In the past year, I’ve seen first-hand how devastating a fall can be to an elderly person. My 84-year-old father has fallen twice in his independent living apartment. The first time, he was on the floor for about 36 hours before he was found; the second time, he was down for about five hours. He has been very lucky – he has recovered fully from both incidents, with no long-term effects. In fact, I think his two artificial hips have actually been a blessing in these  falls – his right hip did dislocate both times, but doctors were able to pop it back into place; had this been his natural hip, it likely would have broken, leading to a much more difficult recovery.

The sad reality is that falls are one of the most common causes of accidental death in the elderly. A series this week in the Minneapolis Star-Tribune aims to raise awareness of the prevalence of falls in Minnesota nursing homes; I have to believe this is a similar problem nationwide, and not just in nursing homes but in assisted living facilities, independent living communities and private homes. In her commentary on the series, Star-Tribune editor and senior vice-president Nancy Barnes writes, “I urge our readers not to look away, despite the distressing nature of these stories. Nothing is more certain in life than death; we can only hope that we will be allowed the gift of dignity. In many of these stories, that is simply not the case.”

The investigative article is long and, at times, difficult to read. But it is important. Worth sharing. As one doctor quoted in the  article states, “”I think if you asked a person on the street, not one of them would know that if you take the frequency of falling and the consequences of falling, it’s as big a problem as heart attacks and strokes.” My father was one of the lucky ones. For many elderly people, a single fall can trigger a rapid decline in health. I hope you will take a few minutes to read this article. And I hope you’ll share your thoughts by leaving a comment.

I remember when my father was trying to select a Florida senior living facility. The process was frustrating (which is in part why I created Florida Senior Living Advisor) and tiring – driving around from one senior facility to the next, trying to keep track of the different features, costs, options, etc. By the time he had made his decision, we were both a bit worn down and just ready to be done with it. In actuality, that was the time we probably should have been at our sharpest – focused on reading every bit of fine print before he signed on the dotted lines. Yes, we did read over the pages and pages of paperwork very closely; but I’m not confident that we truly scrutinized every point, and we certainly didn’t have it independently reviewed by an attorney.

Thus far, my father has not had any issues, and (knock on wood) I don’t foresee any in his future. But when I came across this article from The Washington Post about contracts at continuing care retirement communities, I figured it was worth sharing. It makes reference to a specific CCRC in Northern Virginia, but the concepts are universal.

Scrutinize any contract to avoid nasty surprises at continuing care community

By David S. Hilzenrath

If you are considering moving to a continuing care retirement community, you would do well to consult a lawyer and read the fine print of any contract to determine whether the potential benefits outweigh the risks. A “Residence and Care Agreement” for Ashby Ponds, an Erickson community in Ashburn, illustrates some of the trade-offs the decision could entail.

You might be drawn to Ashby Ponds by the potential to avoid another disruptive move when you are least able to cope with it, but there is no guarantee you would be able to move to an assisted-living or nursing facility on the same campus — even when those facilities are completed. If the assisted-living and nursing home beds at Ashby Ponds are full, management could arrange for you to go elsewhere.

Some delay in building those facilities is routine at Erickson developments, said Ronald E. Walker, chairman of a nonprofit group associated with Erickson campuses. Though Ashby Ponds opened in September 2008, the assisted-living and skilled-nursing portions were not expected to open until the end of 2011 or the beginning of 2012, according to a May report from the community’s management.)

The deposit you post to move in does not limit the amount you could be required to pay on a monthly basis; management can raise the monthly fees. In addition, the fees can go up as you move from one level of care to the next. At Erickson communities, the average monthly fees range from $1,750 for singles in independent living to $5,178 in assisted living and $307 per day — as much as $9,517 per month — in the nursing homes, Erickson spokesman Mel Tansill said.

Management can decide to transfer you to a higher level of care. If you refuse to go, management can kick you out and hold on to your deposit until 60 days after it finds a new tenant. To gain admission to the community, you have to pass financial and medical reviews. If you marry a nonresident, your new spouse would have to pass such a review before being allowed to move in.

To reassure management that you have the ability to pay expenses, you must agree not to give away any assets that would bring your net worth below a minimum requirement. Evan H. Farr, a Fairfax lawyer who specializes in issues facing the elderly, recommends putting any extra assets in an asset protection trust before you move in.

Unlike a real estate investment, the deposit you post to enter the community does not grow as property values rise. But it can shrink as property values fall. If it takes management a long time to replace you, you may be offered the option of accepting a smaller payout so that management can in effect cut the price of admission for the next tenant to occupy your apartment.

Sunday, October 18, life threw me a curve. My elderly father fell in his Florida senior living apartment and dislocated his hip. That triggered a series of events – a trip to the ER to have it put back in place, his release that same night to come stay with me, a second hip dislocation followed by a  second re-location. Then six nights in the hospital to run tests,etc.  He is now back in his Florida continuing care retirement community apartment and gradually re-gaining his strength. So I thought I would share the top ten things I learned in this last week of helping my father recover from this fall:

1 – At any age, life can change in an instant.
2 – Healthcare workers are just like the general population – some are nice, some are not so nice; some are highly skilled, some are mediocre; some genuinely care, some are just doing a job. We shouldn’t make them “God-like,” nor should we start with the mindset they are all incompetent (like my dad is prone to do).
3 – Communication is critical when in the hospital – both from the patient to staff and from the staff to patient. I find nothing puts me, and my father, more at ease then feeling like the medical staff is keeping us up-to-date on his situation; and nothing was more frustrating then having to walk around begging someone to tell us what is going on.
4 – Nothing happens fast in the hospital. Patience is key.
5 – You must be an advocate for yourself, or for your loved one if you are their caregiver. Ask questions, ask for clarification, ask to see test results, ask “What would you do if this was your father?” Don’t be afraid to push a little. I had to call my father’s nurse to say “He would really like to shave, can you help him do that?” and “He has been lying in bed all day, can someone please get him up to walk the halls?” The squeaky wheel gets the grease.
6 – The whole experience of being hospitalized can be confusing and frightening, particularly for the elderly. In my elderly father’s case, anything outside of his normal daily routine causes some confusion. So suddenly being in a hospital, with no familiar faces, a different schedule for meals, none of his personal effects, etc., left him confused and a bit angry. I had to remind myself that his anger was just an expression of his confusion and frustration at the situation and at having to rely on everyone else.
7 – When caring for an elderly family member, remember to care for yourself too. It has taken me a long time to embrace this concept. When my father had a similar fall last year, and was hospitalized for a couple of weeks, I was constantly wracked with guilt if I was not by his bedside 24/7. I have finally learned that is not necessary for him , and not healthy for me. And actually I have found that by taking breaks, I have helped him re-gain confidence that he can do things for himself.
8 – Health insurance & Medicare rules are confusing and can sometimes be an overriding factor in determining care.
9 – When dealing with a variety of care providers (physical therapists, home health, rehab facilities, etc), don’t lose sight of the fact that they are all in business and that factors in to their recommendations.
10 – Getting old is not for sissies (credit goes to my husband for that one).

I remember when I was helping my elderly father select a Florida senior living facility, one of the biggest issues for him was cost: What does it cost up front? What does it cost each month? And most importantly – will those costs increase every year? As someone living on a fixed income, he didn’t want to move into a senior community where he couldn’t afford to stay – forever.

The facility he selected guarantees only nominal increases each year, which gave him the peace of mind he was looking for. But I just learned about a Florida senior living provider that is going one better: Aston Gardens, which operates six senior communities in Florida, has enacted a three-year rent guarantee for new independent living residents.

“We know that times are uncertain and many seniors are faced with the worries associated with living on their own. Seniors who live on their own never know if the property taxes on their residence will skyrocket or when they’ll be hit with an unexpected, expensive home repair bill. Our three year Peace of Mind Rent Protection Guarantee means seniors will never have to stress about their monthly bills — everything remains the same month after month,” said Diana Ferrante Thies of Aston Gardens.

Aston Gardens has senior facilities in Parkland, Naples, Venice, Tampa and two in Sun City Center.

Maybe there are other senior living facilities around the state offering this type of rent-control program. If you know of any, please let me know.

Today, on World Alzheimer’s Day, new data released estimates 35 million people worldwide – a 10% increase over 2005 – are living with Alzheimer’s and dementia, highlighting the urgent need for action and response. With 77 million American baby boomers reaching the age of greatest risk, it is clear that the crisis of dementia and Alzheimer’s cannot be ignored. Left unchecked, dementia and Alzheimer’s will impose enormous burdens on individuals, families, health care infrastructures and the worldwide economy. The impact is already being felt here in Florida, where 25% of our population is 65 or older. Individual families and senior living facilities are struggling to provide care to the growing number of people dealing with Alzheimer’s and dementia.

According to the 2009 World Alzheimer Report, newly released today from Alzheimer’s Disease International (ADI), a London-based nonprofit, international federation, the number of people with Alzheimer’s or another dementia is expected to nearly double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050.  It is estimated that there is a new case diagnosed every 70 seconds.

Much of the growth will be fueled by longer life spans and population growth, especially in developing nations.

“The number of people affected by Alzheimer’s is growing at a rapid rate, and the increasing personal costs will have significant impact on the world’s economies and health care systems. We must make the fight against Alzheimer’s a priority here in the United States and worldwide,” said Harry Johns, President and CEO of the Alzheimer’s Association.

According to Johns, some other countries, like the U.K., have a national Alzheimer’s plan in place. But in the United States, federal spending on research for Alzheimer’s is far lower than some other diseases, like cancer and AIDS. And, there’s no national plan in place that deals with long-term care for people with dementia, as well as “care coordination” of the many different health-care professionals who are often needed to care for patients with Alzheimer’s.

Although there is no cure, experts say that patients who receive active, early medical care may be able to delay progression and experience a higher quality of life. Also, caregivers who receive supportive services early on are better able to manage their loved ones’ illness at home and reduce institutionalization.

The Alzheimer’s Association website provides this very interesting interactive tour that shows how Alzheimer’s affects the brain. Inside the Brain: An Interactive Tour.

If you are trying to find care for a loved one with Alzheimer’s or dementia, many of the nursing homes and assisted living facilities in the Florida Senior Living Advisor database offer memory care services. Visit the individual websites or call for more information. Another option is in-home care, which I wrote about on this blog last week.

The operators of three separate assisted living facilities in Florida have been arrested, all on charges of operating without licenses. One of the arrests was in Volusia County, the others in Duval County.

In Volusia, officers from the state’s Medicaid Fraud Control Unit arrested Marjorie Nelson, owner and operator of Helping Hands Manor I and II in Edgewater. According to the Attorney General’s office, Nelson told investigators she had not licensed the second location because upgrading the septic system and fire suppression systems would cost too much. Those upgrades were necessary to qualify for a license. Nelson is charged with operating an unlicensed assisted living facility, a third-degree felony. If convicted, she faces up to five years in prison and a $5,000 fine.

In Duval County, officers arrested Tommy Teague and Roberto Gallegos on charges of operating an unlicensed facility at 2198 Mossbrook Court in Jacksonville. Teague and Gallegos face third-degree felony charges and could each face up to five years in prison if convicted.

At the third facility, Medicaid fraud investigators determined through a routine spot-check that Torina Brooks had exceeded the capacity of her licensed facility, Pauline’s House in Jacksonville. Brooks placed the extra clients in an unlicensed facility across the street and requested Medicaid reimbursement for their care. She faces one count of operating and/or maintaining an assisted living facility without a license, one count of Medicaid fraud and one count of grand theft, all third-degree felonies, and could face up to 15 years if convicted of all charges.

To legally and properly operate an assisted living facility in the state of Florida, there are various administrative and operational requirements which must be met. These include licensing procedures, staffing requirements, compliance with county health and local fire authority regulations and the safe management of medication by trained staff personnel.

For a searchable database of licensed assisted living facilities throughout Florida, visit Florida Senior Living Advisor. Licensing status can change, so be sure to ask for proof of licensure when visiting a facility. For more information on the Florida’s licensing process for senior living facilities, visit the Florida Agency for Health Care Administration (AHCA).

Confession time… I’m visiting family in Tennessee this week so I’ve been neglecting my blogging duties a bit. Late yesterday I remembered that I had not yet written this week’s “Friday’s Featured Facility.” (That’s the problem with starting a regular feature such as this – you create a natural deadline for yourself!) I decided I wanted to write about one of Florida’s adult day care centers, but which one? A quick search of my Florida Senior Living Advisor database lead me to All One Family Senior Day Programin Merritt Island. Two minutes into my conversation with owner Stephanie Licavoli, and I knew I had found a great senior facility to feature.

Stephanie explained that she and her sister-in-law Karen Wilkes decided to open their adult day care center after their family members had bad experiences in other facilities.

“They would come home with urine-soaked clothes,” Stephanie explained. “And she was left sitting in front of the TV all day and then be up all night when I got her home.” Those personal experiences have helped Stephanie and Karen create a facility that they say is “completely different from any other senior day care.”

According to Stephanie, Florida law only requires that an adult day care center keep its clients busy 60% of the day, so many only meet that minimum requirement. All One Family keeps its clients busy the entire day, alternating between physical exercise and mental stimulation.

“In many centers, all you see are recliners and television,” she explained. “We don’t have any recliners. We play games, we go outside and we have a Wii game that they love.” Stephanie said they also focus on treating clients with respect and dignity, regardless of their physical or mental limitations.

All One Family is open from 7:45am-4pm Monday-Friday, but Stephanie said they are very flexible because she knows from experience that caregivers have needs outside of those times. “If a caregiver wants to go out to dinner, or if you are running late, we don’t charge anything extra for that.” All One Family is licensed to care for 24 people. Their current average is 15-19 per day. The cost is $68 per day, but here again, Stephanie said they are flexible and will work with people who have financial limitations.

Adult day care can be a wonderful option for someone who wants to care for their elderly loved one in their own home, yet who has work or personal commitments during the day that get in the way. There are more than 150 licensed adult day care centers in Florida. It’s clear to me that All One Family is one that is setting a high standard for quality.

To learn more about All One Family, visit their website at www.allonefamilyseniordayprogram.com.

I’m starting a new segment on the Florida Senior Living Advisor blog today called “Friday’s Featured Facility.” Every Friday I’ll tell you about one of the more than 3700 senior living facilities in Florida, everything from assisted living facilities, to nursing homes, continuing care retirement communities, hospice, skilled nursing units and adult day care centers. If you’d like to recommend a facility for me to feature, send it to me at mitra@flseniorlivingadvisor.com.

The inaugural “Friday’s Featured Facility” is Guardian Home Health in Spring Hill, Florida, about 60 miles north of Tampa. This is actually an assisted living facility, but the name “home health” refers to the fact that it is located in a single-family home. The facility is licensed to care for six residents. Of the nearly 3,000 assisted living facilities in Florida, about half have a capacity of less than 10.

Owner Elaine DeCiutiis runs Guardian Home Health, along with her husband Frank and daughter, Paulamarie Aurigemma. DeCiutiis and Aurigemma are both certified nursing assistants and have backgrounds in health care administration. They opened the home last October, with the goal of providing very personalized care to each elderly resident.

“When I’ve gone to big nursing homes, I see people just sitting there and doing nothing,” says DeCiutiis. “We try to keep them active. We play cards.  We discuss current events. We go to the movies or out to lunch.”

DeCiutiis also tailors each meal to the residents’ taste as much as possible.

“You could say we spoil them,” she says with a laugh. “But at their age, they deserve to be spoiled.” Residents are also offered a shower every day, a service that is often not possible in larger facilities where there may not be enough staff to accommodate residents in this way.

For more information on Guardian Home Health, you can visit their website at www.guardianhomehealth.org. You can also call 352-688-8832 or send an email to edecuitiis@tampabay.rr.com.    

There are two things I know my 84-year-old father will always have in his pocket: a toothpick and a wad of bills. Like many elderly people who grew up in a different era, his preferred form of payment is cold hard cash. Over his lifetime, he has used credit only sparingly and I don’t think he has ever had a debit card (no matter how hard I try to explain that it is like using cash, he doesn’t buy it). Since he moved into a Florida continuing care retirement community about a year ago, I have been a little concerned about him keeping too much cash on hand. Thankfully his building has a Bank of America branch right in the basement. Not only does it give him peace of mind to know that he has easy access to his money, but I think it also helps preserve his sense of independence and dignity, especially since he no longer drives. 

I got to thinking about this after reading last week that an employee of a West Palm Beach nursing home has been arrested for stealing more than $2300 from an elderly resident. The employee, Natasha Petit-Homme was an admissions clerk at Woodlake Nursing and Rehabilitation Center in West Palm Beach.  According to Florida Attorney General Bill McCollum, Petit-Homme gained access to the victim’s checkbook, wrote herself a check for $2,341 and deposited the funds into her personal checking account. Petit-Homme is charged with one count of exploitation of an elderly person, a third-degree felony. She faces up to five years in prison and a $5,000 fine if convicted.

I don’t know anything about this victim’s capabilities or her situation, but I have to wonder why a nursing home resident is keeping a checkbook. These are sensitive issues, I know. As I have seen with my father, control of one’s finances is an important part of maintaining dignity and holding on to some independence. And as I have also seen with him, things can change rapidly for the elderly. Someone who is sharp-minded and on top of things today can go downhill in a matter of weeks or even days. Maybe the best we can do for our loved ones who are in senior living facilities is to be aware of these issues, discuss personal security with them and look out for changes in their mental abilities that may warrant a change in their responsibilities.

The arrest in this case resulted from an investigation by the Attorney General’s Medicaid Fraud Control Unit’s Patient Abuse, Neglect and Exploitation (PANE) team. According to their website, the AG’s Medicaid Fraud Control Unit investigates fraud committed by health care providers, and it also investigates the abuse, neglect and exploitation of the elderly, ill and disabled residents of long term care facilities such as nursing homes and assisted living facilities. If you want to report fraud or abuse, you can call the statewide hotline number or contact the Medicaid Fraud Control Unit nearest you:
The statewide hotline number is 1-866-966-7226

Tallahassee (850) 414-3300

Orlando (407) 999-5588

Tampa (813) 287-7940

Ft. Lauderdale (954) 712-4600

Miami (305) 377-5441

Jacksonville (904)-858-6919

Ft. Myers (239) 338-2442

West Palm Beach (561) 837-5000

Pensacola (850) 595-6057

While I was on the AG’s website, I noticed that they also provide a link to a new brochure, “Smart Consumers Can Stop Fraud: A Guide for Seniors.” The information in the brochure provides valuable guidelines and steps for consumers to take to protect their interests, as well as information on tools designed to save money, especially in the important area of prescription medication.

I’m starting to think that the next hit reality TV show should be shot in a senior living facility. Judging from what I have seen at my father’s Florida continuing care retirement community, there is plenty of material. Who sat with with whom at dinner? Who said they’d call, but didn’t. Who is most likely to flirt with the new – and rare – single men who move in? The drama is endless. And I have to believe that it is not just amusing to those of us on the outside, but it is actually mentally stiumulating to those involved.

Prior to moving into his senior living facility more than a year ago, my father had spent about four years living all alone in a traditional apartment building, filled primarily with people much younger than him who were busy with their own lives. I suspect he would go days without interacting with anyone else, especially in the cold winter months when he would not venture out. Imagine eating every meal alone? It took me a while to realize that this social isolation was having a very negative effect on his mental and physical health. He, of course, denied it, trying to take pride in his belief that he didn’t “need” to be around people as much as most. How wrong he was.

Within a week or so of moving into his Florida continuing care retirement community, I could sense renewed energy in his voice. He started making friends and I could tell he was amused by the “soap opera-like” drama among residents. Within the first month, he met a female resident that he really clicked with. Here we are nearly a year later and they are still going strong, sharing meals, long walks and participating in the facility’s organized activities together. His attitude and energy are far better than when he first moved in. At times he does sound a bit disgusted by some of the gossip and nosy-ness that he thinks some of the residents exhibit. But while he may never be able to admit it, I think he does realize it is better than the alternative – living all alone.