Wisdom Wednesday: Aging Wisdom's Podcast

Change IS  hard, no matter who you are,  no matter how old you are. 

Moving is on the list of the Top 10 most stressful life events.  It's understandable why our parent may be resistant to make a move, even when it makes the most sense for their safety and our peace of mind.

Read more here -- Why is Change is So Hard? -- to understand why change is difficult, and why resistance is often the default response on the part of an older parent to your suggest that they move.  Perspective, persistence, and patience will win long-term.

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How can you best prepare ahead of a crisis? Or have things in order ahead of when changes start to become evident?  Do your homework and research ahead of your parent needing help. Here are some key areas to consider:

We always advise families and individuals who come to Aging Wisdom for guidance and ongoing support to first get their legal paperwork in order. This is essential.

Legal paperwork: Have you and your parents completed completed estate planning documents (powers of attorney, wills, and advance directive)? If so, have you reviewed them lately to make sure they still reflect your/their wishes? And Elder Law attorney can help you prepare or review these documents. You can contact us for an attorney referral or you may find an Elder Law attorney here: https://waela.org

Finances: make sure you understand your parents' financial situation. What is their monthly income? Do they have long-term care insurance? If so, do you understand what it covers? When does it kicks in? If they don’t have long-term care insurance, how much do they have saved to pay for long-term care costs? How many years of care would this savings cover?

If your older loved one is at home and needed support, you can start slowly and start small by offering in-home assistance. Wendy offers some suggestions such as a home care nurse to manage medications, someone to come to the home to prepare fresh, healthy meals, or a professional caregiver to assist a few hours a week.

Sometimes coordinating some regular companionship is helpful too, to address isolation and improve overall quality of life. Social isolation can often happen as mobility and cognition changes. A companion can assist with driving, activities, outings, and engagement.

If you are interested in exploring in-home assistance or engaging a senior care companion for your parent, we can help. Schedule a free, get-acquainted call here to talk with one of our care managers.

Resources and Supports:

• Aging Wisdom (serving King and south Snohomish Counties)
• Sound Generations (King County)
• Homage Senior Services (Snohomish County)
• The Memory Hub (Seattle's First Hill)
• Providence ElderPlace (Everett, Kent, Redmond, Seattle, West Seattle)
• Elderwise (Seattle's First Hill)

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When families begin to see signs that an older adult needs help, how can they start having a conversation? Because nobody wants to say, "Hey mom, you need care. We need to move you." How do you get there before there's a crisis?

In this episode, Wendy Nathan, Certified Care Manager at Aging Wisdom, and Sandra Cook, Executive Consultant for GenCare Lifestyle, discuss some strategies to approaching a loved one who is needing help but may not be ready or doesn’t recognize the need. 

As Wendy acknowledged, it important to preserve the relationship. Diving in with “you need to move!” isn’t a good approach. One of the methods our care managers coach families to use is to have a conversation about the future. 

For example. "Mom, in the future when you might need help, what might be some of the things that you would want? Would you be interested in moving? Would you be interested in having care at home?" 

And talking about it in the future doesn't put the pressure on them to have to make any decisions right now. 

Listen as Wendy and Sandra share additional strategies and concerns.

Additional Reading and Resources

• The Dance: Finding Balance with Helping an Aging Parent
• Resistance to Care is a Common Challenge: What's the Best Path Forward?
• A Move to a Retirement Community Count Mean More Independence for Your Parent
• What is Aging Life Care?

Not sure what to do next? Is the person in your care resistant to help? We are experts in guiding families on options and next steps. You can CLICK HERE to schedule a free get-acquainted call with one of our care managers.  Learn more about our Senior Care Services.

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Having concerns about an older loved one’s well-being is normal. Striking the right balance between fostering independence and ensuring safety can be a struggle for adult children and other care partners. Sometimes we offer help and it’s ignored, dismissed, or refused. Granted, this can be frustrating. However, with patience, persistence, and some new approaches, you can build a foundation for conversation, collaboration, and mutual understanding.

In this first of ten bite-sized podcasts, our colleague Wendy Nathan, Certified Care Manager, and Sandra Cook, Executive Consultant for GenCare Lifestyle,  share the common signs that someone may need help and how to help those in our care when they don't want help.

Changes and adjustments are normal for all of us during our lifespan, but sometimes they warrant a closer look. Striking the right balance between fostering independence, respecting autonomy, and ensuring safety can be a struggle for those of us who are part of an older adult’s life. You may find this article helpful too: Seven Signs an Older Loved One May Need Help

By the end of this series of podcasts, part of a larger virtual presentation given in February, you should have some great tools in your toolbox for managing resistance. 

In this series of conversations with Wendy and Sandra, they will: 

• Discuss the value of independence in our society 
• Help us understand why older people may resist care/help 
• Offer techniques to help build and gain trust and cooperation 
• Provide creative ways to support to those who are reluctant to accept our assistance

Not sure what to do next? Are changes in an older loved one a source of worry for you? We are experts in guiding families on options and next steps. You can CLICK HERE to schedule a free get-acquainted call with one of our care managers.

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We're revisiting an interview Lisa Mayfield, founder, principal and care manager at Aging Wisdom, did with Suzanne Newman of Answers for Elders back in early 2020 on an evergreen topic: Family dynamics and caring for a parent living with dementia.

They talk about facing family conflicts and shifting dynamics. Even in families where all have tight relationships, caring for an aging parent can bring out conflicts.

Subtle and challenging symptoms of dementia may also mean that your parent is experiencing a lack of insight in the ways that the disease is affecting them.

Lisa and Suzanne share some great strategies for calming conflicts, recognizing your grief, addressing denial, and in the long run, doing what's best for mom or dad.

Additional Reading and Resources:

• Clash of the Siblings: How to navigate family dynamics when your parents need help 
• My Mom Refuses to Accept Help! Lack of insight may be the reason 
• Surviving and Soothing Sibling Strife When Caring for Aging Parents 
• Get in the Lifeboat: But Don't Float Alone! Key Supports You'll Want in Your Boat

Not sure how to begin? Put our expertise to work for you! Schedule a free, get-acquainted call today with one of our Aging Life Care experts.

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Cost of Long-Term Care*

One of our favorite tools for getting a baseline on long-term care costs is the Genworth Cost of Care Survey.  Enter your city, state, or zip code for the median cost of care for a variety of care settings (including your home) in your location.

We stress median costs, as our experience as geriatric Care Managers is that LTC costs more than the median reflected in the survey. But again, it's a great place to start to get a realistic picture of costs, options, and levels of care.

Skilled Nursing: As Nicole shares in the podcast, if you're privately paying for a skilled nursing facility, you could easily be paying $13,000 - $15,000 a month. It's expensive and a very clinical atmosphere.  Skilled nursing, as discussed last week, is for those individuals who are rehabilitating following a hospitalization or needing 24/7 medical care. There are also residents that are who are utilizing Medicaid funding,  with Medicaid covering the cost of their care. Skilled Nursing podcast.

Adult Family Homes (AFHs): AFHs in our area typically range from $7,500 to $10,000 a month. Occasionally, we see it go a little higher for someone who has a pretty substantial care needs. We've seen it go as high as $12,000.  That's a little bit of an outlier. One of the things about adult family home costs is that they tend to be a little bit more contained over time. Adult Family Homes podcast.

Side note: There's more of a cost ceiling with adult family homes. And there are opportunities in some adult family homes for people to spend down to Medicaid.  

Assisted Living: With Assisted Living there are different levels and points, and so costs can vary widely as a result. We may know what it'd cost today, but it's difficult to predict (though we encourage you to ask questions to be prepared for what care may cost in six months or two years.  Assisted Living podcast 1.  Assisted Living podcast 2. 

Memory Care: Memory care cost are more closely aligned with assisted living.  Total monthly cost we see usually range from $7,000 to $12,000 a month depending on the community and the care needs. Memory Care podcast.

* The costs of care that Nicole discusses in this podcast are what we see in the greater Seattle-Bellevue, Washington state area. 

• You may find this free online course of help. Should I Move Mom? 
• Choosing the Right Long-Term Care Facility (an article from AARP)

Interested in exploring and planning for long-term care housing and not sure where to start? We can help! Schedule a free get-acquainted call today. 

This podcast is part of a longer conversation between Nicole Amico Kane, Director of Care Management at Aging Wisdom, and Brenda Dodd, Director of Training and Special Projects at Áegis Living. 

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This is a common scenario and often what brings families to Aging Wisdom for our expert guidance: The parent that refuses help, especially when it's clear they need it!

In this conversation, Wendy Nathan, Certified Care Manager at Aging Wisdom, and Sandra Cook, Executive Consultant for GenCare Lifestyle, discuss some of the scenarios they've experienced working with adult children and their parents.

Wendy advises to start small, just as she shared in the earlier podcast, which you can listen to by CLICKING HERE.  Bring in a neutral third party, such as a geriatric Care Manager like Aging Wisdom, to help move the conversation forward and provide solutions and options that will work well for the person in your care. 

Worst case scenario, as Wendy and Sandra shared, could be a house fire or Adult Protective Services (APS) is contacted because of a report of self-neglect on the part of the older person.

Find ways to work with your parents before it gets to that point. It takes patience and persistence, but it will pay off in the long run.

Hire a professional to help early on. Especially if you find yourself getting frustrated and overwhelmed. A person trained in guiding conversations and helping with older adults who are resistant to help can honor your parents' feelings and yours  and streamline the process.

Looking for help? Schedule a free get-acquainted call with one of our Aging Life Care Experts today.

Additional Reading

• The Dance: Finding Balance with Helping an Aging Parent
• What is Aging Life Care?

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Skilled Nursing Facility (SNF)/Nursing Home

Skilled Nursing Facilities (SNFs), also known as Nursing Homes, are for individuals that have ongoing physical or mental conditions that require constant care and supervision or need rehabilitation following a hospitalization. 

Skilled nursing services focus on medical care. 

These services typically include nursing care, 24-hour supervision, three meals a day, and assistance with everyday activities. They provide physical therapy, occupational therapy, speech therapy, and medical oversight. 

The goal of rehab is to get patients back to their baseline and stabilize them so they can move on to the next step. Rehab is typically a Medicare-covered stay, following a hospitalization.

Many who live in a skilled nursing facility long-term are either relying on Medicaid funding or paying privately at $500+ per day. 

Additional Resources

• Skilled Nursing Facility Care Coverage - Medicare
• Washington DSHS Long-Term Care Residential Options
• Washington State Nursing Home Locator and Inspection Reports

Planning for long-term care and not sure where to start? We can help! Schedule a free get-acquainted call today to learn more about your situation and to determine together whether our services are a good fit for your needs. 

This podcast is part of a longer conversation between Nicole Amico Kane, Director of Care Management at Aging Wisdom, and Brenda Dodd, Director of Training and Special Projects at Áegis Living. 

Thanks for listening! Follow us on Facebook and LinkedIn. 

Adult Family Homes (AFH)

Adult Family Homes are residential homes licensed to care for up to six non-related residents. They provide room, board, laundry, necessary supervision, and necessary help with activities of daily living, personal care, and social services. 

The adult family home model has created a space for people to get a high-level of care, but in a comfortable home-like setting. AFH are especially wonderful for residents who would benefit from more one-on-one support and a calmer environment.

There are a lot of adult family homes in our area (greater Seattle-Bellevue). We like this model when someone needs a lot of care related to physical changes (such as prone to falls) and medical challenges and especially care for people who are in the more advanced stages of dementia. 

As Care Managers, we start talking to families about adult family homes if the person in their care has been in assisted living and makes the transition to memory care. It may be going well for a while, then something changes, and all of a sudden it doesn't feel right. 

What we typically see is someone at a stage in their dementia where they're feeling overly stimulated by their environment. There's too much going on. They're having a harder time benefiting from the activities that are provided. There's a lot of coming and going and that's too much for them to process. They need a smaller, calmer environment. This is where adult family homes are so beneficial.

Sometimes people are experiencing behavioral or mood changes related to their dementia, and they need more focused one-on-one support. Staffing ratios are usually two caregivers to five or six residents. This way, residents can get more personalized attention.

It's also a great option for people who have medically complex needs. For example, we've had clients move to adult family homes where maybe they were on a ventilator or they had a feeding tube. Years ago, the only option for them would have been to live in a skilled nursing facility, which is a clinical, institutional atmosphere, rather than the more intimate, residential setting of an AFH. 

The number of adult family homes to choose from in our area can be overwhelming. Families often aren’t sure what to look for or how to assess which AFH will be the best fit for the person in their care. We help families navigate and narrow down the options and find the best fit for their loved one. 

 If you’re anticipating a move and not sure how to move forward, click here to schedule a free, get acquainted call with one of our Care Managers.

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Memory care is specifically designed to provide a safe, supportive, and structured living environment, be it a stand-alone community or a separate unit within assisted living or a CCRC. 

Staff provide support with activities of daily living, medication management, and meals, just like in assisted living, but are specially trained to support individuals living with Alzheimer’s or another dementia. Staff provide added structure and extra assistance as residents as experience cognitive change. Staff also offer social engagement and life enrichment activities. 

While units or communities are often secure to protect residents, many offer enclosed exterior spaces for walking, access to greenspaces, gardening activities, fresh air, and sunshine. Others have circular interior walkways with supportive handrails, and windows offering comforting views of nature. 

When touring communities, things to look for:

• Are staff genuinely engaging with residents? Do they know residents on a personal level?
• Is the setting welcoming and friendly? Is it clean and safe? 
• What life enrichment activities are offered? Would they appeal to the person in your care?
• Do the residents seem happy, comfortable?

Is the person in your care appropriate for memory care?

It’s not uncommon for individuals diagnosed with a dementia such as Alzheimer’s to live on their own when they are in the early stages of the disease. This is especially true if there is someone such as a spouse, other family member, friend, or paid caregiver providing ongoing oversight and support.

There may come a time when the person in your care will require more support than you are able to provide. Alzheimer’s and many related dementias are progressive, meaning that changes to the brain are progressive, ongoing. Judgement, reasoning, mobility, executive functioning, memory, balance, and circadian rhythms are all affected. This can make caring for someone increasingly challenging and especially challenging for family caregivers.

These questions will help you assess the situation and determine if a move is appropriate:

• Is the person in your care unsafe in their home? This article may be helpful in assessing home safety: Know Your Options: The Pros and Cons of Living at Home as You Age
• Is your health or that of the primary caregiver at risk? Caregiving is stressful. Oftentimes, family caregivers don’t invest in self-care and this puts their health in jeopardy. You are a priority too.  Read Self-Care is Not Selfish: It’s Essential for Family Caregiver Well-Being
• Are you burnt out, stressed, and growing impatient? Take the Caregiver Burnout Quiz
• Are the needs of the person in your care beyond your physical abilities?
• Would the person in your care benefit from an environment that would provide social and creative engagement, structure, and support?

Looking for guidance on how best to move forward? Our Care Managers are experts in helping navigate important decisions about long-term care. 

Click here to schedule a FREE get-acquainted call today.

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