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Weighing the Options for Assisted Living - Greensboro, NC

Joseph Coupal - Monday, January 09, 2017

Spring Arbor assisted living, Greensboro, NCAssisted living residences are aimed at helping residents remain as self-sufficient as possible with the assurance of assistance when needed. A combination of housing, meals, personal care and support, social activities, 24-hour supervision and, in some residences, health-related services is usually provided. Assisted living facilities are a great choice for those who can’t live on their own, but do not need nursing care. As needs change, these facilities offer different levels of care at different costs – and some are even associated with nursing facilities should your loved one eventually need full-time nursing care.

There is no standard for assisted living residences, which vary in size, appearance, cost, and services offered. Some residences provide only meals, basic housekeeping, and help with the activities of daily living (ADLs) such as bathing, dressing, and grooming. Others go beyond these services and furnish transportation and certain health services. Facilities range from small homes with just a few residents to high-rise apartment-style buildings with hundreds of residents. Living areas could be a single room or a full apartment with a small kitchen, with prepared meals also served in a common dining area.

If assisted living sounds like the right choice for your loved one, here are some steps to help begin your search:

Finding Facilities

Start by making a list of residences to visit. The following resources can help:

  • The state or local Area Agency on Aging (AAA).
  • The long-term care ombudsman’s office .
  • The state licensing agency.
  • Friends and neighbors.
  • Retirement guides.
  • The Assisted Living Federation of America (ALFA), which provides lists of its member residences by each state. These are mostly for-profit residences. The lists do not include all residences in each state.
  • The American Association of Homes and Services for the Aging (AAHSA), which provides lists of member residences by state. These are not-for-profit.
  • The Eldercare Locator helps you find the closest Area Agency on Aging (AAA) office and the state long-term care ombudsman’s office.

Keep in mind that assisted living residences are not defined or regulated by the federal government. Each state decides how they’re licensed. Be sure to find out from the AAA or state health department how the state where you are searching handles this. Make sure all the residences on your list are appropriately licensed—if one of them isn’t, cross it off and move on.

Check, too, with the state licensing agency and ombudsman’s office to see if there have been complaints filed against the facilities on the list. Don’t assume that a state license ensures quality care.

Next: Make the Call

Call each potential residence and ask for a general overview of their facilities. Remember that the person you speak with will most likely be a marketing or sales representative whose job is to promote the residence.

If you’re still interested after the call, ask that more information be mailed to you or your loved one, including:

  • Brochures.
  • A price list.
  • A map or floor plan.
  • A copy of the residents’ rights and rules.

Copies of all the documents that will need to be signed before admittance, including, most important, the contract (sometimes referred to as residency, occupancy, or admission agreements).

Once you receive these materials, review them carefully with your loved one and write down all the questions that come to mind. Strike any residences from your list that don’t meet your criteria.

In our next blog post, see information about planning the visit, signing the contract and other general tips.

For more information, contact Spring Arbor.


Signs Your Parent Needs Help - Richmond, VA

Joseph Coupal - Friday, January 06, 2017

Spring Arbor Assisted Living, Richmond, VAKnowing when to begin discussions about needing assistance for aging parents is not always as simple as one might think. Maybe you've noticed unopened mail is piling up. Or parents who had been meticulous about their appearance are now wearing wrinkled clothes. When you bring up these observations, their instant response is, "Everything is fine, there's no need to worry."

Admitting they need help would mean they can no longer take care of themselves, and no one wants to lose their independence. Denial is the unrealistic hope that a problem is not really happening and will go away by itself. Admitting they need help and accepting assistance is not easy for people as they age. It represents a loss of independence. Denial plays a major role and signs get ignored.

The burden often falls on the family to recognize the signs that an aging parent might need help with daily living tasks. This may mean it may be time that your loved one move to assisted living. If they're not willing to admit it, how do you know if your elderly parent needs help? Look for the red flags listed below.

Signs Your Parent Needs Help

  • Spoiled food that doesn't get thrown away
  • Missing important appointments
  • Unexplained bruising
  • Difficulty getting up from a seated position
  • Difficulty with walking, balance and mobility
  • Uncertainty and confusion when performing once-familiar tasks
  • Forgetfulness
  • Unpleasant body odor
  • Infrequent showering or bathing
  • A strong smell of urine in the house
  • Noticeable decline in grooming habits and personal care
  • Dirty house, extreme clutter and dirty laundry piling up
  • Stacks of unopened mail or an overflowing mailbox
  • Late payment notices, bounced checks and calls from bill collectors
  • Poor diet or weight loss
  • Loss of interest in hobbies and activities
  • Changes in mood or extreme mood swings
  • Forgetting to take medications, or taking incorrect dosages
  • Unexplained dents and scratches on a car

Once the problem is realized, the family must decide if assisted living is the best option.

When and How to Start the Conversation

If you've noticed the warning signs, the time to start talking with senior parents is sooner rather than later. Do not wait until after a crisis has occurred. But how do you bring up sensitive subjects related to aging? Use conversation starters that might help overcome the awkwardness.

Discuss what you've observed and ask your parents what they think is going on. If your parents acknowledge the situation, ask what they think would be good solutions. If your parents do not recognize a problem, or shrug it off, use concrete examples to support your concerns.

Remember, you are having a conversation with an adult, not talking to a child. Patronizing speech or baby talk will only put older adults on the defensive and convey disrespect. Put yourself in your their shoes and think of how you would want to be addressed in this situation.

For more information on assisted living, contact Spring Arbor.

Aging Care

How to Handle Signs of Decline in Your Parent - Richmond, VA

Joseph Coupal - Monday, December 26, 2016

Spring Arbor, Raleigh, NCThe last blog post we discussed signs to look for in an aging parent over the holidays. Here we are going to talk about what to do next.

There may be areas of concern, specific to your family member. Should this year's holiday visit open your eyes to current and potential problems or negative changes in your parent's physical or emotional state, then it's time to put a plan of action in place.

Initial Conversation

First, have a heart-to-heart conversation with your elderly loved one about their present circumstances, concerns and the measures they'd like taken to make things better. Introduce the idea of a health assessment appointment with their primary care physician. Would they feel more at ease if a home health aide visited a couple times a week? Maybe they have legal questions and would greatly benefit from an appointment with an attorney. Or they may need help with housecleaning or bill paying.

Identify Resources

While you may want to keep things light during the holiday season, do take this opportunity to collect all necessary information now to avoid frustration and confusion in the event of a crisis down the road.

Pay a visit to the local Council on Aging for resources and services available in your parent's community. And get a copy of the local telephone book to take home with you if you live out of town– it will come in handy as you and your loved one create a "go to" list of services over time.

This list should include friends, neighbors, clergy, local professionals and all others who your family member has regular contact with. In fact, if you haven't already, take the time to visit with those friends and neighbors and make sure you have their addresses, telephone numbers and e-mail information and make a point to provide them with your contact information as well.

Prepare a To-Do List

Now is the time to begin compiling a to-do list to be implemented over a period of future visits. Keep records of your elderly parent's medical information. Medical information should include your loved one's health conditions, prescriptions and their doctor's names and contact numbers. A financial list should contain property ownership and debts, income and expenses, and bank account and credit card information. You should also have access to all of your parent(s) vital documents that could include their will, power of attorney, birth certificate, social security number, insurance policies, deed to their home, and driver's license.

And remember to give your loved ones the power and permission to be in control of their own lives – as much as is reasonable. The more systems you have in place the more your loved one will be kept independent and safe in their own home, giving you peace of mind as you return home from your holiday and future visits.

For information on assisted living, contact Spring Arbor.


What to Look for During Holiday Visits with Aging Parents - Richmond, VA

Joseph Coupal - Monday, December 19, 2016

Spring Arbor Assisted Living, Raleigh, NCWhen families live far away from one another, the holidays may be the only opportunity that long-distance caregivers and family members have to personally observe older relatives. Age-related decline can happen quickly. Family members who haven't seen their aging loved one since last year may be shocked at what they see: a formerly healthy father looking frail, or a mom whose home was once well-kept now in disarray.

Changes That Indicate the Need to Take Action

For those who have relied on regular telephone conversations and assessment by other closer-living relatives to gauge aging parents' well-being, the upcoming holiday visit may be revealing. Absence – even for a short period – often allows us to observe a situation through new eyes.

Weight Loss

One of the most obvious signs of ill health, either physical or mental, is weight loss. The cause could be as serious as cancer, dementia, heart failure or depression. Or it could be related to a lack of energy to cook for a loved one or just themselves, the waning ability to read the fine print on food labels or difficulty cleaning utensils and cookware. Certain medications and aging in general can change the way food tastes. If weight loss is evident, talk to your loved one about your concern and schedule a doctor's visit to address the issue.


Pay close attention to the way your parent moves, and in particular how they walk. A reluctance to walk or obvious pain during movement can be a sign of joint or muscle problems or more serious afflictions. And if unsteady on their feet, they may be at risk of falling, a serious problem that can cause severe injury or worse.

Emotional Well-Being

Beware of obvious and subtle changes in your loved ones' emotional well-being. You can't always gauge someone's spirits over the telephone, even if you speak daily. Take note for signs of depression, including withdrawal from activities with others, sleep patterns, lost of interest in hobbies, lack of basic home maintenance or personal hygiene. The latter can be an indicator not only of depression, but also of dementia or other physical ailments including dehydration, a serious condition sometimes overlooked in elders in the winter months. If you notice sudden odd behavior with your loved one, be sure to seek medical attention as it could be a urinary tract infection which is prevalent in elders and easily resolved with antibiotics.

Home Environment

Attention must also be paid to surroundings. For instance, your parent may have always been a stickler for neatness or for paying bills promptly. If you discover excess or unsafe clutter and mail that has piled up, a problem may exist. Also, keep an eye out for less obvious indications for concern. Scorched cookware, for example, could be a sign that your parent forgets if the stove is on. An overflowing hamper could mean he or she doesn't have the strength and/or desire to do laundry. And by all means, check prescriptions and medication bottles for expiration dates; and make note of all prescriptions your family member takes and place that information in your personal files as well as the elder's wallet in case of an emergency.

In the next blog stay tuned for what to do when you notice signs of decline in a parent.

For information on assisted living, contact Spring Arbor.


Make Sure the Assistance Care You Seek Fits Your Needs – Greensboro, NC

Joseph Coupal - Friday, December 16, 2016

Spring Arbor, Greensboro, NCIf you have a parent with Alzheimer’s disease, you are probably considering options for care. At Spring Arbor, we commonly get questions similar to the one below.

Q.  After years of caring for my mother who has Alzheimer’s disease and watching her decline, we are thinking of moving her to an assisted-living facility. Are there some guidelines that will make this move smooth?

A. This is one of the most difficult decisions one has to make. It can be a challenge to know the right time for such a move and the type of housing that meets the needs of the individual. Let’s begin with different types of residences.

• Senior housing: This usually is appropriate for someone with early stages of Alzheimer’s disease and can live relatively independent. These individuals are able to care for themselves and are safe living alone. Social activities, transportation and other services are provided. Supervision is limited.

• Assisted living: This type of housing also is called board and care, adult living and supported care. Assisted living is between living independently and living in a nursing home. This residence provides a 24-hour staff, recreational activities, housekeeping, laundry and transportation. Depending on the requests from the resident, the facility also provides help with bathing, dressing, eating and reminders to take medication. The federal government does not regulate them; the state does and it varies by state. Since not all offer services specifically designed for those with dementia, it is important to ask.

• Nursing homes: Also known as a skilled-nursing facility, long-term care facility and custodial care facility. These facilities provide 24-hour care and medical treatment. Services related to nutrition, care planning, recreation, spirituality and medical care. Nursing homes are licensed by the state and regulated by the federal government.

• Alzheimer’s special care units: Also called memory care units, they are designed to meet the needs of those with Alzheimer’s disease and other dementias. They often are a unit within various types of residential care.

• Continuing care retirement communities: Such facilities offer different levels of care consisting of independent living, assisted living and nursing-home care. A resident can move from one level to another. Such facilities typically require an entrance fee with monthly payments or, in some cases, only monthly fees.

For more information on assisted living with customized care plans or for more information on memory care, contact Spring Arbor.


Difficult Questions Family Must Decide for Alzheimer's Patients – Richmond, VA

Joseph Coupal - Monday, December 12, 2016

Spring Arbor, memory care and assisted livingAs the number of Americans suffering with Alzheimer's disease or other forms of dementia increases, those who are responsible for making choices for loved ones all struggle with difficult decisions.

These are a few of the tough situations many caregivers must face:

1) Making decisions your loved one is against

As children, we are wired to try and obey our parents. When our parents refuse our suggestions or outright get angry at any discussion of what we think is best for them, it is very difficult to go against their wishes — even though we have their best interests in mind.

Insisting that our family member needs help at home, should stop driving, or should not cook unless someone is close by, can be met with arguments and indignation that we think our loved one has become feeble or doddery.

It's important to keep in mind that your intention is to protect your loved one.

Remind yourself that you have tried to allow the person to make independent decisions for as long as you thought they could. And remember, you are not alone in this struggle.

Every caregiver must make decisions based on the changing needs of the family member, even though it is difficult.

2) Providing care for a loved one with Alzheimer's

The decision as to where to care for a loved one with Alzheimer's is tempered by finances, what type of care is needed, and what type of care you can personally provide.

Some people feel that going to a nursing home or long-term care facility is never a choice while others really are unable, for a variety of reasons, to provide care for a loved one at home. There is no right or wrong decision. You have to make the one that fits your entire picture.

Alzheimer's patients need constant monitoring and as the disease progresses, patients may need more professional care which nurses and other health care providers are more able to provide.

Even if you start out by hoping to keep a loved one at home, check out facilities that are close by to see what type of care they provide.

3) Visiting if the person no longer recognizes you

The decision to still visit someone who no longer seems to recognize you is a hard one. Deciding whether to visit first depends on whether you emotionally and psychologically feel OK about seeing the person even though he or she no longer knows your name or remembers who you are.

If you find it too difficult or painful to see your loved one who no longer knows you, try not to feel too guilty about not going. It just adds to your stress.

If you feel that you are still able to visit the person, or if visiting helps you feel closer to the person, then by all means visit.

Deep down, we have no way of knowing whether somewhere inside, the Alzheimer's patient recognizes that you are someone familiar to them even if they no longer can say your name. They may still recognize you on some level.

There is no right or wrong decision. There is only the best decision you can make at the time.

For more information on assisted living and memory care, contact Spring Arbor.


Tips for Caring for Those with Alzheimer's – Greensboro, NC

Joseph Coupal - Wednesday, December 07, 2016

Spring Arbor, Memory Care HomeAlzheimer's and other forms of dementia can be scary for the patient and for the person caring for their loved one. Experts weigh in on how to make sure a dementia patient is getting the care they need.

Forgetting how to perform everyday tasks is the life of someone suffering from Alzheimer's. Caring for someone with memory loss can be challenging, but Courtney Finigan with the Alzheimer's Association says it's important to have patience and keep things familiar.

A routine is very important, keeping patients with Alzheimer's disease in a routine so every day kind of looks the same and also keeping them in surroundings that are familiar in them.

Working hard to keep things familiar isn't always enough and sometimes taking care of a person with Alzheimer's can be a lot to handle and you may need professional help.

A memory care facility can be an alternative. These types of communities are often designed to look like home, keeping the residents' needs in mind.

Alzheimer's can impact the way patients communicate making simple tasks difficult.

Is someone refusing a shower in the morning because throughout their whole life they took showers in the evening, and they don't know how to verbalize that? So they kind of lash out.

Patience however, is key. Whether you're caring for them yourself or transitioning into a facility, the most important thing is the safety of the person suffering from Alzheimer's.

If you have questions about a loved one suffering from Alzheimer's, or need support or advice you contact Spring Arbor.


Downsizing Your Home? What to Consider – Richmond, VA

Joseph Coupal - Friday, December 02, 2016

Spring Arbor assisted living homes, Richmond, VAWhat are some questions aging adults should be asking when considering downsizing?

You won’t be alone. Almost four in 10 baby boomers (37%) plan to move at some point in later life. Of those, 42% say they will settle in a smaller home. Here are some questions to consider before going smaller:

• Are you and your spouse on the same page? I speak from experience. I’m ready to downsize, and my wife says she’s willing to do the same. But when we have taken some “trial runs”—looking at smaller homes and discussing what we might need to discard—it is clear that my wife’s heart isn’t in this. Her attachment to our current home, with all its memories and our (many) belongings, simply runs too deep.

Downsizing is difficult enough without both partners being fully committed.

• Do you understand just how big a project this will be? Many people get enthusiastic about downsizing—until they actually begin going through drawers and closets. Then the sheer size of the task overwhelms them.

With this in mind: Get a good book about downsizing and the mechanics involved before you jump into this. (One suggestion: “Downsizing the Family Home” by Marni Jameson.)

• Can your ego handle this? Clearly, our homes are part of who we are. A comfortable and spacious house is frequently a sign of success, a “reward” for years of hard work. Is “smaller” or “modest” (or “tiny”) really part of your makeup?

• Have you run all the numbers? Moving to a smaller place can mean smaller bills (for heating and cooling, taxes, maintenance, etc.). Find out how much will it cost to sell your current home and move your belongings? Will you need to buy new furniture? Are you moving to an area with a higher cost of living? Will you end up spending more money on travel (to visit family and friends where you used to live)?

Downsizing can help many people, but it isn’t foolproof. The savings might be more modest than you anticipate.

• Are you certain that the size of your household isn’t going to change? In other words, is there a chance that an adult child might have to move in with you? Or that an older parent could end up living under your roof? A small (or smaller) home can get awfully crowded.

For more information, contact Spring Arbor.

Wall Street Journal

Moving into a Senior Community is a Huge Decision – Greensboro, N C

Joseph Coupal - Tuesday, November 29, 2016

Spring Arbor, Assisted Living CommunityYou have finally decided to make the move out of your home and are considering relocating to a senior community. Your children may have finally convinced you that you need a different style of living, or maybe you just got tired of mowing grass, fixing toilets, washing windows and shoveling snow.

Others move out of their homes into some type of long-term care facility due to a physical or cognitive chronic disability or decline that arises suddenly.

Whatever the reason, moving out of your home is a significant change on many levels, including financial, physical and emotional. Given the high stakes, let’s look at some things to look out for and how to help make this transition smoother.

1. The planned transition: "Retirement community" is a term used very loosely to describe a variety of living situations. Some communities only offer one level of care, such as independent living, personal care or assisted living. Others offer a variety of care settings so the person can age in place from independent living through skilled nursing care and/or memory support on the same campus.

Continuing care retirement community is a special term under the law that allows a resident to “buy in” to a care plan for his or her lifetime, so that the risk of increased care costs is shifted to the community and away from the resident.

When beginning this transition, it is important to visit and investigate various communities ahead of a crisis and get a feel for how life would be there. A prospective resident should consider the types of assistance offered, what is included in the monthly fee and what types of additional services are charged a la carte.

Inevitably, there is a pile of complex documents that will need to be reviewed before signing.

When buying into a community, there is usually a substantial upfront fee. There are various options to choose from which give the resident the right to a refund of a portion of the entrance fee or none of the entrance fee. It is important to consult with an elder law attorney as well as the resident's financial planner to figure out the best option to finance the entrance fee and future care costs. Whether or not the prospective resident has long-term care insurance can become a critical element.

In addition, residents need to be aware of rights and liabilities under the contract and whether they would ever have to move out of the community and under what circumstances.

2. The crisis admission: Unfortunately, many people end up in a long-term care facility as the result of an acute medical event. Typically, after a hospital stay, a person is given several choices for discharge to a long-term care facility.

This selection should be made carefully because the facility could end up being the place this person lives for the rest of his or her life.

Generally, health insurance such as Medicare or Medicare Advantage plans will cover the cost of rehabilitation in the long-term care facility for the first several weeks. After this coverage disappears, the resident will need to figure out how to afford to pay for care.

In either scenario, it is extremely important for those involved in the decision-making and admission process to obtain the advice of an attorney before signing any contracts. It is important to understand terms such as "responsible party" and what that means as far as financial obligations for adult children as well as people who are acting under the authority of a power of attorney and/or health care directive.

Whether it’s a gradual transition from home to a retirement community or an unexpected medical event, these are significant life changes that impact the resident as well as his or her family. It is important to understand the options and consequences before signing on the bottom line.

For more information on senior living communities, contact Spring Arbor.


How to Downsize Your Home – Richmond, VA

Joseph Coupal - Monday, November 21, 2016

Spring Arbor, downsizingMany in the baby boom generation have been clinging to their big family homes, despite equity gains that have occurred in many areas due to the improving economy.

We’re not yet seeing a dramatic trend toward downsizing. But despite the desire of many boomers to hang on to their family homes indefinitely, an increasing number will soon change their minds or be forced to downsize, however reluctantly, due to medical, financial or family issues.

Very often it takes a triggering event, like a major health problem, to cause people to sell a home they’ve owned for many years.

Whether you’re a homeowner who’s excited to downsize or you’re doing so involuntarily, the emotions can be intense.

It is very difficult it is for those to disconnect from any residence where they’ve lived for a lengthy time, even if doing so by choice.

Part of the problem for downsizers is that the moving process is inherently disruptive to their habits and patterns of living.

It’s fascinating how we humans are wired emotionally and bond to the places where we live.

Here are a few pointers for downsizers:

1. Seek an ally to help you begin the downsizing process.

It can take up to 24 hours of work to de-clutter the average-sized room. To avoid becoming sidetracked, many home sellers need an ally to help them view their possessions objectively and let go of things they can’t take with them when they move.

When you have to downsize, your whole life is upside-down. It’s tremendously stressful. So it’s good to have someone there with you to help you stay focused and create an organized strategy.

2. Ask family members if they want some of your memorabilia.

Older downsizers often hang onto nostalgic items they believe their grown children might want someday. But many parents believe their offspring will want many more things than they do, including their childhood storybooks and elementary school sports trophies.

Typically, Mom and Dad hang on to things the kids don’t really want.  Downsizers should ask grown children what items they value.

3. Make a memory book with photos of your place.

4. Give away functional items you can’t take with you.

As they plow through their property room by room, most downsizers encounter many items that crowd their space. Whenever possible, donations of serviceable items to a nonprofit institution that will put them to good use. For instance, you could donate unused musical instruments to a school serving low-income families.

It can be incredibly rewarding to know your excess belongings will meet the needs of others rather than get tossed in the trash.

For more information on senior living, contact Spring Arbor.

The Pueblo Cheiftan