Selecting a Long Term Care Facility with Long Term Care Insurance

November 14, 2009

My mother, Rose, painting with Dementia

My mother, Rose, painting with Dementia

My mom is back at Sunrise Assisted Living and is thrilled to be back home. The only problem she has been facing currently, is that she is now what they call, “a fall risk”. In fact, since she returned home from rehab at Fox Run, she has fallen four times. This means that her level of care is going up and so will her monthly costs. I have a dilemma to deal with. Since my mother has a long term care policy that pays $90/day for an assisted living facility and $150/day for a skilled care facilitity, my question is: Should I move mom to a skilled facility and collect the extra $60/day benefit or $1800/month for her, or do I use her savings to make up the difference in rent?

Sunrise is not considered a Skilled Care Facility, so the most my mother can receive from her policy is 60% of her monthly $150/day benefit. If she were to move to a Skilled Care Facility like Fox Run (owned by Erikson), for example, she could receive the $150/day. Another issue: Fox Run also requires a $100,000 deposit to move in. Not all facilities do this, however, the deposit is returned to the resident when they leave, OR to their estate when they died. Plus there is an added benefit. The resident will never be forced to leave because they run out of money. Once the deposit is used up, the facility takes care of their expenses.

There is a lot to consider, right? My mom spent three weeks at Fox Run in rehabilitation and what I found is they are an excellent medical model facility. The care, however, is totally different than where she currently lives. Fox Run provides a “Medical Model” of care and Sunrise follows a “Social Model”. While my mom was at Fox Run, she was bored and spent all her time in her bed sleeping. Now that I have brought her home to Sunrise, she has spent her days dressed, socializing and very active. We both like the model so much better.

Be sure to consider this when you are looking for a long term care facility for your loved one. It’s amazing not only how many choices there are, but also how the type of facility you select can affect your long term care policy. Let me explain.

When my step father was diagnosed with lung cancer and my mother with Dementia in the fall of 2005, they moved from their private home to an “Independent Retirement Community”. Here they had a two bedroom apartment and even though they had a kitchen in their apartment, lunch and dinners were provided in a beautiful formal dining room with the other residents. When my father became very ill, the facility actually managed the medications and helped with custodial care for an additional fee. He paid for his expenses out of pocket, and then applied to his long term care policy for some small “home care benefits” that the policy provided.

While they were living in an “Independent Living Facility”, my mother was diagnosed with Dementia and qualified for benefits under her long term care policy. The problem we found out was that Independence Village was neither an Assisted Living Facility or Skilled Care Facility even though they had full time nursing staff. It actually had something to do with the construction of the building!

At this point, although my step-father qualified for his long term care benefits, we would have had to move him a new facility to collect his long term care policy benefits. We decided that peace of mind (staying in place) was more important that collecting insurance benefits during his final nine months of life. Had we known about this issue in advance, we would have selected another facility that offered multiple levels of care. This is a good thing to consider before selecting a facility when you own a long term care policy.

So when my step-father passed away, I moved mom to my house temporarily and began to look for a long term care facility that would work best for her situation. This is when we chose Sunrise. The West Bloomfield Facility was just 10 minutes away and she woudl have a wonderful studio apartment, three meals a day and lots of social activities. Her policy would pay 60% of her long term care policy daily benefit which was $150/day.

So this is where mom stands today: She is moving to another wing of Sunrise where they offer a much higher level of care AND she will not be in a nursing home envirnoment. Instead, she will remain very active and spend her days with the other residents in a “home style” area and just go to her room to nap or sleep at night.

Her rent, however will jump from $4800/month to $6330/month. Again, I can collect another $1800/month for her by moving to a Skilled Nursing Facility, but she would be back to the Medical Model. I have decided to run a financial time line to compare the difference between moving and staying to see how long her money will last both ways. And I have also put her on a list to move to the first semi private room when it becomes available. This will save her around $1200/month.

So the question is would you rather be in a Medical Model Skilled Cafe Facility collecting $150/day benefit (probably still in a shared room), or would you rather be in a very large “studio apartment” style shared room in a Social Model Facility for $600 more per month? My choice is the social model. We will start out paying around $6000/month initially for a private room, and then around $5000/month as soon as a semi private room is available. This sounds like a reasonable solution.

My mother is very fortunate. Because she and my step-father came to me for financial planning right after they were married 20 years ago, they were able to do a financial and estate plan when many options were available and insurance costs wereaffordable.

My mother’s long term care policy premium at age 58 (20 years ago) was under $100/month for a lifetime benefit period, and with an inflation rider (so her policy benefit would increase every year by 4%). If she had waited until she was 70 to purchase the policy, it would have been too expensive and she would have been uninsurable.

The secret is starting to plan as early as possible…beginning with our own planning….and realizing that no matter what your situtuation is today, there is always an appropriate plan of action. The key is finding a caring and knowledgeable advisor to help you through the process.

I would like to hear your experiences. Feel free to share them with us. If you are interested in help with these types of questions and situations, email me at katana@designateddaughter.com or call me at 248-366-0137. Either I or one of our Contributing Experts will be able to help you with your situation. Also, be sure to sign up for my Caregiver’s Manual right here on the website. It’s a great tool for helping you prepare for this entire process.


Who is watching over mom when you’re not there?

October 3, 2009
My parents: Dale and Rose

My parents: Dale and Rose

Women today are faced with a real dilemma as Caregivers:  How do we manage all our roles: as wife, life partner, mother, business owner or career woman, volunteer and more often as primary caregiver to our parents?  This is known as living in the Sandwich Generation.  I call it being the Designated Daughter.

My Story:  Last Sunday, I went to check up on my mother who resides at a local, very upscale, assisted living facility.  What happened next was scary.  Because of my professional training as a Certified Financial Planner and Certified Senior Advisor and my recent experience helping my step-father during his final year long struggle with lung cancer, I may have been more prepared to notice “red flags” in her care.  I just wonder, however, what would have happened had I not stopped by that night, or had been living out-of-state.  Let me first fill you in. 

What happened two nights before (Friday night):  My mother who suffers from Dementia had been in the hospital just two night prior after complaining about heart pain.  She had been receiving the physical therapy that I had requested after her last hospital visit only 30 days prior.  The facility had given her a nitro glycerine pill which had caused her heart rate to drop dramatically.  The facility called an ambulance and sent her to the hospital.

I was called, and when I arrived at the hospital, I found her disoriented, exhausted, in a weakened condition andin very poor hygiene.  I won’t go into detail, but I was very embarrassed for her, and after her vitals were normal again, I took her back home to the facility, where I made sure that she received a shower.   I had not idea at this time, that she had a low grade urinary tract infection and that she should have stayed at the hospital.

Caregiver Red Flags:   This was still Friday night after bringing my mother back to the facility for a shower and helping her get settled.  I went to the nurses station and requested to see her personal file and medical file.  This is when I found that she was still receiving Vicodent to manage her pain on a daily basis.  The Vicodent had been prescribed about a month ago for the pain related to “old” compression fractions. 

Next, I went out to talk with the employees of the facility to see if they had noticed any changes changes in her health or ability to take care of herself, this is what I was told:

  • She had been more tired than normal
  • Spending a lot of time in bed complaining about pain
  • She also seemed to be “out of it” most of the time

My mother has always been very social and very active.  On July 4th, she had played pool with my husband for a couple of hours, helped me in the kitchen and garden.  In addition, she would play cards with her friends for hours.  I would often join them after dinner and we would play until 10 pm.  I was told that in the last month, she would sit at the card table and not even be able to play the cards in her hand because she was “so high or out of it”.

What they were referring to was the combination of prescriptions she was taking, plust the added dose of Vicodent that she had been prescribed for a urinary tract infection last month.   This also explains why she was getting weaker and weaker.  I noticed that over the last month, she had been riding around in a wheel chair, but I had no idea that Vicodent had been prescribed for long term pain management.

So on Sunday night, after receiving a call from the nurse that my mom was not feelling very well, I decided that I would  stop in to check on her.  To my horror, she seemed to be close to death.  She was lying in bed shaking (she had a high fever from a urinary tract infection)

  • She was dehydrated (I gave her a 12 oz. glass of water with a straw and she sucked it down in one gulp)
  • She could only speak in a whisper and had no idea anything was wrong with her. 
  • She looked as frail as a little bird and I knew she was dying. 

Right then, her caregiver walked in

  • I asked her if my mom was receiving food or water.  She said that the day before, my mother was in so much pain, that she was not really eating or drinking. 
  • The young, pregnant caregiver also said that when she tried to help my mother get to the bathroom, my mother had put her arms around her and lifted her legs like a little monkey to be carried.
  • My monther was also in a diaper because she could not control her bladder.

This is when I walked out into the lobby and asked for an ambulance immediately.  It was now almost 7 pm, Sunday night.  Thank God I had stopped by.

When we arrived to the hospital, she was put on an IV and given antibiotics.  She had a very high fever and a urinary tract infection.  This is when the nurse discussed the dangers of the sepsis infection with me.  The high levels of Vicodent may have been masking the pain she was experiencing from the urinary tract infection.  In addition, she had not been drinking enough fluids because of the drugs causing her to be “high”.  This may have caused the UTI to simply get worse and continue unnoticed.

This story has ended up okay, my mom is now safe and recuperating well at Fox Run in the skilled care section.  Because I am experienced in issues related to caregiving, this is what was going through my mind when she first arrived to the hospital on Sunday:

  • my mother needed a three day hospital stay to qualify for Medicare to cover rehab/skilled care for up to 100 days.  
  • She was very week and needed to build her strength and get back to her prior level of strength, but there was no exercise equipment at her current facility and this may have  attributed to her declining health.
  • I better get busy and figure out where I wanted her to live when she left the hospital, because although I loved the social aspect of her current facility, they may not have  a proper protocol when someone’s health is on the decline.
  • I contacted Fox Run, an Erickson facility that had a new skilled care/rehab center and also offered 5 levels of custodial care and I wanted to make sure she could go there, even though the hospital care manager would request 3 different rehab facilities
  • I would need to check my mother’s assets because Fox Run requires residents of the Assisted Living Facility to come up with a $99,000 cash deposit and then go through financial underwriting to see if she qualified.
  • Also, my mother had a long term care policy that paid $150/day benefit for a skilled care facility.  Currently she was only receiving 60% of the benefit since her current facility was classified “assisted living”.

There are so many decisions a caregiver is required to make when dealing with a loved one.  I just hope by sharing this information, I will be able to help others “be prepared for that call in the night”.  Currently, I am working with the management at the assisted living facility where my mother is living to help them see what went wrong so it won’t happen to another resident.  I honestly have loved her current facility…they have been wonderful and this is her home. The problem is that by simply missing a few red flags, a resident’s health can change very quickly.  Also, I needed to be contacted more frequently with important information about her wellbeing. 

Be sure to download your free copy of, “Your Caregiver’s Manual” right here on this website.  It will take you step by step how to get organized financially when helping a loved one.  If you would like a consultation about your own personal situation, please feel free to email me at katana@designateddaughter.com   

I am interested in your stories.  In fact, I am currently writing my new book, The Designated Daughter:  How to Be Prepared for that Call in the Night and interested in your challenges, and success stories of being a caregiver.  I would love to hear from you on this blog, so please leave a reply. Thank you!


Beautifully Imperfect

September 23, 2009

by Steve Pender, video biographer & personal historian, Family Legacy Video, Inc.

At the end of the day, what it is you’ll remember about your loved ones? Great accomplishments? Public acclaim? Perhaps. More than likely, though, it’ll be their endearing and “imperfect” qualities – like in this commercial commissioned by the government of Singapore. Enjoy!


An Olympic Family History Moment

September 2, 2009

by Steve Pender, video biographer & personal historian, Family Legacy Video, Inc.

Imagine finally seeing your father run in the Olympics – the 1912 Olympics, that is.

Creating video biographies is always fulfilling for me. But occasionally I can provide a special service that really gives me the warm fuzzies. Here’s an example:

Just before Christmas of 2004 I completed a Family Legacy Video for a wonderful couple, Mary-Lou and Dick, in Tucson, Arizona. It turns out that Mary-Lou’s dad was a college track star in the 1910s, held the record for the mile for a number of years and placed fourth in the 1500m run in the 1912 Olympic Games in Stockholm, Sweden.

After I finished the video, Dick asked me if I thought film footage of the race might exist. I told him I’d check around. I contacted a few film archives with no success, then managed to find my way to the Web site of the International Olympic Committee. I submitted a query through the site, and then went on to other things.

After about a month, I received an e-mail from an archivist at the IOC. Believe it or not there was a film clip, thirty seconds long, of the race I was looking for!

Long story short, the IOC sent me the clip. The quality of the film was surprisingly good and gave views of the starting line, the mid point of the race and the finish. I added a title screen and created two versions of the clip, one running at normal speed and one in slow motion, adding a freeze frame of Mary-Lou’s father crossing the finish line. Then I put it all on DVD.

After watching the footage, Mary-Lou wrote me, saying, “You can’t imagine what a thrill it was to see Dad running. That was an amazing thing you did for us but it meant the most to me. Thank you again and again.”

I feel great knowing I helped make a very special and unique addition to a family’s archive.


Women Educating Women Miniseries

September 2, 2009

Smart Women’s Coaching’s Own Contributing Experts Danielle Mayoras and Jill Jordan are proud panelists for the miniseries:

What Every Women Needs to Know to Care for Loved Ones

Now and in the Future

Rochester, Michigan – September 15, 2009

A series of three free workshops focused on the financial, estate and care planning issues women face every day.

This community program will take place at the Rochester Community Center, 816 Ludlow St, Rochester, MI

Workshop dates are September 15th, 22nd and 29th, 2009

All three workshops will run from 6:30 P.M. to 8:00 P.M.

This educational series is presented by the Women Educating Women Consortium.

Attendees, should RSVP to 1-877-PLAN-758.


The Women Educating Women Consortium is a collaborative effort of female professionals, for the purpose of educating women in areas in which they are the decision maker.  These are the life circumstances and issues affecting them daily.  The material to be covered in this community event will address and answer questions women have which impact their families.  Some of the areas to be discussed are; indicators which should lead to taking an active role in a loved one’s life, senior care options, what to look for in a senior community,  Medicare and Medicaid and their relationship to funding care,  what are the Veteran’s benefits, information about long term care insurance and retirement and estate planning.

Presenters:

Danielle Mayoras – Attorney and Counselor,  The Center for Elder Law

Jill Jordan – Founder and Principal of Get Ahead by Getting Known

Mary Jo Fresard – Director of Community Relations at Sunrise Senior Living Rochester

Joann Lagman – Owner of  Home Helpers & Direct Link’s  Washington/Romeo office

Nancy Salvia – Financial Advisor, Merrill Lynch

Candius Stearns - Owner of DFBenefits

Call 1-877-PLAN-758 to RSVP, Space is limited – reserve your seat today!


Announcing the Designated Daughter Radio Show

August 25, 2009

Join Katana Abbott, Midlife Millionaire and Danielle Mayoras, Elder Law Expert as they co-host their new and highly requested radio show “Designated Daughter” on Smart Women Talk Radio.

The first show airs Tuesday, August 25th, 8:00 am (PST)/11:00am (EST).

You must tune in to this show if you are a caregiver, a future caregiver, baby boomer, or a professional who services caregivers.  As two highly acclaimed experts in their fields, Katana and Danielle will discuss topics that are surrounding today’s aging population.  Expert guests will join them addressing how to overcome the most common hurdles caregivers, and professionals servicing the aging and caregiving population face.

katana_abbott2Katana Abbott, CFP, CSA

Smart Women Talk Radio teaches you to live with Purpose, Passion and Prosperity.

Katana Abbott knows firsthand the powers of an organized financial strategy. She left her $100 million investment management and financial planning practice to become founder and vision coach of Smart Women’s Coaching, a global online coaching, consulting, leadership and membership resource. Rising from a life of poverty and adversity to one of abundance, Katana spent 20 years with Ameriprise Financial as a Certified Financial Planner. At the age of 48, Katana retired financially independent. She and her partner of 15 years managed over $100 million which placed them in the top 1 percent of money managers nationally. She began pursuing her dream and created Smart Women’s Coaching in 2006, which has prospered into www.SmartWomensCafe.com, the free online networking community that is helping women in mid-life transition all around the world find their niche.

For more information, please visit www.SmartWomensCafe.com or email Katana directly at katana@smartwomenscoaching.com.

DBM Headshot 2008 - revised Danielle Mayoras, Attorney and Counselor, CPG (Credentialed Professional Gerontologist), Director of Education, for The Center for Elder Law, The Center for Probate Litigation and The Center for Special Needs Planning

Danielle Mayoras has dedicated her legal career to educating professionals and businesses as well as the general public on the topics of elder law, special needs planning, and general estate planning through presentations, print, and broadcast media across the United States.  She is a founding partner of The Center for Elder Law, The Center for Probate Litigation, and The Center for Special Needs Planning.

Additionally, Danielle is the co-author of the upcoming book Trial & Heirs: Famous Fortune Fights which you can learn more about at http://www.trialandheirs.com. Trial & Heirs uses real celebrity stories to help you avoid any errors when planning to leave your legacy to YOUR heirs.

Some of Danielle’s recent publications include: Exceptional Parent Magazine, Michigan Lawyers Weekly, and the Detroit Free Press.  She is also an active member of National Association of Elder Law Attorneys, The Michigan Dementia Coalition, National Speakers Association, Institute of Gerontology’s Elder Law and Finance Committee, and National Association for Professional Gerontologists.

Danielle is a founding partner of The Center for Elder Law, The Center for Probate Litigation, and The Center for Special Needs Planning.

For more information, email Danielle at  dmayoras@brmmlaw.com, or call 1-877-PLAN-758.

www.thecenterforelderlaw.com www.thecenterforprobatelitigation.com www.thecenterforspecialneedsplanning.com www.probatelawyerblog.com http://www.trialandheirs.com


A Legacy of Tulips

August 12, 2009

by Steve Pender, video biographer & personal historian, Family Legacy Video, Inc.
Did you ever play Wiffle Ball? Growing up, it was the summer pastime of choice in my suburban New Jersey neighborhood. Every day, kids would congregate on the side street by my house, choose sides and have at it. Games were noisy affairs, punctuated by lots of arguments over close calls, and could last for hours. It wasn’t unusual for us to suspend a game for dinner and then reconvene afterwards. In fact, I remember finishing one game under the glare of a neighbor’s headlights.

It was a pretty safe game, too, thanks to the hollow plastic Wiffle Ball. It would glance harmlessly off just about anything it hit.

The exception was Mr. Daly’s tulips.

Mr. and Mrs. Daly lived on the other side of the street. They were a very pleasant, elderly couple and they tolerated us kids pretty well. Unfortunately, Mr. Daly insisted on planting tulips outside the chain link fence bordering his backyard. He was quite proud of those tulips and the bright red and yellow blooms they provided each spring – and he became quite upset whenever a sharply hit foul ball lopped the top off one of them. Or two. Or three. Not that we wanted to damage the flowers; they were just innocent bystanders that occasionally got caught in our Wiffle Ball crossfire.

The 1960s, as well as Mr. and Mrs. Daly, are long gone. But a recent experience brought all those memories back to me. In early July, my wife Halina and I traveled back to New Jersey to visit family. One day, we drove through my old neighborhood. I couldn’t resist stopping to look at my old house, now vastly enlarged from the little bungalow in which I grew up. I walked around the house and took a few pictures – and it wasn’t long before I caught the attention of one of the neighbors, who probably figured I was casing the place for a robbery.

He strolled over, a glass of beer in hand, and asked if I needed some help. I introduced myself and told him I grew up in the neighborhood. We started chatting, and soon I found myself in the middle of a small crowd of neighbors, answering questions about what things were like in the old days, and who used to live where. During the course of our chat, I mentioned our Wiffle Ball games and the many tulips we beheaded.

Finally, the time came to say goodbye. As I was about to leave, the neighbor currently living in the Daly’s old house said, “You know, I’m glad you mentioned about the tulips. They keep sprouting up and I had no idea where they came from.”

As Halina and I drove away, the thought of those tulips – Mr. Daly’s legacy to the neighborhood – filled me with a warm glow. The experience reminded me that legacies can take many forms, be they video biographies or tulips – and that they enrich and inform the lives of the generations that follow.

Nice job, Mr. Daly.


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