How will we know when it’s appropriate to move my dad from adult day care to a nursing home, or an assisted living facility? . | Chicago Long-Term Care Planning Attorney Anthony B. Ferraro

July 26, 2012

- Alzheimer's Care, Blog, Elder Law Articles, Estate Planning, Medicaid and Paying for Nursing Home Care

The answer is simple: When you no longer can care for him at home. Adult day care is just a day service, so it occupies only part of the time. Care at home is still needed for nights and weekends. There are some adult care centers that offer evening and weekend services, but often it is not enough. Some people “package” services from a home care agency with the time spent at adult day care. In addition, a home care agency can assist with evening and weekend care to reduce the strain on you, and keep your father at home longer. But as you can see, that takes quite a bit of coordination, and still a fair amount of resources, to do properly. Everyone’s situation is different and everyone has a different threshold, so you have to figure out what is appropriate for you and your loved one. It is time to consider a nursing home or assisted living facility if you are feeling overwhelmed and the quality of life at home has fallen. You need to remember that it isn’t fair to either of you if your time with your father is so strained it diminishes your quality of life. If he were to go to an eldercare facility, your time together would likely be decreased, but then your time together could be that much more focused on doing things you like together, and in a lower stress environment. Some assisted living facilities have staff members who are trained and equipped to work with Alzheimer’s residents. But many do not. You must research any long-term care operator’s limitations before making a decision. Some will accept Alzheimer’s residents until they become incontinent or require some other type of skilled care. In that case, you must consider what an extra move might mean to your father’s well being and sense of orientation. This is a decision that you, as primary caregiver, must make. Everyone has different limitations and goals. When you know you have reached your limit, make the most appropriate, effective decision for everyone involved. Realize you have done your best and that that is good enough. Let go of any guilt, for it can only destroy you. For more information about Alzheimer`s, click here for our Resource Kit.

How do I agree to get my loved one to agree to attend an adult day center?

By Anthony Ferraro on

June 12, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Alzheimer’s patients are often reluctant to leave familiar surroundings — and when you think about it, who isn’t? So don’t be surprised if this happens. An adult day center offers respite for the caregiver, not to mention activities and stimulation for the patient — and in a safe environment. Using a participant-friendly name for the center could make your loved one feel more comfortable. You might call it “the club,” for example. Others have had success calling it “school,” “work” or “volunteering.” You’ll know what will work best with your loved one, and whether certain techniques you have used in the past will be useful again. Perhaps saying, “This is your time to spend with your friends” or, “Please do this for me” will work well. Some caregivers advocate simply getting into the car and driving directly to the center. Answer questions along the way with positive answers such as, “It’s your day to go to the club” or, “We’re going to a fun place.” Often, someone with Alzheimer’s won’t remember being there before, but then also have some recognition that it’s a “safe” place with friendly people. If you still encounter resistance upon arrival, the center’s staff will be experienced in helping get your loved one into the center. Make your good-bye short and then leave! If the staff is properly trained, they should know how to take it from there, making your loved one feel welcome and loved. Get to know the staff well so both you and they feel comfortable. They’ll probably want to ask you questions in order to give your loved one the best care they can. You may call during the day to check on how your loved one is doing. Often, in fact, the staff encourages this. One key to success is to develop a consistent schedule. There will be various reasons for your loved one to miss a day, but the benefits to keeping a consistent routine far outweigh the urge to just drop in whenever you think “it’s about time for another visit.” Both you and your loved one (and, to some degree, the center’s staff) will benefit from consistent attendance. Participants often adjust well once they get into a routine and are familiar with it. Besides, this is something that your loved one might very well look forward to. Sharing time with people with like interests and/or backgrounds is usually a good way to spend time. Another way to overcome any complaints or objections from your loved one is to have someone who is NOT the primary caregiver take him or her to the center. This could be a friend, neighbor, someone from church, a family member or even a transportation service. The caregiver then will not be a “bad guy” while the person who will deliver your loved one will become a “hero,” especially at pick-up time (if the adjustment to the center still hasn’t gone smoothly). When your loved one arrives home, always try to put a positive spin on what happened during the day. Talk about any activity or menu items from the center. Ask how he or she felt about the experience. Even if there’s not much memory of what happened, stimulate conversation and reinforce good feelings. Stay focused on the positives and reassure your loved one that he or she will always be able to come home. Reassurance is crucial for dealing with feelings of insecurity. Sometimes caregivers hear that their loved one had a “bad day” at the center — from the loved one, but not the staff. The person might say that he or she never wants to go back. This is where you have to take control, with an adult version of “tough love.” If you feel the center is a good thing for your loved one, you should continue the routine of getting the person there. It takes positive reinforcement and persistence to find adjustments and make a routine work. Remember that because your loved one might be attending only part-time, it might take longer to adjust than if he or she were there for longer periods of time. If the center feels good to you, it is probably a good place. If your loved one complains but your gut is telling you something different, talk with the director of the center or a social worker and discuss the situation. If you still don’t feel comfortable after that, find another center! You are usually not locked in to many terms and you are able to come and go at a center without penalty. Another thing to consider is that some individuals with Alzheimer’s might become over stimulated if they are around a lot of other people, regardless of the environment. You must watch this carefully, too. In some instances, staying home with company or an attendant might be better than placing your loved one in a situation where he or she might be constantly over stimulated, with too many people around.

How do I find the best adult day center for my mother?

By Anthony Ferraro on

June 8, 2012

- Alzheimer's Care, Blog, Elder Law Articles

This can be a complex task, not unlike finding a nursing home for a loved one. There is a matrix of criteria you’ll want to check and meet. One of the first is checking into your options BEFORE day center services are ever needed. This will help both you and your mother. You can find available adult day center lists from the local Area Agency on Aging or ARC. Winnow down your options by asking whether staff members are trained to work with people with Alzheimer’s. Once you find some you are considering, your first move should be to make an unannounced visit to one of them and ask for a full-facility tour. When this happens, observe whether participants at the center seem happy and content. Are they truly involved in an activity or just sitting around with a TV on? Television isn’t necessarily a bad thing, but it shouldn’t just be a personality-free baby sitter. Activities could be created to use it for sing-alongs or discussions, for example. Look around and watch to see if the participants interact freely with one another. Try to learn if staff members encourage individuals to be as independent as possible. Next, learn what’s needed to be admitted. Each facility has its own policies. Typically, a physical from a doctor and a medical history must be given, as well as a TB test from the last 12 months, or a chest x-ray. Ask if the facility itself can do the TB test (and if there is a cost for it). Make sure you go through the admissions packet carefully with someone at the center. Ask about all policies and procedures and pay particularly close attention to anything concerning fees. Inquire as to billing policies — including whether they bill in advance or after the fact. How do they handle absences? If you think of additional questions, be sure to call back to get answers or clarifications. If you let some centers know you’d like assistance filling out papers, they’ll help you get it done. You’ll want to check out licensing issues. Some states require licenses for these operations. They should be posted and available upon request, including how many participants it can legally serve at one time. Find out if the center has been cited for deficiencies — and whether they’ve been corrected, of course. Inquire about the staff-to-client ratio. There should be at least one staff member for every eight participants with Alzheimer’s. Meet the facility director and staff and observe how they interact with everyone. Gauge whether they’re attentive to you and your needs. You should ask about the age of the facility, whether staff members are trained to work with Alzheimer’s and how wanderers are monitored. Here are some other questions to ask an adult day center you’re contemplating using: • Do you have a social worker on staff? Someone knowledgeable in assisting with resources, financial assistance, counseling, discharge planning, etc.? • What are the philosophy and goals of the center and its various leaders? • What are the direct staff members’ credentials? • What is the rate of employee turnover? • Is there a charge for late pick-up? • How long and frequently does a participant have to attend? • What are the emergency procedures? • How are meals prepared and what special diets can you accommodate? • What does a “typical” day’s routine consist of? • How involved can family members be at the center?