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Welcome to Healthcare Redefined: Advocating for Aging Adults and Their Families, where we empower families to navigate the complexities of aging and healthcare. Presented by Your Nurse Advocate Consulting, we share real stories, expert advice, and practical tools to help you and your loved ones confidently navigate aging with dignity.
We explore topics like creating collaborative care plans, demystifying Medicare, handling healthcare crises, and preparing for the future. Join us as we transform uncertainty into understanding.
Pam Dunwald: [00:00:00] Well, welcome, everyone. Before we dive in, have you ever said our goal is to keep mom at home? But then, you know, you cut yourself thinking, what if something changes and home isn't safe anymore? Today we continue our conversation on aging in place and what is an important part of that. Aging in place is having that plan B, because all it takes is a serious health crisis, frequent falls or worsening of their already chronic conditions that can change what's safe even when everyone's trying their best.
Linda Kritikos: [00:00:32] Yeah, our first goal is still aging in place, but today we're asking if home isn't safe, what would be an acceptable plan B? And one option families often consider is assisted living. So what is it? What it isn't. How to know if it's the right type of community and how it's paid for. So stick around. So welcome to Healthcare Redefined. Advocating for Aging adults and their families. The podcast where we tackle the real life challenges of caregiving, aging, and navigating the healthcare system. I'm Linda Kritikos.
Pam Dunwald: [00:01:06] Hi, and I'm Pam Durnwald. We both have over 80 years of combined experience as registered nurses and also board certified patient advocates. We're here to help you feel confident, informed, and most importantly, supported every step of the way. This is a topic that can bring up a lot of emotion. Families often feel pressure to make the right decision, and older adults may feel fear about losing their independence. Linda and I interviewed when we first got started. We interviewed aging adults. I'm sorry. We interviewed the adult children of the aging parents and even some of our own children. I remember my daughter saying the one thing that really stood out to me. She said, the biggest thing that I'm afraid of when it comes to managing the care of my aging parents is the fear of making the wrong decisions. So that is part of what goes into this. That's why we're doing this podcast to help you be able to make those informed decisions.
Linda Kritikos: [00:02:08] So our goal today is to bring this back to something practical. Planning ahead. When you have a plan B, you're less likely to make decisions in a panic and more likely to find a setting that supports safety, dignity, and quality of life. So this episode, assisted living as plan B when aging in place isn't safe. So today we're joined by Dani and Dorsey, nurses who either have worked in assisted living or currently worked in the assisted living space. Danny is going to help us understand what assisted living is and isn't, and how different communities work and what families should and should not ask, especially around assessments, safety medications, and costs. Dorsey will then talk with us about more of the logistics of assisted living and what it takes to run an assisted living and what people should expect from an assisted living. So Dani and Dorsey, welcome to Healthcare Redefined. We are so happy that you're here. You guys have a wealth of knowledge and information. So we hope that you enjoy this time talking about it because it is your wheelhouse for both of you. So Pam, I'm going to have you set the stage.
Pam Dunwald: [00:03:19] Sure, sure. And you know, one of the things we talk about is when people want to age in place, that's great. But a plan B is, is what happens if you can't. And we'll look at in the beginning, we look at some of those signs that you may not be able to be safe in your home anymore. We're looking at things like weight loss, losing or misplacing things frequently, increase in confusion or behavior changes, maybe not taking your medications correctly. Maybe you're not even being able to pay your bills on time. Maybe you're having a hard time getting in a shower or one of the things is if you're neglecting your pets and your pets care, chances are you're also not being able to take, you know, very good care of yourself. So what if you're missing doctor's appointments or, you know, many things? Maybe you're not able to prepare meals. So the first thing I want to ask is, you know, by looking at these things, what are some of the signs that you see most often or right before a move to assisted living? What do you hear more frequently that aging adults are struggling with at home?
Dani: [00:04:32] Well, hi, I'm Dani. I've been an RN for about ten years now and in a multitude of different backgrounds, from hospital to long term care to assisted living in leadership. What I saw mostly was individuals that would come in and they're not able to do their activities of daily living anymore. Or they fell and they got hurt or their memory, they're putting things in the washer that don't belong in the washer. They're, you know, neglecting the bills, you know, so.
Pam Dunwald: [00:05:04] And Dani, before we move on, could you just explain a little bit what ADLs mean? Most of our listeners won't know what that is, right?
Dani: [00:05:12] So that's activities of daily living. So that's something that we all do every day. We wake up, we get dressed, we take a shower, we brush our teeth, we comb our hair, we go to the washroom. Those are activities of daily living, laundry and cleaning and, you know, paying your bills. All those things are incorporated in activities of daily living. So when you see those things start to not happen, the loved one is not taking care of all of those things. You noticed, like I said, different things, maybe in the dishwasher or falls are occurring, or they're wearing dirty clothes every day and you're noticing when you're stopping by that that's not being changed anymore. The pets, like you stated, not being taken care of, the water and food dish being empty, you know, those are the biggest indicators. And loved ones usually do act fast when they see those things change. But the problem is, again, they do not have a plan B, and that's why this is so important, is to talk about it, to get them out there and educated. And just thinking about it really just having something written down so that when they do start to see a decline, because we are all going to decline, it's very rare that you know somebody. So it's just best to always have that plan B and just getting that knowledge early.
Pam Dunwald: [00:06:34] And so Dani,or Dorsey? Whoever wants to answer, what would you say is the most common tipping points that makes assisted living a much safer option?
Dorsey: [00:06:44] I think that it would be and you just said it is basically a safer option. So when safety is at risk. So it could be falling, they may be able to have control over their bowel and bladder, but they're having frequent accidents because they can't make it to the toilet or they make it to the toilet, but they're not able to clean themselves up properly. Things like that. As an adult child, you go over to visit and you're noticing that they just their medications aren't being taken or things like that. So some of those things, when it, when safety is concerned, that's usually a tipping point. Many families will try and take shifts sometimes to go stay with mom or dad and try and handle it that way. And that's usually a first, you know, resort, but it causes a great deal of burnout, a great deal of caregiver burnout. Adult children are putting their lives on hold to help take care of their adult parents, which to them that's good. They may feel like it's their duty. They may feel honored to do it, but it's still disruptive of their own lives. So that could be a tipping point too, where it's just, I'm doing everything I can and my mom still isn't safe or my dad still isn't safe.
Pam Dunwald: [00:08:16] Gotcha. So now that we've kind of talked about some of the signs that tell us something needs to change or it may not be safe at home, I want to turn it over to Linda a little bit to let let us get clear on what assisted living actually is.
Linda Kritikos: [00:08:30] So I want to start by looking at our 11 signs that we have, which is a resource on our website. And then I want to ask both of you about those signs, what you see most. So frequent falls in the last 3 to 6 months. That constitutes bruises, bumps, cuts, burns, possibly even an emergency room visit. Weight loss in the last 3 to 6 months and you may not know it by their weight, but their clothes aren't fitting. Their clothes are falling off of them or they're too tight on them. So weight loss and or gain. Losing or misplacing things frequently with increased confusion or behavior changes like they can't find the keys, they can't find their glasses. Isolation or seclusion from friends, families, or activities. You see them spending more time at home, alone or in their environment instead of out socializing. Not taking their medications correctly. The house is unkept, and some, I have to say some people's homes are just naturally unkempt, but we're talking outside the normal unkempt. Poor hygiene and odors. Like if they smell like urine, like because they haven't changed their clothes or they haven't washed up. And of course, the pet care being neglected if they have pets, and then finding the stove or appliances left on, such as the gas stove on, and that it turned on, but the flames not on. So you smell gas in the house, appliances left on even the electric stove where they leave it on and or forget that they're cooking something. I'm missing doctor's appointments and then seeing their bills or their mail piled up where they haven't even gone through it. So which of these signs do you see most often, right before a move to an assisted living? Which of those that we have gone through, or is it that just one? Is it a combination of more than one?
Dani: [00:10:25] It's definitely a combination. And it's. I wish that question was easily answered. Not everybody is different. And also what they want to bring forth and what they don't want to bring forth, you know, so the individual sometimes will keep a lot of things that they're struggling with. You know, they won't bring that up to their family member, so they're not going to bring it up to the nurse assessing them for placement at an assisted living either. So really, it's looking at when you go for an assessment, which is what the nurse would do prior to being accepted to an assisted living, that nurse would look at the whole picture. They would look at the house, they would look at the family, they would look at the resident. They would look at their medical record prior to even going to do the assessment. So you look at all those things. And a lot of times you look at the family members or the children as the great historians, there'd be times where maybe that individual doesn't want to say they're embarrassed or they don't want to bring it up. So then, you know, usually the nurse will also talk to either the healthcare POA, which is usually a son or daughter separately after the assessment and ask, you know, is this true? Do they need help in this area? So it's really incorporating the whole family. It's a unity. It's the whole situation you have to look at in order to really find out what is their biggest need. And are we able to take care of their needs at our assisted living because they're all different?
Linda Kritikos: [00:11:54] So in saying that, I have a follow up question for that. So what signs or things do families kind of tend to minimize or hide? Because I know they should be honest and they should be transparent, but we all know because they really want them to go in there and they're afraid they're going to be denied. So what do you see them explain away until something bigger happens? What do you see?
Dorsey: [00:12:18] Oh, some of the most common signs. And I'm sorry, I'm Dorsey. I didn't introduce myself with the last thing I said, but I'm Dorsey. I've been a nurse for 27, 29 years. Excuse me. And I'm currently the executive director at Archwood Senior Living. But like I said, I'm also a nurse, so I have been in the director of nursing role myself. One of the biggest things that we see that is hidden would be the level of confusion and memory loss, especially if they. So in assisted living, generally, there could be. Some are different. There could be two different units, one for dementia care, memory care, and one for assisted living. And if they really want their parent to be in assisted living and not over in memory care, they will minimize their level of dementia or confusion. And along with that, if they have behaviors. So if they tend to lash out, they have anger outbursts, wandering, confusion, leaving the house and, you know, walking down the street and getting lost, sometimes they will hide those things because they're afraid that because of those behaviors or the level of confusion and memory loss, that they won't be accepted.
Linda Kritikos: [00:13:40] Wow. So yeah.
Pam Dunwald: [00:13:42] That makes sense.
Linda Kritikos: [00:13:43] Yeah. So let's now that we've kind of talked about that, let's move on to what assisted living is and what it is not. So if you both can answer this and hopefully, but I would like simple definitions in kind of a layman's terms so that people understand that of what, what type of support it is, the type of safety and meals and activities are in these types of communities. So tell us what assisted living is and what does that actually mean day to day?
Dorsey: [00:14:16] Okay, well, I will give you what assisted living is. And Dani, I turn it over to Dani for what it is not. So assisted living is basically a home-like environment. It is not a nursing home, but a home-like environment with adults who may have some independence or no need for skilled nursing care. And they need help with those ADLs. The activities of daily living that Dani talked about earlier. So they need help with medication management. Meals and housekeeping. Support social support. Safety, somebody there 24 over seven that can keep an eye on them. Socialization and any other daily routines. They may need transportation, mobility. Some need help with it all. Some need minimal help. Maybe they can brush their own teeth and they can brush their own hair, but they need assistance in the shower. So anything like that, and the goal is to help them be as independent as possible while providing the assistance they need per their level of care. If they can do it on their own and they just need us to stand by, we do that too. If they're completely independent, they don't need any assistance at all. Then we will allow them that independence. So that's why they get frequently assessed. If there's any level of decline, then we can change the care plan to fit their needs.
Dani: [00:15:51] Yeah, definitely.
Linda Kritikos: [00:15:52] So Dani, tell us what it is not. I know it's not a hospital. And it's not a 247 1 to 1 nurse, you know like that. Yeah. So tell us what else it is not.
Dani: [00:16:05] Well, if they have higher needs or you know disease processes say they there are tube feeder or they need IV fluids you know, maintenance, IV maintenance, anything like that. That's skilled nursing, Foley catheters, they can be managed in assisted living with a third party home health company.
Linda Kritikos: [00:16:24] And so that's a Medicare certified home health company.
Dani: [00:16:27] Correct. And then they would also go through the insurance. It would be Medicare. But then also, if you have the primary is Medicare or if you have a different insurance company as your primary, it would go through that. So those things can be taken care of there. But when it's beyond that, when it's beyond three hours of nursing care, then you're looking at skilled care. The reason being is a home health company can go in, but they can only go in and manage for a couple hours. It's something that is manageable periodically. It's not something that needs to be managed 24 over seven by a healthcare professional, a licensed nurse. So that is what a CBR assisted living is not. They do not have nurses on the floor. They do not have nurses in the state of Wisconsin passing medications on the floor. There is a R.N. that works for the CBR.
Linda Kritikos: [00:17:18] What is a CRF?
Dani: [00:17:19] Assisted living. So it is community based. Residential facility facility. Yeah. So knowing that they are not educated in a way that they're going to be able to assess your loved one that they're going to be able to prevent taking them out to the ER or out to the clinic. They're not going to be able to do that. So the families are still responsible for coming in and helping facilitate that care and or 911 EMS. So when there's something a change in condition or a fall, the staff is not licensed to assess. They're not nurses. They will rely on EMS, which means they will call 911. The individual has a right to refuse EMS treatment to a point if they're bleeding out or they need intervention, they're going to take them. But that's really the difference. That's what assisted living isn't. And I like to say that's what skilled nursing is, because those are the two different facilities, at least in the state of Wisconsin, that I want people to really understand, you know, what they're paying for and what they're getting.
Pam Dunwald: [00:18:28] So when we're talking skilled nursing, you're referring to a nursing home.
Dani: [00:18:31] Correct. Yes.
Pam Dunwald: [00:18:32] Okay.
Linda Kritikos: [00:18:34] Yes. So the nursing home would provide that higher level of care where they would need a registered nurse or a licensed practical nurse on site 24/7 to be able to assess and provide a higher level of care than assisted living would provide. Correct? Okay.
Dorsey: [00:18:52] Correct. And a difference too, being that in assisted living, there is nursing oversight. A nursing on call, but there is not a licensed nurse there 24/7, whereas in a nursing home there is.
Linda Kritikos: [00:19:12] Okay. All right. So when people hear the word assisted living, what does that actually mean day to day? Like, can you go through like what? What goes on in an assisted living day to day?
Dorsey: [00:19:27] So in assisted living, we as care staff are responsible for basically their entire daily routine. And of course, that depends on the level of independence as well. So, we may get them up for breakfast, you know, or get them up for the day if they, you know, need to change their clothes. We can change their clothes, we can make their bed, we can tidy up their rooms. And then housekeeping services will do a deeper clean once or twice a week, depending on what is on your care plan and what the needs are. Grooming and then activities that that one is so important because there's that downtime in between meals where they may be bored. We don't want them just sitting in their wheelchair or their broda chair, which is kind of a higher backed wheelchair, a little more comfortable.
Linda Kritikos: [00:20:25] Or sitting in their rooms.
Dorsey: [00:20:26] Or even sitting in their rooms just staring at the TV.So our activities department will, you know, socialize them. And everyone will gather together. We'll do games, we'll do bingo, you know, go on outings, all kinds of things as far as that's concerned. Other things.
Dani: [00:20:47] Well engagement I mean that's huge. So when they're sitting at home and and they kind of isolate themselves, like you said, was one of the reasons being in a community, like I've said this before, but it they may lose their autonomy in certain areas, losing their home and changing their whole life, coming to a community, but they're actually gaining autonomy because they're within a community where they meet people, they socialize, and they have a choice. So they have a choice whether or not to go to happy hour. They have a choice whether or not to do the activity or, I know Archwood went to the Cubs game last summer. I mean, it gives them that opportunity to have a choice without the burden of it being on the family. Families also have a choice to attend, which is really awesome, at least at Archwood. It's like that where they can come and attend these activities with their loved one and actually be their family member and connect and not have to worry about, okay, you know, mom had an accident. Oh, gosh, I gotta get her to the bathroom. An assisted living, there's aides that are helping do those things. So therefore your, your family member can actually sit with you and connect with you and be your family member in those moments. And it doesn't have to be a stressful situation.
Linda Kritikos: [00:21:59] And I know from my experience just working and going in and out of a lot of different assisted livings, I see kind of like a collaboration and almost like a genuine, sincere relationship development between people, because a lot of them have a lot of the same life experiences. Some of them are veterans, some of them have lost all of their friends and loved ones. And here now in this community, they develop new friendships, new relationships and hang out together. Play cards together and watch movies.
Dani: [00:22:29] They have things in common. We're all human beings and we all have experiences. But we. To be in a community where you're surrounded by people where you can create connections again, that's huge for human beings and just for your thriving, your quality of life. It's huge. And I think a lot of times people don't look at assisted living in a way like that being the forefront. You know, they're looking at all the worries of the medical needs or the falls or the memory. Definitely also look at the activities that are going to be the biggest, make it or break it in your plan B, definitely look at that moving forward. Make sure that is a number one priority.
Linda Kritikos: [00:23:08] And they all have calendars. You have calendars that they have to, so they can look at all the activities that they could participate in at any point in time. So, Pam, I'm going to hand it over to you for the next section here.
Pam Dunwald: [00:23:21] Alright, so what we want to do is a look at maybe addressing some misconceptions. And on the other side, some also have some expectations. And so what do you feel is the biggest misconception families have about the assisted living level of care?
Dorsey: [00:23:40] What I see most often is, thinking that there's one on one that our caregivers, and everyone has the right to feel like they're the most important. And we try to portray that you are the most important. Of course, we know in the back of our heads, everybody is the most important, but the family members need that support. So it's not to say we don't support that, but there are things that we just physically cannot accomplish. One on one being one of them, meaning one caregiver to that resident, where our caregivers are spread out where I know where I am at Archwood senior living. We staff very well at other places. They may be spread a little thin. So just being that we cannot provide those one on one services, especially if there's a safety issue or a behavioral issue. Sometimes the families have to be asked for themselves to provide that one on one, whether it be within the family or somebody that they hire.
Dani: [00:24:50] Yeah, temporarily. Sometimes families will be asked to come in, but that's also a great question. When you go and you tour these facilities and ask in a situation where there's a crisis where all of a sudden they have altered mental status, meaning they're very confused. It is not your loved one's baseline. How would the facility handle that and keep your loved ones safe? Now I know at Archwood I can speak of is we will ask families to come in and be a one on one, but we also, if able, will provide hopefully an aid to be a one on one that's either already there or we'll send out a text message saying, can anybody be a one on one temporarily for so many hours? And then those other plans are in place. Either a family member comes, or they can hire another company to come in and do a one on one. Those are options, but I would definitely ask facilities when you tour them. What would you do in this scenario if this did occur, how would you handle it?
Dorsey: [00:25:47] Another one would be this one is pretty common would be that we can force their loved one to do what that family member thinks is right for them. For example, if they refuse their medications now, there are different options that we can do to attempt to get them to take their medications. We offer them their medications, they refuse. We come back and offer a second time, maybe a little bit later. They still refuse. Maybe we try a different caregiver, somebody that they may trust more there. They recognize their face and their hairdo and their voice, and they trust this person. We can make those attempts, but we cannot force them to take their medications. We also cannot hide their medications in food. So we cannot put it in pudding. We will put it in applesauce. But they have to know that it's there. We can't just be like, oh, you're going to take a bite of applesauce and not tell them that they have medications there. We can't force them to shower. We can't force them to walk instead of using their wheelchair if they have both options there. And sometimes the family members are like, you need to just tell them activities. You need to just tell them they need to come out and they need to do this activity because they need to do, they need to be social. Now we can approach it in a different way. Instead of asking them, would you like to come play bingo? We can say it's bingo time. Come on. I'll walk you down. Because sometimes the approach makes the difference. But if they refuse, they have that right.
Dani: [00:27:30] What I notice, too, is what also makes a huge difference is family involvement. I can't tell you how many times I've been in residents rooms where their story would be one thing to me, and then the family member or daughter or son come in and it's a completely opposite story. I would ask the facilities you tour, how do you incorporate family? How do you involve the healthcare Po when things aren't getting done, like the activities of daily living, the showering, the medication management of taking it? How you handle those situations is what you need to ask the facility. Because if they come back and they say, well, we tried two different approaches, we cannot force them. We will call the healthcare Po. We will reach out to our family. Those are the things you want to hear to create a good plan B and have a good facility in mind for your loved one. You want to ask those questions, give them scenarios, those hypotheticals. That's how you're really going to find out how they manage the care for your loved one and everybody else that's in their facility.
Pam Dunwald: [00:28:30] Okay.
Dorsey: [00:28:30] A team effort. Yeah, sure.
Dani: [00:28:32] 100%.
Pam Dunwald: [00:28:34] Linda, let's move on and let's talk about the differences in the different types of communities. And how do you know which one to consider for your loved one? Many families lump things together. So if we could ask if you could just clarify the different categories, you know, like the difference between independent living, assisted living, memory care. And we did, I think we did talk quite a bit about skilled nursing. So what's the difference between independent senior living assisted living and memory care?
Dani: [00:29:08] So independent living is where an individual chooses to join a community, maybe for the socialization aspect of it, and they don't need any medication management. They don't need any help with their activities of daily living, but they want to be part of a community that is independent living, where they take care of all those things themselves, right? But at least there's someone there. If that changes that, they'll have their eyes on them. They'll be able then to create an adjustment to assisted living within that same facility. Because you have people that are independent, you have people that are assisted. When a change of condition occurs and they need more assistance, they have already lived in the facility, it just switches over to assisted. Then when they need a caregiver to come in and check on them in the morning, get them ready for breakfast, partially assist them getting dressed maybe, medication management. So that goes into the assistance. Now the memory care aspect is the same as the assisted in a sense, except you are in a locked unit, meaning they cannot elope. So with memory care, the biggest safety concern is elopement.
Linda Kritikos: [00:30:18] Which is?
Dani: [00:30:19] I'm sorry, is, you know, getting out of the facility, out of the building and walking across the street and getting hit by a car because they have no idea where they're at, but they're wanting to either a go home or find Susie or Jimmy was picking me up and we have no idea who Jimmy is. So the reason for the locked part is in reality to keep them safe from elopement. When that memory starts to fade, when they start to get diagnosed with Alzheimer's or dementia, and their behaviors are exit seeking, and they're trying to get outside, but they don't even know why or when they're saying they want to go outside. The reason why it makes no sense. So then it transitions over to the memory care unit, which usually is a locked unit.
Pam Dunwald: [00:31:02] Yeah, I just want to share, you know, that Linda and I, one of our very first clients, had Alzheimer's. And that was the first sign she knew as self-awareness that she stopped going to church and isolated herself because she couldn't remember the names of people at church. But why I bring her up with the Memory Care unit is that she went through Alzheimer's stages very quickly from, it was less than a year between she noticed the symptoms and she passed. But she always talked about wanting to go home. We had locked windows, locked doors. She was always trying to get out. We showed her pictures of her old home. We could never figure out where she meant home was, but it was just a continuous driver for her to try to leave. And so that's such an important part with a memory care unit.
Dani: [00:31:59] It is. And most of the time that is what we call a behavior. It's hard to think of that as a behavior. But in reality, in their world, they're going back to the only place they can maybe remember or know, which is I'm going home, whatever home may be. But they're trying to get there and that's living in their world at that time. So having that locked facility is eminent for their safety. It's very, very important. And I, I see families where they do struggle with that and they've challenged that. And they can't really turn that clouded lens of emotional attachment to safety. That's hard.
Dorsey: [00:32:39] It is. And my advice to families to piggyback off of that is please trust the nurses and those who have done the assessment because of what Danny just said, you know, it's hard. You're emotionally attached. It's really hard to see your mom and dad, who was strong once and took care of you and took care of the household and worked. And, you know, basically just the patriarchs or the matriarchs of the family. Now, in a different light, it's hard to see that. So you're still, sometimes the family is still thinking, well, they don't need memory care. You know, they as I said early, they earlier, they just maybe need assistance. Please trust the process. Trust what the caregivers or the nurses or people doing the assessment are telling you. If they feel that memory care is the best place for your loved one to be, there's a reason behind that. And safety is usually the biggest reason. Or if you're already in the assisted living environment and it has been determined through change of condition of your loved one by the nurses doing the assessment that now assisted living is no longer safe. You know, they really need to move into the memory care unit. That's a really hard pill to swallow for families, but please trust your nurses because again, there is a reason and safety is at the top of the list there.
Linda Kritikos: [00:34:17] So safety, a reason why they had falls or behavioral issues, then those would be some of the reasons that someone would need more than assisted living.
Dorsey: [00:34:28] Correct.
Linda Kritikos: [00:34:29] Okay.
Dorsey: [00:34:30] Correct. And in the assisted and in the memory care, you know, there's they're trained on dementia care. The units are locked and staffing at least where I work now at Archwood, the building is smaller. Staffing is beefed up more so there's more eyes and a lot less stimuli and a lot less downtime where they can. It's just a safer, more cozy and comforting environment.
Linda Kritikos: [00:34:58] Calming environment.
Dorsey: [00:35:00] Calming. Exactly.
Linda Kritikos: [00:35:01] Okay.
Pam Dunwald: [00:35:02] What I'd like to do now is kind of shift gears a little bit and maybe bring up a question that causes the most stress to families, and that's how do we pay for this and what should we watch out for? So, Linda, I'm going to turn it over to you to get us talking on that topic.
Linda Kritikos: [00:35:18] You know, in keeping this educational, you know, because I know we're not the financial gurus of all of this and breaking it down to all these little different things that break down into cost. But can you explain what a base rate would be, what the care level would be, or sometimes what they call add ons or a la carte services? I mean, how do families pay for all of this? And how do they know what to pay for based on those things of base rate and care level and that?
Dorsey: [00:35:48] Yeah. So the base rate is basically the room and board, then care levels come in and that's usually based off of the assessment.
Dani: [00:35:57] Yep. So the base rate, obviously if somebody is independent and they want to come join a community, it would be the base rate. They wouldn't need any needs or assistance with their activities of daily living. When an individual needs assistance with activities of daily living, it's based on the assessment on top of the room rate. So the assessment is created by the DHS 83 state.
Linda Kritikos: [00:36:22] They state it's state regulation that breaks everything down of what's required in that.
Dani: [00:36:27] And they create all the questions and the answers and the point system. It's all created by the state. In order for a facility to be able to accurately charge an individual for their care, right? So when the nurse goes and assesses them, they see their needs. They look at their medical history, their record, but they also put their eyes on the individual. They assess everything and they see their needs and they create and answer the questions throughout the assessment, which will generate an acuity care level, meaning a point like a number system. Right. And some facilities have tier one, tier two, tier three, and they'll have little descriptions underneath of like, well, if you need insulin management because you're diabetic, then you're going to be level two automatically or, you know, you're going to be level three if you need a third party to manage your fully care. At Archwood. We have a tier one and tier two, but we do not have a description of certain medical conditions that are going to put you into that tier. It's actually based off the number that comes out of that assessment, the initial assessment, which I personally like. I think it's pretty unfair when you're going shopping for assisted living, to have them put you in a certain level or a certain tier because of a disease diagnosis or process.
Dani: [00:37:45] So my advice to listeners would be to ask, how do you charge for the level of care assistance that they need on top of the room and board? Because if you're looking at someone who, oh, well, if you're diabetic, you're automatically a level two. I personally would steer away from that. I don't feel that's the best approach financially or to appropriately charge an individual for their care. I don't feel that that's the best way to do things. I think just having it be either like a tier one or a tier two, and it's based off of the numbers, because the biggest misconception I see or hear from families is, well, if I add medication management, then I'm going to be pay more. That is not necessarily true. It goes by points. So you could add medication management and say it adds five points to your total of points. You're still in the tier of 1 or 2. You're not going to go up in cost. So it is not that black and white and or it shouldn't be. So I would steer listeners away from facilities that do the whole, oh, if you have this diagnosis, you're going to be in this tier. I would steer more towards the facilities that go by the accumulation of the points.
Linda Kritikos: [00:39:03] So more individualized versus a bucket or a yes, 100 or an umbrella. Yes. Right.
Dani: [00:39:10] Because you're privately paying.
Linda Kritikos: [00:39:12] Right.
Dorsey: [00:39:12] And how much assistance do you need? You could be a diabetic and be independent in every other aspect of the assessment. And to automatically put you in a tier two, just because you're diabetic isn't quite fair. So you know, it should be an accumulation, like Danny said, just summing up all the points of where you need assistance in everything that's on that assessment.
Linda Kritikos: [00:39:40] Okay. So what types of things are considered add ons? What would be an add on like, or.
Pam Dunwald: [00:39:46] What is included? Yeah. Or what's included in that monthly?
Linda Kritikos: [00:39:50] What's included in your room and board rate and what would be an add on.
Dorsey: [00:39:53] So included in the room and board rate is going to be, you know, your meals, the supervision of the caregivers, the assistance with your activities of daily living, which is your grooming, your dressing, your bathing, your toileting. Assistance in what's called instrumental activities of daily living, which then includes housekeeping, laundry, and those things. As far as add ons, that could be maybe you need an extra day of laundry, maybe what's included is one day a week laundry, but you're asking for two days a week. Same thing with housekeeping, meals for your family, you know, things like that could be add ons. It just kind of depends on not only your needs, but then your wants, so add ons would be more like your wants, you know, what, what's going to work best for me? What am I used to at home? You know, I've always done it this way at home. I don't want to give that up, this is more assistance that I need. And then those costs vary, you know, depending on what it is.
Pam Dunwald: [00:41:03] Yeah. And, you know, we assist clients all over the United States, and we have looked for assisted living communities all over. And I just want our listeners to know that in the show notes, we'll put kind of a checklist and what to ask, what you're looking for in assisted living. But just know, depending on where you live, these things, what's included in our monthly fee may not be, you know, at, at a community you're looking at in yours. We've seen where there's maybe two meals a day included. And if you want a third meal a day, that's extra. Maybe they allow you to have pets. They'll have a pet walking service, they'll charge you extra for that. So it's real important to make sure that you understand what's included in your so-called base rate and what the extras are, because not all assisted living have the same kind of a plan.
Pam Dunwald: [00:42:16] Before we jump into the topic of free senior living placement services, we're going to pause here and we're going to split this conversation into two parts, because this is an area where families really deserve time, clarity, and also the full picture. So in part two, we're going to pick up right where we're leaving off and talk about how placement services work, what free really means, and the questions you should ask so you can feel confident you're getting the unbiased guidance that you need. I mean, who is it free to? Is it free to the family? Is it free to the assisted living, the service? Who is actually paying for this service? And if you're listening because you're trying to build a plan B and you don't want to make decisions in a panic, you're in the right place. Thanks for spending time with us today in Healthcare Redefined, Advocating for aging adults and their families. Check the show notes for helpful links in our assisted living checklist. And if this episode has been helpful for you, please share it with a friend, subscribe and leave a review, and we'll see you in part two, where we'll start the free placement services. We'll pick up that conversation and what to watch for. And remember to take care of you and take care of the ones that you love. We'll see you soon.