When the health or capacity of a loved one deteriorates and the family decides that a nursing home is the best care option, it can be a very traumatic time for both the caregivers and the patient. You want to ensure your parent or friend is placed in a facility where they will get the best possible care in a safe, nurturing environment.

However, depending on the length of waiting lists and where you live, your choices may be very limited. For example, this directory of long-term care providers in Saskatchewan illustrates that in many smaller communities there is only one government-subsidized nursing home. And if a bed becomes available you will likely have to decide whether or not to accept it on very short notice.

Last week we wrote about “What you need to know about residential care for seniors in Saskatchewan” and discussed the difference between retirement homes and nursing homes (special care homes). This week we offer a checklist of things to look for when you are evaluating the suitability of a special care home for your family member.

The Canadian Association of Retired People (CARP) has developed an extensive catalogue of things to look for. Here (in no particular order) are some of my favourites, including questions we asked when my mother recently moved into long-term care.

1. What is covered in the regular monthly fee and what additional charges can be expected?
2. Are residents clean, well-groomed and appropriately dressed?
3. Do they seem happy?
4. How do family members of current and past residents rate the facility?
5. What activities are available for residents?
6. How long have senior staff worked for the residence?
7. Do staff appear to be happy?
8. What is the staff-to-patient ratio of PSWs, RPNs and RNs to residents on each shift?
9. Does the home rotate all staff members or try to keep the person(s) caring for each resident?
10. Are there any limitations on visiting hours?
11. How do family members participate in the care plan?
12. How are care complaints handled and by whom?
13. Do doctors, physiotherapists, denturists, podiatrists regularly come to the residence for patient care?
14. Does a hairdresser and manicurist regularly attend to provide personal care?
15. What resources are available for the care and safety of residents with cognitive impairment?
16. Are religious holidays and birthdays celebrated? How?
17. What are the policies and procedures for ensuring that personal clothes and belongings are not lost or stolen?
18. What is the home’s fall prevention program?
19. Can the resident bring personal furniture, pictures and other knick knacks?
20. What are the policies and procedures for handling a resident who is harmful to himself/herself or other residents?
21. Does the home have a palliative care program?
22. Will the food appeal to your loved one?
23. Can a family member have a meal with their loved one? If so, is there a fee?
24. Are special menus available for people who require soft food or other special diets?
25. Does the menu suit your loved one’s cultural or religious regulations?

Regardless of the answers you get to these and other preliminary questions, once your loved one moves in, it is important for family and friends to visit as often as possible at various times of the day and in the evening both to keep his/her spirits up and monitor the actual care he/she is receiving. In many cases elderly or infirm patients are incapable of advocating for themselves.

Generally we are very happy with the facility we chose for Mom, but we have to stay on top of things. For example:

• When she returned to the residence after she broke her hip we had to encourage staff to get her up and walking so she didn’t totally lose her mobility.
• She is supposed to get her hair done every week and a manicure every two weeks but inexplicably, her name sometimes doesn’t make it onto the list.
• There is lots of staff, but they are rotated and often it seems like the right hand doesn’t know what the left hand is doing!

By understanding the rules and limitations of the special care home where your loved one resides, you can monitor care more effectively and provide additional support as needed.

Written by Sheryl Smolkin
	Sheryl Smolkin LLB., LLM is a retired pension lawyer and President of Sheryl Smolkin & Associates Ltd. For over a decade, she has enjoyed a successful encore career as a freelance writer specializing in retirement, employee benefits and workplace issues. Sheryl and her husband Joel are empty-nesters, residing in Toronto with their cockapoo Rufus.

By Sheryl Smolkin

If you haven’t factored health care costs into your retirement budget, it may be time to take another look. Saskatchewan Health Care covers provincial residents for a whole host of services including all medically necessary doctors’ visits and hospital care. But other services such as drugs (until age 65), dental care and physiotherapy outside an approved institution are typically not covered.

Members of employer-sponsored group health care plans have some or all of these expenses reimbursed. But according to a new survey from benefits consulting firm Aon Hewitt, nearly half of Canadian employers do not offer any post-retirement health benefits.

Aon Hewitt’s survey of 225 Canadian employers reveals that 44 per cent of the respondents do not offer any retiree benefits at all, while another 10 per cent have closed their existing programs to future retirees.

Of those employers not offering retiree benefits, the most often-stated reason (76 per cent) was “high costs compared to perceived benefit to employees,” while 66 per cent specifically blame rising healthcare costs.

However, about 20 per cent of respondents say that they would consider offering retiree health benefits such as drug, hospital and dental benefits if the costs were fully or partially-paid by retirees.

Even if your employer does offer some form of retiree coverage, it may not be the same as the coverage you are eligible for as an active employee. For example, your employer may offer you:

• A lump sum at retirement in lieu of future health care premiums or benefits.
• A defined annual contribution to health care premiums leaving you responsible for paying the balance which may increase each year.
• An annual contribution to a health care spending account you can use to by individual health care or to pay for actual expenses for services (i.e. physiotherapy, glasses).
• A retiree benefit plan that is 100 per cent self-funded.

When your workplace health and dental benefits end at retirement, you have three basic options:

• “Follow Me” products offered by all of the major insurance companies are available to former members of employer-sponsored group benefit plans within 60 days after retirement.
• Groups like university alumni associations, professional groups, the Canadian Automobile Association and the Canadian Association of Retired People (CARP) have “affinity plans” for members.
• Insurers like Saskatchewan Blue Cross sell individual plans.

All three types of programs offer basic health and dental plans plus different levels of enhanced plans. Your premiums will be based on the features in the plan you select, how old you are and your health status when your plan kicks in. Dental plans cannot be purchased on a “stand alone” basis.

So how do you figure out what’s best for you?

First, make sure you have plenty of coffee. Set up a spread sheet and try to do an “apples to apples” cost/benefit analysis of the health and dental plan features that are most important to you.

Insurance carriers offering Follow Me programs, affinity groups such as CARP and carriers with individual products like Saskatchewan Blue Cross have websites with detailed information and you can quotes. They also have information lines you can call for assistance. Websites like Kaneix.ca allow you to compare a series of online quotes from different carriers.

Depending on your health status, one reason to opt for a Follow Me Program if you are eligible is that acceptance is guaranteed with no medical questionnaire at the time of application, and no waiting period for coverage. Unlike some other plans, you can also move from a basic plan to plans providing higher levels of coverage at a later date without medical evidence of insurability.

Of course the real problem is that once you are no longer covered by an employer plan you will pay more for less. Coverage is extremely limited as compared to more robust workplace health and dental plans you may have been covered by in the past.

If you are contributing the maximum annual amount to tax-free savings accounts, that may be one source of funds for unexpected medical costs in years when you exceed private insurance plan benefit coverage.

By Sheryl Smolkin

Do you have a spring or summer wedding coming up? Squawkfox aka Kerry K. Taylor discovered H+M now has a Grecian style wedding gown on sale for USD$99. This happily married lady says if she were looking today she would say yes to this dress! The 38 comments (the last time I checked) are even more interesting with lots of great ideas on how to save money on a beautiful dress you may only wear once.

Whether or not to tip the people who provide you with services and how much is a perennial dilemma. On When Life Gives You Lemons Add Vodka, Sarah Greesonbach discusses how much it costs to get a massage and why your tips may be an important part of your massage therapist’s compenstation. Money saving idea: If you need a massage for therapeutic reasons, make sure you see a registered massage therapist in case you can claim all or part of the cost on your employee benefit plan.

In a recent Globe & Mail column Preet Banerjee had some great information on discounts for seniors and you don’t always have to be over 65! For example, by signing up for a membership with the Canadian Association of Retired Persons (CARP), you can get an annual gym membership to GoodLife for $400 per year (plus tax) as long as you are 45 years or older. The cheapest CARP membership is $14.95 per year.

Tim Stobbs writes an interesting blog on Canadian Dream: Free at 45 about adjusting to having a higher self-worth as your savings grow. He says the first most obvious change is that you gain the ability to self-insure for more minor events. For example, you don’t have buy the extended warranty on your appliances because if something stops working you can just buy a new one.  Later on when you have even more saved, you can raise your home insurance deductible since you can comfortably handle greater risks.

There has been considerable press recently about the number of illegal, unpaid interns in both Canada and the U.S. However Cait, a Blonde on a Budget says that an unpaid internship, writing her own blog and writing posts for other blogs she is really passionate about have led to her current full-time job with RateHub.ca.

“My boss saw that I could manage numerous projects with multiple deadlines, I obviously want to learn new things, and she loved that she never found any spelling mistakes in my posts.” Of course, Cait had been trying to build up her writing portfolio, but until that job offer came along she wasn’t conscious of the fact that her blog was a portfolio in itself.

Do you follow blogs with terrific ideas for saving money that haven’t been mentioned in our weekly “Best from the blogosphere. Share the information with us on http://wp.me/P1YR2T-JR and your name will be entered in a quarterly draw for a gift card.