She was born in Chester, South Carolina on January 4,1917, to Thomas and Dora Buckson. Her mother was a teacher, while her father commuted to Baltimore to work at Sparrows Point.

Following several brief hospitalizations, Mrs. Ardis Watkins has enlisted the services of P-B Health Home Care Agency to remain in her home while recuperating.

As a young woman, Miss Ardis Buckson moved to Baltimore City to start her adult life. Here, she met and married Mr. Norbon Watkins, and from this union three children were born.

“We had a wonderful life together until his death in October of 2005,” stated Mrs. Watkins.

Throughout her adult life, Mrs. Watkins worked at Johns Hopkins Hospital and then the old City Hospital. After retiring from City, she volunteered at Bon Secours Hospital for seven years, earning many awards for her service.

Additionally, Mrs. Watkins has been a long time member of The Village Baptist Church and retains her membership today.

After so many years of caring for others, the time came when Mrs. Watkins needed care for herself. Through the Department of Aging, the family was put in touch with P-B Health Home Care Agency.

Following a thorough evaluation of her needs, P-B Health began providing personal care and chore services to Mrs. Watkins. Olivia Cross, a CNA and home health aide, was assigned to her care.

“Olivia has been very courteous, caring and helpful in assisting with my personal needs,” said Mrs. Watkins. “Ms. Cross is a fine representative for P-B Health, and my family and I have become very fond of her.”

In her later years, Mrs. Watkins has had several brief hospitalizations, after which skilled home health services were prescribed. These services have provided Mrs. Watkins with the benefits of nursing care, physical and occupational therapy, and nutritional counseling in the comfort of her own home.

“Each [staff member I have worked with] was skilled and provided exceptionally good service,” reported Mrs. Watkins.

Mrs. Ardis Watkins continues to do well and to live in her home. If she ever needs services again following a hospitalization or illness, she will not hesitate to call P-B Health to help her recuperate.

The medical and companionship services Mildred Bachman receives from Personal Touch Home Care allow her to continue to live with her son Michael.

Mildred’s fall was the first of several health problems that resulted in her moving into Michael’s home. “It’s nearly impossible to envision the amount of stress and upheaval bringing an elderly parent into one’s home can be—especially when it was a sudden, unexpected event with multiple layers of health issues involved,” he said.

After his mother started living with him, Michael realized that other health problems and her diminishing memory were going to prevent her from returning home. Unsure where to turn, he started researching home care agencies. His research led him to Personal Touch Home Care. “They really just seemed to have their act together,” he said. Personal Touch offered a unique blend of medical services and companionship. “So many of the other agencies were just focused on medical needs, and that wasn’t really what I was looking for,” Michael recalled. “I needed some degree of health services, but I really also wanted social and companionship services.”

Personal Touch assessed Mildred’s needs and devised a care plan that focuses on improving her quality of life. “They have helped her maintain her independence and continue doing the things she was already doing.” Michael said. With the help of her aide, Andrietta Allen, Mildred does puzzles, sketches and takes regular walks. She also received physical therapy and has regained full use of her wrist.

“After Personal Touch started helping us, things got so much better,” Michael said. “So many of my biggest fears about my mother living with me turned out to be non-issues.” He added, “Something that seemed insurmountable and impossible became a routine, then actually enjoyable.”

Today, Michael and Mildred are both comfortable and happy with their living situation. It still requires a lot of work from Michael and his partner Jerome, but with the help they receive from Personal Touch, they are able to maintain busy work schedules while Mildred enjoys the hobbies and activities she has always loved.

“I love to dance, I love the ocean and any water sports,” she said, “And I can definitely party.”

Widowed with no children, she has worked in the hospital for 37 years in the critical care field. Primarily dealing with cardiac issues, she has recently moved onto a different area, progressive rehab.

But there was a period in Edy’s life when she could not do all the things she was so passionate about. She needed knee replacements, and with the help of the social worker handling her case she found exactly what she wanted at Brightwood Center. The Progression Unit at Brightwood is just one among the many Genesis HealthCare specialty units in the Baltimore area. Other Genesis centers have specialty units that offer Dialysis, Alzheimer’s care, or Ventilator care, in addition to short-term rehabilitation.

“I chose this center because it has seven day a week physical therapy,” said Edy.

After her bilateral knee replacements in early August, she came to Brightwood Center in Lutherville. The staff, and Edy, knew her biggest challenge would be pain management, as she was experiencing severe and debilitating pain when she was admitted. It took a great deal of open communication with the nurses to control the pain appropriately.

As her physical therapy began, the pain diminished and Edy was able to make rapid progress. She spent about three to four days at the facility after both of her surgeries.

Edy was extremely impressed with the individualized care and attention she received from the staff as a whole.

“It was my ‘home away from home,’” she said, “Brightwood is wonderful and I can’t say enough about them.”

Now, Edy has vowed to be the center’s ‘ambassador’ and plans to return for its future functions.

“I’m a new person,” she said, “I can do the things I haven’t been able to do for years.”

Perhaps the toughest part for Edy recently was deciding what activity to start with first: a party or a day at the beach?

What to look for in a Nursing Care Facility
Before choosing a facility, contact the long-term Care Ombudsman Program of your Area Agency on Aging. Ombudsman programs promote the highest quality of life and care for residents of nursing facilities and can help families and staff with inquiries and complaints.

Tell the ombudsman which facilities you are considering and request any information they have about the facility. Visit prospective facilities at different times of day. Talk with residents and staff members. Be persistent about getting your questions answered.

Entering and Adjusting to Nursing Home Life
Although some people enter a nursing home temporarily for a short-term stay, it is still a sad day for most people and sad feelings are normal. Reassurance from family and friends that love and contact will be maintained can ease the transition. In addition, there are steps to take that may help lessen the trauma of the change:

–Talk about the admission in advance
–Visit the home with the prospective resident beforehand, if possible
–Involve the prospective resident as much as possible in the decision-making
–Describe the home in detail before moving there
–Decide together what items to bring to the nursing home
–Get to know the administration of the nursing home
–Maintain contact with the resident after admission
–Maintain contact with the home after admission
–On the day of admission, be available the entire day to help settle the resident and provide emotional support.

Paying for a Nursing Care Facility
Medicare, Medicaid, private insurance, and personal assets are all used under various circumstances to pay for services in a nursing care facility. If a facility is not certified by Medicare and Medicaid, the care will have to be paid for entirely with personal funds.

In general, Medicare pays for skilled nursing care following hospitalization for the same illness or condition at 100% of the cost for days 1 – 20. However, on days 21 – 100 the Medicare subscriber is responsible for a co-pay. Medicaid, a government program for the indigent, covers nursing home care for individuals who meet strict medical and financial eligibility requirements. Some long-term care insurance pays for nursing home care; insurance payments are usually a fixed amount for a specified number of qualified days. On the subject of buying long-term health care insurance, the National Council on Aging can be helpful, providing practical, objective information on what to look for. Call 1-800-373-4906 and request the “Long-Term Care Insurance” booklet. The cost for the booklet is $14.95 for non-members. Information is also available online: www.ncoa.org.

The “Consumer’s Guide to Nursing Home Contracts,” published by Legal Services of Northern Virginia, Inc., provides additional information and advice on paying for nursing care services. Below is an excerpt from the guide.

What is the Basic Daily Rate?
The basic daily rate is the standard charge the nursing home bills to all residents, which covers the fundamental services every resident receives, including rent for the room, housekeeping, meals, and general nursing care.

It is important to understand all the services and amenities that are not included in the basic daily rate. The fees and charges for “supplemental services” often increase the expense of the nursing home bill dramatically, to the surprise and dismay of the recipient of the bill. Often services expected to be included in the basic daily rate, such as extra nursing services, pharmaceutical needs, and telephone services are extra charges.

Does the basic daily rate include all the nursing care I will need? Probably not. The basic daily rate includes “basic” or “general” nursing services. What is provided with basic or general nursing care may vary from nursing home to nursing home.

But the basic daily rate often does not include many common nursing services. Physical therapy, glucose monitoring, incontinent care, hand or tube feeding, etc. might each involve extra fees. In addition, prescription and non-prescription medicines are not included in the basic daily rate.

How can I avoid being surprised by added costs?
To understand which additional services (and additional costs) a resident will require, the first place to look is the Resident Assessment. This assessment is required by law and analyzes what kind of nursing and other care the resident needs. For example, if the new resident is incontinent, the assessment should indicate this fact.

To get an accurate assessment of the costs, make sure you understand what is covered by the basic daily rate. Then, ask the nursing home representative to discuss the resident assessment and to explain to you what additional nursing and services, beyond what is covered by the basic daily rate, are necessary. The nursing home should give you an itemized list of supplemental services and the costs above the basic daily rate.

Also, decide what additional amenities you want (telephone, beauty care, etc.) and add these costs in. Request an estimate of the total bill. You should have this estimate long before the end of the first month, so that you know exactly what to expect.

Since paying for care in a nursing care facility can be both expensive and confusing, it is a good idea to contact your local department of social services or Area Agency on Aging for more information.

Evaluating Nursing Homes

Use this checklist to judge and compare the nursing homes you call and/or visit.

– Is the facility accepting new patients?
– Does the facility offer skilled nursing care?
– Is the facility Medicare-certified and/or Medicaid-certified?
– Are the home and its current administrator licensed?
– What type of education and training do staff members have? How many Registered Nurses (RNs) and Certified Nursing Assistants (CNAs) are on staff?
– Are background checks conducted on all staff members?
– Is there a care plan developed for every resident?
– Are care plans reviewed and updated by providers and family members?
– Is the interaction between residents and staff members warm and respectful?
– Are public areas and resident rooms clean and comfortable?
– Are there a variety of activities available for residents?
– What is the staff to patient ratio at night and on weekends?
– Do staff members respond to residents requests for assistance promptly?
– Are there enough staff members available to assist residents during meals?
– Does the food in the dining room look and smell appealing?
– Are there handrails in hallways and grab bars in bathrooms?
– Are exits clearly marked?
– Is the facility outfitted with smoke detectors and sprinklers?

Adapted from Medicare’s Nursing Home checklist. For more information, see www.medicare.gov.

When a person prefers to stay at home but needs ongoing care that cannot effectively be provided by family and friends, home care may be the best option. As the Home Health Care industry grows and advances, more seniors are able to age in place-receiving the care they need in the comfort of their homes. Regardless of age or health conditions, all seniors should consider home care as an option when making retirement living decisions.

In addition to care provided in an individual’s home, home care services are also available to supplement the care received in a hospital or facility; 25% of the care we classify as home care is actually performed in hospitals or facilities.

Home Care Options
An incredibly diverse field, home care can serve a variety of senior need levels. Home Care can include home support care, skilled nursing care, or hospice care. For information about hospice care, please see our hospice section on pg. 89.

Home Support Care is for seniors who are no longer able to perform all of the functions of daily living by themselves but who do not require skilled medical services. A home health aide can help with activities of daily living (ADLs), which include bathing, dressing, transferring, eating, and hygiene. Additional services generally include meal preparation, mobility exercises, light housekeeping, laundry services, medication reminders, and accompaniment to appointments.

Skilled Nursing Care is prescribed by a physician and is administered by a registered nurse. The services provided by skilled nurses include: administering injections, administering medications, wound care, IV monitoring, blood tests, catheter care, respiratory therapy, speech therapy, physical therapy, feeding tube administration, and more.

Home Care Providers
Home Care providers can be classified into three major categories: Medicare-certified Agencies, Private Duty Agencies, and Registries. All of these agencies deliver care to patients either in their homes or in a hospital, assisted living community, or nursing facility. Companies or hospitals may have both a Medicare-certified component as well as a private duty or registry component.

Medicare-certified Agencies deliver “brief and intermittent care” for a maximum of 60 days. Care must be ordered by a doctor. Physicians can renew orders for care whenever they deem it necessary. These agencies are qualified to deliver either skilled nursing care or home support care, which is completed by home health aides. Patients generally receive 1-3 hours of care per day several days a week. The amount and type of care provided will vary depending on the doctor’s specific orders. All Medicare-certified agencies are licensed by their home state and surveyed on a regular basis to ensure that federal quality and safety standards are followed.

When care has not been ordered by a physician, it can be obtained thorough Private Duty Agencies. The amount of care provided can range from round-the-clock or live-in care to companionship services, depending upon the needs and desires of the customer. Private Duty Agencies employ a variety of caregivers and can provide a wide array of services. Caregivers range from nurses to companion care workers, all employees of the agency. Agencies are regulated by their state governments, which enforce strict health and safety requirements.

Home Health Care Registries are much like Private Duty Agencies, except Registries do not employ the workers that are sent to customers’ homes. When you request Home Care Services through a Registry, they will refer an independent contractor to work in your home. As with Private Duty Agencies, the amount and type of care received is entirely up to the customer. Registries can provide services ranging from skilled nursing care to home support care and/or companion style services. Registries are monitored by their state governments to guarantee that they meet stringent health and safety requirements.

Costs of Home Care
Medicare-certified Agencies are reimbursed for their services by the federal Medicare or state Medicaid programs. Private Duty Agencies are generally compensated for their services through private payments. Long-term care insurance may cover some of the costs for Private Duty services; individuals can also use other financing options such as reverse mortgages to pay for care. Services by Registries are also covered by private payments, long-term care insurance, or other financing options.

Home Support Care can be provided by any of the agencies listed above, but must be paid for with private funds unless it is prescribed by a physician and provided by a Medicare-certified Agency. Prices for home support care range from $10-$20 per hour. Most long-term care insurance policies will cover home support care. If you qualify for Medicaid, a government program for low-income individuals, it may pay for some of your home support care needs. Since laws vary from state to state, you will need to contact your local Area Agency on Aging for more information concerning government benefits.

Skilled Nursing Care will be paid for by Medicare as long as it is determined to be “intermittent skilled care,” which includes occupational, respiratory, speech, and physical therapy, and is ordered by a doctor. Individuals who meet income requirements may be eligible to receive skilled nursing services covered by Medicaid. Major medical health insurance will also cover a limited number of skilled home visits. The number of visits covered will depend on your medical diagnosis and your health insurance plan. Costs for these services vary greatly depending upon coverage by Medicare, Medicaid, and private insurance and the degree of services required or purchases are options that should be considered. Assistance provided through the Older Americans Act and delivered by local Area Agencies on Aging includes the cost of some home care services. Individuals are generally asked to contribute to the costs in proportion to their income. Veterans who are at least 50% disabled due to a service-related condition are eligible for home health care provided by the Veterans Administration (VA). Services must be authorized by a physician and provided by one of the VA hospital home care units.

Contact you local Office on Aging or State Department of Health to find out if there are funds from social services block grants available to cover home care costs. Outside community organizations may also cover some or all of the costs of home care. Check with your hospital discharge planner, a social worker, the Area Agency on Aging, or the United Way for more information about resources in your community.

Sources for private payments other than major medical health insurance or long-term care insurance include Medigap insurance, managed care organizations, and CHAMPUS. Medigap is designed to cover the gaps in Medicare coverage. It will generally cover home support care to supplement the skilled nursing services already prescribed by a physician and provided by a Medicare-certified agency. Managed care organizations are group health plans that may cover some home care services; services must always be pre-approved. On a cost-shared basis, CHAMPUS provides skilled nursing services for military retirees, their dependents and survivors, and the dependents of active military personnel.

Finding a Home Care Provider
After determining the type and amount of services needed and the payment options that are available, consumers should begin interviewing potential providers. Choosing a Home Care provider is a highly important and personal decision. Finding a provider that is qualified, reliable, and compassionate is essential to the health and happiness of patients and their families.

While completing this search, keep in mind that home care workers frequently become very close to their patients. The bonds that patients and providers form are natural and beneficial to both parties; however, before allowing a provider to come into their homes, customers should complete thorough research to avoid the negative consequences of unscrupulous providers. Prior to obtaining services from any provider, find out more about how they run their company, their employee policies, and investigate their quality rankings published by the federal government (www.medicare.gov). The questions below are intended to help consumers investigate and interview potential providers.

Questions for Potential Providers:

Is the provider Medicare/Medicaid certified?
If yes, do they also operate a private pay division? (This allows patients that receive skilled care for a limited number of days to continue receiving private pay services from the same provider).

How many years has the provider been in business?

Is the provider associated with a larger health care group or hospital?

Is the provider accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHOP) or by the Community Health Accreditation Program (CHAP)?

Will the agency help you find the best homecare options for you?

Does the provider have a written policy describing the patient’s rights?

Are nurses or therapists required to evaluate the patient’s home care needs? If so, what does this entail? Do they consult the patient’s physicians and family members?

Will the provider give you written information describing how they commence and discontinue services to patients?

What backup does the patient have if their caregiver cannot show up at the scheduled time?

What are the internal complaint procedures?

Will the provider give a list of citations they have received from state surveyors over the past year?

Does the provider have a nursing supervisor on call and available 24 hours per day?

How does this provider select and train its employees? Does it protect its workers with written personnel policies, benefits packages, and malpractice insurance?

What types of reimbursements will the agency accept?

Will the provider give a list of references?

Article adapted and checklist borrowed from the Maryland-National Capital Homecare Association’s (MNCHA) and the National Association for Home Care’s (NAHC) websites. For more information, please visit their websites at www.mncha.org or www.nahc.org.

Like Tom, over 1.5 million Americans suffer from Parkinson’s Disease, a progressive neurological condition that is second only to Alzheimer’s Disease in prevalence. Parkinson’s Disease is characterized by tremor, rigidity, slow movement, and trouble with balance. “Most patients first notice difficulties with fine motor skills which are affected by tremor and slow movement,” says Dr. Kevin Biglan, a neurologist and Movement Disorder Specialist at Johns Hopkins University in Baltimore, Maryland. “These include activities such as buttoning buttons, washing hair, and eating.”

Celia Bassich, an Assistant Professor at Towson University, says speech and swallowing can also be affected. “The first voice change usually involves talking in a much softer voice than is typical of conversational speaking. However, the person with Parkinson’s feels that he or she is talking at a normal loudness level.” Says Bruyere, “I recognized that I was slowing down even before I actually knew that it was Parkinson’s. My symptoms were life-changing and continue to be.”

Parkinson’s Disease was first discovered by James Parkinson in 1817 and was chronicled in his early work “Essay on the Shaking Palsy.” It is a neurological disorder characterized by the loss of dopamine-producing cells in the brain. When about 50% of these cells disappear, patients start to experience symptoms such as tremor and slow movement. The theory behind the cause of Parkinson’s Disease is still unknown, although several studies suggest exposure to chemicals in the environment and genetic mutations may both play a role. “There are several genetic and environmental factors that may predispose a person to develop Parkinson’s Disease,” says Dr. Ted Dawson, director of the Parkinsons’s Disease and Movement Center at Johns Hopkins. “In addition, specific chemicals used in the agricultural industry have caused Parkinson-like symptoms to occur in animal models.”

Although Parkinson’s Disease eventually becomes debilitating in its more advanced stages, medications are available to help patients with movement. Levodopa (pronounced lee-vo-do-pa), a chemical that has been in existence since the 1960s is still considered the “gold standard” for Parkinson’s patients, and is perhaps the most widely prescribed medication for the disease. In addition, Deep Brain Stimulation surgery has been shown to be very effective in eliminating several of the symptoms of this disease. For most people with Parkinson’s, a comprehensive approach to therapy is the best way to treat the effects of the disease. Says Biglan, “People should see a Movement Disorder Specialist as soon as possible to help them with the primary symptoms and medications of the disease. We can then refer them to other specialties – such as speech pathology, occupational therapy, and physical therapy – as the need arises.”

Tom Bruyere sees hope for many people with Parkinson’s Disease. He has participated in several clinical research studies for new medications and is on constant watch for new therapies. “I am enthusiastic about some of the new treatments and the research that is going on.” He also participates in area support groups and recognizes the need for patients and caregivers to constantly increase their knowledge about Parkinson’s. “I think there is reluctance on some people’s parts to go to support groups, but once they attend, they learn that they dramatically increase your education. They help people at all levels.”

In searching for a cure for Parkinson’s Disease, Dr. Dawson thinks that research is moving in the right direction to find a cure within the next few years. “The advances that we are making in research are very promising for patients with this disease. New treatments are regularly being developed, and it is only a matter of time before a significant breakthrough surfaces.”

As for Bruyere and his wife, Kathy, they are expecting to make a move of their own in the near future to be closer to their children and grandchildren. “I have hope in research but until they cure this disease, we’ll keep pressing on.”

For more information, contact the Johns Hopkins Parkinson’s Disease and Movement Disorder Center (410-955-8795; www.hopkinspdmd.org), the National Parkinson Foundation (1-800-327-4545;www.parkinson.org), or the Parkinson Foundation of the National Capital Area (703-891-0821; www.parkinsonfoundation.org).

Assisted Living communities have proliferated in recent years, and the offerings continue to expand. The growth in the market has created an unprecedented number of options for seniors and their families who are considering assisted living.

With so many choices, there is undoubtedly a perfect community for every individual, but the large diversity of options can leave consumers feeling overwhelmed and lost amidst industry terminology. The following information provides an introduction to the assisted living marketplace. Industry professionals can offer more specific information about their residences, and, perhaps most importantly, guided tours of their communities.

Assisted Living as a Retirement Option
According to the LeadingAge, there are 36,451 licensed assisted living facilities in the United States; these facilities are home to over a million Americans. To demonstrate the dramatic growth in the assisted living industry, the Family Caregiver Alliance (FCA) notes that “Between 2000 and 2002, the number of licensed assisted living and board and care facilities increased from 32,886 to 36,399 nationally, reflecting the trend towards community-based care…” As the population continues to grow, LeadingAge estimates that 12 million seniors will need long-term care by 2020. Not only are there increasingly more seniors, but today’s seniors are much more likely than their predecessors to leave their home environment to seek a community that offers social stimulation, conveniences and amenities, and various care options.

Services and Amenities
Assisted living communities offer housing and a variety of supportive services delivered by qualified staff members. As opposed to independent living communities, health care services are available at assisted living communities. The Assisted Living Federation of America (ALFA) notes that assisted living is “a unique transition from independent living without care” that “helps seniors enjoy an improved quality of life with independence and care combined.” In order to fill the needs of their residents, assisted living communities generally offer some assistance with the activities of daily living. Activities of daily living include eating, bathing, dressing, transferring, toileting, medication management, and walking. Survey data from the National Center for Assisted Living (NCAL) reports that 81% of assisted living residents need assistance with one or more of the activities of daily living. Most communities offer three meals a day served in a common dining area. Many also offer some type of assistance with transportation. Housekeeping and laundry services are standard offerings. Staff members are available to meet resident needs 24 hours a day. Most communities are equipped with security systems and emergency call systems are often available in all residences. For residents with more acute health care needs, such as Alzheimer’s or other forms of dementia, special units and/or specially trained staff members are often available.

In addition, communities offer a wide range of social activities to stimulate resident contact. Standard activities include religious services, educational programs, games, clubs, and entertainment. Many communities also offer exercise and wellness programs. Often, activities are catered to and driven by resident interests. Community amenities vary widely but can include private units, state-of-the-art facilities, beautifully decorated common areas, barber shops and beauty parlors,pharmacies, physical therapy services, recreation rooms, libraries, gardening areas, and fitness centers.

Types of Communities
Consumers will quickly find that assisted living communities come in a variety of shapes and sizes. Assisted living communities are also commonly called residential care facilities, personal care homes, retirement homes, or community residences. Assisted living also makes up part of the continuum of care offered by continuing care retirement communities (CCRCs).

Assisted living communities range in size from large communities with 100 or more residents to small homes with 15 or fewer residents. From converted family homes to sprawling campuses, consumers will find communities to fit every resident’s needs and preferences.

Payment Sources
Although Medicare does not cover the costs of assisted living, there are a variety of payment sources available. The National Center for Assisted Living (NCAL) reports that “certain services are paid under Supplementary Security Income and Social Services Block Grant programs.” Individual’s who meet income qualifications may also be eligible for assistance through their state Medicaid program. Some communities also offer internal financial assistance programs. State and local governments may offer subsidies for rent to income-eligible seniors. Contact the local Area Agency on Aging for more information on subsidies and other payment assistance programs.

Long-term care insurance policies provide another financing option for assisted living. Most of these policies will cover the costs of assisted living. Some of the costs of assisted living are also reimbursable through individual health insurance policies.

While there are other payment options available, the vast majority of assisted living costs are covered through private payments by residents and families. The nationwide average cost for an assisted living residence is $2,524 per month or $30,288 annually, according to the AAHSA.

These figures are averages only and do not account for more affordable or subsidized options that are available in most areas. Individuals should investigate all available payment sources and obtain specific information on standard rates and fees for additional services before choosing an assisted living community.

Financial and insurance experts can provide more detailed information about all the available payment sources. Additionally, professionals at assisted living residences will be able to offer information about assistance programs and subsidized units available at their communities.

Choosing a Community
Before choosing a particular assisted living community it is a good idea to carefully review several of the available options. First and foremost, consider the needs and desires of the potential resident. Would they like a large community or a smaller home? What types of activities and amenities do they enjoy? What payment options are available, and what communities fit into the price range? Begin the initial process of narrowing the search by reviewing local communities and answering these simple questions. Use the comprehensive housing search engine found on our home page to locate communities.

After narrowing the focus of the search, request brochures from potential communities. Communities can also provide more specific information such as the resident agreement or contract, a list of services and amenities, detailed prices, staffing information, admission and discharge criteria, and community rules. Reviewing this information will help to further narrow the field of potential communities.

The most important part of the decision-making process is visiting the potential communities. During these visits, talk with staff members and residents and tour the entire facility. It is advisable to visit a facility more than once, during different times of the day, to get a complete feel of the lifestyle at the community. If possible, have lunch with current residents.

While talking with residents and staff members, ask a copious amount of questions, and be sure to receive satisfactory answers. Staff members should be able to provide specific information about the community’s features and services. Information about costs and payment sources should be readily available and straight forward. The checklist below provides sample questions to cover during the visit. With the answers to these questions, making a final decision on the appropriate assisted living residence should be easy.

Assisted living communities are becoming an increasingly popular option because they can offer a little, or a lot, of help in a home-like setting. After making an informed decision, new residents can feel confident that their individual care needs will be provided for in an atmosphere that is conducive to continued independence.

Assisted Living Community Checklist

Obtain answers to the following questions while reviewing assisted living options

Is the community location appealing?
Is the outside of the building well maintained?
Are the common areas clean and inviting?
Is the floor plan easy to understand?
Are the hallways and rooms designed to accommodate wheelchairs and walkers?
Are staff members professional and approachable?
Do staff members provide a care plan for each resident?
Are staff members available 24 hours a day to provide assistance with activities of daily living?
Does a physician or nurse visit residents regularly?
Are residents socializing?
Do residents appear happy?
Talk with the residents. How do they like the community and the staff?
Request a daily schedule or calendar. Are there regular activities available?
Are housekeeping and transportation services available?
Are there emergency response systems in bathrooms and/or individual units?
Are three meals provided every day?
Is there a contractual agreement detailing all services, fees, and admission and discharge policies?
Are additional services available should they become necessary?
Request an itemized list of charges. What are the specific costs for services?
Are there any government, private, or corporate programs available to help cover the cost of care?

Adapted from the checklist provided by the Assisted Living Federation of America (ALFA). Visit www.alfa.org for more information

Additional Resources

American Association of Homes and Services for the Aging (AAHSA)
Association is committed to creating the future of aging services by providing an association of member providers who people can trust.
202-783-2242
www.aahsa.org

Assisted Living Federation of America (AFLA)
National association dedicated exclusively to professionally-operated assisted living communities for seniors.
703-894-1805
www.alfa.org

Consumer Consortium on Assisted Living (CCAL)
The only nonprofit, consumer-based organization nationwide focused on the needs, rights, and protection of assisted living consumers, their caregivers, and loved ones.
703-533-8121
www.ccal.org

Family Caregiver Alliance (FCA)
Alliance offers a wide array of services and publications for caregeiver needs, including consumer publications. Although the organization is based in California, much of the information is applicable nationwide.
800-445-8106
www.caregiver.org

National Center for Assisted Living (NCAL)
The assisted living arm of the American Health Care Association (AHCA), which is the nation’s largest organization representing long term care.
202-842-4444
www.ncal.org

Whether performed in the comfort of their own homes or in a facility, home care helps seniors to maintain their independence. Additionally, home care prevents the full responsibility of caregiving from falling on friends and family. These services are intended to promote, maintain, or restore health and help individuals to manage the responsibilities of daily life. Aides and nursing professionals can be engaged privately or through an agency.

*What types of Home Care are available?*

An incredibly diverse field, home care can serve a variety of senior need levels. Home Care can include home support care, skilled nursing care, or hospice care. For information about hospice care, please see our hospice section.

Home Support Care- is for seniors who are no longer able to perform all of the functions of daily living by themselves but who do not yet require skilled medical services. A home health aide can help with activities of daily living (ADLs), which include bathing, dressing, transferring, eating, and hygiene. Additional services generally include meal preparation, mobility exercises, light housekeeping, laundry services, medication reminders, and accompaniment to appointments. Training and certifications will vary from provider to provider.

Skilled Nursing Care – is care that is prescribed by a physician and is administered by a registered nurse. The services provided by skilled nurses include: administering injections, administering medications, wound care, IV monitoring, blood tests, catheter care, respiratory therapy, speech therapy, physical therapy, feeding tube administration, and more.

*How much will Home Care services cost, and who will pay for them?*

Home Support Care – is traditionally a “private-pay” service, which means that it is an out-of-pocket expense for the customer. Prices range from $10-$20 per hour. However, most long-term care insurance policies will cover home support care. You should carefully review your long term care insurance policy with your insurance agent to be sure that the type and amount of coverage you will need will be covered. If you qualify for Medicaid, a government program for low-income individuals, it may pay for some of your home support care needs. Since laws vary from state to state, you will need to contact your local Area Agency on Aging for more information concerning government benefits.

Skilled Nursing Care – will be paid for by Medicare, a government program that covers some of the medical needs of seniors over the age of 65, as long as it is determined to be “intermittent skilled care,” which includes occupational, respiratory, speech, and physical therapy. Major medical health insurance will also cover a limited number of skilled home visits. The number of visits covered will depend on your medical diagnosis and your health insurance plan. Be sure to fully understand what Medicare and your health insurance policy will cover before making arrangements for skilled nursing care. Costs for these services vary greatly depending upon coverage by Medicare, Medicaid, and private insurance and the degree of services required.

*How do I choose a home care provider? *

The questions below will help you choose the home care provider that is appropriate for your medical needs and family situation. Regardless of whether the care you seek is skilled or home support care, it is important that you know the answers to the following questions.

*What should I consider when hiring privately or through an agency?*

AGENCY:
*Is the agency performing criminal background checks?
*How long and what geographical areas are covered in the background check they perform?
*What are the experience levels and specialties of aides available?
*Will the agency be responsible for finding a replacement caregiver if my regular aide is sick or on vacation?
*What hours can I speak to someone from the agency?
*Is the agency licensed and bonded?

PRIVATELY:
*Should the family perform a background check?
*What is the aid’s previous experience?
*Who will replace my caregiver if they are sick or on vacation?
*Does the caregiver have any type of licenses or certifications?
*Do I have to do reference checking?
*Who will be my advocate if I have a problem with my caregiver?

Points to consider when choosing a home care provider:

- How can I cancel the service I requested?

- How much is the cancellation charge?

- Who do I call if my caregiver is unable to work?

- What is their phone number?

- What are the fees?

- What exactly is covered by those fees?

- Will the agency respond to requests for “short notice” services?

- Is there an extra charge for these services?

- Is there a minimum or a maximum number of hours of home care service per day?

- Is there a minimum or a maximum number of days of home care service per week?

- Is there someone available to assist me 24 hours a day, 7 days a week?

- How long will it take someone to return my call after business hours?

- How do I make changes to the initial caregiver schedule?

- Do the aides provide transportation if needed?

- What type of screening does the agency perform?

- How long will I wait for service after placing my request?

- Will the same caregiver assist me every day or will it be somebody different?

- Will someone from the agency call to see if I am satisfied with the services provided to me?

- How often will they call and check-in with me?

- Will I be responsible for providing meals for the caregiver?

- Will my live-in caregiver require a private bedroom?

- Will my caregiver clean my house and do my laundry?

- Do I need to sign a contract with the agency?

- How long is the contract good for?

- What does it entail?

- Do I need to have a qualified, elder law attorney review this contract before signing it?

Special thanks to Family & Nursing Care, for their materials and guidance while compiling this article.