Anyone have any tips on selecting an assisted living/care facility?

Parent Cafe
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<p>We are currently in the unpleasant process of moving my inlaws out of their home of close to fifty years. For anyone who has been through this, do you have any tips/suggestions/recommendations as to the types of questions to ask, the things to look for in a facility, what to do to make the difficult transition a bit easier. Anything you wish you had done differently? Also would appreciate suggestions on how best to go about clearing out decades of ‘stuff’ and who should do this, who makes the decisions as to what to throw away, give away, or keep, and for those things kept, who gets what. Not looking forward to that process at all.</p>

<p>Thank you for any information you may be able to share.</p>

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<p>I have been through and am still going through this.</p>

<p>Let me first say, find your local Council on Aging. They can help you with many aspects of dealing with an elderly parent.</p>

<p>Thank you so much for posting this. I am looking forward to sharing what I can, and hearing what others have to say on this.</p>

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<p>Friend has recently gone through this…As far as clearing decades of stuff…deciding what to take with them to the new home…They first found the facility…made drawing of rooms…parents looked at belonging in house…what was really important to them and what would realistically fit…Started off taking minimum stuff and then slowly added other things as room allowed/needs dictated/memories wanted…only after a few weeks of going through this process did they then tackle how to dispose of everything else…don’t want to move too quickly if you can afford the luxury of taking your time. Don’t want your parents to later regret getting rid of things that mean alot to them.</p>

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<p>Your state should also have a state inspection/regulatory agency that posts the results of recent inspections and compliance with state regulations online. That might be a good spot to look as well.</p>

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<p>We just went through this process with my husband’s uncle. Since the uncle lives in a different state, we called his primary care physician’s office and asked for suggestions about how to find an assisted care facility. The doctor’s office referred us to a geriatric counselor in the area, whom we interviewed and ultimately hired. The geriatric counselor proved indispensable in helping us choose the right facility. After she assessed our needs and wants, she recommended facilities and my husband toured them. My husband then took his uncle to visit the facilities that he felt met his needs best, and his uncle picked the one where he felt most comfortable. Today, our uncle couldn’t be happier with the choice “he made.”</p>

<p>As for the “stuff”, pick a day when all the relatives who might have any interest in it can be there. You can then make group decisions so that no feelings get hurt. It took my husband and me about a month to clear out 87 years worth of stuff from our uncle’s home. His sisters came up the first weekend and helped make decisions about what to keep or toss, and then my husband and I handled the rest. Opera-mom makes an excellent point about not moving too quickly. We found that our uncle remembers something he wants us to bring to him just about every week. Unfortunately, I had already donated the typewriter he belatedly remembered to Goodwill!</p>

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<p>Dh went through this many years ago with his mom. His dad had died, and the house was just too much for her to handle by herself. But she was very independent and was not going to move into a nursing home or anything like it. He found the perfect place for her on the internet – an assisted living community that has different kinds of facilities, depending on the level of care you need. </p>

<p>She bought a duplex, the most independent kind of housing. Lives by herself in the fully furnished duplex with garage and her own laundry facilities. She has a meal plan (just like college!) and can choose to eat in the dining hall with friends or take it to her house. There are all kinds of activities to do – from exercise classes to field trips – but only thing she really does is play cards. The facility does things like have a once-a-week housekeeper and (I know this sounds odd) monitor toilet usage as a way to make sure residents are OK. For instance, if the toilet has not been flushed by 10 a.m., someone will come by and check on her.</p>

<p>If as the years progress she needs more direct care, she can sell her duplex and move into the first level of the large facility. She’d still be living independently, but there is more direct monitoring. And then the upper levels are more like your conventional nursing home care.</p>

<p>This particular facility is run by the Catholic Church, and it truly felt like a godsend (dh and I aren’t religious, but my MIL is). It was just being built when we started looking at it, so she came in on the ground floor, and, while very far from her home, it’s closer to her church (big relief when it came to driving) and less than a mile from one of her dd. She has been very happy there.</p>

<p>In terms of all her stuff, she was blessed with two dd who are every bit the packrat she is, and so they took a bunch of it. We sold off some things in an estate sale. Took much of it to a church she knew that runs some kind of mission program.</p>

<p>Wanted to add that this is a very emotionally charged time. Years of baggage – the figurative kind as well as the literal kind – come to the surface. It helps to take good care of yourself during this process.</p>

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<p>My mother did this all by herself in the mid-90s when she moved into a facility in Florida. She took very little. She died six years ago, so things might have changed, BUT…</p>

<p>BUT: she and her co-residents got slammed with additional fees that weren’t in the original contract. For example, one of her friends developed a physical problem that caused her to be bed-ridden; while the original contract called for hospital care… there was a charge for the incontinence pads. Stuff like that.</p>

<p>My mother actually ended up writing an “underground” newsletter for the residents and organizing some protests. Things did get better. But she’d invested all her money in the entrance fee, and I know that by the end she wanted out in a big way, BUT… couldn’t afford it.</p>

<p>Read EVERY SINGLE BIT of the contract. And watch out for a clause that says they can change the contract ex post facto.</p>

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<p>For the reducing the household stuff: with my grandmother, they moved her into the new place but kept a lot of stuff in storage for several months while she changed her mind on what she wanted in the assisted living apartment. It was a little less stressful that way, too.</p>

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<p>The type of facility that ‘Youdon’tsay’ is referencing is called a Continuing Care Community.</p>

<p>Look at Erickson dot com for examples of places that require a refundable entrance fee. If you run out of funds, the entrance fee is a sort of escrow fund. But if you move (or pass away) without tapping into the entrance fee, it reverts into your estate.</p>

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<p>Many assisted care facilities have an option called “respite care” where potential clients can move in for two weeks to a month and test out the facilities. It’s usually covered by long-term care insurance. Our uncle used this option and it helped make his final transition to assisted living much easier.</p>

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<p>I just heard this individual on the radio this morning. He has a website and of course, has written a book. Might be something worthwhile on his site:</p>

<p>[url=<a href=“http://www.agingoptions.com/]Home[/url”>http://www.agingoptions.com/]Home[/url</a>]</p>

<p>I just checked it out myself. If you click on Radio Show it takes you to a page where you can click on Professional Resources Web Links!</p>

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<p>have been through this process.</p>

<p>there is a tendency to take far more with them than they really need so be careful of that. </p>

<p>try to get a very real evaluation of just how much assistance they need now. understand the “activities of daily living” and evaluate and re-evaluate how much assistance they need. you may find out that they say they are doing some things without assistance but in reality, they are not. ADL (activities of daily living…bathing, dressing, etc.
check to see if they have long term care insurance and is the assisted living facility an approved facility with that insurance company.</p>

<p>not all assisted living facilities are the same. some provide more levels of care than others. some are very similar to long term care facilities and some are not in terms of how much nursing care is available.</p>

<p>what are the policies? if residents require more care, can they stay or will they have to be moved again. there are a couple of highly respected assisted living facilities in our area that provide care through the end of life…in the same building. even hospice patients are admitted. this is a great option if it is available to you.</p>

<p>my two cents…some assisted living facilities only have registered nursing staff actually on duty and in the building monday through friday and basically, 8 to 5 (about 40 hours a week). they say they are on call nights and weekends. however, the problem with this is that if a family member has a fall during the night or on the weekend, our experience was that the nursing staff was in reality not available to come in and only aids were present to handle the situation. the aids will call the ambulance and the family member is transported to the hospital. actually having nursing staff present and on duty 24 hours a day 7 days a week makes a huge difference. if a fall occurs, the nursing professional can make the assessment, not an aid.</p>

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<p>“some assisted living facilities only have registered nursing staff actually on duty and in the building monday through friday and basically, 8 to 5 (about 40 hours a week).”</p>

<p>meant to say “licensed nursing staff”, not registered.</p>

<p>alwaysamom…suggest you visit assisted living facilities and also long term care facilities so that you can really see the difference between the two. try to get a good understanding on what is their care model for that particular facility.<br>
sometimes medical and other needs are so extensive that the parent really does indeed need the constant care that can be provided in a long term care facility.</p>

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<p>My MIL broke her hip last year, and did not qualify for a rehab institute because she was too disabled. That meant placement in a nursing home for her. We looked at the list that was provided for us and called the ones in the most upscale areas and with the best reputations. In this case, the cost was nearly completely met by Medicare and insurance so cost was not an issue. Had it been, we would have had to go down the list until we got to the affordable range.</p>

<p>Having done this, we then had to go on availability. We placed her at a highly recommended home that looked more like the Ritz than a nursing home. It had a theater, cafe, library as well as beautiful sitting areas and common rooms. The meals were served as though the residents were dining at a restaurant. </p>

<p>The biggest problem with the placement was that she was put in a wing that had a lot of severely disabled people including many with dementia. The quality of daily life and the way those were treated was very different than what occurred on other wings. We did get her transferred as soon as a bed opened up elsewhere, and what a difference that made.</p>

<p>So when you are touring a home, make sure that you don’t look at one part of it and end up with placement in another area. It can make a very big difference.</p>

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<p>Just went through this with my folks this year. </p>

<p>Since others have given you plenty to think about in terms of evaluating the facility I will stick to broader, philosophical issues.</p>

<p>As the d-in-law, you are in a slightly different position. Does your DH have siblings? If so, my suggestion is to have a low key get together with just the sibs & spouses and talk about broad categories - type of facility, cleaning out the place, etc. If your DH is it, in some ways you will have more work, in others it will be easier because you know you will be doing everything. </p>

<p>With my folks, once we knew where they were going (it was a new section of an existing facility) we got the floor plans so we could study them. I talked to my folks repeatedly about how beautiful there home was and how much pleasure it had given people, but I also emphasized that we wanted their next place to look beautiful as well and stuffing everything from our home would not do the new place justice. </p>

<p>I spent weeks & weeks with them sorting out their possessions. We would go through a room a day and put things in several categories - donate/pitch, sell (I hated that category) undecided, or moving with them. </p>

<p>As for furniture, I blocked off the area of new rooms and physically moved furniture so they could see what it would look like. There were tears a couple of times because treasured pieces couldn’t go. </p>

<p>Packing took forever. My folks were just overwhelmed by the whole thing. Mom stayed on task, but Dad would put all sorts of junk on his garage sale table and work on fixing them up.</p>

<p>So, my advice comes down to this. Talk a lot to others involved, take care of yourself, and know that everything will take much longer than you think. Think about trying to get your kid ready for college and then think of doing it without showing any frustration or annoyance. </p>

<p>PM me if you like - it is not easy but when they are settled you will feel so much better.</p>

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<p>You’ve gotten some great advice, alwaysamom.</p>

<p>Here are a few additional considerations that I recalled after reading other posts:</p>

<p>–More expensive doesn’t necessarily mean better at an assisted living facility. Our uncle had a respite stay at a facility that was $2000 more per month than the facility he ultimately chose. The facilities were magnificent–gorgeous theater, beautiful dining area, huge bar and cocktail area, and lovely grounds–but the care he received was deficient. He literally felt ignored there. When he called the front desk and asked for assistance, it sometimes took an hour for someone to get there, or they never showed up at all.</p>

<p>–Many facilities have a distinct “culture”, and the sales director should tell you what it is when you’re touring the facility. For example, one facility may be full of residents who love to play bingo, while another is centered around evening happy hour. Another facility’s social agenda might revolve around trips to the symphony, lectures, and more intellectual pursuits. Ideally, you’ll want to match your inlaws’ interests to the culture of the facility.</p>

<p>–This leads in to the social director at the facility. She/he is BMOC at an assisted living facility. When you visit, make sure you meet her and then watch her interactions with the residents. How does she treat them, and do the residents act like they like her? Is she there on weekends? She’s important because she’s usually the person who will visit and interact with the residents who–for whatever reason–decide to socially isolate themselves and remain in their rooms most of the time. She’ll offer help and encouragement to get the residents out of their rooms.</p>

<p>–As your inlaws become less independent, it’s important that the facility offers assistance. Does it offer transportation to doctors’ appointments? To the grocery store? Will the facility do grocery shopping for residents who are physically unable to do it themselves? Is there an in-house store for essential grocery items? Does the facility offer assistance with bathing/dressing/medications, and is there an additional fee? Does the state mandate that you must hire an RN to help with medications (usually provided through the facility for an additional fee)? Will the facility do personal laundry, and what is the fee?</p>

<p>–When you visit, take a look around the common areas. Are there lots of residents there? What are their physical states? Are they friendly? Do they seem like people your inlaws could be friendly with?</p>

<p>–Do your inlaws have pets? Some facilities allow cats and dogs, but the residents must be able to take care of them. Our uncle has two beloved cats that he cannot care for properly, so we’ve hired someone to come in every other day to feed, water, and change the cat litter. The cats help him feel less lonely.</p>

<p>Best of luck!</p>

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<p>I knew I could count on my CC friends. Thank you all so much! Your suggestions and comments are very helpful and also very appreciated. </p>

<p>A little bit of background which may trigger some additional, or different, advice. My in-laws should have moved out of their house years ago and into a facility with assistance. My H and I, and my H’s brother and his wife, have been suggesting this, for years, but my H’s sister who lives in the same city as my in-laws has resisted even raising the subject with them. This has made it difficult, as the burden of the work with them has fallen on her. The rest of us live far away.</p>

<p>My MIL entered the hospital a couple of weeks ago, with a mobility issue, and now it’s crystal clear that she can not return home to the house. My FIL still refused to believe that they’d have to move but after a meeting with the eldercare staff at the hospital, has come to the realization. Somehow it is different if the information comes from a third party. The social worker at the hospital has provided a list of possibilities and that is where we are now. My SIL and FIL will start visiting them on Monday.</p>

<p>The level of care provided is my greatest concern. They both need care NOW, MIL more extensive, but still, neither should have still been living on their own. So, this is the reason I wanted to get ideas as to what to look at when visiting. My H and I have been looking online at the websites and, of course, they all look nice but we all realize that it’s important to look at various different aspects of a facility and not just the nice photos they have on the website.</p>

<p>My H and I want to be sure that they are in a good facility, with caring staff, and pleasant surroundings. We are, fortunately, in a position to assist financially, so that with the combination of their pensions, a small amount of savings, and eventually the proceeds of their house sale, the financial aspect of it is not a big concern. It is to THEM, understandably, but we’ve tried to reassure them that they should not worry about it. I do understand that more expensive does not always equate to a better facility, and we will definitely explore all aspects of the places to determine which is the best ‘fit’, so to speak. :)</p>

<p>Thank you for the advice on taking some time prior to disposing of all home contents. I think that that part of the process is going to be very difficult. My MIL will not be able to be a part of that. She will go directly from the hospital to whatever facility is chosen. My H and I feel that my FIL should be involved, not sure he’d want to be, but that perhaps after talking to MIL, they can determine what they’d like to take with them, if this is indeed possible. Then, a decision should be made by them as to what, if anything, they’d like to give to the various grandchildren, maybe a memento of some kind for each of them. They don’t have much of great value, but there are a few sentimental family belongings that they might want to divide among their grandchildren.</p>

<p>This is such a difficult process, and being far away makes it even more difficult. We’ve all been communicating by phone and email daily, and all plan to gather there in their city in the coming weeks, probably more than once, to assist with the move. </p>

<p>dmd, thank you for the read-the-contract carefully advice. I’ve heard of others who have had those issues. My H is an attorney, so we’ll be fine in that regard. He reads every last letter of the fine print on anything he signs or is involved with, as most attorneys do. Your story about your mom organizing protests made me smile. She sounds like an interesting and feisty woman, I’m sorry for your loss.</p>

<p>My H and I were talking yesterday about his parents and discussing how we will plan, and hope, never to allow this situation to happen to us so that our kids have to deal with it. I know that people don’t intend for it to be difficult and such a mess but it’s been such a lot of stress on my SIL and her family, on all of us really, I don’t want to do that to my Ds someday. Planning ahead and making these decisions before it becomes an urgent matter is so important.</p>

<p>Thank you all again for your help. I may follow up with you again as we go through the process, with additional questions. Any further advice or suggestions will be greatly appreciated.</p>

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<p>alwaysamom - I’d love to spend some time following up with this, but am out of town right now. Will be home tomorrow night, and hopefully can respond to your questions then. In my work, I visit LOTS of assisted living facilities, nursing homes, etc. in several counties of Illinois, and have developed a pretty keen sense of who is doing what right. Don’t judge a book by its cover. The only thing I will add at this point is I would definitely look for a place that is non-profit (unless it’s the ‘county’ facility that takes all the indigent residents). After everything I’ve seen, I’ve told my family that if I ever have to end up in a nursing home, it’d better not be a for-profit one. I will explain more when I get a chance to reply in length.</p>

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<p>A tangetial question for every one reading this thread (not to steal your thread OP, but it is related ;))</p>

<p>What about the healthy, still able to live alone, but newly widowed parent? Any one have thoughts which ought to be considered regarding staying alone in their existing home v moving in with a family member v moving to the ‘healthy old folks home’ in order to not be alone?</p>

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<p>In continuing care facilities, it’s important to understand what criteria is used to determine when the resident will be moved to the next level of care. This should be spelled out clearly in the contract and explained clearly to the resident-to-be.</p>

<p>My MIL started out in independent living and we just completed the process of moving her to assisted living within the same facility. She had a very difficult time accepting that this move needed to be made (there was no question in anyone else’s mind that it did). The transition from one level of care to another can be just as unsettling to the resident as the initial move into the facility. There is furniture to dispose of, a new set of neighbors to meet, and a very new routine that can be much more invasive to the resident than one might imagine.</p>

<p>What we found was that the staff was very good with the nursing care during this transition, but they lacked in the emotional care. I understand that some facilities have a social worker or counselor to help with this transition. How this is handled would be a good question to ask going in.</p>