Selecting a Long Term Care Facility with Long Term Care Insurance

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?

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!