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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

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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.  
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I’m scouting nursing homes for my mother, who has Alzheimer’s. Can they ever kick her out if she runs out of money? ? | Chicago, Illinois Elder Law Attorney Anthony B. Ferraro

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July 25, 2012

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

This is a good question that you need to sort out before making a final decision about specific living arrangements for your mother. Medicaid is for individuals who have little or no means to pay for their own care. Eldercare facilities must be certified by the appropriate government entities to serve Medicaid beneficiaries. Some nursing homes and other eldercare facilities simply are not certified to accept Medicaid funding once a resident runs out of his or her own money. And those facilities that do accept Medicaid could have a long waiting list for the beds designated for that type of care. That is why it is so important to figure out the lay of the land and your options before you initially settle your mother into a facility. Find out the monthly cost of a nursing home that interests you and project how much you think you will ultimately be needed. If you think your mother will outlast her funds, you can ensure you choose a provider that will accept Medicaid, when and if the need arises. Families of individuals with Alzheimer’s usually do not want to move their loved ones if they don’t have to, especially not after they have adjusted to their surroundings. Changing locations can be very stressful for a person with dementia.  To learn more about Medicaid, click here.
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How can I get a family council established at my husband’s nursing home? | Chicago Elder Law Attorney Anthony B. Ferraro

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July 20, 2012

- Alzheimer's Care, Blog, Elder Law Articles

When done right, family councils can be very beneficial. Their goal is to discuss issues with staff members in a constructive, non-threatening setting. They are not supposed to be forums for constant complaining or berating of staff. At these meetings, ideas, concerns and possible solutions are shared. It is also an opportunity for bonding with staff members. If you want to establish a council, speak with the nursing home’s administrator. These councils are common so you might not face much resistance. Establish a place, day and time to meet, as well as a format for how meetings will run and what will be addressed. You’ll also need to determine who will run such meetings, and create a way of informing all residents, family members and staff about them. The meetings can be informal, or quite formal — complete with minutes being taken. It’s up to everyone to decide. The structure isn’t as important as getting information out and distributed. One big function of family councils is to help arrange activities that involve both residents and their families. By this, we’re mainly talking about picnics held at the facility. These can help promote a sense of unity among residents, family members and staff.  For more information, look into our Alzheimer’s Resource Kit.  
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My father lives in a nursing home and we need to know how to deal with him constantly losing things such as his wallet, glasses, dentures, etc. | Chicago Long-Term Care Planning Attorney Anthony B. Ferraro

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July 19, 2012

- Alzheimer's Care, Blog, Elder Law Articles

First, talk to the person in charge of his unit and ask if there are any known reasons why these items are continually being lost. Then go from there. If your father is a hoarder or hides things on purpose, that is one issue; but if the items are disappearing “on their own,” that is another matter you might want to pursue with facility managers. If it comes down to the cost of replacing certain items, you might want to ask whether they are truly making a difference in your father’s life. Are they causing more strain or stress than the quality of life they bring? Replacing a wallet is probably easier to do than more expensive items. A wallet can give a person a sense of security. Therefore, purchasing a new, inexpensive wallet (or several, just to be prepared) can add to quality of life. Getting new glasses or dentures is quite different. If he still likes to read and needs his glasses to do so, then by all means replace them. Less expensive frames are widely available, and maybe inexpensive reading glasses (that can be bought at a local drug store) might be sufficient. Dentures obviously can play a big role in nutrition so they should be taken care of. Fixing them will be more economical than replacing them in most cases. Unfortunately, often a pattern emerges where once one set of dentures disappears, you know others also will get lost. Your father might be taking his dentures out due to discomfort. Also, if they are shifting in his mouth, he could develop sore gums, which could lead to a loss in weight. Check with a dentist for adjustments that can make your father’s dentures more comfortable.
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I think my mom’s medication is affecting her negatively. How can I get her nursing home to adjust it? | Chicago, Illinois Elder Law Attorney Anthony B. Ferraro

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July 18, 2012

- Alzheimer's Care, Blog, Elder Law Articles

I recommend documenting what you have seen since your mother started the medication in question. You can also start out by directly calling the physician who prescribed it and asking about your concerns. Your mother could be experiencing a transition period, which might be expected. If you think you are getting resistance from nursing home staff members, you should speak with the facility’s administrator. You may also ask to sit in on the next care-planning meeting for your mother. This is where various members of the nursing home caregiving staff collectively discuss a resident’s health status and plan of care. By rule, you are to be informed of these meetings and allowed to attend them. If you are not satisfied with what you hear, then you have to make a further decision. There is the option of calling your state’s long-term care ombudsman. Ombudsmen have been trained to advocate on behalf of nursing home residents. This person can work as a mediator to help you and your mother’s facility work out any differences. You should feel comfortable enough that she is in a safe environment, with people who care for her around her. If this isn’t the case, you might have to move her to another nursing home. This is a difficult decision to come to because moving is hard, especially on a person with Alzheimer’s. Weigh the pros and cons. But the bottom line has to remain whether you are comfortable with the facility where your mother is living. If you’re constantly worried, then your qualify of life could go down. If all else fails in a situation like this and you are your mom’s power of attorney for healthcare, you can request a change in her medication. Just be sure to have spoken with her physician ahead of time to ensure that this is the best thing for her.  For more information, sign up for the Alzheimer’s Resource Kit here.
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The nursing home changed my father’s medications and now wants to evict him and have him checked him for possible inpatient admission because of aggression. Should I have him assessed if the odds are he won’t be taken back by this facility?

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June 29, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Extreme agitation is typically the source of aggression. If the agitation is under control, the aggression should lessen, if not stop altogether. If you believe the nursing home’s staff members did not handle this the best way possible, you can meet with the facility’s director of nursing and the care-plan team to discuss the situation. If that doesn’t bring satisfaction, you can take it further, to the state’s long-term care ombudsman program. Ombudsmen are trained volunteers who, upon request, advocate for nursing home residents and their families when there are problems with a facility. If you are confident that staff members did all they could, your father needs to be assessed. Outbursts of aggression are not only difficult on the people around the Alzheimer’s patient, but also on the individual himself or herself. There is little quality to life when one is agitated all the time. There are various good assessment programs throughout the country. You can learn about some at the Alzheimer’s Association website (www.alz.org). Look for a program near your area. One good thing about an inpatient assessment is the 24-hour-a-day observation. Its value is evident because there can be additions, deletions or changes to medications — and observation of any effects of these changes. You could learn that his medication is causing his agitation. Be sure to keep his doctor informed of what you’re doing and what is happening. When he is being assessed, you have an excellent opportunity to meet with discharge coordinators or social workers. They can help you find the right facility. They may not recommend any one facility but they can give you guidance. Another thing to remember is that environment can play a huge role in how comfortable a person is. If your father is not comfortable where he is, a move might be the best idea for him. Even though moving a person with Alzheimer’s can create confusion and possibly setbacks, the odds are he will recover. Your father needs an environment that feels loving and accepting to him. Staff members are usually the key in this regard. So if/when you wind up looking for another nursing home, be sure to meet staff and observe their interaction with residents. Additionally, if your father didn’t live on an Alzheimer’s unit before, look for one now. Their staff members are specially trained to deal with symptoms and issues that accompany Alzheimer’s.    
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How beneficial can I consider a dementia care unit for my mother?

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

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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.
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My mother has Alzheimer’s. How can I help her manage her own medications and stay at home as long as possible?

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June 22, 2012

- Alzheimer's Care, Blog, Elder Law Articles

There are several ways you can handle this situation. Of course, it is very important she takes her medications as prescribed. Otherwise, there can be multiple problems for her, physically or mentally, and ultimately for those around her as well. How you tackle meeting her needs will depend on how much medication she takes, how often she takes it and also her ability to sort things out. If she just needs reminders but is otherwise capable of taking them herself, you can buy any of the various reminder systems available at a drug store or other retail outlet. These can be as simple as pillboxes with compartments for each day of the week. Then, you can just call at the beginning of the week to make sure she has things set up properly — and make sure she starts taking them appropriately, too. If necessary, you might have a visiting nurse or even a friend stop in and fill the compartments. There are also systems with alarms that will issue reminders about when to take meds. You will have to decide which is best for her, depending on her functioning level, possible level of confusion and other ability gauges. If having yourself or someone else phone her and reminder to take her medications at the appropriate times isn’t working, you definitely need to hire or appoint someone to do it in person. Adult day centers also can help with medications. If the center has a nurse, that person can assist with drug administration, should your mother need it. If this is the case, you are required to take the medication(s) in original packaging, with the doctor’s order on the container. This attention to her care will help her stay in her home longer.    
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Could my loved one actually be happier at a nursing home?

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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.  
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