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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] Welcome back to Healthcare Redefined, advocating for aging adults and their families. This is the podcast where we tackle the real life challenges of caregiving, aging, and navigating the health care system. My name is Pam, and you're joined today with my partner, Linda Kritikos, and with over 80 years of combined experience as registered nurses and board certified patient advocates, we're here to help you feel confident, informed, and supported every step of the way. So this is part two of our conversation, Assisted Living is a Plan B, when aging in place isn't safe. If you haven't listened to part one yet, you may want to start there. We've covered the 11 signs that may indicate that your parents may not be safe at home, maybe if something needs to change, what assisted living is, what it isn't, and how to think about the right time of senior community for your aging loved one. So in today's episode, part two, we're picking up exactly where we left off, starting with a topic that can be confusing and stressful for families. Free senior living placement services. And I'm sure every time you Google assisted living, you get all these free services that might come up. So we're going to talk about how they work, what questions to ask, and how to make sure the guidance you're getting truly matches your loved one's needs, and maybe not what's easiest or most profitable for someone else. So let's go ahead and jump back into part two of assisted living as a plan B.
Linda Kritikos: [01:26] So, Pam, I want to talk a little bit about placement services?
Pam Dunwald: [01:36] Well, I need to be careful. So we're going to talk about free services or what is called free services. So oftentimes, and, and this is what I find very frustrating. This is one of the reasons why I thought it was very important to bring on health care professionals to our podcast that day to day work in assisted living communities. Because if someone's looking for an assisted living community on their own right away, if you Google assisted living or Google care for aging or senior living, all of these agencies pop up. I mean, sometimes you'll have to get to the third page in a Google search before you find an actual assisted living community, because these agencies are paying to be listed high up in the rankings. So you'll see all these pages of these services. And what they're doing is they're offering you free placement. Now, are they charging you to help them find a community? No, they're not charging you, but they rely on the communities paying them a referral fee.
Pam Dunwald: [02:48] And if now it depends on the agency, I can't throw them all under the bus. But I would hope that even if they did not get a referral fee from assisted living, because some won't pay them, that they would still match you or still try and find you a community that met your needs. But that's the risk that you take. If they're not going to get paid a commission, they may not send you in that direction. So I want to just talk a little bit about these free services and how they could come back to you, maybe not in the form of paying for this service, but the assisted living communities often have to recoup their expenses. So they may add an extra month of down payment for coming in. So please can we talk a little bit about that? I think it's just one of those things that that consumer beware kind of a thing that I like to talk about.
Dani: [03:42] Yeah for sure. Definitely. Pam, I'm with you on this one. It really touches my heart of what is right morally, ethically and what is wrong. Right. And I'm not going to go into it too much because I'll get a little heated.
Dorsey: [03:57] But Dani is very passionate about this subject.
Linda Kritikos: [04:00] Yeah.
Dani: [04:00] Well, and also because I went to school, I worked my butt off. I, you know, nursing chose me, but it also chose me to help individuals. That is why I'm a nurse. So when I get down to it, the fact is, when you have a plan B, just know that these other companies will do so-called legwork for you and at no cost to you. That is not true. In my experience, from what I've seen in the state of Wisconsin, 100% of the time, these companies take the first month's rent for that apartment from the assisted living. So it may not be coming from the client themselves, like the resident, the individual from their hand to the referral source's hand, right. But it's going from the community's hand to that referral source. And I just want listeners to understand that these referral sources, a, they are not licensed medical professionals. Okay. It is not free. And when you want the best for your loved one, those are things you really need to look at and consider. I'll grant you, if you want to go with a referral source, if you're like, you know what? Nope, I'm going to try it. Ask them. Do you look at skilled nursing facilities for my loved one and assisted living?
Dani: [05:21] Most of the time, from what I've experienced, they do not look skilled. And that's just a little like a red flag, right? Because what if your loved one actually does have diagnoses that need to be managed at a skilled nursing facility versus an assisted living? And this referral company refers you to assisted living. Your loved one moves in, their whole world changes. They lose their home. They lose so much, right? And now they're in assisted living that cannot manage their needs. It is not appropriate for them, whether it be because of certain diagnoses or maybe it's memory, or maybe it's behaviors, maybe it's just above the scope of assisted living. But because that referral agent is not educated or licensed with that knowledge to look at the whole case, now, your loved ones in a facility you paid a bunch of money for. You have to do a 30 day move out. You're going to get charged for that month. It's a whole heap of mess. And your loved one is under so much stress because now they've moved into assisted living and now they have to move again.
Linda Kritikos: [06:35] Can I play devil's advocate on this one?
Dani: [06:37] You sure can.
Linda Kritikos: [06:37] So in this referral source that's placing this individual in this facility, isn't it up to the facility though, and at the end of the day to complete the assessment and say that this individual is appropriate for this facility or not appropriate?
Dorsey: [06:59] I can answer that one.
Linda Kritikos: [07:00] Oh, I think you are going to charge for that one. I'm ready for this one.
Dorsey: [07:04] So the referral source, the third party.
Dani: [07:08] Oh she's rolling up her sleeves.
Dorsey: [07:11] And I am not saying they don't have a heart. Yes. And they don't want to help. They are in the business to help, but they do not have your loved one's best interests in mind. The bottom line for them, in my opinion, is finding placement for your loved one based on what you want, not what they need. 100% so and I will say that's a very example of something we experienced. We did assess a resident found her to be absolutely lovely, but it was very important for that resident's daughter to be in assisted living, not memory care based off of our assessment our nurses assessment team collaboration, we felt that this person would best, her needs would best be met in memory care and it was very difficult to draw her daughter into our logic and to get her to accept what we were saying. And what didn't help was that the third party referral source was advocating for what the daughter wanted, instead of what our nursing team felt was best for the resident.
Dani: [08:38] And what they needed.
Dorsey: [08:39] What they based off what they needed. So while yes, we can stand our ground and say, this is what's best for your loved one, sometimes that referral source becomes a source of contention because they are fighting us on behalf of what the family member wants. So we are trying to educate the family member, really get the family member, give them that knowledge of this is why we feel it's best. But when you have that referral source, then talking in their ear on the other end. Yeah. And going, well, can't we just try it over there? Or can't we just. Yeah. It becomes a battle.
Linda Kritikos: [09:23] Yeah.
Pam Dunwald: [09:23] That's really tough. I mean, on one hand, you know, they're advocating, so to speak, for their client, so to speak. But you know, the bottom line is, they're not advocating for the aging adult. And that's tough. Well, I think we could talk about this. We could do a whole podcast episode on.
Linda Kritikos: [09:44] Absolutely.
Dani: [09:45] 100%.
Pam Dunwald: [09:46] But I know for a matter of time, we just really kind of move on, but just wanted to throw that up there. And my last question for this section is, is this something that Medicare pays for? Or how, how is assisted living paid for?
Dorsey: [10:01] So assisted living can be paid for. Unfortunately, Medicare does not cover the cost of assisted living. So one of the things to get started on right now, if possible, and I feel like this is kind of going away. So if it can be started now, this would be wonderful. Long term care insurance. If you can find long term care insurance, get that started as soon as possible. That is an option. Another option is private pay. Do you have the funds to pay for the rent, which can be costly depending on where you go. It could be from $6,000 a month to $15,000 a month, depending on the location and the facility. So private pay. And then another option is Medicaid in the form of family care. And there are different companies that support family care, such as community care and my choice, Wisconsin. There are facilities that don't accept family care. So we are a facility who takes private care, private pay only. But then after so many years, depending on whether you're assisted or memory care, after you've paid so many years, then you know you can apply for Medicaid. And we would accept that.
Pam Dunwald: [11:32] You know, Dorsey, that I just want to just hold that thought, but I just want to make a point here that that's another really important distinction as you're looking for a community is to ask them, what do they accept for payment? And some will as your facility, your community will take after a certain amount of time of private pay, will go to Medicaid and have that paid for, but some will not. So it's really important for families to know the finances and know when the money might run out so that you're not having to move your aging loved one again. So you really want to narrow down and ask those financial questions as far as what payment sources they accept.
Dorsey: [12:13] And that's a really good point because in certain situations, if private pay is accepted and for so many years and then Medicaid would be accepted after that, if you run out of private pay before those years are up, you may have to move so that is very, very important for your listeners to know.
Dani: [12:33] And it's important for them to ask, like you just said, how many years private pay? That's what you need to ask. If it's private pay, how many years do we have to private pay before Medicare or Medicaid can kick in?
Dorsey: [12:45] If at all.
Linda Kritikos: [12:47] There's one other thing that I keep hearing, I recently had a client that actually was moving from his daughter's home into assisted living, and he said he had to do a buy-in. He had to give a large sum of money. And actually had to put that down. But because he put this and it was almost like buying a house, actually. Yes. And he put that money down and he and they still charged him a monthly rent. It was kind of like in a reserve fund or something. And then they still charged them a nominal monthly rent. He said that he would have a continuum of care. He could stay there, and if he has condition got worse because he was more on the independent side and they said he could move into and get assisted living, and then he could move to the skilled side without having to have any changes and moving out or any other changes to his cost, because he did that buy in. And there are facilities like that.
Pam Dunwald: [13:50] And I've run across them with my clients as well, and it kind of guarantees them a spot in whatever area level of care is in their continuum. But yeah, it's a big, large lump sum upfront. So yes, I agree. Linda, thanks for bringing that up because I had forgotten.
Linda Kritikos: [14:05] To mention it could be anywhere from $150 to $300,000 that they have to put down, and they have to put it all down, and then they're charged so much per month for housekeeping and meals and things of that nature. But yeah, it's money there. So it actually, and then my understanding is and he, as he told me, is that when he passes, if there is money still left for the care that's been provided, the family, it will be returned to the family.
Dorsey: [14:31] So definitely ask.
Linda Kritikos: [14:33] Yeah. Yeah. Yeah.
Dani: [14:35] Benefit to that also. But there's always a flip side.
Linda Kritikos: [14:38] Yeah. There's always a flip side. Yeah. So okay, so let's go on to how, you know, because a lot of times, you know, we've talked about this, falls and calling 911 and the EMS because these are not nurses, these are care staff. So how do the communities, how do assisted living communities keep residents safe day to day? What do you do? How do you do it? Because we all know as nurses, falls are not 100% preventable. You could be sitting next to someone and they fall right out of the chair, but there are things that can be put in place to help decrease that risk. So what does the community do to help prevent that or decrease that?
Dani: [15:26] I would say the community has their eyes on your loved one, more so than if they were at home, or if a family member was taking shifts and coming in and out. So not only that, usually the care staff, they start to get to know your loved one. They know when there's a change they cognitive ability, which is memory. They know if there's a change physically with them being able to help with dress in the morning or whether or not they're going down to eat today or not eat today, their eyes are on them and there is charting and data to back it up for accountability. So that's really the biggest thing is maybe they're not licensed medical professionals. They're not skilled nursing, but they are individuals that have their eyes on the resident. They know what's going on with them day to day. They chart it for accountability according to their care plan. So you have that data to back up and look at, which is huge because when they do have a change in condition or something's off or different, you can adjust the care plan to their needs and then they're safer because of it. That's going to get caught quicker than if an individual is at home and they have family members coming in and out, or maybe a caregiver a couple times a week, it's not going to be as data specific. It's not going to be accounted for daily, every shift, every eight hour shift of a 24 hour period. And that's what you're going to get from assisted living. Is that accountability, that charting that care plan and those eyes on your loved one, that you're going to be able to catch something sooner than if they were in their own environment and having private pay help or families coming in once in a while.
Linda Kritikos: [17:11] So what should they ask for when they're touring? So what should families ask about, like your fall responses or your emergency procedures? What would you want families to ask you or what should they be asking?
Dani: [17:23] Well, they should be asking, do you have a call light system? How is my loved one going to be able to call for staff assistance? Is it a call light? Is it a pendant around their neck? Is it where you walk in the room and it goes to a system where the care staff know now the individual is in their room. There's multiple different ways to alert care staff of whether somebody is in need and needs help. That's definitely a question to ask is what is your alert system and do you have one?
Linda Kritikos: [17:51] So moving on to another important topic. How do you manage medications, like who administers it. How is it stored and what happens if the meds change after a doctor visit or hospitalization?
Dani: [18:06] So this is huge. Usually at assisted living, we definitely encourage the resident to switch their primary care provider to the one that the facility utilizes. And this is why, because that provider will come to the facility to see your loved one. But they are very involved with the care and with the leadership at that facility in correlating that care, which means I, as a DON, would know what's going on with my resident because I have that third party primary care physician coming into the building and talking directly to me and giving me a direct report. Or maybe they have a portal system where I can see exactly what they did during their visit. I can message them and say, you know, well, Mary has a cough today. Did she have a cough when you saw her? You know, give her vital data, her temperature, her blood pressure, all the things where they could actually prescribe things based off of that data, in that continuity of care, that communication. So that's huge. Now, when a loved one chooses, well, I don't want your PCP and my loved ones going to take me to my primary care because I've had them for 50 years.
Dani: [19:13] And I love Doctor George. That's great. The thing with assisted living though, is as the family member and or healthcare POA or resident, please, the biggest thing for continuity of care and to have the facility know if there's been a medication change or what happened at the appointment. Bring back your after visit summary, make a copy of it, give it to leadership at your facility so they understand what occurred at that appointment, what changes occurred. That's huge. And also, if you're utilizing the pharmacy, so say we administer that individual's meds, but they go to a different primary care provider, which is outside of what the assisted living offers. They have to make sure that that medication goes to that pharmacy. That is on the responsibility of the healthcare POA and also the resident. So those are the differences. It is much easier to switch to that primary care that the facility utilizes because they already know any medication change or discontinuation or anything is going to go straight to that pharmacy.
Linda Kritikos: [20:20] It's a little easier, I think, to coordinate that care. Also, I think that they are actually those providers that are coming into assisted living there, they see these residents usually monthly, am I not correct monthly?
Dani: [20:33] And every three weeks.
Pam Dunwald: [20:36] You know, could we just just backstep on that because we kind of just talked about it as an assumption. And I just want our listeners to know that oftentimes, could you just talk a little bit that oftentimes in assisted living communities, they will provide primary care providers for them, and they don't have to go out to go to an outside doctor appointment if they don't want to.
Dorsey: [20:58] Yeah, that is correct. That is correct. We will support them going to their outside provider. Like Dani said, if they've seen them for however many years and they love them, we'll support them. We just need good communication then with the visit.
Pam Dunwald: [21:12] But I mean, what I guess what I'm the point I'm trying to make is, is that if families are worried about memory care or they're worried about their, their loved one not being able to drive or, or they're working and they can't take them and they're worried about transportation. I think a lot of people don't understand that in these communities, they can provide a provider that will come to the facility and manage their care, just like their primary would, versus having to continue to go out.
Dorsey: [21:40] Yes, absolutely.
Linda Kritikos: [21:41] Yeah, that's very true. And I'll also provide, and I mean this. I mean, you have to check with your own because each state is a little different, but a lot of times they'll provide an eye doctor to come in to do vision checks, and the podiatrist to come in to cut toenails and to check people's feet. And they'll also sometimes provide a dentist. So, I mean, there's a lot of different services that can be provided at the site of that facility. You just need to ask when you tour what type of medical services you bring in here to help care for my mom or dad so she doesn't have to go out anymore to see the doctor, especially in the middle of winter when it's 30 below.
Dorsey: [22:23] Including lab and X-ray.
Linda Kritikos: [22:25] Yeah. Including lab and portable X-rays. Yes. Exactly.
Dani: [22:28] Yeah. That's the terminology. Might be third parties. So for our listeners, ask what third party companies do you work with to correlate care in the home, meaning the facility that you're choosing?
Linda Kritikos: [22:41] Yeah.
Pam Dunwald: [22:43] I have a question, you know, when, when we're dealing with that, one of the things our listeners might need to consider is, how are they billed for that provider? Do they bill their Medicare if they have an insurance advantage plan, you know, do they have to deal with whether or not they're in or out of network?
Dorsey: [23:02] Yes, because they are third party providers, the billing does not go through the assisted living at all. So they would bill them as if they were seeing an outside provider. So yes, they have to accept their insurance. Sometimes that can be a challenge. If that provider coming in does not accept their insurance, then they have the option to self-pay or, you know, there may be other options, but other options would have to be looked into.
Pam Dunwald: [23:33] But then again, note to our listeners, you know, add this to the checklist as far as, you know, when you're, when you're looking or touring, you know, communities, what does your aging loved one need for primary care? And can you utilize the services that are going to be provided by the community.
Linda Kritikos: [23:52] So we would need to also contact their insurance company to see once they find out those things. Is this provider in the network or is there a way of changing their insurance plan because now there's a change in living situation? I changed plans because now I have a change in my overall living situation.
Pam Dunwald: [24:17] And that would be a change. That would be a change in a life changing event. So they would be eligible to be able to change from one state to another.
Linda Kritikos: [24:27] And she didn't even realize it. She didn't even realize that she had to change insurances.
Dani: [24:38] And they don't even know that really. They have that window.When you cross state lines and at least from Illinois to Wisconsin.
Dorsey: [24:48] Our location.
Dani: [24:48] Yeah. That is a significant event. So for insurance purposes, a significant event qualifies for an open window of changing your insurance company.
Linda Kritikos: [24:59] So they could get a plan that actually covers those in-network, those network providers that are those third party providers for that facility.
Pam Dunwald: [25:07] So exactly. And that's something that we can assist with your Medicare advisor, your insurance advisor can assist with. So there's lots of help there. So we're getting ready, kind of winding down, looking at wrapping up. One thing I want to touch on before we close is what do you recommend or what can a family expect for a tour of an assisted living community? And, and do they need to bring anything or what do they need to know if they're setting up a tour?
Dorsey: [25:43] Well, they need to bring their questions. They need to bring their questions. That is the biggest thing. They can expect to see the facility as a whole. They can expect to see rooms, empty rooms, or with permission, maybe a room that's furnished or occupied. I would recommend that if we're on the fence and we're not sure, come during lunch and actually have lunch with us or whatever facility you're looking at, come during an activity, you know, see how your loved one interacts and mingles with the rest of the community.
Linda Kritikos: [26:23] Yeah.
Pam Dunwald: [26:25] What do you wish you could tell everyone before they tour or even consider an assisted living community?
Dani: [26:32] Well, I know, I know, we, we kind of talked this offline. So I'm going to give you a little hint. You talked about being transparent about their condition.
Dorsey: [26:42] Honest. Yes.
Dani: [26:44] Definitely come with your questions and the ones that they cannot answer. Ask who can answer them, because that is going to be a big red flag. If you know the marketer, the person that shows you the room initially or does the tour usually isn't anything medical, right? They don't really have the knowledge of that aspect of the needs being taken care of medically. So just know that going in, they are there to show you the facility, the activities, the dining, the room, all the things that are included in, say, an independence rent, right. Without medical or assistance.
Pam Dunwald: [27:26] Sorry. So they would be a non clinical person like a sales person.
Dorsey: [27:29] Yes. So when you're going to be transparent that's for the assessment. So when the assessment gets scheduled and the nurse comes to do it, that's when you want to have open honesty about what is going on with your loved ones. Do not hide if they have been wandering out into the yard and out into the street. Do not hide if they have behavioral issues, they've been lashing out. They've had episodes of aggression. Don't hide any of that because you will be doing your loved one a very disservice by doing that. Because as Dani mentioned earlier, they may be accepted because we didn't know any of that. And we can only get so much information in an assessment.
Dani: [28:16] Correct.
Dorsey: [28:16] And now all of a sudden, we're seeing these behaviors. Your loved one on May 1st needs to go to a place that does deal with behaviors. If you're lucky, you're already in a place that deals with behaviors, but not every facility does. So be transparent, be open so that your loved one can go to a place or a unit that fits their needs and meets their needs the best, so there's less trauma.
Pam Dunwald: [28:46] Yeah. We had a client again that that first client that we had with Alzheimer's. She just really had every I felt so bad for every complication, every behavior you can imagine that goes along with dementia. And things had gotten so out of hand at one point in time, and people don't realize that there are skilled nursing homes that deal in psychiatric issues with aging adults. And she actually spent a short period of time there. And then we got everything under control. They were experts at managing those medications. And then she was able to come back. So maybe if they're not appropriate now, if they get certain treatment or they get things under control, certainly then you can revisit, you know, whether or not that they would be appropriate then for assisted living.
Linda Kritikos: [29:34] Correct.
Pam Dunwald: [29:37] Okay. So as we're moving into the final segment, I just want to ask this last question, and then I'm going to turn it over to Linda as we wrap up. Is there anything that you wish you could tell everyone before they tour or even consider assisted living?
Dani: [29:55] There's a lot of things I think
Linda Kritikos: [29:59] Let's keep it down to.
Dani: [30:02] About another hour. Yeah, we would need to. No, I think the biggest thing is obviously the questions. Know that the person showing you the facility is not where it ends, right? It doesn't just begin with a tour. I would ask to speak with the RN or an LPN in your leadership on your team that I can have a meeting with separately and sit down and ask questions? That would be huge. And if there's not one, I would say, well, is there an executive director that I can sit down and talk with? I'm going to want to know that the leadership team in that facility is 100% involved in communication in a part of everyone's care. It's important. And when you go to a facility and you ask them a question, well, can I meet with the RN or can I meet with the executive director? And they look at you like deer in headlights, I would leave because that may not be the most appropriate. That means, oh my God, nobody's ever asked that. And oh my God, I don't know if they could really meet with no no no no. The whole leadership team that is part of that facility, in order to give the best quality of life is a team aspect. So if that whole leadership team is not willing to meet, answer questions, follow up, I would cut your time short and move on to the next.
Dorsey: [31:22] And it's important to know that assisted living is designed to provide support, supervision, and assistance with daily life. But it is not acute medical care. Yes, it's.
Dani: [31:35] Not a hospital.
Dorsey: [31:36] It's not a hospital, and that your loved one is aware that the goal of assisted living is not to take their independence away, but to provide enough support so residents can remain as independent, safe and engaged as possible for as long as possible.
Pam Dunwald: [31:55] That is really helpful information because, you know, families are often touring when they're tired, stressed, trying to make a fast decision. Maybe there's been a crisis. So, Linda, I'm going to turn it back over to you.
Linda Kritikos: [32:07] So basically, I just kind of want to follow up on some of those prompts people should ask. So I guess people should never assume that two communities are the same. So you need to ask what's exactly included and what costs extra. Ask how many care changes over time, like what happens when their needs increase? Are you able to handle that? Ask about the staffing patterns, especially evenings, nights, weekends and holidays. Ask about medication management. Who gives the meds? How changes are handled and what happens if a dose is missed or when they refuse. Ask about safety and falls. What is the response time? Who do they call? What type of call systems do they have in place and how do they communicate with each other? And what types of things are put in place to prevent the next fall? And make sure you get everything in writing, pricing, add ons, discharge criteria, and rate increases.
Dani: [33:01] The biggest thing I think I would assume Dorsey, you would definitely agree with this one is read through the contract with a fine tooth comb.
Dorsey: [33:11] Agree 100%.
Dani: [33:13] Yes. Highlight. Go through. Ask questions. That contract in a stressful situation has put so many families under stress, not financial stress. There's so many things. So if we could say anything in the midst of something like, say, a crisis and you need to do an emergency. Say, admit to an assisted living. No matter what. Slow down and read the contract and ask the questions to advocate for your loved one. That is your job.
Linda Kritikos: [33:46] Well, you answered my next question, so I'm going to turn it over to Pam.
Pam Dunwald: [33:53] Well, I'm just kind of wrapping up, let's pull this into just a few simple takeaways. Would you recommend that our families take 1 or 2 steps in the beginning? What would be the first couple steps they could do to get this ball rolling, so to speak, or to, to look at an assisted living level of care for a loved one?
Dorsey: [34:16] Definitely do your research. If you can research online, check out Google Reviews. Check out state surveys to see how many citations, if any, that this place has had. That would be step one. And then you make that phone call. It would be step two.
Linda Kritikos: [34:36] Is there something that they can look at outside of their licensure? Isn't there a document that they should be that they could read or look at that's outside.
Dani: [34:46] Is it the program statement?
Dorsey: [34:47] Program statement. Yeah. Right.
Dani: [34:49] Yes.
Dorsey: [34:50] Right. So we have it. So assisted livings have licenses. Every license could be different. Some take people who can walk only if you are in a wheelchair, they might not take you. So the licensure is very huge. Some assisted livings, then they take the gamut. Everybody. It doesn't matter if you're able to ambulate or not, if you're in a wheelchair or not. So the licensure is one thing. And then there's the program statement. So that goes a little more beyond the license. That is, do we take people with aggressive behaviors? Do we take people who require two people for transfers or for getting up or for doing this. Maybe it's only one person that they take. So the program statement is very, very important for them to dig a little deeper that goes beyond what they're licensed to provide.
Dani: [35:51] Yeah. And that's huge because looking at a facility, if you ask them what the program statement is, say to the nurse or executive director, and they don't know, that's another red flag to leave and find a different place.
Dorsey: [36:06] And if the, the community liaison, the marketer, salesperson, whatever they're called, does not know that answer. And they may not. Yeah, then they should know enough to call the executive director, the administrator, the director of nursing to find out.
Dani: [36:23] Yep. As long as they're willing to find out for you because like she said, that's correct. Not everybody is going to know that you are touring, at least if they say that they're going to find out and they will get back to you, then that's promising.
Linda Kritikos: [36:36] Exactly.
Pam Dunwald: [36:38] You know, and the next thing too is, is just recommend, you know, make your, make your, your want list, make your and I like to tell our clients to make a list and maybe an asterisk on the gotta haves, so to speak. And, and yes. And, and what they would like, but they could live without it because they tour 2 or 3 communities before they make their decision, or maybe they're even going to tour more. I mean, each community is unique. Each community has its own feel, each community is different and offers different types of services or different combinations. So it's just real important to make sure that you're looking for a location. Do you want something rural versus more urban? Do you want something, you know, like if they're big into gardening, do they have a garden? Just they all have individual things that, you know, may impact your loved ones. So just kind of figure that all out before you start touring so that you can ask some of those questions and narrow down the communities that may be a good fit.
Dani: [37:45] So that's a really good suggestion, Pam. I think like the need, the want and the deal breaker. Yeah, yeah. Taking that three before you go in, before you even meet with the Don or the executive director, that is a great start.
Dorsey: [37:59] Pets is a big one. Also does, you know, sometimes pets is a deal breaker. My mom has got to bring her 12 year old dog, do you accept pets? Do you charge a separate fee for pets?
Linda Kritikos: [38:14] You know? And who takes care of the pets?
Dorsey: [38:16] Who takes care of them and when they can't take care of them? Who takes care of them?
Linda Kritikos: [38:20] Yeah.
Dani: [38:20] What happens? Who's going to clean that litter box? Yeah.
Linda Kritikos: [38:26] So, you know, so if you're listening and you feel kind of like a little overwhelmed and we want to just say this clearly, you're really not alone. So just start taking one small step. Make that list. Yeah. You know, and make a tour appointment using our checklist. And we'll have that in the show notes. And you can bring that can really bring you a lot of clarity and help you seek to understand what is actually needed, what is wanted, and what's possibly not going to work at all. And sometimes people say, well, we gotta move mom to a place that's really close to home so we can be there every day. Well, do you really need to be there every day? So you need to just look at these things in a broader perspective and say, this is about mom and what's important to mom, not what's convenient for me. Yep. So, Pam.
Pam Dunwald: [39:20] You know, Dani and Dorsey, I just want to say thank you so much for helping families understand this concept. You know, planning ahead doesn't mean you're giving up on aging in place. It means you're building a plan B that protects safety, dignity, and also peace of mind. So as we wrap up, let's pull this into a few simple takeaways and one small step that maybe our listeners can take this, you know, can take this week. So, you know, to sum it up, we connected aging in place with the importance of a plan B. We've started with the 11 signs that your aging parent may need help in the home. And then we kind of talked about assisted living, what it is, what it isn't, how to choose the right type of community, and how payment and pricing really works.
Linda Kritikos: [40:04] So remember, planning ahead doesn't take away independence at all. It actually can enhance their autonomy and it protects it because you're making thoughtful decisions, not decisions that are reactive and based on crisis situations.
Dani: [40:19] You're also allowing them the choice to make a decision when they still can.
Pam Dunwald: [40:25] Absolutely. And we didn't really touch on that. But that's, I think an important point that you make, Dani, is that, you know, one of the things, one of the barriers to aging adults accepting moving into maybe an assisted living community is they feel that they are giving up their independence. And we know that as our aging adults get older, that is really the last thing that they have control over is their own independence. And that's the last thing that they're willing to give up. So if we can frame it when you're talking to your aging loved one, if we can frame it in a sense that you're enhancing their ability to remain independent. And that would be the approach that you would want to take with that aging loved one. And, and did anybody want to add to that?
Dorsey: [41:12] I think we covered our bases pretty well. Yes. And you said it right. It's not to take away independence, but to provide support.
Dani: [41:21] Yeah. And I think them understand too, like, because I can see where it's like, oh, you're looking at a place and now you just want to put me somewhere, right?
Linda Kritikos: [41:30] Yeah.
Pam Dunwald: [41:30] You're, you're not taking me out of this house unless it's in a body bag.
Linda Kritikos: [41:33] Yeah, exactly.
Dani: [41:34] Yeah, I remember.
Linda Kritikos: [41:35] That many times. Yeah.
Dani: [41:36] So instead presenting the information to that individual and allowing them at a time in their life that they can still actually understand it. Yes. And just.
Pam Dunwald: [41:46] Have a voice in choosing where they go.
Dani: [41:49] Exactly 100% that is going to do more good than damage. It's actually going to help.
Linda Kritikos: [41:55] With their transition into those, into that.
Dani: [41:58] 100 percent, and it's going to get the wheels started spinning, right? Because going home, they're in their own environment. They're in their own world for so long, they have their routine, but at least now they have something else to maybe learn about and start to think, oh, well, maybe I do have a choice in this. And it's not so aggressive where families are like, well, nope, now you have no choice. And this is the choice, so you have to choose it.
Linda Kritikos: [42:21] Yeah.
Pam Dunwald: [42:22] I just want to say again, you know, Dani and Dorsey, just thank you so much for spending time with us today. This has been a great topic.
Linda Kritikos: [42:29] Yes. I mean, you guys have been wonderful. Your expertise, your insight, your compassion and your passion actually really shows through in the way you present your experience. So our goal is to make your caregiving journey a little bit easier and a lot less overwhelming. So listeners, please take heed with this and take some of these steps and, and hopefully you can set up a plan B that actually works for you and your family.
Pam Dunwald: [42:56] And don't forget to check out the show notes. We always include some checklists, handouts, you know, free handouts and things that we will include in the show notes and other resources that are more detailed about today's topic. Also, you know, the 11 science checklist and touring questions and questions that you can use to help prompt asking questions as you're touring communities.
Linda Kritikos: [43:18] So if you found this episode valuable, please share it with a friend. Subscribe to us and leave us a review because your support helps us reach more families who need guidance and help.
Pam Dunwald: [43:30] Our next episode, we're going to go deeper into relocating or moving our aging loved one. And stay tuned for that. Many of our listeners don't realize all the health care related concerns and challenges that can arise with an aging adult moving to a new location. And for one thing, a lot of people, and I didn't know this until a few years ago, that there are real estate agents that actually have a special certification related to aging adults and selling or buying a home. So join us for our next episode as we wrap up season two.
Linda Kritikos: [44:02] So see you next time. And remember to take care of you and the ones you love.