In 2001, when I managed a high-end retirement and assisted living community, a resident couple in their early 70′s visited my office heartbroken. The high tech stock bubble had burst, and the investments they once thought would sustain them for the next 20 years was no longer going to last. This was a conservative couple who had planned everything before selling their home and moving in. Unfortunately, their son was a financial adviser and had overexposed in the market.

Given the financial mess the country is in today, my guess is that many seniors are reviewing their retirement plans and expectations. I know several couples who anticipate delaying the move to a retirement community either because they fear they they can’t sell their home for what they thought, or because their investment portfolio has nose dived.

How much do you need for retirement living?

Not an easy question, as variables such as medical and long term care cost can only be approximated. Your health and lifespan will play big role. AARP’s Retirement Shortfall Calculator is a good tool to check how long your current resources should last. Simply input your savings, income, and living expenses and it shoots out how long those savings will last. The results may be eye opening.

How much does Assisted Living Cost?

The cost of assisted living in Whatcom, Skagit, and Island counties can vary widely depending on care needs and desired lifestyle. For an independent senior with no care needs, a retirement apartment can range from $1500 up to $3200 per month depending on apartment size and amenities. For assisted living, I have seen everything from $2200 to $5500 per month based on the health care services being provided.

Free Senior Living Information and Referral -

Feel free to call or e-mail me if you want to talk more about senior living options in Whatcom, Skagit, or Island county. Even if it is just basic, preliminary information I would be glad to talk.

For more senior living information visit my web site: www.ElderServicesNW.com

Mark Robinson, Elder Care Adviser, Elder Services NW

The risks are significant when an elderly person becomes lost. If an elderly Alzheimer’s patient is outdoors for more than 24 hours, chance of survival drops by 50%. In the Bellingham case, a person with Alzheimer’s wondered away from a family home unnoticed. When the family became aware of the situation, they searched the area on their own for 2 hours. Their next move was to call 911, after which police and sheriff searched for 2 more hours. Only then did a family member report that the lost person was part of project Lifesaver. 15 minutes later the Alzheimer’s patient was in a volunteer’s car headed home. Disaster averted.

How Project Lifesaver Works

Each client is provided with a one-ounce electronic bracelet that emits a unique radio signal 24 hours a day. When a client wanders anywhere in Whatcom county, a caregiver call to 911 will trigger a rapid response by a specialized team within the Whatcom County Sheriff’s Department and a search will begin. Project Lifesaver has already had 1,446 searches nationwide and the average recovery time is less than 30 minutes.

As someone who has worked with dementia patients in home settings as well as in assisted living facilities, I would recommend this tool for any family worried about a parent’s safety. Even at retirement or assisted living communities, dementia residents are at risk of wandering off.

If you know of anyone who could benefit from Project Livesaver call the Alzheimer Society of Washington for more information. They are also looking for donations so they can supply the devises to those who do not have the financial resources to participate. I cannot think of a better cause.

Dementia Care in Bellingham, Whatcom, and Skagit Counties

For information about senior living options for seniors with Alzheimer’s or other types of dementia in NW Washington, contact Elder Services NW, which operates a Free Senior Living Referral and Placement Service.

Unfortunately, for many families, the decisions they face about how best to serve their elderly relatives comes down to financial calculations. It is just a reality in todays health care environment and how we have chosen as a society to care for our parents. The more financial flexibility you have the more options you have, and this site is a great resource to help make sure you are getting everything from Medicare that you are entitled to, and help you plan for the future.

Mark Robinson, Elder Care Advisor, Elder Services NW

Helping families and seniors find, “The Right Place at the Right Time.”

A Senior Living Referral Service vs. On Your Own

I believe that a free senior living referral service is the best place to start. Of course, families can research and preview the options on their own. Large retirement and assisted living communities usually have big marketing budgets and advertise heavily in their local markets. A brief look through the yellow pages or on-line will acquaint you with the major players. Typically consumers visit 2 or 3 before deciding which best fits their needs. If you are going it alone, here is some advice before you head out for your tours though:

1) Visit more than once, and at least once unscheduled. Aim for off hours too, when the marketing representative may not be in, and you can interact with other staff. They are the ones who will be spending time with your loved one and are often a better gauge of the community’s attentiveness and professionalism. How open and eager to help are they? Do they seem cynical, or give different answers than the marketing rep?

2) Ask for a copy of the rental contract and the required DSHS Disclosure Form. Read, understand, and ask questions about any points of confusion. Especially important are Discharge Criteria (when they would ask your family member to leave because of care or behavior issues) and how they charge for personal care. Every Assisted Living facility or Adult Family Home has a method of capturing care charges. Some use Care Levels, some use points. In many cases personal care charges can run more than the basic rent. Marketing representatives will try to be vague, but ask for specifics so you are not surprised later by care charges that can run into the thousands of dollars. If you are not getting good answers, ask for a copy of the assessment form they use to calculate charges. Most facilities are ok with this.

The key advantage of using a free senior living referral and placement service, such as Elder Services NW, is that they know the important questions and can get past the marketing to what is really important. What is most important is what it will really be like for your loved one to live in the facility day to day. Because the upfront time a referral specialist spends getting to know your loved one’s individual needs and preferences, he can make sure that these are discussed openly. The facility’s marketing representative’s job is to get you to like the place and move in. A referral specialist typically tours with you and makes sure you have all the information you need before making a decision.

What About Adult Family Homes?

Because there are so many Adult Family Homes it is even more problematic to go it alone. An adult family home is a private home that is licensed to care for up to 6 elderly or disabled clients at a time. They are often a wonderful alternative for seniors who don’t quite fit in larger complexes, or who just prefer a more home like atmosphere. In my experience, anyone looking at a dementia community for their loved one should definitely check out Adult Family Homes as well. Bellingham, Mt Vernon, and Oak Harbor and the surrounding areas have several great homes run by caring, experiences health care providers. Unfortunately there are also some questionable ones too. Each Adult Family Home is unique, and matching your loved one’s needs to the home is especially important. You want this to be the last move your family member makes, so there has to be a good connection with the provider, his or her care philosophy, and the other residents.

A good referral specialist should know the ins and outs of the local homes well and know what type of client thrives, or fails at each individual home. At Elder Services NW, I am in these homes routinely, and keep a finger on how well clients are taken care of on a daily basis.

Lastly, if you are searching on your own, your local Senior Information and Assistance office maintains a list of all licensed facilities including assisted living facilities, adult family homes, and skilled nursing providers in their area. Here is the link for their lists of:

Skagit County Assisted Living and Adult Family Homes,

Whatcom County Assisted Living and Adult Family Homes,

“How do I get dad to stop driving?”

This is a question I am asked a lot by families who are torn between honoring their parent’s wishes and stepping into the unfamiliar role of parenting their parent. There is fear on both sides. Driving can be the final hold an older person feels they have on independent living. Especially for older men, driving is seen as part and parcel of adulthood. Imagine your feelings of loss and isolation if you were asked to give up such a central piece of your identity. Now imagine it is your own kid doing the asking.

From the adult child’s perspective there is fear of humiliating their parent or being confronted with anger and denial when bringing up unsafe driving. A resident I know at an assisted living community still refers to his three daughters as, “The One in Seattle, the One in Bellingham, and the One Who Took My Car Away.”

I have found that extreme reactions such as these to be the exception though, especially when the discussion is handled with tact, humor, and respect. Keeping them part of the discussion and decision making is an absolute must. Our parents are often tougher and more resilient than we give them credit for. As a generation, they certainly understand shared responsibility and sacrificing for the greater good. Hurting another person is the last thing any of our parents would want.

How to Start the Talk

Don’t put it off! By starting the discussion with the first warning signs of unsafe driving there will be more options available, and more chances for the senior to make decisions and stay in control. Start by asking questions, not by making demands. Questions are just questions, not accusations, and leave the senior in control. Examples of good starters are:

Does traffic make you nervous?

Is it harder to see and drive at night?

Are you ever frightened when you drive?

Have you had any close calls?

Once your concerns are out on the table, there are several steps that families can take together short of taking the keys. Children, caregivers, and friends should play a vital role in helping older drivers maintain independence while driving less and more safely. And independence, not driving, is really what it is all about. Here are some ideas:

1. Look at ways of lessening the need to drive:

• Car pool! Invite mom along for your Saturday Costco run. Offer to pick her up on the way to church.
• Check out alternatives to shopping by car. Keep a supple of mail order catalogs on hand. Many grocery stores and pharmacies offer home delivery options.
• Help your parent sign up for specialized transportation through Whatcom Transit Authority. They provide door to door service throughout the county. Call (360) 733-1144 to signup.
• Use financial services that don’t require bank visits, like automatic bill paying, direct deposit, and bank-by-phone or on-line banking services.
• It may be time to talk about the benefits of a retirement or assisted living community. Most have transportation services available.

2. Reduce their sense of isolation:

• Arrange for friends and relatives to visit regularly.
• Invite them to family events, kids ballgames, social events, and provide the transportation.
• This is another benefit of a retirement or assisted living setting.

3. To help with safe driving, get them to consider:

• Taking a driver refresher course sponsored by AARP. You might even get an insurance discount for attending.
• Not driving at night
• Getting their vision checked and updating their prescription
• Not driving on busy thoroughfares or during peak hours
• Getting a wide angle rear view mirror
• Not driving in tough weather conditions

Remember, it is important to get the older driver involved in exploring these issues through open and frank conversations. This builds a sense of personal control and lays the groundwork for responsible decisions.

If all else fails

Most older adults will surrender their keys when the time comes, especially if they have been involved in the decision making along the way and additional supports have been put in place. Sometimes though, due to poor insight from dementia, or just stubbornness, an older driver will continue to drive even when they have become a danger to themselves and others. In this case you may have to consider going to the Washington State Department of Licensing (DOL), which has a process for reviewing drivers reported as unsafe. A concerned person can simply complete a Recommendation for Driver Reexamination Form at any driver licensing office. The DOL does not take action on the basis of age alone, but considers the nature and of each concern individually. The DOL may require the senior to retake the road or written test, or require a medical or vision exam. Based on the results, they may then cancel the person’s license. The downside of this process is that in Washington these reports are not confidential, and your parent may find out who made the report. While that is quit a downside, the consequences of not acting could be even more severe.

Who Should Sign the Assisted Living or Adult Family Home Contract?

Every admission agreement I have dealt with as an administrator or as a consumer with has asked a family member to sign as the “Responsible Party”. This is either in addition to or in place the parent’s signature. If your parent is able to sign for him or herself, then this step is completely unnecessary and a bit disrespectful.

The parent moving in should be the one in charge, and the facility should do everything possible to ensure that the resident remains the one in charge. The more the resident is involved in decisions, the better the prospects are for accepting the move and integrating into the care facility. All facilities pay lip service to this idea, but not all make it part of what they do everyday or take the time to coach families through. Even after the move in, your parent should involved in all care conferences and have a say in decisions.

(This is another subject, but when you tour a care facility with your parent, pay attention to who the representative talks to – you or your parent. Your parent should be the important one to them, not you)

Finally, if you are signing as “Responsible Party,” find out exactly what you are becoming responsible for. In all likelihood, you are unnecessarily assuming financial responsibility for your parent’s care. If your parent is unable to sign, and you are signing as Power of Attorney, be explicit that you are signing as your parent’s agent, and are agreeing to be responsible to pay the bills from the resident’s own resources, not yours. Lastly, federal law prohibits nursing homes from requiring a third party signature for admission.

Help a Parent Chose the Right Care Facility

If you are researching a parent’s options when it comes to moving from home to a senior living community such as an assisted living or retirement community, adult family home, dementia care facility, or skilled nursing home, consider the use of a referral and placement service. My own agency, Elder Services NW, helps families in Northwest Washington make a smooth transition to senior living. This is a free service to families! Visit my website for more information.

Mark Robinson, Elder Care Advisor Elder Services NW

(360) 224-7916

After working through some difficult issues with families this week it was a pleasant surprise to run across an article in The Washington Post reporting on research results suggesting that older Americans are generally happier than their younger peers. At first this struck me as odd, given all the press about depression in the elderly. Then I remembered how uplifting it always is when I get the chance to sit and really listen to the seniors I am fortunate to work with. Even burdened with health care issues and multiple losses of loved ones, the vast majority of elders, whether living at home or in an assisted living community, have a positive outlook on life and a certain serenity or calmness about them. As an assisted living administrator I would typically I would venture out of my office to all stressed with the details of running an organization and return with a new inspiration arising from the gratefulness I found among my residents. Not to mention the way they encouraged and looked after the emotional well being of their neighbors.

I am not downplaying the seriousness of depression and loneliness among the elderly. It is there, and needs to be addressed. It is just nice to remember that there is much we can learn from our seniors about how to approach the challenges of our every day lives.

Washington State’s Long Term Care Ombudsman, Louise Ryan, answered questions recently in the Seattle Times regarding Long Term Care insurance, Assisted Living Costs and Medicaid as a follow up to a recent story about a 99 year old Assisted Living resident being evicted from her retirement community. Here is a link to the discussion: Seattle Times Article. As I discussed in an earlier post, the elderly woman had lived at the Assisted Living facility for a number of years before spending her resources and applying for the Medicaid program and finding out that her facility no longer had a place for her.

Start Planning for Elder Care Today

Once again, a good reminder to start planning today for the costs of long term care. Whether it be an Assisted Living Facility, Adult Family Home, Nursing Home, or Home Care the costs can be staggering and you will not be able to count on the government. A great starting place for information on Long Term Care Insurance is the booklet, “Dignity for Life”, available on-line from LTC Connects. Check it out.

If you have questions or concerns about senior living options in Whatcom or Skagit county feel free contact me, Mark Robinson, or visit my web site.

By Mark Robinson, Elder Care Advisor at Elder Services NW

Elder Care and Medicaid

A recent Seattle Times article about a 99 year old woman being evicted from her Assisted Living community for enrolling in the Medicaid program really struck a chord with me. Unfortunately, her situation is not unique. The only thing I found unusual about the story was the fact that the resident was fighting back and had delayed the eviction. Medicaid (the state program for low income seniors) pays for assisted living care, adult family home care, in-home care, and nursing home placement. The issue is access. Since the state reimburses providers much less than they can earn from private pay clients, many are reluctant to accept Medicaid residents at all.

In the case above, a resident had paid privately at an assisted living community for a number of years and had been promised that when her funds ran out she could convert to Medicaid and remain at the community. Turns out, when the time came, the community said they were at their limit of Medicaid residents and told her to either continue paying privately or find a new assisted living community. Talk about a bad outcome. Here is someone who trusted the community and had been reassured all along that this was her home and not to worry. Finding a new home and starting over is tough enough for anyone at any age. For a senior who has already given up her home, accepted her new situation, and settled in and made new friends to be asked to do it all over again can be devastating. Imaging having to move and start over again at 99!

The Whatcom and Skagit County Assisted Living Scene.

Several assisted living communities and adult family homes in the Bellingham area do not accept any Medicaid residents. Although this limits choices, at least families know the rules upfront and can plan accordingly. Most assisted living and adult family home owners allow resident who have paid privately for a specified period to convert to Medicaid and remain in their facility when funds dry up. There are risks in this though. In fact, two assisted living facilities in Whatcom county recently decided to no longer accept new Medicaid residents, or to allow their current residents to convert to Medicaid when they had spent all their resources. That means, when the money is gone it’s time to find a new place to live. Yikes! So many times I have talked to seniors who expected the Medicaid program to cover their Assisted Living or Adult Family Home costs when they could no longer do so privately. The reality is that a senior depending on Medicaid will have few choices and may even end up in a nursing home sooner because other options are closed to them.

What does all this mean? First of all, read and understand the residency agreement for an assisted living community or adult family home before you sign it. If the part about Medicaid payment is unclear, ask questions or better yet insist on a written agreement that Medicaid will be accepted when the time comes. Second, start planning today for care costs. Long Term Care Insurance policies usually cover assisted living or adult family home costs. Cindy Sherwin at LTC Solutions is a great local resource for policy options. Third, consider working with a qualified elder care advisor. They can ensure that you find the best care setting for yourself or your loved one and that you ask the right questions when evaluating options.

I hope this information is helpful. Taking care of seniors who have given given so much to our lives and our communities is a passion of mine.

By Mark Robinson, Elder Care Advisor at Elder Services NW

Have you have heard about the VA Aid and Attendance Benefit? If you answered “No”, you are not alone. In fact, according to a study prepared by the Department of Veterans Affairs in 2004, up to 2 million eligible veterans and surviving spouses may be missing out on the benefit, which pays for a portion of Assisted Living, Nursing Home, or In-Home care. It is estimated that only one in four eligible veterans, and one in seven surviving spouses are collecting the benefit. When one considers the high cost of care these days, this is indeed a shame. One reason the Aid and Attendance benefit may be underused is the belief that the disability must stem from a service related injury. This is not the case.

Eligibility requirements for the Aid and Attendance benefit are actually fairly straight forward. First, for a veteran or surviving spouse to qualify, the veteran must have served at least 90 days of active military service, one day of which was during a period of war, and be discharged under conditions other than dishonorable. Second, the veteran or surviving spouse must have a physician’s order confirming that they cannot live alone and require assistance with activities of daily living such as help with bathing, dressing, or medication management. The final criteria are financial. In order to qualify, an applicant must have less than $80,000 in assets, excluding their home and vehicles, as well as an annual income of no more than $22,000.

One complaint I have heard from seniors and their families relates to the application process. Applications typically take four to six months for the Department of Veterans Affairs to process, assuming a senior has submitted all the required forms and answered all the questions. Once a pension benefit is approved, however, it’s retroactive to when the senior applied. With nursing home costs commonly exceeding $6,000 per month, it is well worth the effort.

Additional information and assistance in applying for the Aid and Attendance benefit may be obtained by calling the VA at 1-800-827-1000. Applications may be submitted on-line at http://vabenefits.vba.va.gov/vonapp/main.asp. Information is also available on the Internet at www.va.gov or from your local veteran’s service organization.

About Mark Robinson

Mark is the owner of Elder Services NW, a free senior living referral and placement service. He spent several years as a licensed administrator at retirement, assisted living, and dementia care communities prior to starting Elder Services NW. He specializes in referrals to Independent Retirement Communities, Assisted Living, Dementia Care Facilities, and Adult Family Homes. He is committed to walking beside families every step of the way to ensure that families and seniors truly make the right decision at the right time. Please visit Mark’s web site at www.elderservicesnw.com, or feel free to call at (360) 224-7916.