Making the right choice on long-term care
Selecting for a loved one can be tough.
Saturday, January 21, 2012
Resources for finding long-term care
• The Regional Long Term Care Ombudsman can respond to questions about local adult family homes, assisted living centers and skilled nursing facilities, including which ones accept Medicaid and about pending complaints. Call 360-694-9007.
• Information about long-term care providers that accept Medicaid and about pending complaints are available at http://www.adsa.dshs.wa.gov/pubinfo/housing/other/#AFH.
• Long-term care referral agencies serve clients who use private funds to pay for long-term care. Agency contacts are typically available at hospitals and skilled nursing centers.
After a stroke debilitated Virginia Goranson’s father last April, the Vancouver woman had just two days to find him a long-term care center. Her father, Ron Anderson, 71, already had mild dementia and needed a place that could help address his physical and mental needs.
“I really didn’t know what options were available,” Goranson said. “All I knew was, I needed to find a place for him.”
Goranson’s situation is the norm. Many of the decisions about long-term care happen during moments of crisis. Commonly, families end up scrambling to find a placement 24 to 48 hours after a loved one has become incapacitated. While most people will have to make long-term care decisions in their lifetime, either for themselves or a loved one, few know what options are available or what the distinctions are between those choices.
Reading up on long-term care options, knowing what to consider and planning ahead can help families avoid many of the pitfalls of finding a placement.
• Nursing homes, assisted living centers/boarding homes, adult family homes and in-home care are counted as long-term care providers. Adult family homes and assisted living centers can offer specialties, such as memory care.
• Independent-living retirement centers are not considered long-term care because
tenants are by definition able to care for themselves.
• Hospice also falls outside of long-term care because hospice is intended as a place for patients who are expected to live no more than six months. However, some long-term care facilities offer hospice as part of their services.
Adult family homes
Goranson used A Caring Choice placement agency in Vancouver to help her screen the some 350 long-term care facilities in Clark County. She chose Vancouver’s Advanced Care Center for her father because the adult family home specializes in patients with dementia.
Adult family homes are licensed to serve no more than six patients at a time. They are the most prevalent and fastest-growing long-term care option in Clark County. The county has 312 adult family homes and counting, according to the Southwest Washington Agency on Aging and Disabilities.
Adult family homes offer an intimate environment and often are operated out of a house. The staff-to-patient ratio is usually lower than larger long-term care facilities. The homes also frequently develop specialties, such as memory care, and can care for higher-need patients than in assisted living. Some offer customized care through every stage of life, including hospice.
“Each care home has its own personality,” said Mark Nimz, owner of Advanced Care Center. “You should look for a fit with care needs, personality and socialization.”
Some names and definitions for long-term care facilities have changed over time. The nursing home or convalescent home, for instance, isn’t what it used to be, according to experts.
“A lot of people think if they’re going to a nursing home, it means they’re going there to die,” said Kathy McLaughlin, owner of A Caring Heart placement agency. That could still be the case, but it’s no longer the norm.
In Clark County, there are eight nursing homes, also called skilled nursing centers. Many have evolved into rehabilitation centers, McLaughlin said. They serve as a transition between the hospital and home, though some nursing homes continue to offer long-term care.
“They’re focusing on making that person ready to go back into the community,” said Claudia Belindean, senior housing adviser at A Caring Choice placement agency.
Unlike other forms of long-term care, nursing homes have a full medical staff, from a doctor to a certified nursing assistant, Belindean said.
Washington state promotes in-home long-term care because in many cases, it’s believed to cost less and make seniors happier. Home health aides can help with bathing, dressing, mobility, medication management, errands and housekeeping. Their ability to do medical procedures, however, is limited. For instance, home health aides are not licensed to perform sterile procedures such as changing a catheter, said Denise Serafin, social services supervisor at Home and Community Services at the state Department of Social and Health Services. However, in-home care services can provide nursing services that home health aides cannot.
Assisted living centers usually serve populations of more than 100 and offer an on-staff registered nurse and organized activities. There are 26 in Clark County. Some centers have 24-hour nurses, while others have a nurse only during business hours. They offer private apartments, with services including custodial care, medication management, bathing and escorts to meals. Unlike adult family homes, residents can take part in more structured and group activities, such as exercise classes. The centers provide limited medical services; they generally don’t accept patients who need intravenous treatment or have deep wounds. The level of care depends on the center. Vancouver’s Glenwood Place Senior Living offers enhanced assisted living, which offers more extensive medical services, Belindean said.
Making the choice
There are several factors patients and their families should consider before choosing a placement. Placement agencies or Medicaid caseworkers assess a patient’s needs before determining what type of long-term care would be suitable for them. The assessment identifies physical needs, mental needs, cost and whether the facility accepts Medicaid.
But other factors also should be considered before making a decision.
Taste the food
Vancouver resident Pat Norby decided last year it was time to find long-term care for her mother, Deroma “Jerry” Sanford, 91. “I was concerned about her being alone in the house and falling,” Norby said. “I wanted her to be safe.”
Norby asked Belindean of A Caring Choice to help her find a placement. Belindean took the mother and daughter on tours of three long-term care facilities. She made sure the tours included lunch.
“I always encourage people to have lunch at the facility just to try the food,” Belindean said. “Food is important to seniors. Sometimes it’s the highlight of their day.”
Consider the future
Norby and Sanford chose to move Sanford into Van Mall assisted living.
Van Mall is one of the few retirement centers that offers independent living in the same space as assisted living. That means, if a resident’s health or mental condition deteriorates, they can receive assisted living services without the trauma of leaving their friends and moving to another facility.
“We liked the versatility,” Norby said. “If her needs increased, they would still be able to meet her needs without a lot of disruption.”
Vancouver gerontologist Gail Haskett said considering future needs is crucial.
“One of the worst things you can do to an older person is to continually move them,” Haskett said. “Each time a person moves, the stress level is so high.” In some cases, the stress hastens the deterioration of a patient’s health, she said.
Having to move to a higher-care facility also can be embarrassing for some seniors, said McLaughlin of A Caring Heart.
“It’s the stigma of ‘Yesterday, I was independent; and now, I need assistance,’” McLaughlin said.
Considering future needs also means finding out if a long-term care facility accepts Medicaid, the government subsidy for long-term care for seniors who are out of money. Even if a patient can afford to pay for long-term care with private funds now, that might not be the case in the future, Haskett said.
“If you have one year of private funds, you need to find a place that accepts Medicaid,” Haskett said. “Otherwise, the patient might be kicked out.”
The median annual cost in the Portland metro area, which includes Clark County, ranges from $48,620 for in-home care to $87,381 for a private room at a nursing home, according to a 2011 survey by Genworth Financial. That cost is projected to climb by about 60 percent in the next 10 years, according to Genworth Financial.
“Grandma may live until 95 and use all her money up,” said Kathleen Lipiec, social work manager at PeaceHealth Southwest Medical Center. “Is it a place that can accept Medicaid in the future?”
Finding the right placement is similar to finding the right roommate, said McLaughlin of A Caring Heart. It’s important to make sure a patient’s personality and values mesh well with other residents and staff members, she said. For example, if the patient is gay or lesbian, it would be important to find a facility that was accepting of that lifestyle.
“A lot of people think if mom is lonely, she might like an assisted living where she has a lot of people around her and organized activities,” Haskett added. “But if mom has always been socially isolated, if that is her personality type, that might not be the right fit.”
Mike Reardon, community services program manager at the Southwest Washington Agency on Aging and Disabilities, said he encourages people to talk to existing residents or their families to learn more about a facility.
Is the staff awake 24 hours a day? If the patient is a wanderer or violent, does the facility have the resources to handle that? What is the staff turnover? Is the owner involved in day-to-day operations?
When he was looking for a place for his mother with Alzheimer’s disease in 2008, Reardon made a point to talk to residents’ family members.
“One family member raved about how well the place ran and how compassionate and caring the owner was,” Reardon said. “The owner actually worked there. A couple of times, I just dropped by to see how things ran. It turned out to be a very good experience.”
Placement agencies can help assess a patient’s needs and clear some of the fog involved in a placement. They do most of the legwork in sifting through choices, including touring facilities with their clients. Placement agencies’ services are free to the patient. The agencies charge long-term care facilities for their matchmaking services. When a match is made, the facility pays the agent for the placement.
Medicaid regulations, however, prohibit agents from accepting payment for placing Medicaid patients.
Finding a placement is more involved for patients on Medicaid and their families. A patient’s Medicaid caseworker will do an assessment similar to that of placement agencies to identify the patient’s physical and mental needs and narrows the list to those that meet those needs. They may email colleagues to find which facilities have openings, said Serafin of Home and Community Services. Caseworkers are not allowed to recommend facilities, and they don’t do tours or phone calls for families.
Under the gun
The process of making phone calls and visiting facilities when a family has only 24 to 48 hours to make a placement can be overwhelming.
Patients and their families can look up facilities by ZIP code and speciality on the Department of Social and Health Services website. Families also can call Southwest Washington’s Long Term Care Ombudsman program to ask questions about facilities.
One way to manage a long list of choices is to narrow by geography, said Lipiec of PeaceHealth.
“The best place is a place where family can be at often,” Lipiec said. “Look at places geographically easy to get to because you are grandma’s advocate.”
Goranson of Vancouver said location was part of her decision to place her father at Advanced Care Center. The proximity allows Goranson to visit her father every day.
“I wanted him to be close to me,” Goranson said.