So many of us worry about our loved ones being safe, comfortable and treated with kindness when they are living a senior community (i.e. assisted living).

The sad fact is most elder abuse is by a family member. Abuse can come in many forms such as intimidation (emotional), physical or financial, neglect, etc.

But what about in care settings? Most reported abuse doesn’t happen in care settings. But what can you do to make sure your loved one is getting the best care?

1. Come from a place of support to staff. We recommend you are an active, visible advocate in the senior community. Get to know the caregivers, nurse’s and managers and even other family members.
2. Visit often and at different times of the day.
3. Know warning signs of the various types of abuse.

It’s always wise to ask questions of the staff when you are unsure about community procedures and situations.  And it never hurts to bring a treat or something else to the staff. Let them know you respect and care about what they do for your family member.

Questions You Can Ask Your Loved One

Older adults are often grateful for the care they receive and they may not want to complain.  It is true caregiving may never be perfect, but to some extent, we may need to pick the battles.  The other thing you can do is ask the older adult the following questions:

• Who is responsible for caring for you (during the day, in the evening, etc.)?
• Do you feel safe where you are living?
• Does anyone scold you or shout at you?
• Has anyone ever hit or slapped you?
• Has anyone left you alone waiting for food, drink or care?
• Has anyone ever made you do things you don’t want to do?
• Have you ever signed something you do not understand?

When Your Loved-one Has Memory Loss

The important thing to consider in this evaluation is memory loss.  If the resident suffers from Mild Cognitive Impairment (MCI), then you can usually have faith in their answers to these questions.  However, if your loved one has more moderate or severe memory loss or his/her memory is getting worse, be aware that suspicion and confusion is common.  Older adults with memory loss can’t always understand or process what is going on around them, so they will express feelings differently.  In these cases, changes in behavior might be the best indicator of something isn’t quite right.

What To Do If You Suspect Abuse

Get your facts and information together.  Keep an open mind and seek to understand.  Local senior living communities have a grievance process which should be posted in their community in an obvious place.  If you don’t see it, ask for it.  Try to resolve a concern internally with owners and managers.

You may also wish to the local Ombudsman’s Program via the county Area Agency on Aging.  To find your local Area Agency on Aging visit https://www.usaging.org/

A last resort would be to contact the county Adult Protective Services office via the local Area Agency on Aging. https://www.usaging.org/ http://vaaaa.org/

1. Alzheimer’s Association 800.272.3900  24/7

www.alz.org  https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf

2. NIH Clinical Trials

https://www.alzheimers.gov/clinical-trials

3. Good overview videos

What you can do to prevent Alzheimer’s | Lisa Genova

https://www.youtube.com/watch?v=twG4mr6Jov0

Gary Small MD/Successful Aging  https://www.ted.com/talks/gary_small_the_formula_for_successful_aging?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare

4. More in-depth clinical information

Dale Bredesen, MD A Precision Approach to End ALZ

https://www.ted.com/talks/dale_bredesen_a_precision_approach_to_end_alzheimer_s_disease

5. Reversal of cognitive decline in Alzheimer’s disease – Aging (Albany NY). 2016 Jun

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931830/

6. Reversal of Cognitive Decline: 100 Patients-Journal of Alzheimer’s Disease & Parkinsonism 2018

https://www.omicsonline.org/open-access/reversal-of-cognitive-decline-100-patients-2161-0460-1000450.pdf

7. Practical information about dementia care (Teepa Snow)

https://www.youtube.com/watch?v=t–mkzfHuIE

8. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392084/

9. More Basic Information

https://www.nia.nih.gov/health/what-dementia-symptoms-types-and-diagnosis

 10. Blue Zones bluezones.com

11. Recent Article: Do we have to age?

https://www.theguardian.com/science/2021/jan/03/observer-magazine-do-we-have-to-age-biologist-andrew-steele

 12. Improve brain health with the MIND diet

https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/improve-brain-health-with-the-mind-diet/art-20454746

13. Diet: Ketoflex 12/3

https://www.apollohealthco.com/ketoflex-12-3/Keto

14. George Washington Center for Integrative Medicine  www.gwcim.com

202-833-5055

15. Brain Growth Exercises

Elevate – Brain Training Games (phone app)

https://www.dakim.com/  Online and best used on a touch screen/iPad/Tablet

https://enrichvisits.com/  Workbooks for purchase

www.luminosity.com   Online, phone, tablet

https://www.goodwinhouse.org/stronger-memory/  Down loadable, free, worksheets

15. Help for Families

Aging Life Care™ Association  www.aginglifecare.org

National Alliance on Caregiving www.caregiving.org/

Dementia Action Alliance www.daanow.org

Other recent news…

Alzheimer’s Association International Conference 2020  HIGHLIGHTS

Flu and Pneumonia Vaccination Tied to Lower Risk of Alzheimer’s

New research at AAIC 2020 suggests that flu and pneumonia vaccination are associated with a reduced risk of Alzheimer’s. Two studies of older adults found that those who received either a flu or pneumonia vaccination were less likely to develop Alzheimer’s. Those who received the flu vaccine more regularly had an even lower risk. For pneumonia vaccination, the largest risk reduction was observed in people who do not carry one of the known genetic risk factors for Alzheimer’s — a variant of the TOMM40 gene.

• Blood tests that measure abnormal versions of the tau protein may — if verified through further research — diagnose Alzheimer’s dementia without additional confirmation; that is, not requiring autopsy examination, or both an amyloid and tau positron emission tomography (PET) scan.
• Heart health risk factors — such as high blood pressure, diabetes and being overweight — as early as adolescence can influence late-life memory and cognition, especially in African Americans.
• Higher quality early-life education is associated with better language and memory performance and lower risk of late-life dementia. This association can differ between men and women and between Black and white individuals.

5 Things an Aging Life Care™ Professional Did Today – The last one may surprise you!

You asked your attorney, “How do families cope with all they have to know about taking care of an aging parent?  When do they find the time and how do they know they’re making the best decisions?” That’s when your attorney gave you our number and after a brief conversation you recognized this was the help you had been looking for.

Senior Living Myth Five:

Medicare pays for long-term care.

False. Let’s clear up some of the confusion surrounding this issue. First, let’s define ‘long-term’. The quick answer is long-term care is care that last longer than three months. While Medicare Part A covers up to 100 days of rehabilitation and skilled nursing, this is considered short-term. Requirements include hospital admission of three days or more and a doctor’s order for rehabilitation therapy or skilled nursing. Long-term care insurance policies can have a 90 day (or more) waiting period to receive benefits for long-term assisted living.*

Overall, there are only three options for long-term care:  Long-term Care insurance, your own resources, and if you have no resources, Medicaid.  Veteran’s Aid and Attendance can also pay a portion of care and there may be some subsidies available through a state.

*Insurance policies vary

Senior Living Myth Four: “I’m probably going to live in my home just as I am now and then I will pass-away quietly one night.”

Well…..maybe. Wishes can come true, but the odds are against you.  According to the Centers for Medicare/Medicaid (CMS), seventy (70) percent of us will need at least some care as we age. Weigh all your options, and find out if you and your loved-ones feel comfortable making important decisions during a crisis. Remember, right now the decision is yours….until your children have to make a decision for you.

You can move into a senior community earlier (e.g. while you’re in your 70’s) and enjoy the independent resort-style living.  If you feel some responsibility to your children, moving before a crisis is a gift to them.   Moving at a younger age can provide more choices. Transitioning never gets easier as you age.  I have often heard, “I wish I would have moved sooner,” but I have never heard a senior living resident say, “I wish I would have stayed at home longer”.

In the end, it’s your decision.  You may wish to remain at home, make changes as needed and then move to assisted living if necessary. After all, thirty percent of us will not need care in our later years.

Senior Living Myth Three: “I will lose my independence.”

I can totally understand the feeling of being under someone else’s roof and having to change lifestyles and habits.  When was the last time you did that?  Was it in your parent’s home or perhaps in college? The transition can feel overwhelming at first.  You may feel you have no control and you are dependent on others or perhaps being driven by a schedule feels unpleasant.

The truth is, older adults who live at home are almost always dependent on others. Do you pay someone to take care of your yard or shovel your snow?  You may not drive anymore, so does your family or neighbor help you with shopping?  Do you have to schedule it in advance? Do you rely on others to change light bulbs or make small repairs?  Does your daughter fill your medication box?  The need for help has probably happened slowly.  Change is much more difficult as we age. Talk about what you are going through with a compassionate family member, friend, minister, rabbi, nurse or counselor.

Taking time and taking steps to care for your emotional and physical well-being shows your independence.

Focus on what you will gain.  I no longer have to shop and cook, but I can if I want in my apartment. I will be less lonely. I no longer have to worry about home maintenance.  I will only have to pay one invoice each month for most of what I need.  These things and more can make an older adult feel more independent.

Participate in the community events as little or as much as you want.  You do not have to participate in things you don’t want to do.  Recognize you do have a voice in what happens in a senior community. Resident council meetings are opportunities to enhance the community you live in. Start your own gathering or club.  Getting involved in your community shows your independence and gives you a sense of purpose—something all of us need.

Senior Living Myth Two: “I would consider a retirement community, but I cannot afford it. Besides, I own my house free and clear.”

I hear this explanation, but I often ask families if they have calculated the cost of care and housing in detail. Many assume living in their home with home care is less expensive. Consider the following questions:

1. How much does it cost to live in my home? It’s important to include taxes, meals, utilities, car costs, insurance, etc. I also recommend calculating annual home repair costs at 1% of the value of your home. Living in a senior community eliminates most, if not all, of these costs.

2. How much does home care cost when I need 12-to-24-hour care every day? Some of us may underestimate, or even deny, that we will need care someday. Seventy percent (70%) of older adults will need care for 2–5 years. In the DC metro area, caregivers cost about $26 per hour. That adds up to over $18,000 a month for 24-hour home care. Now add that to your monthly living expenses from above.

3. Have you considered alternatives to a “buy-in” community? Many people assume there are only buy-in retirement community options. However, there are rental options that do not require a large buy-in (e.g., $300,000). When learning about any retirement community or assisted living facility, keep in mind how much care is offered and what the contract covers.

4. Would you consider a smaller apartment and/or a different location if it meant an overall lower monthly cost? If you are willing to make compromises, you may find the perfect place with lower costs. Would you consider a one-bedroom apartment vs. a two-bedroom one? Would you consider moving out of state to be near family if it meant your monthly expenses would be lower in a retirement community?

5. Have you discussed financial planning with the help of a professional who can calculate the potential scenarios and associated risks? What expectations do you have for children to contribute (or to not contribute) to your care and housing?

6. And last, what is your REAL reason for not learning more about senior living options? Most of us have difficulty imagining the day when we can no long dress, bathe or go to the bathroom by ourselves. Many people are anticipating dying earlier than they actually will. Ask yourself, “What kinds of emotions arise when I think about needing help one day?”

Retirement communities, assisted living, etc. are not for everyone. Many of the options are driven by finances and sometimes there is no perfect solution. If someone is 75 and has not thoroughly investigated facets of senior housing and care while they are still healthy, then it’s time to become educated and have the conversation.

Senior Living Myth One: “I am suitable for independent living because I currently live by myself.”

Heidi L. Garvis, CSA® (Certified Senior Advisor), Senior Housing and Care Consultant. Caring Considerations: Plan For Peace of Mind

Recently, I had an 84 year old client who, living alone, clearly needed some support in her life. Over the course of a year, changes occurred. Her car was dented in two places. (“Someone backed into me.”) She paid her electric bill twice in one month. She forgot to take her blood pressure medication. She fell twice but, luckily, was not severely hurt. Her house was becoming difficult to manage. Her family did not live in the area and they were justifiably concerned. Her children said they could not sleep at night knowing their mother might be unsafe. They asked her if she would look at assisted living as one of the options.
She remarked, “I have had some issues, but I can take care of myself. I will look at places, but I want independent living—not assisted living.”

Independent Living vs. Assisted Living
Senior communities (including Continuing Care Retirement Communities, Assisted Living, Memory Care and Skilled Nursing Facilities) have assessment processes which determine how much care you will need. They interview potential residents and review a physician’s report for health history and diagnosis. You may consider yourself independent (and you might be in many ways), but senior communities have their own evaluation. For example, answer these questions:
• Have you had one or more falls recently? Hospitalizations?
• Do you manage your own bill paying without significant or frequent errors?
• Have you made some poor decisions with regard to your well-being, finances, etc?
• Do you drive? Would your grandchild be safe riding with you?
• Can you name all your medications, their dosages and describe what they are for?

These questions and others can have an impact on your admission into independent living or a Continuing Care Retirement Community (CCRC). Notice I said independent living, not assisted living. CCRC’s require a medical and financial review. A nurse’s assessment may conclude that you are safer in assisted living. In general, reputable senior communities do not want to take unnecessary risks with your care, but they also don’t want to suppress your independence. The amount of care you receive is adjustable and you can be very independent.

No one wants to be dependent or deemed ‘incapable’, but senior communities have a responsibility to provide quality care and communities vary in their independent living admission criteria.