How to Evaluate Living Arrangements for Seniors Who Need Assistance
For adults with aging parents, the holiday season may provide an unexpected glimpse into their Mom or Dad’s declining condition. Admission departments in Assisted Living Communities notice a spike in inquiries when out-of-town children are visiting. Often, these children did not realize their loved one’s quality of life had become unsafe or undignified. They can also help recognize warning signs that in-town relatives may not have noticed through gradual changes.
Whether your loved one is living at home, with family or in an Independent Living Community, there may come a time when increasing assistance is needed to maintain their safety and health. An environment where 24/7 care and oversight are provided may be the best answer, and can be provided by an Assisted Living Community.
Warning Signs for a Senior Who is Unsafe Living Alone
Here are common situations that can indicate when independent living has become unsafe:
- Falling, particularly if this happens frequently;
- Inability to bathe without standby or hands-on assistance;
- More frequent incontinence and inability to clean up;
- Trouble navigating stairs or steps;
- Help is needed to get dressed or undressed and use the toilet;
- Confusion, perhaps due to decreasing cognitive abilities;
- Inability to evacuate in an emergency without assistance;
- Malnutrition or dehydration resulting from not eating or drinking properly; and,
- Unable to handle medications properly.
It is worthwhile to note that many seniors who move into Assisted Living may need substantial help in several of these situations, and only minor help in others.
Although you want to be sensitive to your parent’s wishes, you must be mindful of the priority: the need for their health and safety. A loving but firm approach may be the best way to communicate with your loved one about the need for a change in their living arrangement.
You cannot move your parent without their cooperation unless you have been appointed their Power of Attorney for health care decisions, and a physician has confirmed in writing that the parent is incapable of making their own decisions. If you do not have legal authority to move your aging loved one into a safe environment, consider reaching out to an elder law attorney.
What is an Assisted Living Community?
An Assisted Living Community is run by a certified or licensed onsite administrator. These communities provide three meals per day, along with housekeeping, laundry, some transportation services, and a variety of social activities. Assisted Living may be provided in a small group home or in a building serving 50 to 150 residents. Most residents in a larger building have their own apartments, but there are shared apartment arrangements, as well.
State regulations vary, but there are generally two defined levels of care in Assisted Living:
Level 1 Assisted Living:
Level 1 offers minimal resident assistance, similar to an Independent Living Community, although the resident may be able to hire private duty help with certain needs.
The resident must be able to respond in an emergency with minimal cues, and must be able to evacuate the building on their own. They should be able to walk or transfer independently with infrequent falls. They also handle their medication and set their own appointments without verbal reminders. Lastly, there can be no memory impairment that interferes with safety or health, such as an advanced stage of Alzheimer’s disease.
Level 2 Assisted Living:
Level 2 is the most common level of care offered in Communities today. Level 2 provides standby and some hands-on resident assistance. The ideal resident may:
- Need more guidance in an emergency;
- Require hands-on assistance to evacuate the building;
- Need transfer or standby assistance for toileting or bathing;
- Be subject to falls;
- Rely on reminders and verbal cues; and,
- Require assistance with medication and occasional incontinence.
Mild cognitive impairment with occasional disorientation is usually acceptable, as long as the resident is not “exit seeking.” This term refers to searching for a way to get out of the building, possibly with the intention to “go home.” Some Communities have wander guards or door alarms to alert the staff of someone identified as an “exit seeker” who is trying to leave. Communities that do not have these devices are usually unwilling to accept exit-seeking or wandering residents because they cannot guarantee their safety.
Level 2 Communities must maintain 24-hour nursing assistance in the form of nursing aides, who are usually certified nursing aides (CNAs). They are also required to have a registered nurse (RN) or licensed practical nurse (LPN) onsite for a certain number of hours per week based on the number of residents. A nurse must be on-call 24 hours a day when a nurse is not in the building.
Memory Care: is a specialized care program provided in a Level 2 setting for dementia patients. It provides full assistance for residents with significant cognitive issues that prevent them from thriving in a standard Assisted Living environment. These residents are housed on a separate unit, usually secured, and do not require skilled nursing care. Often, the residents have their own dining room and activities that cater to their needs. Please note: Memory Care is not provided in every Level 2 Assisted Living community.
Your loved one will be assessed for suitability in an Assisted Living Community by its Director of Nursing. If your loved one needs significant assistance throughout the day due to physical or medical needs, a Skilled Nursing environment may be a better fit.
Anticipating the Cost of Assisted Living
Depending on the level of care and services provided, the cost of Assisted Living in the greater St. Louis area can range from $2,500 to over $10,000 per month. For Level 2 care, the average cost is $3,500 to $7,000 per month. Some Communities add fees for extra assistance with bathing and laundry, or for complicated medication passes.
In most cases, Assisted Living is a private pay arrangement. A resident uses their income, savings, long-term care insurance policy or other cash assets to pay their bill. Veterans and widows of veterans may qualify for a VA pension to pay a portion of their expenses. There is also a Medicaid fund source called Supplemental Nursing Care (SNC) that may help.
A limited number of group homes and Communities contract with the VA and accept direct VA payment for qualified residents. There are also a few Communities that may be willing to accept the resident’s income and SNC only. Contact our attorneys to discuss your financial situation, particularly if you have concerns about affording the cost of long-term care.
Discuss Your Assisted Living Questions with Beck & Lenox Estate Planning and Elder Law
The attorneys at Beck & Lenox Estate Planning and Elder Law in St. Charles want to help you feel confident that your loved one is safe, respected and cared for. We can draft Power of Attorney documents so you have the full legal authority to make decisions on your Mom or Dad’s behalf when they no longer can. In doing so, we will make sure their estate is positioned to fund long-term care, if possible, and utilize any government funding they may be eligible for.