Finding the right senior living situation

Transcript of Interview: “Finding the right senior living situation”

Mike Barnes:

When you broach the subject of potentially moving mom and dad into something other than maybe their house or their apartment and you start thinking and hearing all the terms and names and skilled nursing and assisted living and independent living and adult 55 blah blah blah, it can get really confusing.

Kim Barnes:

Very overwhelming, isn’t it? Well, we’re lucky to have John Brown of Oasis Senior Advisors with us right now, and he can kind of sort things out a little bit because there are so many terms that we all need to know.

John Brown:

Hi, thanks for having me. Yeah, there are a lot of different types of senior living from, like you said, CCRCs (Continuing Care Residential Communities) to skilled nursing, nursing homes, assisted living, assisted living type B, memory care, independent living, and it goes on and on. And then so many communities can kind of blur the line a little bit because they can offer some care that may be a little out of their area.

Kim Barnes:

And you brought up a good point which is there’s also a lot of acronyms that come into play as well which can get a little bit confusing. So let’s just start with a little bit of explanation of just the different kinds of care, what they are and what they’re not, if that makes sense. So let’s just start with, you know, the—I guess some of it is independent living and/or 55 and up. It seems pretty common sense, but let’s start with that.

John Brown:

So, 55 and up apartments are just that—they’re a regular apartment but just for residents that are over the age of 55. Some of them are even 62. But actual independent living is truly where you start kind of adding those little bits of services to make life a little better. Think of independent living as a cruise ship that never leaves the dock. You get meals, you get housekeeping, you get transportation, social stimulation, and often they have things on-premise like home health and home care so that you can do some aging in place. But it is still independent—you’ve got to be able to exit the building, you’ve got to be able to do all your activities of daily living yourself.

Kim Barnes:

So, yeah, but then assisted living and just the different levels of that, it’s so confusing about where should my mom or where should my dad go.

John Brown:

Right. So, assisted living is when you actually start to need the care with the dressing and the bathing, the transferring, and the incontinence. And then there are levels of assisted living. You have type A, which is a lower level, meaning that the individual can actually get out of the building on their own. That person might need help with dressing or bathing, but they’re still able to ambulate, they’re still able to evacuate on their own. Type B is a higher level of care. Often that’s where you see two-person transfer, a higher level of med management, and things like that.

Mike Barnes:

Though in that scenario they will get you out of the building if there’s a fire. That’s a good way to differentiate.

John Brown:

That’s right. And as you see, the bigger communities, the type A are much larger, usually around 150 residents. When you start getting into type B, they get much smaller, so that’s a pretty common way to distinguish.

Kim Barnes:

And then what’s the difference with skilled nursing and/or rehab? Those are still different too, aren’t they?

John Brown:

Correct. So, after assisted living, for those people that need it, you might also need memory care. Memory care is a type B assisted living—it’s a much more structured environment for those people with dementia, Alzheimer’s, and things like that. Then you start going into the skilled nursing and/or rehab setting. There’s inpatient rehab hospitals, which are actual hospitals that focus on rehab. Then there’s skilled nursing that is a hybrid of the old nursing home but they’ve added the rehab wing. And then you have the nursing home, which most of those don’t do any rehab—it’s just the old version of the nursing home.

Kim Barnes:

The big difference between an inpatient rehab versus a skilled nursing rehab is how it’s billed on Medicare and how many hours of care you get per day or how many hours of therapy you get per day. In an inpatient rehab, you might get three hours a day of intense rehab—maybe an hour of physical therapy, an hour of speech, an hour of occupational therapy, and other activities. In skilled nursing, that’s on Medicare Part D and limited to about an hour a day—15 minutes of physical therapy, 15 or 20 minutes of occupational therapy, and another 10 or 15 of speech. It’s just different.

Mike Barnes:

My head’s spinning. I feel like I should have been taking notes because I felt like you gave me about 50 different options. So the question is, if my mom or my dad, if I think they need more than independent living but I’m not sure what, how do I decide?

John Brown:

That’s kind of where we step in because no community is the same. Even though they may all have the same licensure, they don’t necessarily line up with what they do. Just because they’re all an example of type A or type B doesn’t mean they can do a two-person transfer, a Hoyer, or take certain med management like diabetes. I went through this journey myself. It took me six months to figure it out. I know we were talking earlier, and you said it took almost a year for you to figure it out. It can be daunting. That’s why we at Oasis really focus on the care. We start with every person’s specific care—what’s their diagnosis, what’s the long-term prognosis look like—and then we start trying to figure it out from there.

Kim Barnes:

Are there assessments that are done to figure out that you qualify potentially for this care or this care depending on what your abilities are or your health conditions?

John Brown:

Yes, so in 55 plus, it’s like, “Hey, can you move in and can you fill out the paperwork?” That’s different. But when you start getting into independent living and assisted living, they want to make sure that you’re going to be safe. One of the main questions we always ask is, can they walk up a flight of stairs? And if the answer is no, well then maybe it’s not appropriate for independent living because they wouldn’t be able to evacuate the building. When we get into assisted living, absolutely, they have to do some form of assessment. The assessment can be done in many ways—it can be done in person where the facility or community comes and does an assessment, it can be done clinically using clinical records and history. It just depends. But absolutely, each senior living community should do some form of an assessment to make sure they’re accepting somebody they know can live there and that they meet their needs.

Mike Barnes:

We talked about the long process that I went through with my mom because there were Alzheimer’s going into memory care, and it was actually about a year and a half process. So we were proactive in that respect, but a lot of times it’s a crisis situation. Mom falls and breaks a hip and has to go into rehab or skilled nursing or something like that. Is there a big difference in how tough it is, not only on us but on someone like you, whether it’s proactive or a crisis?

John Brown:

It’s not a big deal for us—it really is hard on the family. Often, when you have a life event and you get into the hospital systems or medical system, everybody has their way of doing things and they’re looking for their pattern, I guess is the way to put it. The hospital is going to look for the fastest way to turn the bed. If they feel like, “Okay, we’ve done all we can do to help mom; it’s time for her to leave,” they’re going to look for the fastest way they can turn that bed and get that discharge. That’s where the family, going back to what we were talking about earlier, we really feel like everyone who has a loved one who’s over the age of 75 should already have kind of their plan in place for rehab and for assisted living if they ever need it. Because you’re just one fall away, and people say, “Well, I’ll be fine. I’ll just go home.” You never know. You never know what happens when you have a fall or if you have a small accident or even an auto accident. So we always recommend you kind of have that plan so that when you’re stepping into that environment, you can say, “Mom wants to go to this rehab. She’s already picked it out.” That gives you control. If you don’t, often they’ll come to you and say, “Here’s a list of three places. Which one do you want to go to?” and you are making decisions on the fly. That’s where an advisor steps in and helps. We know all the communities, we know all the facilities, we’re in and out of them every day. We know what’s going on, boots on the ground so to say.

Kim Barnes:

Because I think it’s so overwhelming when you are trying to make those decisions in a crisis. And I bet that a lot of people, it’s hard to have those conversations with mom or dad proactively sometimes to say, “Hey, just in case,” but I can see the value of that for sure.

John Brown:

Yeah, it really is to give that senior their options and hopefully let them choose. Of course, in some scenarios, due to dementia, they can’t make those decisions, but it’s also for the children, the sandwich generation. We’re juggling family, we’re juggling kids in school, and all of a sudden you get a call that mom’s in the hospital.

Mike Barnes:

Is there any help that we can get if we think dad needs to go into assisted living or skilled nursing and he says, “I’m fine. I’m not going anywhere”? What do we do then?

John Brown:

Often our advisors and my team, we’re used to dealing with that. Bringing in that third party, that person who’s not connected to family, who’s not trying to parent the parent, who’s not pushing but giving you the options and explaining everything and explaining how Medicare works, what’s covered, what’s not, here are our suggestions on what you should have in place. It’s giving them the information but not pushing them to make those decisions in a vacuum.

Going back to your original comment, we’ve helped families in less than three hours in crisis situations. It can be done. It’s doable. It’s just sad for the family to have to do that because they’re not prepared.

Kim Barnes:

How much should we be thinking ahead, say in Mike’s mom’s situation where they knew she needed to go to memory care? She didn’t need to go tomorrow, but they needed to start planning ahead, and they had to wait for a spot to open up and things like that. So how much do people need to be thinking of that perspective to start planning ahead so that you can potentially—you know, is it hard to find a place? Are there situations where you know if you want if you have a move, when you want?

John Brown:

When you have a specific place in mind, there are some specific things that make it very hard. The more complex your medical condition makes it harder. If somebody is a two-person transfer and has diabetes or sliding scale diabetes, that’s going to be harder. If it’s a couple and one person needs a lot of care and the other is totally independent and they want a two-bedroom with a study, yeah, that’s going to be a little bit harder and something you want to work on. But if you’re talking about just the care, it can be done instantly if you’re doing the right type of search. Again, that’s what our system and my staff do—everything is based on care first. If mom needs help with dressing and bathing and in a way that it can’t be done scheduled, we’re not going to recommend independent living. We’re only going to look at assisted living. But if it’s something mild and she doesn’t have any other issues, then maybe independent living is appropriate. But it all goes back to that care—you have to start with that care and then expand on budget, expand on geographics. Oftentimes, we run into the child really wants mom to be five minutes away. That’s great, but if five minutes away from you the only assisted living are things you can’t afford, we’ve got to find the ones that you can afford that meet the care.

Mike Barnes:

We didn’t even talk about finances. That’s probably a whole other topic, but that comes into play a lot because there’s such a difference in prices. There’s differences in the places that provide just one kind of care, and as you mentioned, the places that—I know the place where my grandparents lived had independent living, skilled nursing, and there was one other piece too, but they had multiple so they were able to stay even in the same building, although not in the same apartment. But yeah, there are so many pieces.

Kim Barnes:

Well, one of the things that I think is so interesting that I didn’t know before is that a lot of people probably don’t realize that in many ways, they’re familiar with what an apartment locator does to help you find the right place. What you do is like that but with the health piece involved, right? People probably don’t realize that it’s a free service to people.

John Brown:

Correct. Our service is free. We are also one of the only ones in the industry that has confidentiality built in. Unlike a lot of other internet companies out there, we don’t give out emails or phone numbers and things like that. What we do is we give you the options based on your specific scenario, give you the resources. If you need some resources like you’ve got to get power of attorney, you need to get a will in place, you need to get downsize specialists or the home sold or a reverse mortgage, whatever that is, we’re going to give you that information that you need so that you can take care of mom or dad. But we’re not going to have everybody bombard you. You tell us what you need, what you want, and then we help you get through that process.

Kim Barnes:

It seems like one of the best things is you’ve got to be able to communicate and ask. Don’t be afraid to ask for help because a lot of us don’t know what we’re doing in this field.

John Brown:

It is a whole industry. Like you said, it’s got its own jargon, it’s got its own ways of working, and it can be daunting to families, especially transitioning from that rehab scenario, discharging from that hospital, and trying to figure out what to do next. What can I do next, or is it okay for my loved one to go home? Oftentimes, what we see is they’re like, “Well, mom’s going to go home when we’re done,” and they’re not being realistic. You need that outsider approach to sit down and talk to you and say, “Okay, wait a minute. If we’re here, this is about where we’re going to be in two weeks when mom gets done. Let’s be honest. Let’s talk about it and make sure they understand.”

Mike Barnes:

So if somebody needs to bring that third party in to try to assist them, what are the kinds of things that they should be looking for when choosing somebody to help them?

John Brown:

There are a lot of designations out there. I personally feel that the Certified Senior Advisors (CSA) is one of the better designations. We are accredited; we do have to go through rigorous training, and we do have to do continuing education. It’s all about the well-being of a senior, taking care of them, and making sure we’re treating them ethically. For me, it’s a big deal. There are some other designations out there, but when you’re talking about anybody in the senior industry, if they have the CSA, the Certified Senior Advisor, you know they’ve been educated, they’re doing continuing education, and they’re held to a very high ethical standard. To me, that is a very good designation to look for.

Kim Barnes:

And you have that on your name, and we appreciate all the information.

Mike Barnes:

Yes, thank you. John Brown, Oasis Senior Advisors. Thanks so much for giving us so many tips today.

*This transcript is auto-generated. Please excuse any typos or mistakes.