Memory Care Explained with Anne Farley

Join Kelly and her guest, Anne Farley, Director of Community Relations at The Ganzhorn Suites.

In this episode: 

🔹 How people know when it's time for memory care for a loved one

🔹 The difference between assisted living and specialized memory care

🔹Important considerations when choosing a memory care community

🔹How people pay for memory care communities

Watch this episode on YouTube:

https://youtu.be/hVXN7xB842k   

Find out more about The Ganzhorn Suites and Anne:

https://www.ganzhorn.com/ 

For additional information about Kelly, check her out on Linkedin or www.SteadfastAgents.com.

To explore your options for long-term care insurance, click here.

Steadfast Care Planning podcast is made possible by Steadfast Insurance LLC,
Certification in Long Term Care, and AMADA Senior Care Columbus.

Come back next time for more helpful guidance!

Transcript

Kelly Augspurger  0:00  
Hey everyone. Welcome to the Steadfast Care Planning podcast where we plan for care to live well. I'm your guide, Kelly Augspurger. Today I have with me Anne Farley. Anne is the Director of Community Relations at Ganzhorn Suites specialized memory care facility in Powell, Ohio. Welcome Anne. Thanks so much for being here!

Anne Farley  0:22  
Thanks for having me!

Kelly Augspurger  0:23  
Today we are going to be talking about memory care and Anne is an expert in this area. So Anne we look forward to learning lots of good detail from you. The first question is, how do people know when it's time to place a loved one in memory care? What kinds of issues do most people face?

Anne Farley  0:43  
That's a great question. And probably the number one question I get asked more than anything from family. So I think there are about four qualities of life that people look at when they are thinking about placing their loved one in memory care, I think first and foremost, it is safety for not only the potential resident, but for the family as well. So imagine you have someone living at home that you're providing care for that is living with dementia, and they are wandering out of the house, or they are trying to go out into the garage and drive their car, they are leaving the stove on, they are putting something covered in foil in the microwave and the microwave is caught on fire. So those are some of the safety issues from the residents standpoint. And then you have the safety for the family members, if you have an older adult, female spouse that's providing care for her husband, who may be is 185 pounds, and the wife is 110. And he takes a fall. How is she supposed to get him up safely without injuring herself? 

Kelly Augspurger  1:59  
Impossible. 

Anne Farley  2:00  
Yeah. And then also Kelly, there's just sometimes the aspect of people living with dementia have the propensity to have behaviors, some of which can be aggressive. And so if that is the case, again, with a spouse, to a spouse, or an adult father to an adult child that is providing care. If they have that propensity to get aggressive, that's another safety factor. You know, so I think that's the first thing that a lot of families look at. I would say, second, would be just caregiver burnout. I mean if anyone out there who's listening to this is a caregiver to someone live with dementia, you know, you are living it. It is relentless, it is exhausting to provide care for someone. And so I think that so many times, if they are a caregiver, and their loved ones still living at home, they are many times isolating in their houses. You know, think about it, everything can be delivered. Now, you can have food delivered, medications delivered, clothing, everything can be delivered. So, which is convenient in some ways, but if you're a caregiver, that just allows you to become more isolated and more hermetically sealed in your environment. You stop going to church, you stop going to the gym, or the Y, SilverSneakers. And all you're doing is focusing in on this person that you're providing care to. And it can be distressing. And so that can cause a lot of burnout physically, socially, spiritually, financially, all the burnout.

Kelly Augspurger  3:43  
Yeah. 

Anne Farley  3:44  
And then probably one of the other ones that maybe people don't think about quite as much unless you're living it is that the inability to keep your loved one living with dementia engaged. You know, they get bored or under stimulated. So many times when someone is placed in a memory care community they can thrive because they are surrounded by people that are on the same journey. They're being provided appropriate activities and programs that are enriching to them. And they thrive because they're able to be social again you know,

Kelly Augspurger  4:19  
Right. They're not stuck at home with maybe just the one person, one caregiver, doing the same thing.

Anne Farley  4:25  
And, you know, I have caregivers who say,"Oh, my gosh,  I ordered all this stuff offline and, and I got everything set up and my husband was seated at the table, and I got up to go get a cup of coffee, and I come back and he's sitting in front of the TV because I can't get him to focus in." But if you have a group of people that are doing the same thing, that are living that same journey, it's a lot easier for them to stay focused. And then lastly, I think, people with the incontinence issue. We're going to get really specific here, you all, that for people that are listening. Incontinence is a very difficult part of the disease. Bladder incontinence is one thing, but when they become incontinent of bowel as well, it can be really difficult for families to manage that at home. And then there's a piece of that is just the personal care that goes along with it. Imagine if you're an adult daughter, and you're providing care for your father, the personal care piece can be very uncomfortable. And obviously the same thing with a son who's trying to provide that personal care with his mom, it can be really off putting and feel very uncomfortable and awkward. And so I think those are really the four things that people look at most that we talk about, as we meet during this process that people are thinking about,

Kelly Augspurger  5:45  
Anne - can you say those four altogether?

Anne Farley  5:47  
So the four altogether, I would say, would be: 1. Safety of the potential resident, as well as the family members  2. Caregiver burnout 3. Lack of stimulation or boredom at home between the caregiver and the in the person living with dementia, and then 4. Incontinence and personal hygiene care issues for someone living at home.

Kelly Augspurger  6:12  
Great, thanks for that summary. And those are things that I'm seeing on my end of the insurance world, when people do have a cognitive impairment, those are the reasons that the loved ones, the caregivers, do end up placing their loved one in a memory care facility. And it can provide so much freedom and a burden lifted off of the caregiver and off the family when they finally realize and decide, "You know what, I can't and I should not do this alone anymore. I need help." 

Anne Farley  6:42  
Right! It's the team. It's the team approach, you know, then you have people at the memory care, they have access to medical care, they have access to good food, and again, the food thing, when you're sitting with your loved one by yourself at home, it's not social, right? So a lot of times they stop eating, they don't enjoy eating anymore. But when you're in a memory care setting, where you're sitting with maybe 20 or 25 of the people who are eating with you then suddenly become social. So yeah, so there are just a lot of benefits for families and you can see the relief, you know, and you see it too Kelly, you can see the relief in their faces.

Kelly Augspurger  7:19  
Right. And I think there's a stigma behind when people think of memory care, or even facilities, assisted living, just facilities in general, there's a negative stigma behind that. And I really want to change that. I do know, most of my clients say when I'm working with them and planning, "we want to stay at home as long as possible." And I'm with you, I want to receive care at home as long as possible too, but there comes a point where it's not safe for the person receiving care and it's not safe for the caregiver. And that care recipient may be better off in a community, in a facility, where they're getting the care that they really need and they deserve. And really that burden is lifted off of everyone. 

The Steadfast Care Planning podcast is sponsored by Steadfast Insurance, an independent insurance agency in Westerville, Ohio that provides home, auto, business, life, disability, and long term care insurance solutions. Visit www.steadfastagents.com to learn more. 

So Anne, tell us what's the difference between assisted living and a specialized memory care setting?

Anne Farley  8:25  
So there were a couple of different types of of health care settings. So I think what most people want to steer clear of in their mind, is that nursing home, oh my gosh the nursing home, you know. How many times have you heard from spouses saying I promised my wife I'd never put her in a nursing home and I understand that but nursing homes, they have to be a part of the healthcare system. They can provide an amazing level of care for people that are really complicated medically that need that skilled level of care. So that's a nursing home. Totally separate from an assisted living, nursing homes are paid for differently. They have different abilities as far as what they can provide to a person medically. So assisted livings, generally speaking, private pay, so families pay out of pocket. Medicare, Medicaid, for the most part, do not cover any of the of the room and board unless someone in assisted living is receiving some therapy services, then Medicare might pay for that. But it's not gonna pay for any of the room and board. When it comes to the difference between an assisted living and a specialized memory care assisted living. Like whatGanzhorn Suites is,  for us, it means that anyone living in our community has some form of cognitive impairment. So we are set up staffing wise, enrichment wise, nutritionally, medically, to understand and deliver the care to someone that is living with this disease. A traditional assisted living without the specialized memory care component is more for someone maybe that has been living at home doing fairly well, but maybe is just declining a little bit, maybe they're struggling with their medications, they take a lot of medications. So now they're having medication mix ups or they're just struggling to get in and out of the shower because they're not as mobile as they used to be. They're lonely, they would like to be around other people. So they move into an assisted living, where the expectation is this person is fully cognitively intact, and doesn't necessarily have any cognitive impairment needs, they just really need medication management, help getting in and out of the shower. You know, they enjoy eating around a lot of people, their meals are provided to them. Maybe there's transportation, you know, maybe the assisted living has a bus and they go on outings, they go look at, in the holidays, they look at the Christmas lights, they go shopping, they can run to the grocery or doctor's appointments. So that's really predominantly the difference between an assisted living or a specialized memory care facility.

Kelly Augspurger  11:16  
Okay, great. And what kind of questions are important to ask when a family is looking at a memory care facility for their loved one? Like what kinds of activities and therapies are available? What's a good checklist?

Anne Farley  11:31  
I'm a social worker. So for me, it's about the connection. It's about the feeling you get right when you walk in the door. And that's just for me, that would be something that I would want. If I'm greeted warmly, if the building looks nice and smells nice. And again, I'm not talking about a brand new spankin building with all the bells and whistles. I tell families all the time, you can get absolutely incredible care in a building that's been around for 35 years, it still has wallpaper on the walls, you know, because a lot of times what those buildings are doing is they're not updating because they are spending their money on the care and the staff that they're hiring. So it does not have to be 

Kelly Augspurger  12:15  
Quality care, right? 

Anne Farley  12:16  
It does not have to be some brand new facility. So for me, though, it's the connection, but if I was the family, I would ask about staffing ratios. What do you do when you have a call off? Do you use an agency? I would ask about programs and activities, you know, I would ask about how your staff is trained? And then I would usually do visits, I would do one that is scheduled, because you really want to be able to sit down and have your initial meeting with the person within the community that can tell you a lot about the community. You know, if you stop in for your initial visit on four o'clock on a Saturday afternoon, you're likely going to get a nurse or someone that's working the floor. And while they are probably very knowledgeable, they're not going to know everything, they're not going to know probably about the rates, about availability. They're not necessarily going to know some of the real nuances. So I would absolutely schedule your first visit with usually it's going to be the admissions person. In my case, it's the Community Relations Director, it might even be the executive director and then if you really liked that building, then I would stop in maybe a second time unannounced, just to see what it's like. Again, not to catch them doing anything wrong, but just to get a feel for what it's like when someone arrives unannounced and unexpected. You know usually you'll receive a really warm welcoming. You should still be able to say "Hey, can I walk in and just see what what a meal is like?" If they say, "Oh, no, no, no, no." You know, then that would be a head scratcher for me. But if they say "Yes, sure, come on in. I can't necessarily sit with you for the whole time, but yeah, come on in and I can get you seated." You can kind of watch how the staff does things. Those would be some of the things that I would ask. And then finally, I would say when they talk about rates, I would find out what's included in the rate, if they have levels of care, what those levels of care look like, what does each one cost? And if they're talking about an a la carte pricing structure, which is totally fine, say I would like a handout of what each of those a la carte services cost. If you're taking medication to my mom, you know, four times a day what is that going to cost? And then finally, the last thing would be - I always tell a family please find out from the community, what would cause them to discharge your family member. It may be nothing. There may not be anything that would cause them to discharge your family member although there has to be a parameter.

Kelly Augspurger  15:02  
Okay, what are some typical things? Yeah. Can you give us an example?

Anne Farley  15:07  
Some other communities, sometimes what causes a community to discharge of loved one, is when they become a two person assist. So the way that I explain to families think about this way, if you're in a memory care community, and there were 36 people living in that memory care unit, and the staffing ratios are one to eighteen. So that means there are two caregivers there for those 36 residents. Kelly - if your mom then requires two people to give her a shower, and that shower takes a good hour. Right? Then that means those other 35 residents are unsupervised because those two caregivers are providing that shower to your mom. So it doesn't mean it's a bad building. It doesn't mean that at all, it just means that they have parameters around their staffing ratios. So a family might say, "So Kelly, at your memory care, what would cause my mom to be discharged?" If they say "When your mom becomes a two person assist, that will be a reason that we would have to ask your mom to leave." Sometimes the follow up to that would be your mom could stay though, if you provided outside caregivers to help. And again, for something that's not financially feasible.

Kelly Augspurger  16:26  
Sure. Would that be in special circumstances, though? And like maybe mom only needs that two hands assist for a shower, but all throughout the day, the rest of the day she just needs one person? 

Anne Farley  16:37  
Yeah, it could be you know, it's just really going to depend on the community. It really is. 

Kelly Augspurger  16:42  
Okay. 

Anne Farley  16:43  
A lot of the other 

Kelly Augspurger  16:43  
What do you guys do at Ganzhorn?

Anne Farley  16:45  
So we're able to absolutely take care of someone who needs two person assist. We have two neighborhoods, and our neighborhoods are setup according to kind of the stage of the disease where that person is, so we have one neighborhood is kind of for moderate stage residents and then we have a neighborhood for a very late advanced stage residents and they all require two people to help them with their care. So we're able to manage that, but that's because of our staffing ratios. Again, it does not mean that a building is bad if they do not have their staffing ratios. It's just something that families really, really need to be cognizant of because anyone livingwith this disease, if they live with it long enough, they are eventually going to need two people to help them with everything. The other reason that sometimes buildings are not able to manage someone's care is because they require certain equipment, there's something called a hoyer lift, there's something called a sit to stand and so that equipment is big, it's bulky, you need to be trained on it, you need to have two people to use that safely with the residents. So that might be another reason, and then finally, sometimes what it is, is that someone has behaviors. Let's say those behaviors are the person is combative with care, let's say the behavior is they scream and yell, they're very distressed, they can be very loud and very verbally aggressive. Or maybe that behavior is the person walks all day, and walks in and out of other people's rooms where they pick things up or, you know, whatever it may be. That again, might be a reason that a community says "Kelly, we just, we just can't keep your mom here, if that's what she starts doing because it can be very unnerving to a lot of our other residents who are higher functioning, and really would be in great distress if your mom kept walking, and now they're worried, especially at night or something like that." So those are some things I would ask, you know, as you're looking at memory care.

Kelly Augspurger  18:51  
Great, great examples, I think especially the discharge, I hadn't thought of that, you know, what would it take in order for our loved one to no longer be able to stay here? I think that's a really important question to ask. When you are serving residents and they're in your facility, how are these families paying for care, Anne? What are you seeing at Ganzhorn and just in general, in specialized memory care, but then specifically Ganzhorn?

Anne Farley  19:15  
So at Ganzhorn, as I mentioned, because we're a licensed assisted living, we are a private pay community. So you know, many of our families, their loved ones were very successful and whatever they did for a career, and they were good savers, and good investors, and that's how they're paying for the care. Sometimes family members kick in as well. And then many of our residents, probably about a third of our residents utilize long term care insurance. And I mean, if that is the case, they are so incredibly blessed and lucky that they either they themselves got the long term care insurance years ago, or 10 years ago, or they purchased it within the past couple of years. And I mean, it's just, it's a game changer for many families.

Kelly Augspurger  20:09  
A life saver for the family. Right? Financially, and then obviously not having to provide that care. The loved one, the spouse, the adult kids. Knowing that you know what, Mom and Dad, they made these financial decisions years ago, they planned, they saved. I would imagine too there's a combination. Are you seeing a combination of self-funding, using savings and maybe Long Term Care Insurance together combined? To be able to... okay, 

Anne Farley  20:37  
Yes!

Kelly Augspurger  20:38  
What is the typical, let's say, monthly fee for at a specialized memory care facility, maybe that's Ganzhorn or even in Columbus, like what can people expect to pay?

Anne Farley  20:50  
So depending on, you know, again, what's included in the rate or how their pricing structure is, Kelly, I would say families could plan for anywhere between $6,500 to $12,000. You know, if you have levels of care, that is when you tend to get up into the tens, elevens or twelves. Because, you know, again, just to explain to the audience, since we're talking about this, if a community has levels of care, what the families going to pay is the base's monthly rent, for lack of better word, and then whatever level of care that person enters the community under. So let's say a building, and I'm just making this easy numbers, let's say a building has four levels of care and each one is $1,000. I'm just again doing this arbitrarily, and someone moves into that community, and they are paying $6,000 for the monthly rent. And then the person moving in who has dementia is still pretty capable of doing a lot of things. So maybe they're only that first level of care. So they're paying the $6,000 plus the first level of care step $7,000. And maybe that person stays in that level of care for a year, but then they fall. And they break a hip, and they come back and they're not able to do anything on their own. So now they've gone from this first level of care up to the fourth level. So now it's the $7,000 a month, plus the $4,000 for the level of care. So now they're at $11,000. That's how that works. A la carte pricing is just what it sounds like, Kelly. You and your husband go out to, you know, J Alexander's, and you order a steak and a baked potato and a glass of wine and a salad, the bill comes and everything is priced out separately. That's what a la carte pricing is. So as people need more stuff, it's added onto their monthly to their monthly bill. So again, it really depends on the pricing structure, and what's included. An average monthly rent rate at Ganzhorn is around $9,000. We have an all inclusive pricing model, there's nothing that's not included, no rate other the hair salon and if someone had a TV with cable. Anything medically is run through their Medicare, Part D drug plan, anything supplemental or secondary. So, you know, that's why it is so important to plan. And I know that for many people out there, it's you know, it's just not even feasible for them to plan because they can't get long term care insurance because they're too far into their disease. But if you are out there listening to this, and you are able to look into long term care or other, you know, modes of of planning, I highly recommend it.

Kelly Augspurger  23:40  
Yeah. And really that leads to my final question, Anne, is final advice on how people can plan now to live well? Right, it's doing this sooner than later. Don't wait until that diagnosis happened.

Anne Farley  23:54  
No, don't wait till the diagnosis happens. You know if you do feel like there's something happening with your loved one, get to a neurologist because right now all the medications out there are designed for people with in the early stages. The way that our medical director, Dr. Douglas Scharre, talks about it is, it allows your brain cells to fire more efficiently longer. So what that means is that extends your life at home and by living at home longer, that also extends your financial life and extends your social life and everything else. You know, but early diagnosis is critical. And you know, and all the other things that we always talk about and hear about Kelly is you know, exercise your brain you know, try to eat well, try to do something for exercise. Again, I don't want to preach to the choir, but you know, I don't care if it's walking every day. Go to the Y and walk around the track. During the summer walk outside. You know, try to eat well, be social. You know, get online there are so many things online about ways to keep our our brains healthy and it's not difficult. I mean, there's simple steps is what I'm saying. And you know, just reach out for help. The Alzheimer's Association is a great resource. I am happy to talk to anyone. I have support groups, we have educational lectures, we have programs for caregivers, because I feel strongly that, you know, people that are caregivers are isolated, and they need to be around other people that are caregivers. So they understand that and reach out to you. You know, I mean, when you and I talked the other day, you opened a lot of doors for me in my brain about things that my husband and I need to think about when we're thinking about our long term care. 

Kelly Augspurger  25:42  
Yeah I mean really, the goal is to plan sooner than later that way, not only your family's protected, but your finances are protected as well, because then we are living well. And hopefully, we're not burdening our loved ones with the financial, physical, mental and emotional consequences that really come when a family member needs extended care. So the sooner we can do that, the better off everyone will be. And if you don't qualify for long term care insurance, if you didn't plan in enough time, you know, there's still other things to consider, like who is going to provide care? What will that logistically look like if you do have to pay for care? What facilities are nearby? Uou know, start even to look at facilities. And logistically come up with a plan with your family of how that's going to work, to be able to all be on the same page so that you're not waiting until the event happens. And then you're really scrambling,

Anne Farley  26:40  
Waiting for the crisis that's what I always talk about - have the conversation before the crisis. It is not an easy conversation. You know, I mean, talking to your parents about their finances, you know, a lot of our parents were in that generation where we don't talk about finances with our kids. But oh, my goodness, oh, it is critical. It really is. And get together as a family and put a plan together and stick to the plan if you can and reach out to others, because there are people out there that want to help. 

Kelly Augspurger  27:10  
That's right.

Thanks, Anne. Final question. Where can people find more information about you and how you help people, Anne?

Anne Farley  27:17  
So you can go to our website, which is just www.ganzhorn.com. You can call our community. Our number's 614-356-9810 and ask for me, or you can email me crd.powell@ganzhorn.com. No matter what we have a Facebook page. Just all kinds of ways to reach me. I'd love to talk to you guys out there if anyone needs me.

Kelly Augspurger  27:46  
Wonderful. And thanks so much for your time. Such a pleasure talking with you.

Anne Farley  27:49  
You are so welcome. I loved it!

Kelly Augspurger  27:52  
Have a great day!

Anne Farley  27:53  
 You too.

Kelly Augspurger  27:53  
Thanks. Bye bye.