Florida elder advocate’s passion for long-term care reform driven by what she sees in the business she founded – and her own elder-care tragedy

Florida’s long-term care industry, state regulators charged with overseeing the industry, and state policymakers are failing families caring for older loved ones. Annalee Kruger sees the painful and sometimes catastrophic results of these failures every day.

Founder and president of Care Right Inc., (https://carerightinc.com/) a for-profit caregiver support company, Kruger is passionate about the gaps she sees in the long-term care and health-care systems, not only in Florida but in many other states.

She gives Florida a ranking of one on a scale of 1-10, where 10 is very good care. “It’s not even just Florida, it’s everywhere. If we were supporting family caregivers, we wouldn’t be in this mess,” she says. “Families and seniors are falling through the cracks.”

Neither policymakers nor families are aware of how widespread the issue of lack of support for family caregivers is, she says. Some 58 percent of adult kids get thrust in the role of family caregiving.

“If parents have a child who develops a chronic illness, parents research that illness,” Kruger says. But when it comes to aging, families have never been educated to understand the aging process, the way the healthcare and long-term care industries work, or the progression their loved ones are going through.

Families also often don’t realize that other families – millions of families, in fact – are facing the same problems they are, Kruger says. Before a family’s loved one encounters these systems, few Americans understand that neither the long-term care industry nor government regulators and policymakers responsible for overseeing care are effective in supporting families.

For millions of Americans, the result is a lonely, uphill fight against the odds, with time and resilience running short, to understand a convoluted care system, identify the resources they need, find ways to pay for the care and hold care facilities accountable for delivering high-quality care.

Kruger created her business in 2011 to meet the needs of families that struggle with the health- and long-term care needs of older loved ones. The company provides coaching on planning for caregiving, guidance for families, help with mediating family disputes over caregiving issues, coaching on how caregivers can become “bold advocates for their loved ones,” and help in equipping families with advance plans that can be put in place when a caregiving crisis emerges.

If there is one need that is critical, Kruger says, it’s well-informed advance planning for aging.

Some 92 percent of the families she serves are already in crisis when they first contact her, she says – facing huge problems not only because of a loved one’s medical emergency or declining health but also because the stress of family caregiving has strained or even ruptured relationships within the family. “Things are a mess when they come to me.”

Annalee founded the company in the Milwaukee area in 2011. She had had good experiences working in long-term care facilities earlier in her career, but what she saw when she came to work at a continuing care retirement community in Wisconsin convinced her that families needed a different approach.

Kruger found that families commonly had little information on crucial questions about their older loved ones, including whether their mother or father had a living will had prepared power-of-attorney or medical surrogate documents, details of their financial situation, or whether they had long-term care insurance.

She relocated to the Estero/Bonita Springs area just before Hurricane Irma struck the area in 2017.

Her service is essential, she says, because of the shoddy, low-quality care that she sees too often in long-term care facilities in Florida and many other states. America’s long-term care industry is failing seniors and families through poor customer service, failed consumer education, and the inability to maintain and manage adequate staff. Worst of all, there is little accountability for the delivery of high-quality care, she says.

For Kruger, the issue of supporting family caregivers and holding long-term care facilities accountable is personal. She says her own mother died due to incompetent care at a Florida memory care facility.

Her mother had been in declining health, and her father had been caring for her at the family farm in Iowa. Just before the COVID pandemic hit in 2020, she invited her parents to come to Florida and stay with her. Two weeks later, a fall injured her mother’s shoulder. Though the emergency room staff at the local hospital could not initially find a broken bone, later they found she had fractured her shoulder. Her mother went to the hospital. Annalee and her father split time at the hospital, helping to care for her mother. After two and a half weeks in the hospital, hospital staff transferred her mother to a rehabilitation facility without telling her.

Annalee went to the rehabilitation center to help her father get her mother get settled. But during the visit, Annalee suddenly realized her father had become unresponsive and was having a stroke. Nurses refused to help Annalee get him into a wheelchair to get him to the front door for paramedics to pick him up. Meanwhile, her mother was panicking and calling for her father.

The incident led to her mother entering a local memory care unit. Care at this facility was also substandard, Annalee said. A change in leadership and growing staffing concerns led to a catastrophic decline in her mother’s care – “Mom’s care plummeted.”

Kruger eventually filed a 35-page complaint that led to a Florida Agency for Health Care Administration investigation. The facility eventually fired 15 of its staff and committed to improving care.

However, Kruger said, just after a visit with Kruger, in June 2021, the facility staff gave her mother the wrong food for lunch – a regular diet rather than a mechanical soft diet, using no foods that are difficult to chew or swallow. Her mother choked to death. “She ended up dying around people who didn’t care about her.”

Kruger believes that the Florida Legislature’s decision to water down care standards in 2022 was a move that took long-term care in the state – already bad – in exactly the wrong direction.

“We need to be going in the opposite direction,” Kruger says. “If (legislators) could just follow me and spend some time in these facilities, they would see that all these facilities are the same. The care is just subpar.”

“All this caregiver burnout, adult kids leaving the workforce, stepping away from their jobs, not taking job promotions, much of the strained family dynamics, confusion about care options, etc., could all be prevented if (health- and long-term care industries) stepped up and held families by the hand and walked them through the journey they are on.”