My “Going Home Again” series started out to be stories of myself, going home to Kansas to visit my aging father. Dad’s doing quite well and isn’t giving me any material to write about lately, so I’m branching out into stories of other people that I know, and how they are dealing with long term care decisions and caregiving.

I met Maureen and her husband four years ago, when they were first contemplating moving to Assisted Living. My recommendation was that they try NOT to have to sell their house right away, because if either of them needed Medicaid long term care payments in the future, their home would be an exempt asset. If they sold it, the cash they received would become a liquid asset and half of it would have to be spent before either of them could get Medicaid. But, Maureen’s Multiple Sclerosis was progressing faster than her husband, Ray, could learn to care for her. Daily living tasks were piling up, and Ray being of fairly good health, wanted to feel safe going away for his frequent road trips, leaving Maureen in the care of an assisted living staff.

When I learned of the choice they had made – a local facility that offers three levels of care but does not allow pets of any kind – I asked, “What’s to become of Gracie?” I had never met their scaredy-cat because she was the type of cat who only liked her owners and hid whenever visitors came by.

“I don’t know what we’ll do about Gracie,” Maureen’s eyes had that pet-lover’s fear in them that said she was worried about her kitty.

Being a cat lover myself, and already owning 6, I blurted out without thinking, “Well, I’ll just have to take her, then, until we can think of something.” Maureen was grateful but tearful when I managed to grab Gracie and place her on her owner’s lap for one last cuddle before stuffing her in the carrier to venture off to her own new living facility.

Gracie is a beautiful black tortoise-shell kitty (flecks of orange and white mixed in with her mostly black coat). She has no claws at all so she can’t scratch elderly, frail skin. It took her awhile to fit in with my cat household, and eventually we had to let her live in our bedroom so she didn’t have to mingle with the other, less sophisticated kitties. After two years, she’s settled in quite nicely as “the bedroom kitty.” She has a charming love of people, once she gets to know them; and because of her lack of claws, she has a “grace” that surpasses most clumsy cats. The way she jumps high above the bed to land gracefully upon it with all four paws is a feline Olympic feat.

I’ve stayed in touch with Maureen and Ray, and we exchange Gracie stories. They had settled into their own new living arrangement fairly well, but just recently mentioned that they weren’t as happy as they thought they would be. They felt that the fee they were paying, depleting their assets at an alarmingly rapid rate, was not worth the amount of services they were receiving. They were thinking of moving to a less expensive facility, relinquishing their nonrefundable lifetime deposit, in order to keep from depleting their assets prematurely. I was ecstatic. There is a facility they were interested in that they had considered in the past – and small pets are allowed there!

Ray began to visit facilities as I called ahead to ask if they had a two-bedroom (a necessity with Ray and Maureen who wanted to keep all their stuff). Before I knew it, Ray was calling to tell me he had decided to move soon, and would I be willing to “relinquish Gracie.” Now, mind you, much as I love Gracie, I have decided that 7 kitties is really too many for my size of home. Reuniting Gracie and Maureen would be my heart’s desire. But my heart’s desire was to run into a snag.

Maureen’s MS was escalating and the care that she needed was also increasing. The latest news was that Maureen’s bladder function was worsening and she would need to be straight-cathed twice a day. This function must be performed by a skilled nurse, or a family member, and Medicare does not pay for this for more than 120 days in a year. Ray is a good caregiver, but he has his limits as do we all. Maureen had tried to learn the technique, through a brief session with the office nurse at the urologist’s, and they felt they could not do it themselves. When Ray approached the management staff at the assisted living facility, he was told that Maureen would have to be placed in their nursing home for that type of care.

Maureen was devastated when she was told this news. I was almost as devastated myself. I really wanted a better quality of life for this lady whose mental capacity was intact but her body was beginning to fail her.

I called my partner, Marti Zarkower, an RN with 30 years’ experience advocating for seniors. What did she think of this scenario? “Who is the urologist?” she asked, and then said “Oh, I’ll bet there would be other solutions. We have another client with him and he knows me.” Marti called Ray and Maureen and offered to accompany them to their next appointment with the urologist. I was sitting on pins and needles waiting to hear how it went. Evidently, through discussions with the office nurse and the urologist, Maureen had only tried one time to learn the procedure and had given up because she felt unsteady. Marti explained to Maureen that she could try different techniques such as positioning with pillows, and explained to Maureen and Ray that it might take several sessions with a home health nurse to learn how to do it independently. Meanwhile, Medicare WOULD cover up to 120 days for the nurse to come out and perform the procedure and teach Maureen how to do it herself, perhaps with Ray’s help at times. The doctor agreed, and a referral to a visiting nurse agency was made.

“Enough with the nursing stuff – are they moving or not?” I shouted, unable to stand the suspense.

“Of course, they are,” Marti replied confidently. “And we’re not billing them for my time,” she declared. “I’m just glad to help you get down from 7 to 6 cats in your house!” We laughed. Marti is not a cat person.

So, what lessons did we learn from Maureen and Ray and Gracie’s experience? When looking at whether it would be a good idea to move from your own home into a care facility, be sure to compare facilities apples to apples.

• What care will you need now AND in the future, and what will that cost of care be?
• If an assisted facility also has a nursing home on site, be sure to scrutinize the difference between what the assisted wing will offer and not offer. Oftentimes, I am finding that facilities with no nursing home attached will go the extra mile to keep you in your independent apartment longer rather than rush to have you fill their nursing home bed.
• Consider carefully whether to sell your home and move, or whether you could get the socialization you need in a local senior center, and purchase assistance services ala carte when you need them. Many home health companies can provide what you need at a one-on-one quality that does not exist in many assistance facilities where the staff-to-client ratio is quite high.
• Work closely with a financial planner and an elderlaw attorney to maximize your resources and prepare for the costs of long term care. Many options exist to stretch your assets and improve your quality of life.

Maureen and Ray haven’t moved yet, but are starting the preparations. I’m tempted to take Gracie to her now anyway. What’s her current landlord going to do – evict her? I’ll keep you all posted. Let’s have a welcome home party for Gracie when I get to put her back into Maureen’s arms to stay.

Debra Sorensen, MSW, LISW, CMC, is a professional care manager and owner of, Debra J. Sorensen & Associates Inc., a private geriatric care management company in Maumee, Ohio. She can be reached at 419-367-8835 or e-mail dsorensen@buckeye-express.com.