Senior Placement Terminology
00:00 Monica: Welcome to A Right Place for Seniors. Hi everybody, I’m Monica. Nice to see you guys. We decided on the last time that we got together, wanted to talk a little bit more about terminology and what seniors who are leaving the hospital or having to leave their home for placement, families call us, and a lot of times we have to start off with the basics, which is talking to them about what the terminology is, so we thought we’d just go over real quick today, just kind of cover that a little bit. So we put together a little PowerPoint, so get a little visual aid on it. And let’s move into it. But before I do, Mary Golden, my business partner there at the bottom, Eileen Piersa, Eileen does our North County placements and covers pretty much all the North County and San Diego. With that said, let’s move forward.
00:46 Monica: Senior placement terminology. We always wanna know where we’re gonna land, all the different options that are out there, and we’re gonna get into those right now. So most of time we’re doing placement, we get calls from the hospital, saying we need some help with one of our patients who are being discharged. Oftentimes people get to go home, which is great, and they’ll get home care when they go home. But if people can’t go home because they don’t have the support at home or the financial wherewithal to hire private caregivers at home, then we move into other options. A lot of times before you can go into any kind of assisted living situation, they’ll go to a skilled nursing facility, and we’ll go into that in a minute, or assisted living communities, memory care communities, or board and care homes. So skilled nursing facilities. Mary, you wanna handle that one for us?
01:36 Mary Golden: Sure, sure. Skilled nursing facilities are post-acute care following hospitalization. So if you can’t go home right away because you’re not quite strong enough, you go there to recover and get stronger, get rehabilitative services like physical therapy, occupational therapy and speech therapy. In this case, Medicare or your insurance, combination of private and Medicare will pay for at least a portion of the skilled nursing time that you’re there, and the rehabilitative services. After a designated amount of time, and that’s all based on how you’re doing, and if you’re continuing to make progress and so forth, you’ll be discharged at some point. There’s maximum days they’ll allow you to stay in a skilled nursing facility, and if you overstay, it’s very, very expensive. So most people don’t stay beyond their days, they have to either go home because they can go there or they have to find some kind of care outside their home, in a senior community that will assist with their activities of daily living.
02:50 Monica: Yeah, and speaking of that, let’s go in a little bit into what activities of daily living are, and it’s exactly what it sounds like. They’re non-medical needs that people have to have to exist. You have to get dressed, you have to bathe, sometimes you need help with toileting or ambulation. So activities of daily living are things that when people can no longer, independently can no longer care for themselves in that way, then they go into an assisted living community. Oftentimes, family assist until they can’t do it any longer at home. And again, they’ll put them into assisted living, help them transfer into an assisted facility to get those needs met.
03:32 Monica: So placement options, we had discussed this on the previous slide, and the first one is an assisted living community, and Eileen, do you wanna talk a little bit about the different kinds of levels of care they have in assisted living communities?
03:45 Eileen Piersa: Absolutely. So it all depends on what that person needs. There’s still people that can live very independently, they don’t need any help with ADLs. We call that independent living. If they need some type of assistance, so all those things that we talked about on the previous slide, they may need one or two or all of those, so they would go into assisted living. And then there’s memory care for people that have dementia that might need to be in a really special environment where it may even need to be a locked facility because they tend to wander.
04:18 Monica: So just like Eileen said, independent living is just that. You’re just going to an assisted living community. Typically, that has… Sometimes they have a separate building for the independent living, sometimes independent living apartments are smattered in with the assisted living apartments, and so people like that because they’re independent. Some people pass without ever needing any assistance, but if it’s a need for a short period of time or permanently, they know it’s there on campus and available to them for additional charge.
04:54 Monica: It’s something to really think about when you move somebody into a community because there’s a base rate for your apartment and then your care levels or points depending on the kind of a community you go into are an additional charge. So you may be able to afford an independent living apartment, but as your assisted needs get higher, if they ever do, wanna make sure you’re moving them into a community that matches a budget that they could sustain for a lifetime. So they can greatly increase, somebody can go into a $3500 apartment and be in an $8000 assisted living wage five years later. So if they don’t have the financial wherewithal to do that, we try to be very careful not to put people in situations where they can’t stay, although some people will choose to go into a place and then make a change later in life when their financial needs don’t meet the criteria of the place that they chose to begin with. Next place doesn’t have to be the last phase, but typically people try to look for that.
05:52 MG: Yeah, so another environment in the assisted living community is for people with memory issues. So we talked about the last presentation to you, people with dementia diagnosis, Alzheimer’s, any kind of memory issue will, if they’re in an assisted living community, some communities, and actually most of them now have secured memory units, if you will, and this means that they’re living in an area that is secure. They can’t leave. They often reflect or look like near the communities at large, and people can still go visit them and so forth, but it’s for their own safety and for the safety of others, they don’t wander off, get lost and get hurt. So the pricing has to be more straightforward in these. It’s more inclusive, so they’ll say, you have maybe three levels in memory care as opposed to all the different levels in the main assisted living. And it’s typically more expensive because the residents require more care and supervision, but it is all geared toward people with memory issues.
07:09 EP: One of the things about having this inside an assisted living community is if one spouse just needs help with daily living, but the other one has memory care. What’s really nice is they can go back and forth and visit each other.
07:26 Monica: Yeah, that’s great.
07:27 EP: Assisted living community. So I’ll grab this one. So then there’s the standalone memory care communities, and this one, they really do specialize in dementia care, they do also in the other ones, but we have found that when we’ve got somebody that has some behavior issues or some special needs that oftentimes see stand-alone memory care communities are a great place. Of course, they’re gonna be more expensive, staff is additionally trained, they’ve got extra services. The ratio of residents to caregivers is high so that way they can address different things happening, but there’s some amazing standalone memory care communities out there that are wonderful for your loved one.
08:09 Monica: And then the last one we wanna talk a little bit about is, not the least of which we wanna talk about, which is board and care or residential care homes. Lots of people can’t afford assisted living facilities. Even if their care needs are modest, they don’t have six, seven and $8000 a month. So board and care homes tend to have a lower price point, and it can be dependent on the area of town where the home resides, just like any other piece of real estate, but they all give good care, at least the ones we work with do. And the main reason that people go into them is because they do have a higher care need that they can’t financially manage at an assisted living community, so they go into these board and care homes.
08:56 Monica: These are regular homes just like you see on the slide, typically six seniors live in that home, you can get a private room or a shared room. Shared rooms tend to be a little less expensive. They do provide a higher level of care in that the ratio is a lot higher for caregivers to residents, you have two caregivers and six residents. And it has a real intimate environment, so you can hear somebody calling down the hall if you need, or they walk and see somebody 15-20 times a day as they’re passing by their room or they’re all in the communal living room or they’re all in the dining area. So it’s a much easier environment to monitor people. That’s why a lot of folks who have family members with dementia choose board and care homes because it’s more like a home setting for them, it’s easier for them to navigate and learn, and they get a lot of one-on-one attention from the caregivers there.
09:49 Monica: You guys have any other comments about board and care homes? Because I know that’s about two-thirds of our placements that we tend to do. Eileen, did you have any comments that you wanna share about board and care and your experiences in North County?
10:03 EP: One of the reasons why we like to educate people about all the options is you may start off with one option and move into another. For instance, what oftentimes happens is if the senior is gonna take part in all the activities and the fun things going on in assisted living, ’cause they have lots of activities, they’re going out and doing things, but then eventually if they do…
10:25 Monica: Decline?
10:26 EP: Decline, thank you. And they’re not doing those kinds of things, then we find that it’s much better to be in a board and care environment, also saves money, and they’re in a much safer for them environment that’s more homey and all like Monica was talking about earlier.
10:44 Monica: One of the other things that we wanted to mention about board and care options is sometimes it’s a second landing place for seniors. They’ll start off in assisted living, whether it be assisted living or memory care and an assisted living community, but they’ve gone into such decline that they’re not enjoying the activities, they’re not socializing, they don’t wanna leave their room, and their family is paying an enormous amount of money for them to be in those locations. So sometimes we can find more reasonable pricing in a small board and care home that specializes in dementia care, and the person has a smaller environment where they can manage a little bit better with less people, and they tend to do real well in those situations. So it’s always a second option for families who don’t wanna remain in the big facilities or can’t afford to remain in the facilities.
11:38 EP: And that’s why we like to educate everybody on all the options at the beginning of the journey so that they can know how things might change up as time goes on.
11:47 Monica: Right.
11:48 MG: And one more thing, just to point out, all of these communities that we work with, assisted living, memory care and board and care homes are licensed communities, meaning they are overseen by the State of California, and they have to meet certain qualifications, and they’re monitored on an ongoing basis. So one of the things that we’re able to do is to look at what kind of a track record they have, if they have violations of any kind, what those violations are, etcetera, so that you can have some peace of mind that where you are putting your loved one is a quality home that hasn’t had a problem history.
12:27 Monica: Great point, Mary. Okay, so well, thanks, you guys, that I hope was helpful for the people that are coming on and trying to learn a little bit about the placement experience. I just wanna reiterate that we’re here to help when placement is right around the corner. We’re happy to help guide families through this process. It’s overwhelming, it’s a lot of facilities, a lot of places, a lot to know, and hopefully, this is a first step in helping people get a little bit more educated.
13:00 EP: And remember, our services are free to use.
13:03 Monica: That’s right.
13:04 EP: Or to just contact us to have a conversation.
13:07 Monica: Yeah, yeah.
13:08 MG: And we’ll work closely with your case manager, or the case manager at the hospital or the skilled nursing facility to make sure it’s all seamless.
13:19 Monica: Great, well thanks, guys.
13:20 MG: Alright, thank you.
13:20 EP: See you next time. See you next time.
13:21 Monica: Nice to see you ladies. See you next time. Okay, bye-bye.
13:23 MG: Bye.