If I had a dollar for every time I was asked this question as a geriatric care manager in NYC, I might be able to retire. Obviously, I understand why my clients ask me what's the best nursing home in NYC. For seniors in need of that level of care, their families want the best. I think the same thing every time: "They're asking the wrong question."

And that's OK. People wouldn't need geriatric care managers if they had all the answers on how to choose a nursing home, or if they knew all the right questions. 

The truth is, there is no perfect, or "best" nursing home out there. Of course some have sterling reputations, and others do not. If you ask 10 geriatric care managers to rattle off the top 5 they'd recommend - all other things being equal - you'd get the same 5 answers every time. What's the use in asking- we all have google, don't we?

So, back to my earlier thought: What are the right questions? I tend to break that down into two categories: 

1. Questions to ask the nursing home facility;
   
2. Questions to ask yourself. 

Let's start with the facility. Here are a few sample questions for which you'll want concrete & specific answers from the admissions director:

• How are care plans created? How often are care plans updated? 
• Who would be my dedicated contact person at the facility to whom I could bring my concerns?
• Under what circumstances would you be calling me with important updates about my loved one?
• What's your approach to ensuring the best mental health of my loved one? 
• What disciplines are represented on your team? How often will those individuals meet with my loved one?
• What is your approach to pain management?
• How are religious and spiritual needs met?

Now, on to perhaps the even more important set of questions: the ones you ask of yourself. First, take a tour of the facility. Speak with various staff if you have the opportunity. Nurses, physical therapists, anyone and everyone. Take a look around. Now ask:

• Did the residents look comfortable? Did they look well cared-for? Well-groomed?
• Did the staff look engaged, or were they just going through the motions? 
• Were staff and residents talking to each other, or talking at each other? 
• Were the residents interacting with one another, or were they all sitting alone? Interaction and social connection is important.
• Did the staff give you sufficient time and respect? If they don't do it for you, you can assume the same will be true of your loved one. You'll want to feel reassured by the answers you get. If you get vague answers, or if the answer isn't the one you were hoping for, that's a red flag. 

You probably have your own set of questions and areas of importance, which is great. Do not sell your own feelings short because you've heard good things about a facility. And don't count out a facility if you've heard a less than stellar review. In my experience every nursing home in NYC has at least a few people who will give a nursing home a bad review online. It comes with the territory, and should not dissuade you from deciding for yourself with a site visit and interview with the admission department. 

If you need additional help through this difficult process of choosing a nursing home, be it advocacy, information, or help with a family dispute around this process, be in touch. I'm here to help.

Generally speaking, and perhaps relative to other segments of the population, advocates for senior citizens have had more success through recent decades in ensuring that the needs for our aging population have been met. I think about Social Security, Medicare, and the wealth of programs instituted through the Older Americans Act, and I'm so thankful that these things exist.

As the population skews ever older, these resources are clearly in need of further strengthening so that the promise they bring will be there for future generations. I'm glad we're having having regular policy discussions nationwide about how to do this.

However, as a geriatric care manager in NYC, I believe not enough attention is being given to the issue of ensuring that seniors have adequate and affordable housing. Nowhere is this issue more acute than in NYC. When I think about the cost of living for younger people with full salaries, the idea of having to make it in this city with increased needs and a decreased budget sounds downright daunting. 

In my geriatric care management practice here in New York, this issue comes up with regularity. When this issue does come up with my clients, Im able to tap into my years of experience working at an organization that deals specifically with senior housing in NYC. Here are a couple of the many ways I'm able to help:

• I help seniors with "aging in place", where assessments are made, resources & services are explored, and through comprehensive care management, plans are eventually devised and implemented. Sometimes it takes very little to accomplish this and sometimes it takes a lot more, but it's very often a worthwhile and achievable goal. 
• Others simply want to know what's available other than nursing homes, which are obviously more medical in nature than what many of my clients are looking for. Im always happy to meet with clients and their families in consultation to explore options like assisted living and so-called "enriched housing facilities".  I can help clients apply for, and facilitate transitions to these facilities, as well.

If I could give a single piece of advice to those who are thinking about these things, even if only a little bit: start planning early. The options for facilities on the more-independent (and more-affordable) side of things have huge waiting lists. Sometimes years long.

This is obviously a tremendous topic that demands more than a short blog post. If you would like to discuss this topic more, be in touch anytime. We're here to help.

As a young lad from Liverpool once sang, "It was 50 years ago today..."

Well, maybe not exactly today, but this summer, Medicare will have been around saving lives and improving health outcomes for 50 years. Incredible. I've had a special relationship with Medicare during my career. When first working with Medicare consumers about 15 years ago, I saw how flawlessly (relatively) it worked compared to my own healthcare plan at the time. When I later went to work on the advocacy side at the Medicare Rights Center (a wonderful and smart NYC-based organization), I think it's safe to say I went full-blown Medicare nerd. I even wrote a policy brief on it. And when not fulling my role as a geriatric care manager in NYC, I spend my days on the provider side at NY Presbyterian Hospital, and have been able to see more clearly the Medicare issues that affect doctors, and how that, in turn, can impact care.

Through it all, I remain a major fan of the program, and have no problem saying that I think people are living longer, and not going broke as often in old age, because of it. It's an exemplary social program.

In honor of it's birthday, I wanted to post a couple helpful Medicare tips and facts for anybody on Medicare, or for people who work with Medicare consumers.

• Though relatively inexpensive as far as health insurance programs go, there are so many ways to help keep your medicare costs down, particularly if you are in the dreaded (yet slowly shrinking) "donut hole". Medicare Savings Programs and Extra Help are two of those ways. 
• Do you have original Medicare with a Medigap supplemental plan? Did you know that once you find the Medigap plan "letter" you want, that you should pick the cheapest one? It's true, all Medigap plans of a single letter are basically identical as far as coverage goes. Don't go for the one you saw advertise on TV. Guess who's paying for that ad? Yep, it's you! Here's a handy chart of current Medigap costs by plan letter.

I can talk about baseball, long-distance running, Sichuan food, my kids, and Medicare pretty much all day. Feel free to contact me sometime and we'll chat about it. 

Maybe you've guessed I also like the Beatles. You didn't think I'd start a blog post with a song lyric and not link to the song, did you?

It's a recurring theme. I'm sitting down with a new acquaintance, making small talk, trying to explain to them what a geriatric care manager is and does. The conversation feels a little foreign to them. That's not for me, they'll think. None of this is part of my life right now. And that's OK. Most of the time they're 100% right. I'm not in the business of telling 30 year-olds they should think about buying a long term care insurance policy, or start vigorous estate planning (thank goodness). Talk too much about senior housing options at a wedding and you start to get funny looks.

But once in a while, something clicks. Something applies to them.  So let me inaugurate this blog with something most people associate with aging, but probably shouldn't exclusively. 

NYS Healthcare Proxy

That hyperlink I placed right above this sentence? Go ahead, click it. I promise it won't mess up your new iPhone. What it will do, though, is potentially improve your experience as a hospital patient. I say this not exclusively as a geriatric care manager, but also as a hospital employee. It's a standard healthcare proxy form for New York State residents, provided by the NYS Department of Health, and it's something you should fill out now. Literally, now.

If you lose the capacity to make medical decisions for yourself, you can use this form to appoint another person to make them for you. The trick is, you won't be able to fill this form out after you've lost that capacity, which is obviously a tough thing to predict.

Ideally, the person you designate is someone you trust, to whom you've made your general medical wishes known. Short of that, it should be someone who knows you as a person, and has a sense of what your values are.

The file itself has an excellent FAQ, so I won't go overboard with more information, but please know the following before you decide to click away and check basketball scores:

• You don't need a lawyer for this;
• It's free;
• It doubles as an organ donation directive;

Take 10 minutes. Fill this out. Get two witnesses to sign it. Give a copy to the people you've designated. That's it. Done. Go back to your regularly scheduled programming. 

I'll take some time in other blog posts to cover items I feel are applicable to people of all ages. This one deserved my first post, though. I hope you'll agree.