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Questions Applicants Should Ask
About Mental Health Care Before Signing a CCRC Contract

By Lillian L. Hyatt, M.S.W. and a Resident of a CCRC

Excerpted from the Summer 2008 The CANHR Advocate newsletter

All of us know, intellectually, that we are mortal. At the same time, we put up myriad roadblocks to avoid confronting or dwelling on that macabre fact. It is well known that a full half of the people over 85 years of age may suffer Alzheimer’s or another form of dementia or memory loss before their deaths. But even those in the "lucky fifty percent" will still fall victim to diseases ranging from cancer or diabetes to heart attacks. Therefore, like it or not, seniors must face the fact of their mortality when they sign a contract with a Continuing Care Retirement Community.

Since we sign over and obligate ourselves to a substantial portion of life savings in entrance and monthly service fees, which include health care costs, the care that will be given when our minds or bodies fail should be of great – if not prime – importance. Hence it is also of great importance to consult with a social worker specializing in care for the elderly. Direct questions must be asked, written manuals must be perused and facilities must be carefully surveyed by a knowledgeable professional concerning the CCRCs arrangements, trained care givers and managers. Planning for a resident’s last years requires careful attention.

Marketing Directors spend a great deal of time speaking of arrangements for meals, entertainments, and even the view from an apartment window, but adroitly dodge visits to and questions about health care facilities, their staffing and management. But the applicants – and the social workers responsible to them – must press for answers – if not from the Marketing Director, then from the Executive Director or another responsible administrator. This is a right given all applicants to CCRCs by law (SB 244. 2007). An important part of an applicant’s life, i.e., his/hers mental or physical demise which may take years, is at stake.

An opening question might concern the size of the Skilled Nursing Facility (SNF) vis–à–vis the total resident population. Are there sufficient beds available or are patients shunted off to Assisted Living or even to other facilities? Some contracts offered to applicants contain such clauses. Residents who are over age for a particular facility may even encounter clauses that have care exclusions and surcharges. What are a resident’s rights as he/she begins to show signs of mental or physical deterioration? What can the ill resident expect in the way of treatment?

Does the administration treat the ill resident and his/her personal doctor and relatives with respect, or are papers merely filled out and sent to Contracts Branch of the Department of Social Services to see if the paper work has been done properly before being committed to a course of treatment determined solely by the administration? This can alter a person’s entire future while no one outside of the CCRC ever sees the resident–patient. Nor are complete state inspection reports available for an applicant’s inspection.

Since it can be predicted that a number of residents may eventually develop some form of mental incapacity, is the SNF properly designed, equipped and staffed by personnel to care for these residents? Are residents with diminished mental capacity put in the care of registry (outsourced–care Certified Nurses Aides with only four months of training) personnel or are residents cared for by staff who are trained and employed by the CCRC? The financial difference to a resident can be substantial over and above the basic monthly care fee charged by the CCRC.

Is there a locked or monitored facility on the premises? Or, if not, are the physically or mentally disabled housed separately? Or are they housed together?

There is a woeful lack of consistency and wide variation in the care given to CCRC residents. It is most important that an applicant seeking admission to a CCRC get detailed information concerning: (1) the physical arrangements provided for residents who may be afflicted in their final years by some form of dementia; (2) the education and training of staff charged with the care of the residents; (3) whether the resident or the CCRC will pay for this care; (4) or will the residents have to bear the considerable cost of round–the–clock care in their own apartments? If the care offered in the SNF is deficient or refused, the cost may be as high as $11,000 to $18,000 per month.

Many CCRCs without properly trained or sufficient staff for the accommodation of dementia residents routinely transfer them to other facilities specializing in such care, forcing the other residents to pay higher monthly care fees since they bear the additional cost. In addition, an already confused person is removed from familiar surroundings, loved ones and friends. One of the strongest arguments for having a separate unit in a person’s own CCRC is the specialized needs of residents suffering from diminished capacity or dementia. There is a difference in the type of care needed by those recovering after a hospital stay and those needing supervision and care related to dementia. Those only convalescing require task–oriented care – bathing, dressing, and perhaps help with eating and toileting. Residents with dementias or Alzheimer’s require continuity with familiar trained staff they have to come to trust.

The solution is to choose a CCRC that has made provisions for an increasingly older population, many of whom may suffer some form of dementia. A trained and experienced (and impartial) social worker is absolutely necessary to examine the situation and make informed decisions with the applicant.