Assisted living

[tcufrog]

it looks like I need to find an assisted living place for my parents. I could use any advice y’all have for me regarding what questions and what to look out for.

 

[jdb in AZ]

What kind of activities do your parents enjoy? Some of the larger facilities offer as many activities as a cruise ship (without the ocean.)

Check out the dining room. Hopefully you can have a sample meal there.

Do the residents seem happy, or do they follow the director around complaining?

What kind of hospital care is nearby?

When we needed assisted living for DMIL, her doctor knew of a great place, a small home with lots of individual care. I doubt we would have found it on our own. It was a great fit for her needs.

 

[disykat]

One thing is that many people mix up the terms, so you need to know the level of care you want. Residential or independent is basically just a rental home with meals, housekeeping, activities and possibly a daily check in if desired. This is not considered assisted living. Assisted is when they start to require additional personal care help and their medications and other medical needs are partially monitored by the staff. ( I say partially because it is still not full nursing care, just some monitoring and help with the goal of remaining as independent as possible.)

Once you hit the assisted level, one thing we struggled with clarity on was what was included as part of the "rent" and what involved "care points." The price for rent is easy to figure out, care points are much more variable and will probably change over time. What we discovered is that the rent is higher in assisted living because of the availability of care, but the care points are tabulated separately. We had falsely assumed that some of the minimal care listed was included in the higher rent cost. We actually have no problem with the amount we're paying, but we were taken by surprise that no care was actually included in the initial price we were given.

Another important point is that any care points are considered medical expenses, so you should see a separation for tax purposes.

 

[barkley]

find out if the 'assisting' staff are employees of the facility or through an outside company, and what their qualifications are (in our experience it can be severely lacking). some places provide VERY minimal base assisting (little more than light cleaning of unit/linen changing and meals in a dining room) and all other assisting requires you contracting through an outside vendor. other places provide the same base and then increasing tiered levels of assisting provided by their own staff (at additional cost).

find out at what level of need THE FACILITY considers their top level of assisting. some places unfortunately permit residents who truly require f/t nursing care or other supervision and it can pose a danger to the person in need as well as other residents.

find out if as a resident increases in need levels if they will be able to stay in their existing unit or will they get moved to another type (this gets very important with couples).

i think talking with your primary care physician is a good idea esp. if their practice includes lots of older patients-they know which places work well their practices to best serve their patient's needs.

check w/ombudsman or other oversight agencies for ratings/complaints/violations.


general stuff-do they provide for meal delivery to the rooms if there's a temporary need (and what charge if any does it incur), if they will have a car is there assigned parking close by (is it well lighted/walkways kept clear/monitored), if there is shuttle service how user friendly is it (can you make reservations or do you have to schedule your appointments/errands around their timetable/routes), do they offer some services in house (mil liked that there was a hairdresser that came in a couple times a week and had a full service hair salon on site, some places also have pedicurists who come in regularly), is there a pharmacy that does deliveries. what limitations are there on guests staying over night (both places mom and mil stayed in had one or two units that could be reserved for a minimal fee for a few nights for visiting guests which was nice for out of town visitors but both also allowed overnight visitors in some levels of care rooms).

 

[clutter]

One thing is that many people mix up the terms, so you need to know the level of care you want. Residential or independent is basically just a rental home with meals, housekeeping, activities and possibly a daily check in if desired. This is not considered assisted living. Assisted is when they start to require additional personal care help and their medications and other medical needs are partially monitored by the staff. ( I say partially because it is still not full nursing care, just some monitoring and help with the goal of remaining as independent as possible.)

Once you hit the assisted level, one thing we struggled with clarity on was what was included as part of the "rent" and what involved "care points." The price for rent is easy to figure out, care points are much more variable and will probably change over time. What we discovered is that the rent is higher in assisted living because of the availability of care, but the care points are tabulated separately. We had falsely assumed that some of the minimal care listed was included in the higher rent cost. We actually have no problem with the amount we're paying, but we were taken by surprise that no care was actually included in the initial price we were given.

Another important point is that any care points are considered medical expenses, so you should see a separation for tax purposes.

This. Times a thousand. Know what you believe that your parents need so you can research what level of care you believe they need. Most facilities will want to evaluate future residents as well. For independent living, they will want the resident's doctor to tell them that they can live independently. For assisted and nursing care, the facility might want to evaluate them to ensure that they qualify for the services they provide.

Continuing care facilities are wonderful places if your parents are good to start with independent living services. There they will have the activities, meals, and selected services, with access to moving to assisted living and/or nursing care as needed. (One nice thing was that when a resident returned from a hospital stay, the facility would re-admit the resident to nursing care until they evaluated that he could go back to being independent.) At the continuing care facility, my dad's rent never changed when he went from independent to assisted living. And the facility billed Medicare for all of his medical type services, so it never cost him more after he made the move.

 

[McKelly]

I don't know what your financial situation is, but find out about how many years they need to "private pay" before they will allow Medicaid to kick in. We found most of them required two years. Medicare does not cover costs for dementia patients - they might for other medical conditions - not sure.
Move quick - most of the good ones have waiting lists. Get on a couple of the waiting lists.
Find out how many people are on the night shift. The place we had my mom in, only had two people. When she became angry (dementia) we were called in to take her to the hospital. I don't think I slept for a year!

 

[tvguy]

Do you have Residential Care Facilities for the Elderly in your state? They have no more than 6 residents, live in homes in residential areas, home like setting, and less expensive. Your folks will be exposed to fewer germs with fewer people.

http://www.canhr.org/RCFE/rcfe_what.htm

 

[Frantasmic]

Howdy! I live in your alma mater city. We moved my father from Lubbock to DFW area last year after he suffered a fall and broke his leg. He is in his late 80s. There are various levels of assisted living. Some are Type A (basically the individual can evacuate the building in emergency by themselves) and Type B (will require help). Some places will have several types of facilities within their grounds from Type A, Type B, to full nursing home with 24 hour nursing care. So, be sure to look for the "type" your parent(s) will need. If you expect a decline in functionality, which could be rapid or not, find a facility with different levels of care. There are several in SW FW. Visit, visit, visit. They will each have a salesperson; make sure you also talk to nursing staff, etc. It really will depend on level of care you are looking for. If you are still in the area, I liked Brookdale on Bryant Irvin, Sunrise further south on Bryant Irvin (I live in that area and had no idea there was a facility there until I started looking), and Brookdale on Hulen near the bridge.

Ultimately, we choose a place in Bedford since my sisters live there.

 

[Pea-n-Me]

Definitions of what assisted living entails vary by state.

https://www.aarp.org/home-garden/li...004/Assisted_Living_in_the_United_States.html

In my state, the resident has to be able to do things for themselves with minimal assistance. For instance, even in higher levels of care (such as an assisted level dementia unit), they can have their pills put out for them, but they have to be able to take them completely on their own. If crushing or spoon feeding them becomes necessary, that entails skilled nursing care. Same with someone getting up and out of bed in the morning, say. Assisted living may have someone lay out clothes for the client, but if they need to be dressed by others or even helped out of bed, this can be the beginning of the need for skilled care. Residents also need to be able to toilet themselves with minimal assistance, etc. Obviously some of these lines may get blurred, but once there starts to be more help needed, you'll get called into the care planning meeting to say it's time to start thinking about the next level of care. There is peace of mind in these cases to be in a place where the next level of care is within the same residence, for an easier transition.

Hidden expenses can add to costs. Laundry is sometimes one. If someone has or develops a behavior problem, such as aggressiveness, a private-duty behavioral aide may be required at an additional expense (which happened to our family). Lastly, in some cases, private pay costs may be lower than Medicaid costs.

 

[OneOftheB's]

Do you have Residential Care Facilities for the Elderly in your state? They have no more than 6 residents, live in homes in residential areas, home like setting, and less expensive. Your folks will be exposed to fewer germs with fewer people.

http://www.canhr.org/RCFE/rcfe_what.htm

While my experience is (hopefully) not across the board, be very wary of the smaller, "in home" type care facilities. I inspected personal care/assisted living/nursing homes for several years while I worked for the health department. The smaller home type facilities were, without exception, the worst of the worst. Unscreened or background checked caregivers, mentally incompetent caregivers, missing caregivers were seen very often by myself. The food quality was very poor, as was the general housekeeping. The locally owned and operated mid-sized facilities were typically the better option with the large, corporate owned facilities usually falling in the middle.

As part of my job, I did unannounced inspections of about 30 facilities at least twice a year. So, to routinely find significant staffing and care issues is a huge red flag, IMO. There was one inspection where the "caregiver" on duty was a individual with no background check (as required by law), who was mentally incompetent and living in the pantry of the facility due to her being homeless. Just an awful situation and the residents were in terrible shape. It was also common to see really terrible food-ie a pantry full of expired Little Debbies and nothing for a decent meal for any individual, much less the number of residents in the home, when they were to post the week's menu and have a minimum of three days of meals on site. These were not issues found in a larger facility-with better checks and balances and a larger staffing pool, you get better care, IMO.

My father is in an assisted living currently. We chose a facility that is locally owned, with now four different locations in the area. The main staff has a relatively low turn over rate and actively encourages groups to visit and interact with the residents (a college prof gives history talks twice a month, a therapy dog group visits a few times a month, a gardening club meets with residents monthly, school chorus come sing, individual students can perform for the residents, etc. It's not cheap, but my dad was not able to safely take care of himself at home.

The biggest tips I can give you are schedule a visit, so you can get the details. Then go back and visit at different times, unannounced, just to chat with residents or watch interactions with staff and residents. You should also be able to review the inspections performed at the home(s) you have narrowed down.

 

[tvguy]

While my experience is (hopefully) not across the board, be very wary of the smaller, "in home" type care facilities. I inspected personal care/assisted living/nursing homes for several years while I worked for the health department. The smaller home type facilities were, without exception, the worst of the worst. Unscreened or background checked caregivers, mentally incompetent caregivers, missing caregivers were seen very often by myself. The food quality was very poor, as was the general housekeeping. The locally owned and operated mid-sized facilities were typically the better option with the large, corporate owned facilities usually falling in the middle.

As part of my job, I did unannounced inspections of about 30 facilities at least twice a year. So, to routinely find significant staffing and care issues is a huge red flag, IMO. There was one inspection where the "caregiver" on duty was a individual with no background check (as required by law), who was mentally incompetent and living in the pantry of the facility due to her being homeless. Just an awful situation and the residents were in terrible shape. It was also common to see really terrible food-ie a pantry full of expired Little Debbies and nothing for a decent meal for any individual, much less the number of residents in the home, when they were to post the week's menu and have a minimum of three days of meals on site. These were not issues found in a larger facility-with better checks and balances and a larger staffing pool, you get better care, IMO.

My father is in an assisted living currently. We chose a facility that is locally owned, with now four different locations in the area. The main staff has a relatively low turn over rate and actively encourages groups to visit and interact with the residents (a college prof gives history talks twice a month, a therapy dog group visits a few times a month, a gardening club meets with residents monthly, school chorus come sing, individual students can perform for the residents, etc. It's not cheap, but my dad was not able to safely take care of himself at home.

The biggest tips I can give you are schedule a visit, so you can get the details. Then go back and visit at different times, unannounced, just to chat with residents or watch interactions with staff and residents. You should also be able to review the inspections performed at the home(s) you have narrowed down.

What state? The care planners at the big nursing homes ALL said the smaller care home facilities were a much better option for my mom.

 

[OneOftheB's]

What state? The care planners at the big nursing homes ALL said the smaller care home facilities were a much better option for my mom.

I'm in Georgia. This was several years ago, when the state office did not have the staffing to inspect the homes (I can't imagine what it's like now, the elder care housing has exploded in my area) and the routine inspections were given to the local Env Health inspectors to complete, but compliance was still part of ORS. Again, hopefully my experiences were isolated, but there were a number that were frankly awful. I just didn't see the same issues, or as extreme issues, in a mid sized facility or larger ones either.

 

[tvguy]

I'm in Georgia. This was several years ago, when the state office did not have the staffing to inspect the homes (I can't imagine what it's like now, the elder care housing has exploded in my area) and the routine inspections were given to the local Env Health inspectors to complete, but compliance was still part of ORS. Again, hopefully my experiences were isolated, but there were a number that were frankly awful. I just didn't see the same issues, or as extreme issues, in a mid sized facility or larger ones either.

They are regulated and inspected just like nursing homes here in California. Huge industry. I was amazed how many were within a mile of my home

 

[tcufrog]

Thanks for all of advice. We live a little more than an hour from my parents. For a variety of reasons I can't check on them as often as I should so my original plan was to move them to senior independent housing close to us so I could help them out more often. After seeing the shape my dad's in now and how much trouble my mom is having with picking up the slack, I decided that I need to look at assisted living. Both of them use a combination of canes and rollators. My mom can still drive but we got rid of both their cars and replaced them with my old minivan so that they could easily load and unload their rollators and get in and out of the car. My father shouldn't drive anymore so we're taking away his ability to do so. I would like a backup shuttle in case my dad needs to go somewhere and my mom can't take him. My mother can still cook but she finds it tiring to put 3 meals a day on the table now. My dad has diabetes and I learned the hard way that his doctors had never explained what changes she needed to make to what she cooked for him. They were over at our house a few weekends ago when he had a very scary sugar crash due to a lack of protein that day. Luckily my dh and I knew what to do (hi mom has diabetes and lives with us part-time) so we were able to prevent the need to call 911. We want him to live somewhere where they will cook him meals suitable for a diabetic. They can dress and undress without help as well as manage their medicine but they are at a risk for falling so I want them to have someone available to help them up if they fall. The state provides them with help showering and doing laundry a few times a week so they don't need that.

Is this level of help suitable for assisted living.

 

[Simba's Mom]

What excellent timing! We just "crossed that bridge" looking into assisted living for Mom yesterday. Fortunately, she's well enough right now to be a big part of the looking around. She really liked an independent living facility in northern Connecticut, and is looking at a couple in southern Massachusetts (she lives right on the Mass/CT border) this week. I appreciate these comments.

 

[kaytieeldr]

https://www.bankrate.com/finance/retirement/choose-assisted-living-facility.aspx

 

[clutter]

Thanks for all of advice. We live a little more than an hour from my parents. For a variety of reasons I can't check on them as often as I should so my original plan was to move them to senior independent housing close to us so I could help them out more often. After seeing the shape my dad's in now and how much trouble my mom is having with picking up the slack, I decided that I need to look at assisted living. Both of them use a combination of canes and rollators. My mom can still drive but we got rid of both their cars and replaced them with my old minivan so that they could easily load and unload their rollators and get in and out of the car. My father shouldn't drive anymore so we're taking away his ability to do so. I would like a backup shuttle in case my dad needs to go somewhere and my mom can't take him. My mother can still cook but she finds it tiring to put 3 meals a day on the table now. My dad has diabetes and I learned the hard way that his doctors had never explained what changes she needed to make to what she cooked for him. They were over at our house a few weekends ago when he had a very scary sugar crash due to a lack of protein that day. Luckily my dh and I knew what to do (hi mom has diabetes and lives with us part-time) so we were able to prevent the need to call 911. We want him to live somewhere where they will cook him meals suitable for a diabetic. They can dress and undress without help as well as manage their medicine but they are at a risk for falling so I want them to have someone available to help them up if they fall. The state provides them with help showering and doing laundry a few times a week so they don't need that.

Is this level of help suitable for assisted living.

Your best bet is to call around and ask what the facilities believe. Figure out what they can afford, talk to facilities and go from there.

When my dad moved into the Continuing Care facility, he had sufficient equity in his house to cover the buy in. And his pension/social security covered the monthly fee. While it was close, once that and medical bills were paid (Medicare Part B and prescription coverage), he really didn't spend much else. Even with only one meal a day, his grocery bill was pretty low. When he moved to assisted living, every other resident was single/widowed, so I don't know how they would have dealt with a couple. It sounds like your parents could manage independent living, except for the meals. But at my dad's independent and assisted living, the residents picked off a menu, so I don't know how they would have handled diet restrictions. In independent living, the residents are required to wear a call button at all times. Assisted living the buttons were in the room, but nurses and aides walked the halls all day long, and frequently checked on residents.

Good luck. The hardest part is convincing them to move.