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How to Start the Conversation About Senior Living

Joseph Coupal - Monday, July 29, 2019
Spring Arbor, SC, NC, VA, TN

Telling your aging parent that it’s time for a different living solution is never easy.

For most seniors, losing their independence is something they dread, so the thought of moving into a new community can be very unsettling. Putting off the conversation will only exacerbate the fear and anxiety for both you and your parents, but with a little planning and fortitude you can help ensure a positive outcome.

  • Talk to your parent(s) about assisted living options as early as possible—before the situation becomes urgent. That way you can spend more time exploring different solutions, and your parent will be able to more fully participate in the process.
  • Know the options and the benefits of each one. Moving into an Assisted Living Residence is just one option, but there are many others. Depending on the level of independence and care your parent desires and needs, there may be home care solutions or other senior living communities that may be a better fit. Learn more about the various options.
  • Address your concerns about their current situation openly and completely. Be realistic – and help them be as well – about their health care needs and safety and the potential needs they may have in the near future. Be candid about the impact their care may be having on you, and emphasize your overwhelming concern for their well-being. Now is not the time to dance around delicate topics. Being honest and upfront is the best approach, but make sure you do it with a tone of empathy and respect.
  • Listen carefully to their fears and objections. It’s best to have an initial conversation to get the ball rolling, then take a few days to digest their initial reaction and comments before continuing on. This also shows them that they are being heard and honored, and will have a role in the process.
  • Find out what’s most important to them. Perhaps they are concerned about leaving their friends behind, or being forced into a routine that they don’t like. Understanding these issues can help you address them upfront, and find a solution that will provide them with the care they need along with the lifestyle they want to be happy and fulfilled.
  • Be prepared to talk about finances. Part of the fear of losing independence is the concern about losing control of their finances. Have a realistic assessment of their financial situation, along with ballpark costs, and financial benefits they may be able to utilize ready to discuss. Consider the potential “what if” scenarios that may arise, and how they may each impact your long-term financial situation.
  • Take a positive approach and tone. Your parent will be more likely to embrace change if it’s presented in the most positive and caring light. Humor can help lighten the situation, but it’s important not to let the conversation become too light hearted or trite. After all, this is one of the most important decisions of their life, and the decision that you make together will make all the difference in the quality of their remaining years

For more information on assisted living, contact Spring Abor.

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When Is It Time to Move to a Care Facility?

Joseph Coupal - Wednesday, July 24, 2019
Spring Arbor - VA, NC, TN, SC

While home care for seniors with Alzheimer’s or dementia is quite possible, in some cases it can become a bigger challenge than the family or a lone caregiver can manage. Full-time care is taxing for the caregiver and there is extensive burnout. Also, as dementia progresses, remaining in the home might become too difficult or dangerous for the senior. In these instances, it may be wise to seek additional help or move your loved one into a community that can support their cognitive needs. In some cases, living in close proximity to other seniors can actually be a better option for helping a senior with cognitive issues.

You can recreate a lot in home care, in terms of the custodial things – bathing and medications. But the socialization piece that’s so important may be harder to duplicate. And because socialization has been shown to be a critical component of care for people with dementia, in some cases it may be more logical, efficient, and possibly even cheaper to place your loved one into a community that has the right resources to care for their dementia. Families typically do exhaust all avenues, but when safety becomes an issue, it may be time to consider your options.

If it is time to place a loved one in an assisted living or long-term care facility, look for a community that offers more than just the occasional bingo game or chair aerobics class. There’s a difference between engagement and entertainment. For activities to have a cognitive impact, they must reach a person and stimulate what makes them unique. It needs to be what makes every individual tick. That’s when you know the person feels nourished.

For more information memory care, contact Spring Abor.

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health.usnews.com


The Different Types of Long-Term Care

Joseph Coupal - Friday, July 19, 2019
Spring Arbor - VA, NC, TN, SC

Atmosphere, supervision and levels of assistance, services and staffing vary widely among senior care facilities.

If you hear long-term care facility and automatically think nursing home, it's not surprising. However, long-term care encompasses a spectrum of options and a progression of choices.

Early on, the "facility" where an older adult receives treatments, help with medications or personal care is often his or her home. Nursing homes represent a traditional solution when home care is no longer enough. But they're not the sole solution.

Alternatives such as assisted living and continuing care retirement communities attract many older residents, including some who are still healthy and want to remain active. For seniors who crave a more family-like atmosphere, out-of-the box options like adult foster homes exist.

Of course, payment is a major limiting factor in long-term care choices. For many families, assisted living facilities and CCRCs are prohibitively expensive. The issue of how to pay for long-term care, and what is and isn't covered by Medicare or Medicaid, is a huge decision element.

Impactful Decision

Long-term care decisions rarely involve a sudden crisis followed by a parent's dramatic uprooting to a supervised facility. It's usually not 'Mom's fine' and then the next day she needs to go to a nursing home. It's a continuum. Long-term care options fluctuate as people develop mobility issues or chronic conditions gradually worsen.

In many cases, long-term care starts at home. Family caregivers and home health aides, often in combination, can help make it possible. For adult children who aren't certain what kind of assistance a parent needs, particularly when they live at a distance, geriatric care managers – also called aging life care managers – can assess people in their home environments.

These professionals determine and manage appropriate services, and also may make suggestions on reducing potential safety hazards in the home, says Avitabile, who is president of the board of directors of the Aging Life Care Association.

Local services can extend the interval an aging adult is able to manage at home. Look up your Area Agency on Aging and find the plethora of resources that are out there in your community.

Constellation of Choices

At some point, in-home caregiving and community services combined may no longer suffice to meet an older adult's changing health, safety or personal care needs. In other cases, seniors who can still live independently, or with minimal assistance, realize they're ready to move into a residential setting where they can socialize with peers.

The following continuum of long-term facilities appears in mostly ascending order of how much care and supervision their residents need.

Retirement living/independent living.

Independent or retirement living focuses on a self-sufficient lifestyle for seniors. These residences might be part of self-contained retirement communities or high-rise apartment complexes, among other models. Costs vary widely based on location, services (like housekeeping) and activities offered. Wellness centers may be available on-site.

You're really looking at a situation that's very light on care. People considering these options might prefer a more "hotel-like" environment, with congregate meals in attractive dining rooms. There are a lot of planned outings and activities, sometimes of a very high caliber.

With home care agencies sometimes right on the premises, Avitabile says, someone who wants to age in place in independent living, but who eventually needs more care, could hire that type of assistance as if he or she were in their own home.

Assisted living.

Assisted living facilities offer services such as medication management and light personal care within a supervised setting. Housekeeping, prepared meals and assistance with daily personal care are available. Assisted Living is known for its focus on group and individual activities and efforts by staff to prevent residents from feeling isolated.

Medical services, such as nurse practitioners who follow residents, are available. Assisted living also has different levels of care that someone would buy into. Residents who need lighter care might opt for medication management, check-in services and morning assistance getting out of bed and showered.

Continuing care retirement community.

CCRCs offer a tiered approach for aging adults. Typically, residents move into single-family apartments or condominiums designed for independent, healthy adults. As their needs change, they can transition to on-site assisted living or nursing home facilities. Continuing retirement care communities represent a significant financial investment, with hefty upfront entrance fees and monthly charges.

Medical foster care.

Also known as adult foster care or residential care homes, medical foster homes are private homes that are run by a trained caregiver. For military veterans with chronic medical conditions that meet the nursing-home level of care, the Department of Veterans Affairs oversees its Medical Foster Homes Program. Availability is limited, although the VA is working to expand the program.

Other older adults who have chronic physical or cognitive health needs and require assistance in daily living activities – yet prefer a noninstitutional setting – can seek adult foster arrangements, too. Adult foster care homes are not covered by Medicare.

Nursing homes.

Nursing homes provide medical and personal care services beyond what's available in assisted living. Nursing care, 24-hour supervision, assistance with activities of daily living and three daily meals are standard. Most nursing home residents have chronic physical or mental health conditions, or both. Nursing home residents can receive prescribed treatment and personal care as needed.

As with any type of long-term care facility, it's essential to do some research and ask critical questions before choosing a nursing home. You can explore U.S News' Best Nursing Homes ratings and also find information on Medicare- and Medicaid-certified nursing homes on the Medicare.gov website.

Memory care.

For people with Alzheimer's disease, other types of dementia or serious memory problems, memory care involves an extra level of care and supervision. Secured memory care units are located within many nursing homes and assisted living facilities. Staff members receive special training to provide 24-hour care and daily assistance to this group. Memory care typically costs more than non-memory care.

In nursing homes, memory care usually goes by a different name, such as the Alzheimer's unit. The atmosphere can differ by type of facility. In general, a memory care unit attempts to be kind of more normalizing – a little bit more humanistic and kind of person-centered. It doesn't have that institutionalized feeling.

Skilled nursing facilities.

The terms nursing home and skilled nursing facility are often used interchangeably, because the types of care involved often overlap, but they aren't identical. Skilled nursing facilities are more likely to have a consistent presence of nurses or physicians and offer rehabilitation services such as occupational, physical and speech therapy. SNFs and nursing homes fall under different sets of regulations.

Covering Costs

It's never too soon to plan ahead for long-term care, whether for yourself or a family member. People underestimate the cost and they underestimate the amount of time they may need services.

Learn what Medicare and Medicaid cover, as well as long-term care insurance, if you have it. Also make sure your family knows you have long-term care insurance.

Family decisions on long-term care should include adult children and significant others.

For more information caring for aging adults, contact Spring Abor.

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US News - Health


Senior Care: Finding the Right Fit

Joseph Coupal - Tuesday, July 16, 2019
Spring Arbor - VA, NC

There are a variety of choices to suit desires for independence and meet care needs alike.

With advancing age and changing care needs, many older adults – and their families – face what can be a daunting task: finding suitable senior housing.

To begin the process of narrowing the search, it’s helpful to get a better idea first of the types of senior housing and determine which might be optimal. One of the biggest factors is taking into account what the individual’s needs are, and there are lots of different options for receiving care.

Of course, a nursing home offers the highest level of care for those who need it round-the-clock – like a person with advanced dementia. In addition, residents get help with activities of daily living, such as dressing themselves, bathing and grooming. Those who benefit from living in a nursing home usually need ongoing medical care and personal attention. They will need help with medications; they need assistance with really all aspects of their daily life, and they need some skilled nursing care.

What Care Options Are Available for Aging…

But, options for care have expanded, even for many with intensive needs. Many who may have once gone to a nursing home are able to get the care they need in other settings, such as assisted living – which provides some of the same types of daily assistance for people with less intensive medical care needs, and help managing medications – or even through home health services that allow many seniors to age in place in their own homes. That’s becoming more and more available as that’s what the public is demanding. People want choice, in terms of where they receive services. Policies at the federal and state level are moving in that direction as well, giving people more choice in terms of where they receive care as they age.

Medicaid, for example, which is one of the primary payers of long-term care and traditionally had been only available for people in nursing homes, is now being expanded through waiver programs so that people who are eligible for Medicaid might receive services in a variety of different settings.

Evaluating Different Types of Senior Housing

Certainly, though, not everyone needs the level of care offered in a nursing home, in assisted living or even through home health services. Some just want to live in communities where more basic supports, like lawn care and housekeeping services are offered, and where they can commune with peers.

For those individuals, one option is moving into a 55 and older community. These communities often cater to active older adults with amenities such as a fitness center and pool and walking or biking paths, and offer services like yard maintenance that free up time for other activities. Like other desirable communities, they’re often located within easy access of restaurants, groceries and entertainment.

Seniors who foresee possibly needing limited assistance but still want to live on their own terms may find the right balance in an independent living community. Most serve up a meal or two daily for residents, provide security services to keep communities – often apartment complexes or condos – safe, and also often offer other services, like housekeeping. That’s in addition to ample opportunities for social engagement with other residents.

One central consideration for those thinking about moving into an independent living community is, will you likely – now or in the near future – need any type of ongoing care? “One of the big questions is whether or not to go into a freestanding independent living community. In some places there are both independent living communities and assisted living units in the same complex or building – even apart from the continuing care retirement communities, which have independent living, assisted living and a nursing home in a single complex.

Such hybrid arrangements – whereby, for example, independent living communities provide some home health services – further expand the options residents have and ensure they don’t have to pay for a higher level of care that they don’t need. In other cases, residents can contract their own home health services, if needed. Related to continuum of care, increasingly and importantly, many independent living communities, while they don’t provide any kind of care with their own staff, do allow older people to bring in their own care in the units.

Experts say it’s worth keeping in mind – and a reason continuing care retirement communities and hybrid models are an option some choose – is that it can be difficult to have to go through the search and moving process all over again as a person’s health declines.

It's important to always keep a person's specific needs in mind during the search for senior housing, particularly as health issues and care needs become more significant. Some people with Alzheimer’s disease or other forms of dementia – particularly in the advanced stages – may benefit from moving into a memory care unit. Memory care is a type of long-term skilled nursing care that caters to people with dementia and other memory problems, helping to ensure residents are kept safe and engaged, with everything from supportive staff to alarm systems designed to prevent residents from walking off and possibly into harm’s way. This is for individuals who need supervision and help with activities of daily living.

While in certain rural areas options may be more limited, in most markets there are a variety of different senior housing options. Whatever type of senior housing one chooses, it’s also critical to keep something else in mind – as with all housing: location, location, location. In this case, particularly for residents who have significant care needs, it’s about staying within close proximity to loved ones, who can also advocate on the senior’s behalf.

Think you’ve found a winner? There’s nothing that can take the place of site visits – at various times, and even unscheduled – to get a feel for the place, experts say. Check out state inspection reports for assisted living and nursing home facilities (access those for Medicare and Medicaid-certified nursing homes at Nursing Home Compare on Medicare.gov) to make sure there are no glaring issues.

That’s in addition to talking with administrators about specific care needs and – if at all possible – with other residents or friends or family you know who live in the community or facility. It’s an involved process. You have to envision what it’s like to be living where you – or a loved one – are considering going. But experts say doing that due diligence, and trying to determine whether a senior housing option really aligns with one’s wants and needs, before moving in, can make all the difference.

For more information on senior care, contact Spring Arbor.

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health.usnews.com


5 Strategies for Talking About Assisted Living with Aging Parents

Joseph Coupal - Friday, July 12, 2019
Spring Arbor, SC, NC, VA, TN

Have the discussion as early as possible, preferably before a health crisis strikes. Having the conversation before a health emergency occurs can afford you and your loved one the opportunity to methodically discuss plans to tackle a host of issues, like downsizing and getting rid of extra possessions, figuring out finances and gathering medical records. Your loved one's wishes will be respected if you have a plan in place. If a medical emergency arises, whether it's from a fall or from complications related to a chronic health problem, you or another family member may have to make a series of important medical and financial decisions. If those decisions are made relatively quickly in the middle of a crisis, they may or may not align with your loved one's wishes.

Look for an organic window of opportunity. Rather than bringing up the idea of transitioning to assisted living seemingly out of nowhere, look for a natural opportunity to raise the idea. For example, say your mother falls and sustains minor to moderate injuries that don't require hospitalization. This situation would be a good time to explain that you can't respond to such events every time, particularly if you don't live nearby and have kids of your own. Speaking to a loved one about their need for assisted living doesn't have to be a difficult conversation. Especially if you're sparking the conversation after a minor event like a non-major fall or time when you were unable to provide the immediate support your loved one needed. This conversation is about reconciling expectations. Your parent's needs have to be reliably met. If you live far away or work full-time, explain why a change like an assisted living community should at least be considered and looked at together.

Listen carefully to your loved one's concerns. Don't try to minimize your loved one's anxieties about the prospect of making the transition from being on his or her own to moving into an assisted living facility. It's very important to acknowledge and offer understanding that your loved one is fearful about the life change of moving into an assisted living community, and to offer understanding about [his or her] trepidation. Rather than putting forth a sales pitch, listen and ask lots of questions. This approach makes it clear that you want to follow your loved one's wishes.

Don't issue orders. Keep in mind, unless he or she is mentally incapacitated, your loved one gets to decide where and how to live. Issuing orders or ultimatums attacks your loved one's sense of agency and could make him or her feel dishonored and defensive. Legally and ethically, it's their life and they get to choose. You should deal with your family in a loving way, and that's not a loving thing to do.

Let your loved one see what assisted living looks like. Ask if he or she is willing to tour assisted living facilities. Use the [assisted living] staff as a resource to help families with these difficult conversations. We should be a partner in the process and help foster a sense of 'connectedness. Visiting an assisted living community could ease some of your loved one's anxieties.

Keep in mind the discussion may be a process, not an event. Your loved one may need multiple conversations to reach a decision, and that's OK, given the stakes. Most people prefer to age in place. However, we can [and] should try to ease their transitions [from home to assisted living]. That may mean a series of conversations, not a single talk.

For more information about Senior Living, contact Spring Arbor.

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health.usnews.com


Tips for Talking to Parents About Senior Living Choices

Joseph Coupal - Monday, July 08, 2019
Spring Arbor, SC, NC, VA, TN

You can dance around the issue and pretend there’s no problem. That’s what 75% of families do. But when it’s too hard to ignore, take a deep breath, set aside sufficient time, and use these tips to begin a rich conversation about senior living choices.

Start with these tips when you need to talk to an aging parent about senior living, senior care, and the way forward for your family.

Before the Conversation … Where to Begin

Do your homework. Before you initiate the conversation about senior care, prepare yourself:

  • Create a list of your concerns for your aging parent. Are you worried, for example, that their home is no longer a safe environment for them? Or that the mistakes they keep making with their medication will have a dangerous outcome next time around? Write down all your concerns.
  • Educate yourself. As you learn more about senior care options, you’ll get ideas about what will fit your parent best. Admitting just how much help your loved one needs isn’t easy, and you may find yourself downplaying just how serious their need for help really is. But be as objective as you can.
  • Learn how important environment is for seniors. Where you live influences how well you live as you grow older – meaning location and environment have an effect on everything from physical safety to mental health to longevity. The more you learn about this, the better prepared you’ll be.

Exploring the options and learning more about successful aging can give you the confidence and credibility you need to begin this conversation. But exploring and learning doesn’t mean you’re making decisions without the consent of your parent or aging family member. Instead, you’re preparing yourself to be as helpful as possible for the conversation and decisions ahead.

Tips for a Better Conversation about Senior Care

Once you learn more and feel you can confidently explain the options, following these tips can help you have a productive conversation:

  • Talk in person. This isn’t a conversation to have by telephone if you can avoid it. Instead, pick a day when you and your parent are well-rested and relaxed. Block out a time and a location where you can talk without interruption.
  • Empathy, not sympathy. No older adult wants their child to feel sorry for them. But empathy is another matter. Your kind, calm voice and demeanor will show you care – and that you’re trying to understand the fears and frustrations they may feel. The idea of accepting in-home care or moving to a senior living community is tough. You begin to help as soon as you really begin to listen.
  • Don’t rush. Once you’re armed with knowledge, you may feel ready to make a decision. But your parent may need more time. Allow them the time they need to find the words to express how they’re feeling. Coming to an unpressured mutual agreement now will continue to pay dividends as you move forward together.
  • Plan to talk again. And again. As much as you might want to wrap things up in one conversation, the reality is this will likely be a series of talks. Unless your aging family member is in eminent danger, that’s okay. It’s a process, not a once-and-done discussion.

Senior Care Conversation Starters

As with many difficult topics, beginning the discussion is often the hardest part. These conversation starters may help:

  • How is it living at home alone? Do you still feel safe? (You may want to mention specific safety concerns such as managing medication, falling on stairs, struggles in the bathtub or kitchen. Crime may be another fear they haven’t shared with you.)
  • Do you feel lonely sometimes? Would you like to spend more time with people your own age?
  • How do you feel about driving? Would you be interested in other options for transportation, so you don’t have to worry about getting where you need to go, car maintenance costs, traffic, parking, etc.?
  • Is it ever hard to manage your finances and keep up with paying your bills?
  • Ever wonder about getting a helping hand with housekeeping and laundry?
  • Would you feel less stress if you didn’t have to worry about the house?

Open-ended questions are the best way to encourage them to talk. Sit back and really listen to their answers.

Avoid Information Overload

Finally, beware the flood. Sharing a little basic information up front can be helpful, but overloading the conversation with research and statistics is overwhelming. What’s worse, when people feel overwhelmed, they can get defensive. And defensiveness will end a conversation fast – and make it hard to resume later. Take your time, and make this a journey of discovery and growth.

For more information, contact Spring Arbor.

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