website and or it’s content by any of the following means: 1. Using any of the share icons at the bottom of each page. 2. Providing a back-link or the URL of the content you wish to disseminate. 3. You may quote extracts from the website with attribution to Diane Masson CASP and link http://www.marketing2seniors.net For any other mode of sharing, please contact the author Diane Masson.