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Senior Assisted Living Blog

Considering Long-Term Care

Joseph Coupal - Monday, June 24, 2019

Spring Arbor, NC, VALong-term care is for people who need daily living assistance and/or skilled medical care. The main types of long-term care facilities are assisted living centers and nursing homes. Long-term senior care is also integrated with residency in select retirement communities.

Assisted Living Centers

Assisted living centers are also called personal care homes. Traditionally they’re for people who don’t need skilled nurses, but do need help with personal care tasks such as brushing their teeth and showering. Memory care (specialized caregiving for dementia patients) is available in some personal care homes. Some of these facilities are combined with nursing homes to provide what’s called “a continuum of care.” Nursing homes add skilled medical care.

1. How do people pay for assisted living?

People tend to pay for assisted living with more than one funding source. Spending a few hours with a geriatric planner (or estate planner) could be very valuable.

2. How old are the residents in assisted living centers?

People of all ages might need assisted living, so assisted living centers have different population profiles. Some personal care homes operated by the VA, for instance, are multigenerational and serve soldiers as young as 18.

State laws provide age guidelines for assisted care centers meant especially for seniors. Common age minimums are 55, 62 and 65.

3. What pets are allowed?

Finding an assisted living center that accepts pets is tricky, but an increasing number of assisted living centers are pet-friendly, especially to cats and small dogs. Some offer pet care services such as grooming and walking.

4. How independent are the residents of assisted living centers?

Residents of assisted living centers generally need support with two or more activities of daily living (ADLs) such as getting out of bed, using the toilet or taking a bath. In facilities tailored for memory care, patients get 24-hour supervision for safety against wandering and other dementia-related risks.

For more information, contact Spring Arbor.


Questions to Ask Memory Care Centers

Joseph Coupal - Friday, June 21, 2019
Spring Arbor, NC, VA

Touring memory care centers, it's best to collect facts and also trust your intuition or “gut feeling.” Here are questions to ask when you visit a facility.

How is the memory care center secured?

This question relates not so much to safety from intrusion, but a resident's safety against exiting the facility. Protecting the residents against “exit-seeking behaviors” is a main benefit of a memory care center. Most facilities have their entrances locked 24/7 and keep any elevators for staff and visitors carefully monitored as well. In some facilities each resident wears a bracelet with an electronic sensor. Additionally a resident can have a personal security alarm on his or her bed and/or wheelchair. A personal security alarm can alert a staff member in case a patient tries to stand up without remembering that they require assistance.

When do residents get exercise and fresh air?

Memory care homes need to guard against exiting, but ideally the residents have a secure outdoor area for getting fresh air and recreation. Circular paths for walking, both inside the facility and outdoors, are common in the best facilities for dementia patients.

Does the facility have structured daily activities?

Structured activities led by skilled nurses and therapists can greatly improve a person's quality of life. In the best facilities each day has a full programming calendar. For example, residents might get art therapy, bake bread and cookies, sing, and visit with a therapy dog. The facilitated activities are designed to help keep residents' minds active and lessen symptoms of decline. This sort of memory care might also help slow the progression of dementia.

Are psychiatric and psychological services provided?

Many memory care centers have staff or visiting specialists to help with residents' psychological needs on a one-on-one basis. These caregivers can provide therapy and help patients establish or adjust a medication regimen as their disease changes.

Do physicians and other medical specialists visit the facility?

Such visits can make life easier by eliminating the patient's need for transportation to a clinic.

What training do the caregivers receive?

Ideally a registered nurse will be on duty 24 hours/day, as residents could have medical emergencies at any time. Ask for the hours of skilled nursing, and also ask about the training that personal caregivers receive. What are the criteria for getting hired? How are staff trained once hired?

What is the ratio of staff to residents?

Memory care costs more than standard nursing home care partly because a higher ratio of staff to residents is needed for safety and comfort. Ask for the staffing ratios for daytime and night.

Does each resident have a customized care plan? Alzheimer's and related diseases develop differently for everyone, so the best care for dementia patients is highly personalized. It's also good to ask whether residents are grouped by cognitive level.

What is the discharge policy?

Residents of a senior facility, like residents of any mainstream apartment complex, can be evicted. This might happen if the resident becomes physically aggressive or otherwise disrupts the community. With memory care patients, disruptive behaviors are more likely regardless of the residents' temperaments when they were more “themselves.” Be sure to ask how the staff is trained to respond in case your loved one or another resident exhibits disruptive behaviors, and get a full understanding of the center's policies for discharge.

What type of care is the facility unable to provide?

Understanding the center's criteria for involuntary discharge can help you understand what sort of care they cannot provide. Also be sure to understand whether they'll be able to continue caring for your loved one if he or she becomes bedridden or needs to use a wheelchair. Some patients would also benefits from Parkinson's therapy and other specific care options.

For more information, contact us.


Garden Therapy for Memory Care Residents

Joseph Coupal - Friday, June 14, 2019
Spring Arbor, NC, VA

At Spring Arbor Senior Living, our philosophy is to make every day special for our residents suffering from Alzheimer’s disease and other forms of dementia. As a result, we are always discovering new and invigorating ways to engage and stimulate our residents. Our Gardening Therapy program is a prime example!

Research shows that access to the outdoors and physical activity are both extremely beneficial for adults living with memory loss. Our Gardening Therapy program exercises the mind and body and stimulates the senses. Gardening has many other benefits such as lowering blood pressure and stress levels, building confidence, creating a sense of purpose and more.

Signature programs such as Gardening Therapy bring unparalleled quality and dignity to the lives of our residents while simultaneously inspiring confidence, trust and peace of mind for loved ones. Our Coordinators treat each resident as an extension of their own families and are committed to providing them with a high quality of life.

It’s how you live that matters and this philosophy applies to our memory care residents. Learn more about Spring Arbor’s innovative programs by contacting us


Alzheimer's Disease Signs and Symptoms

Joseph Coupal - Tuesday, June 11, 2019
Spring Arbor, NC, VA

Alzheimer's disease attacks the brain, causing problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks. Alzheimer's is a form of dementia and accounts for 60 to 80 percent of dementia cases.

What are the symptoms?

Memory loss is one of the earliest symptoms, along with a gradual decline of other intellectual and thinking abilities, called cognitive functions, and changes in personality or behavior.

Symptoms of Alzheimer's disease include memory loss, language deterioration, impaired ability to mentally manipulate visual information, poor judgment, confusion, restlessness and mood swings. Eventually Alzheimer's destroys cognition, personality, and the ability to function. The early symptoms, which include forgetfulness and loss of concentration, are often missed because they resemble natural signs of aging, rather than warning signs that indicate something more serious is at work.

Who gets it?

It usually begins after age 65 and the risk increases with age. About one-third of people age 85 and older have the disease. AD is a progressive condition, but its course can vary widely. It damages the brain, which in turn can result in complications that lead to death, such as trouble swallowing, increased risk of choking, aspiration and increased susceptibility to infection. The time course of the disease varies by individual, ranging from five to 20 years.

What are the stages?

Dementia symptoms gradually increase in severity over a number of years. The disease advances in stages, progressing from mild forgetfulness and cognitive impairment to widespread loss of mental abilities. Generally, as the disease goes on, symptoms are more easily noticed and become more serious. Forgetfulness escalates and begins interfering with daily life and activities.

The early stages are almost unnoticeable. A person can function independently, drive and participate in social activities with little to no difficulty. Within a few years, friends and family will most likely begin to notice the person has a hard time remembering names or uses the wrong words when speaking.

The moderate stages usually last the longest period of time. Your loved one may become easily frustrated or angered and not want to participate in normal daily activities such as bathing or getting dressed. Those in the middle stages may forget how to do simple tasks like brushing their teeth or combing their hair. They also begin to have problems speaking, comprehending others when they are speaking, and reading or writing. Changes in sleep patterns become noticeable and disruptive as well. Actual personality changes may take place.

In advanced Alzheimer's, people become dependent on others for every aspect of their care, including basic activities of daily living. Many patients lose the ability to respond to their environment. Memory and cognitive skills will almost disappear as they lose awareness of their surroundings and recent experiences. Communicating will become nearly impossible, and the risk of infection increases dramatically.

Later on, people with AD may become anxious or aggressive, or wander away from home. Eventually, patients require total care and supervision, often around the clock for their safety.

How does it affect the brain?

The "clumps" that develop in brain tissue are called amyloid plaques and the tangles are called neurofibrillary tangles. These plaques and tangles in the brain are the prime suspects in damaging and killing nerve cells, and are considered telltale signs of this disease.

Microscopic changes in the brain begin long before the first signs of memory loss, though. Cellular degeneration occurs, especially in pathways and areas of the brain that are vital to memory and other mental abilities. There also are lower levels of some of the chemicals in the brain that carry complex messages back and forth between nerve cells. The disease disrupts normal thinking and memory by blocking these messages.

How is it diagnosed?

AD often goes unrecognized or undiagnosed in the early stages because the first symptoms are often viewed as normal effects of aging. For proper diagnosis, doctors use a series of tests and tools to evaluate thinking, behavior and physical function because there is no single scale that can definitively diagnose the disease.

Diagnostic tests may include the Clock Drawing test, the Mini-Mental Stage Examination (MMSE) and the Functional Assessment Staging test (FAST). In addition to these tests, the doctor may also conduct a medical and family health history, a routine physical exam, an exam that tests physical sensation controlled by the central nervous system, a brain scan, a neuropsychological evaluation, and interviews with family members and friends.

However, the only definite way to diagnose this disease is to find out whether there are plaques and tangles in the person's brain tissue. To inspect brain tissue, though, doctors usually must wait until they do an autopsy. Therefore, doctors can only make a diagnosis of "possible" or "probable" Alzheimer's disease while the person is still alive. At specialized medical centers, doctors are able to correctly diagnose the disease up to 90 percent of the time.

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


Checklist and Tips on Finding a Good Assisted Living Community

Joseph Coupal - Friday, June 07, 2019
Spring Arbor - VA, NC, TN, SC

Choosing an assisted living community is challenging.

Moving your older adult to assisted living is an incredibly difficult choice. Deciding when to make the transition is tough, but once that’s resolved, finding the right place is the next challenge.

The biggest question is how to find a good assisted living community. You want to find the best fit for their lifestyle and personality as well as make sure they’ll be well-cared for. That means looking at your older adult’s budget, visiting places, and comparing all the options to arrive at the best choice.

To make the process easier, we found a useful free guide that summarizes key information and has a handy checklist that helps you find the right assisted living community for your older adult.

Checklist for choosing a senior living community

Looking at facilities is an overwhelming process; there’s a lot that can be accidentally overlooked. The checklist puts the most important questions at your fingertips. We recommend browsing the entire guide, but you could also go straight to the checklist in the last section.

Click here to view the guide and checklist.

How to use the assisted living review checklist

The checklist goes beyond the usual questions about assisted living services. It helps you notice the “little things” that can be easy to miss as a casual visitor. These are the important details that give you an idea of what life is truly like there and how good the care really is.

Checklist questions we thought were most useful:

  • Are you able to talk with residents about how they like the community and staff?
  • Are visits with the resident welcome at any time?
  • Is staff available to provide 24-hour assistance with activities of daily living (ADLs) if needed?
  • Does the community conduct criminal background checks on employees?
  • Does the community train staff on elder abuse and neglect? Is there a policy for reporting suspected abuse?
  • What are the most common reasons why a resident may be asked to move out of the community?

Bottom line

Every older adult has different needs. It’s best to evaluate each against what’s most important for their specific situation. This guide and checklist help you organize your thoughts, notice important details, and compare one community against another.

For more information on assisted living, contact Spring Arbor.


Does Insurance Cover Alzheimer's Care?

Joseph Coupal - Monday, June 03, 2019
Spring Arbor, SC, NC, VA, TN

Private and government insurance programs may pay for some of the costs of Alzheimer's Care.

One in eight individuals 65 and older suffers from Alzheimer's disease -- quite a sobering statistic for the growing number of baby boomers crossing that age threshold. And the costs can be an overwhelming financial burden.

Private and government insurance programs may cover some costs. Here's a primer on your options.


Many people are shocked to discover that Medicare does not cover the long-term custodial care that Alzheimer's patients need. Custodial care is the non-medical care associated with activities of daily living, such as bathing and dressing.

Medicare does cover limited care in a nursing facility or at home. For home care, the patient must require skilled-nursing care or physical or occupational therapy to help with the recovery from an illness or injury -- not to help an Alzheimer's patient with daily-living activities. One of the most difficult situations is when a loved one needs personal or custodial home care, but Medicare will only cover that if there is some type of skilled-care need.

At-home services in most cases can be provided for fewer than seven days each week or less than eight hours each day over a period of 21 days or less. Limited custodial care could be provided during these visits -- perhaps if an Alzheimer's patient treated by a registered nurse for a broken hip needs help bathing. Medicare pays the cost of a skilled-nursing facility, but only to provide continuing treatment following a hospital stay of at least three days. Skilled care in a facility is limited to 100 days.

While Medicare offers little by way of custodial care, it does provide diagnostic and medical treatment that Alzheimer's patients need. The new annual wellness physical exam, which is free and part of the health care law, includes testing for cognitive impairment. This is a critical, yet hardly known, provision.

Alzheimer's patients and their families need to carefully choose a Medicare Part D prescription-drug plan or private Medicare Advantage plan. Alzheimer's medications are generally covered under Part D, but plans vary regarding co-payments. Use the Medicare Plan Finder to compare the total costs of your drugs under each policy. The Alzheimer's Association offers a guide about coverage for common Alzheimer's drugs.

If you choose an Advantage plan, make sure your neurologist and other physicians you see often are covered as in-network providers. Otherwise, you will pay higher out-of-pocket costs. You can compare Advantage plans by using the Plan Finder.

Long-term-care insurance

These policies provide coverage for the custodial care that Alzheimer's patients usually need. Benefits typically kick in if the patient needs help with at least two activities of daily living or if a doctor provides evidence of cognitive impairment. Because most people with Alzheimer's receive care in their own homes, look carefully at the policy's home-care requirements. Typically, a patient must wait 60 or 90 days before benefits begin. But policies differ on when the clock starts ticking, which could be a big headache for caregivers.

For example, some policies start the 60-day waiting period on the day the doctor certifies the cognitive impairment -- and benefits kick in 60 days later. But other policies count only the days a patient receives care from a qualified caregiver during the waiting period. If the caregiver visits two days a week, the policy only counts those two visits toward the 60-day waiting period -- and benefits won't kick in for 30 weeks. In the meantime, the family has to pick up the tab for the caregiver.

Before you hire a caregiver, check the policy's fine print on the type of caregiver the company will cover. Some policies pay for any caregiver who is not a family member, while others only pay for licensed caregivers who work for an agency. Some families who hire an unlicensed caregiver later discover that the caregiver doesn't qualify under the policy.

Don't expect a policy to pick up round-the-clock home care. Daily coverage is based on the daily benefit. A policy with a $200 daily benefit, for example, will likely cover the cost of eight to ten hours of a home health aide. If a family caregiver can't fill in the gap, a nursing home may be a better option.

You can't use more than your daily benefit in a day, but you can stretch your daily benefit over longer periods. Say you choose a benefit period of three years, at $200 a day. If you only use $100 a day, your coverage can last for six years. Some policies cover adult day care, which can cost a lot less than daily caregivers. Many adult day services specialize in care for those with Alzheimer's disease and similar disorders.


This program, whose costs are shared by federal and state governments, is the primary payer of long-term-care services for the elderly. Unlike Medicare, it provides custodial care for Alzheimer's patients. Custodial care typically is provided in Medicaid-eligible nursing homes, but many states' Medicaid programs now pay for home care and sometimes adult day care or care in assisted-living facilities.

The downside: You need to be virtually impoverished to qualify. Many people end up qualifying after spending their retirement savings on care. While state laws differ, generally you can't have more than $2,000 in countable assets, including investments. A spouse who lives at home can generally keep about $113,000. You're allowed to keep your home, car and assets in certain kinds of trusts.

To protect more of your assets, you can buy a state-approved long-term-care policy that is "partnership" eligible. The policy would allow you to qualify for Medicaid without having to spend almost all of your money first. For example, if you buy a partnership policy that covers $200,000 of care, you would pay out of pocket until you have $200,000 left and still qualify for Medicaid. Go to the National Clearinghouse for Long Term Care Information to see if your state allows these policies.

Disability benefits

Individuals who develop Alzheimer's while they're still working may be eligible for some coverage from disability insurance, either through an employer or an individual policy. Their cognitive impairment can quickly reach a point where they can no longer maintain gainful employment. Most policies tend to end benefits at age 65, but rules vary by policy so it's worth checking.

The benefits triggers will depend on the policy's definition of disability. Some policies will make a partial payout if a newly diagnosed worker needs to cut back to part-time and will pay more if the worker needs to leave the job.

Individuals with early-onset Alzheimer's could qualify for Social Security disability benefits if they can't work. Early-onset Alzheimer's disease is on the government's "compassionate allowance" list of conditions subject to fast-track benefits approval. When you reach full Social Security retirement age, your disability benefits will convert to retirement benefits.

Other sources of help

If you have a life insurance policy, you may qualify to withdraw most of the death benefit while you're still alive if your doctor certifies that you have less than two years to live. The accelerated death benefit could help pay for care.

Some veterans may be eligible for help from the U.S. Department of Veterans Affairs. The VA may provide custodial care at home, in adult day-care centers and in VA nursing homes for veterans who pass strict eligibility tests. Disabled lower-income vets may be eligible for Aid and Attendance benefits of up to $20,448 for an individual or $24,440 for married veterans. To qualify, a veteran must have wartime service and be unable to perform personal functions, such as bathing and dressing.

For more information, Spring Arbor.