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Aging Wisely February 2013 - Aging Wisely

Senior Care Management Mistakes: Making a Mess of Transitions


aging and changeAs we age, we tend to face a lot of life changes which sometimes feel beyond our control.  These transition points naturally bring stress.  However, the way they are handled can make a significant difference in the experience and perception of the change.

Some of the major aging transitions elders face include moving to a care facility, bringing in help for the first time, going to (and leaving) the hospital, getting inpatient rehabilitation services, and moving in with family members. There are many accumulated losses that come with aging as well, such as the death of a spouse and other loved ones, giving up driving or other activities, reduced mobility and independence.

A lot of things can go wrong during these transition times, from little things like scheduling glitches to big mistakes and communication gaps.  Here are some pointers on “what not to do” when it comes to helping with the senior care management of aging transitions.  Don’t:

  1. Rush things.  Allow sufficient time for the elder to discuss/process the changes.  Sometimes these changes come with a crisis and time is precious, so this can be particularly tricky.  As your loved one’s advocate, you may be able to find ways to buy time and even a few minutes of listening and empathy can make a big difference (when you’re facing a crisis like this, it’s a great time to call us for immediate help!).
  2. Ask your neighbor what to do or pick your provider based solely on what a friend suggests.  It may not be the right option for you.
  3. Get caught up in appearances. While first impressions are important, getting too caught up in appearances may steer you wrong. This is a common mistake when it comes to facilities, since you see the bricks and mortar.  Quality of care is not as transparent as the lobby or the room size, but it’s far more important.
  4. Use the list method.  You get a list of all the available options (such as a list of all Assisted Living Facilities from the Area Agency on Aging or a list of local home health providers from the state’s website) and go through the list, interviewing or visiting every provider on the list.  You will most likely become overwhelmed.  Oftentimes, half of the list could be eliminated automatically as either not appropriate for your loved one or offering poor care.  You also need to understand issues like regulations, levels of care and how options match up to what your loved one needs.
  5. Forget about the little things.  Details impact the experience, from timing and meals to comfort and having the right items available (i.e. what to pack).  The day of a major transition can be a rough experience with little glitches, or a nice introduction to the new service or environment if done well.

For a good real-life example about the different ways to manage senior care transitions, you might want to check out our client’s story, “One Daughter’s Eldercare Experiences: A Tale of Two Transitions“. 

We offer several good resources for facing transitions.  For example, check out:

Moving Day: Making a Good Transition to a Senior Care Facility (includes our Guide to Choosing the Best Senior Care Facility)

Checklist for Discharge to a Rehabilitation Facility

Give us a call at 727-447-5845 or click below to schedule a care consultation.  We can help ensure a better transition for your loved one (and peace of mind for you!) with resources, suggestions, and an analysis of options.

A few of the senior care management tasks we can assist with include:

  • Assessing the situation and optimal solutions; providing an evaluation of level of care needed.
  • Maximizing resources and help available to you.
  • Navigating insurance (Medicare, private insurance) and Medicaid, VA and other benefits.
  • Guiding conversations, providing pointers to talk with loved ones about concerns and changes.
  • Anticipating concerns and ways to avoid pitfalls during transitions.
  • Ensuring good senior care management and communications between parties.
  • Crisis management, helping you to “buy the time” needed to comfortably make decisions and process the change (for example, suggesting short term solutions while a more permanent decision awaits, planning discharge and working with providers on most appropriate time frames, helping with alternatives as compromise).
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Senior Living: Home Improvement Do’s and Dont’s


a walker in senior housingAccording to the National Association of Home Builders, nine out of 10 people over age 50 are committed to living in their own homes for as long as possible. In order to make this work, many people need to make home improvements to ensure maximum mobility when physical health declines.

According to, companies and organizations, including the National Association of Home Builders (NAHB), are offering assistance to make homes more livable and safe as they age. The NAHB offers a three-day course that teaches contractors and remodelers techniques and strategies for making age-appropriate modifications to homes.

In addition to this list of senior living home improvement tips, there are minor modifications and resources that can make a huge difference in home safety.  Check out EasyLiving’s Fall Prevention Checklist for a review of home safety.  Consider getting a professional home assessment done by a geriatric care manager for a wide array of custom recommendations for your safe senior living.  This advice, the resources and tips a geriatric care manager offers can be invaluable to healthy aging in the comfort of your own home.

Here are some do’s and dont’s as you approach a home remodel to better equip your home for healthy senior living:

Don’t Neglect the HVAC System

Upgrade to energy-efficient heating and cooling systems to optimize savings on electricity. The National Association for Home Builders recommends getting units that can be installed in an easily accessible location to change the filters without using a ladder.

Do Widen Narrow Door Frames

Many older homes feature narrow doorways that aren’t handicap accessible or navigable with a walker. Have door frames widened to provide at least 32 inches of clear width. Replace any doorknobs on interior doors with levered hardware.

Don’t Skimp on Lighting

Make sure that light fixtures have at least two bulbs in vital areas such as the entry way, bathrooms and kitchen. This way, when one burns one, your parents won’t be relegated to darkness while waiting for someone to come change it. Add task lighting in kitchen work areas, near the computer and at the bedside to prevent eye strain. Install a soft-glow LED in the hallway to gently illuminate the space at night and prevent falls.

Do Install an Alarm System

Elderly people are often targeted by burglars and a security system can help thwart criminals. You can check out various options online; for an example check out a home security review of LifeShield.  Whatever system you choose, post the yard sign and stickers that come with the system in prominent places of your parents’ home. Often just seeing that a house is protected by security is enough to convince burglars to move on to an easier target, according to 

Consider the added security of a personal emergency response system, with a call center available in case of a fall or other concern.  Many of these systems offer no or low cost installation, with a monthly fee to cover the monitoring costs.  It is best to go with a system which has flexibility regarding cancelling services, in case your needs change.

Don’t Go Without a First Floor Bathroom

If your parents live in a multi-story home and don’t have a bathroom on the first floor, AARP suggests you add one. While it may seem like a big expense, it’s really an investment that can also pay off should your parents decide to eventually sell the home.  If putting in a new bathroom (or remodeling a current one), review the accessibility and safety issues since the bathroom is where seniors often fall.

Do Update the Shower

Get rid of that bathtub/shower combination and replace it with a handicap-accessible curbless shower. Getting in and out of a bathtub and shower combination can be dangerous as your parents’ agility declines. Install a bench seat in the shower and wall handrails in and out of the shower to safely maneuver in and out. Adding recessed shelves are great because they’re at arm’s level and will stop your parents from having to reach down to the floor or up to the shower rack.

Don’t Forget the Toilet

Upgrade to a taller toilet basin and install an elevated toilet seat for ease of use. If your parents have knee or back problems, install grab bars on the wall to make it easier to get up. Make one bathroom the go-to bathroom for your parents with the right accessories and toiletries accessible.

Do Get Rid of Carpeting

Carpeting can be difficult to move around on for those who use a walker or wheelchair. Replace carpet with hardwood flooring, tile or another smooth surface that’s ideal for rolling wheels.  Be aware of the dangers of throw rugs as well, which can pose a major risk for falls.  These can be secured with double stick tape, but the best solution is to remove them.

We can help!  We offer home safety assessments and our expert care managers know a wide array of resources to help with minor changes, large remodels, home medical equipment and various programs and assistance in your home.  By bringing you our experience, we can often suggest no or low cost changes that can make a big difference!

You can reach us at 727-447-5845 to find out more or complete our request for a phone appointment to answer your questions.

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Discharge Planning Checklist: Stroke Care and Rehabilitation


Stroke is the leading cause of adult disability. A stroke occurs when a blood vessel to the brain is either blocked by a clot or bursts/ruptures. When either of these things happens, brain cells begin to die and brain damage occurs.

Fast, effective treatment is key to recovery from a stroke. Experts sometimes say “time is brain” as quick treatment can save brain cells and reduce residual damage from the stroke. It is vital that you know the signs of a stroke and seek immediate treatment when those signs are present.

stroke symptoms for senior healthcare*From the National Stroke Association

After acute care treatment, the patient faces the recovery and healing process.  Rehabilitation should begin as soon as possible during this healing process. One third of stroke patients need help with activities of daily living after a stroke, and one quarter cannot ambulate without assistance. The most common effects of stroke are: speech impediment, decreased motor skill coordination, and depression. The nature and extent of disability after a stroke varies widely depending on the type of stroke and area of the brain that was impacted, as well as the course of rehabilitation.

Due to the nature of our brains, rehabilitation can be very effective in gaining back abilities, compensating and gaining new skills to be more independent–and the process can continue over a long period of time. The rehabilitation process will depend on many factors such as the nature of the stroke and resulting damage, the person’s overall health history and other diagnoses/disabilities, living situation/caregiver availability and more. Any good rehabilitation process is a coordinated team effort, involving the patient, family and various medical and rehabilitation providers.

The average length of stay for patients with an acute ischemic stroke is between 6-10 days in the acute care setting, so rehabilitation options must be evaluated quickly. Rehabilitation for stroke and other acute medical issues can occur in different settings. An acute care rehabilitation setting (inpatient in the hospital or a special hospital unit) may be advised for intensive therapy and acute/complex medical needs. This type of care is often appropriate for a stroke patient and may help extend the benefits of rehabilitation services (hospital/acute care falls in to one “bucket” under Medicare coverage, and rehabilitation/skilled nursing falls in to another “bucket” of coverage days).  Rehabilitation facilities offer different types of programs and levels of intensity. Some of these may be stand-alone short term rehabilitation centers, while others may be part of a hospital campus or long-term skilled nursing facility (i.e. many nursing facilities have long term and short term sections or mixtures of patients).

Discharge planning and the appropriate rehabilitation setting depend largely on the various factors that make up the patient’s situation. As an advocate for a stroke patient, it is vital you help communicate expectations and hopes for recovery and ask questions to ascertain the proper level of care, options and expectations for possible recovery and ongoing needs. With any medical crisis, but particularly in cases like stroke where the rehabilitation process can have long-term impacts on quality of life, consider involving an expert geriatric care manager as a professional patient advocate and care coordinator.

The National Stroke Association offers a fact sheet with an overview on choosing a stroke rehabilitation program, which you may want to review and save as you go through the discharge planning process.

We have created a “Discharge planning checklist for transition to rehabilitation” to help you with the key steps and questions when transitioning to an inpatient rehabilitation program after being hospitalized for a stroke, broken hip or any other acute care need requiring rehabilitation. This discharge planning checklist is a handy tool as you evaluate options and advocate for a good transition to help the patient have the most successful outcomes possible.

As the patient progresses through the rehabilitation process, the next steps will involve discharge planning for the longer term, whether the patient returns home living independently, with some support services, with a caregiver or home caregiver services, or moves to assisted living or a skilled nursing facility.  An ongoing prevention plan is essential to reduce the risks of recurrent stroke.  Patients should work closely with their medical team to understand modifiable risk factors and work to reduce them, as well as follow their personalized treatment plan (medications, diet, wellness/screenings and monitoring).

Need help or have questions?  Contact at 727-447-5845 or online.  Our expert patient advocates can help you:

  • Manage the hospitalization and advocate for the best use of services and benefits to maximize recovery;
  • Choose the best rehabilitation options;
  • Navigate your insurance and other benefits;
  • Coordinate the discharge plan and ongoing recovery;
  • Attend doctors’ appointments, serve as a liaison during your treatment and coordinate ongoing prevention;
  • Set up services according to your goals, wishes and needs.
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A Senior Living Checklist: Evaluating Assisted Living Facilities


checklist for choosing senior housingWhen a senior and family make the big decision to consider moving to senior housing, evaluating the choices can be daunting.  We have several resource articles and fact sheets on different levels of care in senior living and will be covering more of your questions on this topic in upcoming posts.  Today we offer some valuable information that can help you more clearly evaluate assisted living facilities.

Florida’s Agency for Healthcare Administration (AHCA) describes assisted living facilities as places “designed to provide personal care services in the least restrictive and most home-like environment. These facilities can range in size from one resident to several hundred and may offer a wide variety of personal and nursing services designed specifically to meet an individual’s personal needs”.  The state licenses and regulates assisted living facilities.  They can operate under a standard license or specialty licenses which permit them to provide some additional services designed to help residents “age in place”.  Each state regulates their own healthcare and senior living facilities, so check with your state about regulations, oversight and service levels.

You can find the Florida AHCA Assisted Living Unit information online. is Florida’s healthcare facility portal, offering a search tool for assisted living facilities, home health care agencies and other providers.  You can use the search tool and then click on the specific facility to see details such as license, owner/administrator, contact information, and inspection reports.  Most states are offering this information online now for greater consumer transparency.

Here is a checklist, as well as tips and resources, that you can use as you evaluate assisted living facilities:

  1. Review Aging Wisely’s free guide to “Choosing an Assisted Living Facility“.  This concise one-page overview gives you a road map for how to approach the search–where to begin, how to prioritize and what factors can help you narrow the search. (As an example of why this is so vital, a quick search for all assisted living facilities in Aging Wisely’s home county shows 205 facilities.)
  2. Understand your state’s regulation of assisted living facilities and what services are permitted.  Make sure the facility posts its license and provides its most recent survey information.  You can likely also do some research on this online before you get started to weed out any facilities with negative reports.
  3. Now you need to get beyond the survey, which is really only a regulation tool to identify problems and sanction providers who do not meet essential requirements.  It is vital to understand the management of the facility–its history and service, daily life and how well the facility operates from basic safety needs through life enrichment.  There are a number of checklists for visiting assisted living facilities, but here we have provided you with some additional tips on getting the whole picture:
  • How interested is the staff in you/your circumstances?  Do they focus on “selling” the facility to you without finding out about your needs/if the facility is really a good fit for you?
  • Talk to more than just the marketing staff.  Successful sales and marketing professionals do a great job welcoming you and portraying all the great things about their assisted living community, but you need to know the staff who you will be dealing with more closely after you move.  Ask to meet some of the management team such as a Director of Nursing/Nursing Supervisor, Resident Services Personnel and some care staff. 
  • Are staff open and willing to help?  Are they bothered by your request or rushed with you?  Do various staff offer to help or greet you when you are visiting?
  • If you can meet and ask some questions of the care staff, you might want to ask questions like: what do you like most about your job, what is the hardest part, how long have you worked here/how or why did you get in to this type of work and what is the best thing about this facility.  You can ask positive questions that will not necessarily make the person feel they are “on the spot” to reveal anything bad about the facility, but the answers may often be revealing in their own way.
  • Similarly, when talking to management and marketing staff, ask some less common questions.  Talk to them about how they help with the adjustment period, what residents or families say is the one best thing about the facility or the hardest thing to get used to, or to give a recent example of a resident problem and how they resolved it.
  • Make several visits at different times.  Facilities often invite potential residents for a meal, which is a nice way to check out the food.  However, it’s also great to ask to attend an activity and come by at various times to see how things operate throughout the cycle of the day.
  • Cleanliness and upkeep can be outward signs of good management.  Bad smells or major housekeeping or maintenance issues are potential warning signs.
  • Get recommendations and talk to others (residents, family members, friends who have evaluated facilities for their loved ones, trusted professionals).  However, take input with some caution–others may have very different circumstances or expectations than yours.
  • You may need to rethink perceptions/priorities.  Sometimes families (and potential residents) get “hung up” on the room size, especially when moving from a large home.  Assisted Living Facilities are generally designed with your room(s) being more like your bedroom at home, with common living/dining/activity rooms, so it is a shift in thinking.  The room may be important, but quality care and other factors trump square footage when it comes to the reality of life in assisted living.

As you can see, the process of thoroughly evaluating assisted living facilities to make this major life decision can be daunting.  Many families find the help of a professional geriatric care manager invaluable in this process.  Not only can a care manager assess your needs to ensure a good fit and the correct level of care, but he or she knows the facility “beyond the inspection”.  Often the care manager (or team members) are working with current residents and get to see the day-to-day operations.  But, even when that is not the case, the care manager’s expertise in helping elders through such transitions and advocating for assisted living residents provides you remarkable insight during the process.

There are different options for services that can help you evaluate assisted living facilities, including referral services which do not charge you.  When considering these options, make sure you understand the parameters and experience/expertise of such providers.  Typically, referral services are paid through a marketing arrangement with the assisted living facilities, whether a referral fee (which is not allowed by many states, such as Florida) or some other arrangement.  This may limit which facilities are promoted to you.  Additionally, you want to know the background and knowledge of the provider and their experience particularly in working with assisted living residents.  Last, find out what the professional’s role can/will be during and after the transition.

A geriatric care manager is: hired by you as your advocate only, paid by the client/family and not marketing arrangements, able to help you negotiate and show you a range of options as appropriate to you, and available to help with any/all aspects of the transition and ongoing oversight and troubleshooting.

Need help evaluating assisted living facilities in the Tampa Bay area?  Looking for an assessment to determine best care options?  Just want to talk to someone about your situation and how to get started?  Call us at 727-447-5845.

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