When It Comes to Senior Care — Start Early, Stay Local

Derrick Yee, Senior Relationship Manager, First Republic Bank
May 14, 2018

Dr. Jacquelyn Kung has dedicated her life to improving senior care. From her time as a specialist in geriatric care for Brown University’s Alpert Medical School to serving as a senior strategist for a $1.5 billion senior care living company to her current role as CEO of Activated Insights — which offers “employee engagement solutions across aging services” for the sake of improving “quality of care, profitability and organizational excellence” — she has been a lifelong champion for quality senior services.

Along the way she’s gained deep insight into how to navigate the industry’s complicated landscape. For this second piece in our two-part series on the business of aging, Jacquelyn shares her top four tips for finding the best senior care. 

Make a plan as soon as possible

A recent survey by revealed that 52 percent of people would rather have the birds-and-the-bees talk with their children than discuss senior care with their aging parents.

But, according to Jacquelyn, considering your senior care wants and needs today can pay dividends down the road. Since the best senior care communities have wait lists — some of which are several years long — determining your preferences in advance increases your options.

Plus, there is the benefit of peace of mind for everyone involved, which is a huge boon for busy families. “When you plan ahead, you have control of your life. You have time to sort out your feelings as well as your physical stuff. You are in control of what to bring if and when you move — if you’re moving.” Jacquelyn continues, “It certainly beats being forced into it by others, such as your adult children.” As a result, “you are much happier.”

Know your options

“In senior housing, the options vary widely in what they offer,” Jacquelyn says. Understanding what’s available ensures you make the right choice.

The offerings include:

  • Active adult age 55+ community. You usually buy your home or condo in one of these communities, and you may need to pay a monthly HOA. No care services are offered but sometimes there are restaurants on-site.
  • Independent living community. This is similar to an apartment complex and you typically rent your unit. These communities often provide meals, housekeeping and other convenience services. Assistance with activities of daily living (ADLs) is not part of the monthly rent, but you may be able to add on services for a fee.
  • Assisted living community. Within this community, you usually pay a monthly fee for food, transportation, cleaning, laundry, medication reminders and ADLs. Memory care is a type of assisted living with caregivers who are trained in Alzheimer’s and dementia care.
  • Skilled nursing facility. These facilities provide 24/7 nursing care and usually on-site therapy. This is usually for a few days after a hospital stay or for people on Medicaid who have no other long-term living options.

For at-home care, the options also vary. Investigate the options that are most appropriate for your situation.

Hire a geriatric care manager

Given the befuddling array of services and options, if you do find yourself or your family in need of elder care on short notice, a geriatric care manager can be a lifesaver. These trained professionals — often social workers or nurses — help you determine the manner of care you or your relative may need now and can also make a plan for the future.

Often people choose to rely on their doctor for this type advice or to help with a plan. Jacquelyn advises against that. “Your doctor is usually overwhelmed,” she explains. “After a few minutes with you, he or she is usually starting to think about the next patient. Plus, doctors are not trained on helping families make life plans.”

A geriatric care manager, on the other hand, is able to devote as much time as it takes to find your best solution and provide unbiased guidance, offering services that range from assessments and monitoring to problem-solving and even caregiver coaching. Like lawyers, they are highly trained in elder care needs and, like lawyers, they often bill for their time in 15-minute increments.

Some health insurers offer care managers for their customers. If not, or if it’s limited, care management is a service you may have to pay for out of pocket. The stress relief, however, may justify the expense.

Investigate local options

Those seeking in-home services or senior housing should be aware that the types of care and services available and the cost of care will vary greatly depending on location. Very few national brands exist that control quality and offer consistency in experiences from location to location.

“Unfortunately, it’s not as easy as a Google or Yelp search,” Jacquelyn says. “Plus, if you find a free advice service that is not a nonprofit, government or employer-provided resource, know that there is usually a placement or referral fee and all the skewed incentives that come with it.”

Under these circumstances, gathering personal feedback about specific places and services from friends and family can be invaluable. If you’re organizing care for someone far away, consider hiring a case manager to facilitate the process.

Do your homework

Once you have collected recommendations for housing or in-home care agencies, dig into the data. Jacquelyn advises looking at large, data-driven sources for reports on facilities and companies, paying close attention to factors such as low medical complications or mortality rates. That said, she notes that, like the care itself, publicly available sources also vary in their quality. For instance, Medicare’s Nursing Home Compare is a popular resource, reporting on inspections and penalties. But industry insiders know how flawed the metrics are and how much state surveys vary (e.g., a one- or two-star facility in one state may be deemed a three- or four-star in another neighboring state).

As with all consumer products and services, Jacquelyn recommends doing your own in-depth research in senior care. When available, one unbiased metric you can review is an employee engagement score: happy employees will usually offer better care. After that, she advises sticking to nonprofits and government agencies when possible to get unbiased guidance online and supplementing that with expert help if you can afford it. Ultimately, senior care will get expensive: Care for a parent can often cost as much as or more than sending a child to college.

The best plan for senior care, however, may be simply to have one. Get guidance sooner rather than later. You and your loved one will feel more empowered — and less stressed — as you enter this next phase of life. 

Want to continue the conversation? Read our interview with Jacquelyn on how technology is transforming senior health care.

The information in this article is presented as is.