Questions That are Frequently Asked

Why is this so emotionally upsetting to my elderly loved one(s) as well as our family?

Many factors effect us emotionally. Among those that elicit strong responses from us are change, relocation, preconceived ideas and conceptions, as well as feelings of guilt a nd frustrateion. Let's now examine in detail each of these characteristics.

Change

The life events that occur in older adulthood have several distinguishing characteristics from the events associated with youth and early adulthood.
They are viewed as losses, not as gains.
They tend to occur in a much shorter period of time.
They are longer lasting, and may be chronic.
They are inevitable, resulting in a feeling of loss of power or control.

Preconceived Ideas and Conceptions

The common thought people have when they think of a care facility for the elderly is usually pessimistic. The perception is that of a place to finish off a person's time on earth. Nothing could be further from the truth. Ivy Ridge believes that to be alive is to be just that-alive. We organize activities and outings that take place both on site as well as off. Our philosophy is to celebrate life, no matter what our age.
Another misconception prevalent today is that our elderly can be a burden with the increased need for care and attention. Today, with a growing elderly population, enhanced sensitivity, knowledge, and professional care with regard to aging is producing some very attractive alternatives. Each person has a right to enjoy their life, without the stigma of being a "burden".

Feelings of Guilt and Frustration

Without a doubt, guilt and frustration are two of the biggest emotions people experience with respect to caring for, and dealing with, their elderly loved ones. More important, these feelings are shared by the very ones they are caring for. Today's lifestyle is hectic and fast-paced. It is crammed with events that require decisions that are not easy to arrive at. That doesn't have to be the case anymore with facilities like Ivy Ridge. Now, instead of perceiving the experience as "putting mom or dad in a home", Ivy Ridge lets you see it as "Mom or Dad's new home is a million dollar residence with a beautiful courtyard. They get to enjoy the service of caregivers, cooks, maids, gardeners, and chauffeurs". More importantly, they are under the care and supervision of professionals who can recognize and satisfy their needs 24 hours a day - at an affordable cost.

I understand the aging process in general, but specifically what is going on?

The human body experiences anatomical and physiological changes as it ages. These changes include a degradation of our physical senses such as visual and auditory acuity. Psychosocial changes are those of a functional and cognitive basis. However, it is difficult to determine, and research has not been conclusive, as to which changes are a normal part of aging, and those that are the result of disease, and/or risk factors (i.e. poor diet, improper medication administration). The following are common functional and cognitive changes that occur with aging:

Memory impairment
Slower cognition
Changes in sleeping patterns
Decreased visual and auditory acuity
Poor gain and/or posture

The elderly individual in our society experiences "losses". These losses can usually include losing the opportunity to work, losing a spouse, losing a home, and losing the ability to perform self care. Without access to proper support systems and coping mechanisms, many of the elderly are left to adjust to these losses on their own. The staff at Ivy Ridge prides themselves on their skills at providing a strong support system to assist our new family residents in dealing with these events. We know it is very important to meet these psychosocial needs. This not only provides a sense of well being to our family residents, but also reassures their own family that their needs are being met. This leads us to the process of determining where do we go from here.

The way in which the "tasks of aging" can be successfully completed, must be taken into consideration in the formula for "Where do we go from here?" A few of the tasks are:

Adjusting to decreasing physical strength
Adjusting to retirement
Adjusting to the loss of a spouse
Establishing an association with one others in one's age group
Adapting to social roles in a flexible manner
Establishing satisfactory physical living arrangements.
Ivy Ridge creates an environment that is conducive to accomplishing these tasks as our elderly move from one role in society to the next.

How does the changing role of the elderly in society affect the decision making process?

One of the biggest challenges faced in our society as we age is that of changing roles. Our roles change throughout our lives, but the change becomes accelerated as we age. When we reach old age, society expects us to move over and make room for the new. We are expected to, and usually do, retire and prepare for the "golden years". The Disengagement Theory is one in which the maintenance of a balance in society is maintained by a mutually beneficial process of withdrawal between society and the elderly. According to this theory, older people desire, and are happy with this withdrawal. This theory helps society as a whole begin to identify aging as a complex process that is extremely individual.

What is Dementia?

Dementia is used as a generic term for a host of mental disorders. It must be noted that "Dementia" is not a disease, it is a syndrome. There are however, many diseases that can cause primary dementia. Some of the more notable include:
Alzheimer's Disease (described in its own section below)
Multi-infarct (vascular) dementia
Mixed Alzheimer's with multi-infarct
Pick disease
Crueutzfeldt-Jacob
Parkinson's Disease
Senile Dementia

Of these diseases, Alzheimer's, Parkinson's, and Senile Dementia are perhaps the most recognizable and prevalent. For that reason, each are described in greater detail in their own sections.

Secondary Dementia (20% of all dementia) is related to some other cause or disease. It can be treated if the underlying cause is discovered. Those underlying causes can include:
Alcoholism
Substance abuse
Vitamin B12 deficiency
Poor nutrition
Metabolic disorders
Cerebral diseases (e.g. tumors, multiple emboli)
Infections
Pseudodementia (often related to undiagnosed depression
The symptoms of dementia include impaired cognitive function, memory loss, impaired speech, poor abstract thinking skills, impaired perception, emotional changes, and behavior manifestations.

What is Alzheimer's Disease?

Alzheimer's Disease is a progressive degenerative disease of the brain now considered a leading cause of dementia. It affects an estimated 2.5 to 3 million persons in the U.S. The incidence of the disease increases with advancing age, but there is no evidence that it is caused by the aging process.
The average life expectancy of persons with the disease is between five and ten years, although many patients now survive 15 years or more due to improvements in care and medical treatment. The cause of this disease has not been discovered, although palliative therapy is available. The ability of doctors to diagnose Alzheimer's disease has improved over the last ten years, but this remains a process of elimination and final diagnosis can be confirmed only at autopsy.
Alzheimer's Disease is a neurological disorder that results in the destruction of vital cells within the brain. The destruction occurs in the outer portion of the brain (the cortex) which is responsible for higher cognitive function. The destruction of these cells results in the symptoms associated with the disease.
The degenerative process of the disease is progressive, getting worse over time. The symptoms of Alzheimer's are cognitive decline, and are seen eventually in all cases of the disease. These symptoms include:
Decline in the perception senses. This results in the loss of the ability of interpreting sensory cues and relationships between objects, self, and the environment.
Decline in the patient's attention span and ability to concentrate.
Decline in the ability to understand spoken or written language. This also causes difficulty forming words or expressing oneself orally or in writing.
Decline in memory. This will cause poor awareness of one's surroundings, and poor retention of, and retrieval of memories. Long term memory usually remains intact the longest.
Poor emotional reaction, causing inappropriate reactions to events as well as exaggerated responses.
Decline in the ability of abstract reasoning and judgement. This causes problems in following sequences, forming concepts, and reaching conclusions.

What is Parkinson's Disease?

Parkinson's Disease is a slowly progressive disabling affliction. It is marked by tremor and increasing stiffness of the muscles. The disease affects more men than women. It is most likely to develop after the age of 35. Approximately 200,000 cases are recorded every year in the United States.
The disease results from degeneration of the basal ganglia, an area of nerve cells that are located at the base of the brain. The chief carrier of nerve signals in this area is the chemical, dopamine. This chemical is usually severely deficient in Parkinsonian patients. The cause of this deficiency is not known, but the discovery in 1983 that the chemical MPTP ( a by-product of a synthetic form of heroin) could cause similar damage suggests that Parkinson's disease may have an environmental origin. Symptoms of the disease include:
Excessive salivation
Poor coordination
Faulty body balance, tremors, and muscle rigidity
Shortening of muscles along the front of the neck tends to bend the head and spine forward

What is Senile Dementia?

Senile Dementia is a form of intellectual impairment found primarily in elderly people. Approximately 10% of all persons older than 65 years have clinically important intellectual impairment. However, about 20% of these cases may be due to treatable causes such as toxic drug reactions. Most cases turn out to be Alzheimer's disease.
The Dementia first begins to manifest itself with failing attention and memory, loss of mathematical ability, irritability, and loss of the person's sense of humor, as well as poor orientation in space and time.

What are "ADL's"?

ADL stands for Activities of Daily Living, i.e. activities performed on a daily basis. They are essential to maintaining physical, mental, and social health and hygiene. These basic activities include dressing, bathing, brushing one's teeth, combing your hair, feeding, and toileting.
Usually, the inability to perform certain of these activities on a daily basis results in a relocation to an "Assisted Living" environment. Each family must access the items and assistance required in determining which alternative is applicable or appropriate for their family resident.

What are the different types of care facilities?

There are three basic alternatives to private residency, depending on the physical, mental, and social needs of your loved one. Additionally, that person's own preferences and financial standing are key factors that must be included in the equation. It is important to involve the elderly in the evaluation and decision making process to the maximum level of their capacity. The "change" and transition in living environment goes much smoother if they feel or perceive that the decision is partially or totally theirs. Let's examine the alternatives with respect to living arrangements for our elderly loved ones.

Independent Living
This is the least supportive of the alternatives. The facility or building units are not licensed for care unless they have other levels of care within the organization. Most of these types of organizations consist of small apartments, studios, or rooms where the residents live on their own or with their spouse or roommate. Meals are usually served in a common dining area, usually at specified times. The monthly fee usually includes some or all meals and light housekeeping. Residents are responsible for bathing themselves, grooming, and personal daily care, including administering their own medication. Additional "in home care" can be arranged outside of the facility, but this can become rather expensive. The rooms usually have panic or call devices in the rooms for an emergency. However, these facilities do not usually assign staff to physically check on the residents day and night.
These types of retirement communities are a sensible solution for active independent seniors who primarily feel the need for companionship, desire social activities, and want opportunities to interact with individuals with similar interests. As you would suspect, this alternative requires a senior to be in reasonably good physical and mental condition.

Residential Care Facility for the Elderly (RCFE)
These facilities are licensed and regulated by the State of California. All Administrators must be certified and maintain a continuing education program. The staff must pass health and criminal record checks, which includes fingerprinting. The fingerprints are submitted to the Department of Justice for review. The staff residents are trained and certified for First Aid. The staff also undergo a regular training program in client care and responding to emergency situations
. Smaller facilities caring for 2-6 residents are usually referred to as "Board and Care" homes. The larger facilities that handle anywhere from 10 to 200 patients are usually termed "Assisted Living" residences. The rooms, private and semi-private, are licensed for ambulatory and non-ambulatory use. Ambulatory is defined as unsupported walking, or walking with a cane. Non-ambulatory covers walkers and wheelchairs. In these types of homes, the resident cannot be totally bed ridden. However, this restriction does not cover the short periods that may be necessary for treating a cold or the flu.
RCFE's are not medical facilities. They do however, provide custodial assistance with Medication Administration under a Doctor's prescription. Improper usage of prescribed, as well as over the counter medications, can be of serious risk to the elderly. In addition to providing transportation (when it is not practical for the family to do so) to scheduled doctor and dentist appointments, most RCFE Administrators work closely with the Home Health Specialists who can provide a wide range of medical and social services to their residents.
In addition to 24 hour care and observation, RCFE's normally have a higher staff to resident ratio then Independent Living or Skilled Nursing Facilities. Many will allow the families to furnish the sleeping quarters to give the Elderly a feeling of possession and individuality. This also helps to eliminate that "institutional" feeling, and gives them a stronger sense of "being home".
With the large divergence and personalities of the respective facilities available, a personal inspection of these residences is a must prior to making a final decision. We at Ivy Ridge welcome you, and extend an open invitation to you. Come see for yourself, how we can meet the needs of your family resident, and give you the peace of mind that comes from making a sound, informed decision.

Skilled Nursing or Convalescent Care
Skilled Nursing institutions are usually large with 60 plus beds, and two beds per room. they are very much like a hospital, and are fairly regimented. Although the staff tries to make the stay pleasant by allowing the families limited decoration of rooms rights, it is still primarily a medical facility. A physician has to prescribe this level of care prior to admission. The patients (in contrast to residents) are usually frail, bed ridden, or under restricted non-ambulatory status. There are many situations when this level of attention is necessary on both a short term, and long term basis. However, once the acute medical needs are met, the other alternatives are far more beneficial from a quality of life standpoint.

How do I make the right decision?

First and foremost, you need to make an inventory of the physical, mental, and social needs of the loved one in question. Remember to factor into the equation your loved one's unique personality. Get them involved in the process to the level of their capability. Recall that the more involved they are in the decision making process, the better the transition will be when it comes time to implement your plans. Consult with their doctor if the transfer is following a medical condition.
Another excellent source of valuable information is support groups and organizations on aging. An Ombudsman is another great source of information to help you determine your course of action. Don't forget friends and peers who have already gone through this process. They can provide you with a wealth of insight and help you steer clear of the obstacles they encountered.
One of the best tools you can utilize is a check-off list or survey when you tour a particular care home. We have included a model of one, and suggest you print it out and use it to help you in your decision. Keep in mind while using this tool, do not be afraid to also listen to your heart. So often, our minds are trying to synthesize all the information, while our hearts are already telling us exactly what that information is pointing to. Trust your intuition as well as your data.
It is vital that you physically inspect the facilities you are considering. Inspect them with your mind, your eyes, and your soul. Is that place one that the family and the loved one can relate to as "home"? Are the other residents ("family residents" to us at Ivy Ridge) compatible in needs and level of care? Be bold, ask the hard questions of your tour guide. At this point you need straight forward answers, not salesmanship. You can learn much from the Managers or Administrators from their manner of presenting their home, to how they relate to their residents as they guide through the facility. These people need to be professionals, dedicated to the care, comfort, and happiness of the elderly they are responsible for and to. Make every attempt to develop a feel for the environment and attitude generated by the facility, the staff, and the other residents.
Ask for references from the facilities under consideration. You should be able to talk directly with family residents who made the decisions you are now facing. See how they feel about those decisions with hindsight as an aid. Now is not the time to be apprehensive or timid. Be bold, you WILL make the right decision.

What are the financial aspects of this type of health care?

The cost of long term care is significant, and little assistance is available through Medicare or other health insurance. If the elderly's income is not sufficient to cover the monthly expense, it usually has to be supplemented by either savings, the conversion of assets, or assistance from family residents. In some cases long term care insurance has already been put into place and may now be utilized. Other sources that can be tapped into include life insurance policies, annuities, and reverse mortgages. Each person's financial status is different. You should explore your options with your attorney, CPA, or insurance agent.

Rate Structure
There is not a formal industry wide rate structure for care and living quarters. Rates for RCFE's will vary from $900.00 + (SSI) to more than $4,500.00 per month. Rates are usually based on the physical aspects of the facility, staff to resident ratios, services offered, and the elderly's level of care requirements. The latter can only be determined during a Pre-Admission Evaluation by the facility's Administrator. There are however, three common methods used in establishing a rate:

Flat Rate
Tiered System Based on Level of Care
Fee for Service
Let's briefly examine each of these aspects.

Flat Rate
Under this method, every resident pays the same rate, regardless of their diagnosis, level of care requirements, or specific quarters provided. This method is simple, and does not require monthly statements. Family residents can easily project the expenses on a long term basis, and the plan works well if all placements are congruent. The disadvantage to this is that it can be unfair to those residents who use very few services. These residents are essentially subsidizing the care of those who utilize many services.

Tiered System
This pricing method is based on varying levels of care, based on resident need. In other words, the fees change in relation to personal care requirements and the services rendered to meet those requirements. Embedded in each tier are basic charges for room, meals, activities, and housekeeping. You may recognize this system as a "menu" style of plans offered. It may be described in their pamphlets as "Service Plan A", "Service Plan B", or termed "Basic", "Catered", and "Deluxe". Fundamental to this method is the concept of paying for what you use. The more services needed or consumed, the more the expenditure. The disadvantage to this is if the resident is placed in the wrong tier, they could be either overcharged for their true level of needs, or undercharged but not receive the level of care required.

Fee for Service
This fee structure charges each resident a base rate for room, meals, and housekeeping. Each and every personal service is then charged individually. Some facilities use "Fee for Service" to prevent sticker shock when families are shopping for care. An advantage to this is no subsidization for care of others, or for services that are not utilized. However, if fees, instead of needs, is the driving force for individual care provided, this can become a major area of conflict between the facility, the resident, and the family. Another disadvantage to this arrangement is the inability to project and budget the actual monthly expenses that may be incurred. This can become a problem when families are relying on somewhat "fixed" incomes.

Ivy Ridge, because of the diversity in the individual living quarters, utilizes a hybrid rate method based on the particular living quarters selected and the specific level of care required by our residents. The specifics of care needs are usually determined based on the input of the family and prospective resident, or at the Pre-Admission Evaluation.

What is an "SSI Room"?

A question we hear quite frequently during an initial inquiry is "Do you have a SSI Room?" Many people do not understand that SSI is strictly a supplement to Social Security provided to individuals with insufficient income or assets to sustain life. It is basically a welfare program to subsidize those persons defined as living below the poverty level. It is not technically a description of a specific room or facility. Simply put, SSI provides the elderly and/or handicapped with approximately $835.00 per month for board and care, and another $90.00 per month for living expenses. Of course, these figures are approximations, with actual amounts determined by models developed by Social Security.
Until recently, those receiving SSI could not utilize family supplements to make up the difference required to provide the care they and their family desired. This regulation, recently repealed, added a very stringent burden to the families whose primary considerations were restricted to seeking the lowest level of care cost available.