Assisted Living: Everything You Need To Know To Comionately Care For Your Elderly Parent f292o

Assisted Living

Everything you need to know to comionately care for your elderly parent

Written by: Davis Zavik, BA in Sociology from the University of Miami, Florida Assisted Living Facility , and Facility Owner

Foreword by: MD & Ph. D Julio Cesar Penalver Gonzalez

This book is dedicated to my Grandma Wilma Mitchell and my Grandma Dora Firth- Thank you both for being the best grandmas in the world, I wouldn’t be who I am today without your love and .

P.S. I love you more.

the elderly- 100% of all profits are donated to charity

All rights reserved. In accordance with the U.S. Copyright Act of 1976, no portion of this book can be replicated without written consent from the publisher, excluding a reviewer who can quote short ages in a review with suitable recognitions. No part of this book can be copied in any way without written approvals from the publisher. Thank you for your of the author’s rights.

The materials covered in this book are not presented as legal, financial or medical guidance. Readers who require this kind of assistance should find the skills of licensed legal, financial, and medical specialists. The publisher and the author expressly reject any ability for any liability, loss or hazard (financial, private etc.), which can be stated as a consequence from the use and/or application of any of the concerns of this book.

This publication is a ive and useful resource for family of aging loved ones and specialists. Author is based in Florida and regulations are strongly reflective of Florida statutes, although regulations vary from state to state. All suggestions have been made without guarantee on the behalf of the author; the author and publisher reject any ability in relation with the use of this material.

First edition: March 2016

Visit www.alfliving.com for additional resources and to order more copies.

Forward:

I encourage you to read this book very deliberately. It speaks to a fundamental truth that has become lost- or at the very least, obscured- in modern times. We are consistently bombarded by messages telling us that senior care is too expensive, scary, lacking dignity or only used by people who don’t care enough for their loved one. The true reality of staying at home for most seniors includes isolation, little mental stimulation, unsupervised nutrition, more money spent on a private caregiver who most likely won’t be there around the clock, and constant uncertainty regarding their bills and affairs. All of this commonly leads to depression and tension on your relationship with your loved one. This has resulted in people struggling with the task of caring for their loved ones themselves, leading to high stress and less time spent with their kids and spouses and higher expenses. There is a better way to live, and it’s much greater than you could have ever imagined. As you’ll learn more of in this book, assisted living facilities are small communities intended to provide a place to live, personal care services and health care to elderly individuals in need of help with their activities of daily living. In an assisted living setting, you’ll find a community of likeminded people who become friends, around the clock care, families visiting their parent(s) constantly, and a safe place to live with dignity and independence. Think of them as the midway point between independent living and a nursing home.

Davis is the master. I should know because I followed her path and watched her transform herself from sociology student, to senior assisted living expert and humanitarian. As a graduate in Sociology from the University of Miami, she knows how to think critically about human social life, understanding human social relationships, and holds the ability to look beyond normal, taken-forgranted views of reality, to provide deeper, more illuminating understandings of social life. She puts to rest conventional assumptions about assisted living for seniors, and explains everything you need to know to get the best care for you aging parent. The first time I met Davis Zavik, I could tell she was someone special. She is consistent, reliable, positive and warm hearted. Davis delivers

practical resources to the greatest senior care imaginable, giving us the tools needed to make it work for our unique situations. Fortunately, she’s now written a book that will enable you to tap into your caregiving potential.

As an MD with a Ph. D in Biological Psychology, I have a great understanding of senior medical needs. Over the years I’ve been one of the leading healthcare experts, dedicated to teaching and scientific research. Among many endeavors, I have opened a handful of memory clinics for seniors around the world and was the president of the Latin American Psychiatric Association. I had the pleasure of working with many elderly individuals in my practice and after having read this book, Assisted Living, my only thoughts were that I wish it had been written sooner. I would have recommended it to all of my patients and their families. When asked what was the most surprising part about working with the elderly, I always say it was the fact that they waited too long to seek care. In fact, most individuals and their families waited until they had health issues before making the decision to seek proper assistance. As a physician who cares deeply for all seniors, I advise you from a place of comion not to wait until your loved one is too old or too sick to seek care.

I love this book, and I deeply respect the woman who created it. Thank you Davis- Assisted Living is certain to become a classic in its realm, and I’m grateful that you have asked me to write this foreword for it. As an experienced doctor, I celebrate because of all the effort that you put into this monumental work, and I know millions of people will be celebrating as well. If you have an aging parent or loved one who needs care and you only read one book this year, make it this one.

-MD, Ph. D, Julio Cesar Penalver Gonzalez, Neuroscientist, Biological Psychiatry, Neuropsychopharmacology, Cognition Rehabilitation, Elderly Memory Clinic Doctor

Table of Contents

Preface

Introduction

What is an ALF?

How Does Assisted Living Relate to You?

Aging Parents and the Sandwich Generation

Why is Assisted Living so Important?

Questions and Answers:

1. Do Assisted Living Facilities need to have a license or can any residential home with caregivers tend to my loved one?

2. What kind of care is provided with a standard license?

3. What happens to the property and personal affairs of my loved one when moving into an ALF?

4. How does a facility decide on the suitability of placement and continued residency?

5. What are the resident care standards of an ALF?

6. Where do they store my loved one's medications

7. What does "assistance with self-istration of medication" mean?

8. What are the staffing standards at an ALF?

9. What are some of the food service standards in place at an ALF?

10. What should we expect to see in a resident contract?

11. What security features will you find at a typical assisted living community?

12. How do you talk to a family member about the need for assisted living?

13. Who do you talk to when you can't persuade a loved one to move into assisted living?

14. What do you do when a family disagrees over the necessity for assisted living? What if parents are divided and what if siblings are divided?

15. What are the obligations of a facility if a resident is injured onsite?

16. Are residents able to move out of an assisted living facility if they don't like it?

17. Before moving into an ALF, does my loved one need clearance from their physician?

18. What is commonly required to move a loved one from their existing residence to an ALF closer to their family?

19. How do I relocate a loved one into an assisted living facility when I don't live nearby?

20. What’s the difference between a shared room and a private room?

21. What are the standard activities presented for residents in an ALF?

22. How do I deal with a prejudiced loved one in a diverse assisted living facility?

23. How do ALF's manage resident disagreements?

24. What kind of resident groups are accessible at most ALF's?

25. How do assisted living facilities manage dietary requests?

26. Do ALF's permit residents eat their food in their room? Can they bring the meal to their room?

27. Do most assisted living facilities offer transportation?

28. Do most assisted living facilities offer doctors visits?

29. What are the collective policies on bedding, towels, clothing and personal items?

30. How is laundry handled?

31. Do most ALF's have a swimming

32. Do most facilities permit their residents to use their personal furniture and belongings?

33. Can a resident keep their car while living in an ALF?

34. How does a facility work with residents to remove driving privileges?

35. Would you say that most facilities animal-friendly?

36. Do most facilities permit smoking in rooms or designated areas?

37. Is there access to alcohol in most ALF’s

38. Is it possible for ALF residents to have family stay overnight with them?

39. Who has access to the resident rooms in an ALF?

40. Do most ALF's provide access to Wi-Fi for residents?

41. Do most assisted living facilities come equipped with a workout room?

42. Is around the clock maintenance included in the total amount of the assisted living fee?

43. Do most facilities use security cameras?

44. Do most ALF’s take in elderly with mental health conditions like bipolar, depression or schizophrenia?

45. What is aging in place and how can I be realistic about the present or future necessities of my loved one?

46. Do most ALF's offer safes for my loved one's valuables? If so, who has access?

47. How will I know that I’ve chosen the right ALF for my aging loved one?

48. What does the resident contract include?

49. What paperwork is required when moving into an assisted living facility?

50. What should we be aware of when authorizing the facility agreement?

51. Can assisted living facilities raise their prices at any time?

52. When acting as a responsible party for an assisted living resident, who is the ideal person to select?

53. Who is the best person to act as power of attorney for a resident if a loved one is unable to?

54. What happens when a resident's economic reserves are exhausted when living in an ALF?

55. Is there a provisional financial solution to help your loved one pay for assisted living until they can sell their primary residence?

56. If a power of attorney sells estate without permission, what happens when Medicaid tries to recover the assisted living expense?

57. How can I help in the prevention of financial elder abuse for my loved one?

58. Who’s financially responsible?

6 of the most common financial planning mistakes to avoid

59. What is Hospice and how does it work with an ALF?

Conclusion

Important Definitions

Important Information

State Supervision Agencies

Preface:

I wrote this book for you, the person whose loved one requires additional assistance in searching for a place to live out their golden years. Whether they are your parent, partner, or sibling, know that you’re not alone in your search. This book will be a useful tool that you can carry with you and gather information you need to make well-informed and wise decisions with or on behalf of your loved one. Currently, there are more than forty million caregivers in the U.S. who are folks just like you who wish to assist but don’t have an understanding that is needed for managing elderly health challenges. Three main options for elderly individuals and their families include in-home care agencies, assisted living facilities, and nursing homes. It makes sense to most people that nursing homes, with their more intensive levels of care, cost more than assisted living. What many don’t realize is that the elder care costs associated with home care can quickly outpace the costs of assisted living as well. Home care agencies typically charge by the hour, meaning it will depend on how much care is needed, but the expenses can add up quickly for anyone who needs extensive care. In this book, we’ll be focusing solely on assisted living facilities, although I wanted to explain how ALF’s relate to the other options so you can make the best decision possible.

It’s my hope that I will you in navigating the multifaceted, overwhelming design of today’s American senior care system. At some point we will need to make decisions for our loved ones or ourselves, when living alone at home is no longer feasible and more care is needed. In the pages ahead, I deliver practical resources to the greatest care imaginable through every step of the way in the realm of assisted living. Caregiving starts with you and extends beyond to the team you surround your loved one with, therefore this outline contains lots of guidance intended to help you manage throughout this challenging time. Your loved one needs your , but that good caregiving means taking good care of yourself as well. Just like in the case of an emergency on an airplane we are told to put on our oxygen masks before helping others. When we follow this protocol, we’re able to breathe properly and assist even better for those around us. The same applies to your aging loved one.

If you are reading this book you have already decided that living at home with in-home care is not the best choice your loved one. I won’t be covering the possibility of residing at home with assistance, although I understand it as a wish of every elder. Almost everyone wants to age in place in his or her own home, but for most it’s just not a possibility. The pursuit for suitable care can be an intimidating task. Sometimes you and your family will disagree with how you see the future. There could be conflict; there might be disputes, but that everyone involved only wants the eventual result, which is to find the greatest facility and caregiving you can afford.

Introduction:

If you're like me, you have aging family that at some point will require more care and supervision than you can provide. You want to make sure that they are going to find a place that cares for them and treats them with dignity and love, but you might not know where to begin. One of the things we don't learn enough about are senior’s needs and the care that follows (unless you're in the industry), and one of the things that undoubtedly affect us all at some point is aging. I was lucky enough to start my life with four incredible grandparents. One of my grandpas ed away quickly from cancer in a hospital, and the other grandpa slowly deteriorated, losing mobility and mental function over time. It was hard to see my grandma bear the burden of caring for him, as she is older too. He eventually ed away at the age of 89. I believe it would have been less taxing on my grandmother and him had he been in an assisted living facility, but there’s a certain negative stigma that accompanies senior care. I think it’s everyone’s gut instinct to want to care for his or her loved one, and all the power to you if you can sustain that existence. The challenge is that life doesn’t always work out the way we’d like it to. In my experience, the notion that your loved ones won’t be taken care of in an ALF is an exception, not the norm. The big difficulty lies in knowing the right things to ask s when looking for a facility for your loved one. Like anything in life, the quality of answers we get is in direct proportion to the quality of questions we ask. This book is designed to give you the tools you need to make an educated decision with confidence when that time comes.

Every weekend growing up was spent at my grandparent’s home. It was something my brother, and I looked forward to all week. We would have movie nights, go golfing, enjoy the treats our parents didn’t allow in our healthy home and no matter what we we’re doing, we enjoyed each other’s company. During my high school years when I wasn’t studying, I volunteered at various elder homes because I saw the need after being around my grandparent’s friends and neighbors. I’ll never forget Sarah Jones, who lived next door to my grandparent’s home because she was like a grandma to me. She was a widow who had one son but lived all alone. Grandma Sarah was in her 90’s, and her son

wasn’t very kind to her. He never arranged the type of care she needed, and she lived a very isolated life in her golden years. On the weekends, my grandma Wilma would prepare meals for my brother and me to bring over to grandma Sarah while we visited. I loved drawing her pictures and hearing her stories, and I know she loved the company. Grandma Sarah opened my eyes and my heart to a difficult reality that can happen to anyone at some point as we age. I didn’t understand her circumstances thoroughly, but I felt deep comion for her and wondered about other elderly people in similar situations. Fast forward to my post-high school years, I attended the University of Miami and graduated with a degree in Sociology. I knew with the tools from that kind of an education; I would be able to make the greatest impact on the world around me. I believe that growing up with my grandparents and their elderly friends close by shaped me because every class I took in college would somehow relate in my mind to the elderly. After graduating, I decided to learn as much as I could about the different kinds of care homes offered to those in need. I was most drawn to the idea of assisted living facilities, so I focused on everything assisted living had to offer and learned their guidelines/regulations. I took the time to attend seminars, courses, and training for assisted living facilities. It’s been said that you’ll do more for others than you will yourself, and I can see now more than ever how true this is. It was when I saw the immense need for better eldercare that this mission became bigger than me. I saw a need for aging care that included dignity and comion beyond my grandparents and Grandma Sarah, and a society that had yet to fulfill it truly. In this book, I share with you the questions I initially needed answers to, as well as the ones I added to my list as I learned more along the way. So, it's my hope that after reading you should have a comprehensive understanding of what to look for, what to look out for and the right questions to ask facility s when looking for a place for your elderly family . Time is the only thing on this planet that we can't get more of, so use this book as a resource to help collapse time frames from my education and experience to help you find the best care for your loved ones.

What is an ALF?

ALF: A senior living solution for those who are in need of some assistance with activities of daily living yet aim to live as independently as possible. Assisted living facilities are small communities designed to provide a place to live, personal care services and health care to elderly individuals in need of help with their activities of daily living. This kind of housing takes place in a more independent setting than typical nursing homes and a more structure and care than the Golden Girls way of living. A typical ALF is a non-medical home (medication is provided at the correct times in the exact doses but never forced) that offers twenty-four-hour monitoring of its residents while providing the resident with more freedom, dignity, individuality and privacy than a nursing home. ed nurses (RNs) and Licensed Practical Nurses (LPNs) are accessible and on call but not always in the facility. Currently, there are approximately 39,000 ALF’s in the U.S. and are considered home to nearly one million seniors. The average facility size has around 54 units (although this varies from small residential homes to large scale buildings). The most common form of assistance needed is meal preparation (around 87%), then medication management (around 81%), bathing (around 64%), dressing and toileting (though the list doesn’t end here). The average age of an ALF client is around 86 years old and their general length of stay is around 2 years (though this can vary). At the moment, there is no federal standard for assisted living facilities, so every state defines an assisted living facility in their way. You'll find that some federal rules affect assisted living facilities, but the majority of governing happens at the state level. Most states are moving towards defining their facilities as ALF's, but others go by different names like personal care homes or residential care facilities. Assisted living facilities are intended to provide a wholesome and protected environment for elderly residents and offer several levels of caregiving. Certain ALF's specialize in fostering a comionate and secure setting for elderly individuals who are mainly independent but require minor reoccurring help with medication management or activities of daily living. Other assisted living facilities have established their services for the frail seniors who require a high level of care every day. Nursing homes are being replaced more frequently by this kind of facilities because they offer a lot (although not all) of the same care services as a nursing home with skilled nurses. According to Genworth Financial (major long-term care insurance source) the typical

resident living in a private room in an ALF home is paying over $3,500 a month to $8,000 a month or more. It's important to know which kind of senior care facility caters to your loved one's taste so that they will be most comfortable.

How does assisted living relate to you?

As of today, the oldest baby boomers are already in their sixties. Come the year 2030, almost one in five Americans will be older than sixty-five, and experts have claimed that the aging population will place a burden on collective welfare structures. For decades, the retirement of the baby boom generation has been a looming economic threat. Now, it’s no longer looming because it’s here. Every month, more than a quarter-million Americans turn 65. This increase in people is a trend with overwhelming economic consequences. Quite simply, pensioners just don’t contribute as much to the economy as workers do because they don’t directly produce anything. This lack of production from the boomers also means that they don’t spend as much, and they’re much more likely to depend on others like the government or their children, most often than to themselves. The issue of aging is a rather new phenomenon. In 1935, President Roosevelt authorized the Social Security Act into regulation. At the time, 65 years was seen as old age. Nowadays, 65 is the new 45, at least that’s what most baby boomers would like to think. In the U.S. many resent growing old and the absence of their freedom more than they’re scared of dying. With developments in medicine and technology, the new old for your offspring could be 90 or even 120. Essentially, growing old is a new and increasing chance and challenge. In 2012, the American government confessed that the Social Security would be bankrupt by 2033. How old will you and your kid be in 2033? A lot of baby boomers will just begin entering their 80’s. The question to ask is, how will governments afford to keep an elderly population housed, fed, and provided with suitable medical care? The Social Security istration reported in 2012 that 10.8 million Americans we’re currently obtaining disability reimbursements. To give you some perspective, that’s a 53% rise over the last ten years. More than 5 million people have applied for disability compensation since the economic disaster started in 2007. When unemployment increases, more individuals gather disability. What will happen if the economy stays level for the next two decades, as many foresee? Today, most governments are going broke; incapable of funding the promised pensions of their municipal workers. The state of California's pension organization is a complete mess. How will government provide for the future of the elderly (the future being not that far away)? This big elephant in the room will be yours and your child's problem.

IMPORTANCE OF BABY BOOMERS 76 Million Americans are Baby Boomers

Aging Parents and the Sandwich Generation

For as long as I can , the American Dream was to have a house to call your own. Accommodations today have become multi-generational, placing many generations under one roof. This is the reason why so many industrialists are creating homes with many distinct dwell spaces under one roof. Currently, many American families have something called, “boomerang kids”-offspring who leave home and go to college or university, only to come back jobless and incapable of living in the real world on their own. Due to a weak economy, research shows that current American society has had considerable rise of young post-college kids who return home to live with their parents of continue living with their parents through out college. Furthermore, most adults have aging parents who rely on them for help. The “sandwich generation” is an extension of the “boomerang kids” phenomena. It refers to the family caregiver sandwiched between their elderly parents and children-both in need of assistance. This could reference someone with young kids or adult children, depending on their age. Presently, the classic American Sandwich Generation Caregiver is employed, married, in their forties, and tends to their family and aging parent (most commonly their mother). Having said this, we must give credit to the rise in male caregivers sandwiched between generations. My dad is one of these incredible caregivers, as he is caring for my 4 year old brother and his elderly, widowed mother (my grandma). It’s a real challenge dividing time between children/family and your senior parent. In America, continuing and assisted living care can begin as high as $8,000 a month, which is beyond what most people make in a month. Will your kids move back in, or will you relocate to be with them and their kids? Will your child be able to pay for your long-term health care if you’re fortunate to live an extended life? The most costly challenge in the distance isn’t Social Security or even generational housing. The main problem hiding silently in the room is Medicare. Medicare was established in 1965 and to date is an unfunded burden projected at over $100- trillion that is more money than all the money in the world. You and your children will struggle with the $100-trillion elephant, one way or another. President George W. Bush made the most costly societal challenge in recent years, and the biggest Medicare burden when he authorized Medicare Part D. President Barack Obama’s Obama care sets the stage for another massive problem that your child will pay for, one way or another. I believe Obama care is more problematic than

Medicare. Today, the first wave of approximately 80 million U.S. baby boomers has begun to collect on Social Security and Medicare. Keeping the math simple, if 80 million baby boomers collect $1,000 a month from the government, that is $80 billion each month in taxpayer money- yours and your child’s taxes. Baby boomers will live longer than their parents and demand expensive medical care to stay alive, as long as someone (your child and their peers) is willing to fund their golden years.

Why is Assisted Living so Important?

If you’ve ever turned on the news, you’ve heard the frightening senior care stories. We are constantly blasted with media messages telling us about the horrors of nursing homes, abuse, isolation, depression, elderly outliving their resources, and the list goes on. These messages have resulted in people being fearful for the wellbeing of their aging loved ones when they are not with them. What you’ll come to realize after reading this book is that there is a better way to live and care for your elderly family member. As you learned in the previous pages, Assisted living is a form of long-term care best described as the halfway point between independent living and a nursing home. These kind of facilities are especially important right now, because we are moving into a time where there will be more senior citizens needing care than ever before. I’m sure you’ve heard about the wave of baby boomers, but for those who haven’t- there are 10,000 seniors turning 65 every single day in this country and 4,000 turning 85. Many of them will need to find quality care and assisted living is going to be a major solution. Close to nine months post-World War II having finished, “the cry of the baby was heard across the land,” as historian Landon Jones later explained the movement. A higher number of babies were born in the year 1946 than ever before (3.4 million-20 percent more than in 1945). This increase marked the commencement of the so-called “baby boom.” In 1947, an additional 3.8 million babies were born; 3.9 million were born in 1952, and more than four million were born each year from 1954 until 1964 when the boom ultimately slowed down. At this point, there were 76.4 million people born that fall into the “baby boomers” category in the United States alone. This group has made up almost forty percent of the country's population. Approximately a quarter of Americans were born between 1946 and 1964, the typical definition of the baby boom generation (meaning more than 75 million people). In their younger years, the baby boomers were an extraordinary economic energy, increasing the amount of homeowners, spending, and most essential of all, employment. It’s no accident that the United States workforce involvement rate (the portion of the grown-up population that is employed or is looking) hit a record high in the late 1990’s when the baby boomers were at the summit of their salaried lives.

Questions and Answers:

1. Do Assisted Living Facilities need to have a license or can any residential home with caregivers tend to my loved one?

Every ALF across the spectrum of housing (including residential homes) is required to have a valid license before services may be provided by authorizing statutes and agency rules. It should be comforting to know that assisted living communities are regulated by very strict licensing requirements and guidelines to operate and offer services. Furthermore, every facility needs to have a zoning permit from their local department before accepting residents. Applying for a zoning permit is no walk in the park; as it requires extensive business plans, property blue prints, financials and more just in order to get approval. While there may be general federal guidelines regarding caring for seniors in a facility, licensing is determined by each state. States license ALF’s through their Department of Health or Health Services and are licensed as "residential care facilities" (RCF). By law, all facilities are required to hold an up to date license including the total number of beds or capacity requested, the name of the person supervising the provider will run and the name of the . A license must show the name of the licensee, the type of provider or service that the licensee is authorized to operate, and the date licensed locations. The license for each facility is renewed biennially (every 2 years), and facilities are inspected at random by the governing body to ensure resident safety. Some of the additional licensure requirements for ALF's include the proof of financial ability to run. If the person looking to open a facility holds assets, credit, and projected revenues meet or exceed anticipated expenses, and the applicant shows independent proof that the funds needed for beginning costs, operating capital, and contingency financing exist and will be accessible as needed, the applicant has confirmed financial ability to operate. Anyone looking to open a facility needs to create an ALF specified version of a business plan. The licensee needs to present projected financial statements including a balance sheet, income and expense statement of cash flows for the first two years of operation. A licensee must maintain proper authority for the operation of the provider at the address of record. If such authority is rejected, withdrawn, or terminated by the local zoning or code enforcement authority, the agency may reject or withdraw an application or license or enforce sanctions. All facilities (be it residential homes or large communities) must adhere to the above regulations to be in business and stay in business, so you should feel at ease knowing there is a high standard no

matter where you choose to relocate your loved one. Ask the facility about the ownership: is it privately owned, locally owned or part of a corporation? Be sure to inquire about the facility license and history before moving your loved one in, to make sure they are licensed and running their facility sufficiently; there's nothing worse than moving your family member into a home just to find out they have to relocate because they weren't following the authorizing statutes. Having said that, you can see that it takes a lot to open a facility after reading this section, so chances are most of them are safe, up to code and reliable.

2. What kind of care is provided with a standard license?

Not all care is created equal! There are three kinds of specialty licenses you’ll find in an ALF: extended congregate care (ECC), limited mental health (LMH) and limited nursing services (LNS). A facility using an ECC license can offer additional nursing services and total help with personal care. Seniors who are living in any of these special facilities typically have higher impairment levels than those in a standard home, which is why I’ll be focusing on the standard license. A standard license delivers assistance with self-istration of medications, examining the resident's vital signs, management of separate weekly pill organizers for residents who self-ister their medication and prepackaged enemas ordered by their physician. For hospice residents, any nursing service permitted under the facility's license and total help with the activities of daily living. Catheters must be self-maintained by the resident meaning no insertion or removal by the facility staff. Caregivers can help the residents with emptying their catheter bags. A licensed nurse contracted by the resident for their specific needs could assist with catheter care provided that the resident remains suitable for sustained residency. Each resident must be able to completely self-maintain the istration of oxygen, including identifying when oxygen is needed or not needed, fastening/removing face apparatus without , instigating/discontinuing the flow of oxygen with help in turning the dial if needed. A licensed nurse under contract with the resident can aid, provided the resident continues to meet the residence requirements. A resident with a stage two pressure sore can be itted and retained in a written plan of care supplied by a physician, providing the resident contracts directly with a licensed home health agency or nurse to offer the care and the circumstance is documented within 30 days. A resident with a stage 3 or 4 pressure sore cannot under any circumstances be itted or retained in an ALF. A resident who needs the assistance with the istration and regulation of portable oxygen, assistance with regular colostomy care, or assistance and supervising of the application of anti-embolism stocking (TED Hose) may be itted under certain circumstances. If the following criteria are met: the facility must have a nurse on staff or under contract, the nursing staff may not deliver the instruction to unlicensed people to perform these services. A CAN may apply anti-embolism stockings (TED hose) under the supervision of a nurse. An individual ed in and getting hospice services may be itted to an

ALF as long as the person meets resident ission standards. The Department of Health licensing division also investigates any complaints. All visits are unannounced. The criteria for licensing must be continually met, or the facility's license can be revoked. While licensing of assisted living communities is not as complex as memory care facilities, strict guidelines provide peace of mind to residents.

3. What happens to the property and personal affairs of my loved one when moving into an ALF?

Residents are given the option of using their possessions as space in the facility permits. If they prefer to share a room with someone, they're allowed to choose their roommate. Unless the resident is decided incapacitated under state law, they can manage their affairs. The resident won't ask the facility, (owner, , employees, or representatives) to manage, use or get rid of any property of the resident. ission won't confer on any people or any author or responsibility for personal matters of the resident, except concerns that relate to the safe management of the facility or the safety of the resident. A facility, owner, , employee or representative thereof, may not act as guardian, trustee, or conservator for any resident of the ALF or any of such resident's property. An owner, , or staff member or representative thereof may not act as a payee for social security or other benefits without the permission of the resident. Any facility whose owner, , the staff serves as representative payee for a resident must file a surety bond in an amount equal to two times the standard monthly income or personal funds due to residents with the agency. Any facility granted power of attorney for any resident of the facility must file a surety bond within a total equal to two times the usual once-a-month combined income or private funds due to residents, or disposable for their , which are received by a facility. Upon mutual consent of the resident, the facility will provide the protection in the facility of personal effects not in a surplus of $500 and funds of the resident not in a surplus of $200 cash, and must keep comprehensive, and exact s of all funds and individual items received. If your loved one is absent from a facility for 24 hours or more, the facility may provide for the security of the resident's personal effects more than $500. In the event of a death, a licensee must repay all refunds, funds, and property kept in trust to the resident's personal representative if one has been assigned. If not, the resident's spouse or next of kin named in a beneficiary title form supplied by the facility to the resident.

4. How does a facility decide on the suitability of placement and continued residency?

The first thing to note is that each resident must be free from any signs of transmissible illnesses that are likely to be ed on to other residents or facility staff. However, an individual who is HIV positive may be itted to a facility, provided that they would otherwise be suitable for ittance according to this rule. Activities of daily living must be completed with the supervision or assistance if necessary for all residents in an ALF. They must also be able to transfer (with help if needed) and the of more than one caregiver is acceptable.

Residents must be able to take medication by self-istration, help with selfistration, or by supervision of medication. To explain a bit further, if the resident needs help with self-istration, the facility caregiver must notify the resident of the specialized requirements of facility staff who will be offering this assistance. If unlicensed staff will be delivering help with self-istration of their medication, the facility needs to obtain printed informed consensus from the resident or the resident's surrogate, guardian or attorney. The facility may it the resident who necessitates the istration of medication if the facility has a nurse to offer this amenity, or the resident or resident's legal representative contracts with a qualified third party to deliver this service to the resident. If the preferred facility can't deliver the unique nutritional requirements of the resident, they will not be deemed appropriate for placement. They may also not be of danger to themselves or others and a physician, or mental health doctor determines this. They also can't oblige 24-hour licensed professional mental health treatment, residents can't be bedridden, and they cannot have any stage 3-4 pressure sores on their body. A resident needing care of a stage 2 pressure sore may be accepted, providing that such person either lives in a standard licensed facility and contracts with a licensed home health agency or nurse to deliver care or lives in a facility with a limited nursing services license. The condition must be documented in the resident's record and ittance and release the record, and if the resident’s condition neglects to recover within a 30day timeframe, the resident must be discharged from the facility. Each facility

will do an evaluation of strengths, requirements, and preferences of the individual and the medical examination report. The facility's ittance policy and the services the ALF is equipped to offer or provide to meet resident's wishes. Such services may not exceed the extent of the facility's license and arbitrary checks will be done to ensure sufficient care of the residents at facilities of all sizes.

5. What are the resident care standards of an ALF?

An assisted living facility needs to provide care and assistance suitable to the needs of residents accepted for ittance to the ALF. Facilities must offer individual supervision as appropriate for each resident, including monitoring of the amount and quality of residents diets, day-to-day observation by selected staff of the activities of the resident while on premises and mindfulness of the overall health, security, and physical and emotional well being of the resident. ALF's must uphold wide-ranging awareness of the resident's location. The resident may travel independently in the community. Reaching out to the resident's health care source and another suitable party such as the resident's family, guardian, and health care alternate or case director if the resident is discharged or moves out. They must preserve a printed record revised, as needed, of any noteworthy changes, any illnesses that ensued in medical attention, changes in the process of medication istration, or other variations that resulted in the delivery of added services. Residents will always be encouraged to partake in community, leisure, educational, and additional activities inside the ALF and the community. The facility must offer a continuing activities agenda with varied individual and collective activities in keeping with each resident's needs, capacities, and ions. The facility must discuss with the residents when choosing, organizing, and scheduling activities and must display resident's involvement through one or more gatherings, committees, resident counsel assembly, idea box, group conversations, surveys or any other method of interaction. To enable resident access to health care as desired, the facility will help residents in making appointments and remind residents about planned appointments for medical, dental, or nursing services. They will also offer transport to required medical, dental nursing or mental health services or coordinate for transport via family, friends, volunteers, taxis, public buses, and organizations offering transportation. It is important to note that facilities may not require residents to receive services from a specific health provider.

6. Where do they store my loved one's medications?

Failure to keep track of medication is one of the main motives for your loved one to move into an ALF. The agreement will most likely require the facility to medication assistance. It’s always smart to dig a little deeper and get answers to your detailed questions. To accommodate the requirements and requests of residents and to inspire residents to remain as autonomous as possible, they can have their medications (both prescription and over the counter) in their custody both on and off the facility grounds. At least fifty percent of seniors in any specific ALF require assistance with managing their medicine. The way in which the facility accomplishes this is critical. Caregivers are allowed in resident rooms, but they must be kept locked when residents are away, except if medication is in a safe place within the room. However, both prescription and over the counter medications for residents needs to be centrally stored if the facility manages the medication or the resident asks for central storage. If the medication is determined and documented by the health care supplier to be dangerous when kept in control of the person for whom it is prescribed or if the resident fails to uphold the medication in a secure way it must also be centrally stored. In specific situations, the facility might only need central storage of medication, and that policy will have been offered to the resident before ittance. Centrally stored medications need to be retained in a secure cabinet or room all the time, situated in an area free of humidity and irregular temperature except medication needing refrigeration. Refrigerated medications will also need to be kept in a locked container in the fridge. Medication needs to be available to staff liable for filling pill-organizers, assisting with selfistration, or istering medication. Such staff must have access to keys or codes to the medication storage areas all the time. A stock reserve of over the counter products for numerous resident uses isn't permissible in any ALF. Over the counter merchandise including those prescribed by a health care provider must be marked with the resident's name and the company's description with instructions for usage. In many of the smaller facilities, you’ll find a central place where medications are kept and organized for delivery to residents. The mode of circulation will fluctuate from place to place. It should be the your loved one’s right to hold and ister their prescription and over the counter medications (so long as they’re is capable). Certain ALF’s challenge this notion and ask that all medications be given to the staff or caregivers. For the qualified

residents, this can be humiliating. This system can lead to damaging effects because, in certain cases, residents might not feel good asking for the “take as needed” medications (i.e.: antacids, gas relief, etc.) This fear can lead to some folks going without instead of needing to reveal their need to a caregiver. As you can see, there isn’t a seamless method of medication distribution to all residents on a steady basis. A lot of facilities will favor prepackaged medications, where all of your loved one’s medicine is packed together for a specific dose and time. The morning medications would be bundled together, all of the afternoon medications together, and so on. This arrangement is very convenient for the ALF, and it appears to decrease some of the medication blunders. Nevertheless, in some situations it can cost two times the normal price of an elder’s medication. Beware of “favored pharmacy” challenges if your loved one subscribes to Medicare HMO or other insurance that entails the use of selected pharmacies.

7. What does "assistance with self-istration of medication" mean?

Informed consent means guiding the resident or the resident's surrogate, guardian or attorney of the risk they could be taking. An ALF is not required to have a licensed nurse on staff for your loved one to be getting help with selfistration of their medication. Assistance provided by an unlicensed person may or may not be overseen by a licensed nurse. An “unlicensed person" refers to someone not presently licensed to practice medicine but are working for an assisted living facility with training on assisting with the self-istration of medication in an assisted living facility before providing such assistance as described above. Residents who are capable of self- istering their medications without help should always be encouraged to do so. Nevertheless, an unlicensed person may, consistent with a dispensed prescriptions description or the directions on the container of an over-the-counter medication, assist a resident whose condition is medically stable with the self-istration practice, habitually planned medications that are intended to be handled by your loved one on their own. If or when your loved one ever needs help with selfmedication, an unlicensed person can assist but only with a documented request by, and the written informed consent of, a resident or their guardian. Selfistered medications include a map and over-the-counter oral doses, topical, otic, and nasal dosage forms including solutions, suspensions, sprays, and inhalers. Assistance with self-istration of medication includes taking medication in its expertly dispensed, properly labeled container, from where it is being kept, and bringing it to the resident. In the presence of the resident, reading the label, opening the container, removing a prescribed amount of medication from the container and closing container. Placing a pill with the right dose in the resident's hand or another vessel and assisting the resident by lifting the container to proper storage. Keeping a record of when a resident receives assistance with self-istration. These rules do not include mixing, compounding, converting, or calculating medication doses, except for measuring a prescribed amount of liquid medication or breaking scored tablet or crushing a tablet as prescribed.

8. What are the staffing standards at an ALF?

Each ALF needs to be managed by an who is able for the operation and upkeep of the facility, and this includes the organization of staff and the provision of suitable care to all residents. s need to be at least 21 years of age or older, have at least a high school diploma or GED, be in compliance with a level 2 background check and have fulfilled the core training and core competency test. They must also satisfy the continuing education requirements, keeping up to date with latest rules and regulations. Within 30 days after starting work, newly hired staff needs to present a printed report from a health care provider showing that they do not have any signs or symptoms of communicable diseases. The exam completed by the health care provider needs to have been done no sooner than half a year before submission of the report. Newly hired staff doesn't include an employee transferring without a break in service from one ALF to another when the facility is under the same ownership. If any staff member is assumed of having the transmissible disease, they need to be instantly removed from responsibilities until a printed report is presented from a health care provider showing that the employee does not create a danger of spreading a transmissible disease. The staff member also needs to be competent to complete their assigned work consistent with their level of training and experience. Staff who are delivering services needing licensing or certification needs to be properly licensed or certified. All staff must follow through on their responsibilities to observe residents, document reflections and report the comments to the resident's health care provider. Level 2-background screening must be done for staff, and this includes people contracted by the ALF to offer services to residents. One staff member who has access to the facility and residents records in case of an emergency need to be in the facility all of the time when residents are in the ALF. Residents serving as paid or helper staff can't be left alone in charge of other residents while the facility , manager or another staff is away from the facility. Staff who have completed courses in first aid and R and holds a presently valid card ing completion of such courses need to be in the facility at all times. The good thing about being in this kind of facility is that you know the owner and have the resources and knowledge to do thorough screenings and background checks of every person they employ. This means that you don’t have to have the experience of screening and hiring people to provide care on your own for your

loved one. You also greatly reduce the risk of theft by moving them into this kind of facility compared to keeping them on their own. If you hire a caregiver to visit your loved one, they’re commonly unsupervised (when no agency involved) so it’s difficult to recover the property if you even realize it’s been taken. You also won’t need to report the caregiver’s income or withhold taxes for any employee you hire to care for your aging parent. According to the IRS, anyone who hires a private caregiver on a steady basis at home has an employee, rather than an independent contractor. Therefore, you, the employer, has to withhold taxes according to the law, payroll tax, and report the earnings of your caregiver. Additionally, you might also have to provide workers compensation insurance. Did you know that back injuries among caregivers are very common, and you could be held responsible for all medical costs? I suggest speaking with your local and state laws to decide if you need to purchase unemployment insurance, even for a part-time employee, who is working in the home. In an ALF, you will also get the peace of mind that a reliable caregiver brings. Elders often have trouble keeping track of things like medications. Filling their prescriptions, ing when to take them and knowing which ones are prescribed for them can be challenging. In the right assisted living facility, the staffing standards are exceptional, and knowing that your loved one is in good hands should help you breath easy.

9. What are some of the food service standards in place at an ALF?

When food is offered by the facility, the caregiver selected in writing by the must be able for total food services and the day-to-day supervision of food services staff. Also, if the designee is someone who has yet to complete an official assisted living facility core training course, they must also take the food and nutrition services component of the core-training course before taking charge of the facility's food service. The designee is not subject to the one-hour in-service teaching in safe food handling practices. If they are a certified food manager, certified dietary manager, ed or licensed dietician, ed dietetic specialist or department sanitarian, the designee is excused from the requirement to attend the nutrition services and food module of the core training course before assuming responsibility for the facility's food service. An or designee must offer consistent meals that meet the dietary requirements of residents, and therapeutic diets as ordered by the resident's health care provider for those who need particular diets. The meals offered by the ALF must be organized based on the up-to-date USDA Dietary Guidelines for Americans and the current summary of Dietary Reference Intakes established by the Food and Nutrition Board of the Institutes of Medicine of the National Academies. Therapeutic diets need to meet these dietetic criteria to the extent possible. The residents nutritional essentials must be met by proposing an assortment of food modified to the habits, partialities, and physical capacities of the residents and must be made using consistent recipes. For ALF's with a licensed capacity of 16 or fewer residents, consistent recipes are not mandatory. Unless a resident elects to eat less, the facility has to serve the normal minimum helpings of food according to the Dietary Reference Intakes. Every regular and therapeutic menu used by the facility needs to be revised yearly by a licensed or ed dietitian, nutritionist, or dietetic technician supervised by a licensed or ed dietician, or a licensed nutritionist to guarantee the meals meet the dietary standards. The yearly evaluation needs to be documented in the facility files and contain the primary autograph of the assessor, registration or license number and date reviewed. Helping sizes need to be shown on the menu or an individual page. Food on the menu can be replaced with something of similar nutritional value based on the availability of fresh harvest or the favorites of the residents. Each menu must be dated and organized at least seven days in advance for regular and therapeutic diets. Residents need to be encouraged to contribute

to meal preparation. Organized menus need to be noticeably displayed or easily accessible to residents. Regular and therapeutic menus as served, with replacements, noted prior or when the food is served, need to be held on file in the facility for half a year. The caregivers need to record when a resident refuses to comply with a therapeutic diet and give notice to the resident's health care provider. Food needs to be served nicely at harmless and appetizing temperatures. Residents must be encouraged by caregivers to eat at in social settings in the dining table area. A three-day reserve of non-perishable food (based on the number of weekly meals the ALF has decided in advance with residents to serve) needs to be on hand all the time. The amount needs to be based on the resident census and not on authorized capacity. The amount needs to consist of food that can be stored safely without cooling. Water adequate for consumption and food preparation needs also to be stowed, or the facility needs to have a strategy for getting water in an emergency, with the proposal synchronized with and evaluated by the local disaster preparedness authority.

10. What should we expect to see in a resident contract?

The assisted living facility needs to offer an agreement for implementation by the resident or the resident's legal representative before or at the time of ittance. The agreement must also to have a list of detailed services, materials, and accommodations to be offered by the ALF to the resident. The agreement will also contain the daily, weekly and monthly rate, a list of all supplementary services and charges to be offered that aren't built-in to the rates or a reference to an individual payment schedule that needs to be attached to the agreement. You should also expect to find a provision affirming that at a minimum, 30 days printed notice would be given before any rate increase. A printed bed hold policy and requirements for ending a bed hold arrangement if a facility approves in writing to spare a bed for a resident who has been itted to a nursing home, health care facility, or psychiatric facility. The resident/responsible party needs to inform the facility in writing of any modification in status that would inhibit the resident from coming back to the facility. Until written notice is received, the arranged daily, weekly, or monthly amount can be charged by the facility, unless residents medical situation inhibits them from giving written notice, such as when a resident is comatose, and they don't have an able person to act on their behalf.

11. What security features will you find at a typical assisted living community?

Security and safety are important for your confidence in the facility. In a residential ALF, you might find less privacy than in larger facilities. However, the upside to less privacy is often more safety. In a small home, caregivers are constantly close to the residents. They can always hear a resident from anywhere in the house if they’re loud enough. In this kind of facility, there are no lengthy, isolated walkways or elevators to deal with. Front doors are regularly locked, and outsiders can’t walk in the facility unnoticed like in some of the larger homes. If your loved one is reasonably independent, then nightly safety checks will feel invasive and annoying. On the other side, if your loved one is confused or requires guidance then regular checks throughout the evening will be an appreciated safety. Pull cords are a security system that some ALF’s have connected in resident rooms. When someone pulls the cord, an alarm goes off to alert caregivers of a likely emergency. The rooms have this cord connected in the bathroom and near resident beds. Facilities have also been known to use personal response alarms. A resident wears this kind of safety alarm around their neck or as a bracelet in case of a fall. When needed, the senior pushes a button on the alarm. The upside to this is that it can be worn in the shower, and phone or beeper directly s the chosen response caregiver. The way in which your loved ones are checked on can differ widely. When residents decide to move into an ALF and their family come to see them, they should assume a cozy environment, free from concern about upholding a home, and caring for those activities that have become more challenging to do. One of the essential features of an assisted living community is the safety features afforded. Some facilities have a system connected to the door of their room. When the door is open, an unobtrusive message is sent to the main office computer. If the trigger isn’t used for a specific time in the day, a caregiver will check on the resident. Many facilities use mealtime as a checkpoint. If a resident neglects to show up for breakfast, their room is ed or visited by a caregiver. The security considerations ALF's prioritize are safeguarding entry and exit areas to the public and preserving residents' rooms along with their private possessions from thievery. These precautions are delivered via 24-hour security personnel and usually include video surveillance of the facility. Entrances and locks on residents' rooms are intended to offer freedom while still being in a protected and potentially monitored atmosphere. They are also easy to

operate, which is explicitly critical for those suffering from arthritis or other physical restrictions. Emergency methods and precautions are part of an ALF's global safety and security program. Residents' spaces are furnished with 24-hour emergency call systems and smoke alarms. Facilities are required by their licensing and procedural standards to have very precise emergency/fire/safety proposal and to make them accessible to residents and family for assessment. The ALF's staff is instructed to be attentive to residents' security and safety requests, responding and managing emergencies if they happen. If a facility is licensed (and it should be), then it needs to provide the local fire department with their emergency evacuation plan in the event of a fire or storm. Furthermore, fire drills are regularly held by each facility to ensure the safety of all residents. Be sure to inquire about the facility’s exit strategy in the case of an emergency and how often drills are performed.

12. How do you talk to a family member about the need for assisted living?

Caregiving works best when the weight is distributed. Siblings, cousins, coworkers, neighbors, and friends-everyone can offer their help no matter how big or small. Don’t be scared to ask a family member whose agenda appears full because the fact is that we’re all busy. Those folks who wish to make time will, and those who don’t want to won’t. You’ll never know until you ask. Studies have shown that people who reach out for help from others tend to be happier and in better health than those who demand to manage things themselves. If possible, the greatest method is to introduce the topic progressively over a period of several weeks or months. In order to communicate effectively, we have to realize that the way we see the world is different from everyone else. We should use our understanding as a guide to even better communication with others. Express yourself in a relaxed, low-key manner without being excessively persistent, offering assisted living as a possibility for making life less taxing and more pleasant for your loved one while at the same time diminishing concerns about home upkeep or responsibilities. If declining health or concerns over their security have precipitated the necessity for assisted living, share your worries in a wholehearted and loving manner. Tell them that assisted living will help guarantee his or her security since there are caregivers there to supervise their health, ensure that they are using their medication correctly, and help them in a case of emergency. Recognize your family member's thoughts about how difficult it will be to move from a house with so many cherished memories, but emphasize that your main priority is their health and wellbeing. If they still say no to this kind of care, this could simply mean that they haven't had all of their questions or concerns addressed yet. Confusion typically leads to a "no"; it's an instinctive protective device of the human psyche. You could also suggest doing some exploration to educate your loved one and yourself about the benefits and features of various ALF's in your area. Show your loved one the websites of some of the facilities that you feel may be best for them. Advise taking a tour of some of the most pleasing places so that your loved one can personally see what exact ALF's have to offer. Timing is another reason they might object to assisted living. Saying no upfront could be their way of slowing down the process. They might say no, but it could simply mean "not right now". Good timing is critical so be sure to talk about options in timing, and you could uncover a time frame that works for your loved one (even if it isn't for today). As a relative of a close

friend of your aging loved one, you are the one who can ultimately determine what their concerns might be and how to overcome them. Do this by keeping the conversation alive through the use of precise questions from a place of love.

13. Who do you talk to when you can't persuade a loved one to move into assisted living?

Bringing up the idea of an assisted living facility with your loved one is hardly easy or enjoyable. Select a meeting place where you will have confidentiality and no disruptions. Aim to find a place where the care receiver feels at ease and relaxed, like their home or yours. Sidestep daunting places like a physician’s office, and don’t raise the subject in an open place like a restaurant. You might not have a lot of flexibility for when you should have this conversation, especially if the problems are pressing. If you are having a challenging time speaking one on one, consider the presence of a third party who can show an impartial but empathetic view may be advantageous to the conversation. As you organize this meeting, be mindful of your loved one’s agenda. Avoid setting a time that clashes with their activities (example: their favorite TV show); if you do they could be late or resent the entire conversation. If the family isn’t cutting it, you may want to refer to your loved one's health care provider. With complete access to your loved one's medical records, the doctor can act as a dependable voice in making the case that it is no longer secure or sensible for your loved one to remain living at home. Other possible ers in emphasizing the need for assisted living may include an esteemed clergy member or spiritual guide, a close comrade or relative whom your family member respects and trusts, and perhaps someone within your circle of family or friends who can speak personally about their experience with assisted living. You may also want to the or counselor at a local ALF. Even after all this, there’s a chance your loved one will still feel scared and upset. that most people think of this kind of care as a horrible thing. Some of the most common objections you’ll hear along the way include “I don’t need help, I was just having a bad day.” Let your loved one know that your worries didn’t start from one occasion but from a continued repetition of conduct. Use precise instances to demonstrate your fears. At some point, they might start to use guilt in their plea saying things like “you would never do this if your dad were still alive.” This one is especially tough to handle because it knocks you directly in the heart. Look beneath what your loved one is trying to express. Their words imply that you’re taking advantage of a feeble senior. Clarify that you’re not trying to get away with anything; that you only want them to have the greatest imaginable care. Bonus: point out that they’re hardly feeble. The fact that they’re arguing

with you over this is confirmation of their feistiness. No matter what is thrown your way during this conversation, don’t give into the care receiver’s objections although always come from a place of love and understanding. It’s been my experience that objections come from an inaccurate understanding of what assisted living is really like. Look for a facility that is well matched to your loved one's necessities and don't be shy ask for guidance. The best-case scenario would be for you to influence your loved one to see it with the mindset that it's simply for educational reasons. When you're there, your loved one might get the opportunity to speak with the caregivers and current residents, take a tour, and see that ALF's are not something to fear. Do your best to focus 5% of your time addressing the challenge with your loved one, and the other 95% on the solution. If your loved one is still unwilling and you're worried about their wellbeing, it may be sensible to reach out to a senior law attorney who can give you options like guardianship for safeguarding your family member. Sometimes, notwithstanding your finest efforts, your loved one stands their ground and repudiates the consideration of assisted living. This can be extremely wearisome, but if they’re in danger, you should proceed with finding an ALF despite their protests. In this case, know that you’re doing the right thing, but beware that some disputes are prone to happening. The family’s greatest protection is to stay unified, ing one another in their choice. All across the America, there are expert emergency intermediation services (commonly called Geriatric Assessment Teams or Geriatric Evaluation Services) for elderly people who are contesting urgently required care.

14. What do you do when a family disagrees over the necessity for assisted living? What if parents are divided and what if siblings are divided?

One of the main challenges I’ve seen is the impractical expectation that a sibling who’s been irresponsible in the past will suddenly step up because their parents need them to. I’ve noticed that reliable family continue to be reliable when caring for aging loved one is needed, and unreliable siblings tend to continue to be unreliable. Taking care of aging loved ones can lead to big challenges for their family , particularly when they experience a decline in their health. This is exceptionally tough on the main caregiver of the family. When people have different views on the need for assisting living for their loved one, it can divide a family who was once close. This transition can bring out the best and the worst in everyone, depending on how it’s handled. Think about what happens as a minor concern for their health progresses into a regular responsibility. Families seldom expect the need for long-term care, which means they could have idealistic expectations regarding the amount of help that will be needed long term. The unrealistic beliefs can lead to anger toward your family who aren’t pulling their weight. A lot of the time, a spouse might not want their significant other to be away from home. Added to the pressure of the caregiving family member is the issue that people living farther away from their aging parent will usually have differing perceptions from their siblings who live nearby, meaning they see more of the progression first hand. This kind of barrier lies at the heart of many disagreements, which commonly stem from a sense of guilt of their parent’s isolation. Relatives can also get into intense arguments about a parent relocating to an ALF. Those who are in of assisted living could be the ones who are there most in caring for their mom or dad. Having spent substantial time in preserving their parent's home and their wellbeing, they have seen the decline of their parent's health and mental capability more than the siblings who aren't around as much and perhaps living further away. For those resistant to assisted living, they may not recognize the degree to which their parent needs assistance. They might not want to lose the family residence, or they may feel guilt that they are relocating their loved one against their requests or the requests of their other parent. The initial step in solving such a disagreement is to have a family get-together where each person shares his or her perception. With everyone's worries exposed, it could be feasible to come to a solution that brings everyone back together. If you're in the position where you

see the value in assisted living, and you're working to get your family onboard you can use these tools at your meeting. It's important to begin with praise and honest appreciation; perhaps try thanking them for taking the time out of their busy lives to be here. Be sure to ask plenty of questions instead of giving direct order orders. If it arises, call attention to their mistakes indirectly and follow up by talking about your mistakes before criticizing them. When you ask questions, you're able to guide the conversation smoothly while getting a tour of their objections, which can be addressed, later on in the conversation. It could be beneficial during this time to give your opposing relative a good reputation for them to live up to by reminding them of a time when they took a chance on something similar, and it worked out well because of a good characteristic they have. Use encouragement and make the fault seem easy to correct (they'll be more receptive to change this way). Finally, do what you can to make the other person happy about relocating the loved one and let them feel that the idea was theirs. The overworked caregiver of the family member could be relieved of some obligations by their brothers or sisters deciding to contribute more. A better understanding of a spouse's or parent's wellbeing, including an acknowledgment of the possible risk the loved one may be to him or herself, can assist the family to reach an agreement on the necessity of assisted living care. Having the family member's health care provider weigh in with their point of view as an unbiased third party could also lead to consensus. Sometimes misinterpretations of what assisted living involves is producing the dispute. In that case, proposing the family take a tour of an ALF could shift their perspective to how their family member can be better cared for in such a place. Furthermore, a care consultant or a senior care leader can offer advantageous arbitration and advice. They are skilled with such trials and recognize the subtleties and can advise suitable solutions.

15. What are the obligations of a facility if a resident is injured onsite?

Assisted living facilities are advised to have suitable safety and security measures in place to avert injuries from happening. These measures should involve correctly fastened floor covers to avoid falls, marking bottom steps with illumination or colored tape or using proper lighting. They should have handrails where needed (in bathrooms and hallways), using a non-skid coating on slanting areas, offering security locks on doors/windows, and using sufficient smoke detectors, sprinklers, and fire extinguishers in case of fire. Also, if the ALF has a memory care unit, measures should be in place to keep residents with dementia from meandering and ensure those with violent inclinations are not hurtful to themselves and others. If an injury happens, the ALF caregiver or is obliged to offer basic first aid in the timeliest manner and out-ofresidence emergency medical services as required. The person in charge should quickly inform the closest family member or responsible person chosen by the resident. States usually want a report to be filed in writing to the licensing agency for any out-of-residence emergency medical services or hospitalization. If a resident feels the facility's carelessness contributed to their injury, the family may want to see an attorney for legal guidance.

16. Are residents able to move out of an assisted living facility if they don't like it?

Prospective residents should speak with the assisted living facility regarding your decision before their move in. Make sure you read the resident contract with diligence before g. In most cases, there should be a clause that spells out the circumstances under which the resident or the ALF can terminate the arrangement. A standard contract will allow the tenant to end the agreement when they want to (with or without cause) by giving thirty days notification to the facility. If the resident is completing the deal because they require a greater level of care offered at another facility, the contract can be dismissed instantly upon the resident leaving the ALF and taking all of their personal possessions. Numerous tours of the facility before moving in can provide the prospective resident and family to make an educated choice and confirm if the ALF is the best fit, so the need to move in and out of facility doesn't happen. Some ALF's will allow you to move in on a trial basis so be sure to inquire about that when doing your research. Many places offer interval care as a short-term placement for people who might need time to recover from a short illness. Elderly can use this brief stay to decide if they enjoy the atmosphere, caregivers, activities, services, and food of their impending assisted living facility.

17. Before moving into an ALF, does my loved one need clearance from their physician?

Most folks move into an assisted living facility because of health or activity restrictions that make living in other kinds of settings difficult. While assisted living isn’t seen as a medical facility, medical aids linked to long-lasting conditions (mental and physical), play a vital part in everyday life in these homes. Most seniors living in them use walkers or wheelchairs, might use oxygen, and others need regular supervising of their conditions. While I visited facilities, I saw residents experience sickness and grievances requiring hospitalization and rehab. I heard about complex prolonged conditions such as congestive heart failure, Parkinson’s, diabetes, and Alzheimer’s disease and observed a few residents with terminal conditions receiving hospice care (including my grandfather). In residential ALF’s, a lot of the elders spent their daytime in the living room or dining room. Caregivers could easily keep an eye on residents as they made meals, cleaned, filled out paperwork, and fulfilled many of other chores by keeping them in open view. Medications were managed, diapers were checked, and vital signs were observed as needed during the day, often in the living room. Assisted living is intended to provide with activities of daily living such as bathing, toileting, cleaning, cooking and so on, as opposed to progressive medical or nursing care. It is because of this that it's crucial for these facilities to evaluate a potential resident's health status to confirm that they can accommodate them with the proper assistances. If your loved one is in need of more skilled care, the assisted living facility might refuse the application and propose other options. Most assisted living facilities to need a doctor's report to be finalized as part of the application procedure. On-staff medical professional might also be asked to complete a physical exam on the future resident. These procedures are handled with the resident's best interest at heart, and also to safeguard the liability of the ALF. Given the measures that spark the move to an ALF, the choice to relocate usually includes from experts such as doctors, social workers, recommendation agencies, or lawyers. Doctors are often seen as the expert in deciding if an elder, in the middle of an emergency, is unable to return home. Occasionally the doctor of your loved one verifies your suspicions, but their influential view often seals the conclusion. As a person who is looking for the seamless solution for your elderly loved one's care, you will feel more at ease having a physician perform an exam so that you

know your loved one will be in a place that suits their needs. Routine health checks will establish when those care needs vary over time so that you and your family can reevaluate your loved one's living arrangement.

18. What is commonly required to move a loved one from their existing residence to an ALF closer to their family?

With all big life choices, assisting your loved one relocate from an assisted living facility to a new one that's closer to you and the remainder of the family should take vigilant preparation. The most imperative part of this process includes understanding if the elder is ive of the move to begin with. Think about how happy and established they are, and ask yourself if having them start over in a new ALF will be an enhancement or a challenge. Supposing the resident is content making a new beginning, you will want to explore the new facility just as you did for the first time around. You will find the process varies depending on the type of assisted living you’re looking for. The best place to start is by calling to make an appointment at a community near either where you or your loved one lives. It is preferred that you make an appointment so you will be directed to the marketing or sales person. At residential facilities, you will commonly speak with the and sometimes the facility owner, which is a bonus. If you secret shop (as some may suggest you do) you run the risk of wasting time, as the person you need to talk to may not be available. You will then need to make a second visit, which is scheduled. After the tour with the sales person or /owner, go back if you wish and see how the services and appearance differs. If the change is drastic, keep looking but if you notice consistency that’s always a good sign. It's possible to explain to the s the circumstances and the level of the care plan that is working for your loved one currently so that you can decide if the equivalent level of services is offered. At this point, it's simply a matter of completing the paperwork and other pre-ittance procedures, which include the organization of medical transportation for far away moves. Typically, the case file can be transferred over to the new ALF so that you're not beginning from scratch. It's important to review the agreement from the primary assisted living facility to see what reimbursements (if any) your loved one is entitled to.

19. How do I relocate a loved one into an assisted living facility when I don't live nearby?

Caregiving from a far is a challenging situation. The difficulty in caregiving is one of the many reasons why a lot of families decide on assisted living to help their elderly loved one with the activities of daily living. Assisting them with the relocation will most definitely take time and energy, a lot of research, many phone calls, and eventually a trip or two to see the ALF's that are in the running. It also helps if there is a responsible family member or companion who lives nearby the elder who can drive them back and forth to visit the facilities and to any essential medical exams. The challenge is that many of us live further away from our elderly parents. Over the years family tends to disperse across states and move to different countries, so when the health of our loved one starts to decline, we can’t help but worry. I can relate to this because although I live in Miami, I’m Canadian and have family up in Canada. I have the tendency to think ahead, and I wonder how I’ll navigate these waters when the time comes to move my grandma. To help like-minded people, I’ve put together a few simple preparation ideas to assist your aging loved one from afar. First off, anticipate for your loved one’s potential need for assistance. Be sure to retain numbers for their friends and neighbors with you at all times and think about hiring a care to help you. A care manager is a service you will most likely need to pay for privately and the best way to find one is online. They are the eyes and ears close to your loved one and can make a world of difference in what happens to your parent and how they are taken care of. This kind of caregiver can visit your loved one when you’re unable to and report back to you to let you know how they are doing. They can also make doctors appointments and accompany them along the way. In the case of an emergency, a care manager can act as an advocate at the hospital or assisted living facility where they might not be able to speak up for themselves. This kind of care is great for long distance families but is more of a short-term option as the average cost is around $80 an hour. I think it’s wise to engage in discussions about your loved one’s capacity to pay for care and lastly, talk about end-of-life desires so you can honor them when the time comes. Having said this, I think we can all agree that one of the major concerns at the moment is their safety. When you decide on the facility, and they're ready to relocate, the elder will need assistance with packing and determining which of their belongings can be left behind. The time leading up to the move could be a

great time to organize a trip, so you're there to help comfort the emotional change. Keep in mind; it's not only a physical encumbrance to move to a new home, but also your loved one might also be upset about leaving behind their home. When it comes to paperwork, technology has made life much easier as agreements, and other papers can be faxed or emailed so you can evaluate and assist with getting items finalized. As their children, we need to foresee that our aging loved ones will need assistance and plan ahead for when that time comes. Honest and straightforward talks might not be your loved one’s forte, so starting the discussion could be up to you. Prepare yourself for that call at midnight, or an abrupt incident when you’re too far to get there in time. Hold on to those local s on your phone. Consider finding a qualified care manager to help you if you are in s circumstance similar to mine where my elderly grandma is all the way up in Canada for half the year. You need to be able to someone who can be there quickly and tell you what’s going on. I hope this will help you be as organized for your loved one’s progression in health as you can be.

20. What’s the difference between a shared room and a private room?

According to the American Census Bureau, 11 million people aged 65 or older live alone. While living alone does not inevitably lead to social isolation, it is certainly a predisposing factor. A 2012 study from the Proceedings of the National Academy of Sciences showed that both isolation and loneliness are associated with increases the risk of mortality. It’s also been said that feelings of seclusion can negatively affect both physical and mental health. When it comes to assisted living, there are a few options for the kind of room for your loved one. Both “private” and “shared” rooms are pretty straightforward. A private room is one they have to themselves and a shared room is one they live in with another facility resident. There are benefits to either option, so I suggest talking it over with your loved one to see what they prefer as well as what their budget will allow. Private rooms are more expensive than shared, but it allows them a space of their own where they can do as they please. A shared room doesn’t allow for as much flexibility, with freedom but it can be an excellent option if you’re looking to spend a bit less money and keep your loved one social. Regardless of the kind of room they choose, just the fact that your loved one has decided to move into an ALF significantly reduces senior isolation and feelings of depression. If a private room is more their style, you can be sure they’ll still be surrounded by others when they want to be or at meal times. In smaller residential facilities, you’ll find the possibility of isolation significantly reduced because everyone gets to know everyone. In big facilities or small, you should know that residents are entitled to live in a secure and comionate living environment, free from abuse and neglect. They should always be treated with kindness and respect and with due recognition of dignity, independence and the need for solitude. They have the right to keep and use their clothes and other personal possessions in their immediate living quarters. Your loved one should always be free to private correspondence, not limited to sending and receiving unopened communications, access to a telephone and visiting with anyone they please. Residents have access to suitable health care consistent with established and recognized standards within the facility.

21. What are the standard activities presented for residents in an ALF?

The best part of assisted living is that residents have even more free time to enjoy their lives. Without being burdened by the challenges of housework, washing, and handling medications, residents can now take the time to relax with their friends instead of devoting most of their time to chores that are difficult to take care of on their own. Typically guided by an activities director and ed by staff, most assisted living facilities offer the chance to participate a book club, a gardening group, or take off on a theater outing or field trip. The smaller, more homelike facilities will offer most of the same activities but will be more tailored to your loved one's interests and ions. Regardless, all licensed facilities are obligated by law to offer 12 hours or more each week of a variety of activities. Religious/ spiritual services are also available. Most of the time s will inquire about your loved one's religion to make sure that they can provide the best services for them. Anticipate lots of smiling, laughing and enjoyment at the weekly poker, bridge, or card game. You’ll find knitting, crafts, computer classes and some facilities are now using simple video games to entertain residents. Most ALF's bring in presenters of interest for the residents, including history buffs, musicians, singers, and guest lecturers from local schools. The physical aspect of living a healthy life is a fundamental part of the assisted living experience. Caregivers inspire residents to participate in daily walks, visits to the fitness center (if applicable), in on yoga classes and continue to improve their bodies and minds. Most facilities understand that activities are a crucial part of a happy life for seniors. Be sure to ask up front what exactly your loved one’s facility offers.

22. How do I deal with a prejudiced loved one in a diverse assisted living facility?

If you see this as an opportunity for your family member to grow from a diverse group of people it can help to shape their experience to one, that's more positive. The population of seniors transitioning into assisted living might not have had as many opportunities to experience cultural diversity. They can be cynical, uncertain, and utterly unaware of how alike we all are even beyond racial and ethnic lines. Again, this presents an occasion to learn in an assisted care setting instead of remaining in isolation. Inspire your loved one to extend themselves to people they may see as different. Everybody is in an ALF because they require some extra help putting him or her all in the same boat. This viewpoint also serves well because your loved one isn't exactly going to have caregivers of the same ethnicity or race as themselves. Caregivers at an assisted living facility are there to help and enter this kind of work without a hidden agenda. Each person is specially trained and works for the improvement of each resident. Caregivers deserve the same respect and kindness your loved one most likely experienced when they were in the workforce. Personal beliefs aside, the actions of the family are often set the tone for how the elder responds to new racial groups so be kind and social with everybody.

23. How do ALF's manage resident disagreements?

As with any group living setting, it's feasible that disagreements could come up in an assisted living facility. Roommate arguments are usually the most common in assisted living, and can be some of the toughest to speak to. Conflicts regarding TV volume, restroom practices, visitor’s use of t space and the list goes on. Insert various ethnicities, beliefs, and cultures, and it’s a miracle any ALF roommates got along. Facility or social work employees usually ascribe roommates, and in many places alterations can be done if your loved one is miserable. Usually the faultfinder is moved and beware that relocation in an ALF usually includes an additional cost and inconvenience. Another thing to keep in mind is a rambunctious child visiting a facility. Some elders love their presence while others get upset that the attention is being directed towards them when it’s their time to visit. Residents can sometimes get agitated when they hear noise and become nervous. In cases like this, I suggest being mindful of your kid’s impact on the seniors living at the facility. If your presence were disturbing them, it would be best to quiet down or take a rain check on the visit. Wouldn’t you agree that you’d want someone to do the same for your loved one if they were being bothered? Whether it's between the residents or residents and caregivers, it's always smart to ask in advance what procedures are in place at the ALF to manage arguments. When an argument is small between residents, the caregivers are typically the first ones to step in and assist with diffusing the tension. Caregivers will show respect for each resident's opinions and begin in a friendly way. They will ask questions to hear all perspectives and assess how to best handle to situation. They will also notify the facility and family if they see fit or if the family inquires. Some facilities have a resident committee, a board that acts as an impartial representative to listen to both sides of a disagreement, and then propose resolutions. Arbitrators and conflict solution specialists are sometimes brought in based on the gravity of the challenge. Furthermore, there might also be a family committee or council to keep them up to date about life in the assisted living facility, and to talk about their worries. Partaking in a resident committee is a great indication that the facility cares about the requests and needs of the elderly living there. It's common that they'll meet with caregivers and s to address fears and talk about possible difficulties before they begin, and also make recommendations for a superior living experience.

24. What kind of resident groups are accessible at most ALF's?

To warrant the security and safety of your loved one, there are many advocacy groups helping residents. The first thing to keep in mind is that assisted living facilities are controlled by the state, meaning the regulations vary dependent where you live. The federal government is involved by providing the Eldercare.gov website for you to search and find local advocate agencies in a particular zone. The organizations ed through this website are for everyone- not just elderly in assisted living circumstances as they all seniors no matter their living situation and their families. At a federal level, the government also advocates the Long-Term Care Ombudsman Program. Every state features a variety of local ombudsman volunteers and staff who are guided by a full-time state mediator. Ombudsman workers are ers for residents in all senior care facilities, and this includes ALF's. Their goal is to act as a voice for those who might not have one in their facility leading to enhanced care and an improved quality of living. The Assisted Living Federation of America and the Assisted Living Consumer Alliance approach activism from unique angles, which offer those exploring the possibilities some great places to begin conducting general background information. The ideal action is to look into your state's guidelines when it comes to senior care/living. Please refer to this website for a state-by-state analysis to know the particular laws in your state: www. alfa.org/alfa/State_Regulations_and_Licensing_Informat.asp

25. How do assisted living facilities manage dietary requests?

For your loved one, mealtime is one of the most important gauges in assessing the quality of an ALF. When the meals, dining area, and service are excellent the residents tend to overlook other minor annoyances. If the meals and dining experience are lacking, the criticisms of all else tend to grow. Keep in mind that one of the first areas a facility will attempt to save money on is food. If you look online, you’ll find that the usual daily meal budget in larger ALF’s is less than $4 a day per person. Certain facilities claim that their residents don’t care to wake up and eat a hot breakfast at a particular time. In turn, facilities serve a continental breakfast (coffee, juices, muffins, and cold cereal) in the morning. This way of eating is suitable for seniors who just aren’t into breakfast. However, the person who looks forward to their pancakes and bacon every day won’t be pleased. Facilities (big or small) should allow some freedom to choose at mealtime to cater to the resident’s requests. Not everyone knows what he or she’ll want to eat in three weeks, which is why this is difficult. If your loved one doesn’t enjoy a specific food option, making changes to one of the 30 days on a paper is taxing. This is where some of the smaller facilities excel because they have a smaller group of people to serve and they usually know their residents better. Religious views and lifestyle choices can also be motives for dietary limitations. Many ALF’s neglect to provide unique diet menus. It would be demanding to cater to all of the feasible recipes for every possible diet. Additionally, most facilities would like to avoid the medical liability that comes with delivering unique dietary meals. Most ALF’s advise their residents to maintain their specific diets hassle free by selecting from the foods they serve regularly. This may or may not work for your loved one, as there will always be things that are unique to each. The way in which an ALF tries to alter to these variances will spell the difference of an outstanding and average or poor facility. It’s been said that exceptional service requires exceptions, so keep your eyes peeled for those exceptional facilities. As a vegetarian, I understand the need to find places that can accommodate your needs. Everyone has their personal preferences when it comes to the food they eat so be sure to do your research, be sure to look for information about the ALF regarding dietary aides or a nutritionist. This kind of person works carefully with individual residents to establish what they can and can't or what they should and shouldn't eat. When a resident has a particular request (such as an allergy/intolerance, foods not within

their diet, or avoids foods for religion), the dietary aide manages it, so residents don't have to care for themselves alone. Be sure to ask plenty of questions and make all requests required to warrant the resident is safe and comfortable from a food/health standpoint. Assisted living facilities are familiar with special diet management, so it's not going to be a nuisance to the staff. When it comes to what is being served (to ensure it meets the dietary needs of all residents) every state has different rules so be sure to do your research with your local regulatory organization. Diabetes, high blood pressure, kidney disease, allergies, the list of ailments that could call for dietary changes or limitations goes on. It’s a rare breed that reaches 80 without being told by a doctor to avoid certain foods.

26. Do ALF's permit residents eat their food in their room? Can they bring the meal to their room?

Mealtime is one of the most significant considerations for elderly selecting an assisted living facility. Having some favored snacks close by can be soothing to the resident. It can be seen as another familiar item in a new environment which can go a long way to assisting your loved one to feel at home. If you plan to pack some snacks for moving day, be sure to speak with the first. Most ALF’s permit residents to have treats (so long as there is no medicinal objective no to), but most facilities have regulations for proper food storing. It’s likely that when asking, many facilities will be happy to provide refrigeration or secure food accommodation in a reachable space by your loved one’s room. Beyond this, wholesome, nutritious meals are classically provided three times everyday at organized times in a common dining hall (or table for the smaller residential facilities). Residents are usually given an entrée, and the main course followed by dessert and the ALF should have menu choices appropriate for residents with dietary restrictions. You'll quickly learn that meal times are a joyful, social occasion for residents as they look forward to meeting with company and conversation. Nonetheless, there may be times when a resident doesn't want to partake, possibly because they're feeling sick or tired. At most assisted living facilities the caregivers will bring a hot, freshly cooked meal to their room (upon request) if the resident isn't feeling up to eating in the dining hall or at the table for a low delivery fee (although this differs by facility). Larger scale ALF's could have small efficiency kitchens. This allows residents to put together a light meal if they don't want to dine in the common area. While most elderly residents don't wish to cook for themselves, it's nice to have the option. Most of residents in assisted living facilities say that sharing meals with fellow residents are one of their favorite parts of senior living facilities. Helpful tip: before choosing an assisted living facility, be sure to pop by once or twice during mealtime to see what you can anticipate.

27. Do most assisted living facilities offer transportation?

Assisted living facilities commonly offer transportation to doctor's appointments, hairdresser appointments, shopping, and even day trips to around the area. When seniors enter an ALF (even the high-end options), they find they can save money because they automatically reduce their daily expenses. Most elders in this type of facility can't, or don't want to drive anymore meaning they can save every month by not maintaining a car. This isn’t to say that they're confined to the facility. Assisted living s often organize excursions, which are an excellent opportunity to socialize and experience the neighboring communities. These visits could involve trips to an art gallery, plays, or dinner parties. Transportation is commonly offered by bus or shuttle at organized times, but residents should be able to get a ride around town when requested with notice. When it comes to smaller residential facilities, the commonly provides their transportation. Some facilities will assist residents schedule doctors appointments and organize transportation to get there promptly, but these can also be great times to bond with your loved one. Picking them up and taking them to an appointment is nice for both you and your loved one because it gives you something to connect over and chances are they will be eager to add some variety to their day with you. Easily accessible transportation is essential to helping seniors feel more autonomous in ALF's. Before selecting an assisted living facility, inquire about the arrangement and regularity of permitted transportation for residents and take a look at the nearby community to see what the closest town has to offer.

28. Do most assisted living facilities offer doctors visits?

Assisted living facilities aim to do everything in their power to make living more convenient for residents, and this involves delivering easy access to doctors. Many facilities partner with local doctors who visit the ALF frequently and can see elderly residents in an on-site room or the resident's room (commonly done in smaller facilities). If a senior is considering switching physicians, it might be helpful to meet with the doctors who recurrently visit the assisted living facility. Residents usually find the quality of care they desire with the ease of on-site physician. Furthermore, seniors anticipating a move to an ALF can ask their personal doctors if they make house calls to specific facilities seeing as some do. It's very crucial to note that an ALF resident always has the option to maintain their physician and can get help to organize appointments. Transportation to appointments is commonly offered free-of-charge via bus, shuttle or car. Some facilities provide emergency medical services, although this is not as common. Please note that twenty-four-hour medical care is not usually offered in an assisted living facility. The difference with this kind of care is that it's nonmedical as we mentioned earlier. Medicare doesn't cover most parts of assisted living, but Medicare Plan B usually includes doctor's visits both in the facility and at a physician's office.

29. What are the collective policies on bedding, towels, clothing and personal items?

One of the best parts of moving to an ALF is the fact that your loved one is no longer able for housekeeping. Primary cleaning (bathroom scrubbing, thorough vacuuming, etc.) should be provided at least once a week. Cleaning staff or caregivers will visit their room every day to empty trashcans, make their beds, and look for any other cleaning needs. Beds, mattresses, and bedding is offered and kept in good condition and is frequently cleaned. Mattresses and pillows will have cleanable coverings, which will be cleaned between uses by various residents. Sheets, towels, and personal clothing will be washed at least weekly, but usually you will find that the laundry is done more frequently. Blankets, sheets, towels are clean or dry-cleaned as needed and between uses by various residents. Blankets, sheets, towels and clean clothing need to be stored in a clean, dry place between laundering and use. Individual, separately ascribed places need to be provided for storage of individual items and toiletries. The use of common towels is forbidden so be sure to look for and inquire about these nuances as you tour different facilities.

30. How is the laundry handled?

The laundry is always a major concern for seniors moving in and their families. Commonly residents are given laundry bags with a place to mark their name on them to ensure they’ll be returned to the right person. Laundry is handled every few days by the caregivers or cleaning staff. Most facilities use larger commercial washers and dryers with high temperatures of water and heat of dryers, and after a while your clothes may all be the same color. If you have the option of an apartment where you can do your own, that’s always best. The issue is that sometimes it takes too much work for a senior to manage. In residential ALF’s, you’ll find the laundry is handled in a normal washer/dryer and clothes tend to be taken better care of than in a large facility because there a fewer residents to care for and the resident to caregiver ratio is better. Where laundry amenities are offered, they need to be suitable to certify a sufficient amount of clean clothing, bed linens, and towels. Washing amenities have to be of sound construction and must be kept sanitary and in good repair. Acceptable space needs to be offered for the thorough separation of clean and dirty clothing, linen and towels. Laundry rooms must have fixtures that deliver at least 30 footcandles of lighting, be kept clean and free of lint build-up, and be appropriately ventilated. Clothing dryers must be expressed to the outside. Carts used for moving filthy clothing; linens and towels can't be used for moving clean articles unless they have been carefully cleaned and sanitized. “Flat” laundry is typically built-in to the base rate of the ALF. Flat laundry refers to towels, sheets, and possibly a bathmat. Clothing is not included in the flat laundry, which will be gathered and cleaned weekly. Typically, it’s up to the residents to have multiple sets of everything, so that there is always something fresh and usable. Some facilities offer sheets and towels for your loved one but you need to ask about the cost. Other facilities (usually the smaller residential homes) will handle flat laundry and clothing of each resident so clarify upfront. If your loved one is sensitive to certain detergents, it’s best you or someone handles their laundry offsite. It’s hard to be sure that personal detergent will regularly be used, even if you provide it. Your loved one’s clothes should also be washable in heated water if the facility is handling the laundry. To decrease the risk of contamination, ALF’s will be cautious to wash clothes and flat laundry completely. They will most likely use a heated dryer as well. If the resident enjoys wearing outfits that require hand washing or need additional care, you shouldn’t anticipate having

private laundry done by the facility. When visiting facilities, ask where their washers/dryers are so you can see the room. Does the staff manage the laundry, or is it coin operated and residents are expected to do their own?

31. Do most ALF's have a swimming pool?

We can all agree that there's nothing quite like a refreshing dip in a pool on a beautiful day. This is why a lot of senior living facilities have pools for residents to enjoy in the warmer times of the year and to depend on the location, with some lucky folks that can swim year-round. Pools can be heated for use in cooler climates if you're lucky. Most elderly enjoy participating in water aerobics, which is a wonderful for those with arthritis, thanks to low-impact movements that keep stress off your ts. Some ALF's provide water aerobics and trainers for organized exercise. Residents who simply want to take a swim in the water can do so, and then spend time soaking up the sun on a chair next to the pool. Certain places might also come equipped with hot tubs, which are especially cozy when the climate is cooler. Sometimes hot tubs border the facility's swimming pool, making it easy to go back and forth to calm and relax aching ts. However, realistically speaking, if your loved one requires assisted living care there’s a good chance they won’t want to go swimming. It’s very challenging to do so when you already need a lot of care in your everyday activities. Most of the time pools will be found in independent living facilities, which cater to a younger group of seniors than assisted living does. If your loved one will want to enjoy a swim now and then, look for an ALF that offers a calming pool for it's able-bodied residents to enjoy.

32. Do most facilities permit their residents to use their personal furniture and belongings?

Transitioning into an ALF is a big move. What they’ll need to bring to their new home is usually dictated by the person’s care requirements. Many times it includes economizing from a bigger house and separating with some precious keepsakes. The general rule is modest; your loved one should keep enough to please their immediate needs, but not much more than that. Additional space usually costs a in most assisted living facilities and additional storage is difficult to come by. Your loved one will most likely have to appropriate their belongings into one closet and a couple of dressers, so begin moderately small by keeping off-season clothes and other non-essentials somewhere else. that you can always bring them into their new home later as needed. Occasionally, being able to hold a favored lounge chair is all that's needed to feel at home in new surroundings. Elderly who need very little help in their daily lives can do best with their furniture while those who have trouble moving find value from a pre-furnished rooms that have beds and chairs that are simple to get in and out of. Most of the time, it comes down to your loved one's preference. Certain folks want to have as much of their past life brought with them while others are happy with smaller, ornamental items decorating their new space. What I’ve found to be true is that most seniors end up downsizing by taking old clothes to charities and giving away things they no longer have use for (like a lawn mower, vacuum etc.) For some people, it’s very difficult to give up items that are closely linked to their life and identity. If you’re having trouble with this, recruit loving family and friends to help your elderly parent downsize their mementos. Having others around to share the memories with can make it easier both emotionally and physically. If your loved one has managed to downsize enough to fit their belongings into their new home but they need a few items not provided in the facility, they can always rent. Rental furniture can better serve residents of the facility so be sure to ask if the ALF of your choice has that option. A traditional reclining chair can be exchanged for an electronic option that helps boost the resident up to a vertical position if getting up becomes a challenge. Each facility has its own policies when it comes to furniture, but typically it's not an issue to move in a few of your pieces. When it comes to clothing, its best to ask the facility caregivers and employees what to bring. If they’re used to a certain temperature but find it’s different in their ALF then

dress accordingly (too cool, pack sweaters). If your loved one is bedfast, they might want to bring more nightdresses and housecoats. Someone with incontinence should consider packing extra underwear that is larger to permit space for diapers. Don’t forget to pack them a fine ensemble for possible outings to a specialist's workplace or for a festive meal in town. Most ALF’s offer essential toiletries but many anticipate that your loved one will bring with them their toiletries (bath products, diapers, makeup, etc.) A good plan would be to start with standard quantities of toiletries they usually use and feel it out over a two-week period and add or eliminate products as their needs become more evident. For some people, a preparative shopping spree can be a provisional fun activity. When it's all said and done, your loved one being comfortable in their room should be a top priority.

33. Can a resident keep their car while living in an ALF?

Very few people enjoy the thought of old age, much less having to give up their ability to drive. A vehicle and driver's license symbolize independence to most people. From the teenage years, a car has been the route to freedom, leisure, friends, employment, and more. The thing is when learning to drive the instruction course never tells us how long we’re okay to be on the road for. Public programs for senior driving care highlight the importance of keeping elderly individuals safe by studying refresher material about safe driving. However, we’re not given a well-defined idea of when our driving skills no longer warrant as safe. If you have an elderly parent and feel anxious when they get in the driver’s seat, know that planning what to do is a process that shouldn’t be taken lightly. Bringing up the issue of saying goodbye to their car is complicated at best and emotionally traumatic at worst. Some easy-going seniors choose to give up driving on their own without being asked. Conversely, a lot of elderly folks who become impaired drivers don’t realize it on their own. Aging loved ones moving into an ALF might feel as if they are losing a lot, so it's essential to the residents' physical and mental wellbeing to be able to preserve their independence. So long as a resident can physically and legally operate a car and has an up to date license, they can have their vehicle after moving to an assisted living facility. Most communities offer parking spots for residents with cars but be sure to ask to make sure. With flexible transportation options, a resident might choose to avoid the additional expense of upholding, insuring and gas their vehicle. If an elder has an accessible car, they're welcome to take advantage of the transportation provided by bus, shuttle or private vehicle if they choose not to drive on any given day. Elders in assisted living embody a wide-ranging spectrum of proficiencies and requirements. If a resident can drive and wishes to hold on to their car, be sure to inquire about facility rules and availability. Regardless, the responsible adult child needs to step up and engage in the tough conversation to make sure everyone is safe. If you just avoid it, everyone crossing the street and other drivers that share the road are at risk. If reluctance and anxiety are the worst emotions you might feel when talking about your loved one’s unsafe driving, think again. The worst thing the wounded or victim’s family could feel experience include heartbreak over a death or was agony because someone neglected to grab the car keys away from the senior who shouldn’t be on the road. I have seen this happen first hand when my cousin

was injured in a horrific accident caused by an elderly man who shouldn’t have been on the road. My cousin Shane was enjoying a nice lunch on the patio of a restaurant with his friend and their mother when an elderly man drove his car through the gate and over their table. Shane’s instinct was to push his friend’s mother out of the way but sadly put him in the way of the car. He was pinned under the table, which the man had driven into a brick wall behind them. Shane was rushed to the hospital with broken ribs and major head injuries that took years to recover from but thankfully he left the site of the accident alive. For elderly drivers with impaired thinking, this is not an uncommon scenario. Memory delays, reduced reaction time, confusion, vision problems, hearing loss, and other age-related challenges all add to the hazards of certain elderly drivers being on the road. the safety of your loved one is critical too. Confusion or forgetting seemingly simple things is a red flag that your loved one could have early stages of memory issues, and it might be wise to keep them off the road.

34. How does a facility work with residents to remove driving privileges?

Although residents of an ALF have authorization to keep, own and operate a vehicle (as long as they have an up to date license) occasionally residents get to a point where they can no longer properly drive. As we get older, our vision, hearing, and reflexes diminish making driving unsafe. In certain situations, medications have side effects that make it risky to get behind the wheel. This physical change is usually a challenging scenario for aging loved ones but assisted living caregivers can be able to assist. Recommendations from a person of influence that a resident stop driving can be taken more seriously coming from someone other than family. Caregivers, therapists, or visiting doctors can make the suggestion while reminding them of the accessibility of convenient transportation offered by the facility. In exceptionally hard situations where your loved one neglects to give up their vehicle and license, a doctor can complete an assessment and release a report to the state's Department of Motor Vehicles to invalidate their license. In some states, family or caregivers can ask a resident to complete a driving exam. This involves a hand was written and vision test and road test. In the case that the senior fails the exam, the license is invalidated. The caregivers of the ALF are no foreigner to these situations and can advise you on your state policy if your aging family member is unable to drive safely.

35. Would you say that most facilities animal-friendly?

Healthcare sources and ALF caregivers understand the benefits of pet therapy and animal custody for elders. Taking care of pets allows seniors in assisted living a significant responsibility they can be proud of achieving. Most facilities have resident fish or birds that are kept in communal rooms and tended to by the caregivers. Some ALF’s have dogs or cats, but constant worries about contagion control have made this situation almost unheard of. Planned animal visits from local pet centers or charity groups are common practice. Stroking puppies or kittens has been proven to decrease anxiety, lower blood pressure and generate encouraging physiological progressions. For many elderly, their pet is considered a member of their family they wouldn't part with when they transition into an ALF. If you would like to bring your loved one’s animal in for a cuddle, first run it past the facility. A lot of ALF’s have leash regulations for safety, others have paperwork to be filled out, and some require verification that the pet’s immunizations are up to date. Set aside some additional time for visits when you have a pet with you- you’ll undoubtedly be very popular among the residents. Many facilities are pet-friendly, but the rules are dependent on the facility. For example, certain assisted living facilities only permit one pet per room. Other ALF's only allow cats or little dogs below twenty pounds. Some facilities will accept almost any breed or size of pet (including exotic pets). There are many exceptional levels of pet-friendly elderly living options. Certain assisted living facilities are very ive of domestic animals, and caregivers can help with the upkeep and feeding if a resident can't do it on their own (perhaps due to sickness or injury). Although caregivers can assist when your loved one is unable to, it's important to note that those with pets need be able to care for them on their own. On-site vet care at larger facilities or transportation to the veterinarian's office might even be offered so be sure to ask. Certain ALF's have their residential pet for the group or provide animal therapy meetings to their residents. If keeping your pet is important to you or your loved one, be sure to inquire about the rules before you decide on an assisted living facility. According to animal health and safety, the owners must control violent, poisonous or unsafe pets from access all the time. Pets must be kept in such manner so as not to be able to become free and injure the residents, visitors or caregivers at the facilities who allow them. There are many places to choose from so you should certainly be able to locate an ALF that will welcome your loved one and their pet.

36. Do most facilities permit smoking in rooms or designated areas?

There are no federal laws concerning smoking in communal areas, which means the rules and regulations for smoking in public places differ by state. Seeing as an assisted living facility is also a workplace, it might fall into workplace standards and regulations when it comes to smoking. Certain ALF's could have elected smoking and non-smoking rooms. Others might have banned smoking entirely in residents' rooms. Most facilities prohibit smoking in public places inside but in states where smoking is permitted, there could be selected indoor or outdoor smoking areas. Permissible smoking areas should be located in a way so that smoke won't enter into "smoke-free" areas. Outside smoking should be reachable, sheltered from the elements, and situated in such a way that smoke will not enter non-smoking areas (like rooms). Assisted living caregivers should have a choice to escort residents to smoking areas. In any case, assisted living facilities need to follow state or local laws concerning smoking in public places. Please understand that even in areas where there is a nonpublic smoking prohibition, an ALF can still establish their "no smoking" guidelines for the health and wellness of their residents and caregivers. Keep in mind that electronic cigarettes (ecigarettes) are usually not (but can be) subject to the same regulations as normal tobacco cigarettes. If your loved one is moving into an ALF but refuses to stop smoking or switch to e-cigarettes, ask the facilities about smoking guidelines and the availability of smoking rooms before you commit to the facility that's best for your loved one.

37. Is there access to alcohol in most ALF's?

When someone becomes a resident at an assisted living facility, it commonly means they need assistance with their activities of daily living and require some form of medication. It's unlikely that a facility offers alcohol to their residents because of the hazards that come with mixing their drinks with medicine (both prescription and over the counter). The fact is that every facility has varying rules and regulations concerning alcohol. Too much drinking can lead to difficulties balancing for anyone, expressly those with age-related health challenges and the last thing anyone wants is to fall and get hurt. With proper supervision (and occasionally your physician's permission), some facilities make alcohol accessible to residents during mealtimes in a communal room and during special times like organized happy hours. At this time, they can have a cocktail and socialize with fellow seniors. Residents can also bring alcohol with them into their ALF just like any homeowner or tenant can unless the facility firmly prohibits it. Be sure to check the regulations for your loved one before bringing over liquor for them. Otherwise, enjoying a glass wine with their meal or a beer with their friends can be a great way to wrap up their day.

38. Is it possible for ALF residents to have family stay overnight with them?

When your loved one moves to assisted living, they might find a renewed connection with yourself and their loved ones. Seeing as the families no longer need to act as primary caregivers, they can start to enjoy a healthier relationship again. Family who were caregivers will be less tense out and appreciate visits with their loved ones even more. They might even decide they want to visit overnight at some point. A lot of facilities allow overnight visitors, which include family and friends. Some of the assisted living facilities have additional guest rooms that can be used for a small fee for their loved ones. Certain facilities are managed by landlord/tenant rules, which means residents can have visitors as often and for as long as they want (so long as they're not disturbing the neighbors). Other facilities might allow visits during sensible hours. Whether your visitors stay overnight or merely visit for the day, they are invited to in on many of the events residents enjoy (including movies or card games). The duration of your visit ought to be decided by your loved one’s temperament and attention span that day. If your time together seems to be going well, stick around longer and if not, don’t stay as long. The quicker and more frequent visits are usually greater than less, lengthier ones (particularly for those with cognitive challenges). On a side note, it’s important to that when you’re visiting, your elderly parent is your hostess. This dynamic means there’s a chance they might not feel at ease to say goodbye until next time. Do your best not to wait for your loved one to express to you they’re worn-out or that your entrance overlapped an appointment. To avoid this, be attentive and they’ll let you know in their indirect way that it’s time for you to go. If your loved one is sharing a room with someone else, overnight guests might not be permissible. While some folks enjoy surprising their elderly loved one, the planned visit is most appreciated by both the residents and the caregivers. It’s been my experience that seniors like knowing when you’ll stop by so that they can get excited about your visit and plan around it. Another aspect of visiting includes spouses of residents. It’s not uncommon that couples need to be split up to receive suitable levels of care. Partners divided by varying care necessities want alone time for things like lovemaking, catching up, or just enjoying each other’s company. Caregivers will be happy to make the needed preparations. Most ALF’s have conventional methods for this kind of visit (handle hangers, signs, etc.), and they’ll organize the matter as privately as possible with some notice. If

your loved one requires special from a caregiver to prepare for a marital visit (within the activities of daily living) these matters can also be handled early on. Don’t be reluctant to ask the or social services manager how much of your loved one’s needs are cared for at the facility. Regulations vary depending on the ALF so get clear on the rules of the facility you're interested in. Facilities understand that routine visits from loved ones of the senior are a vital aspect of preserving a healthy lifestyle and can help avoid feelings of sadness or isolation. All ALF's should inspire regular visitors to make sure their residents are feeling their best. If it's important for you or your loved one to have overnight guests, ask what's allowable in each facility, you're considering.

39. Who has access to the resident rooms in an ALF?

Once your loved on is settled in their room, you'll find that only a select group of people have access to their private space. One of the many upsides of assisted living is having someone else complete light housework every day and upkeep to the home as needed. In light of this, housekeeping and maintenance staff will enter your loved one's room to clean or repair, regardless if the resident isn't present. Think of this the same as if your loved one were to have a cleaning service or housekeeper enter her residence to clean. Each resident will want to protect any valuable items (like money or jewelry). However, most staff at assisted living facilities should have gone through thorough inspection and background checks and can be trusted in your loved one's room. Personnel and caregivers who are there to assist with activities of daily living (like bathing or showering, toileting, personal hygiene, etc.) will also have access to resident rooms. All caregivers and staff should give warning before entering and respect the resident's personal space. Conversely, if a resident doesn't answer when a caregiver has knocked or an emergency alarm or pull cord goes off, a caregiver or staff can enter to make sure the elder is okay. I think we can all agree that the resident's security is always number one in an ALF. In general, no one should enter a resident's room without having a good reason for being there.

40. Do most ALF's provide access to Wi-Fi for residents?

Society is slowly waking up to the fact that the Internet is a place that can benefit everyone and the elderly are using it more than ever. Email remains innovative to many ALF residents though nearly all homes provide web access and a lot of elders savor the connection made via computer once they understand it. Having said that, some residents find the entire concept of email and the Internet puzzling. If your loved one has trouble navigating a computer, request family who always email to send them to you. This way you can copy the messages or share the great news with your loved one during visits. No matter which category your aging loved one fits into, it’s hard to argue that today's elderly are very linked in, with personal computers, tablets or smartphones of their own. A lot of grandparents use Skype or video chat to stay connected to their family while some sign on to photo sharing pages frequently. Internet access is a significant part of living an enjoyable life for many people, including our elderly loved ones. Many assisted living facilities to provide safe, -guarded Wi-Fi access as an amenity. This connection might come from a single connection or in many cases the entire facility would be set up with a cable provider hotspot similar to coffee shops, airports, and other public areas. No matter the form it takes, most ALF's provide complimentary Wi-Fi. Residents and visitors can access the Internet from their room or in common areas with their devices. Some facilities even offer a computer zone where your loved ones can take lessons and learn how to use certain programs or use the computers in a more social setting than their room. When looking for an ALF, you might find a few facilities without on-site Wi-Fi, which means that residents would need to pay for the Internet through a service provider. Regardless, you'll find the majority of facilities see the value in Wi-Fi access and the positive impacts on seniors, and it shouldn't be foreign to them if you ask what they can offer.

41. Do most assisted living facilities come equipped with a workout room?

Remaining healthy and fit as we mature is a great way to preserve good health, reduce cholesterol, lower blood pressure, stabilize blood sugar and avoid symptoms of diseases like dementia and Alzheimer's. For this purpose, individual and group exercise is encouraged to be part of every assisted living facility. Many ALF's have an onsite workout room, where residents can benefit from cardio machines like treills and ellipticals as well as weight training equipment. Facilities could even have private trainers that can teach residents the best way to use the workout machines and design an efficient program to keep seniors exercising frequently. If an ALF doesn't have an on-site workout room (not all do), they might offer free, routine transportation to a nearby gym or health club. Additionally, some residents might prefer to take a group exercise class, swim, walk, play tennis, or do other activities to stay fit. When you're shopping for a facility, find out what workout activities are offered (on campus and off) that will align with your loved ones interests and abilities.

42. Is around the clock maintenance included in the total amount of the assisted living fee?

Most facilities have decided to have residents pay extra for certain amenities like 24-hour maintenance. Sometimes it's included in the rent every month and not for an additional fee. Changing a light bulb when it needs to be replaced in a ceiling fixture can be a difficult job at any age, and not everyone knows how to unclog a backed up sink or prevent a toilet from leaking everywhere. Who wants to shovel snow in the cold winter or cut the grass in the heat of summer? It's easy to forget about the challenges of menial tasks like these that need to be taken care of when you have so many other things to consider with you aging loved one. This is why around the clock maintenance is so essential to elderly residents in assisted living facilities. Instead of worrying about the small chores, your loved one can spend that time concentrating on activities that make them happy. Some ALF's charge their residents a maintenance-free, suggesting that those who live in the residence don't need to worry about maintenance. Please keep in mind that this doesn't mean the facility has a team on call 24 hours a day to offer , so you'll have to inquire about the facility-specific policy. The evaluation of a 24-hour maintenance fee is contingent on the facility. You might be charged for the amenity, and it usually covers interior and exterior maintenance. It could be included in a monthly fee or billed separately so ask up front as you do your research.

43. Do most facilities use security cameras?

The security of your elderly loved one is an essential priority in an assisted living facility. This is why the majority of ALF's have some security management methods in place to proactively safeguard their residents both inside and out of their rooms and around the facility. Video cameras make up only one aspect of a well-planned program, which monitors the facility 24 hours a day every day of the week. Your loved one can sleep easy knowing safety cameras placed around the home work as both a crime deterrent and an observing system incase anyone needs help. It's comforting to know that security cameras monitor and record every movement in the ALF and that security staffs evaluate everything to avoid illicit visitors. Cameras also serve the benefit of keeping an eye on memory-impaired residents who have the tendency of wandering. An additional function of these cameras is to confirm the safety of medications and medical provisions (over-the-counter and prescription) situated in the facility. No one should have to concern themselves about their private belongings or safety, specifically those who need help with their activities of daily living. With the installation of security cameras, ALF's prove their ability and a commitment to resident safety. You should also know that each licensed and regulated ALF needs to create an evacuation plan for their local fire department in the event of an emergency. Evacuation routes in the building in the facility are required to be posted, and drills should regularly be run. Most ALF’s are aware of the hidden hazards in any home that most people can’t see which ensures even more safety. The first significant threat to elderly is bathtubs and showers because they’re slippery. Alf’s commonly use non-slip tiles in showers and chairs or grip mats. Electrical facilities are next, so staff ensures circuit breakers are working. They check outlets for possible shorting and clean up extension cord bundles. The following risk is a heating/cooling machine. Alf’s have their heaters examined and cleaned annually and ensure fuel is supplied at suitable times. Plumbing is another danger, which is why facilities have their pipes and faucets observed frequently. Railings should be secured to residents while bathing and using the toilet. Often time’s seniors will hold on to anything near them when they feel off balance, so it’s crucial to have . Last but not least is lighting. Facilities must have sufficient visibility so that your loved one can see to avoid falling.

44. Do most ALF’s take in elderly with mental health conditions like bipolar, depression or schizophrenia?

Living with mental illness is far from easy at any age, but elderly folks seem to have more trouble managing because of their physical disabilities or weaknesses. If your loved one wants to transfer to an assisted living facility, you'll need to know if the ALF is prepared to treat and manage mental health disorders. Mental health concerns like depression, bipolar disorders, or schizophrenia entail special treatment that could involve a blend of medication and therapy. For facilities to it people with mental health challenges, appropriately trained caregivers and well-thought measures need to be in place. Not all assisted living facilities are equipped to handle these conditions so never assume they do. Once you’ve found a facility that handles mental illness, understand that it’s up to the to decide if they will be able to care properly for your loved one suffering from mental illness. They will also assess what your expectations are for treatment whether at their facility or off-site. While these places help those who require more assistance in their daily lives, ALF’s might not always be the ideal fit for individuals whose mental health is suffering. It would be wise to make an appointment to speak with an at the facility to see if it's the right fit. If not, the caregiver might be able to suggest a facility better prepared to meet the needs of your loved one.

45. What is aging in place and how can I be realistic about the present or future necessities of my loved one?

One of the commonly asked questions is how long residents stay in any given ALF. While most seniors live out their last years in a facility (with occasional hospital visits, or rehab outings before a final illness), other residents find they have to relocate to a more sophisticated kind of care. Aging in place is talked about often as an important goal of assisted living. The notion refers to allowing elderly folks to stay in their present or desired place, with needed adjustments and ive services, till they take their last breath. The assisted living industry has embraced and adjusted this model so at the time an elderly individual moves into their ALF; the supposition is that they can stay there with increasing care to meet varying needs. Rather than focusing on aging in place as the only outcome, you should examine the process of how aging occurs in places. In any challenging situation, it’s important to see things exactly as they are- not any better or any worse. Do your best to avoid dwelling on your concerns and face them head on. Perspective is everything, so do your best to reframe your view of the situation you and your loved one is facing. It’s not the conditions that keep you from having the reality you want; it’s the story you’re telling yourself about them that shapes your reality. Life can be messy and unexpected, so be prepared to modify course as you go. Did you know that most of the time when you take a flight, it’s off course by a few degrees? It’s the micro-modifications the pilot makes in the way that allows it to land in the right location. Likewise, keep your eyes open for how you should be altering your approach as you help your loved one navigate their declining health issues. Understand your loved one’s current care needs so that you can anticipate what they’ll need in the future. Preferably, you will select a facility that is prepared to deliver care now and in the future, as your loved one’s age. Many times families will come to an ALF for help after originally choosing a facility that in incapable of delivering the level of care required. Moving your loved one from one facility to another is not only taxing and expensive, but it can also be tough both emotionally and physically for your loved one. If you’re having a tough time, to think of all the things you are grateful for as you go through this stage of life with your elderly family. Not everyone gets to help his or her aging loved one find an ALF to call home. Some people never make it to their golden years; they’re not on speaking with their family, or they don’t have the

financial means. Gratitude for what you have been the most potent tonic for life yet too often we concentrate on what is absent or what didn’t go as planned in our lives. Be sure to celebrate the little wins along the way with your loved one and it will help you through the challenging and beautiful stage of life of an aging family member.

46. Do most ALF's offer safes for my loved one's valuables? If so, who has access?

Moving into an assisted living facility means helping your aging loved one make a lot of decisions, not the slightest of which is what they should do with their valuables. It's okay to want to keep your cherished belongings and important papers close, but the decision of whether or not to have safes on-site for resident use is up to each facility because of the liability it brings. If your loved one has the option to keep their precious valuables in a safe, find out who all has access and the method of removal for items like jewelry or papers when they are needed. Certain facilities offer private safes in the resident's room where residents are the only ones with access to their valuables. Please note that family of residents needing memory care might feel better if their aging loved one didn't have direct entree to their valuables in case they lose them or mistakenly give them away. In this situation, keeping their valuables in the facility safe is the best option, and only an authorized individual (in writing if doable) would have access. However you decide to keep your loved one's valuables safe in an ALF setting, put them away so that there's no chance for misplacement or theft because it's always better to be safe than sorry.

47. How will I know that I’ve chosen the right ALF for my aging loved one?

Occasionally families will assume a facility is best for their loved one because the ALF is economical, but later realize that cheap doesn’t lead to quality care. It may very well be true that you can find a similar facility for less money elsewhere, and in today’s economy we all want the most for our money. The challenge here is that the cheapest price doesn’t always deliver what we want. Most people look for three things when shopping for an ALF: the best quality, the best care/ service, and the lowest price. I have yet to find a facility that could provide the finest quality and best care for the lowest price. So for you and your loved one’s long-term well being, you have to ask yourself which of the three you would be most willing to give up- quality, care, or low price? People often find that they need to relocate their loved one to a new facility that’s more expensive but more suitable regarding care. I suggest you and your loved one take the time to speak confidentially with residents and caregivers about their thoughts on the facility and the care they’ve been given. Happy caregivers are comionate staff, and a facility full of happy residents is usually a good indication. Look into the certified backgrounds of the ALF’s that you are exploring online or meet with a representative at the Department of Elderly Affairs to learn more. The office of your local Long-term Care Ombudsman (which you can locate at www.eldercare.gov) can tell you about recognized deficiencies that local facilities have had so that you don’t pick a facility with a past of violations and substandard care. Before committing to a long-term contract, you might also consider arranging a temporary respite stay at communities your family is exploring. Some communities even offer no-cost trial stays to qualified prospective residents.

48. What does the resident contract include?

The presence of each resident in an ALF needs to be protected by an agreement fulfilled at the time of ission or beforehand between the licensee and the resident or his or her legal representative. Each party to the contract must be given a duplicate original, and the licensee must keep on file in the ALF all such contracts. The licensee cannot destroy or get rid of any agreement until five years after its expiry date. This means that if you need information for your loved one even after they have moved out of a facility, the ALF should still have their files for up to 5 years after. Every agreement has to contain exact supplies, especially for services and housing provided by the facility. A 30-day notice protects the rights, duties, and obligations of your loved one. Whenever money is given or advanced by a resident in a contract as safety for the performance of the contract agreement or as advance rent for the next proximate rental period. Such funds will be placed in a bank in the state it is located, if possible, in the same community in which the facility is located. It must be kept independent from the money and property of the ALF and cannot be represented as part of the assets of the facility on financial statements and must be used only for the resident. The contract must contain a refund policy to be applied at the time of a resident's relocation, discharge or death. The refund policy must offer that the resident or responsible party is entitled to a prorated refund based on the daily rate for any unused portion of payment beyond the termination date after all charges. This price includes the cost of reparations to the residential unit resulting from circumstances other than normal use, have been paid to the licensee. If the resident's belongings aren't claimed within 45 days after a statement, the facility may dispose of them. A resident must give 30 days notice of termination except in the case of death or a discharge due to medical reasons.

49. What paperwork is required when moving into an assisted living facility?

Relocating into an ALF is no minor decision. Like most big decisions, there is a lot of correspondence involved. To begin, anyone who is looking to become an assisted living resident will typically need to have a physical exam and get the physician to complete a form that evaluates the overall health of your loved one. Upon completion of the review, the key paperwork is the contractual agreement between the facility and the resident. This is an official record that safeguards both the assisted living facility and the resident as it very clearly documents the expenses, the amount of care, and other items like discharge procedures. You might also find a resident care proposal that spells out the services the resident will obtain and the along with the costs. To stay on the safe side, understand that these binding agreements could be evaluated by a legal professional so that you know what you're paying for and what you agree to. There might be extra paperwork to be handled before the move in which may or may not be a necessity. Some of those contain asg powers of attorney for health and finances, forming a living will, and a healthcare commandment amongst other documents. Below are a few questions to keep in mind as you review paperwork:

What specific papers create the agreement at the ALF you’re considering for your loved one?

Is the agreement self-contained, or does it mention a “resident handbook” or other pamphlets to reference?

Does the agreement say that the contents of those other papers are a part of the contract?

If the manual on resident behavior policies or other documents are “part” of the

agreement, does the agreement say these other papers can be altered or modified by the ALF anytime?

When helping your loved one review their agreement, look to see if the ALF can alter or amend any part of it as needed. This means that they can make an adjustment it whenever they want to. Essentially, this means the ALF could modify the agreement anytime, and if your loved one has signed it, they’ll have no choice but to work with the new structure.

50. What should we be aware of when authorizing the facility agreement?

Assisted living agreements are pretty straightforward, unlike other legal paperwork. Regardless, they can still be made up of unclear language, or include extra fees that aren’t entirely clear. Unexpected price surges trap some families, which is why it’s important to be conscious and revise the agreement. Assisted living facilities have a variety of pricing so be sure you understand the way it is for your loved one. Some facilities charge a single fee for room and board, and an additional fee for care. A facility could charge $3,000 per month for the room and the food, and an additional $1,500 per month for personal care. Other ALF’s might charge separately for amenities or rank the level of care your loved one requires on a scale with cost based on the degree of care the caregiver concludes is required. Some facilities don’t charge a care fee but provide an allcomprehensive pricing whereby resident’s fees are not reliant on the care needed. At a facility with full pricing, a feeble resident who needs a high level of care has the same fees as someone who is mostly independent. Furthermore, you could find a one time entrance fee, a fee for laundry, medical supplies, and medication delivery and so on in their agreement. Additionally, facilities commonly raise their prices annually by 5% to keep up with the advancing level of care and inflation. Unless your loved one’s agreement details a locked rate, their fees rise every time they renew their agreement. If there is anything about the agreement that concerns you or you just don’t understand, ask questions or review it with an attorney.

51. Can assisted living facilities raise their prices at any time?

Like any product on the market, prices are affected by inflation rates. For anyone who doesn’t understand, inflation is a measurement of how much costs increase over a period. The inflation rate impacts the value of money because the greater the inflation rate, the less that exact amount can buy. This means that a bigger degree of inflation can be hard on the economy as folks might not be able to afford to purchase the products they used to if their salary doesn’t increase. This doesn’t just affect individuals; it affects businesses like assisted living facilities too. The reason this is important to understand is because inflation plays a huge role in prices rising at the facility of your loved one. This can be tough for you or you loved one finically, but it can also be seen as a responsible action on the part of the facility. Consider this: if a facility wants to continue to provide the best care, and they aren’t charging prices with high-profit margins to begin with, it’s best to work with them so they can continue to take the best care of your loved ones. Prepare yourself for sticker shock early on. The standard assisted living facility can charge anywhere from $2,000 a month for the absolute basic amenities, and some pricier residences can run as high as $7,000 a month or more. While Medicare and Medicaid cover nursing-home care, they don't pay for assisted living. (Side note: there are four states where a Medicaid contract can be organized, but funding is limited and hard to come by.) Elders who are trying to put together a budget need to recognize that a facility can increase its costs at any time and with little notice. The challenge is further intensified by the economy's immense growth. When a new facility opens it will offer customers a teaser rate to help fill their rooms and once the beds are filled, they will increase their cost. Alternative methods to charge inhabitants a rudimentary monthly rate are to cover a flat set of services and then add on supplementary charges for care not built-in to the initial list. Some of the reason prices will rise due to inflation in the economy or the demand in the industry. Be sure to ask up front how the facility structures their services and fees. It's important to understand for yourself and your loved one how the pricing works to avoid payment penalties and the possibility of having to displace your family member because you're unable to afford their care.

52. When acting as a responsible party for an assisted living resident, who is the ideal person to select?

It's critical to recognize what it means to be a responsible person for an assisted living resident. Essentially, it encomes responsibilities for the costs of care in the case where the resident is incapable of making payments on their own. The responsible individual might be financially able for picking up the costs from their personal funds, or they may only have access to the resident's income/banking s and be able to make fiscal choices on their behalf. It's essential to recognize this discrepancy because it will eventually be part of the assisted living resident contract. Once you decide what taking on this responsibility involves, then you have to figure out the best individual to manage those roles. Be sure to ask a lot of questions upfront regarding any language in the agreement that you're uncertain about. Only then can you sit together with your elderly loved one and the remainder of the family to see who is best suitable to take on the task. Many times, the best person is the oldest child who is most involved in the elderly care choices all along. , because of the likely financial commitment, you want to understand and be comfortable with how it could include your private finances to get the care your loved one needs.

53. Who is the best person to act as power of attorney for a resident if a loved one is unable to?

Standing in as a power of attorney (sometimes seen as P.O.A. in documents) for an ALF resident is as serious as the name suggests and the commitment shouldn't be taken carelessly. There are healthcare/medical and financial powers of attorney; both have you representing the ALF resident should they become incapable of making decisions regarding their own that preserve their greatest interests financially, medically or socially. A healthcare provider or medical power of attorney can make assessments about medical care on behalf of a resident, representing as their health care agent. Quite often, when designating an individual to take on this responsibility, it is done in concurrence with making a living will. When done this way, the resident's desires are distinctly listed, and the power of attorney is essentially there to guarantee those requests are carried out. A financial power of attorney is the individual who manages the financial choices of the resident up to and including bill pay, investment management, and paying for care. A proper arrangement will detail under what conditions each power will shift to the power of attorney and will explicitly list what these responsibilities will involve. When selecting somebody to take on some or all of these important obligations, it needs to be someone that the resident deems to be orderly, educated, able, and can commit the time required to make such choices should the necessity arise. There can surely be two individuals to take on these various tasks, but there's a good chance they might need to collaborate so keep that in mind when deciding. It's important to note that if the elderly person does not have any next of kin, or if the family can't agree, a probate court might step in to assign a guardian. Sadly this can result in choices that neglect to benefit the resident. Even worse, there have been cases of cruelty, negligence, and exploitation of the elderly's assets. Above all else, the powers of attorney (both medical and financial) should be an individual who the resident wholeheartedly trusts and who could continuously put the resident's greatest interests first.

54. What happens when a resident's economic reserves are exhausted when living in an ALF?

Don't be mistaken: Assisted living can be an expensive accommodation option and most of the time it's funded out of pocket. Nonetheless, for those who have long-term care insurance know that it can be used for the cost just as Veterans' benefits can. It's important to know that before your loved one can move into an ALF, they will have to prove that they're financially capable of paying for the cost of living there for a decent amount of time. If the economic reserves of your loved one run out, there are other policies about the procedure. Residents could be qualified for Medicaid Assistive Care Services if the state and the ALF are benefactors of those packages. If you intend to use long-term care insurance to assist with ALF expenses, grab your loved one’s plan before you make a final decision. Find out if their plan covers assisted living because some long-term care providers offer coverage for assisted living. Be aware that some of the older policies might not cover ALF’s. If your loved one’s insurance handles skilled nursing care and has an “Alternate Plan of Care” advantage for care in a different setting, check with their insurance. The list below highlights some of their guidelines for covering assisted living?

What will be needed so that the person who is insured can make use this coverage?

Can the insurance provider approve you for the particular facility you’re looking at before you commit to moving in?

What paperwork does the insurance provider want from the ALF, and what will they want from the resident’s doctor?

Will they ask to have a meeting with the policyholder before they confirm that assisted living care is suitable and needed?

If an interview or medical exam is required before benefits will be granted, can you do this before to moving forward?

Get the insurance provider to send you any documents the physician will have to complete. The policy should distinctly state the plan’s description of assisted living (including licensing necessities), the smallest suitable size of the facility, staffing requirements (find out if a ed nurse needs to be on staff), and the services offered. Collect the papers the insurance provider is going to need and be sure to include a copy of the facility’s license. Be sure to have these papers sent to the insurance provider before g a lease and save duplicates of everything you send. If there are any complications when using your insurance at the ALF you chose, it’s best to resolve them before your loved one makes a commitment. Unless there is someone else (like a family member) who has agreed to cover the expenses, it's likely that the elder will ultimately have to move to another place of residence that takes Medicaid (such as a nursing home). Some assisted living facilities will help the residents to find alternate solutions such as offering the opportunity to share a room with another resident. Either way, it's essential to know the choices beforehand to best prepare and care for your loved one.

55. Is there a provisional financial solution to help your loved one pay for assisted living until they can sell their primary residence?

Almost everyone has an experience to tell real about real estate by the time they retire. For majority of the initial baby boomers, it’s a good story of wealth gathering, starting with the nostalgia of purchasing their first residence. Some people were fortunate enough to buy their first home and remain in it through the majority of their grown-up lives, having already paid off their mortgage. Others working their way up the business ladder, getting married, and starting a family has synchronized with the decision to sell their smaller house for a newer, bigger and more valuable place to live. Many seniors have created a substantial nest egg merely by owning the home they lived in. I explain this because one of the easiest ways to pay for your loved ones assisted living is to sell their primary residence and use that money to pay for their room and care at an ALF. If the idea of cashing in the family home is terrifying, (Understandably, it has been your safe haven, your tangible nest egg as well as your nesting place) you have other options. A secure alternative most seniors have held in their pocket is having, but not using, a home equity line of credit (HELOC). This was intended to allow homeowners with adequate equity to use small amounts here and there, instead of getting another mortgage. It’s great to be prepared and proactive, but in many cases, the elderly individual’s health has declined rapidly and there weren't preparations made for the next step. For this scenario, there is a loan product on the market designed in particular for those who have a short-term requirement to pay for assisted living while waiting for other resources. The product from "Elderlife Financial Services" is the "Elderlife Line of Credit". Elderlife is a company that delivers eligible individuals with up to $100,000 as a short line of credit to help the family's predicament providing the means to fund their loved one's care as they wait for a home to be sold. This option can also cover supplementary veterans' reimbursements waiting to be accepted or for funds from a life insurance policy conversion to become accessible. With the line of credit configuration, loan clients use only what they need for elderly housing and care. Reserves for assisted living fees are paid straightforwardly from the Elderlife Line of Credit to the assisted living facility while the loan client pays the reduced loan expense until the home is sold and earnings are used to pay off the line of credit. Elderlife is a company that has partnered with more than 3,000 senior living facilities and ALF's throughout the country, many of

which cover part of the loan's interest payments. Families who need a line of credit to back their loved one's transfer into an ALF might want to ask about this when exploring communities.

56. If a power of attorney sells estate without permission, what happens when Medicaid tries to recover the assisted living expense?

It's important to know your rights and the rights of your loved one in case they find themselves in a terrible situation with their power of attorney. Very often, Medicaid places a hold on the property on a senior citizen's residence for compensation (once the individual has ed) of what it expends on the resident during their time in an ALF. If a power of attorney (POA) sells the residence with or without consent, the lien guards the money Medicaid spent up to that point. In the case that Medicaid doesn't have a claim on the home, the challenge still rests with the power of attorney and not the ALF resident. Medicaid can prosecute the power of attorney for compensation. Hypothetically speaking, a power of attorney doesn't have the right to sell a home without permission. The power of attorney could claim they have the right to sell the property because the resident can't make their choices. This is where the local ombudsman (representatives chosen to investigate elderly grievances against malistration, specifically those of public authorities) should be considered to help. This county-chosen worker acts on behalf of defending the rights of the senior. In the case that the resident still has family alive and involved, then those individuals might want to talk to a lawyer to further defend their loved one's rights and perhaps invalidate the power of attorney. Even if the power of attorney sells the home without the agreement of the elder, the POA doesn't have a lawful right to the profits from the sale. The finances are returned to the primary instead of the POA because the sale of their property can only benefit them.

57. How can I help in the prevention of financial elder abuse for my loved one?

Sadly, elder abuse is a reality for many people growing old whether it’s physical, emotional or financial. As we age and begin facing a mental regression, we lose our ability to see that someone is taking advantage of us. The concept of mental decline is tough for us to accept. One of the most challenging parts is that it happens gradually and almost sneaks up you. It’s important to realize that natural aging doesn’t mean mental decline. This sort of regression doesn’t just happen to everyone because they’re old. Mental impairment makes an elder susceptible to exploitation because fiscal judgment if often the primary area of function being disturbed. The senior with early mental decline might appear to be fine. They could carry on a normal conversation without any issues. They might even be capable of paying bills on time and discuss relevant topics including politics. The subtle impairment isn’t apparent right away. It’s common when initial cautionary signs appear, we as their family want to reject them and write it off as signs of aging. If you think you see signs that something is off, there probably is something wrong with your loved one. This makes it easy for people to use the occasion to get an aging loved one to do things that are not in their best interest. Commonly, family are in a situation to exercise this type of dominance over a susceptible individual. Seniors don’t have to be cognitively weakened to be a target of unwarranted influence. The good news is that it’s easier to protect your loved one from these kinds of abuse when moving them into an assisted living facility instead of keeping them alone in their homes with hired caregivers. The reason for this is because there are other people around so there is more ability than you might find if they lived on their own with a caregiver checking on them. It’s harder to abuse someone and get away with it when you’re not alone with hired caregivers or nurses at your home. It’s especially safe in the residential ALF’s because the ratio of caregivers to residents is usually 1-3 compared to the larger facilities where you’d find 1-20. The first thing you can do for your aging loved one is to help them request a copy of a free credit report. This way you both know where they’re at if this number changes. The next step is to help them remove their name from any direct-mail lists. While you’re at it, remove the name of deceased individuals from mailing lists. You should also avoid posting private information on social media sites and read the with them. Another tip is to opt out of pre-approved credit offers on their behalf. Remove email addresses from the

Internet if they have any or email ads and remove their name from telemarketing lists. Last but not least, stay in touch with your loved one. They are at a vulnerable time in their life, and the best thing to do is check in now and then either over the phone, over a video chat or best, in person.

58. Who's financially responsible?

Assisted living facilities don't have the ability to bill Medicare or Medicaid for their services because they aren't healthcare facilities. Medicare doesn't ensure custodial caregiving; no matter what the setting in which they are provided is like. Medicare and Medicaid both differentiate between care that is said to be custodial or skilled care. It is because of this that most residents pay privately for their assisted living. Some exemptions in fairly new, trial programs called Assisted Living Waiver Programs exist. This program is made to keep vulnerable residents out of nursing homes by permitting low-income seniors to pay for assisted living with their current resources like Social Security Income. To be honest, I have yet to see a high-end ALF partake in the Assisted Living Waiver Program. The likelihood is greater that the qualified, low-income senior that requires the insurance would get restricted selections, and the available homes will be smaller with fewer conveniences. Ninety percent of residents in ALF’s pay privately. Traditionally (before waiver programs) only folks with higher revenue or disposable resources could afford assisted living. Though this is shifting, money still comes primarily from the senior and not from an assistance plan. Some elders sell their home to pay for assisted living, and some long-term care insurance policies cover parts of the cost. If you or your loved one has a home to sell for your loved one to have enough money to cover their ALF, reach out to an SRES certified realtor right away and get the ball rolling. The simple fact is that most of the seniors who move into an assisted living facility are starting to struggle with memory and financial organization. It is because of this that most ALF’s are reluctant to it a resident without a trustworthy individual as a backup. The responsible person is obliged to certify directly that all expenses and fees will be punctually and adequately paid. If you aren’t ready to assume this kind of responsibility, don’t sign any paper that will obligate you to do so. It’s important to understand that if you refuse to sign, a number of facilities you can then pick from could be strictly limited. If you have been granted your loved one’s power of attorney, and you’re authorizing documents on their behalf, to check with a lawyer for directions on how to approve these types of papers so that you don’t jeopardize your finances. There is usually a precise language your lawyer will tell you to use. If you are unsure, have all the papers revised by an attorney before you, or your elder, sign them. You should also beware of hidden costs. The hidden expenses are

commonly called “care points” at the larger ALF’s. Devised by the industry, this is a way of adding charges to each addition of service offered. As an example, if the elderly individual needs help bathing, larger facilities will add care points on every month per shower. These can vary from medication assistance to meal delivery and other additional aspects of everyday living. Besides the base rent and care points, the larger assisted living facilities may have separate fees to move in and become a resident. They vary widely and can be very expensive. It is not a typical first and last months rent as one would find in an outside apartment. It can be much higher. In smaller homes, there may be no community fee at all. If you or your loved one do not turn out to like the facility, be aware that sometimes the community fee is not refundable. Be sure to read the facility’s contract to learn if the fee if refundable or not. To make this simple, the more care resident needs, the more expensive it is for your loved one to live in an ALF. I’ve known seniors paying as much as $12,000-$17,000 every month for their care. As always, be sure to ask up front how their services work as each facility may vary, and not all of them charge their residents in this manner.

6 of the most common financial planning mistakes to avoid:

1. Overlooking Inflation: Inflation means that your cash is progressively valued less over time because prices increase and the value of your dollar doesn’t rise with it. Over the past twenty years, standard yearly inflation has been around 2.55%. The most secure investments like a savings or government bonds will usually provide earnings at a rate inferior to inflation. It seems that taking a modest risk is needed to ensure your savings aren’t exhausted by inflation. Alongside this, I would advise you educate yourself financially. There are many great books and resources online that are accessible to almost everybody that can greatly assist when your decisions when hedging your money against inflation.

2. Neglecting to plan for long-term expenses: The majority of us most likely want to spend our golden years at home and in decent health. Like all seasons of life, our pre-winter years rarely go precisely as planned. Whether we find the notion enjoyable or not, many of us will ultimately encounter substantial longterm care expenses as we age according to a recent study. The old saying: “Hope for the best but plan for the worst” holds remarkably true for retirement and long term care preparation.

3. Submitting to scams: Imposters fool more than a million American elderly individuals every year, adding up to roughly $2.6 billion yearly. Elders should do their best to stay educated about strategies and plans used by frauds, and be careful of proposals that sound too good to be real. For more information about elder fraud avoidance, do your research online and educate yourself as best as you can.

4. Not understanding the ins and outs of Medicare: Most pensioners think that Medicare covers longterm care, but it doesn’t. This false notion can have truly awful consequences for elderly individuals who no longer earn a wage. Elders who have relied on Medicare to cover costs for assisted living facility care are

susceptible to being financially and emotionally destroyed when care needs occur. Those enrolled in Medicare should know that this service won’t help whatsoever if long-term care is needed at a nursing home, assisted living facility or in their residence. The government package that can cover long-term care, in particular conditions is Medicaid rather than Medicare. Conversely, Medicaid is only obtainable to elders who have previously expended almost all of their assets on care and is seen as a last resort alternative.

5. Over dependence on social security benefits: Social Security was introduced as an aspect of FDR’s New Deal in 1935 as a fundamental way to keep most elders out of poverty. However, don’t assume your benefit will offer relaxing retirement as most imagine, let alone to manage long-term care expenses. According to the Social Security istration, the average benefit for a retired employee is about $1,230, while a report by Genworth Financial discovered the average price of a one-bedroom apartment or room at an assisted living facility is $3,300. Furthermore, real budget aggressors have been eyeing Social Security for privatization and a potential benefits reduction, so it’s future isn’t entirely visible. If it’s conceivable, try to ensure that you’re not completely reliant on Social Security income by adding to a supplementary retirement program, or by retiring with adequate reserves.

6. Having an invalid estate strategy: Often time’s seniors outline their will’s and then disregard it thinking everything has been taken care of. This error often means that elders’ estates go to the incorrect folks, or that their families encounter additional legal fees. Reevaluate your will and the will of your aging loved one with them along with other estate planning actions yearly. This review is particularly vital if any of the recipients have died, gotten divorced or had kids. Likewise, if the estates executor dies, modifications to the will are in order.

It’s tempting to evade severe problems, particularly those associated to health care and long-term fiscal planning. Resist this temptation. If you take a preemptive approach, tackling hard subjects early on, you can avoid them from accelerating into emergencies with your loved ones. Poorly organized solutions to intricate health and economic issues seldom end well so be sure to plan ahead. The next best thing to do is to get advice. If you don’t understand something, ask. Folks who have already been through this can often be a helpful resource of guidance and relief. Perhaps you could a group and surround yourself with local people who can relate. Speak to medical practitioners, ed nurses, and mental health specialists to learn as much as you can. When legal and financial fears develop, talk to a lawyer, ant or financial organizer. Reach out to your local agency on aging or one of the associations highlighted at the end of this book. , no one can be a specialist in everything, but the responsible caregiver knows what he or she doesn’t know and pursues guidance from those who do.

59. What is hospice and how does it work with an ALF?

My Grandpa Marvin ed away this year at the age of 89 in his room at home. He went peacefully in his sleep the way he wanted to- with no tubes, no needles, and on his . Grandpa was where he wanted and needed to be, in his living room surrounded by loving family who said their goodbyes with heavy hearts and the highest degree of gratitude for being lucky enough to have known him. If he hadn’t been able to stay there, he would have hated that. It was a wonderful and fitting way to end a life that by anyone’s standards was truly well lived. The hospice people were delightful. Anytime we needed them, they were there. This was so nice to have him live out his last wishes, and I want you to know that even in an ALF with all their rules and regulations, you too can do the same. There is a rule in every facility about residents being able to stay when care needs increase substantially with no exemption. If you’re looking for a way around this, there is one. Hospice care is the service that can make this feasible for you and your loved one. Hospice offers in-home medical care provider for the terminally ill patient who needs help. Their goal is to keep your loved one free from pain and relaxed instead of violently trying to treat them. Many seniors wish to live out their last bit of time at home, rather than in a nursing home or hospital. Folks living in an ALF are no exception. For the elder who has lived in the facility for a while, the facility has become their home. If they have a terminal illness that is predictable (though not needed) to result in death in a sixmonth timeframe, or if treatment is no longer an option, then Hospice in the ALF is a possible route for some folks. Medicare handles Hospice, with the likely exclusion of low co-payments for some medicines and gear. A group of doctors, nurses, caregivers and social workers work closely with the family and facility to deliver care to the senior and encouragement for the family. Keep in mind that if you’re considering Hospice, the need for another person to be with the patient in their room will progressively increase. Although Hospice sends nurses and caregivers as needed, they can’t regularly stay with the senior for lengthy periods of times. The reality is that the facility doesn’t have the capability to offer caregivers to stay with a resident for hours on end. So, if you’re thinking about Hospice in an assisted living facility (and you can’t stay with your loved one), you will ultimately need to hire help. A sitter might be enough at the start, but a caregiver will be essential if the resident becomes bedridden or requires care from someone with training. If you find that the investment in Hospice care for

your loved one in an ALF becomes excessive, Hospice care can be delivered in a nursing home. The reality is that none of us can foresee when or whether a fatal illness might come up. It would be wise to gather some information from the facility before making a move-in guarantee. that seniors receiving Hospice are expected to away at home. Usually when a patient s with a Hospice plan, he or she agrees that R or other revival methods won’t be done. Furthermore, where acceptable by law, being ed in a Hospice plan also means that paramedics will not be called, and your loved one will handle all the necessary details with you.

Conclusion:

Assisted living facilities are a beneficial substitute for seniors who can no longer live unaccompanied without any assistance with their daily activities. Now that you have decided assisted living is the best solution, ask the MD or geriatric specialist of your loved one for a list of local facilities. Set a meeting to visit them with your parent or relative and bring with you a checklist of things to look for and questions to ask the caregivers. You want to make sure that the ALF suits your loved ones taste and needs and you want to look for cheerful staff and quality food. Make sure there are enough employees to manage the residents by asking how many seniors are matched with a caregiver. There are a lot of fears, questions and misunderstandings around ALF’s, and it’s essential for families considering assisted living to familiarize themselves with the ins and outs of this type of living arrangement. There are good people and there bad people in this world, so trust your instincts if something feels off but I’d like to believe that most are good. Similarly, you’ll find there are good facilities and bad facilities but again, I’d like to say that most are good. I hope this book has helped to demystify the world of assisted living and empowered you and your elderly loved one. Some key takeaways to : the senior’s resources or a family member, not from insurance, covers most facilities. The investment in assisted living for your loved one, particularly if it’s incurred over a period, can diminish your loved one’s financial reserves just like any other kind of care. One of the most critical aspects to consider about selecting an ALF is to be a smart shopper. Educate yourself about the minutiae and cost of the facility your loved one is considering and ask a lot of questions. This means that once you’ve found a facility that fits the criteria, be sure to review all costs. Include fees for any extra services they might need now, or further on down the line as their health progresses to be safe. Your elderly loved one may need to visit the hospital so set aside a budget for that, as well as rate increases for facilities (due to inflation). not to assume that the facility will care for your loved one if they require skilled nursing. No nursing is offered (unless otherwise stated); rather facilities provide an enhanced social setting with essential care for someone who might have challenges with activities of daily living. ALF’s are a wonderful solution for many seniors and can be inappropriate for others. Assisted living can cost less than skilled nursing facilities and in-home care, which is a highly advantageous. This kind of service allows your loved one to hold on to their

independence while getting to help with their activities of daily living. Caregiver’s help with bathing, medication management, meal preparation or transferring from a wheelchair to bed and can make the difference that your aging loved one needs to manage well for a while without having to consider a nursing home. Most residents can stay in their ALF for the rest of their lives, which means no need to move around. You should know that some ALF’s work with the local hospice and deliver end of life care, which is a significant part of thinking ahead for you loved one. Many seniors are thrilled with the community connection, the friends they make, and the fun they experience in this setting. An ALF (especially a residential facility) feels like home. Rooms are set up to promote individualism and some even allows pets (whereas pets aren’t usually allowed in skilled nursing homes). Certain facilities are bright, pleasantly furnished, and have attractive amenities on site. They can be located in appealing places and cozy residential homes with access to gardens, patios, and backyards where seniors can unwind, hang out and relish in the good weather. Most of the time elders’ physical necessities don’t get to the point where they need skilled nursing (which has a hospital appearance and institutional smell). If given the option, the majority of seniors would go for a comfortable, well-furnished ALF before a choosing a nursing home. An ALF is simply more interesting for many who can manage without skilled nursing and who can afford the investment. Though this can be a tough time for you and your loved one, it’s best to look for the good in this part of your journey because the time will either way. Our beliefs have the ability to create and the ability to destroy because we assign meaning to our life experiences. No matter the circumstances, we all hold the power to take any experience and make a meaning that devastates us, or one that creates a life more incredible than we ever dreamed possible. If your aging loved one is having a bad day and it’s affecting you, there are people out there who would do anything to have just one more day (good or bad) with a loved one they had to say goodbye to. When we live in a state of gratitude, fear fades and abundance emerges. What’s wrong is always available, but so is what’s right. It’s up to you to see the beauty and find the love in everyday life.

Important Definitions:

Accreditation: A certification course that a senior housing or service supplier takes and an association (usually the state) awards credit that the facility has been carefully assessed and meets distinct criteria.

Activities of Daily Living : (ADL) The simple tasks that are usually done by the person such as eating, toileting, dressing/undressing, personal hygiene, and mobility.

: person who manages a facility

Adult Day Care : Program in a community where seniors are provided structured activities and services in a secure setting during the daytime.

Adult Foster Care : One or more seniors living with an unrelated person or family who provides care.

Adult Protective Services : Agency that investigates suspected senior abuse, neglect or exploitation.

Advanced Directives : Legal documents intended to make an individual’s health care preferences known.

Aging in Place: Staying in the selected environment as ability decreases and care needs increase

ALF : Assisted living facility, a non-medical residential community offering meals, housekeeping, assistance with activities of daily living, and medication monitoring and assistance-also known as Personal Care Home, Board and Care Home or Residential Care Home.

Alzheimer’s Unit : A living area inside an assisted living facility intended explicitly for the care of individuals with Alzheimer’s disease (usually locked to avoid wandering)

Ambulation : Walking, ability to walk

Assessment : An official assessment of physical or mental condition

Care Conference : A resident care session with medical professionals and family which focuses on assessing the most recent plan of care and including any needed changes.

Caregiver: An individual who cares for the needs of an elderly of a senior on a daily basis.

Chronic Care : Non-medical or medical care for a ailment with no anticipation of drastic improvement.

Cognitive Impairment : Challenges with memory, orientation and reasoning.

Community Fee : Commonly a single time fee collected at the time of agreement. The fee is used by the facility for restoration after the resident has left the community and can also be used for upkeep of shared areas.

Companionship Service : Folks who offer conversation and friendship, but don’t provide personal care.

Continence: Capacity to control bowel or bladder

DNR : DO not resuscitate order

Guardian : Someone assigned by the court to act on behalf of another individual who has been declared incompetent.

Hands-On : Physical help with an activity requiring the helper to touch the person getting assistance.

Home Health care: Care offered in the home by a licensed or unlicensed provider

Hospice : Special care for the terminally ill elderly individual that concentrates on relaxation and pain relief.

Incontinence : Incapacity to control bladder or bowels.

Independent Living : A kind of housing that offers meals and other helpful services for residents who are functionally independent. (Individuals who are in independent living would progress into assisted living)

Living Will : A legal paper declaring someone’s desires for treatment options in the event of terminal illness.

Long-Term Care : Services provided to seniors who need help with activities of daily living. This amenity can be done at home, in senior living communities, assisted living facilities or nursing homes.

Medicaid : t subsidized federal and state health insurance helping elderly and people with income issues and minimal resources.

Medicare : Federal medical insurance for people over 65 years old

Medigap Insurance : Private health insurance that covers standard Medicare that isn’t covered. Total of coverage changes by plan.

Non-Ambulatory : Incapable of walking

Non-Medical Home Care : Care provided in the patient’s home that resembles protective care and is non-medical.

Nursing Home : A place that offers complete medical care for elderly patients who need a lot of help with their activities of daily living. Services include modified health care, organized social activities, meals and medicine istration.

Occupational Therapy : Specific therapy intended to improve the capacity to manage activities of daily living.

Ombudsman : An impartial sponsor for residents of care homes. These people are qualified to resolve problems and grievances.

Power Of Attorney : A written document in which someone appoints another person to act as a representative on his or her behalf. Essentially, they award power to the representative to complete certain tasks for them.

Respite : Provisional for a caregiver when care is offered in a home or at a facility. Caregivers are encouraged to have a respite care plan in place before needing relief.

Survey : An examination by the agency liable for licensing a facility. Inspections can be routine or a reaction to a grievance.

Transferring : Moving from one position to another (sitting to standing or from their bed to chair).

Important Information:

• American Association of Retired Persons (AARP): 800-424-3410, www.aarp.org

• Family Caregiver Alliance: 415-434-3388, www.caregiver.org

• Elderweb (Eldercare Resources): 309-451-3319, www.elderweb.com

• National Council on Aging: 202-479-1200, www.ncoa.org

• Department of Social and Health Services (DSHS): A state umbrella association for health and social services. DSHS is used when your loved ones require Medicaid funds for housing and care. A caseworker will be appointed to you.

• t Commission on the Accreditation of Healthcare Organizations: 630-7925800, www.tcommission.org

• Social Security istration: 800-772-1213, www.ssa.gov

• Medicare: Health Insurance for the elderly and incapacitated managed by the Federal Government and subsidized by the Social Security plan. It doesn’t involve housing. There are on-going alterations with Medicare so visit their

website for the most up to date information at the time you are searching for an expert, or rehabilitative care. 800-633-4227, www.medicare.gov

• Medicaid: Health Insurance benefits for those in need of financial assistance, managed and funded by the state with federal government subsidy. Medicaid provides care and housing for seniors with inadequate funds to pay privately in assisted living, skilled facilities, rehab centers or adult family homes. Medicaid won’t cover housing for independent living. A need must be displayed for assistance with ADL’s (eating, bathing, dressing, toileting, medication assistance etc.) State guidelines and regulations will differ so check with your local DSHS.

• National Association for Homecare and Hospice: 202-547-7424, www.nahc.org

• Elder Law Attorneys: Expert attorneys who concentrate on serving senior citizens and folks with special needs. They teach and long-term care preparation, nursing homes, housing, and Medicaid. Check with the National Academy of Elder Law Attorneys, Inc. for an elder law attorney close to you.

State Supervision Agencies:

Alabama: Alabama Department of Public Health, 334-206-5075, www.adph.org

Alaska: Health Facilities Licensing, 907-561-8081, www.hss.state.ak.us/hflc.htm

Arizona: Arizona Department of Health Services, 602-674-4200, www.azdhs.gov/

Arkansas: Arkansas Department of Health, 501-661-2165, www.healthyarkansas.com/

California: California Department of Health Services, 916-445-3054, www.dhs.ca.gov

Colorado: Colorado Department of Public Health, 303-692-2819, www.colorado.gov

Connecticut: Connecticut Department of Public Health, 860-509-7543, www.dph.state.ct.us/

Delaware: Office of Health Facilities Certification, 302-577-6666, www.state.de.us/dhss/index.html

DC: Department of Consumer & Regulatory Affairs, 202-727-7780, http://dcra.dc.gov/service/assisted-living-residencies-regulations

Florida: Agency for Health Care istration, 850-487-2528, www.fdhc.state.fl.us/index.shtml

Georgia: Department of Human Resources, 404-657-5700, https://dhs.georgia.gov/

Hawaii: Hawaii State Department of Health, 808-586-4090, www.hawaii.gov/doh

Idaho: Idaho Department of Health & Welfare, 208-334-6626, www.healthandwelfare.idaho.gov

Illinois: Illinois Department of Public Health, 217-782-2913, www.idph.state.il.us

Indiana: Indiana State Department of Health, 317-233-7403, www.in.gov/isdh

Iowa: Iowa Department of Inspection & Appeals, 515-281-4233, www.idph.state.ia.us

Kansas: Kansas Department of Health, 913-296-1240, www.kdhe.state.ks.us/

Kentucky: Kentucky Cabinet for Human Resources, 502-564-2800, www.chfs.ky.gov/

Louisiana: Louisiana Department of Health & Hospitals, 504-342-0415, www.dhh.state.la.us

Maine: Maine Department of Human Services, 207-624-5443, www.maine.gov/dhhs/programs.shtml

Maryland: Maryland Department of Health, 410-764-2750, www.dhmh.state.md.us

Massachusetts: Massachusetts Department of Public Health, 617-727-1299, www.mass.gov/dph

Michigan: Health Facility Licensing & Certification, 517-241-2637, www.michigan.gov/mdch

Minnesota: Minnesota Department of Health, 612-643-2171, www.health.state.mn.us

Mississippi: Mississippi State Department of Health, 601-354-7300, www.msdh.state.ms.us/

Missouri: Missouri Department of Health, 573-751-6302, www.health.state.mo.us

Montana: Montana Department of Health & Human Services, 406-444-2037, www.dphhs.state.mt.us

Nebraska: Nebraska Department of Health, 402-471-4961, www.hhs.state.ne.us/reg/regindex.htm

Nevada: Nevada Department of Human Resources, 702-687-4475

New Hampshire: Department of Health & Human Services, 603-271-4966, www.dhhs.state.nh.us

New Jersey: New Jersey State Department of Health, 609-588-7733, www.state.nj.us/health

New Mexico: New Mexico Department of Health, 505-827-4200, www.health.state.nm.us

New York: New York State Department of Health, 518-473-1564, www.health.state.ny.us

North Carolina: North Carolina Department of Human Resources, 919-7337461, www.dhhs.state.nc.us

North Dakota: North Dakota Department of Health, 701-328-2351, www.health.state.nd.us

Ohio: Ohio Department of Health, 614-466-7857, www.odh.state.oh.us

Oklahoma: Oklahoma State Department of Health, 405-271-5288, http://www.ok.gov/health/

Oregon: Oregon Health Department, 503-731-4013, www.public.health.oregon.gov

Pennsylvania: Pennsylvania Department of Health, 717-787-8015, www.dsf.health.state.pa.us/health

Rhode Island: Rhode Island Department of Health, 401-222-2566, www.health.ri.gov/

South Carolina: South Carolina Department of Health, 803-737-7205, www.dhhs.state.sc.us

South Dakota: South Dakota Department of Health, 605-773-3356, www.state.sd.us/doh

Tennessee: Tennessee Department of Health, 615-741-7539, www.state.tn.us/health

Texas: Texas Department of Human Service, 512-438-2625, www.tdh.state.tx.us

Utah: Division of Health Systems Improvement, 801-241-2345, www.health.utah.gov

Vermont: Vermont Department of Aging & Disabilities, 802-241-2345, www.dad.state.vt.us/lp

Washington: Washington Department of Health Services, 360-493-2560, www.dshs.wa.gov/

West Virginia: West Virginia Department of Health, 304-558-0050, www.wvdhhr.org

Wisconsin: Wisconsin Department of Health, 608-267-7185, www.dhs.wisconsin.gov/guide/assisted-living.htm

Wyoming: Wyoming Department of Health, 307-777-7121, www.health.wyo.gov/ohl