Dear Readers

This spring, I’m taking a brief break from blogging. While I have loved writing for you, I have an interesting opportunity that I just can’t turn down. However, I am still researching, speaking and writing about senior housing.

Although I’m not actively blogging, you can still find plenty of good stuff on the site about senior housing. In order to make it even easier, you can read my best, most informative articles by clicking on the links below. I’ve roughly grouped them by topic, but there is a great deal of overlap:

General:

Continuing Care Retirement Communities:

Independent Living:

Assisted Living & Memory Care:

Nursing Homes

Hospice/Home Health/Living at Home:

And, of course, you can always buy one of my books on Amazon:

Also, just because I’m not blogging right now doesn’t mean that I’m not here to help answer your questions. If you have anything that you don’t see answered on my site, feel free to email me: Virginia@SeniorHousingMove.com.

Additionally, I’m still happy to come speak to your group about senior housing issues. You can email me for more information.

Have a safe and prosperous 2015, and thank you for visiting Senior Housing Move.com.

Virginia

Researching nursing homes, assisted living in Mexico, crazy causes for dementia symptoms, and complaining to Medicare

Reading glasses help seniors in hospitals

Finding a nursing home isn’t simple, but lots of research generally pays off.

Would you move to Mexico for assisted living?

Diabetes can cause dementia symptoms if left untreated. Another culprit: hearing loss.

How to complain to Medicare.

Seniors bust dishonest business, assisted living staff member buries patient behind facility, abuse & neglect in nursing homes, and checkered pasts

CSI logo

Next on “CSI: Adult daycare,” a senior busts adult daycare operators who falsify documents!

Creepiest thing I’ve heard in a long time: An assisted living staff member was arresting for burying a resident behind the facility.

85% of nursing homes reported abuse or neglect in 2012.

Assisted living operators sometimes have a checkered past.  That’s why it’s always good to check with your local nursing home ombudsman or check your state’s assisted living complaints database.

Understanding a CCRC’s “permanent transfer” policy

There are three things that I think everyone should understand about their move into a CCRC: the community’s amount of debt, the community’s entrance fee refund policy, and the community’s policy on permanent transfers to assisted living or nursing.  Today we’ll talk a bit more about the third one: permanent transfers.
When you move into a CCRC, you agree to move to a higher level of care in the event that you can’t stay in live alone anymore.  It’s called “permanent transfer” because they assume that you will never move back into independent living and thus can resell your apartment to someone else.
There are a few things you should note about CCRCs permanent transfer policy:
The community will decide when you have to move. By and large, almost all CCRC contracts have policies regarding residents who can no longer live on their own.  Due to the sensitive nature of the decision, most contracts require that the community’s executive director and its director of nursing sign off on the transfer.
You don’t have much say in the process. While the community will often consult you and your family about the move, you generally won’t have too much of a say.  This makes sense if you think about it.  Especially for residents who have dementia or other cognitive problems, it can be hard to spot one’s own inability to live independently. However, some seniors bristle at the idea of someone else telling them when they must move out of their independent living apartments.

Read your contract.  Policies vary from community to community, so read your documents carefully. In most cases, your doctor, the community’s head nurse, and administrators must “vote” in favor of your permanent move.  If you disagree, then you’ll have to either prove your independence or move out.  It sounds drastic, but that’s the way it’s handled in most places.

The benefits to the CCRC are many.  For one, the community can ensure resident safety by moving people who need more care to assisted living or nursing.  They can also resell the apartment, which improves their bottom line.

While permanent transfer policies help residents who are in denial of their conditions get the additional help that they need, sometimes there are disagreements.  Unfortunately, they usually work out in favor of the community.  So, if you’re not moving into a community that allows aging in place, it’s in your best interest to read and understand the permanent transfer policy.  It’s probably one of the most important things that you can do before signing on the dotted line.

Want to learn more about senior housing? Check out these posts:

Is it cheaper to stay at home or move into a CCRC?

How do I time my move into a CCRC?

Thoughts on the Frontline documentary about assisted living.

The naked truth about entrance fee refunds.

New email scams, retirement is becoming more difficult, helping parents control money better, and finding an assisted living roommate

Danger

A new scam is out there: Don’t open any emails sending you condolences about your “dead friend.”

Retirement is going to become more difficult all around the globe.

Giving your aging parent a prepaid debit card might help them maintain independence but also prevent fraud.

Assisted living with a roommate may help make it more affordable for more seniors.

Should retirement communities be owned and run like a McDonald’s? (Part 2)

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 Note: This is Part 2 of two. Read “Should retirement communities be owned and run like a McDonald’s? (Part 1)” here.

The Bad News:

Managers don’t always care as much about customers. To be fair, this is an issue that every company faces. As a business owner or manager, your goal is to make money. Most of the time, you do that by making the customer happy. But, sometimes that goal can be obscured, especially when managers have bonuses or other competing interests at hand.

It’s worse in corporate situations where managers get bonuses based on financial performance. This can sometimes lead to short-term thinking, which is not always in the best interest of the customer.

For example, real estate investors and hedge funds are under enormous pressure to improve their return on investment, and sometimes this means taking more aggressive approaches to investing. Some of these plays will pay off. Others will blow up.

Risk is magnified.  Aggressive growth strategies in a large provider of senior housing can blow up quickly if the market shifts at the wrong time.  What’s worse is that communities that are perfectly healthy and vibrant can be dragged down by disasters in other parts of the country.  For instance, declines in real estate in one part of the country can impact sales at retirement communities in that area.  If these communities are owned by a regional provider, then no one outside of that area is really impacted.  However, a national provider that has trouble in one market might be tempted to pull cash from an otherwise healthy community to help cover the costs.

Parting Thoughts:

None of these benefits or drawbacks are set in stone.  There are plenty of corporations that begin shaving services and customer care as they get bigger.  Also, there are plenty of companies that are huge behemoths and yet still manage to make customers happy every single day.  The success or failure of a national chain of senior housing communities depends largely on the way the company is run, which is why it’s really, really important that these companies hire good managers.

I can’t say for sure if the consolidation trend is good or bad. In fact, it doesn’t matter because it’s going to happen one way or another. It will certainly impact residents’ lives, although not necessarily in bad ways.

My instinct is to rattle my saber and declare war against the invasion of Wall Street. Seniors shouldn’t have to worry about their home being sold at a bankruptcy auction after hotshot managers make silly decisions and invest foolishly. But, then again, that sort of thing happened in the industry prior to Wall Street arriving.

Ultimately, I think the rules of the game will have to be rewritten a bit, and, unfortunately, it will be big corporations wielding the pen.  Competition will continue. Consolidation will continue. There will be bankruptcies, but, by and large, the ramifications will be felt only for managers and debt holders, not seniors themselves. However, the benefits of consolidation mean that seniors might see better amenities and more activities.

Read Should retirement communities be owned and run like a McDonald’s? (Part 1)

Want to learn more about senior housing? Check out these articles:

Five questions to ask during your visit to senior housing.

Why do CCRCs charge an entrance fee?

What is adult daycare?

Take your pet with you to the retirement community.

Should retirement communities be owned and run like a McDonald’s? (Part 1)

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Note: This is Part 1 of two. Read “Should retirement communities be owned and run like a McDonald’s? (Part 2)” here.

Five or ten years ago, there weren’t that many really large companies building continuing care retirement communities. Sure, Brookdale and Sunrise were big, as was (and is) Emeritus and Atria. But, they largely focused on nursing homes and assisted living.  Most CCRCs were owned by smaller, regional companies or by nonprofits.

Since the market crashed in 2008, that has changed dramatically. Senior housing has become an increasingly attractive play for anyone from hedge funds to real estate investors.  This has spurred a round of consolidation that is relatively unprecedented.  It’s very possible that in the next decade, the majority of retirement communities in the United States could be owned by the same two or three companies.

Is that a bad thing? 

We tend to distrust big corporations, and I think for good reason.  But, yet, we all tend to eat at chain restaurants, shop at chain stores, and buy products from the same big online retailers.  Is it really a big deal if retirement communities follow suit? Would having a few national chains control the entire market impact consumers?

I see several benefits and drawbacks to this scenario:

Most large firms have better access to capital. Smaller retirement communities have to work harder to get credit in the event of financial difficulty, and it’s more expensive.  Larger firms can negotiate for loans and financing on a much more national basis, making it easier to finance campus improvements or new communities.  They also have better access to development consulting and other services, which might be prohibitively expensive for smaller companies. Overall this is good for residents, since providers can get the funding their need in a more efficient manner.

Standards and procedures will be more uniform. Ever visited a family restaurant that just didn’t function well? The cash register was too close to the buffet line, and the tables didn’t leave enough room for servers to walk? Well, most of those issues have been solved in chain restaurants.

As firms get larger, they learn which strategies work the best, and they optimize their organizations.  That’s good news for senior housing where staff have to handle a large array of situations and can benefit from additional training that smaller companies might not have been able to provide.

Lifestyle improvements. Larger corporations will probably be better-suited for creating amenities and activities that improve residents’ quality of life:

  • Better activities:  Smaller companies usually rely on one dedicated activity coordinator to handle all aspects of resident life.  If there were a few national providers, these organizations could pay a department of people to craft activities, travel, or other amenities that would help improve resident quality of life.  Since large corporations can negotiate on a grand scale, these services might also be cheaper.
  • Travel agreements among communities in the same chain would allow seniors to effectively visit any city in the country and always have a place to stay.
  • Large corporations can afford to investment in aging in place technology, which might help seniors stay independent for longer.

Read Should retirement communities be owned and run like a McDonald’s? (Part 2)

Want to learn more about senior housing? Check out these articles:

What to expect on your first visit to a retirement community.

Three sneaky sales tactics and your best defense!

How to find a CCRC.

What is LifeCare?

Helping Friends find the Right Community

Togetherness

I’ve got a friend who just moved into a senior housing.  Her children live miles away from here, and as she gets older, she has decided that her best bet is to move into a an independent living community.  As she’s gone through this process, I’ve helped her with some of the aspects of the move and, through it, have gained a better appreciation for the role that friends can play during this time in life.

If you’ve got a friend who needs your help in finding the right retirement community, here are some tips:

Ask first. Before moving forward with any of these other suggestions, make sure to ask whether or not your friend wants help.  It seems like common sense, but not everyone wants a companion when they visit retirement communities.

Offer to drive. The retirement community that my friend ended up picking was right down the street from her old apartment complex, but having me there to make sure that we arrived on time, drive her, and drop her off at the door really helped her focus on making the most out of the visit.

Help carry papers or purses. The marketing department will offer you all sorts of goodies during your visit: a folder containing community information, a bottle of water, etc. It’s a lot to handle, especially for a person with mobility issues.  Bringing a backpack or even just offering to help carry these items can be very helpful.

Make a list of questions beforehand. When in the thick of things, it’s hard to remember which items are important.  Consider helping your friend write down a list of questions ahead of time.  Carry the list in your pocket so that it’s easy to reach during the marketing visit.

Offer emotional support. The idea of moving to senior housing can be very stressful for some people.  Seniors often just need a friend to hear their concerns.  Try to focus on listening, and let them discuss their concerns.

Try not to push the issue one way or another. It may be blatantly obvious to you which decision is “the best,” but try to let your friend work through the decision on her own.

Allow her time to come to an independent conclusion. Again, it may be hard to be patient.  But, most people will recognize when they need help.  If you can, allow your friend time to come to a decision regarding her move.

After visiting the local retirement community with my friend, we went out for Chinese food and discussed our impressions of the visit.  At the time, she was against moving, since her apartment offered numerous advantages over the retirement community.  After several months of consideration, she finally decided to move.  Now that she’s been in her new apartment for a few weeks, she wishes that she had moved earlier!

Gone are the days when we could rely on our family to handle all of our aging needs.  Seniors who have no close family members benefit from the trusted companionship of friends.  If you’ve got a friend who is interested in moving into senior housing and has asked for your help, don’t hesitate to tag along and lend a helping hand.

Want to learn more about senior housing? Check out these other articles:

Why it’s not a good idea to get pushy with a senior housing decision.

Signs of trouble in any community.

How to time your move into a CCRC.

Slightly scary articles about senior housing.

Signs of Trouble in any Community

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It doesn’t matter if you’re looking at independent living, assisted living, or skilled nursing, there are some things that are bad news in every community:

Lack of maintenance. Communities in financial danger or communities with incompetent management will sometimes postpone maintaining the property in order to save some cash in the short term.  This is a bad idea, since small maintenance issues can grow quickly into large problems.  If you see things like unkempt grass, out-of-order toilets, torn carpet, trash in the hallways, or other indicators of maintenance problems, you can bet that there are other things that are wrong that staff isn’t working to fix.

Bad odors. You might be tempted to forgive foul smells in a nursing home, but doing so is a mistake.  The only aroma that you should smell in any retirement community is that from cleaning supplies or food service.  Anything else is a sign that something is awry.  Even nursing homes, where staff have to change adult diapers, should have measures in place to remove the soiled linens from the building.  While there are exceptions to this rule, it’s generally a good bet to skip communities that have a foul smell in the air.

Ill-tempered staff. Regardless of wage rates and turnover, no one wants to live in a place where angry, unhappy people work.  If you see any staff member lose their temper or lash out (especially if management is around to see the episode), see yourself to the door.

Thinly-stretched staff.  There is a lot of staff turnover in the senior housing industry.  For one, most people who work at retirement communities aren’t paid very much.  They also do manual labor jobs like lifting patients or cleaning rooms.  As competition has increased in the senior housing industry, managers are forced to cut wages and staffing ratios even more.  That means that people burn out faster at their jobs.

Staffing ratios (the number of patients to one nurse) have been stretched in recent years due to market pressures.  But, good communities will make sure that staff members aren’t overworked such that they can’t care for patients.  So, if you visit a community where everyone always appears to be in a state of panic, consider other options.

Untrained staff. Unfortunately, staff in retirement communities need to know how to handle many different types of situations not normally experienced in other unskilled positions. When emergencies occur, untrained staff can be downright hazardous to themselves and to residents.  Make sure to ask about the training and background checks that staff members receive prior to joining the community’s workforce.

Angry residents or families. While there will always be at least one resident who is not happy living in the community, pay attention to the attitude and demeanor of the folks who live on the property.  If they’re not happy, then you probably won’t be happy either.

Please remember that it’s ok to listen to your instincts.  If something doesn’t feel right, then you’re perfectly fine to end the meeting and leave.  Also, remember that your decision doesn’t have to be made in one day.  Feel free to do multiple visits to the community.  You can also request lunch or dinner with some current residents to get a feel for the place.  Sometimes retirement communities will also offer you a one night stay in their guest suite to give you an idea of what it’s like to live there.  Feel free to take them up on this offer and to get an idea for how the community functions on a daily basis.

Want to learn more about senior housing? Check out these other articles:

Pushing for a move to senior housing isn’t a good idea.

What is adult daycare?

How to “test drive” a community.

Pets and senior housing.

Paying for a CCRC.

Pushing for a move to senior housing isn’t a good idea

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If anyone should win an award for being too pushy, it’s probably me.  I can’t seem to take “no” for an answer, and I don’t mind throwing all of my powers of logic and persuasion into the argument to help make it harder for the other person to deny my position.  But, when it comes to senior housing, trying to convince someone who doesn’t want to move is a bad idea.  Here’s why:

  1. Their stubbornness isn’t based on logic.  Well, at least not the type of logic that you’re probably employing.  The problem with arguing about a person’s safety and comfort is that they don’t view the decision in those terms.  A large number of seniors view the move to assisted living or a nursing home as an admission of weakness, or worse, that the end is near.  Giving up one’s home and autonomy isn’t something that they want to do because it implies that they’ve lost relevance. So, any arguments you make, no matter how persuasive, will likely fall on deaf ears.
  2. For every action, there is an equal and opposite reaction. The more you push, the more they’ll push, the more they’ll hate you.  Your best bet is to help them discover senior housing on their own.
  3. Do you really want to be “that” person? There is a fine line between being a crusading child who cares about a loved one and being a crusading child trying to push through his/her own agenda.  While you may see yourself as the savior in the situation, you might also be turning people off with your tactics.

If you feel that there are safety concerns associated with your loved one staying home alone, then you have some options:

  1. Begin documenting health and behavioral problems. The more data that you can bring to the table, the better prepared you’ll be for future discussions.  Having a demonstrated pattern of behavior or health problems can help convince otherwise reticent family members that there is truly a problem.
  2. Call a family meeting. Inevitably, there will be one family member who says, “Everything is fine, Mom’s just a little confused.” There will be another family member who wants to send Mom to a nursing home as soon as possible.  The trick is to lay out all of the information and craft a plan so that everyone feels more comfortable with the situation.
  3. Considering hiring help. The easiest way to delay a move to a nursing home is to hire someone to come in and help on a daily basis.  This has a few benefits: not only will someone be there to report back on Mom’s progress, but Mom will also have someone making sure that she eats and bathes on a regular basis.
  4. Focus on quality of life. Being able to prepare your loved one for life in a new community is your greatest asset as a caregiver.  Having scheduled transportation and an active social calendar can help give seniors back some of the independence they may be losing by staying at home.  Focusing on the benefits of such an arrangement is to your advantage.  Another option, especially for seniors who have had surgery or need short-term help, is to emphasize how temporary the move can be.  Once they regain their strength, they’ll head back home.

While almost all seniors have qualms with giving up their independence, most will eventually realize when they can no longer live on their own.  Unfortunately, that realization may take longer than you would like.  Rather than try to force someone to move when they aren’t ready, take time to understand why they’re reluctant to move.  Don’t try to reach a conclusion in one sitting.  Instead, focus on small changes that can improve your loved one’s quality of life and help give you peace of mind.