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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 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.

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 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.


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.


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.


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.