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

AnudduhMom · June 28, 2009, 12:45pm

It will be interesting to see what teriwtt says! Everyone has had very wise input.

I worked in an assisted-living facility in Activities for a brief period, and I would add:

Make sure that the facility you choose has no “visiting hours” – in other words, you can drop in anytime. 
As you tour the halls, be very observant. Obviously, is it cheerful and clean, but are the residents actually doing something other than sleeping in the wheelchairs or watching TV? An activities schedule for each floor or hall (or center in the case of individual apts.) should be posted in every room. Ask for a copy. Check to see that there are activities your in-laws might be interested in. Ask if you or other family members can volunteer or do activities with residents. There should be a broad range of activities, from musical presentations, karaoke, “sports” for movement, to one-on-one time with an activities professional. It is nice if they have a bus or van for off-site events and excursions. The facility should have a complete 7-day-a-week schedule of events.

Privacy: The facility should have a policy that NO ONE on staff should enter the residents’ room or apt. without knocking. The staff should show respect for boundaries, and you should observe whether this is the case. Furthermore, your in-laws are a married couple and that should be respected. Nuff said.

Pastoral care: it may or may not be important to have a religious atmosphere for your in-laws. Even very active church or synagogue-affiliated facilities should provide access to clergy and ceremonies of other faiths, and activities for residents who choose not to participate in religious activities.

Every licensed facility has charts and reports that, by law, must be carefully kept and reported. Data tracking health matters are recorded: how many incidents of residents falling, cases of C-Diff or other infections, bedsores, if any, and many other health concerns MUST be noted. In facilities, charts are compared between “competing” or similar facilities. I think you can probably get copies of these data sets, but I’m not sure who you would ask. (teriwtt, do you know?)

If it is an issue for your folks whether to live among residents with reduced cognitive abilities (Alzheimer’s or other dementias), make sure that there are separate floors, wings, wards, or buildings for varying abilities. It is a lifestyle choice – every facility handles it differently.

You should ask “How quickly does the staff answer the call bell?”, but be prepared to hear “Right away!”, but this isn’t always the case. It is good if they say – everyone on staff is expected and required to check in on a resident if the call light is on, no matter if they are RNs, Activities, Kitchen, or whatever. Sometimes residents will just bang on the call bell repeatedly because they are bored and lonely. (and some residents will call 911!) This is not a medical concern, this is an activities concern and an important one.

Please do send as much personal memorabilia as can comfortably fit in your in-laws living space. Not only is it a comfort to them, but personal items serve as “conversation starters” with other residents and staff. “Oh is this your beautiful family?” “Did you make this lovely afghan?” or “is this you during the war?” often would provoke very meaningful conversation with my residents. For those experiencing cognitive decline, photos and mementoes can be important ‘aides-memoire’.

Best of luck with this! Though it is all a heart-wrenching process many nursing-home or assisted-living residents are happy and busy. My grandparents loved it. My grandpa was a great favorite with the “chicks” (okay, they all had walkers), G & G were very social, and died at ages 94 and 97.

And I LOVED my job and loved my residents and miss them. Unfortunately, there was a lot of horrid infighting, bullying, and harassment among the staff, and AnudduhMom voted with her feet rather than jump in the fray. It’s too bad!

worknprogress · June 28, 2009, 1:51pm

Somemom - after watching my folks and my m-i-l age, I think moving to an extended care facility when one is still young enough to join in activities can be great. Obviously, it has to be a place that has a vibrant atmosphere, but based on the people I have met where my parents are now, the ones who seem happiest are the people who moved there while they were still young. They are so involved with day trips, volunteering, etc.

Alwaysamom - since you and your DH live farther away and the daughter has been the primary go-to person, please understand that she may be feeling a little defensive now. I am sure she is having second thoughts about what “should” have been done before now. She may have had this unrealistic dream of helping to keep them in their home until they passed away. Fortunately, in my situation my brother and I were in agreement with the need for our parents to sell their house, so my parents’ reluctance was theirs alone. What we did not agree on was how the work of moving should be handled. As the person who did virtually everything I was extremely irritated and defensive when he questioned what I did. He may have even been right at times, but I was in no mood to hear what might have been a better way to do something. So - I am sure you will be more considerate than my brother - he is one of the most smug people I know - but just a warning that you are all entering into an emotional landmine.

worknprogress · June 28, 2009, 1:54pm

One more thought - DH and I have also come to the realization that we never want to put our girls through this. Live and learn.

cathymee · June 28, 2009, 4:43pm

Have been through this with my Mom,though slightly different circumstance…we were looking for an assisted living with a dementia unit and we needed to find it fast. I didnt know where to start, the social work staff at the hospital she had been taken to wasnt helpful at all (NYC suburban area). I remembered seeing an online ad for a service called “A Place For Mom”.I contacted them and they were most helpful in giving me a list of appropriate facilities,after extensive questioning, which I then started visiting.The woman I dealt with was caring,kind and patient with me, being in the middle of an emotional meltdown.
There was no fee, as far as I can tell, they are independent advisors who make a referral fee if you chose one of the facilities on the list they provide.
I wound up choosing a place off their list after meeting the staff.It had a seperate building for dementia residents,not just an “area” and had different levels of dementia care so residents could stay in the building and move from floor to floor as their needs changed.This place had furnished rooms (suites on the assisted living side) and residents supplemented those furnishings with their own belongings.

jmmom · June 28, 2009, 5:27pm

I’m not sure if anyone has covered the question of your parents’/in-laws’ attitudes about going into Assisted Living.

When my I was researching places for my MIL, we knew that she did NOT want to go. She spent a year living with her daughter… what she and they thought she preferred to Assisted Living. I believe she still labored under the “being put out to pasture” view of any type of facility. She had no real understanding of the different range of options available now vs when her own mother needed skilled nursing care forty years ago.

I found it enlightenting, when visiting different facilities, to discuss with the staff this question. “How many of your new residents are happy to be coming here?” Often the answer was “very few” or “none.” But this gave me the opportunity to see the culture of the place in terms of helping our parents acclimate. The places I liked best gave me insights into how the first weeks or months would go in terms of my MIL’s frame of mind… helped us know what to expect. Helped me know that the staff had a good understanding of the process and how to help.

I was told that the feeling of loss of control (whether the resident is conscious of it or not) is a big part of the adjustment. To expect complaints like “they don’t cook my meat the way I like it”. These types of things can make us, the sandwich generation, feel that our parents/inlaws are quite unhappy. Not always so… just part of the process. I was told that the adaptation and acceptance of the new living arrangement (it’s really more than that of course; it’s a major change in life) can take typically about 3 months.

In my MIL’s case, she loved her new place almost immediately. Despite thinking it was not what she wanted. She is a very social and active person. A “joiner” and a “doer.” Being at her daughter’s place all day - with daughter at work - was actually quite lonely and boring… even if she did not complain. Being at her new Assisted Living facility was full of activities, social contact, good food. She also loved having, for the first time in her life, someone else do her laundry, cook her food, clean… She had not anticipated the pleasure in that.

Just a few musings that might help.

alwaysamom · June 29, 2009, 12:25am

Thank you, again, to all of you for your thoughtful and informative posts. I truly appreciate them.

worknprogress, I very much understand how difficult it is for my SIL, and I have truly attempted to be sensitive to her when we’re discussing all of this. It’s more difficult for my other SIL but I try to keep my thoughts to myself. The SIL on whose shoulders the inlaws’ care has primarily fallen, is unfortunately a person who has the type of personality who will avoid any sense of confrontation at all costs. So, this is why there was no advance planning, not even any recent planning, even as they went downhill very drastically. I feel very badly for her because now that the situation is an urgent one, it is falling to her primarily to do all the running around, and she does not handle stress well. My H and I will be there in a couple of weeks so will do whatever we can to assist her at that point but all we can do until then is to support her as much as is possible on the phone.

jmmom, you bring up some interesting points and a couple which I’ve been discussing with my H this weekend. With my in-laws, they are at the point now where there really is no choice that they have to move. There is no option of living with one of their children. It’s just not a feasible option. However, as I said to my H, I would not be at all surprised after they get through the stress of the transition and get settled, if they actually start to feel better than they have in a while. Things like meal prep, laundry, shopping, etc. will all be looked after for them. My H and I have paid for a housekeeper for a few years now for them so they haven’t had to clean in a while but having other daily chores looked after will be nice. The other issue of making sure medications are taken properly is also an important one. I’ve worried for a while that they don’t always take their medications at the appropriate times. I also think that my FIL, in particular, will enjoy having others around to talk to, as he and my MIL have become increasingly isolated in their home in the past couple of years.

annudduhmom, thank you for your expertise. It’s interesting hearing from someone who has worked in a facility. I’m looking forward to hearing more from Teri, too.

momwithhope · June 29, 2009, 10:51am

The perfect option for my MIL is different than most. She is in what is called “Adult Foster Care” It is a licensed facility in a home setting. At the time she entered, she was eating with a feeding tube so most facilities wouldn’t even take her. It has worked out better than we could have hoped for. For this family, elder care is a calling, not a job. Her health has significantly improved as she gets such personal attention. Emotionally fragile by nature, she feels comfortable and well-cared for. While this may not be the solution for everyone, I thought I would put it out there as it was something we were not familiar with when we first started looking at options.

Do look at your states licensing and complaint info. With our state at least, there was a wealth of information. The place originally recommended by her rehab facility had such complaints (abuse, neglect) that I wouldn’t let my MIL go there. When looking at complaints, etc. make sure you read “between the lines”. There is a huge difference between complaints of abuse and minor administrative errors. Also look to see how long they have been licensed for as an indication of experience and track record. I found that reading the investigation reports gave great insight to the true nature of the problems.

Best of luck with finding the right place for them.

condor30 · June 29, 2009, 11:37am

alwaysamom…hope your s-i-l doesn’t beat herself up over the parents staying too long in their home. it’s truly difficult to move a parent when they want to stay in their own home. sometimes is seems like it does takes a serious crisis …ER visit, a hospitalization…to make the move to other living arrangements happen. i found the doctor to be of great help in these situations. they can flat put their foot down and say that the parent cannot return to their home. jmho, but i don’t think it’s uncommon for parents to stay in their home longer than they really should. it’s just a very difficult situation to handle…and it oftentimes takes a crisis…to put the wheels in motion to get them to move to assisted living, long term care or to move in with a family member, etc. sometimes it is the impairments in their cognitive abilities that is the problem. their decision making ability is impaired…and so they make no decision. my kids are familiar with what we’ve gone through over the years with our elderly parents and relatives and i remind them to not let us stay in our home too long.

BusProfMom · June 29, 2009, 4:28pm

I went through this decision with my mom several years ago. She ended up in the hospital and needed to find an assisted living/nursing home option right away.

I asked several friends and colleagues for recommendations. I got several pieces of advice, many similar to those already posted. But, maybe the best piece of advice was pick a location close to where I lived or that would be convenient going or coming from work. No matter how nice the facility looks, there is a need for relatives or a close friend to check in often to make sure needs are being met. Elderly people moving into new surroundings can be disoriented and are sometimes not as communicative as a relative or friend.

Since your SIL will be the closest relative, this should be a consideration. You might prefer a different facility, but if it’s not easily accessible to your SIL, there will be less frequent visits. The staff need to know there is a caregiver who is there to help, communicate, and sometimes be a little pushy.

Best wishes for a successful transition.

worknprogress · June 29, 2009, 5:09pm

BPM - you are so right! I can’t believe I didn’t think of this!!

When my parents finally decided they wanted to move they visited one or two places and really liked one (and it is wonderful), however, they did not visit any that were close to me. They wanted something close to familiar grocery stores, church, particular branch of bank, etc. I didn’t want to discourage them from making a move (it took long enough for them to get that far in the decision), but I can’t tell you how many times as I drive by a really great place by me to see them, I wish I had spoken up.

Probably wouldn’t have changed their minds.

JHS · June 29, 2009, 7:22pm

I don’t have the time or the emotional energy to give this thread its due, but I’ll try to sketch some important points:

<ol>
<li>Trust is important. They CAN change the agreements, they CAN do all manner of nasty things. Look for the places that serve the community of which you are a part, where you know other people have their parents, where you know people on the board, etc. It’s not perfect, but at least it restrains bad behavior. And talk to as many people as you can, find out what they like and dislike before signing up.</li>
<li>Stay involved. Visit a lot. Chat everyone up, from the director to the maintenance staff. Develop those relationships, and use them. Everybody working in these places wants to do a good job, to help. If they feel a personal involvement with you, you will get heard in ways that may not happen without that personal involvement.</li>
<li>Things will NOT be perfect. Pick your fights carefully. Try not to have fights.</li>
<li>Recognize that good activities for a wheelchair-bound person who is mentally acute are very different from good activities for a physically healthy person with dementia. Someone with dementia can’t play cards or Bingo; someone in a wheelchair can’t garden (often). Ideally, there are lots of both kinds of activities available.</li>
<li>If dementia is a concern, look for dementia units. People with dementia often need significantly more assistance than “Assisted Living” provides, but a lot less than a nursing home level of care (and they may need more freedom than is available there, too).</li>
<li>Adverse drug reactions happen. A lot. Stay on top of the medication and know the side effects.</li>
<li>A lot of places will promise (not in writing) not to kick someone out if they run out of money. This is a lot more credible if all appropriate levels of care are included in the same institution. You do not want to be in the position of running out of money, and then having the Assisted Living facility decide that your parent needs a nursing home, so that you have to look for a nursing home placement as a pure Medicaid patient. And you can bet that if your parent runs out of money at an Assisted Living facility, your parent will be deemed to need nursing home care in very short order.</li>
</ol>

An institution can thrive with a mix of full-pay and Medicaid patients, but it can’t thrive for long with a mix of full-pay and no-pay patients. Medicaid will pay for nursing home care, but not Assisted Living.

<ol>
<li>Don’t guarantee your parents’ payments unless absolutely necessary. Make certain you are not signing a guarantee that calls itself something else.</li>
<li>The facilities will analyze your parents’ resources to a fare-thee-well. You should analyze their’s, too. If they get into financial difficulties, all bets are off.</li>
</ol>

geezermom · June 29, 2009, 10:13pm

Since my mother had a severe stroke four years ago (it seems like forty years ago), I have become a walking encyclopedia and self-help guide on dealing with the needs of a parent in a long-term care facility. Overnight she lost the capacity to take care of herself, so we had to learn fast, and sometimes the hard way. I just want to say that this thread is amazing–so much wisdom and experience, and great practical advice, all of which I wholeheartedly second. It deserves a stickie!

Montegut · June 29, 2009, 10:32pm

We’re at the stage JHS speaks of. My mother has been in an assisted living facility for four years now. The only way we got her there was evacuation from a hurricane. She is wheelchair bound, but otherwise, in perfect health, although weighing over 300 pounds. We have been paying for this from the proceeds of the sale of the family home, but we are now at the end of our funds. We truly did not expect her to outlive her resources, as most people we have known that enter an old folks home, don’t last more than six months there. To their credit, the facility has taken very good care of her, but we do not even know where to begin to get her into another facility, how to apply for government assistance, and how we’re going to pay for her care in the interim. She has mental issues, so it will be a challenge to find a place willing to accept her. She cannot live with us because our home is not wheelchair accessible, especially the bathrooms. If anybody can give any advice or guidance, it would be much appreciated.

teriwtt · June 30, 2009, 12:16am

You’ve gotten some excellent advice here. My perspectives come from my mom’s living experience in an assisted living facility, and my job which involves going into them.

This may get poo-pooed, but I have to throw it out. Is there any chance they can stay in their home, and have full-time live in caregivers (CG)? It might involve a rehabilitation period in a nursing home, with the goal of returning her to her home. I’ve seen many elderly people who are so resistant to moving out of their house that the family finds live-in caregivers. I’ve seen some absolutely incredible CGs who become like family to the elderly. You can sometimes find some from other countries who have advanced medical degrees, and move to the states, and can’t practice here due to licensing requirements, Visa issues, etc., but are way more than qualified to care for all the needs the elderly and infirm might have. However, some elderly are also reluctant to have someone move in their homes… they are distrustful, and there’s not a lot you can do to convince them. Just mentioning it as an option. We deliberated back and forth with my mom about how to handle her transition after my father died. She was the one with many chronic health issues, so when he died after a short bout with cancer, it was obvious something needed to be done. It involved having someone come to the house several times a week (sound like what’s going on now with your in-laws) for several months, until my mom just realized on her own that even if she had someone doing everything for her, she didn’t want the responsibility of a home anymore. The weeks leading up to the move, family members had the opportunity to come in and claim items of sentiment, etc. A couple of days before the move, she had an estate sale to get rid of everything else that she was not going to take with her. What was left over, was donated to a charity that she had been very active in (Catholic Charities) over the years.

I, too, lived far away from her, and deferred all decisions to my two brothers who were in the area and involved in her life on a daily basis. I pretty much stayed out of any advice, suggestions, etc., since I would not be the one ultimately responsible for her placement. They toured several places and she had the final say. Interestingly, prior to my dad getting sick, they had already started to talk about independent living/assisted living facilities, but never finalized anything. But she had an idea of what was out there, etc., which I think helped.

If you feel so inclined to chime in to SIL’s discernment, the most glaring problem I see with facilities is the level of care they provide when someone has a decline. (My own mom had LTC insurance, which didn’t take effect until she’d been in the facility a couple of months, but once it did kick in, it paid around 90% of her expenses which was nice) The realty is, either your MIL or FIL will likely have failing health until they die, and various facilities have different contingencies in place for that. Someone above mentioned Continuing Care Community. A good one will be a large campus, because it will need to provide many levels of care/living. My mom wanted something more intimate and went with a facility that was just assisted living. A couple of weeks prior to her death, she had a major flare up of her CHF, and the hospitalization took more out of her than usual. She was forced to go to an nursing home for ‘rehab’ because she was too weak to go back to her apartment. She made it very clear over the years that she despised nursing homes. She was only there for a day and a half when she was admitted back to the hospital with peritonitis, which she eventually died from in the hospital three days later. The hospital was across the street from the assisted living facility, and several of the staff members came over to see how she was doing, and I think even the facility administrator was there visiting when she died (along with many of us family members). That’s how her situation played out, but I want to mention some other possibilities… one, had she been in a continuing care center, at least she would have gone back to a place she was somewhat familiar with (in her case, it didn’t matter since she eventually died in the hospital). However, had she survived some rehab and been able to go back to her apartment, the only way she could have stayed there would have been to ‘hire’ some extra help. When I got involved in healthcare, I was amazed at the number of families that hire CGs for loved ones who are not only in independent/assisted living facilities, but in nursing homes, too. They just want that reassurance that nothing is being overlooked. I’ve seen people hired for a few hours a day, a few times a week, to 24-hour. For my own mom, this could have been a possibility had she returned to her apartment, as she had a two-bedroom place. I’ve seen hired caregivers live-in with the elderly in assisted living facilities that have limitations in place as to what they’ll provide.

Another difficult situation I’ve seen in hospice in assisted living facilities, is when an elderly person no longer qualifies for the assisted living guidelines of a facility… meaning that they require more care than the facility can provide… and somehow the family thinks the facility will continue to serve the person (since, afterall, they are on hospice), or at best, the facility and hospice can tag-team the individual’s care, allowing them to remain where they’re at. But hospice will not take responsibility for daily tasks of living (nor would Medicare authorize it), and the facility has limits on what they will provide and it often reaches a point that they have to tell the family move them out now, or pay for a hired caregiver until they die. Hospices will discharge patients from their care for non-compliance safety reasons if their needs become more than a facility can provide and the family won’t step in and provide some additional care (I have seen family members temporarily ‘move in’ if a patient has little time left and requires total care in order to avoid a transfer). I’ve seen families with unrealistic expectations (or maybe just uneducated) who get mad at the end when their loved one seems to fall in a gap and they are forced to make other arrangements. With continuing care centers, this is not an issue. Honestly, if your in-laws are not willing to hire a full-time CG in their home, and they both have mobility issues, I’d really, really look for a CCC. I’ve been incredibly heart-warmed by experiences, where an elderly couple moves to an independent/assisted living facility, one spouse requires a more advanced level of care, and the remaining spouse (who is not appropriate for driving) is able to come spend the day with their ailing spouse. It gives both of them great satisfaction and comfort, knowing that they can still be together, without necessarily living in the same room. It does break my heart when I see couples where one requires advanced-level care in a nursing home, and the other, although perhaps healthy for their age, cannot drive, leading to a premature feeling of abandonment and/or isolation which could have been avoided had they both been in a CCC.

The four CCC facilities that I visit most often are church-affiliated (although you do not need to be a participating member of any church to move in these places). The larger religious denominations seem to have honed in on the reality that taking care of the elderly is a ministry that needs to go beyond nursing homes. It should do everything to empower couples to stay intact as long as possible, and when they must be separated, make it as easy as possible for them to be together as often as possible. Like I said, in the several county area that our hospice agency serves, I can think of four communities like this (if you’d like to google them, it’s Friendship Village, The Moorings of Arlington Heights, Addolorata Village, and The Lutheran Home). I also know that when we get hospice patients at these kinds of facilities, we get such positive feedback from the families regarding the person’s care prior to their hospice diagnosis. I wish I could say that for other LTC facilities that I visit (which primarily are strictly rehab/nursing homes). If I’m going to hear complaints from families, it’s usually from those who are in for-profit facilities. Please don’t read that wrongly, that I’m saying for-profit facilities cannot provide good care; it’s just that I just can’t really remember major complaints coming from families whose loved ones are in a non-for-profit place.

So I’ve thrown a lot of things out there. Digest it and if you need any clarification, let me know. Since this is sort of my line of work, I tend to talk about these things, assuming people understand certain practices. Also, I’m basically speaking to my experience in the Chicago area. If someone is in a more rural area, things could be different (although some of our territory is in some pretty rural areas).

I still have travel-brain freeze, too, so if something I’ve said doesn’t make sense, I might not have written it in a way that I might have verbally said it if I was having a dialogue with a family.

geezermom · June 30, 2009, 10:53am

A response to Montegut: In order to qualify for Medicaid Long-Term Care Assistance (i.e., have Medicaid pay for a nursing home), the resident must qualify both medically and financially. Within your county department of health and human services, there should be an office dedicated to long-term care medical assistance. Call them and get information. It is complicated. Unfortunately, many people don’t realize there is a medical examination involved, and you must require a certain “level of care”; exhausting your resources doesn’t automatically qualify you for Medicaid. Individual states and counties also have their own assistance programs, and again, HHS can help you. You could also find out whether your county has well-regulated assisted living group homes. There are options, but you have reached that limbo that many people find themselves in nowadays.

teriwtt mentions one of the things that I find deplorable about elder care. Hiring a caregiver for a family member in assisted living or a nursing home is very common–so common, in fact, that some facilities seem almost to expect that you’ll do this. But if there are no funds for extra help (as in my mother’s case), you may be at a serious disadvantage. I actually heard a nursing assistant in a nursing home where my mom was in rehab complain that a patient did not have a private-duty nurse. In the (thankfully) short time my mom was there, the attention to things like laundry and hygiene was not good.

We feel fortunate (knock on wood) that in my mom’s current nursing home, where she’s lived since the winter, they do not make that assumption. People who don’t have private-duty nurses, or Medicaid patients, or those with limited resources do not have inferior accommodations or lesser care. This place does not have award-winning interior decor, but it has excellent food, an extensive activities program, attentive administrators, and caregivers who show a lot of respect toward residents. It is a for-profit nursing home; I agree with teriwtt that nonprofits generally have the best reputations, but where we live nonprofits have limited Medicaid bed availability so they were not an option for us.

If you can pay for private-duty nurses, by all means do it. But if you can’t, be extra careful when choosing a long-term care facility. Ask how many residents have private-duty nurses–or, better yet, look for yourself because the management may not tell you. If this seems to be common practice, and you can’t afford it, I would look elsewhere. I believe that we all deserve the same quality of care, regardless of resources. But our long-term care system doesn’t operate that way.

condor30 · June 30, 2009, 11:33am

caregiving…housekeeping and home health…

has anyone else’s elderly mother tried to fire their housekeeper, not once, but twice?

my mother would also call the home health agency and cancel the bath aid. i could write a book on the weird but true stuff that sometimes happened.

alwaysamom · June 30, 2009, 11:55am

teri, thank you for all of the information you’ve provided. Up until fairly recently, we had seriously considered the possibility of opting for the stay-in-home-with-care choice. A friend of mine had done this with her mom and it worked beautifully for everyone concerned. However, for a variety of reasons, this is not an option for our family, and the hospital confirmed our conclusion by strongly recommending against it in this case.

As some of you know, we’re in Canada so the process is a bit different here. Facilities which are government run are available to everyone, at no charge. Surprisingly enough, most are very nice and well-run, and families are happy with the care that their loved ones receive. There are also many which are not government run facilities, some as Teri mentions which are run by churches, some which are non-profit, and others which are for-profit operations both small and individual organizations, as well as larger corporations like Sunrise.

There are a few reasons that families would not take advantage of the ‘free’ care facilities - you cannot be assured of getting into the one that you want. Usually, you will prioritize 3 or 4, and then when there’s an opening, you are required to take that position. This prevents some people from getting a location that is convenient for the family which can be a problem. The real problem, though, is that there is a waiting list, and in our case, it isn’t always a guarantee that you could get them both into the same facility at the same time. This is essential for us.

So, this week is the week of the visit. Seeing many different places with different levels of care, different options, different amenities, a few of which provide continuing care through end of life. All are within a 5 mile radius of my SIL’s home, which I agree is an important point.

momwithhope, thanks for telling us about the Adult Foster Care option. I had never heard of that before but it sounds like a great idea.

I’m so thankful to all of you for sharing your experiences and information on this topic. All of us are likely to have to go through this process with aging parents at some point and I’m sure that the information being posted here is helpful to many others in addition to our family. Thank you all very much.

condor, your story about your mother reminded me of the days when my mom was in the process of dealing with my aging grandmother who refused to move out of her apartment. My mom had arranged for meals-on-wheels and a caregiver to come a few times a week to help her with certain things in the apartment. My grandmother would refuse to let them in!

Montegut · June 30, 2009, 12:57pm

Thank you to everyone for sharing your experiences and advice. I have a number of friends who are dealing with old and/or infirm parents right now, married, widowed, single, and all of your comments are helping all of us.

I want to take the time right now to go back to the original poster’s question about disposing of items, just to share something from my experience.

When we sold the family home, even though I am one of five children, I was left with the task of cleaning out the house. Some of the siblings were able to quickly gather some things while in town, but they left things behind that may or may not have been sentimental to them.

For my twin brothers, they left behind their yearbooks, college photos, other personal mementoes. I boxed those up and put their names on them. It’s only a few boxes. I put those in a storage unit, with some furniture that was sentimental to me, although needing repair, as they did not take up much room.

I was chided by acquaintances that I shouldn’t do that, why spend my money to store their things, if they want it, they should get it themselves. I, of course, ignored that. I love my brothers, and they had their wives and children and were busy with their lives, and may not have felt that those things were important.

Within the year, we were struck by Katrina. Mom’s new house received some water, but not all was lost. The storage unit was safe.

In the coming year, one of my brothers passed away suddenly. His wife moved his children away, and we do not have much contact with them anymore. It has been devastating for my other brother, his twin.

As they went to the same college, a lot of those photos that were left behind include the two of them. Many of them include the two of them with my dad, at various father-son activities at their college. And I am holding on to other mementoes that my late brother left behind, that one day, his children may want, but will not appreciate now.

So please, when you go to throw something away, think of not only what it means to you, but what it would mean to your family if you lost one of them.

teriwtt · June 30, 2009, 1:01pm

alwaysamom - I wondered if your in-laws were in Canada, also, and if that might change the picture a bit.

Just as an insight, I’ve had several patients in Sunrise facilities. A couple of years ago, Sunrise added a hospice division to their company (Trinity Hospice). However, last fall, they sold it off because it was losing so much money and they could not turn it around. These are the pitfalls of facilities that also have hospice divisions within the same corporation. When Trinity went down, they had to transfer all their patients to other hospices. We got quite a few, and from what I’d heard, not all patients could stay in their assisted living facilities once Trinity know longer offered hospice, because the hospices their care was transitioned to, would not take responsibility for the level of care being provided by Sunrise, without families paying for additional help.

condor30 · June 30, 2009, 3:24pm

alwaysamom, that’s a funny story.

be sure that you have a family member check all billing invoices line by line…for any services, etc. provided to your folks. i’ve found numerous errors over the years. it usually just takes a quick phone call to clear things up. i worry that sometimes the elderly don’t have anyone to do this for them and they wind up paying for services, prescriptions, etc. that they did not receive. also make sure that insurance claims are filed properly. i have received billings where they didn’t file the medi-gap insurance and only filed with medicare.

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

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