Next week the commentary will again focus on the market and economic events. This week we have selected a subject that has become increasingly important to our clients and their families.
I, (Toan Nguyen Director of Operations for IIA) being 28 years old, can’t say that I’ve put much thought into nursing home or assisted living facilities, and prior to last year I had never even been inside either. I never knew how much research it takes or what all was involved in selecting a suitable home, until I had to do it for my wife’s grandmother. During this experience, I learned that there is more to choosing a care facility than a nice building and well manicured landscaping. I wanted to share my experience and help provide a starting point in case you would ever find yourself in a similar situation.
After a fall left my wife’s 83 year-old grandmother (let’s call her Anne) with a broken hip, we remodeled our basement to be handicap friendly for her to move into as she recovered. The intention was for her to eventually move back into her own home. Since Anne was from out of town and my in-laws live out of state, we thought this would be a great solution to have her stay with us until she healed and save her some money at the same time. We also thought it would be beneficial for her to be around family and have more personal interaction than what she would have received in a care facility. Luckily, my wife wasn’t working while completing her graduate degree and would be able devote time to taking care of Anne.
Subsequent to moving Anne into our home, we began to realize that Anne’s senior dementia had progressed further that we originally believed. It seems as though every time we visited Anne at her home (before the accident); it was always on a “good day.” The longer she stayed with us, the more it appeared that the bad days outnumbered the good. She was constantly in a state of confusion and paranoia. For example, she was continuously suspicious of people coming into her bedroom to steal money out of her purse. But in reality she didn’t have any money because she only left the house with us and didn’t need to buy anything. She was also prone to extraordinary delusions. Anne would also constantly forget that she was staying with us and thought she was in a hotel. She would regularly criticize the food and how terrible the help was. I found it a little humorous; however, my wife did not.
After a few months, we began to realize we would not be able to provide her with the level of care she needed with all her special requirements. We initially thought that she only needed help with activities specifically relating to her hip, but it turned out that with her dementia she was beyond our care level. Our hearts were in the right place, but we were not properly trained to treat and deal with all of her symptoms. We saw that we needed to find her a facility with staff trained specifically to deal with senior dementia patients. Daily errands became increasingly more difficult because my wife and I were not able to both leave our house at the same time. We were not comfortable leaving Anne alone for any longer than an hour for fear that she would become confused and delusional. It almost came down to the point where there would have to be someone there with her at all times. In our daily routine my wife would stay with Anne during the day and wait to run errands until I got home from work. As much as we love Anne, it began to feel like we were trapped in our own house.
Reluctantly, we temporarily moved her back to the nursing home where she stayed while recovering from her knee injury. We felt that by moving her to a place she was familiar with, it would give us the time we needed to find her suitable facility closer to us. That being said, this facility was much more than she needed and even though she had the means, it was quite more expensive compared to other facilities and lacked any social interaction among the residents.
When we started looking for a facility for Anne, we really didn’t know where to begin. All we knew was that she needed a facility that specialized in senior dementia patients. We began our search as most people would; through the internet. The first website we found was the local agency for senior citizens; Johnson County Human Services. Their website; http://hsa.jocogov.org/aging/aging.shtml was very helpful, they had information on housing, nutrition, senior activities and other resources that are available. Another helpful website we found was the Medicare Nursing Home Comparison page: http://www.medicare.gov/NHCompare. There, you can search Medicare rated facilities by name, city, state and distance. You are also able to sort facilities by ratings and view any deficiencies a facility may have. If a facility is self-pay and not Medicare rated, then it is overseen by the state in which it is located. Several of the facilities we visited were self-pay and overseen by the state of Kansas (KS). The state of KS does not rate facilities; instead it only lists deficiencies, which later proved difficult when trying to compare Medicare ratings to KS reviews.
An important step in finding a suitable home is deciding the level of care you need, the level of care varies depending on the type of facility. Facilities range from retirement communities; where seniors live in their own apartments and generally do not receive any specialized or medical care, to nursing homes; where residents are monitored 24 hours a day and are under the care of trained medical staff. Assisted living centers are somewhere in between retirement communities and nursing homes. Assisted living centers generally allow you to pay according to the level of care you need. Available amenities can include prepared meals & snacks, laundry services, entertainment, medication monitoring, transportation, and other daily living activities such as bathing, changing clothes, etc. Another difference is the amount of medically trained staff on site. In nursing homes a medical staff is on duty 24 hours a day, typically in assisted living centers there are usually nurses and CNAs (certified nursing assistants) on duty during business hours during the week and on call on weekends and afterhours. Anne’s needs were between a nursing home and an assisted living center due to her facture, macular degeneration, and dementia.
While looking for care facilities, we found that there were several facilities that specialized in treating specific residents. For example, we toured a nursing home that specialized in senior dementia and the sight challenged. While this facility was properly trained to address Anne’s needs, the building and the living conditions were not a good fit. This facility was given 4 and 5 star ratings by Medicare in several different categories, however the building was a run down and she would have had to have a roommate. The only available room was with a resident that would cry for help non-stop even when the staff was right next to her. The staff would get her what she wanted and turn their back and this woman would begin screaming at the top of her lungs again. Needless to say, we left there as soon as we possibly could.
Another facility we toured was a private-pay assisted living center. This place was immaculate and could be easily mistaken for a high end hotel. Their facility was gorgeous and everyone was very friendly; however, it did not fit our needs. This facility did not have the level of care that Anne needed. This assisted living center was geared more towards residents that were more mobile and able to take care of themselves. Most of the residents we spoke to were there mainly for senior companionship and not for care. Another issue we had was that this facility was multilevel and had a big, unattended staircase. Even though this center had many elevators, we were not comfortable because we thought Anne might forget her current condition and try to take the stairs. This facility was also an “open facility” that allowed residents to come and go as they pleased. We needed a “locked facility” that prevented residents from mistakenly walking out. There was never a concern that Anne would purposely attempt to leave, but she might get confused on a “bad day” with her senior dementia. We also feared that in the less regimented atmosphere, she would be forgotten about at meal times and would not have enough people checking in on her throughout the day.
Despite the fact that the second facility we toured was self-pay and not rated by Medicare, we were able to obtain their most recent State of Kansas Review. I cannot stress enough the importance of reviewing deficiency findings. This particular facility was cited for having four incidents of the same resident falling within a one-month period. We also found issues with the facility not reporting sores found and seizures suffered to resident’s families or doctors. Facilities that are state regulated are required to provide you with their most current review. If you are looking at a state regulated facility, ask for a copy to review. Medicare regulated facilities are given star ratings for different criteria along with their deficiency findings. The different criteria are: health Inspections, nursing home staffing, and quality measures and are also given an overall star rating. It is important that you do your due diligence and review any deficiency findings and see how they were addressed prior to even considering a care facility. It’s just like when looking to buy a house or used car, you have to make sure you kick the tires and see what’s under the hood. Just because a facility may look great from the outside, it doesn’t mean you’ll get the type of care you’d expect. Conversely, a facility may not have the best amenities, but they may have the level of care you need.
In our search, we ended up touring seven different facilities and were able to find one that had the amenities that Anne liked, was able to provide her with the level of care she needed and was deficiency free in their last three annual reviews. The facility we chose is an assisted living center that has more care available than the standard assisted living center. She has her own apartment that was unfurnished, but she has her own bathroom, mini kitchen and a small living room. She has three prepared meals a day, daily activities, medication monitoring and help with daily living activities. We were also able to bring her belongings from her home to furnish it and she is settling in very nicely.
In the end, we moved Anne from the temporary nursing home that was approximately $6,200/month, to an assisted living facility which is $3,200/month. Yes, it is nice to save Anne, $3,000/month, but more importantly she is in a facility that that is much closer to our home, provides her the specific level of care she needs and she receives much more social interaction.
Finding a suitable care facility can be a long and sometimes frustrating process, but if you look hard enough, you’ll be able to find the one that best fits your needs. You have to make sure you do your part and do the research and use as many resources available to you as you can. Moving family to a care facility is never easy, but once you find a place that you know can take care of them, you’ll know that they’ll be safe and well cared for.
Economic and market related comments from someone with a truly global perspective and stellar track record
Michael Hasenstab is one of the top global bond mutual fund managers, and attached is a link to 2:44 minute interview with Mr. Hasenstab that took place this morning on CNBC. I believe the information provided in this interview is extremely enlightening for investors who want to know what is occurring globally and how it relates to their investments.
Before viewing this video, let me give you a little background on Mr. Hasenstab and why you should put some credence in his comments. He has a PhD in economics, has extensive international travel and business experience, he oversees management of over $80 billion within the Franklin-Templeton Fund Group, and his Templeton Global Bond Fund has been ranked in the top 12% (one –year), 4% (three-year), 1% (five-year) and 1% (ten-year) of funds within its category for the period ending 6/24/2010. Separately, this fund is the top sixth holding (excluding money market funds) for all combined clients with IIA.
Please take the time to view the following video.
http://www.cnbc.com/id/15840232?play=1&video=1530063749
Performance reporting improvements
In our ongoing attempt to better our service to our clients, we will be changing our reporting format for your mid-year performance reports. Instead of receiving a full set of performance reports (Portfolio Report, Family Summary, and Merged Account Summary) in July, you will receive a Family Summary Report and Merged Account Summary. If you only have one account with us, you will receive an Account Summary report. After listening to feedback from clients, we have found that the additional reporting mid-year was excessive. However, you will still receive full year-end reporting in January. If you have any questions regarding our streamlined reporting, please do not hesitate to give us a call at 913-897-2074.
Toan Nguyen, Director of Operations
Integrity Investment Advisors
12721 Metcalf, #202
Overland Park, KS 66213
tnguyen@iia-kc.com
913-897-2074
The information listed in this commentary is a compilation of various publicly available sources and is for informational purposes only. It is not a recommendation or solicitation of any particular investment or strategy. A risk of loss is involved with investments in the stock and bond markets.
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