Feature Stories - July 2007

Caring for Aging Parents

Critical Care for a Critical Time

by Liz Gamble

During her dad’s lost battle with cancer and her mom’s Alzheimer’s diagnosis, Jayne Cayton joined the legions of adult children who find themselves in the position of caring for aging parents. They’re called many things, the sandwich generation, middlers, but no matter what the label, it means baby boomers are stepping up to take care of parents who are either sick or in need of assistance simply because of the effects of aging.

“Even when you see it coming, you’re never fully prepared to essentially switch roles with your parents; to become the one responsible for caring for the people who always cared for you,” said Cayton.

Where, when and how does this caregiving start? Aging experts agree that, while it’s difficult to discuss, planning ahead might ease the road that could lie ahead. June Connelly, executive director for Las Ventanas, a life care retirement community in Las Vegas, offers the following tips for adult children to consider:

• Talk openly with parents about their needs and desires.

• Be prepared to take over parents’ financial matters. At the very least become knowledgable about all aspects of their financial picture, including investments, debts, assets, etc.

• Make sure parents have an up-to-date will.

• Make sure parents have a living will and have provided for power of attorney for health and financial decisions.

• Don’t be ashamed to hire help, but be sure to check references and outline a contract that specifically details what will be required of each party.

• Remove throw rugs; tack down loose carpets; make sure smoke detectors work; clearly label all chemicals, cleaning fluids, insecticides, medications, etc.; post emergency phone numbers; use nightlights, and get a medical alert system so your parent can push a button for help from anywhere in the house.

• Encourage seniors to participate in creative outlets.

• Research housing options before a move becomes a necessity.

Senior Living Options

Among the many senior living options, the three that most often come to mind are independent living, assisted living and skilled nursing. Combining all three and offering seniors the ability to move seamlessly from one to the other without the necessity of relocation is a relatively new concept for Nevada – the life care community. While a common and sought after living option for the “secondary retiree” across the nation, there is only one life care community in Nevada.

Las Ventanas is located in the master-planned community of Summerlin in Southern Nevada. A resort-style retirement community where the average age of the resident is about 70, Las Ventanas has been open since July 2004. The community is located on 17 acres and offers individuals and couples the opportunity to live

independently in private apartments, which range from one to three bedrooms with dens and all the amenities associated with private residences including full kitchens and washer/dryers. Residents also benefit from the planned and unplanned social gatherings between healthy and active residents, participate in scheduled activities held in the community’s common areas including the library, dining room or health club, and utilize the community’s transportation options for short trips and outings.

Making life care different from other independent senior living options is the fact that professionally staffed assisted living and skilled nursing centers are located on the community’s grounds and are immediately available to residents, when and if needed. Because of this continuum of care and the guaranteed availability of these services, life care offers predictable costs.

Las Ventanas’ comprehensive nursing care differs from many Medicare certified skilled nursing centers in that it offers all private rooms. Many life care communities require a nonrefundable entrance fee for independent living determined by the size of the apartment selected. However, at Las Ventanas, 90 percent of the fee is refundable to the resident or to the resident's estate. This refundability is, in a sense, a form of estate preservation, and can help to ensure that an individual's or couple's hard-earned life savings is left intact to be distributed as they choose.

“Life care encompasses everything that we help people plan for during their retirement years. It can potentially protect their assets, while also providing the emotional freedom to pursue the social aspects that enhance life as you age. Life care adds to an active lifestyle so that seniors can enjoy all the benefits of retirement while still having prepared themselves for the unexpected,” said Connelly.

At some point in time, seniors may need the help of an assisted living residence. Web sites like The National Center for Assisted Living (www.ncal.org) offers free assessment tools that can provide guidance on the level of help required.

Assisted living helps residents remain as independent as possible while giving assistance when needed. Assisted living homes differ in size, appearance and the types of services they offer. Some provide only meals, basic housekeeping, and help with the activities of daily living (ADLs) such as bathing, dressing and grooming. Others also arrange transportation and certain health services. This is beneficial environment for people who can't live on their own, but who don't need a nursing home.

“If an assisted living facility sounds like the right choice, a personal visit is important before making a final decision,” said senior care industry veteran Tom Feeback, who is director of Las Ventanas’ healthcare centers.

“Start by making a list of several facilities and plan a visit to each. It's one of the best ways to see what different places are like, to compare them and ask questions of the staff and residents,” added Feeback.

Feeback suggests calling each facility bearing in mind that the person on the other end of the phone is most likely a marketing or sales person whose job it is to sell a contract. After receiving all the necessary answers, ask for more information, specifically, a copy of the contract, as well as a brochure, a price list, floor plans, a list of residents' rights and rules, as well as copies of all the documents that need to be signed before moving into the facility. Write down more questions to ask when visiting the facilities.

There are numerous assisted living facilities from which to choose in Nevada. Some are not-for-profit, while others are corporate-owned like Louisville, Ky.-based chain Atria, which has three locations in Las Vegas- Atria Sutton, Atria Seville and Atria Sunlake – and one location in Reno – Atria Summit Ridge.

While the main purpose of assisted living has traditionally been to provide seniors with added help for daily needs, Atria’s trendsetting assisted living plan creates an environment designed to promote a senior’s capacity to remain physically active and mentally alert. Nationwide, Atria has guidelines called “Engaged Life” – an eight-category system of activities. Atria offers one and two-bedroom apartments with kitchenettes; bed and bath laundry service, restaurant-style meals and medication service among other amenities.

Assisted living can be costly and Medicare does not cover it. Before seriously considering assisted living as an option, decide if the monthly cost is affordable, while also keeping in mind that fees will go up over time due to cost-of-living adjustments. In addition, as needs change, monthly costs also will increase.

Because brochures will only discuss fees in general, experts agree that it is important for the assisted living contract to spell out in detail all of the costs and expected payment methods. Typically, assisted living centers provide the following:

• Individualized services that help residents function with daily activities.

• A plan that coordinates the delivery of services to each resident including an assessment or evaluation of the resident’s physical and social needs.

• Three meals a day in a common dining room.

• Medication assistance.

• Social activities.

When ongoing medical attention is needed, a skilled nursing care facility may become a necessity.

Each state decides how to license and oversee its assisted living and skilled nursing facilities. The Nevada Bureau of Licensure and Certification, Nevada State Health Division, 1550 East College Parkway, Suite 158, Carson City, Nevada 89706, 775-687-4200 is charged with the oversight of senior care facilities in the silver state. The U.S. Department of Health and Human Services web site lists 47 nursing homes in Nevada and provides readers information regarding the results of inspection reports.

“If a facility isn’t licensed, cross it off your list,” said Feeback. “However, having a state license doesn't assure quality care,” He cautions, “The proper agency can tell you if any complaints have been made against a facility.” Feeback recommends the following when researching facilities: • Talk with some of the residents. Ask them what they like and don't like about where they're living.

• Specifically, in the case of a skilled nursing facility, do the

residents look well cared for? Are they dressed appropriately, well-groomed and content? Do the residents’ quarters appear well-maintained and sanitary?

• Make more than one visit, and include an unscheduled visit on a weekend or in the evening.

• Ask yourself how you feel as you tour the facility.

• Are the grounds and buildings well-maintained?

• Is on-call medical care available?

• Is there flexibility in meeting a resident’s needs?

• Is staff open to adult children’s involvement in a parent’s care plan?

• Does the contract include everything promised by marketing pieces and agreed upon in conversation?

Feeback cautions that nursing facilities often claim to be Alzheimer’s centers, “However, facilities for the care of Alzheimer’s patients are not as common as marketing brochures lead people to believe. Alzheimer’s care is very specialized. Be sure and ask what specific programs are offered by a facility in this area of care.”

While life care, assisted living and skilled nursing are the three types of living options generally associated with aging seniors, Nevada also offers other avenues ranging from independent living apartment complexes to supervised care. For example, Carefree Senior Living, which is owned by Chicago-based Orion Residential and managed by Seattle-based Leisure Care, offers independent living in one- and two-bedroom apartments with a total of nine floorplans. Carefree senior living offers residents a wide range of benefits, including planned activities, transportation, on-site pharmacy delivery and on-site hair salon, in addition to the amenities typically associated with a high-end apartment complex. These types of independent living apartments do not offer assisted living or skilled nursing services.

The Cost of Aging

The cost of aging can be somewhat overwhelming. While most assisted living and skilled nursing facilities won’t state a standardized cost generally because cost is dependent on the level of services needed by the resident, it can be estimated that assisted living can cost more than $45,000 annually, while the cost of skilled nursing care can exceed $90,000 yearly.

The U.S. General Accounting Office predicts that approximately 40 percent of people age 65 will spend some time in a nursing home. The costs of long-term care are staggering and expected to rise even higher in the coming years. The Federal Financing Administration projects that spending on nursing home care will increase to $330 billion by 2030.

Additionally, studies show that 80 percent of an individual's life-long earned income can disappear due to major expenditures in the last years of life.

Many seniors face the real possibility of watching a lifetime of savings disappear. Couples may end up paying for an assisted living or skilled nursing facility for one partner while continuing to pay existing household expenses.

An Atmosphere of Respect

For any adult child faced with caring for elderly parents, the emotional and financial responsibility weighs heavy. Marriage and family therapist Diane Donovan-Vaughn of Las Vegas says many adult children wait until it’s too late and are forced to make hasty decisions. She tells potential caregivers to plan ahead and approach their parents in an atmosphere of respect and love. “Ask your parents what they want and then listen carefully to their desires,” said Donovan-Vaughn. “Set aside a specific time for a serious discussion; don’t use Thanksgiving dinner as the time to bring up future living arrangements or financial topics. And, if you’ve planned ahead, the Talk doesn’t have to take place all in one sitting. Gauge just how much your parent is willing to discuss and share; make your point and then back away and wait for another time to continue the conversation.”