Pam Foti, Co-Owner and Elder Care Consultant
When you hear the word “nursing home,” what images do you conjure up? I go right to my first experience with a nursing home in Truman, MN where my Great Grandma Emma lived her last days. It was the 70’s, I don’t think I was yet a decade old, and Grandma Emma was well into her ‘90’s. To this day, we drive by the facility when we go to visit family, and I remember visiting my grandma there. Sometimes she was in a wheel chair, other times she was lying in bed. Either way, she had a crocheted afghan across her legs to keep her warm. I also remember sitting with her the last time in her home, after she had a stroke, and she knew she couldn’t stay there anymore. I remember her sitting next to the stove that helped to heat her house, and she patted that stove as she said in a very broken voice, “I love my house. I love my stove.” To this day, I have yet to meet anyone who had their bags packed and were ready to move from their homes.
Fast forward 20 years to my next experience in a nursing home. This time it was my Grandma Effie, or Gram. She had Alzheimer’s and could no longer be left alone. Although she lived with my aunt, my aunt worked, and it just wasn’t safe. Gram had diabetes. We could never be sure if she took her insulin, how often she took her insulin, whether she had eaten the lunch Meals on Wheels had provided, or if she had shared it with Dinky, the dog. Interestingly, in 20 years’ time, not much had changed. Gram was in her early ‘80’s, could walk, could dress herself in her signature sweats, and was what I like to call “pleasantly confused,” at least for a while. My Gram’s needs were different than my Grandma Emma’s, but the facility, despite being 500 miles from Truman, MN, and 20 years later, was not all that different. My Gram was on Title XIX, or Medicaid, so she often had a roommate. Sometimes she got along with her, other times she didn’t. Sometimes she thought her things were being stolen, but perhaps the reality was she just didn’t know where she had put them. There was a big “activity” area where they would line up all the wheelchairs and gather those who could get there on their own for entertainment, crafts, and a lot of times simply so that the staff knew where everyone was and what they were doing.
Thankfully, the last 20 years has made a difference in the world of long term care, at least in Wisconsin, where my expertise lies. According to US News and World Report, Wisconsin is ranked 6th in the country for how well we take care of our elders! Twenty years ago, our only choices for our loved ones needing care that couldn’t be provided at home were nursing homes. Now, Wisconsin creatively uses part of the Medicaid budget to pay for people to stay in Assisted Living when they outlive their assets or run out of money. Assisted Living provides a far more home like environment and allows people to maintain as much independence as possible.
For many, and I dare say “most,” older adults, a nursing home or a SNF (skilled nursing facility), is overkill. Skilled nursing is designed, particularly today, to manage medical needs and individuals with very high care needs. Gram was medically stable, as are so many of our older adults, and really only needed personal care, not skilled care. What’s the difference? Well, personal care is help with the “Activities of Daily Living,” ADL’s, and those activities are things like cooking, housekeeping, bathing, dressing, and grooming. Those activities don’t require the “skill” of a nurse, and can be performed very well and very safely by trained caregivers. For this reason, the cost of assisted living care can be half of the cost of a skilled nursing facility. In 2017 Wisconsin dollars, that could mean $5-6,000/month, rather than $10-12,000/month. This is not only a huge savings for a family or the state who may ultimately have to cover the cost, but it also helps someone to be in a more home-like, far less institutional environment, yet still get the care he or she needs. I was just with a family who will be moving Mom to an assisted living community next week. When they finally made their decision and realized what they were going to be able to provide for their mom, the daughter said, “I don’t have to feel guilty about bringing Mom to this place. It really feels like home.”
So often, when we are working with older adults, we ask them what their vision of long term care is. We frequently hear “The fox farm (where old horses go to die)!” “That’s expensive!” “One foot in the grave!” We take these comments as a challenge and an opportunity to help people to understand what long term care really is like today. When we hear these things, we know that these individuals have likely not seen an assisted living community and only have memories like I have of the nursing homes my grandmas passed in. We are so fortunate to have so many great alternatives. With the “graying of our population,” comes a lot of opportunity for us to create true homes for our elders where they can get the care they need, be safe, be happy, and live their golden years.
Co-Owner, Pam Foti talks about Vesta Senior Network and the importance of finding the right home for your loved one.
Pam Foti, Owner and Elder Care Consultant, Vesta Senior Network
Earlier this week I attended a presentation by a very insightful gentleman who works a lot with older adults, as well as with children with disabilities. The major take away for me was his observation that “Doctors and Judges live to be 100.” He postulated that the reason for this is that even long after retirement, people continue to hold them in the high esteem and treat them with the respect they garnered as working professionals. Retired doctors and judges CONTINUE TO FEEL IMPORTANT long into retirement.
I have put some serious thought into this layman’s speculation and frankly agree with his point in principle. Because I have a tendency to be a fact finder and like to have evidence to back up my debatable theories, I did a little bit of research. Interestingly, the American Journal of Preventative Medicine published a study in October of 2000 entitled “Mortality Rates Among US Physicians.” The research done as part of this study concludes that “Among both US white and black men, physicians were, on average, older when they died…than were lawyers, all examined professionals, and all men.” Now because judges frequently are lawyers, there may be a bit of a whole in this theory. Nonetheless, I am going to go with it. Another article written by Linda Carroll and published online in TODAY Money in May, 2012 states “Ambitious, successful people who actually make it to the top not only are richer than the rest of us, but they apparently live longer, too, a new study shows.”
I am sure that we could discuss and debate why these things are true ad nauseam: access to healthcare is surely better for wealthy, successful Americans. Doctors and lawyers aren’t working in the coal mines of West Virginia or on fishing boats in the Bering Sea. There is no disputing that socio-economic status is a significant piece to this longevity. However, I am going to make a simple observation. Being respected, having purpose, and feeling important has a profound effect on our psychological well-being, and therefore our physical health.
When I am walking through assisted living communities, I have a tendency to notice the names on the placards outside of the doors. Perhaps, I am looking to see if I might know someone, but I think I also am interested in gaining some insight into the PERSON who lives behind that door. I love looking at the memory boxes. I especially love seeing the wedding pictures and baby pictures. Time and again, I will see “Dr.” Robert Jones or “Dr.” Roberta Jones on a door. Never do I see, Robert Jones, over-the-road truck driver, farmer, painter, or even teacher on the door. I have known many doctors throughout my career as a pharmaceutical sales rep and a senior care consultant. I know that these people have achieved the status of “doctor” or “lawyer” through sacrifice for their education and profession and long hours and time away from their families. I also know that many of these men and women are humble and would be the first people to say, “We all put our pants on the same way – one leg at a time.”
One would think that infirmity or old age would be the great equalizer, but it isn’t. Why don’t we do our best to change that? The next time we have the opportunity to talk with one of our elders, let’s make it a priority to ask a question about what he or she liked most about her work on the farm, in the classroom, court room, serving our country, or in the hospital? Let’s show some appreciation for his individual contribution to whom we are and what we have become on a universal level. One of my newest clients was a “Rosie the Riveter.” I can’t wait to talk with her more about that!
Pam Foti, Owner and Elder Care Consultant, Vesta Senior Network
It is no secret that getting old can get expensive. With declining health and rising need for help around the home, in the home, or even a move to an assisted living home, the cost can become overwhelming and scary. “What happens when Mom runs out of money?” “Dad doesn’t have that kind of money!” “I didn’t work my whole life to pay to sit in a nursing home!” “I want to leave this for my kids!” These are all comments we hear at Vesta Senior Network on a very regular basis.
So, what does happen when Mom runs out of money? Well, in the state of Wisconsin, we are fortunate to have Family Care. In simplest terms, Family Care is the piece of the Medicaid or Title 19 pie that will pay for assisted living. Title 19, or straight Medicaid, has long paid for nursing home care when an individual has exhausted funds. Since 1999, Wisconsin has found a more pleasant, more cost effective way to care for elders through the Family Care program. Assisted living communities, as you may have recognized, are popping up all over and provide a more homelike, less institutional, and more cost effective way to care for our loved ones.
This sounds great, doesn’t it? Sign me up, right? Well, hold on a minute. The race to Medicaid (or Family Care) is not the race you want to win. When an assisted living community accepts Family Care benefits to care for someone, it is taking a significant cut in rate. After all, Family Care is a government contract. Not only are these communities taking a much lower contracted rate, getting a raise on this rates to adjust for inflation is difficult, if not impossible. Think for a minute…what would your household budget look like if half the month you were working with half your income, and you didn’t always get paid on the day that you expected that direct deposit to hit your account? Not pretty, right? But, if that were truly the case, you would plan and adjust for that. And that is exactly what the well run assisted living communities are doing. These communities are working with a plan in place.
With that said, in our experience, we have found that the really good facilities are requiring that new residents have some ability to pay privately for a designated period of time prior to converting to Family Care (one would become eligible for family care when her or she has no more than $2,000 in assets as a single person, aside from money set aside for funeral expenses.) For example, an assisted living community will require that someone has enough assets to last perhaps 2 years. Once a resident has outlived those assets, the community will accept Family Care assignment to pay for care. So what does 2 years look like in dollars? Let’s say that on average, someone’s care may be $5,000 each month. To be safe, $150,000 is a nice number to consider as your long term care nest egg. That nest egg is what is going to provide you with some really good choices when it’s time to consider assisted living. Those communities that are balancing their budgets by having both private pay and Family Care residents are the ones that can continue to offer the best services: good staffing, good activities, good food…all the things that are important.
An important fact to remember is that assisted living communities are privately run businesses and can set their financial requirements independently. This means that some places may not take Family Care at all, others may have a specific requirement with respect to assets, and others may accept Family Care “1st Dollar,” meaning they will admit someone already on Family Care.
In a perfect world, every community could admit everyone already on Family Care. However, the reality of the situation is that it just can’t work long term. These communities have rising costs, building maintenance, all of the same issues that each of us has to manage in our own homes. The communities that have worked out a plan or formula that provides for a mix of private pay residents and Family Care residents are the ones that we choose to work with. These are the communities that have the integrity to help their residents plan for the future. One wonderful assisted living community owner once said to me, “What am I going to do after I have taken all their money, kick them out?” Fortunately, we have found enough community owners and administrators who feel this way. Unfortunately, there are others who will say, “Don’t you want your mom to have the best while she is still healthy enough to enjoy it? Later, perhaps a place that isn’t as nice won’t matter to her.” That is a philosophy that we don’t agree with at Vesta Senior Network. However, every family has to make their own decisions regarding care for their loved ones.
So what’s going to happen to our benefits for seniors with a new administration? As this Tsunami of Seniors swells, we will be pushing the system to its very limit. We can’t say what will happen next. We don’t have a crystal ball. What we do know, however, is that at Vesta Senior Network, we will continue to work to find those gems who are providing the best care while honoring those who have worked their entire lives to provide for their families and save for their retirements.
For questions or comments, please contact Pam Foti at firstname.lastname@example.org or 414.750.6767