Caregiver Environment - A Broken Industry


Many years ago, Mom tried to make me promise that I would never place her in a nursing home because of her understanding of what state-run nursing homes represented. My response then was that the only promise I could make was to keep her home with us as long as possible. I knew the time would come that her needs would surpass my level of care and boundaries. I also knew that someday our two-story house would become a safety hazard for Mom to navigate day and night.

I started to do research two years before the time came to make the official transition. As I looked at different communities, I started to see something I did not appreciate. Seniors are commoditized like healthy conscious individuals seeking a neighborhood gym. On most tours, I was presented with the bells and whistles followed by a hefty price, which only reinforced my gut that assisted living industry does not truly understand Dementia. Training of staff caregivers may vary, which might help slow the effects of turnover, but the environment is crucial.

Christopher Han understands the need for seniors to have an environment that supports their current living, which goes above and beyond safety. As an investor across various interests, fate led him into a passion-based investment in Texas in becoming an owner-operated memory care platform. His passion paved the way to the founding principle behind the award-winning Stoney Brook Communities in Central Texas. With over 19 years of experience in the senior care space, Christopher has become an established developer known for high-quality and successful projects in the Midwest and Texas. Christopher Han is a recognized expert with the HUD 232 LEAN protocol for new construction financing. He has a 100% approval rate over more than a dozen projects across three portfolios.

Before senior care, Christopher Han spent 14 years as a specialist in structured derivatives in New York after graduating from the University of Pennsylvania with a BA in Economics and a minor in Art History. During his tenure on Wall Street, he specialized in derivative structures and risk management, taught derivative theory at NYU and Seton Hall to over 30 domestic corporations, regional banks, and central banks in Brazil, Mexico, Singapore, and Indonesia. Christopher is not all business because, in his spare time, he enjoys master's ski racing, cycling, tennis when the shoulder allows, and true NY-style pizza.

I met Chris one day as I visited with Mom. Our conversation was so pleasant as we talked about our interests. As the conversation transitioned to more of a business aspect, I could see how passionate he is about creating a place he would be proud of for his mother to live in when the time came. I loved his vision of what seniors living with Dementia should be. Until we can create a cultural shift, taking care of our aging adults should not be just another sales pitch for the rich to utilize.

When Mom was willing to accompany me to a senior living community to see what assisted living looked like versus her impression of a poorly run nursing home, she could only see old folks home. I saw an opportunity for her to engage in more activities or with others, but she saw an end to her life in what appeared to be an adult daycare. I asked her after leaving the second community, "So, what did you think?" Mom shook her head, squinted her eyes at me, and leaned in to say, "If you put me in any one of these, I will kill myself." Although I learned this response is very normal, it scared me and made me push as far past my boundaries as I could before I had to decide to begin her transition.

Mom's response to two communities made me search for a home with younger residents in addition to the safe environment, adaptability to her pending decline, and lower cost that would not outlast her retirement with the cost of living increases. I was stuck between what Mom needed and what she wanted. Understanding her limitations from living with mixed Dementia and Bipolar Manic Depressive Disorder, I felt forced to choose as close to a forever home for Mom to meet her needs.

Consumers must be better educated on the deterioration caused by Dementia to know how to care for their loved ones and who is justifiably capable of passing their torch to when the time comes. Caregivers do not need to be treated like they stepped onto a car lot waiting for a salesperson to show them the bells and whistles and then negotiate price based on individual budget. When I toured communities to start a tour, I knew within the first 5 minutes of stepping in whether the home would make my list of potential homes. I attempted to see the place through Mom's eyes, but for me, my senses had to be engaged, or I struck it off the list. I mean by senses, are our basic sense of smell, sound, sight, touch, and even taste.

Smell

If I was assaulted with the stench of urine as I walked in the front doors, I completed the tour but immediately struck it from my list. Our sense of smell is the strongest sense we have, and for our loved ones aging with Dementia, it is vital. Not only does our sense of smell alert us to danger like gas leaks or rotten food, but it also aids the brain in processing emotions, memory, and creativity. Our loved ones may not need to be tracking food and water in a community, but this is one sense that contributes to agitation.

Sound

Next, I assessed the security and ease of entering the building then listened to indicators of doors opened, closed, and how many seconds the doors could be open before an alarm sounded - if one sounded at all. Stepping inside the secured doors, I listened for what sounds filled the main living areas. Are they watching loud television, or is it silent for them to see pictures only? Are they enjoying uplifting music or sitting in silence?

This sense covers both their safety and their ability to function. Hearing loss shrinks some parts of the brain responsible for auditory response and causes our loved ones to be less active. Mom's ENT explained that those with hearing loss untreated declined faster. Those who enjoyed music were less agitated, more active, slowed gray matter loss and cognitive decline.

Sight

While I looked from left to right, I assessed the brightness in lights, colors selected for decoration, and how quickly I would be greeted with whom greeted me. As our loved ones decline cognitively, so does their vision. Blurred vision makes faces, and common objects become harder to recognize. Slow recognition may be linked to memory, but their pupils react slower to light, making it hard to switch from light space to dimly lit or dark spaces.

So looking outside a window and then turning to look inside may challenge taking firm steps. Since their vision adapts to smaller visual fields, they may have a narrow field vision to only 12 inches or less. Plus, adding in the loss of peripheral vision and depth perception, then having their line of sight well-lit also becomes vital.

Touch

Once the tour began, I made it a point to touch the chairs we passed by to feel the fabrics, bedding, communal showers spaces, hallway railing for ADA compliance, and even flooring throughout the community. Visual hallucinations are caused when complex texture images interfere with the perception of an individual living with Dementia. Overstimulation due to building materials with too many patterns or textures may cause our loved ones behavior problems from environmental design. Textures and lines of different widths or different ranges or crossed lines can also create agitation. Even if the flooring is smooth, the visual image may create a problem with depth perception as they walk down a hall or from their bed to the bathroom.

Taste

Complimentary culinary treats were nice to taste and also an opening to ask about what to expect for their culinary habits. Cooking in bulk batches may cover costs internally but making sure there are various options when your loved one has restrictions or becomes particular needs to be declared.

The rest were what I quickly categorized as bells and whistles. Salon parlors, movie rooms, activity rooms, and outdoor paths for your loved one to walk safely were irrelevant. Why? Although we want our loved ones to feel their best by having their hair done, charging extra for blow-outs but making it available to them inside the community is gym member mentality. If they are helping my loved ones shower and understand the dangers of leaving them with cold, wet hair, we should not be charged extra to dry their hair. Haircuts remain a necessity but do not happen nearly as often when their hair is growing faster. Perhaps, having a stylist come in every two months for a basic trim at a reasonable cost or more for gentlemen makes it affordable.

Movie or TV rooms are places for residents to be "parked" in larger communities while the staff takes a break but in smaller communities gives the residents a homey living room feeling to relax. Activities directors in larger communities are typically the first to be cut when the community attempts to tighten up the budget. However, you will still be told about the wonderful games and activities planned on certain days to ease your mind. Outdoor paths are wonderful if a caregiver accompanies your loved one to assist them or help in case of a tumble. This approach requires a 1-1 care time. In large communities, the staff is faced with a much higher ratio of residents to staff during their shift which does not allow 1-1 time. They all go outside, or none go because there is not as much autonomy as we wish.

When you understand Dementia and the fact that no amount of activity will reverse the effects, other factors become far more important. When it comes to the fluctuation in monthly rent across memory care communities, I appreciate those who truly understand the deterioration and design accordingly. Christopher Han has taken this approach because he knows the cost of care and what is important. When I told him we were not paying for your grand front entrances, landscaping costs, or property taxes, he responded with a respectful question, "why should you when that has nothing to do with the care your loved one receives?" I was relieved to know - He gets it. My mother would not be marked with another dollar sign on her forehead.

I share this part of our journey because I know so many struggle with deciding to begin the conversation of a new home with their loved one, let alone figuring out how they will afford the transition for their loved one. You already struggled with learning how to care for your loved ones as they declined. You already pushed back your boundaries in an attempt to keep them home longer. Now your journey feels like yet another steep hill to climb. These decisions force you to become a smarter or more attentive consumer in memory care living. With the rise in Alzheimer's patients, we, the consumer, must demand more options in more demographic areas. Alzheimer's does not affect only the rich, and our seniors deserve a dignified, affordable home to age in a safe environment.

One area that made me postpone the search or transition was the holiday months. I used the time of year as my excuse because if I had one more Thanksgiving or Christmas with her in our home, then I would begin my search. If I had shared one more birthday with her celebrating at home or in her favorite place, then I would look. If I had one more reason to talk myself out of it, I would have kept searching for those reasons while Mom struggled on our stairs or needed 24/7 care. There never is a right time to have the conversation. In your waiting, your loved one increases their risks of falls, loses cognitive abilities for adapting, and challenges your health even further.

Research now because when we know better, we do better, and we achieve better outcomes. Choosing to make the transition is difficult but far less challenging than finding yourself in a medical emergency. Be sure to listen to the podcast with Christopher Han as he explains how to become a better consumer while you search for an assisted living community for your loved one. God Bless you, Dear Caregiver.





Thank you for joining in and listening with us today. You can find more about this topic on the blog at www.jessicalizelcannon.com. I hope this gave you more food for thought and until next time, BE PROACTIVE. Take care everybody.



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Music:

Intro: Vacation Time by Khris Paradise

Outro: Misty by Khris Paradise

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