Navigating Elder Care
Before you do anything.
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Take a deep breath, remove yourself from your immediate situation and try to become as objective as possible. Now, having done that, acknowledge that no matter how hard you try, it is nearly impossible to become truly objective at this stage. It doesn’t always, but, hopefully, objectivity will come later. Denial is a powerful and effective barrier.
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It is therefore wise to consult an unbiased source for quality information on your situation. Keep in mind that although a physician may seem to be the correct choice in asking about care options, they often are not. Also keep in mind that your diligence in seeking out the altruistic and unbiased source of information is imperative.
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You will need to have a comprehensive geriatric assessment done by an individual who is trained to perform one. A physical assessment can be done by a physician and a psycho-social assessment can be done by a psychologist. Or, you may choose to enlist a geriatric case manager.
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​Prior to embarking on finding a place, it is wise to have the following in check:
Physical Assessment
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Ambulation
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Any diagnosis/prognosis
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Medications
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Dietary needs
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Allergies
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Recent hospitalization
Cognitive/Psycho-Social Assessment
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Memory impairment
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Social requirements/Preference for interaction
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Anxiety
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Depression
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Isolation
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Inclination to wander/purposeful elopement
Financial Assessment
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Long-term care coverage/insurance
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Liquid/solid assets
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Conservatorship
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A durable power of attorney
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Creating/Sticking to a reasonable budget
History
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Tendencies
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Family tree
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Important people and events
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Items that bring comfort
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Important rituals
Health Care Desires
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Durable Power of Attorney – health care
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Advance Directives
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End of life wishes
Your Well Being
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Is making this large decision within your emotional capacity?
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Are you educated? Or are you setting yourself, and your loved, one up for disappointment?
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The term “Continuum of Care” is somewhat of a misnomer, considering there is no logical or predictable path of progression as we age. Meaning, aging is a process unique to each individual – I will do my best to put each option in some sort of order – please don’t expect to necessarily follow this path.
In-Home Care
In-home care ranges from part-time non-medical “companions” who simply provide supervision and social companionship to around-the-clock nurses who assist with every aspect of the person’s well-being.
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Independent Living: Aka, Retirement Living
Independent Living is a broad term. From the structural standpoint, most Independent Living communities are set up like hotels. Each apartment’s main entrance is within the building for safety and security. The industry of Independent Living, like In-Home Care, is once again an unlicensed field. However, by law, Independent Living communities are prohibited from providing care. Although most Independent Living communities are set up with apartments boasting kitchenettes, for an extra cost, they will offer dining services – some offer all 3 meals, while others will offer only 2. Since this setting is like an apartment, and they are not able to offer care, you can obtain In-Home Care (above) as you would at home. Most Independent Living communities offer or coordinate several social activities and outings.
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Assisted Living
Assisted Living is a very large segment of the long-term care field. Assisted Living is a regulated entity guided by the Department of Social Services, Community Care Licensing Division www.ccld.ca.gov . The Assisted Living industry is mainly run by the smaller family-owned 6-bed “board and care”. Within the past 10 years, the hospitality field has recognized the opportunity and capitalized on the multi billion dollar Assisted Living industry. Operators are allowed to offer any range of services within the parameters set forth by DSS/CCLD. Some operators will only offer care for those with minimal needs, whereas others will offer a wider range of care, further some will offer specialized care such as dementia care or hospice care. Assisted Living allows elders to receive housing, 24 hour care, supervision, meals and activities. Assisted Living is NOT a medical model – meaning, the operator is prohibited from providing nursing care.
Memory Care: Assisted Living (Dementia/Alzheimer’s Disease):
Bridging the gap between Assisted Living and our next category, Skilled Nursing lies Memory Care. If no “Nursing” or “Medical” care is needed, the elder may qualify to live in an Assisted Living community that specializes in care for those with Memory Impairments such as Dementia and Alzheimer’s Disease. The state has strict minimum requirements for operators to provide this type of care. Activities, Additional Staff Training, Conducive Physical Plant Layouts, and Increased Staffing Ratios are a few examples of provisions that differentiate a non-memory impairment provider from a memory care community.
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Skilled Nursing: Aka, SNF, Nursing Home, Convalescent Home
Skilled Nursing facilities offer nursing and rehabilitation care for those needing more than what can be provided in the home or in an Assisted Living setting. Licensed by the Department of Health Services, strict regulations guide these hospital-like environments. All care personnel are at least Certified Nursing Assistants (CNAs). The three main reasons why elders find themselves in this level are: Rehabilitation from a recent hospitalization, Debility and Decline, and, because most skilled nursing facilities accept Medi-cal, running out of funds. Over 50% of all nursing home patients have a level of memory impairment severe enough to be classified as dementia.
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Hospice Care: Aka, Palliative Care, Comfort Care
Skilled professionals who assist in making the process of dying a pleasant experience. The general rule (there are exceptions region to region) is that once a physician gives the elder* a prognosis of six months or less to live, Hospice becomes an option. There are multiple approaches to Hospice; PPOs, HMOs and Non-Profit Hospice organizations. Hospice is typically a service, which comes to the elder**, however, a growing trend is for Hospice organizations to build facilities to accommodate the terminally ill. In most cases, particularly with the non-profits, the services of Hospice are free of charge.
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* Hospice is not exclusively available to the elderly, anyone of any age who is terminally ill, can qualify.
** Hospice will come to the elder’s home. However, it is imperative that you verify (preferably before making a decision in long-term care) the operator supports Hospice coming into their community – you will find how few Assisted Living communities allow hospice in their buildings.