How can we encourage a more collaborative spirit, rather than “them vs. us,” when it comes to my mother’s nursing home staff? ? | Chicago Long-Term Care Planning Attorney Anthony B. Ferraro

August 22, 2012

- Alzheimer's Care, Blog, Elder Law Articles

First of all, for family members: When you first admit a loved one to a nursing home, you should get to know the staff. Let them know that you care about their well being (in addition to your loved one’s) and that you would like an open relationship so you all can discuss issues concerning your mother’s care. Inform them about pertinent information concerning her and her life — what she likes, dislikes, any habits she might have, typical moods, and what seems to work when approach her in different situations. The more her caregivers know, the better they can care for her. Compliment staff members when you learn about them doing something you like. Be involved at the facility as much as possible. Attend social events and family council meetings if you can. One good example of relationships being built very well involves a man who took a picture of his wife and the staff on her unit. He had an 8-by-10-inch shot of it made and wrote the name of each caregiver underneath it. When placed on his wife’s closet door, it served as an aid to helping her recognize the people taking care of her. It also made the staff members feel very included. It made them feel important and let them know that the family really cared about them. This gesture built a lot of good will and enhanced his wife’s care. To the staff: Don’t be intimidated by residents and/or their families. You are the frontline worker, an honorable position. Without you, there would be no care for their loved one. That is a compliment of the highest order. Show interest not only in the resident, but also his or her family. Introduce yourself and tell them a little bit about your background, your interests, how long you have been a caregiver and why you are in that line of work. When family members enter the unit, greet them cheerfully and give them information about their loved one, whether the news is good, bad or indifferent. What many caregivers don’t think to do is call a resident’s family if something good happens during the day. These are blessings that can be few and far between for family members, and they’ll go a long way. Unfortunately, there can be stigmas about nursing homes and their caregivers. For the most part, these workers are intent on doing a good job and truly care about what they do and who is in their charge. Everyone needs to work together to overcome negative stereotypes so residents will have positive experiences in their new home.

My father keeps asking to go home. What do we tell him? ? | Chicago, Illinois Elder Law Attorney Anthony B. Ferraro

By Anthony Ferraro on

August 20, 2012

- Alzheimer's Care, Blog, Elder Law Articles

When your father or any loved one starts to ask about home, someone could drive them past a previous home, even from childhood. Often, he will not recognize the old house because a house and a home are two different things. That’s why it is best to make him feel safe and secure, regardless of wherever he is. To most people, “home” is a place where we feel loved and accepted — and safe. So the best way to answer your question is to think about the word “home” and what it signifies. Depending on where he is with memory loss, your father might be conjuring thoughts of a childhood home with his parents and siblings. Or the home where he was first married, the kids were young or any time before, after or in between He might be living in the same home he’s been in for 20 or 30 years and still ask to go home. Due to the nature of Alzheimer’s, your dad is likely feeling insecure, fearful, even unlovable. Please pay close attention to this next point: It is not your fault. He is dwindling a bit, day-by-day, and he is frightened. Fear can drive many emotions, not the least of which are insecurity, anxiety, anger and low self-esteem. Your father needs to feel safe. If he doesn’t carry good feelings about himself, he probably doesn’t feel he can be loved by anyone. Remember that the most important thing to realize is you need to constantly validate his feelings. Instead of telling him he is home, tell him simply that he is in a safe place and that he is loved very much. You can tell him, for example, “Dad, you’ll be staying with me and Anthony for a while. We’re happy you’re here and we love you.” Reminiscing about his childhood and looking back at his life and life accomplishments also should make him feel good about himself and decrease negative feelings. Because Alzheimer’s patients typically have short-term memory loss, he will nonetheless continue to ask about “home.” Repeat over and over that he is in a safe place and loved very much. Giving hugs throughout the day will truly say much more than words. A hug produces feelings of love, acceptance and security — three big concepts that continually need addressing. For more information regarding how to treat a loved one with Alzheimer’s, click here.

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

By Anthony Ferraro on

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 beneficial can I consider a dementia care unit for my mother?

By Anthony Ferraro on

June 27, 2012

- Alzheimer's Care, Blog, Elder Law Articles

If it’s done well — with proper staffing and development — it can be very beneficial. The idea of the dementia care unit is to provide specialized care, which includes trained staff for dementia, smaller units to soothe residents’ feelings and a locked area that will be safe for those who wander or pace relentlessly. The last two are symptoms that most Alzheimer’s patients experience at one time or another. Dementia units do not try to stop it from happening but rather aim to contain it to a safe environment. If your mother lived in an open facility — not a specialized unit— she might become more confused. Many such facilities are larger, have wide open spaces and high ceilings, and a lot more people coming and going. Those conditions are virtually eliminated in a special care unit. Dementia units raise the level of care while lowering the levels of stimulation. Many have done away with overhead intercoms since they can cause serious confusion or agitation for residents. The standard for Alzheimer’s care in most facilities is that the special unit has its own activities director. Often, direct care staff also are trained specially to participate in resident activities, which are specifically geared to the residents’ needs. For more information on special Alzheimer’s care facilities in your area, contact your state’s Department on Aging. It can give you a list of units or tell you where you can find one. If you have the option, visit at least three of these units in your area before making a choice. As always when visiting a potential home for a loved one, take someone you know and respect who preferably isn’t in the family. That way you can get a more objective view of what’s going on. Meet the staff and observe how they treat the residents, and how the residents respond. It’s not unusual for a facility to have a few deficiencies, but how serious were they and have they been corrected in a timely manner? You need to know these things. When you make a decision about a facility for a loved one, listen to your gut feeling. It is often a very accurate way to gauge. You still need to take stock of basic needs and questions; talking with the person who accompanied you on your visit will help sort things out. Then you can make a rational decision that everyone can live with more comfortably. For more information regarding Alzheimer’s, click here.

Are group homes appropriate for individuals with Alzheimer’s disease?

By Anthony Ferraro on

June 25, 2012

- Alzheimer's Care, Blog, Elder Law Articles

States use different names for residences like these, which may have four or five people each. In some states, they are referred to as boarding-care homes. Some states license them and some do not. You should call your state’s facility licensing agency and ask. You also can inquire about getting a list of them. Look for homes like this, which are specifically designed to help people with Alzheimer’s or other dementia. Typically, staff there will be specially trained to work with such individuals, and keep everyone safe. If there isn’t a facility like this near your home, you might want to reconsider pursuing such living arrangements. One of the considerations for this type of living arrangement is whether your loved one can live out the rest of his or her life there. What happens if he or she runs out of money? Does the place accept Medicaid? Can he or she stay if she becomes bedridden, needs incontinence care or needs a wheelchair? With regard to dementia care, sometimes the smaller homes are ideal because they feel more like home, not an institution. The facility manager can keep a closer eye on things, though the appropriate employees still need to be hired and trained. Smaller homes like these typically have staff members cross-trained; they might be personal care assistants, as well as cooks and cleaners. You’ll want to observe at any home like this you may be considering whether residents have a daily schedule and routine. Some tasks might need to be modified to take an individual’s level of functioning into consideration. But by and large, residents can assist with things such as preparing meals, setting the table, folding clothes and towels, sweeping the floor, watering plants, helping in the yard, taking out the trash, and numerous other tasks. Allowing residents to help with daily chores makes it feel more like a family environment for everyone. This will be a community of its own for your loved one. It should be a place where he or she will make friends and have other caring individuals around. For more information about Alzheimer’s click here.

Could my loved one actually be happier at a nursing home?

By Anthony Ferraro on

June 20, 2012

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

Yes. Many people are happier at a nursing facility, for a variety of reasons. First of all, nursing home residents have decreased feelings of intimidation because they are surrounded by others who similarly have decreasing abilities. Also, the intimidation of being in one’s own home but being far less able is taken away. Some view a nursing home like a specialized college dormitory. Each resident has his or her own living space, plus access to common living areas. There are good opportunities for social interaction in places such as the dining room or TV lounge. Even individuals who were not particularly social earlier in life usually enjoy socialization at this point. A good eldercare facility also offers daily activities. There typically is enough variety to have something that meets the needs of almost everyone. There can be group activities such as bingo or book clubs. There might be reading or jigsaw puzzles that can be made. If a favorite activity is not offered, a facility often will make an attempt to add it, as long as staff members know there is interest in it. Throughout, residents are monitored by nurses and nurse aides. Another plus is that a facility doctor is available, at least by phone, to answer questions and write orders as needed on a personalized basis. Realize that once someone enters a nursing home, he or she may still leave for short trips or overnight stays with family or friends. If there is dissatisfaction with a certain facility, a transfer to another facility is always a possibility. It’s you and your loved one’s choice — always. Being in a nursing home also can increase feelings of independence for an individual. How? A nursing home is a safe, secure place with care around the clock, good hot meals, socialization aspects usually not found at home, and activities available all day. Residents who might have felt they were a burden to their families can find some sense of comfort and satisfaction that they can live “on their own” and not be such a strain on their loved ones.

How do I pick the ‘right’ nursing home or assisted living facility for my loved one?

By Anthony Ferraro on

June 18, 2012

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

Be aware that you can narrow your choices by location and by whether they offer specialties such as Alzheimer’s and dementia care — at both assisted living and skilled nursing facilities. You can get a list of facilities from the Alzheimer’s Resource Center, Alzheimer’s Association, Area Agency on Aging or various telephone directories. Check out facilities that interested you in your area before your family needs one so you can make a decision under less stress. Take notes on several facilities so you can comparison shop because that is exactly what you’re doing: scouting out some of the most important services you may ever need. Make a few visits, and make them at different times of the day. Take someone you trust with, preferably not a family member, as this type of person will be more objective and see things in a different light. Gauge the atmosphere of the facility. Is it warm and inviting? Does it pass the “smell test”? How do staff members interact with residents? Are they treated with respect? Are they attended to promptly? Is the facility clean, both inside and out? Are there secure outdoor areas intended for resident use? Is administrative staff available? Does it seem like a friendly facility? Ask for at least three names and phone numbers of families you can talk to who currently have a resident at the facility. Ask around in the community about the reputation of the facility. Any nursing home you visit must have readily available the results of its last state survey (inspection) so don’t be afraid to ask to see them. Or check out the Nursing Home Compare website that the government publishes precisely for this use. Once your loved one is admitted, your responsibility for checking out a facility is not over. You can stay as involved as you want, and you should keep as prominent of a presence as you wish. Research has shown that proximity is the top reason most families choose a certain facility. This means visits should be convenient, and possible for other family members and friends. Use visits — by any others — to serve as check-ups on living conditions for your loved one. Although there are more and more Alzheimer’s-specific facilities opening, it is not uncommon for them to have waiting lists. It can be months before a spot opens up, so if you’re at all inclined, go ahead and put your loved one’s name on a waiting list. If you are called about a vacancy and aren’t ready for the move yet, tell them. They are usually more than willing to put you back on the list, farther down, and they will call again. For more information regarding Alzheimer’s, you can click here to view the Alzheimer’s 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?

Medicaid Reform Again, But WORSE!

By Anthony Ferraro on

May 25, 2012

- Blog, Elder Law Articles, Estate Planning, Medicaid and Paying for Nursing Home Care, Probate, Estate, and Trust Administration

The SMART Act SB 2840 will reverse many of the DRA changes Elder Law attorneys fought for on behalf of our clients. The changes include the following:

Legal fees are no longer exempt for 3-month backdating.
Abolishes spousal refusal entirely.
A homestead in Trust is no longer an exempt asset.
Except for the Community Spouse Resource Allowance ($109,560) and Minimum Monthly Needs Maintenance Allowance ($2,739, HFS is no longer limited in how much it can seek when pursuing a support order against a community spouse.
Reverts to the old limits on prepaid funeral contracts.
Reduces the home equity exemption to the minimum allowed under federal law (base figure of $500,000, adjusted annually for inflation, rather than the $750,000 adopted in the DRA rulemaking).
No exception for prepaid funerals for 3-month backdating.

More to come.