Alzheimer's Disease Care in Assisted Living

Alzheimer's Disease prevents challenges which some other age-related diseases do not, simply because the personality of the senior can change, along with the memory loss.  As is often said, Alzheimer's Disease is the "long goodbye" to a loved one.  And it can be even more confusing to family members because the senior can have a good day, tossed in with the bad days or they can seem just fine during short visits. 

Caregiverlist's Assisted Living Expert, Lisa Sneddon, with Senior Living Experts, just assisted a senior with Alzheimer's Disease to move to an Assisted Living Community which specializes in elder care for those with memory loss.

The family member sent her a note telling her that they visited their loved one and realized they were doing well and they then had their first night of peaceful sleep in 8 years.  You can read the entire note about this senior's move to Assisted Living in Lisa's blog.

Caring for someone who may become confused about "person, place and time" presents unique safety challenges.  Many times the senior will take out all of their anger about their condition on the person who is closest to them.  This is why in some instances, the best care may be at a senior care community which offers a special environment and is able to rotate Caregivers to prevent burnout when the senior is combative.

Some Assisted Living Communities have created rooms with memorabilia from certain eras and provide music and movies for times the senior can remember.  Many seniors are able to remember events from many years ago, while not being able to remember recent events.  Just as finding the right medical doctor who is able to specialize in certain medical conditions can be vital to obtaining the most effective medical treatments, sometimes senior care requires a specialized solution.






, , , ,

How to Choose a Senior Home Care Agency

Caregiverlist has organized a checklist to assist in making sure you have the right information at hand when you begin the search for a Senior Home Care agency for elder care needs.  Sometimes family members are not aware of all the various care needs which an agency may be addressing in order to provide a quality Caregiver and to develop an appropriate schedule for the care services.

Most agencies will meet with the senior to conduct a Client Assessment Interview and then will create a Plan of Care which will include specifics on the care needs.  By effectively communicating the care needs to the agency, you will assist them to be successful in providing a quality senior care solution.'s Checklist: Choosing a Home Care Agency

  1. Needs

    First consider the actual care needs and write out a list of items that need to be provided. Be able to give an example of a typical day for the care recipient, from the moment they wake up until they go to bed and include a timeline of when they prefer meals, naps and other activities.
  2. Hands-on

    How much hands-on care is needed vs. companion care? If more companion care is needed, make a list of possible activities.
  3. Transportation

    Do you need a Caregiver who can escort the client to doctor's appointments and social activities? If so, what mode of transportation will they use? Will the Caregiver drive the client in the client's car? Keep in mind that you may need to research your car insurance coverage if this is the case. Will the Caregiver drive the client in the Caregiver's car? If so, be aware that it will be difficult to be 100% sure that the Caregiver's insurance policy is up-to-date even if you verify this in the beginning. If they have a late or missed payment the policy could be cancelled without your knowledge. Will they take public transportation (bus or taxi cab)? This is probably the safest method of transportation to prevent the risks of insurance issues. (Some cities provide special transportation privileges for seniors and you may want to contact your local Department on Aging for information).
  4. Memory Loss

    Is there memory loss? If so, have you had the type of Memory Loss diagnosed (Alzheimer's Disease, Huntington’s Disease, Pick’s Disease, Frontal Lobe Dementia, Frontotemporal Dementia, Lewy Body Disease, Normal Pressure Hydrocephalus, Vascular Dementia, Parkinson’s Disease)? Blood clots and brain tumors may also cause dementia. A diagnosis of dementia type will help the agency to better understand the care needs and assign a Caregiver with the right type of training and qualifications.
  5. Language

    Do you need a Caregiver who speaks a certain language?
  6. Hours

    How many hours of care per day will you require? Review the list of services you will need performed during the care visit and decide on the minimum number of hours per day which would work as a starting point. The agency will need to know the hours of service to assign a Caregiver and will allow you to adjust the hours after the first week to accurately meet the care needs.
  7. Dietary

    Are there any special cooking requirements? Communicate any food allergies or specific cooking requests and consider how groceries will be purchased or delivered if the care recipient is unable to shop for groceries on their own.
  8. Additional Skills

    Are there any "skilled" care requirements, such as taking blood pressure, blood sugar testing, wound care or a feeding tube? Communicate if these specialized services will need to be performed or monitored.
  9. Medication Management

    What is the care recipients method for managing medications? Do you know for sure if the medications are currently being taken correctly? Be able to provide a list of medications and the method of monitoring so the Agency will be aware of possible side effects and other requirements such as taking pills with or without food, etc.
  10. Case Management

    Will medication management be required (organizing the medications in a pillbox and obtaining refills)? Due to insurance purposes, this service usually must be provided by a Supervisor or R.N. depending on the state and an additional fee is charged for the service, separate from the daily or hourly caregiving rate. If the client is unable to manage their medications, determine if a family member will take on this responsibility or if you will need the Agency to perform this task too.
, , , , , , ,

Nursing Home vs. Other Care Options

As Medicare only pays for a short nursing home stay, after a major medical incident, seniors and their loved ones must evaluate if they want to private pay to stay in a nursing home or seek an alternative for their nursing care.  Alternative senior care choices include a Senior Home Care Agency providing a Caregiver and Care Management in the home or relocating to Assisted Living.

Most Nursing Homes accept Medicare and Medicaid patients but there are a small percentage of nursing homes which only accept Medicare patients.  At the same time, some nursing homes only accept Medicaid payments after a patient has spent all of their assets and qualifies for Medicaid.  They will not accept new Medicaid patients.  In 2006, 48% of nursing home care was paid for by Medicaid which matches the trend industry experts report:  seniors are seeking an alternative to nursing home care.

Reasons seniors may opt for an alternative to staying in a nursing home:

1) Staff to patient ratio:  nursing homes often staff one Nurse's Aide to 12 to 15 patients.  The nursing aide is the person responsible for assisting with personal care, such as  showers and bathroom visits.  Each patient's care depends on the ability of the aide to juggle the needs of multiple patients. 

2) Cost:  although the daily rate for care may be acceptable, sometimes the additional fees for everything from hair cuts to transportation can add up and cost much more than the cost of paying for an individual Caregiver in the home or a private apartment with part-time care in an Assisted Living Community.

3) Care needs:  many times a senior will recover from medical conditions which require rehabilitation in a nursing center, such as a stroke, heart attack or hip replacement, and be able to function on less care.

4) Specific care needs:  seniors who may need more specialized care for conditions such as memory loss or diseases such as Parkinson's Disease, may opt to find a community which specializes in this type of care.

5) Quality of nursing facility:  sometimes hospitals discharge patients to a nursing home for rehabilitation and do not consult with the patient on which facility they will be transferred to when they leave the hospital.  The nursing home may not suit the personal desires of the senior and this is often when families begin their search for elder care.'s experts on Assisted Living, Long-term Care Insurance, Estate Planning, Elder Law and Reverse Mortgages answer questions about all of these aspects of elder care to assist seniors to find the right option for their finances, medical needs and personal preferences.





, , , , , ,

Elder Abuse

Monday's Wall Street Journal featured a story on elder abuse and reported that in many states there are no laws regulating Background Checks for senior home care.  While it is true that there may not be formal laws in place, any professional Senior Home Care Agency which carries professional liability insurance and covers Caregivers through Worker's Compensation insurance (this is a law - Worker's Comp Insurance must be provided for employees), will require all their employees to go through Background Checks.  These checks will verify the individual's name matches the Social Security number they provided and matches the addresses associated with that number.  They will also check the criminal records in the counties which the Caregiver applicant has lived. 

These agencies also will require that money does not exchange hands between the Caregiver and the Client, unless a special "petty cash" fund has been set-up and is strictly monitored, with proof of receipts, for tracking purposes.  At the same time, the petty cash is usually funded through the Senior Home Care Agency and then billed to the family to make sure accountability is in place.

Professional Senior Home Care Agencies are experienced in managing Caregivers and all the aspects of the care and will incorporate a Senior Care Manager to assist with the case when required.  This prevents financial and emotional abuse from happening. has created standards for the Senior Home Care Agencies we refer to, since there are no nationwide laws. also provides information on Background Checks.  It is important to make sure background checks not only match Social Security numbers and past addresses for an individual, but also check criminal court records in each county the Caregiver has lived in.  Even some websites that connect caregivers and nannies with families for direct-hire, do not provide complete Background Checks but only a Social Security number and name match.  There is always a risk with a hire-direct situation because the extra insurance liability of Worker's Compensation Insurance and Professional Liability Insurance are not in place to protect the senior and the senior's family.

Elder abuse is easy to avoid when there is active management of a Caregiver.  While Caregiving can be exhausting, a professional caregiver will know how to react to all types of clients and their Supervisor or Care Manager will be there to coach and support them.  In addition, professional caregivers are providing care as a career - they will be the first to report any unsavory activity by family members or friends.



, , , ,

Assisted Living: Does it include a Caregiver?

Senior Assisted Living Communities vary widely in the services they provide their senior residents and the extra amenities offered.  There are no national licensing requirements for senior "assisted living" which causes even more confusion when you begin the process of looking for an appropriate community for yourself or a loved one.  Many times, communities which call themselves "independent living" may offer as many services as an Assisted Living Community.

Another challenge when evaluating an Assisted Living Community is learning about what elder care services are included.  While communities do hire a staff of Caregivers which usually including Certified Nursing Aides and Registered Nurses, they may only have a small number of these caregivers who are keeping an eye on all the residents .  These Caregivers are usually not available to work one-on-one with an individual senior resident to provide care services.  It is important to determine how much one-on-one care may be needed and how this will be provided.

Many Assisted Living Communities partner with Senior Home Care Agencies to provide private Caregivers for their senior residents, when more individual care services are required.  Seniors who have memory loss may require more care and some communities offer special customized services for these residents.  Other communities are not equipped to manage care for seniors with Alzheimer's Disease and other types of memory loss.

Separately, some Assisted Living Communities provide nursing care, just like a nursing home, and others do not.  Usually the nursing care is on a separate floor and will require the senior to move from their apartment to a room or bed in the nursing center area of the community.

What if the senior will eventually require nursing care which can cost as much as $80,000 per year - - will they need to move again or will the Assisted Living Community be able to provide this?  And what if the senior runs out of money and will need to go onto Medicaid?  Will the Assisted Living Community allow the senior to stay and accept the Medicaid payments or will the senior need to relocate to a Medicaid nursing home?

As an initial move into an Assisted Living Community may be connected with the death of a spouse or the diagnosis of a new medical condition, the emotional and social needs of the senior should also be considered.

Finding the right Assisted Living Community presents a complicated task because of all these dynamics.  In addition, another type of assisted living is called "continuing care" and available at Continuing Care Retirement Communities.  These communities usually require a large initial deposit (some seniors sell their home and use the proceeds to pay for this deposit) but guarantee the senior will be able to remain in the community as their care needs may change.  Usually condos or townhouses, apartments and nursing centers are all located on the campus and the senior may move between them, as needed. provides an "expert" to answer all your questions about Assisted Living.  Lisa Sneddon, owner of "Senior Living Experts" serves as a resource to families and a coach to seniors to assist with finding the right assisted living solution.

, , , ,

Congress passes Medicare bill

Seniors depend on Medicare for their health insurance after age 65.  Archaic legislation would have decreased the Medicare reimbursement rates for senior's medical services by 10.6%.  This would have meant some medical doctors would opt to not accept senior clients as they could better cover their costs by focusing on clients who could pay their rates.  This especially becomes a problem in smaller population areas where there is already a shortage of medical doctors, leaving the elderly population needing to travel further for medical care.

Although President Bush says he will block the bill with a veto (since he doesn't need to worry about being re-elected), Congress has enough votes on the bill to over-ride his veto.  A few Republicans joined the "Yes" vote after Senator Ted Kennedy (also a senior) took a break from his chemotherapy treatments to fly to Washington, D.C. to break the dead-lock.

I have always thought it was interesting that Medicare will only pay to "rent" a manual wheelchair for a senior but if the qualifications are right, they will buy a power wheelchair for the senior  -  and pay what I have heard is as much as 4 times over the wholesale price for these power wheelchairs (you may remember the Scooter Store had hired their own "doctors" to write up medical authorizations for seniors to qualify for a scooter since Medicare was paying and they had no problem buying Infomercials to advertise this to seniors.  They also apparently hired telemarketers to tell seniors they could only qualify for certain expensive power wheelchairs through Medicare).  When the U.S. Justice Dept. filed suit against the Scooter Store in 2005, they had already billed Medicare for $400 million since 1997.

I am all for making a profit for providing a service that is of value, but I don't believe the government should be willing to foolishly over-spend on certain elder-care products and then be unable to pay for necessary senior services at a fair market rate.

Perhaps a new President will be able to help guide Medicare in a better direction as the voting population ages. And at least we know most most first-term Presidents want to be re-elected and should pay attention to the voice of seniors.

, , , ,

Senior Care: How Much Does it Really Cost?

Fidelity Investments, a leading mutual fund company which manages the 401K retirement assets for many Americans (Fidelity manages billions in assets), recently released results of a study which found a 65-year-old couple needs $85,000 on average to cover insurance costs for long-term care such as nursing home stays in retirement. 

However, this would be the amount required just to pay for the long-term care insurance premiums.  If someone does not have long-term care insurance, they can expect to pay that much per year, just for a nursing home ($85,000).

Fidelity also reports that just about 5 million Americans are covered by long-term care insurance policies, a number which has remained mostly flat for the last 10 years.  At the same time, the number of Americans needing elder care will increase to 27 million people in the next 30 years.

I have found that most Americans assume that Medicare will pay for a nursing home and just don't think about needing to pay for these services.  This is because Medicare does pay for care in a nursing home in certain situations, for up to 100 days.  And it seems nearly everyone has a senior relative who was in a nursing home for a moment and the care was paid for by Medicare and this builds the assumption that Medicare pays for a nursing home forever.

Seniors only qualify for the Medicare nursing home benefit after a major medical event, such as a stroke, hip replacement or other major surgery and typically the care is considered rehabilitation.  When the 100 days is up, the coverage is up, and sometimes it does not even cover 100 days.

After the Medicare benefit expires for a nursing home stay, seniors must decide if they want to remain in the nursing home and pay the fees, or move to their home and hire a Senior Home Care Agency or move into an Assisted Living Community where they may need to also hire a private caregiving service.  Long-term Care Insurance usually covers caregiving for seniors in any location - at home or in a senior care facility or Assisted Living Community. contacted some nursing homes around the country in May to find out their daily rates.  Here are the daily costs in these nursing homes:

Balboa Nursing & Rehab Center, San Diego, California:  $260 per day for private room/$225 day for semi-private room

The Village Healthcare Center, Hemet, California:  $334 per day in a semi-private room

John Hopkins Bayview Care Center, Baltimore, Maryland:  $210 per day for a private room

Senior Citizens Home, Henderson, North Carolina:  $175 per day in a private room, $150 per day in a semi-private room

Westminster Commons, Atlanta, Georgia:  $165 per day in a private room, $155 per day in a semi-private room

Coral Reef Nursing & Rehab Center, Miami, Florida:  $295 per day in a private room, $285 per day for a semi-private room

Stoneybrook Retirement Community, Manhattan, Kansas:  $184 per day in private room, $147 per day in semi-private room

Neuro Rehab Center, Worcester, MA:  $265 per day in a private room, $245 per day in a semi-private room

Let's do the math for 365 days in a year times these daily rates:

$165 = $60,225.00 a year

$175 = $63,875.00 a year

$184 = $67,160.00 a year

$210 = $76,650.00 a year

$260 = $94,900.00 a year

$265 = $96,725.00 a year

$295 = $107,675.00 a year

$334 = $121,910.00 a year

Those are the actual nursing home costs.  These fees do not cover "extras" such as beauty parlor visits and clothing.  Keep in mind that in most nursing homes, there is just one Certified Nursing Aide taking care of 10 or more patients, so one-on-one care is not provided.  For this reason, if other dynamics are appropriate, some seniors will opt for in-home care.

How much do Senior Home Care Agencies charge?  From $15 - $26 per hour and from $150 - $275 per day for live-in care, depending on the area of the country you live in.

Annual cost of in-home elder care provided by a professional Senior Home Care Agency:

$18 per hour for 20 hours of care per week = $18,720.00 per year

$190 per day for live-in care = $69,350.00

Senior care in the home does provide the advantage of one-on-one care but seniors must also be able to pay for the costs of food and maintaining the home.

So the annual cost in a nursing home is easily equal to the cost of all the long-term care insurance premiums one could pay, according to Fidelity's study. 

Long-term Care Insurance can be sold in a variety of packages and depending on your age and health conditions upon purchase, you could spend from $2,000 on up per year - - but $5,000 a year is better than $80,000 for one year of nursing care.

You can learn more about long-term care insurance form our "expert" Chris Lynch and you may get answers to your questions to Chris in our Ask the Expert section.  Chris is one of the top long-term care insurance professionals in the nation and has also experienced caring for his own family members:'s Ask the Expert.

And what do you do if you have no money at all, except for your monthly Social Security check?  Well, the interesting answer is, the U.S. government will provide you with admission in a nursing home, at no cost to you, via the Medicaid program.  But this is welfare-for-seniors and managed by each state.  Usually you cannot own a home and may have no more than $2,000 in assets.  You can no longer give your assets away to go on this free program as now Uncle Sam has a "look back" law.  At the same time, most seniors probably don't want to be at the mercy of the government's care unless it is a must. 








, , , , ,

AMA Ads Trying to Prevent Medicare Cuts

You may have noticed recent advertisements by the American Medical Association urging Congress to not allow cuts in reimbursement for Medicare, the health insurance for all U.S. seniors over age 65. This is an even larger issue because some medical doctors who are specialists in certain areas - from vision to heart surgery - could simply opt to not accept seniors as clients if they are using Medicare as payment.

The pressure is being placed on Senate Republicans, who sort of just let the bill drop before they left for their 4th of July holiday.  The House of Representatives passed a bill to prevent the Medicare pay cut by 355 to 59.  The cut then took effect on July 1st, as required.  The Bush Administration has delayed processing of new claims to give Congress a chance to make this right.

Why would anyone want to deny this benefit for seniors?  Some insurance companies with deep pockets don't want their payments reduced and they can afford to have lobbyists in D.C. to represent their interests.

The bill would reverse the 10.6 percent cut and increase Medicare payments to doctors by 1.1 percent in January. Under the current formula, doctors would still face cuts of more than 5 percent a year from 2010 to 2012.

Many low-income seniors have not had health insurance until they were old enough to quailfy for Medicare.  Military personnel, military retirees and their dependents receive care through a government insurance program called Tricare, which mirrors Medicare's fee structure.

There are about 44 million seniors receiving Medicare benefits and of those about 10 million have opted for a private Medicare Advantage program which offer extra benefits - even though studies show they cost the government more than traditional Medicare.

Many Republicans oppose the bill because it would finance an increase in doctors’ fees by reducing federal payments to insurance companies that offer private Medicare Advantage plans as an alternative to the traditional government-run Medicare program.

Medicare receives 15 million claims a week.  It will be interesting to watch what happens - and if I have time, I'll look to see which insurance companies have donated to which candidates up for re-election.

And we won't even mention the lack of Medicare payments to provide for senior care in the home.



Napping: Good for All Ages

Anyone caring for a senior knows that part of their daily routine includes time to take a nap.  Some seniors nap in both the morning and the afternoon, especially if they are early risers.

This week's Newsweek talks about the "Three-Martini Nap".  A new company in NYC offers private rooms with sleep pods and charges $15 for 20-minutes.  Some companies also offer a nap room now.  It seems we are realizing that a break in the day to relax will make the rest of the day much more productive.

The health benefits of napping have been proven by many studies, including a recent one by the Harvard School of Public Health and the University of Athens Medical School which showed that taking naps at least three days per week reduced coronary mortality by 37 percent.

The suggested nap length is 20 minutes, to boost alertness and motor performance.

Caregivers, especially, can find an afternoon nap a welcome reprieve from both the emotional and physical demands of their work.

I have long wished we Americans could enjoy a long lunch, followed by a siesta like our friends in Spain.....maybe that day is getting closer.




Emergency Planning for Natural Disasters

One of Caregiverlist's Senior Home Care Agencies is located in Waterloo, Iowa, and has had to meet the challenge of providing care services while flood waters were rising.  The Senior Helpers franchise owner offered free caregiving services to seniors in his community during the flood crisis.

It seems family members are confronted with so many challenges when managing care for a loved one, that sometimes they forget about making sure the basic emergency plans are in place.  Organizing an emergency plan for an aging parent can make it easier for everyone to weather the storm when it hits.

I know we all like to think natural disasters will never strike us.  However, it is a good idea to plan, just in case, because tornadoes and hurricanes and floods really do happen,even in the middle of Iowa which is in a 500-year flood plain. 

Here are a few simple items that most Senior Home Care Agencies check for when they start senior care services for a new client:

Senior Care Emergency Planning Checklist

-Flashlight with working batteries or matches and candles located where the Caregiver will easily find them

-Heating and Air Conditioning system controls (is the water heater in the basement? etc.) and service contacts if they have problems

-Emergency Contacts: phone numbers for reaching the family decisionmaker for emergencies and a back-up contact person if the first person is unreachable at all contact numbers

-Insurance: know where to locate all insurance policies and have name, phone numbers and policy number for each type of insurance

-Medical Doctors:  name, address and phone number for all doctors

-Medications:  names of all medications and schedule for taking them along with the contact information for the doctor who wrote the prescription and for the pharmacy

-Evacuation plan:  where would the senior go if they needed to leave their home during an emergency?

Formulating a game plan and communicating it will make it easier to react to an emergency.

When I owned a Senior Home Care agency we had a client with M.S. who was a smoker.  Even though she was not supposed to smoke when she was alone, she did so and caught her bathroom on fire.  We moved her to a hotel nearby and then assisted her to find an apartment to rent while her condo was being renovated.  She did not have any family members she could stay with and also required a location with wheelchair access that would allow her to smoke.  She did not have a plan in place so we had to improvise as best we could which meant renting an apartment in an area away from her neighborhood and her friends.  Perhaps if a plan had been made ahead of time, she would have had a temporary living location in her usual neighborhood.





, , ,
Log in