Wednesday, July 18, 2018

Choosing the Right Facility

Dimensions of Dementia

The entrance to The Arlington, a senior living facility in Naples. | Photos by Shirley Woolaway

One decision that almost always faces caregivers is when and where to place a loved one with dementia when the person’s care becomes overwhelming. In my experience, the dementia care receiver’s decline is often slow so there is time to check out the various facilities that offer memory care. On the other hand, several caregivers I’ve known have quickly had to place a family member who suddenly became overly aggressive or has a health crisis. Then it’s a matter of taking the first spot available which may not be the best place for that person. So, if possible tour facilities ahead of time and decide what works best for your situation.

My late husband, Tom and I made the rounds of facilities when he was in a medium stage of decline from Alzheimer’s. None appealed to him until we toured Terracina Grand on Davis Boulevard, Naples. Evidently this Welsh man loved the Italianate style and was enthusiastic about moving there. Since I could not picture myself there, we stayed in our condo. Instead he continued participating in day care three days a week at Sanitasole, an assisted living then on Marco Island and spent the last year and a half of his life there as a resident.

Since I had not seen the Villa at Terracina Grand, their relatively new memory care unit, I recently asked for a tour but the marketing staff was unable to accommodate me though I called ahead. So, I stopped by and picked up a brochure about their Pearl Garden Memory Care. It consists of, “all inclusive memory care and personal assistance with activities of daily living including mealtime, nutrition, weekly laundry, medication management, mobility, dressing, grooming, hygiene, and bathing. Living spaces include studios, friendship suites and one bedroom apartments.”

The Villa’s Lifelong Wellness program includes a 24-hour nursing staff, visiting physician services by appointment, a Montessori-inspired lifestyle, FIT Functional Fitness and access to a caregiver support group, according to their brochure. I regret not being able to see the space and learn some specifics about their program.

Since it is a short drive from there to the Arlington, I stopped for my planned tour and was greeted by Isabelle Miranda, director of assisted living and memory support, who talked about the three floors covering health care needs in Oakton Place. The third floor offers round-the-clock nursing care, the second, short-term rehab, and the first, individualized memory supportive assisted living called “My Tapestry.”

The rooms were light and spacious as was the dining room with its many windows. The My Tapestry facility has the largest number of beds devoted to memory care in Naples according to Miranda. The activities calendar for June 8 was 10 AM, coffee talk and snack, 11 AM trivia challenge, 2 PM bingo, 3 PM song trivia and puzzles, 3:30 PM exercise, 4 PM TCM movie, 6 PM circle of friends. Music is a part of every day’s agenda. Participants appeared busy and involved when I visited. Mona Ceurvels, activities director for the center spoke enthusiastically about the program and the care receivers becoming known to each other and staff through sharing their life stories in the newsletter.

The Arlington is a continuous care retirement community located just off Route 951 in Naples and is the closest CCRC facility to Marco Island. Others in Naples are the Moorings, Glenview at Pelican Bay and Vi at Bentley Village.

Terricina Grand, an independent retirement community, expects to add a new building where skilled care and rehab services will be provided according to a sign or their site. Other independent retirement communities near Marco Island are Lely Palms and Discovery Village.

According to Bruce Rosenblatt of Senior Housing Solutions, one important feature to check when looking at facilities is whether an independent retirement community has the Extended Congregate Care License. With this license the community’s assisted living can offer many of the medical services that a CCRC offers with one exception, there is no 24-hour skilled nursing care. Instead, assisted living facilities with ECC beds may keep residents who become frailer than would normally be permitted in order for the resident to age in place.

Rosenblatt spoke recently in Naples on choosing the right senior housing. His 30 years of experience, 25 with senior living communities here and elsewhere, was evident in his talk. He said there are three types of senior communities: rental, condominium, and CCRC. The rentals have a non-refundable community fee, a monthly rent, and higher levels of care are paid out of pocket. With a condominium, the title is in your name, there is an on-going monthly fee, and you have the pros and cons of real estate ownership. No medical requirements are necessary to move in. You pay for medical care as needed.

Rosenblatt explained that the CCRC is a life-plan community with contractual obligation to provide care and services over one’s lifetime. There is an up-front entrance fee, an on-going monthly fee and medical and financial criteria required to move in. Some are for profit, others, non-profit.

He said both rentals and condominiums could offer independent living, assisted living, and memory care, while the CCRCs offer all these plus skilled nursing care. There are also specialty communities for those who wait too long to decide about a facility. The costs to become part of a community in any facility vary, as do contracts for CCRCs and medical licensure so do your homework ahead of time.

Rosenblatt said, “It’s better to be five years too early than five minutes too late.”

He posed the question, “How will your life change when (not if) you or your spouse’s health starts to change.”

A telling statistic claims that 65 percent of those over 75 will need long-term care and that in 7 out of 10 couples one will need skilled care. A reminder of the high cost of medical services is that 70 percent of all admitted to skilled care will spend all their assets in three months.

Rosenblatt said staying in your home and bringing in outside help is a short-term solution for a long-term problem. If a paid caregiver is needed 24/7 it is expensive, with home care at $25 an hour with a four-hour minimum daily, or $700 a week, $2,800 a month. He said it’s hard to manage with different aides available on the different shifts. Also, if the person needing care is alone there can be problems associated with isolation such as depression and the person could be subjected to exploitation and abuse.

The advantages of living in a senior community include:

  •   Peace of mind about your future
  •   Maintenance-free lifestyle
  •   Access to onsite services and amenities
  •   Onsite health care
  •   Chef-prepared meals
  •   Built-in social network
  •   Maintenance-free lifestyle
  •   On site health care
  •   Chef-prepared meals
  •   Built-in social network
  •   Emergency response 24/7
  •   On site exercise classes and programs
  •   Freedom from fear

Rosenblatt said people resist leaving their homes for various reasons but often it’s because “I love the view or can’t part with my antiques (fill in the blank)”. He added how would your antiques help you when you have an emergency and need medical care? This got me thinking. I really do LOVE MY VIEW. But maybe I could entertain the possibility of leaving. Do you watch those TV shows like “Fixer Upper” or “Love it or List it”? Just maybe I need to decide—do I love it or leave it?

Shirley Woolaway has an M. Ed. in counseling and worked in journalism, in business, and as a therapist in Pennsylvania. She has 25 years personal experience with dementia as a caregiver for family members with Alzheimer’s disease, and nine years as the coordinator of an Alzheimer’s Association memory loss/caregiver support group, earlier in Pennsylvania and now on Marco Island. She has been leading a dementia support group for eleven years, three in PA and eight on Marco Island. We believe that Shirley’s insights will prove helpful to many of our readers.

For help on all aspects of Alzheimer’s disease and other dementias call the national Alzheimer’s Association confidential, 24/7 helpline at 800-272-3900 or the local Bonita Springs office at 239-405-7008 for care consults and support group information. Also helpful with local educational programs, workshops, and support groups, is the Naples Alzheimer’s Support Network, 239-262-8388.

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