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

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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.

Who owns CCRCs?

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For many years, CCRCs were owned by local or regional companies or nonprofits.  By some estimates, up to 80% of CCRCs were nonprofits.  But, that’s been changing recently. When the housing market crashed, so did a lot of new nonprofit CCRC developments.  This caused a wave of acquisitions by for-profit providers between 2009 and today, which has forever altered the landscape of senior housing.

Here are some of the big players in the senior housing industry and a summary of who owns them: (Note that this list is certainly not exhaustive.  If there’s a big one that I’ve left off, please let me know.)

Also, as more and more retirement communities become more professionally-managed, companies have sprung up offering management services.  Life Care Services is one of the largest in the country.  They manage care for over 28,000 seniors.

Why does this matter for seniors?  For the most part, it won’t change life for seniors all that much.  But, there are some things to keep in mind:

  • Communities that used to be owned by small, local companies are now owned and operated by much larger companies. This doesn’t necessarily make that a bad thing.  Rather, it’s a fact that senior should keep in mind when shopping for retirement housing.
  • It isn’t always clear who owns what. Olive Garden is owned by Darden Restaurants, but you never really see their name.  It’s not that they’re being secretive.  It’s just that Darden owns about ten other chains of restaurants.  Similarly, Sunrise and Erickson are owned by much larger companies.  So, when you go visit the campus, remember that you’re visiting part of a much, much larger company that has service lines in dozens of other aspects of real estate and senior housing.
  • Get ready for that “big company” feel.  On the one hand, large companies having significant ownership stakes in restaurants, shopping centers, and other facets of American life has worked out well for us.  We see a Wal-Mart sign, and we know instinctively what types of things we can buy there.  It sets our expectations and helps us to understand the types of services offered in one location.  On the other hand, we’ve all had the experience of eating at a restaurant that “got too big.”  There will be senior housing chains that fail because they cut costs too much and service gets sloppy.  There will be others that people flock to because they offer the best service for the best price.

Seniors housing is undergoing a major change.  But, at the end of the day, you’ll still be looking for the same things when shopping for senior housing: good care, professional staff, a history of safety, well-kept facilities, and happy residents.

Want to learn more about CCRCs? Check out some more articles:

Should retirement communities be run like McDonalds? Part 1 Part 2

Signs of trouble in any community.

Helping friends find the right community.

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.

Nursing Homes 101

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Note: This post originally appeared at Cariloop.com.

When most people think of retirement communities, they are actually thinking of nursing homes, which are a specific type of facility that cares for people with very high needs.  If you think that your loved one needs to move into a nursing home, here are some things to know before you start your search:

Nursing homes provide nursing care around the clock. Compared to an assisted living or independent living where residents receive some services, nursing homes are staffed with nurses who have experience working with people who need high levels of care like wound care or special therapy.

Most nursing home visits are paid by Medicaid. Medicare will cover the first 100 days following hospitalization, but after that, you’ll need to apply for Medicaid, tap your long term care insurance policy, or pay out of pocket.

Nursing homes cost about $75,000 per year. The cost varies based on location and room configuration (private or semiprivate rooms), but nursing homes aren’t cheap.

Medicare and Medicaid rate nursing homes. Want to know what a professional inspector thought of the community? Check out Medicare’s site: Nursing Home Compare. It’s got ratings for every nursing home in the United States.  It’s free to use, and you can search by city.

Nursing homes are only one type of retirement community.  There are several other options (like independent living, CCRCs, assisted living, and memory care), but nursing homes provide the most care and are most suitable for patients with advanced diseases who need skilled nursing care around the clock.

Dogs in nursing homes, sex in nursing homes, caring for loved ones with dementia, and banks tackling fraud

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There’s a new book out about a nursing home dog and his owner.

Is it ok to have sex when you live in a nursing home? “The Atlantic” grapples with the idea.

If you’re looking for good information on caring for a loved one who has dementia, there is a great blog dealing with that subject.

Banks don’t always help seniors who have been victims of fraud.

Cute dog on table” © 2012 epSos .de, Attribution 3.0 Generic http://creativecommons.org/licenses/by/3.0/

Pets & retirement communities, CPR, nursing home costs, and diabetes & dementia

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More nursing homes are allowing visits from your pets!

Do staff at retirement communities have an obligation to provide emergency services?

How much will an average nursing home set you back this year? $84,000.

Diabetes get dementia more than 2 years earlier than those without it

PUPPY” © 2010 my talking tree, Attribution 3.0 Generic http://creativecommons.org/licenses/by/3.0/

 

Women & long term care insurance, fewer seniors are investing, Boomers & Alzheimer’s, and aging

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Women pay a lot more money for long term care insurance.  (Why? Because they live longer and spend more time in nursing homes.)

Fewer seniors are investing; more are working into retirement.

More Boomers have Alzheimer’s than expected.

Aging is mostly in your mind. (Best news I’ve heard all week!)

Plate of money” © 2009 GS+, Attribution 3.0 Generic http://creativecommons.org/licenses/by/3.0/

Best nursing homes, selling your home now, best places to retire, and tips for grieving caregivers

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The US New & World Report recently released a list of the best nursing homes in the country.

Thinking about selling your home and moving to retirement in about 10 years?  Now could be a much better time to do it.

Nerd Wallet just published their top 10 best places to retire.

More tips for grieving caregivers.

Nurse” © 2009 Walt Stoneburner, Attribution 3.0 Generic http://creativecommons.org/licenses/by/3.0/