Care-Facility Residents May Need to Double Their Budgets

Those requiring safer or additional care are hiring private-duty companions. Some institutions insist on this.

By Annalee Kruger
Annalee Kruger
Annalee Kruger

Editor’s note: In this companion piece, caregiving expert Annalee Kruger writes about how advisors can become better advocates for clients and how they can encourage their clients to do the same for their loved ones.

There is a significant need for advocacy for our senior family members and clients who enter the healthcare system. The World Health Organization website reveals that:

  • Around 1 in 6 people age 60 and older experienced some form of abuse in community settings during the past year.
  • Rates of abuse of older people are high in institutions such as nursing homes and long-term-care facilities, with 2 in 3 (or 64%) of staff reporting that they have committed abuse in the past year.
  • Rates of abuse of older people increased during the COVID-19 pandemic.

The landscape of healthcare post-Covid is alarming. Many hospitals, home-care companies and senior care centers are experiencing massive turnover in leadership, causing the quality of care to suffer. An unhealthy workplace culture, combined with poor pay/benefits for healthcare workers, lax training and failure to hold care workers accountable for their care delivery have also made our vulnerable seniors more susceptible to neglect and abuse by healthcare workers.

To meet staffing compliance levels, many senior care facilities and hospitals are using staff from agencies. But bringing in these independent contractors to fill staffing shortages is frequently problematic. They are often bounced from facility to facility or floor to floor, so they don’t get to know the patients’ or residents’ plan of care, care needs, and personalities and preferences. Although staff from agencies often do the best they can, the demands are too great.

An additional burden

Even without these latest problems, senior care facilities were never set up for and never promised to provide one-on-one care. One worker has the responsibility of several residents and that ratio also depends on what level of care they work in (assisted living, memory care, nursing home, skilled rehab) and what the state requires.

As more families realize their aging loved ones are not receiving the quality of care and attention they expect from senior care workers, they’re hiring private-duty companions to help ensure their loved one is eating meals, being bathed, receiving some sort of stimulation instead of staying in their apartment all day (if in assisted living) or getting out of bed or at least repositioned if in a nursing home bed.

Now many care facilities even require the resident (or family) to hire private-duty companions to assist if the resident needs more one-on-one attention to prevent falls, manage difficult behaviors or meet basic care needs. This could run as much or more than the cost of the care facility itself.

[The median annual cost for a private-pay patient in a private room in a nursing home in the U.S. is $108,405, according to the latest Genworth Cost of Care Survey. Hiring a private-duty health aide at $27 per hour — the median national rate per the survey — costs $118,260 a year for 12 hours of extra care a day or $236,520 a year for extra support round the clock. Depending on the area of the country, nursing home and health aide rates can be significantly higher.]

When we toured a memory care facility with one of our Care Right clients, the admissions person proudly reported that 60% of their families pay for private-duty companions because the facility is so short-staffed.

Are you addressing these issues when you meet with families and are you adjusting their financial plans accordingly?

Senior rights

Every single patient, young or senior, and their family ought to feel confident that the people taking care of them are properly managed, supervised and trained, and held to a high standard of care.  However, our seniors are especially vulnerable and at the mercy of healthcare workers.

Many seniors and families are too intimidated to boldly advocate for themselves or their loved ones. Or families naively assume their loved ones will be properly taken care of by healthcare professionals. Meanwhile, advanced dementia patients and other vulnerable adults are completely unable to advocate for themselves.

We have also learned, through our conversations at various care centers and home care agencies, that managers are often reluctant to write up or discipline the workers because they fear they will quit and leave their facilities even more short-staffed.

Our Advocacy Division of Care Right Inc. serves families across the globe. Our families determine the frequency of virtual or in-person advocacy from our team. Most seniors receive check-ins weekly or every other week. For example, last week we did (virtual) call-light audits for our clients residing in long-term care settings.

Seeing is believing

The general rule of thumb is a resident should be tended to within 10 to 15 minutes after activating their call light.

But last week, it took the nursing home staff one hour and 37 minutes to respond to the call light for one of our clients.  Granted, our client didn’t need anything when we asked him to push his call button so we could time the response. But he certainly needed help getting to the bathroom by the time the worker arrived.

While we waited for the worker to respond to the call light, we went through our usual advocacy-visit questions. We asked our client about the food, his tablemates and roommate, how the workers engage with him, what concerns he has about his care, if his pain is being managed, etc. Of course, many clients are unable to answer these questions themselves.

We also encourage our families to agree to having a camera installed in the room since we can’t be there during all hours and shifts.

One of the families in our advocacy program finally agreed to a room camera and what they saw was eye-opening. During each of our advocacy visits, we had grown more and more concerned about their father’s care and safety. We requested to see him every other day so we could quickly identify and address the suspected care issues, but the family initially only wanted a weekly check-in.

After we obtained the camera authorization from the facility, and had the camera installed, we saw that the family’s loved one was sitting in his wheelchair for hours on end (during the entire third shift). He also wasn’t being served meals consistently or given his diabetic medication, and he was not toileted for hours during the second and third shifts. The staff also neglected to attach the foot pedals to his wheelchair so his legs dangled for long periods of time.

After seeing this on the camera and being horrified, the kids agreed to our request to see their dad more often. This would give us the time we need to properly advocate for his life. He is a frail elderly person who needs assistance with bathing, dressing, grooming, medication, meals and socialization.

Care not commensurate with charges

This client was also being billed at the assisted living center’s highest level of care but not receiving it.

Again, families often assume that because they are paying thousands of dollars a month for care, their loved one is actually receiving that care. Because of this misperception, it can take us a bit of time to educate each family about the reality of the care being administered.

In this case, the facility our client lives in has had seven executive directors in the last two years.  I cannot emphasize enough that residents will suffer when there is not consistent, quality leadership at their facility

A huge difference

Now that we are overseeing their client’s care and advocating for him and his family, he is being tended to regularly and properly throughout each shift. This has alleviated such problems — and the likely need for hospitalizations — from pressure sores, unmanaged diabetes, pain from being slumped in a wheelchair for hours on end, and falls from him trying to get up on his own to use the restroom.

We also coordinated with our client’s doctor to get him physical and occupational therapy. The client is starting to get stronger. He may soon be able to decrease his care level now that he’s getting proper nutrition and exercise, regularly receiving his medications, sleeping better, and getting the care he should have had all along. We also prevented a premature move to a nursing home, which would have impacted not only his finances but also his goal to stay in his beautiful assisted-living unit overlooking a pond. Had he moved to a nursing home, he would likely be sharing a tiny space with a roommate.

Although this is just one example, millions of adults over 65 live in or spend time in some type of care facility each year, according to the National Center for Health Statistics. It’s important that they budget for and receive the care they need.

Not only do aging clients deserve a safe and quality care experience, their adult children need peace of mind that their frail, vulnerable parents will be safe, happy and have the best quality of life and quality of care possible.  Financial advisors can be the conduit to start these conversations and bring in experts to help families have the best outcomes.

Annalee Kruger is president of Care Right Inc. (a nationwide senior care planning/aging plan consultant and virtual patient advocate) and co-president of Plan4LifeNow (an education and financial planning consultancy teaching financial advisors to become Elder Planning Specialists). As a virtual and nationwide senior care planner and senior advocate, Annalee teaches advisors and families how to boldly advocate for their clients and loved ones. Her book, “The Invisible Patient: The Emotional, Financial, and Physical Toll on Family Caregivers,” is available on Amazon and Audible.


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