Continuing Care Retirement Communities

Every month Chris and I explore another option in your Care Arsenal, and this month we will help you understand what Continuing Care Retirement Communities are. For short, we call these types of care communities “CCRC’s.”

Sometimes CCRC’s are called Life-Care Communities. A CCRC is a retirement community that covers a full range of aging services and levels of care, from independent living cottages or apartments to assisted living housing, to full-blown skilled nursing services. In most cases, each change in care-level requires a move to new living quarters. The different levels of care may all be housed on different floors of a high-rise building or in different wings or buildings across a single campus.

Independent living is usually the entry-level for most residents. The idea is that residents enjoy a higher quality of life in a community of peers with similar life experiences. Independent living residents experience maintenance-free housing and landscaping, housekeeping services, and sometimes even congregational meals in a restaurant-style dining room. A variety of activities and opportunities abound for those who enjoy hobbies, concerts, games, dances, and even excursions.

As the resident begins to need assistance with personal care needs like bathing, toileting or walking, they must move into the Assisted Living section of the CCRC. This area has more of a nursing presence and closer supervision of the residents. CNA’s, Home Health Aides, or Nurse Aides will assist with those personal care items that need help. With this transition usually comes a higher monthly cost.

Skilled Nursing Assistance is the highest level of care provided in CCRC’s. You would probably think of this as a Nursing Home, but still on the campus. It will have the highest monthly cost for the resident, but it provides constant nursing supervision of the resident. Frequently when a couple resides in a CCRC, and one spouse needs Skilled Nursing Services, the other spouse will need to remain at their current level of care unless both require the same level of care. It is sad when a couple married 60+ years must live separately because of the declining health of one.

Payment options for CCRC’s vary greatly. There are many models that may apply. Some require a large sum of money for an entry fee, but remain relatively consistent with the monthly residential fee, even when levels of care increase. Others require a minimal entry fee, but the resident is in a “pay as you go” program where every level of care costs significantly more than the one before.

You might want to check out Genworth’s Cost of Care resource:

So that’s more or less the rundown on CCRC’s. They can be very expensive but can also be very enjoyable for the socially active retiree. Be sure to ask lots of questions and understand the contract and its requirements. If your loved one has dementia, or if you suspect they might, be sure to ask if the CCRC has a Memory Care facility. That’s also critically important to know. Finally, ask if they allow private duty caregivers in their facilities, and how they screen and track those individuals. Arm yourself with knowledge and visit several times throughout the year before you decide to commit so that you can experience lots of different seasons and conditions within the community. The more you know, the better the decision you can make.

Money and Care Management

As a Family Caregiver, your job can be quite demanding. Understatement of the year, right?? And if part of your responsibility is paying the bills and managing the money, this job can also be risky, especially if the one you care for is not your spouse. You can find yourself in the unpleasant position of having to defend expenditures or even being accused of embezzling from a loved one. This situation can lead to family turmoil and broken relationships, and in some cases, legal action may be taken.

Betsy found herself in an awkward situation at the end of her mother’s life. Over the last year with her mother, Betsy went with her mom to the bank and signed some paperwork to put Betsy on the list for access to the safe deposit box. She also thought she signed a card giving her signatory access to her mom’s checking account. Over the last couple of years, Betsy’s brother had moved most of Sarah’s bills to be automatically debited from that account, but there were a few things like the church tithe for which Sarah still wrote checks by hand. These contributions were a personal commitment for Sarah, but in the last year of her life her memory began to fail, and she stopped writing the checks. When Betsy discovered this, she knew that her mother would want to be caught up, but by now Sarah could no longer sign her name, so Betsy wrote a few checks and signed them.

The day after their mother died, Betsy’s brother went to the bank to ask what he needed to do about the checking account and how he could pay for the funeral expenses out of it. The bank mentioned that Betsy had written checks which the bank honored, but that she was not approved to write them. The account manager told Billy that she should not write any other checks. Betsy and Billy were equally surprised by this information, but her brother knew that Betsy had not been mishandling the money, so all was well. Had the two not been in close communication, this situation could have turned out very differently.

When a Family Caregiver is managing the money for a loved one, and others are involved in oversight of the care, one person should accept responsibility for managing the money, and accountabilities should be established to prevent the possibility of mismanagement. Such accountabilities might include the following:

  • Most utilities can be set up to pull automatically with an ACH draft. Other expenses may also be set up this way, but only with trusted businesses.
  • To minimize the possibility of fraud, keep a little money in the care recipient’s checking account. More substantial sums could be invested or held in a passbook savings account, and most banks also can automatically transfer funds into checking from savings once the account falls below a certain amount. This practice lets your loved one still enjoy a sense of financial independence while protecting them from the theft of more considerable sums.
  • If your loved one is reluctant to set monthly bills up in an auto-pay system, you could forward the bills to a professional accountant who could, for a modest monthly fee, pay the bills and balance the checkbook for you and your loved one. Remember, delegate whenever possible!
  • When you shop for groceries or other items, keep all the receipts organized in a kitchen envelope. Create a monthly filing system and when May is over, drop this month’s envelope into the “May” slot. That way other family members can look over purchases and even get a feel for what it costs monthly for their loved one to live through this stage of life.

Finally, establish a relationship with a CPA. Their knowledge is most helpful in understanding your loved ones spending, savings, and earning patterns. With the establishment of a baseline, and then regular oversight, you will quickly recognize changes that might indicate something is irregular with your loved one’s financial health. Think of your CPA as a doctor; with regular check-ups, you have a much better chance of diagnosing a problem early and preventing a long-term financial crisis.

Careless money management can lead to significant difficulties for the care recipient as well as the Family Caregiver. Some attention placed early on this vital responsibility can protect you both as you take this caring journey together.

The First Family Caregiver

There are lots of Family Caregivers mentioned in the Bible. Adam and Eve raised Cain and Abel, and then probably other children as well. Ruth refused to leave her mother-in-law’s side even after they had both lost everything and Naomi tried to send her away. Instead, she stayed and provided for Naomi into her old age and disability. Joseph cared for his whole family when famine decimated the entire area. Jesus asked John to care for his mother while he hung on the cross. There are many more examples I could give, but here’s my point:

Family Caregivers are as old as time, and even OLDER!! Consider this.

If you have come to God the Father through Jesus Christ, then you are a child of God. As a child of God, you are a member of God’s family. And in the 46th chapter of Isaiah in the Old Testament, God commits to caring for us across our entire lifespan. In this passage, God says he made us. He has cared for us since birth, and He will always care for us until our hair is white with age. So actually, God Himself is the first Family Caregiver, and He is constantly caring for you and me!

3bI have cared for you since you were born. Yes, I carried you before you were born. 4I will be your God throughout your lifetime—until your hair is white with age. I made you, and I will care for you. I will carry you along and save you. (Isaiah 46: 3-4) NLT

When we talk about having the Heart of the Caregiver, we are talking about having God’s Heart. God’s Heart has a higher capacity to care than you or I can even imagine. His care never ends. God never gets stressed out or fatigued. He never needs to take a vacation or a sick day. God doesn’t even need to sleep! And no challenge is too hard for God. He can handle caring for you, and for me, and for the whole world all at the same time. God always cares for us, even when we can’t take care of ourselves.

When being a Family Caregiver starts getting to you, when you are feeling overwhelmed or exhausted, discouraged or at the end of your rope, cling to your personal Caregiver, the First Family Caregiver, the Lord God Almighty. He will send His Holy Spirit to give you comfort, to lift you up and carry you, and to provide strength and a renewed sense of hope for even your darkest hours. He cares about what you are going through because He has the Heart of the Caregiver. He is the original Caregiver. Your Caregiver and mine is the all-powerful, ever-present, omniscient King of the Universe! Wow, I think that’s AMAZING!

How has God made his presence known to you and demonstrated how much He cares for you, even when you have nothing left to give? How has He restored your hope? I hope you will join our conversation this week at Heart of the Caregiver and share your heart.

She Doesn’t Remember Me

Today’s blog is penned by guest contributor Bobbi Carducci. Bobbi is the author of Confessions of an Imperfect Caregiver, as well as a caregiver advocate, caregiver support group leader, and blogger.

She Doesn’t Remember Me

Four of the saddest words ever spoken.

I hope my children never have a reason to say them. But it could happen. If it does I hope they know that even in my confused mind they are still in there with me.

By the time I reach that point I will have lost much already.

My short-term memory.

My rich vocabulary.

My love of long, hot showers.

My ability to cook.

My driver’s license or even how to find my way home if I did still have that privilege.

I pray I’ll still have the ability to read and understand the words my favorite authors have so painstakingly crafted.  A world without books would be barren indeed for someone who loves to read as much as I do.

Alzheimer’s or some other form of dementia will have taken me somewhere back in time. Perhaps I am reliving my days as a busy young mother and you, my darling daughter or son, are still in elementary school.  You have not yet grown into the wonderful adult you will become.  I see you pink-cheeked and out of breath after running up the steps, opening the screen door, and calling out, “Mom, I’m home. Guess what I got on my spelling test today!”

It may not seem like it in the moment but the memory of you is deeply implanted in my heart. The heart that beat so close to yours during the time I carried you. The heart that cried with you when you were hurt and rejoiced with you when you achieved a goal.

If the day comes when I look at you and ask, “Who are you?” I hope you will smile and tell me your name and share memories of your mother.

I love you. I pray you never forget that.

Many thanks to Bobbi for sharing her heart with us. Please let us know if you enjoyed the blog.

Sabotaging Care

Do you feel like a failure as a Caregiver? If you do, you are not alone! Caregiving is sometimes resisted, often unappreciated, and frequently even unrecognized!

Chris’s sister lived with their mother for several years before their mother’s death. She claimed the role of Family Caregiver to their mother, and when we were at family gatherings, she would talk about how hard she worked to provide care for her mother. Chris’s mother was a vibrant, active senior who still drove, did home-bound visits, staffed a local crisis hotline, and taught Bible study. While we all knew she moved a little more slowly, she did not appear to need anybody’s care, so his sister’s Caregiver claims mostly fell on deaf ears. The family didn’t see her as a caregiver until much later.

There are many ways that Family Caregivers can be sabotaged. Feelings of personal failure, the absence of recognition or appreciation for the challenging work you do, and even your loved one’s resistance to receiving the care you offer can undermine your best intentions to be a great Family Caregiver. If you have experienced any of these things, you might find yourself discouraged and wondering if your sacrifice is worth it.

Family Caregivers make great personal sacrifices when they embrace their role. You might give up such things as time with other family members or friends, professional advancement, monetary gain, vacations, social events, and spiritual growth. Your health may suffer if you aren’t intentional to exercise, eat right, and get enough rest. Social impacts include damage to marriage or friendships and loss of social engagement. Emotionally, feelings of isolation and failure can cause clinical depression. Spiritually, lost opportunities for corporate worship can leave you feeling as if God and your church family have all forgotten about you.

If you allow these negative feelings to persist, your attitudes and behaviors could negatively impact the care you give. Your words might grow sharp and impatient, or your hands might not be so gentle when offering assistance. Before this happens, reach out for help! Take a break and evaluate how well you are taking care of yourself. If others don’t recognize the need for the care you provide, ask for their help and let them experience first-hand what you do during your days. Reach out to your church family and ask for help or prayers for support. As hard as it may be, allow yourself to be vulnerable and admit that you cannot do this alone. Even Jesus asked for help when he needed it, and God will never call you to a task that he will not equip you to complete. Part of that equipping is the provision of resources like tools, techniques, and support from friends or family members. Don’t forget to use those resources when you need them!

The critical thing to remember is to keep yourself fresh, so you can be up for whatever your caregiving day may bring. Chris and I hope you will join the conversation and share your heart about what you do to overcome negative emotions and experiences and keep yourself healthier and happier in providing care!

Spring Cleaning Ourselves (Taking care in your appearance can enhance how you feel)

Spring is here, and with it so is the urge to freshen up everything around us. When the flowers outside start blooming, and everything greens up, I feel better! It’s like God is painting the world in bright, fresh new colors and bringing everything back to life! I love this time of year. At home, I open windows, cut flowers from the yard to put around the house, and physically bring outdoors inside as much as possible.

As a Family Caregiver, you can give yourself and those you care for this same fresh newness periodically, and it will make you both feel better! When we do something that makes us look better, we feel better, too. That’s one of those amazing things about being alive. It’s like going to the hairdresser for an updated style or color; we’re the same person when we come out as we were when we went in, but we feel better afterward, even if we only got a trim and blow-out.

It’s vital for you as the Family Caregiver to treat yourself with renewal from time to time, but it’s equally essential for you to pamper those you care for as well. My mother always loved going to get a pedicure in her later years. She couldn’t understand the small Asian man who trimmed her toenails, but he smiled at her the whole time, and she had a wonderful time. Sometimes I walked her in and waited, but if I left her and walked down the sidewalk to my brother’s office, the small man always walked my mother down to me. She felt like a new woman between the outing, the pedicure, and the attention she received. It always brightened my day to see her smile after she got pampered.

Something as simple as putting on a favorite “dress-up” outfit, adding a little lipstick, and fixing a lady’s hair, or taking a gentleman to get a barber-shop shave and trim, could give your loved one a fresh new perspective on life. Adding a cut flower arrangement to the kitchen table, scheduling lunch or coffee with friends, or taking time to go by a favorite place when you are out running errands, can give the whole week a different tone. Don’t forget the camera for pictures if appropriate so that you can enjoy the memories later.

You probably know the person you care for better than anyone, but if you don’t have intimate knowledge of their likes and dislikes, don’t be afraid to ask others who might know them better. Discovering activities they enjoyed in the past can lead to new adventures as you find innovative ways to give them exhilarating experiences that lead to good feelings for you both!

Resurrection: New Life for Caregiving

Each year when Christians observe Easter, we have much cause for celebration! The remembrance of Jesus’ crucifixion and resurrection symbolizes many things: God’s unfathomable love for us, His unchanging nature, His provision of a sacrifice (Himself) as payment for our sins, and His power over death to rise again in the flesh, among others. Hallelujah, He has Risen!

When we come to believe in the resurrection of Jesus Christ, a change occurs in how we relate to this world. We are invited to have fellowship with the God of Abraham, Isaac, Jacob, David, Matthew, Mark, Luke, John, Paul, and so many others who have put their faith in the Author and Creator of the Universe, and our sins forgiven. In discovering this fellowship and embracing it, our horizons expand, and our life takes on new purpose and meaning. True believers redirect their focus from self to God, serving others in Christ-like love. They walk different paths, choose other activities, and reflect God’s love and forgiveness in all areas of their lives.

If this sounds like a Sunday School lesson, don’t worry. I have a point that relates to you as a Family Caregiver.

As a Christian, when you are caring for an aging loved one you become the hands and feet of Christ. Through your words and actions, you can share His love every day with those for whom you care. Some days will be hard, and sometimes you will want to give up, but we can all find renewed energy, strength, and hope as we return again and again to our source of faith, Jesus Christ.

When your day is stressful, pray more. If your loved one’s behaviors are aggressive, or their condition is deteriorating, spend more time in scripture study. You are probably thinking, ‘How can I possibly take MORE time when I already don’t have enough time to get everything done?’ But an amazing thing happens when you spend more time with your Heavenly Father. The time you spend on your knees or in God’s Word acts like a tesseract in reverse.

It seems to S-T-R-E-T-C-H time. If you don’t believe me, just try it and see what happens.

Also, remember that you are not alone in your situation. Ask other believers to pray for your specific circumstances and be open to their wisdom, insights or advice. God hears your desperate cries for help. He knows your struggles and will provide for your every need in His perfect time.

Keep a journal so you can see His hand at work in your life over time. He will never fail those who love Him and follow according to His purpose. He will resurrect in you a spirit of hope, strength, and endurance as you walk the path He has called you to travel.

God calls Family Caregivers to a God-sized challenge that they cannot fulfill without God’s guidance and assistance. Today, celebrate life in Him and draw power from Him for tomorrow and all the days ahead along your caring journey. He lives, and because of that, we can live every day more fully when we live it for Him, and in service to others. Hallelujah, Jesus the Christ is Risen Indeed!