The Caring Generation® – Episode 14 October 30, 2019 On this caregiving radio program, Pamela D. Wilson, caregiving expert, answers the question “What Is Assisted Living?” Guest Corky Kyle of the Kyle Group talks about legislation requiring disclosure of financial relationships between assisted living communities and referral agencies.

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What Is Assisted Living and How Does It Work? Radio Show Transcript


00:05 Announcer: Caregiving can sometimes feel like an impossible struggle. Caregivers may be torn between taking care of loved ones and trying to maintain balance in life. The good news is that it doesn’t have to be that way. The Caring Generation with host Pamela D. Wilson is here to focus on the conversation of caring. You’re not alone. In fact, you’re in exactly the right place to share stories and learn tips and resources to help you and your loved ones. So now, please welcome the host of The Caring Generation, Pamela D. Wilson.

00:49 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert, and your host. You’re listening to The Caring Generation radio program, coming to you live from the BBM Global Network Channel 100 and Tune In radio. The Caring Generation focuses on the conversation of caring, giving us permission to talk and laugh — we must be able to laugh — about aging, the challenges of care-giving, health well-being, work-life-family balance and everything in between. All the important things that we should know about life. You’re not alone. Please invite your family, friends, co-workers, and others to join us each week on The Caring Generation where we talk about how to be proactive to avoid surprises about health, well-being, caring for ourselves and our loved ones. Helpful information for caregivers and aging adults are on my website at My caregiving library, blog, and online courses Stay-at-Home and Power of Attorney. Today, I’ll be answering the question, “what is assisted living?” We will talk about the different types of living communities for older adults. The types of care provided so that you can be more informed about assisted living, independent living, memory care, and skilled nursing that is sometimes also called a nursing home, a rehabilitation community, or a SNF.

02:19 Pamela D. Wilson: The more that you know about these types of communities, the better informed that you’ll be so that if moving a loved one to a care community ever becomes a need or if an aging parent or spouse has a short-term skilled nursing stay, you will know what’s going on. In the second segment of this hour, we’ll visit with special guest Corky Kyle of the Kyle Group. Corky is a professional lobbyist with over 38 years representing businesses, and he works in all areas of government relations and advocacy. He joins us to talk about legislation to protect consumers choosing to work with a referral or a placement agency. For example, if you don’t know what that is — a referral or a placement agency is — and you may have seen the commercials for A Place for Mom. They are companies who help family members find an assisted living community for aging parents or spouses. Many referral and placement agencies tell consumers that their services are free. What they omit saying is telling consumers how they are paid, and by whom. Knowing how and how much referral and placement agencies are paid is important. You want to make sure that you’re choosing the best assisted living community for a loved one, not the assisted living community that writes the biggest check to the referral or placement agency.

03:42 Pamela D. Wilson: These payments range from one to two times the monthly rent, which can be a payment anywhere from $3,000-$10,000. We’ll talk more about how referral and placement agencies work throughout this program. Let’s begin with a few basic definitions as the term assisted living is kind of like a catch-all description for all types of care communities. Independent living is the type of care community for older adults who are independent, but who want to live in a community with other people of a similar age may be for socialization or for activities. In some cases, not all independent living communities offer services. These services could be as simple as housekeeping, access to meals, occasional transportation, and in some situations, independent living communities have employed staff, or they hire a care agency who can help with managing medications and provide other similar types of services. The goal with independent living or really any community living setting is to help older adults live in place or age in place. This is industry terminology that you might hear and wonder what it means. The idea of living or aging in place relates to an aging parent living in their home and staying in the home as long as possible. That staying at home happens by having family provide help or by hiring outside services and help to come to the home.

05:16 Pamela D. Wilson: The same idea of living or aging in place applies to care communities, independent living, assisted living, memory care, and nursing homes where family members can also help and hire outside services so that a parent can stay at the same level of assistance. The main idea really is to avoid multiple moves. Although moving can still be necessary if there are health issues. Every type of care community has rules and regulations about the type of outside assistance they allow, and they have specifications for the activities that residents must be able to perform independently or with help. Many of these involve safety concerns. A safety concern might be a person who lives in an independent living apartment, and maybe they repeatedly burn food on the stove, which causes a fire hazard for the whole building. More than likely, this resident will be asked to leave the community due to the safety concern of a fire. Other concerns would be a person who needs more help, who might be living independently.

06:25 Pamela D. Wilson: Frequent falls are a concern for the staff. Especially if the person is unable to stand after a fall. The concern would be that the person might lay on the floor for hours or really days before being noticed by anybody. For people with memory loss, wandering outside of a building is a safety risk. All of these details are in the agreement that the communities provide to future residents and families, this paperwork, and it can be daunting —  anywhere from 10 to 40 pages. You want to make sure that you read every single page before you sign or agree to move into the community. Make sure that you know why a community would ask an elderly parent, or a spouse to leave. If that happens, how much notice would you be given? And all of the other information about services provided or not provided. Rent increases, the ability to hire outside help,  and so on. All of these details are in the agreements, and this information is very important.

07:30 Pamela D. Wilson: The last thing that you want to have happen — and I’ve seen this — is to say, “nobody told me.” Then you’re surprised to learn about a rule or a regulation that a community has. I’ve had families call me and say, “Oh my gosh, a community gave us 48 hours to move our parents. We didn’t know that “this” meaning this thing would cause them to be evicted.” Those agreements, all of those pages, extremely important for you to read every single word  — and even more important, unless you are the financial power of attorney don’t sign the agreement. Have your elderly parent or spouse sign the agreement, because you don’t want to become the financially responsible party by innocently signing your name on the agreement. We’ll talk more about assisted living agreements in the second half of the show. Coming up after the break. We are going to talk extensively about referral agencies and assisted living communities and how all of that works. Corky Kyle, from The Kyle Group, a professional lobbyist is going to join us to talk about legislation protecting consumers searching for assisted living communities, so important to know

08:43 Pamela D. Wilson: And it is not in all states. Helpful information for caregivers and aging adults is on my website at as well as podcast replays of all of The Caring Generation radio shows. You’re listening to The Caring Generation live on the BBM Global Network channel 100 and Tune-In radio. Stay with me. We’ll be right back.


11:26 Pamela D. Wilson: This is Pamela D Wilson caregiving expert. I’m your host. You’re listening to The Caring Generation coming to you live from the BBM Global Network Channel 100 and Tune In radio. We’re back to hear the real truth about referral agencies who say there’s no cost to you and what that means. What is the relationship between referral agencies and assisted living communities? Corky Kyle welcome, I’m so happy to have you with us.

11:52 Corky Kyle: Thank you, Pamela, it’s fun to be here.

11:56 Pamela D. Wilson: So this company that I see on television all the time is A Place for Mom and their commercial say, and this is a quote they are “the nation’s largest senior living referral service. It’s a free service, and there’s never any cost to you.” Meaning no cost to the consumer. How can A Place for Mom operate if they are not paid?

12:17 Corky Kyle: Well, they are the largest in the country, and they are paid. But they’re paid by the assisted living home, or nursing home or any of the other placements. Based upon their referral, A Place for Mom goes out and finds seniors that are looking to go ahead and move into assisted living or switch from where they are to another assisted living home. And that’s how they’re paid. They’re paid by the facility.

13:00 Pamela D. Wilson: And this usually I know isn’t disclosed to the consumer, which is why we’re having this conversation. There’s some different terms out there. So, there’s placement agencies and referral agencies. Are they the same, or is there any kind of difference between the two?

13:14 Corky Kyle: There’s really no difference between the two, Pamela. They provide the same service. What you have to look for, though, when you’re looking at a placement agency or referral service is how much service do they provide you in getting you to an assisted living home that you’re going to enjoy, and that’s going to meet your needs. And so everyone’s different. Everyone has a different operating philosophy, business plan. And it’s really important for the kids or the seniors, who are looking to go ahead and move to understand that and to do their research on each one of them and ask the questions that need to be asked like, “Are you familiar with the assisted living home that you are suggesting that I consider?” Do they know what the requirements are for getting to the assisted living home, costs and the list goes on and on. It really is a question of service, and you have to really get down in the weeds with them to find out what they’re going to do to help you to make a very important decision finding a place where you’re going to live.

14:41 Pamela D. Wilson: Well, and I think the downside for the consumers is they hire these referral or placement agencies because they don’t know what to do. And so they really don’t know what to ask. Which is why all of these problems have happened. Which has led to legislation in Colorado, Washington, Oregon, and Arizona. Why did that legislation happen, and how does it work? How does it protect consumers?

15:06 Corky Kyle: Well, Colorado last year sponsored legislation. As a matter of fact, it was the Colorado Assisted Living Association, which I’m the Chief Executive Officer of. We had so many complaints from our members where they were having problems with the referral agencies because nobody really understood what was being asked. Whether or not the facility could meet the requirements of the resident, what the costs were. All of those things. It got to be quite a problem in the state. As a result, the Assisted Living Association went ahead and introduced legislation, House Bill 1268. And anybody can go online to the Colorado Legislature and get a copy of that piece of legislation. It’s only two pages long, and it spells out what must be disclosed between all of the parties, meaning the assisted living home, the resident, and referral or placement agency. And everything had to be disclosed in writing to all the parties, and the parties have to go ahead and sign off on it. And the assisted living home had to keep a copy of that agreement for a year in the file of the resident.

16:44 Corky Kyle: The whole purpose was, was to get all three parties talking to one another so that there was a discussion on whether or not this was going to be the right place to go. Can I afford it? What is expected from the referral agency? From the assisted living home, and what was expected by the assisted living home, from the referral agency and the resident? And so, this is a big first step for the industry because there is minimal rules and regs, not rules and regs. Legislation that helps people go ahead and get through this maze of information that’s out there about what this means when you decide to move into an assisted living home.

17:35 Pamela D. Wilson: Well, and you just made me think of a question. So, I’ve had consumers sometimes because I used to be a care manager, and families would come to me saying, “Oh my gosh, we moved our parent in with this referral agency. Now, we have to move.” How many situations, or did the discussion ever come up that somebody went to a referral website, didn’t even realize that they signed up with them, but then yet mom or dad moves into a community, and that community has to pay a check to the referral company.

18:04 Corky Kyle: Well, it happened all the time. And then there was another practice called “churning” where they might put somebody in there for a month or two and then suggest that they move to another residence. This just created problems. Just huge problems for the industry. And again, this piece of legislation that we passed prevents that from happening without full disclosure and having it in writing.

18:36 Pamela D. Wilson: So then let’s say that a consumer hires A Place for Mom. Somebody from A Place for Mom has to actually hand them a piece of paper that explains everything and meet with them. Yes?

18:49 Corky Kyle: That is correct. That’s what any, with any of them, here in the state.

18:55 Pamela D. Wilson: Okay, and we’re going to head out to a break. We’re going to come back and finish up these questions. We will continue our conversation with Corky Kyle of the Kyle Group after this break. I’m Pamela D. Wilson, your host. You are listening live on the BBM Global Network Channel 100 and Tune In radio. Podcasts of the show are available on my website Stay with me. We’ll be right back.


21:40 Pamela D. Wilson: This is Pamela D. Wilson caregiving expert. I’m your host. Let’s continue our conversation with Corky Kyle of the Kyle Group about being transparent about costs and payments made to assisted living and referral services. Corky, I’m going continue my questions because, as you say, I am fired up about this. [laughter] So assuming that agencies disclose how they’re paid, is there any follow-up? So let’s say that you find a place for mom and dad. Mom and dad move in. Does the placement agency have to do anything after that to say, “We were paid $3000, or we were paid $10,000?” Do they have to do anything?

22:20 Corky Kyle: No, they don’t. They don’t have to do any follow-up with that at all. They’ve met the requirement of getting their resident, locating a home for the resident. And that’s what they’re all about is getting people in there. Now, not all placement and referral agencies do that, but they will do a follow-up. They will go ahead and talk with the resident on how things are going. Is it meeting their expectations? Are they satisfied? Are there any issues? A lot of the referral agencies and placement companies really try to build a relationship with the assisted living home so that they have a working partnership that allows them to go ahead and go a little bit more. Take that extra step to go ahead and see how things are progressing. But that’s not in all. And again, that’s one of those things that you need to do your due diligence on before, “I’m going with that particular placement service or referral agency.”

23:37 Pamela D. Wilson: Do most of these agencies have first-hand knowledge? And by first-hand knowledge, I mean, have they personally visited the communities that they recommend? Or are they just giving a family a list and say, “These are good places to go.”

23:53 Corky Kyle: Well, it’s all over the board, Pamela. [chuckle] It’s all over the board. Many do go out and visit the assisted living homes and get to know the marketing person, the executive director, or the administrator. Get a feel for that particular assisted living home. What are the specialties of that particular assisted living home? Maybe they do more activities. Maybe they do, they offer more programs. With those with mental health and brain injuries, obviously care is a big concern there. And so, they would get to go and visit those particular areas. See the level of care. See how the residents are treated and become familiar with the facility almost like a part of the staff. But they’re really a partner in the whole industry of assisted living and with the seniors.

25:10 Pamela D. Wilson: Earlier, you had mentioned the idea of churning, meaning a person gets put in one place, that doesn’t work out, they go to the next place. Is there any requirement for these referral agencies to really look into a client’s background, so maybe request medical history or ensure that this is hopefully the last move and that there won’t be any kind of future moves.

25:38 Corky Kyle: Well, right, right. And you never know. You can get into a nice place, and then all of a sudden, because of medical conditions they have to move because that particular facility can’t take care of them. And so that’s a legitimate reason to go ahead and look for another place. The degree of involvement, again, is all over the board with those referral agencies and placement services. There is an association of referral agencies and placement companies. It’s the Greater Denver Placement and Referral Alliance. The most amazing thing is they’re not even a year old. They’ve just been formed. And this group has a standard practice that members subscribe to when they join. And those pre-qualifying issues they do. Many of the placement services do  — do an evaluation, work with the resident, work with the family, do an evaluation of the prospective resident. And then, they take that information and go ahead and then check and review all of the assisted living homes that they are affiliated with to make sure they can make the best fit. And that’s hugely important to make sure that the person gets to the right home the first time.

27:25 Pamela D. Wilson: So it sounds like that organization is trying to provide some oversight. So in reality, there’s no licensure  or certification or any type of qualifications that anybody has to have to become a referral agency. Is that what I’m hearing?

27:42 Corky Kyle: You are hearing that correctly. They are not regulated. They are not licensed.

27:45 Pamela D. Wilson: So really, anybody who wanted to, yes, get in and make a lot of money could just show up tomorrow and be a referral agency.

27:52 Corky Kyle: That is true. I could do it tomorrow. I could start this afternoon. So there is no regulatory oversight on the industry at all. It is wide open.

28:08 Pamela D. Wilson: Do you think there ever will be?

28:11 Corky Kyle: Oh yes, I think eventually there will be. Absolutely. And in some states, they are already.

28:18 Pamela D. Wilson: So let’s say that a consumer used one of these agencies, and they are totally dissatisfied. Move mom in. She has to move again. How do consumers make complaints if there’s nobody, no agency or regulatory agency to complain to? Where do they go?

28:36 Corky Kyle: Well, the first step has happened with the passage of House Bill 1268. If there is a complaint, they can file it with the district attorney for that county, for that municipality, or they can file it with the Attorney General of the state. And there is a civil penalty of $500 for anyone that does violate what was prescribed in the legislation. Meaning the full disclosure, written disclosure. And so there is a beginning process to allow a mechanism to file complaints.

29:26 Pamela D. Wilson: Corky, I thank you so much for joining us. Again, this is one of those subjects I get fired up about. I thank you for your time today and informing all of the consumers here. Coming up after this break, we’re going return to our discussion of assisted living contracts, levels of care, and talk about the differences between care community types. I’m Pamela D. Wilson, your host. You’re listening to The Caring Generation live on the BBM Global Network channel 100 and Tune In radio. We’ll be right back after this break.


31:13 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host of The Caring Generation, the place where we share caregiving and health tips and things we should know about caring for ourselves and our loved ones. Help, hope, and support for caregivers are available on my website You’re listening to The Caring Generation radio program for caregivers and aging adults, coming to you live from the BBM Global Network Channel 100 and Tune In radio. We’re back to continue our discussion about assisted living agreements and the importance of reading every single page of that agreement, whether it’s ten pages or 100 pages. The same recommendation really goes for all contracts, whether it’s for independent, assisted, memory care, skilled nursing. The other very important part of these agreements is usually stuck somewhere in the middle. If you notice one or several pages called something like “patient arbitration agreement,” whatever you do. Do not sign this part of the agreement. What this means is that if harm comes to you or a loved one, you’re giving up the right to a jury trial. And harm could really be anything from an unexpected medical error. Let’s say a loved one gets hurt because of a mistake or believe it or not, harm from another resident. Believe it or not, there is resident to resident injuries that happen in these communities. My recommendation is to put a big X over these pages, and on the signature line, write the word “decline” “refuse.”

32:58 Pamela D. Wilson: These arbitration agreements, they protect the company that drafts the document and not the consumer. Having an arbitration agreement in a document may also mean that that company was involved in a lawsuit, and they want to avoid future legal issues. So also important to obtain a copy of the agreement and read it before you decide to move into a community. Because many of them won’t give you the agreement until after you’ve made that commitment and made the down payment then it’s too late. It will feel very difficult — not impossible though — to change your mind and stop that move. Always look at the small print. Look at the agreements before you agree to anything, and once you sign, make sure you have a copy of the agreement. We talked in our first segment about independent living communities being suited for aging parents who can generally take care of themselves. They can still drive; they want to cook. The next type of community that is a step up and offers more services is called assisted living. And here’s the important thing. Listen to the name. It’s assisted living.

34:08 Pamela D. Wilson: This means that you, or an aging parent, or a loved one, they need limited assistance. So not the care that is provided in the next step, which is skilled nursing that we’ll talk about. The most common services provided in assisted living are weekly housekeeping, three meals a day. From here there are what I call levels and add-ons for additional assistance that all has a cost. On the show next week, we’ll talk in detail about care costs. About paying for care and the Aid and Attendance benefit that is available through the Veterans Administration. A wonderful benefit. One service in assisted living that usually has an added cost is medication reminding. The greater the number of medications taken, or the frequency, meaning twice a day, three times a day, the higher that rate. There are large and small-assisted living communities. The large ones may have 50 to 200 residents. There are also care communities called personal care homes that are really like it sounds. A personal care home is an assisted living community, but it’s in a private home setting. The number of residents is usually small, typically three to 12.

35:23 Pamela D. Wilson: These personal care homes are homes that have either been remodeled to have individual or shared bedrooms, or some of the homes are built specifically for this purpose. The other part of the name, “personal” means that the staff is more likely to know your loved one and their daily activities very, very well. In large communities, that type of familiarity or one-to-one is more difficult because they have large numbers of residents, large numbers of staff that are needed to manage the care. Personal care homes are a really good option for people who have memory loss, or those who need a little more time and a little more assistance. In most cases, the care staff can really provide that one-on-one care versus a larger community. And the setting is —  it’s like a private home. It’s quiet. It doesn’t have all the hustle, the bustle of the larger communities. So when considering small or large, it’s important to consider the needs of your loved one and their preferences. Do they want a quiet place? Do they want a large place that has a lot of hustle and bustle and social activities?

36:36 Pamela D. Wilson: Other services that are provided by assisted living communities — either small or large —  that usually have a cost include bathing and hygiene. Now, these costs sometimes are just add-ons, or they go into levels. So, every level could be another $300. These hygiene tasks include showering, washing hair, helping brushing teeth, skincare lotion. In some cases, because of balance concerns many older adults will use a walker, and so it would be help with a walker. Incontinence care, dressing, the use of a wheelchair, feeding assistance, help with oxygen equipment meaning, filling out and changing those tanks, cleaning the machines. All of those are add-on services that can be provided. If you’re in an assisted living community, some residents need a mobility device, so that is a walker or a wheelchair. The larger communities allow what are called electric wheelchairs or power chairs. But they may charge a fee because there are always concerns of an older adult either driving into a wall and damaging the building, or accidentally running over or into another resident.

37:52 Pamela D. Wilson: Help with transfers is also an important area to talk about if you’re moving a loved one into a community. Because in some states, there are different regulations that limit the tasks or the care services that staff are able to provide. The ones they can’t do and the ones they can. Some individuals need a little bit of help with transfers, and if you don’t know what a transfer is it’s basically a hands-on assist to help a loved one get out of bed, stand from a chair, sit or stand from the toilet, use a walker. Residents who need more assistance can remain in some communities, but they may have to use what’s called a lift. There’s a couple of kinds. You may have heard of an Easy Pivot lift or a Hoyer lift. Again, it depends on the type of community whether they allow this or not.

38:42 Pamela D. Wilson: Another common need is a special diet, which could be low salt, low sugar. The smaller personal care homes can manage special diets better. Now, it really does depend on the diet. If it’s very restricted, that might be a little difficult, but the easier ones are low salt, limited fluids; if they have to grind foods or pureed foods for people to swallow,  the smaller communities can do that. A lot of the larger communities don’t have the flexibility for these special diets because they have large kitchens, and they plan the meals ahead of time, and it’s not possible really to make an individualized meal for one person. Nursing homes are the exception. And we’ll talk about nursing homes, which again are also called skilled nursing rehabilitation communities in the next segment of the show.

39:32 Pamela D. Wilson: Dressing is another add-on service that we talked about. And many residents, because of physical limitations or weakness really do need assistance with dressing. Putting on shoes, tying shoelaces. Some communities also have visiting providers. So, for example, this would be like a beautician, a barber, a professional that will come in to trim fingernails or toenails. They have visiting dentists and doctors. When you’re considering a community, it’s essential to look at what your parent needs and try to plan ahead. So think about how those needs might change in the next six months or a year or next five years. Because moving can be super stressful. The goal is to have your parent age in place and not to have to move multiple times. In our next segment, we’ll talk about how consumers find assisted living communities on their own.  Helpful information about staying at home is on my website. This is Pamela D. Wilson caregiving expert I’m your host. You’re listening to The Caring Generation live from the BBM Global Network channel 100 and TuneIn radio. Stay with me. We’ll be right back.


42:00 Pamela D. Wilson: This is Pamela D. Wilson caregiving expert. I’m your host. You’re listening to The Caring Generation coming to you live from the BBM Global Network Channel 100 and Tune In radio. We’re back to continue our conversation about how to find an assisted living community large or small. Depending on where you live, there may be so many communities to choose from, or on the other hand, if you live in a rural community, there may only be a few that have long waiting lists. This is the time when looking at a community, to consider whether a move to be closer to family would be best in the long run for an elderly parent. Many family members think that moving an elderly parent into an assisted living community means that everything is taken care of, that all of their needs will be met. This is not true. The family still must help out. They still must show up. And it really is better if family shows up often. It’s important to become well-acquainted with the management staff and the staff of the care community and to make sure that they know who you are and to really thank them for everything they do for your loved one.

43:13 Pamela D. Wilson: Elderly who have family visiting, receive much better care and attention than those who do not. The same applies to elderly living in nursing homes where visiting is even more important. We’ll talk about nursing homes in a moment. After this decision is made where to look for an assisted living, meaning the same area where the aging parent lives or closer to the adult children, that’s when the search begins. The obvious place is to go online or on the internet. And earlier, we talked about legislation in only four states: Arizona, Colorado, Oregon, and Washington that requires assisted living referral and placement agencies to be transparent. If you choose one, they should explain to you how they’re paid, and how much they receive from communities. If you’re in the other states that don’t have legislation, it’s up to you to ask. Remember that all assisted living communities do not contract with these placement agencies. This means that more than likely, there could be a really great community for your loved one that the agency isn’t going to tell you about or won’t show you because they are not paid that fee of $3,000 to $10,000.

44:31 Pamela D. Wilson: You should also know that if you visit one of these websites and you’re not in a state with legislation, you more than likely have given implied consent for them to contact you or to provide your information to other companies who might begin calling you, and this factor is upsetting for consumers. They tell me all the time — and it should be disclosed — because they don’t realize by visiting that website, what permission they gave. It’s all in the small print. It’s in the terms and conditions of the website. So just with an assisted living contract, you want to ask the referral agency for their agreement if they have one. Read the small print. Many websites have these disclaimers that say, “We exercise no independent judgment as to the quality of nor do we recommend or endorse any participating community.” Now, you have to wonder if they’re recommending a community to you, how could they not recommend or endorse it? A lot of these advisors that you speak to according to Corky, have never set foot in the community that they’re recommending to you. They’re not going to ask for medical records or medical history that would really tell you that your loved one is appropriate and that you’re making a long-term decision.

45:47 Pamela D. Wilson: The other really important question for you to ask is, who do they represent you, or is it that assisted living communities? If you look at the small print, there’s also statements on some of these websites that say, “We are not a representative of the consumer or of the community, and we don’t act on either’s behalf.” So, they’re basically saying that they don’t represent you as the client, and they don’t represent the community. You wonder how that could be accurate? These statements really mean that if something goes wrong, you are on your own. Especially if you make a bad choice which really leads to the question of why not invest the time to complete the search yourself and not involve one of these placement agencies? Or the alternative and many families don’t know this, is that you can pay someone, hire someone individually, like a care manager who will act on your behalf. Who will talk about health issues and medical needs at length. Who more than likely, has been to these communities. Who knows the owners and the management.

46:57 Pamela D. Wilson: Now again, these are questions that you have to ask upfront. Moving a loved one to a care community, it’s a life-changing decision. During the time that I was a care manager, I helped a lot of families who paid me privately, to find a community for a loved one because they knew that I did not take fees from these communities. That’s a big thing. It really is important to know who’s representing you. Is it the referral agency who’s going to get a $10,000 check, or is it a care manager who is going to charge you $500 to find the right place?

47:36 Pamela D. Wilson: Many of these care managers will visit the communities. They’ll share information about your loved one with the goal of making sure that this is the last move, of course, unless something unexpected happens. Now, a lot of communities will be honest with the care managers. They may turn down a client because they can’t provide the care. Now a family member might hear this and think, “Oh my gosh, our loved one was turned down. That’s horrible.” Being declined is a blessing because it means that that community is being honest in saying that they can’t provide the care. That they don’t want your loved one to move in and then have to move again in a short period of time. This type of honesty is important. I’ve had families come to me, who use these placement and referral agencies, and have had that happen. The loved one moved in, and two months later, the community asked the parent to leave. Discussions with the care managers and the community are so important, and family members should be honest.

48:36 Pamela D. Wilson: I’ve had a lot of family members who wanted to have a loved one accepted, and they stretched the truth about a loved one’s abilities. Not being transparent and honest, only harms your parent when they have to move again. So being honest, all the full disclosure, all of the honesty with everybody involved is the key to making the best move and to avoiding surprises of having to move again. You don’t want to take a few steps forward and then have to go all the way backward. Aging parents may also resist the idea of a move because nobody wants to leave home. We’re going talk about that after the break. And how to convince aging parents that moving might be a good idea. I’m Pamela D. Wilson please share The Caring Generation with your friends, family, co-workers, the companies where you work, your social groups and at church. One in four people that you know are caregivers. You’re listening to the Caring Generation live from the BBM Global Network channel 100 and TuneIn radio, we’ll be right back after this break.


51:05 Pamela D. Wilson: This is Pamela D. Wilson caregiving expert. I’m your host. You are listening to The Caring Generation radio program for caregivers, and aging adults coming to you live from the BBM Global network channel 100 and Tune In radio. Helpful information, my library, my blog, the podcast replays, my newsletter, and courses are on my website at What do you do when you move a loved one to a care community, and they are having a difficult time adjusting?

51:35 Pamela D. Wilson: The first thing that you should do is to talk to the management and care staff and ask for their suggestions because they experience these situations all the time. Their recommendation for you may be to not visit for a period of time to allow your elderly parent or spouse to adjust. Family caregivers hear this, and they feel, oh so guilty. And they don’t like this recommendation. And I laugh because I’ve seen it work. It gives the elderly parent or the spouse time to make acquaintances, to make friends in the community rather than only relying on the visits and the companionship of a family member. Other options are to make very short visits, excuse yourself, say that you have to run an errand, or do another task. Don’t stay for more than 30 minutes.

52:26 Pamela D. Wilson: Let’s also talk about nursing home care, which everybody talks about as the last resort. None of us wants to end our life by living in a nursing home. And unfortunately, as we talked about before on the podcast show called, When Work and Caregiving Collide and Work-Life Balance, women are the main residents in nursing homes. Family money is often spent on the care of a husband, leaving little or no money to care for the wife, who may have raised all the children, taken care of aging parents, and a husband. And this is one of my soapbox subjects that I could talk about forever. The reasons for nursing home placement are the need for daily medical care or a high degree of oversight. Nursing homes are staffed with nurses. Doctors visit frequently. Tasks like managing insulin, taking blood sugars, managing feeding tubes, those are easily done in nursing homes. And transfers are important. The ability to walk or transfer or not do this. So if somebody requires the help of two people — that really does change the level of care from assisted living to skilled nursing. People with memory loss or other brain injuries or mental illness, many times they reside in nursing homes.

53:43 Pamela D. Wilson: Nursing homes, as we talked, can provide the special diets. They have special rooms for the residents who need assistance with eating or drinking, and they can do a lot of extra care. Elderly parents or spouses who may have been able to live at home, who experienced an unexpected change in health or maybe a hip fracture, maybe they can’t return home. Maybe the nursing home is the only place for them to go. Others who become incontinent, and that incontinence turns into a full-time job for the caregivers, sometimes that results in a move to a nursing home. The other things are a regular day and night schedules that don’t allow the caregiver to sleep, and they are exhausted. These result in moves to nursing homes. And the nursing home again, is the option when medical care needs or personal care needs, the wear and the tear on the caregiver becomes too much. But families still have to visit. It’s not that putting a loved one in any care community or in any nursing home means that you don’t have to visit, you do. This family oversight is very necessary to ensure better than average care.

54:54 Pamela D. Wilson: I want thank our listeners who are professional caregivers working in care communities. I know this work can be so exhausting and so challenging. And for all caregivers, if nobody has told you that you are amazing or hasn’t thanked you this week for everything that you do as a caregiver or in helping others, I want be the one to say thank you. Please share this program with your family, your friends, your co-workers so that we can really make caregiving something that we talk about. It makes caregiving so much easier and results in a lot less stress. I’m Pamela D. Wilson, caregiving expert. I’m your host, thank you for joining me on The Caring Generation radio program for caregivers and aging adults. Visit my website for helpful information, the podcast replays, my blog. I look forward to being with you again next Wednesday evening. Join me next week here on The Caring Generation live from the BBM Global Network, channel 100, and TuneIn Radio. God bless you all, sleep well tonight, and have a fabulous day tomorrow.


55:58 Announcer: Tune in each week for The Caring Generation with host Pamela D. Wilson. Come join the conversation and see how Pamela can provide solutions and peace of mind for everyone here on Pamela D. Wilson’s The Caring Generation.

Looking for more help managing family relationships? You’ll find what you are looking for in The Caring Generation® library in the section called Care Communities and Housing.

About Pamela Wilson

PAMELA D. WILSON, MS, BS/BA, NCG, CSA helps caregivers and aging adults solve caregiving problems and manage caregiving needs through online programs, live support groups, and an extensive caregiving library that includes articles, podcasts, videos, and webinars.

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