Assessing Your Parents’ Needs
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Sonoma House - Assisted Living and Alzheimer's Care
Dr. John Dunlop, a doctor of geriatrics in Connecticut, explains what it means to age well in all spheres of life-physical, mental, social, financial and emotional.
Assisted Living Policy And Regulation: State Survey
How to Check for Assisted Living Violations
Assessing Assisted Living Quality: Consumer Reviews, Ratings & Complaints
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All of us will have to deal with aging parents. Jim Stroud gives some wise tips for rightly assessing an aging parent’s need for assisted living.
Assessing Your Parents’ Needs
Bob: As our parents age, they become more forgetful. It’s true for us too; right? How can we know whether the forgetfulness we’re observing is a sign of something more troubling? Here’s Jim Stroud.
Jim: It’s not a memory loss if they forget to go to the grocery store. The memory loss component of dementia or Alzheimer’s is if they forget—if you just had a family reunion three weeks ago—they forget the whole episode. From a standpoint of physical, you recognize a coordination deferential. You can tell usually by shuffling of the feet and the agitation factor. You start watching and are looking for these warning signs that are there.
Bob: This is FamilyLife Today for Friday, January 5th. Our host is Dennis Rainey, and I’m Bob Lepine. What should we do, as adult children, if we’re noticing troubling signs of memory loss with our parents?
We’ll talk more about that today. Stay with us.
And welcome to FamilyLife Today. Thanks for joining us. So, have you and Barbara thought ahead to when you’re in your—
Dennis: No! [Laughter]
Bob: You don’t even want me to—
Dennis: We’re going to die with our boots on, Bob. [Laughter]
Bob: Well, that’s what we all aspire for; right? I mean, we all have this idea that we’re just going to keep going, and moving on, and serving the Lord until the day He calls us home; but you know, life has this funny way of slowing you down or putting limitations around you, and you’ve got to make some choices as you get older. Some of those are hard choices to have to make.
Dennis: Yes; and today, we’re talking to our listeners about—not just you growing old—but: “What if you’re dealing with a parent who is growing old?
“How can you rightly assess what their needs are and when they should consider assisted living or some form of housing, maybe near you?” You know, we’re such a mobile culture today. This has to be a much larger problem than it was 40 years ago.
We have a guest, who is a good friend, Jim Stroud, who is all the way up from Dallas/Ft. Worth. Jim, welcome back to FamilyLife Today.
Jim: Thank you, Dennis.
Dennis: Jim is a very successful businessman in the Dallas/Ft. Worth area. One of the things he started—and was the founder, CEO, and Chairman of the Board of—was a New York Stock Exchange Company that he founded called Capital Senior Living Corporation. He gave leadership to that for 19 years.
Let’s—first of all, let’s just address our age.
Dennis: I had a friend say, “If you are talking to Jim, I want to know what he would coach us to do.”
Jim: Let me frame the issue so that your listeners can understand. Right now, there are 20 million adults in the United States that are, at least, 75.
Out of the 20 million, 20 percent—or four million—live in senior living communities.
We three are baby boomers. Right now, on a daily basis, ten thousand U.S. citizens turn 65 a day. What we’re talking about here today—either you’ll deal with it with your parents or you’re going to have to deal with it with yourself—we’re focused on: “How do the baby boomers take care of themselves?”
The other factor that is startling is longevity. The longevity factor—if you now look at it—for men, it is right around 83 years of age/84 years of age—women / it’s 86. We now have this longevity swing that’s taking place. The first thing to do is look at—“One, educate yourself,”—see what the options are—understand: “What is the cost of home healthcare?”
I often hear individuals my age say: “Not a problem. I’m going to stay in my home. If I have to lose my spouse, then, that’s going to be a sad event; but I can still hire home healthcare coming in. It’s not that expensive.”
Well, let’s roll that forward. Home healthcare cost $17-$18 an hour on a national basis—$17-$18 an hour. That’s not so bad if it’s 8 hours a day / 5 days a week; but if it turns into being 24-hour care, you’re now up to $12,400 a month. There is no insurance for that—so you’re talking $144,000 in which to stay in your home, adding on all the additional care levels you’re going to need for the yard, for the maintenance, etc., for food preparation.
You educate yourself and say, “Okay; what are the levels?”
Well, independent living, on a national basis, is right around $2,900 a month; assisted living, which now helps you with food as well as the medical side, is up to about $4,400 a month. If you look at memory care and/or Alzheimer’s care—it can be between $6,000-$6,200 a month—but skilled nursing is right around $12,000 a month. So, the point being: “You educate yourself as to your level of need and your level of care.”
Now, “How do you pay for it?” is the big issue. Oftentimes, I recommend that people go to their HR Director and say, “Is there a policy / is there a program for long-term care?” If not: “Are there insurance products out there?”—which are great insurance products now compared to what they were 20 years ago and 30 years ago for sure. The earlier you look into that, the more realistic the premium is. The key there is to be sure the coverage takes care of your needs—not only assisted living but also skilled nursing.
Jim: So, you look at that aspect. Then, the third thing is sit down with a financial planner or your accountant, because you need to project this longevity phase.
Oftentimes, people say: “Well, you can retire at 65. You can start taking Social Security at 65.” But if you look under the covers of Social Security, how in the world did they ever choose the age of 65? The answer—after World War II, that was the longevity rate—65—actually, it was 62. They looked at it and said, “Well, most people are going to pass away before 65 or it’s going to be in that area. So, therefore, the burden on the Social Security Administration won’t be that great.” We’ve now gone right passed that because we, sitting at this table, are 83 and are wives are 86.
Dennis: And I’m thinking back to your advice about checking out insurance. My son, Ben, who lives in the Front Range of Colorado, sells insurance; and he’s talked with me about this.
When you reach the age of the late 60s or 70, at that point, you’re getting a little old—aren’t you?—in terms of considering some kind of policy like this?
Jim: Not today. The reason is—it’s kind of like your home. You can determine what the deductible is. You may self-insure up to a certain point and then decide: “Okay; these are my finances. I’m willing to go ahead and can dedicate this dollar amount to long-term care needs; but I need some type of insurance over that as catastrophic can be.” Also, that allows you to go ahead and fashion the type of insurance program that you need.
Bob: When you’re starting to look for some kind of an assisted living or an independent living facility, how do you know where to look / what to look for? We see, on the news, stories of terrible nursing home scandals. Nobody wants to send Mom and Dad to a place where you have to worry about their care.
How do you know what to look for?
Jim: Well, the first thing out is research. I ask the adult children to first do their own research before talking to Mom and Dad. The internet is a great source. You can go on, and you can look and see what the communities are in their area. There are a number of companies out there that will help you determine what communities provide the services you think your loved ones may need.
Likewise, a good source is the trade associations—the trade associations that have been formed—and we were part of the early group. Like, in the state of Texas, we helped form the Texas Assisted Living Association—all not-for-profit / all designed to get out good quality information—they have phenomenal resources. “What is the type of care that’s out there?”—and then look on the internet and see if it’s in your local area.
Dennis: Jim, to that point, is there any kind of accreditation—I don’t know exactly what the term would be—
—but the Good Housekeeping Seal of Approval for assisted living? Has anybody put together an association that measures all companies that provide this service against a common standard and can give a potential customer a fairly objective look at what Bob was talking about earlier: “Are they good? Are they safe?”
Bob: “What’s the track record here?”
Jim: Well, there is no organization like UL—like a product company that will come in and say that this satisfies certain requirements and grades those communities. The best thing is the state. These communities are regulated by the state—assisted living, memory care, skilled nursing. You can go on to the state websites and look at what they call surveys. Each of the communities is surveyed, generally, once a year—sometimes every 18 months. On there, it will indicate what the survey results are and if there have been any deficiencies.
Deficiencies are very common in skilled nursing. Why?—
—because there are more regulations in skilled nursing than there are for someone on death row; because it’s supported by the federal government through Medicaid, and the states also contribute to it. So, there are surveys; but don’t get concerned if there are a lot of deficiencies on small areas. But you can see a pattern—if there are multiple deficiencies that haven’t been corrected, then, you know that there could be a problem there. So, that’s one way to look.
Another way to look—whenever you click on the internet and you go to a webpage, it’ll show the number of stars. You have to be careful there; because what happens—is that, if you get the right people writing the right reviews—and I won’t use the name of the services—then, all of a sudden, it may not really match what the level of care is. There is no better way to determine it than when you walk in. That’s the start.
I often say, “Go back at lunch time and then go back right around five p.m.”
Why at five p.m.? The staff have been there for—and now moving into the second shift that comes in. You get to see their interaction with seniors and residents that are at the end of their day when they may not have such good days. How do they handle those [residents]?
Dennis: Any coaching for those, who are listening, who have other adult siblings who may have a different opinion about Mom or Dad going to an assisted living facility?
Jim: What you find is the family dynamics are unique. What we try to come together with is—we’re here to educate the adult children and to help the loved one. What we do with the adult children—again, it’s the same principles that you are using with your parent—is one, again, is respect among the adult children and to recognize the common goal: “We are really here to help Mom,” or “…Dad.”
Now, having said that, we have stories that are the saddest stories ever, where you find a situation where they’re trying to restrict the money for the parent because the children have financial needs. What our industry and our marketing people are taught to do is kind of dive down and understand that dynamic. Likewise, we’ve had situations, where we’ll have an open house—and this was a memory care story—where adult children brought their parent and told them, “We’re here for lunch to see if you like this,” and then turned around and left their parent with us.
Dennis: Oh my!
You’ve mentioned it several times, and I didn’t realize that there were actual memory care facilities. Let’s talk about Alzheimer’s/memory loss, and how you measure whether or not your mom or dad may need one of these units to care for them.
Jim: It’s a critical area today, and it’s growing. I’m going to break it down into two areas that our industry recognizes the most—and the adult children—this will help your listeners. You have dementia; and then, you have the medical diagnosis of Alzheimer’s.
So, let’s focus on dementia. Right now, the Alzheimer’s Association estimates there are about four or five million senior adults that have some form of dementia. Now, the problem there is no one can really come up with one definition that fits all stages; but the one thing that everyone can agree on is the direction. Right now, that number is going to double in 20 years. So, you go from four to five million to eight to ten million seniors.
Now, let’s take Alzheimer’s care, which is Alzheimer’s diagnosis—a medical diagnosis. Right now, the Alzheimer’s Association says four million seniors have Alzheimer’s.
Generally, there are seven stages—it goes from mild/very mild to steep decline, which is stage seven. So, what is the trajectory of that? Well, likewise, it’s significant. That number of four million will be twelve to fifteen million in twenty years; and it’s because, again, of this age wave.
The way that you recognize the symptoms are completely different. You may do the refrigerator test with your loved one; but really, it’s not a memory loss if they forget to go to the grocery store. The memory loss component of dementia or Alzheimer’s is if they forget—if you just had a family reunion three weeks ago—they forget the whole episode—not just “Was Pete there?” or “…Mary there?” but the whole episode.
From a standpoint of physical, you recognize a coordination differential; and you can tell usually by shuffling of the feet / from a standpoint of delayed reactions—
—you can see that type of a need. Again, agitation—and I always say, “Go meet with your loved one at four or five p.m., the sundown time period.” What happens—the anxiety level raises and the agitation factor—if the behavior doesn’t match the circumstance, then you recognize there could be a greater need. You start watching and are looking for these warning signs that are there.
Bob: I had a friend, a doctor, tell me that normal forgetfulness—because we’re at an age where there is some normal forgetfulness—he said, “If it’s nouns and names,”—he said—“that’s normal.” He said it’s the kind of thing, you’re talking about, where you completely forget an event that is not normal; but if you go: “I can’t remember who—what’s that guy’s name?” He said, “That’s just—you’re getting older, and the synapses are not firing the way they used to.”
So, there is a difference between just kind of the normal aging process, where you may forget somebody’s name for a moment, and something that is dementia or that is Alzheimer’s.
Dennis: My mom lived four hours away in southwest Missouri. I would go see her as frequently as I could when she was alive. As I would go visit her, back in the ‘90s into the early 2000s, I began to notice certain things beginning to change about her. One of the things that really got me was the heat in the house being turned up, and she got very confused by the thermostat. That was one of the first real tip-offs that my mom was struggling with something beyond normal memory loss.
Toward the end of her life, in her early 90s, she did have Alzheimer’s; and it’s what took her life. At the end, she didn’t recognize me at all. I’d still go visit her and so would my brother; but Alzheimer’s is a terrible disease that just robs a human being of his or her dignity.
Jim: It really does. It was interesting, because when we first started this industry—and it really was ’88, ’89, 1990—beforehand, you had what was called congregate care. Congregate care was really age-restricted apartments. It was very predominate in vacation areas; for instance, Florida. You could go down to Florida. You would see an apartment complex—you would recognize that the cars were old, that there were no children, there was no playground. That was because it was an age-restricted apartment—so generally 55 years or older. So, that was the model that was there.
Then, the industry grew into independent living: “No; we need to provide, rather than garden style apartments, where you have entry up a stair and down an opening to the exterior. Let’s provide it internally. Let’s have an activity area.
“Let’s have a desk where people can come and go, like a concierge desk, as well as internal elevators.” So, you had independent living.
Then, as the industry recognized the aging that was taking place, we moved to assisted living. Well, you roll that forward, ten years ago; we now have dedicated memory care units and communities. What those are—they are secure communities—meaning they have maglocks on the door that, if individuals have a sense of flight, they have to go through a controlled exit and entry as well. What those communities now do—that they recognize, “It’s not only a medical issue, as well as a social interaction issue, as well as an activity area.” The programs that are out there in these communities really enhances the lives of those who do have Alzheimer’s or severe dementia.
Just to give you an example—you’ve often heard of pet therapy and the interaction when animals—
Dennis: Oh, yes.
Jim: —are brought in.
Dennis: Right; right.
Jim: Well, what we ended up doing is—we’ll have communities where we have a house dog; and boy, that dog is loved on. You wouldn’t recognize—when, all of a sudden, that dog comes into the community or stays at the community—how the residents interact with him that have memory care issues.
Likewise, one of the most phenomenal programs—and I heard of this and we have done this—we go to the public school, and we talk to the special ed teachers. We identify—ask them to identify students that will come and teach our memory care residents. [They] say, “Well, what are they going to teach?” We say, “Whatever they want to teach.” They bring work tools; they’ll bring knitting; they’ll bring computers. It’s fascinating to watch the interaction; because what happens with that teacher, after a month—and I check back in—guess who is really benefitting the most?—[Laughter]—
Jim: Because the students are appreciated for what they are. Their handicaps are accepted. They’re looked at as their time, and energy, and love is the most important thing. It’s a phenomenal program to watch this interaction between those with severe dementia and Alzheimer’s and those that have handicaps—whether it be physical or mental.
Dennis: I said it earlier, but you have a great ministry. You started a ministry, back in 1990, caring for seniors and help create an entire industry; but you look at it, and it really is caring for an overlooked “least of these”—not orphans—but widows and folks who are getting older, who are just in need of someone reaching out and caring for them.
Jim, thanks for your friendship and thanks for sharing about how we can age wisely and choose wisely as we go forward and being on FamilyLife Today.
Jim: Well, thank you very much. It’s always a blessing to be here at FamilyLife®, and you and Bob have a dynamic ministry. I really appreciate the opportunity, and I hope in some way that I helped one of your listeners today.
Bob: Well, you undoubtedly have. I just want to let listeners know as well—if you go to our website, FamilyLifeToday.com, there are links there to additional help. If you’re looking for help in this area, go to FamilyLifeToday.com.
I mentioned earlier a book called Wellness for the Glory of God written by a gerontologist named Dr. John Dunlop. He’s been a guest with us on FamilyLife Today. In fact, if you’d like to listen to the interviews we did with Dr. Dunlop, I think those would be instructive. This book is for those of us who are not yet in our elder years but may be passed 40. We need to be thinking about how we can prepare / how we can steward our own lives so that we are ready for that transition into the elderly years.
Again, the book is called Wellness for the Glory of God. You’ll find more information / you can order it from us, online, at FamilyLifeToday.com; or if you’d like to call for more information, call 1-800-FL-TODAY—1-800-358-6329—that’s 1-800-“F” as in family, “L” as in life, and then the word, “TODAY.”
You know, we are excited, here, at FamilyLife about what is ahead for us in the weeks and months to come. We’ve got a lot of projects in the works. You’ve been hearing a little bit about The Art of Parenting video series that will be released later this year / about the movie that we’ve been working on called Like Arrows. We’ve got a lot of other things in the works all designed with the same goal in mind. We want to effectively develop godly marriages and families. We want to provide practical biblical help and hope for your marriage and your family.
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And we hope that you have a great weekend.
I hope that you and your family are able to worship together in your local church this weekend, and we hope you can come back on Monday. Lacey Buchanan is going to join us. We’re going to hear from a mom who experienced tragic circumstances with the birth of her son, but we’ll hear how God used those tragic circumstances for something beautiful. Hope you can tune in for that.
I want to thank our engineer today, Keith Lynch, with special help from Justin Adams, and our entire broadcast production team. On behalf of our host, Dennis Rainey, I’m Bob Lepine. Have a great weekend. We’ll see you back Monday for another edition of FamilyLife Today.
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