Since I am now looking into Assited Living for my wife I have some information and some questions. I realize that the legal definition of Assisted Living varies by state so I don't expect uniform answers, I'm in Virginia, might consider Maryland. I am probably looking for an ALF with a Memory Care unit, even if L doesn't need MC initially.
I have only toured on facility and it looks very good. It was built in 2010 based on the latest ideas in Memory Care (it is all Memory Care). 64 residents split into 4 neighborhoods. Each neighborhood has its own common areas including dining room. Residents have freedom to wander everyone inside and out but cannot leave the grounds. All private rooms with bathroom, but no bath or shower, those are in the hallways bathrooms (which also lock). Organized activities for most of the day (this is important to me since L often doesn't know what to do) but no one is forced to do anything. Rooms are small but that makes sense in Memory Care and people spend much of the day out of their room. Everyone is checked on an hourly basis, 15 minutes if outside. Residents usually start as respite care and then become regular residents if everything works out OK, and then pay a community fee.
I was told that residents need to be able to move themselves (walk or wheelchair), feed themselves and transfer themselves. It makes sense to me that these are requirement for being accepting into an ALF. Do ALFs usually require someone to leave if they cannot do one of these 3 things for themselves?
Are entry fees, sometimes called community fees, common? How much are they, the one I looked at the Community Fee was 6/7 the cost of one month of care.
Are there extra fees to look for? SunRise has a reputation of nickel and diming you (if only it was nickels and dimes) and has all sorts of levels of care, frequently moving people up to more expensive levels.
Do they offer ways to keep costs down, such as doing your own laundry if they soil their cloths frequently?
The one you visited sounds like a Somerford Place. They have an excellent reputation, and that might have been my first choice had the one in my area been close. It's 20 minutes away, which I realize doesn't sound like much compared to some situations, but with the Sunrise that Jeff now lives in being 2 minutes from my house, distance was a big selling point.
Perhaps you do get nickel and dimed more by Sunrise. I don't have experience with the other options to know how it compares, but it is true that a resident is apt to start at a lower-cost level then be bumped into a higher costing tier. There are also different prices depending on what sort of room your LO takes--a shared double being cheapest (what we have,) a private efficiency with a kitchen-like area (no stove or heating surfaces in the memory area) being the priciest.
Regardless of the rules or requirements for entry--no, the resident does not get evicted when he/she loses the ability to ambulate, remain continent, or self-feed. The only change which would necessitate a move to a nursing home would be if the resident required particular ongoing medical interventions which ALFs are not licensed to perform, or if you elected to (for example) have a feeding tube or something. In general, caregivers of people with terminal dementia do not choose medical interventions near the end of life (your mileage may vary, obviously,) so they can be hospiced-in-place, so to speak.
Yes, entry fees can be hefty. The Heartlands near me did offer to wave the entry fee, as a personal favor, but it was not the location I ended up choosing. I understand it is possible to negotiate entry fees in some cases. I paid it, but I put it off for the first 2 months by having Jeff there on a respite basis, so that I could feel pretty confident things would work out before I paid.
A possible fee where you can cut your expenses a bit is in disposable undies, bedpads, and wipes. I could pay to have those supplied by Sunrise, but order them in cartons from Amazon instead, and bring things in. In theory, this is cheaper. In practice, I'd have to do a study to make sure, because I think that sometimes a pack of wipes grows legs and walks, and I end up bringing more. In our case, laundry is part of the base rate.
In general, I am very happy with Jeff's placement. I have a good relationship with the staff and management, and they treat him kindly and genuinely are fond of him. Certainly the proximity to home has been a plus.
Activities were important to me, in theory, at first. But Jeff rapidly progressed to where they were essentially meaningless to him. But the food is good, and he seems to enjoy it. (He must be fed.) For a while, I could take him outside to walk around the lovely grounds, or to the bistro area near the main entrance to have a cookie, but his deteriorating condition nixed that a while back too. It was nice to have those things, while it lasted.
Do either of these facilities require you to show a certain amount of assets in residents name? It seems all that I've called about require any where from 275,000 to over 300,000,all that are available are so called non-profit,faith based facilities.So my DH will have to go into a NH instead of ALF, even thor the ALF wpuld be better for him.Home care has been too much stress for me
My expierence here in Mich,they'll tell you anything to get your business an then most will give you the business,in this state they can do what they want almost at will with little or no state rules to follow,my LO spent two nights at a well known ALF,the second day she "escaped" an the police were called,two days later she climbed over an 8' fence an was loose again with three aids standing there watching her,they told me they wern't allowed to physically stop folks,huh she could have broken her neck,I reported them to state an after an investigation was told the ALF did nothing wrong,the admitting person when asked if they could handle her lied an said there would be no problem as they could handle anything that came up,I could go on and on but I get so worked up thinking about it I better just cool down,if anyone wants to hear more of the problems we faced email me,I'll be more than happy to fill you in on some of the things to look out for
These comments are all very useful to me. A few things struck me about the place I visited:
1) The marketing person was familiar with FTD and could talk about it in detail. My SIL visited places that had never heard of FTD.
2) I was told they would not accept my wife if she was disruptive to he other residents and it they said it sounded like she wasn't ready yet.
3) No pressure to put her on a waiting list.
The rate for this place is a little over $7,000/month. My SIL thought this might be normal for memory care in our area. We discussed differences between this place and the ones she looked at, but some differences, such as room size, could be attributed to Memory Care vs. General care.
I can see why some ALFs look at assets. They don't want someone moving in who has money for only a month. I suspect removing someone who has run out of money isn't that simple.
paul, as you said ALF's differ not only by state but by company. We live in NJ and all the ALF's with and without memory care units require a community fee up front which here is equivalent to 1 month's room fees. The ALF nearest to our home (and my preference) requires financial disclosure and admission is predicated on the fact there is enough money to pay the fees for 24 months (minimum $275,000) at which time the facility will then try to place the person in a Medicaid bed if they qualify and if it's available. If a Medicaid bed is not available, then the choice is continue to private pay or find a facility which will take Medicaid. The application even asks if there are unpaid income taxes and if so the projected liability.
This same facility would also require the resident to move if they required skilled nursing care, required a wheelchair for mobility and/or required a 2 person transfer.
As abby* said, one of the biggest issues we had when looking for a place for DH after discharge from a psych hospital (he was 58 at the time) was that most facilities would not admit someone under age 62 or 65. The only one who took him at that time assured us that the staff was qualified and could handle a physically healthy and strong dementia person. The reality was the staff was totally not qualified to handle him. A good indicator is to look at the stage the other residents are with their dementia-if they have "aged in place" and are in the later stages of the disease and basically sit around with the empty look, there is a very good likelihood that they are not equipped to handle a younger, more mobile person. As phranque* says, the staff is trained not to physically restrain a resident, so they will stand by and not take action. In DH's case, he tried climbing over a 10 ft fence (the facility stupidly had benches next to the fence) but failed. Then he removed the screen from the window and climbed out the window...thank god he was on the first floor. Like phranques* experience the facility management called the police who took DH to an emergency psych unit and then refused to take DH back saying they "couldn't keep him safe".
Also many facilities charge more based on the level of care required by the resident. They should provide you with specific information on the review process, how they determine the resident needs greater care and what the fees associated with the increased care are.
I am considering Arden Court (1 hour away) which is entirely memory care. Their buildings have the quad set up and the residence is set up exactly like you describe. MarilyninMD's spouse is in an Arden Court facility and she is very happy with his care there.
I would recommend emilys approach - try respite care for 1 or 2 months to see if your wife adjusts and likes it there and you're happy with the care.
A friend of mine said that the building I described sounded just like the Arden Court near us, so I will probably be looking at it but I have to check the location. Right now the maximum travel time I want is 30 minutes in good traffic (in bad traffic time can take twice as long).
Your comments reminded me that good question is to ask the age range. Where I looked it it was mid 60s to 90s. Around 1/3 to 1/2 the residents I saw were in wheelchairs but they navigated themselves. People looked like that covered the full dementia spectrum. I saw residents in groups and by themselves.
Availability of Medicaid beds are a good question. This one doesn't have any. This can be important to most people.
I forgot to mention age. Yeah, many don't consider under 62. Some may consider it but say age may be a problem.
Number of floors is a good question. 1 is a good answer.
Ask how many days of respite is available. This one has up to 90 days for the exact reason you mention, to avoid the entry fee if it isn't the right place. And have them write in the contract under what conditions they will refund the entry fee.
It will be a difficult process. I don't any place to have everything I'm looking for, so I will have to decide later what is most important.
My husband is still at home. But his Aunt was required to move out of assisted living and into a nursing home (part of the same facility) because she was a fall risk. Then we had to move her out of that nursing home because she is getting close to running out of money and they don't take Medicaid. We knew it would be better to start out as private pay at a place that would eventually take Medicaid.
I am in Florida, but the rules governing Assisted Livings are similar in most States. Basic Assisted Living facilities have a license as an ASSISTED LIVING ONLY. You have to be sure to check the guidelines for remaining in the facility. In most AL's, the patient MUST be able to transfer from chair to walker or wheelchair without any lifting from the staff. They do not have the license for that. And yes, once the patient no longer meets the criteria of the facility, by law, they must move to a facility that has a license for lifting, such as a NH. That is what happened with my father. Once he could not hold his own weight, and needed lifting, I had to move him to a NH that had the lifting license and a Hoya Lift. IF a resident is perpetually aggressive or escapes, yes, they can be made to move to another facility that handles that type of behavior. You absolutely MUST check the criteria before moving your wife to a facility.
Here in Florida, there are ASSISTED LIVING FACILITIES that have an ADVANCED LICENSE that allows the facility to keep the patient when they can no longer transfer from chair to walker. Along with the license, they have the trained staff.
In Assisted Living facilities, it is considered an apartment that you rent. Therefore, you are responsible to furnish it, pay for the incontinence supplies, and all personal hygiene type supplies - personal wipes, latex gloves, toothpaste, powder, hand cream, soap, towels, etc. Just as if you were stocking your own apartment. You must pay for the medications just as you are doing at home.
Most AL's have CNA's who tend to the patients. A nurse may be on staff certain times of the day, but it is not like a nursing home where they are staffed with CNA's, LPN's, and RN's. As well as doctors who do regular rounds.
In NH's, the furniture, all the supplies, and all the personal hygiene supplies are provided.
Most AL's cost between $2500 and $5000 a month, depending upon the "cosmetics" of the facility.
The place I looked at provides all of the furniture but you can bring your own
I don't remember the details about the nursing staff but the director of nursing is a RN and they have LPNs and CNAs. They keep bringing in nurses straight out of school so they have people bringing in new ideas. Some of these nurses stay on, some move on. They also provided the names of the doctors who make rounds at the ALF. You can use these doctors or bring your spouse to their own.
paul, another question to make sure to ask is the staff to resident ratio and the turnover rate. And the make up of that staff-RN's, CNA's, LPN's and aides. It is also important to know the daytime ratio and the nighttime/weekend ratio as they differ. Typically there s a director of nursing (RN) who oversees the hands on staff but is only there during business hours. The facility my husband was in had a CNA on staff at night who would also dispense meds. Also important to know is how many of the management staff are on duty off hours and weekends....they handle what to do in emergencies.
In our area most of the ALFs MEMORY CARE units offer a furnished room with the option of bringing your own furniture. This is helpful if you're trying a respite stay before committing to the facility. And yes, it is important to know what the "refund" policy is in case your wife has to be moved for any reason. Usually the community fee is not refundable and I had to engage an attorney to recover the portion of the "rent" not used when my husband escaped. Of course I know you will have an attorney read the contract and make any changes before you sign.
Also make sure you visit during different times and unannounced so you can get a good feel for the place and the staff. I had lunch with my husband one day and was absolutely astonished at how the staff at lunch handled a woman who had dementia but was still living in the regular part of the ALF, not the memory unit. She started to choke, one of the aides tried to get the attention of the CNA who was across the room. The CNA ignored several requests to come to the woman (who was still choking) and finally said "You know she does that when she wants attention. She's ok".
Community/Entry fees are common in most companies- but you can start off as respite to see if you think it will work out (and to see if the facility thinks so too) before paying that fee. Sometimes communities will offer "incentives" but you may have to ask to see what they are. It's also worth asking to see if you can get a very good discount later on down the line if you stay a certain number of months- it's worth it for them to have you stay 6+ months, so they may give you a great break after 6 months-to a year on one month that can basically "pay back" your community fee.
One of the best ways to see how well staff does with residents is to see if you can observe a meal. You can watch how staff interacts with residents, what kind of cuing/prompting/assistance is given during a meal (are the residents needing to be feeding themselves fully or being totally fed? Or are they offering cuing/prompting rather than direct feeding to help them maintain the abilities they've got?). Do they get all the utensils- fork, knife and spoon? If residents can manage all utensils, they should get all utensils (and it's a good visual cue). They shouldn't assume that just because someone has dementia that they can't use a fork or knife anymore. Do they adapt foods to make them "dementia friendly"? Instead of spaghetti, maybe penne pasta. Boneless/skinless meats.
It's also normal (per state guidelines) to have expectations in relation to mobility and toileting for someone moving in. But ask about "aging in place". As the dementia progresses, will your loved one be able to stay, or will they have to move to skilled? Ask up front about pricing- what to expect for rising costs and what you can do to save on expenses. They will need to do an assessment prior to move-in and should be able to give you a break-down of what the costs will be.
I have been carefully following this thread as I am also looking at some facilities. At this time I think I just want to try respite. I know, many of you say the more cognitive they are when placed the easier it is to adjust. My problem is that he will never be eligible for Medicaid as his monthly income is too high but still lower than what a NH would cost. At $100,000 a year it wouldn't be too many years before it would eat up all of our savings.
My thought is to keep him home as long as he can stand and walk. He needs help getting up out of his recliner chair, but once he is on his feet and gets balanced he can walk (shuffle) to where he needs to go.
So I figure I need to know whats out there so if we need something in a hurry I won't be totally lost. Lots of good ideas of what to ask when visiting facilities. Thanks!
My husband was in an ALF in Florida. There was a separate Memory Unit. The rooms were furnished. The other area could bring their own. There were beautiful sitting areas & activity areas. They had a fenced outdoor area with a Gazebo. They had things to do all day long, if they chose. Several times a week they had entertainment. Music, singing that kind of thing. I was there everyday. We often danced. The food was good and was presented in a very nice way. Visitors could join the residents for a meal for $1.00. The residents were always treated with great dignity. He was hospitalized, then to a nursing home before he passed away. The fee for the ALF in the Memory Unit was $3500. a month. He was there for 6 mos. The nursing home was paid for by Medicare for 1 month. They stopped payment because he was not improving. I paid the last 2 months. That was $7500. per month. He couldn't go back to ALF because he couldn't make the transfer. He stayed in the NH to the end. I think his care was much better in the ALF. As far as the money goes, I feel. we saved for a rainy day. That was our rainy day.
ALF's and NH's seem to be a lot cheaper in Florida then here in Penna. Knew we should have moved down there when my sister invited us to come live with her.
MaryinPA, Have you seen a Medicaid certified Eldercare Lawyer. There might be a way to rearrange you income so you might become eligible for Medicaid. I am not going to suggest anything specific because I don't know, but it might be worth exploring. But I understand the problem, income is too high but won't pay for ALF and your living expenses.
paulc, The Medicaid certified and VA knowledgeble (sp) eldercare lawyer are on my to-do list. Got a name this past week at my AZ support group. Its a husband-wife team. If I could protect the investments that are in my name only I'd be happy. That would leave me something for life "after".
In PA medicaid goes back 5 yrs from when you enter a NH,not from when you apply for medicaid.Since my DH declined so quickly we will not meet that time period.
I just learned this week about some MAJOR difference in assisted living facilities in NY. For some facilities, a resident will only be admitted while still not experiencing problems with continence, eating, transferring, mobility, etc. Other facilities have special licenses and more highly trained staff that allow them to admit residents who are incontinent, unable to eat independently, etc. As per the NYS Dept. of Health website ...
What is an Enhanced or Special Needs Assisted Living Residence? An Assisted Living Residence (ALR) can obtain additional certification to become an Enhanced Assisted Living Residence (EALR), which permits the ALR to offer aging in place services. It can also obtain certification to become a Special Needs Assisted Living Residence (SNALR) and offer specialized care. ALRs with an EALR certification can admit and retain residents who exceed certain retention standards of assisted living residences. If a residence has an EALR certification, individuals can continue to live in the ALR even if they need another person to help them walk, transfer, climb or descend stairs, or operate medical equipment. Essentially, an EALR allows residents to age in place.
Care for Residents with Alzheimer’s or Dementia As Alzheimer’s or dementia progresses, individuals may develop the need for more specialized services because they have the tendency to wander, are less able to receive direction, and require more frequent cueing or one-on-one assistance. Residences with a Special Needs Assisted Living Residence certification have tailored programs to serve these residents and provide a secured living environment. Also, in some cases, these residences may accommodate people who require skilled nursing services.
Another major difference is that with some facilities in NY, if you are on their wait list and reject a bed/an apartment when it becomes available, you remain at the top of their wait list. At other facilities, you go back to the bottom of the list.
So ... BE SURE you check out these important factors when looking at facilities for possible placement in your area!!