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RadioMD Presents:Healthy Talk | Original Air Date: May 27, 2015

Healthy Talk with Dr. Michael Smith M.D. And now here's the country doctor with the city education, Dr. Mike.

DR MIKE: Some of my listeners might be having to go thru a really tough decision right now. And that is trying to decide whether somebody they love can undergo home care or they need to go into assisted living. I'm going to be perfectly honest with my listeners. I've really never thought of this before, I wasn't aware that a lot of people go through this. It makes sense that people go through this tough decision. I just never thought about it.

When I saw Stephanie Erickson, she's a social worker, she pitched Healthy Talk and this idea of how to make this decision, and I jumped all over it. I really like it. I'm happy she's on. She's a social worker with over 20 years of experience. Her primary focus is in dementia and decision making capacity.

She works with seniors living by themselves and in care facilities and acute care in hospitals. She also provides training and consultation to families, The Alzheimer's Society, community groups, financial and legal institutions and at professional conferences. She has her own weekly podcast called Caregivers Circle on WebTalkRadio.net. Stephanie, welcome to Healthy Talk.

STEPHANIE: Thank you so much for having me again.

DR MIKE: Homecare or assisted living? This is obviously really tough for people, isn't it?

STEPHANIE: It's extremely tough because I find that most of the time, the adult children want one thing but the senior, him or herself, wants something else. To me that probably presents the greatest challenge. More than what is the most appropriate environment, it's actually how can we decide as a family what is going to be best.

DR MIKE: Just the way you presented it right there – that's a dilemma. Here you have a maybe a father, a mother, an older uncle who wants to live by themselves but maybe you feel that's not necessarily safe for them. So, we have to balance that freedom they want, that autonomy they want versus what's safe for them. And that's obviously going to be very tough. Let's start here. What's the difference between assisted living/assisted residency and full care facilities?

STEPHANIE: Assisted residency is usually in a much larger environment. Typically, the services that are offered for all of the people that live within the environment are meal services. So, usually three meals a day. There's very likely not a kitchen within their own personal apartment but there may be. That's kind of a flexible option.

Often an assisted residence also provides medication services and perhaps a little bit of hygiene care but the person is more autonomous. They can go to the dining room, back and forth themselves. Maybe they just have some slight memory problems and just need a few prompts and guidance but generally they are functioning on their own.

A full care residence would be somebody that has severe memory losses or perhaps some physical disabilities or physical loss of mobility problems and they require much more care and services. Ambulation, transferring assistance, for sure there is no kitchen within that person's room and often the person is sharing a room as well.

DR MIKE: In the assisted residence, is that someone living maybe almost in a smaller apartment by themselves versus more like the traditional hospital or something?

STEPHANIE: Well, it's not really a hospital. It could be a regular apartment building but there's going to be a main dining room. Sometimes it's on the ground floor but often it's on the second or third floor within the residence.

So, they have their own small apartment but they take the elevator and go down to the dining room for their meals. The nurse checks in on them, let's say twice a day, when they are obtaining their medication. Other than that, they are sort of free to come and go as they please.

DR MIKE: Let's help my listeners. Let's say there is a listener who's maybe in this tough decision. What are some of the things or some of the advice you could give that person? When is it the right time to move somebody into assisted living or to get them home care? What are some of the things you look for?

STEPHANIE: Well, in terms of what signs in the home – because that's going to be the first indication for the family. Number one, you're going to look at the person's physical health. So, things like weight loss, mobility problems, falls, the home environment in terms of hygiene, personal hygiene problems and they are going to consider the cognitive functioning of that person. And those signs and symptoms would be things like expired food in the home, disorganization of papers, utilities or rent or mortgage not being paid, taxes not being paid, burning pots on the stove – those sorts of things. When you're deciding if it's the right time there are a few factors you have to look at.

One is safety. That is the most important thing. Medication compliance issues obviously present them pretty high risk. Second would be wandering. If the person is leaving the home and not able to find their way back. That's a pretty significant risk as well. But always you have to consider, financially can we afford to bring care into the home? Enough care, enough hours to keep the person safe in comparison to what the cost would be for residence.

DR MIKE: So, let's say you get to a situation where all the signs are there. You feel, based on the things you are seeing, like you mentioned the medicine compliance and leaving stuff on the stove, all the signs are there. Is there a better way to then approach your mom or dad who you feel needs to move into an assisted living, is there some advice you can give my listeners there?

STEPHANIE: Yes, hindsight is always 20/20. So, my first advice would be actually start talking to your parents now when they are healthy. Talk about what environments they would want to live in should they need assistance. So, that way we sort of already know what our parents want and it's going to help us if a crisis arises.

But if your listeners are already in the situation, the first thing I suggest is that the listeners start documenting all the signs and symptoms that they are seeing over maybe a two or three week period and then presenting those to their parents. "Mom, I love you very much. I've observed a few things over the past few weeks and I really scared about your safety and your health. Can we talk about it?"

So, not going in and saying, "Mom, you're not doing well, it's time to move" but coming from love and asking for the senior's opinion and their own perception of what they think is going on.

DR MIKE: So. what about the actual place that you are looking at? Are there things that we want to look for that might indicate that a place is not so great in assisted living or are there things that say, "Hey, that's a great place" ? How do I pick the right place is what I'm asking.

STEPHANIE: I think it depends on what issues you are trying to resolve. If it's a memory loss problem and we know that they person has dementia, that's a progressive and persistent disease. It's only going to get worse. So, you are going to want to find a place that has a continuum of care so the person doesn't have to be moving around a lot. If you are looking at physical problems then, obviously, you are looking at something else. But I tell families, more than anything else there are two things that I recommend. Number one, go to at least four places. At least.

And pop in and make sure you go during lunch time and try a meal because you want to check out how the food is. Number two is to make sure you meet the director in charge and get a feeling how he or she runs that residence. And the third point is don't doubt yourself.

The way that you feel when you walk into a place, even if you can't put words to it, that should be considered and its absolutely important information to keep in mind when you are evaluating.

DR MIKE: So, my guest is Stephanie Erickson. She's a social worker for many, many, many years and has a great podcast called Caregivers Circle on WebTalkRadio.net. Stephanie, how much does all of this cost? Do we have any average cost on home health care versus assisted living?

STEPHANIE: Well, if you wanted home health care and you needed 24 hour care--not everybody needs that-- you're looking at about $120,000 a year for full time health care. It's crazy. That's if you go with private home care companies. There are some other options that you can do that would lower the cost.

DR MIKE: We will come back to that cost question. That's a lot of money , Stephanie, for the private caregiver. When we come back we will continue our discussion with Stephanie.

This is Healthy Talk on Radio M.D. I'm Dr. Mike. Stay well.