I would appreciate help in asking questions when we are "touring" a facility. I have looked at two memory clinics in the area and the marketing is very good. With non-refundable deposits ( few thousand) and almost $6,000 per month I really am approaching this with eyes wide open. I don't want to get husband in a facility and find out it's not what they (the sales people) cracked it up to be.
Staffing ratio to resident especially how many staff on in evening and night. You want to see their weekly activity schedule. I will probably think of more later unless the rest of the members cover it.
I was told staffing was 3 patients to 1 attendant and he would be probably be a level 3 based on what I told them. I wasn't shown an activity schedule, but tomorrow I am looking at DC and I will make a point of that!
See if you can watch activities as they happen. See what residents are doing. One place that I saw a few people wandering around and many people at a cooking activity, another similar one saw many people just in a room with a TV.
Ask about costs. Some places are flat fees, others nickel and dime you for services. And I wish they were just nickels and dimes.
Ask about waiting lists. Every place I visited had at least one opening, so no deposits necessary.
How does the place smell. Should not smell of urine not disinfectants. I think the smell test is very important.
Is there a house D&F, and if so, what is it like. I've seen some very mellow dogs.
Eat a meal there if you can.
Talk with executive director and head of nursing. They may be more truthful than a sales person. I felt at one place the exec dir was trying to steer us away, that the level of care there was for people worse off than my wife.
Take someone with you. My SIL came and she asked better questions than me. And we could talk about the places afterwards. We both had the same first choice.
Ask if entry fee is refundable if your spouse leaves within 2 months. Ask of you can start at respite fees with no entry fee, and if all goes well if respite fees can go towards respite fees.
Thanks! Yes, the smell test....did that. I don't want that institutionalized urine smell! Talking with the head nurse is an excellent idea! I did feel that today the "Marketing guy" was glossing over costs and with the expense of what wasn't included. Financial planning is so difficult with this disease and I am trying to hold off as long as possible being a "self-pay".
Now that you have placed L in an ALF are you satisfied with the care? And is it what you expected? I don't mean to pry into your affairs, and you don't have to share, but I am trying to absorb as much as possible. Husband is declining so rapidly. This "sales dude" --lol---said he thought the way I was explaining spouse's rapid decline I would be ready for placement in 3 months! I am so unprepared! My weekend was a disaster with another major decline :(
All of the above suggestions r good. I just placed my husband in a memory unit yesterday. It went all right. It is not fancy but clean and does not smell of urine. I did not have as much of a choice because I am applying for the PACE program. Once I apply for Medicaid and he gets accepted. He will have a team of professionals handling everything. I believe his medical care will be better. I am calling the person who handles the program later in the week. I did not fall apart like I thought I might. I slept better last night than I have in a long time and am enjoying the blessed quiet. It took about 8 months for a bed to be available. My husband is having toileting issues, is still walking and talking but does not make sense when he talks. They r going to make him use the walker which he refused to do for me and wear depends which he hated. I know he will beg to come home so I am bracing myself before I visit.
It is going as well as can be expected. The first week was hard. The second week much better. The staff needed time to learn L's likes and dislikes (such as not being woken up at 5am just to introduce yourself) and a few things fell through the cracks, I suspect because the activities director was just returning from vacation and the ALF is understaffed (they are looking for new staff). And it takes time for L to adjust, which she is slowly doing. One problem we face is that L is the youngest resident and possibly the most cognitively able. OTOH being high functioning is making it easier for her to adjust, the idea is that she will have new routines in place by the time her FTD progresses which she is no longer so capable.
She may be making friends, but she is meeting more staff. She likes the art teacher and the activities director, once involved, seems to be doing a good job. The cat helps. I have noted a decline in language skills since moving in (the movie theater she passed by shows Netflixes). And I get 60 phone calls a day, mostly to tell me what she has just done or is about to do, with lots of repetition. L is slowly joining activities, nothing that involves games, which is key because the activities allows her to meet the residents who are also highly functional.
Her normal dining partner speaks very little and is over 90, but giggles a lot. L finds the giggling makes her giggle and that pleases her. Didn't expect that to happen.
One thing that surprised me is that L was assessed as more capable than I expected, so we are going in paying $2,000/month less than I budgeted, but I am sure we will climb up to that number in a year. L is doing her own meds (I set up a weekly pill box for her) but we had one glitch. But I need to make sure that her GP faxed the ALF a list of approved medications before I can have the ALF take over the medications ($600/month). The state law is very inflexible, either a person can take all of their own meds or none at all. And L needs a number of OTC drugs PRI during the day.
In terms of marketing people. At one ALF which was Memory Care the marketing person was very good. She understood FTD and as she gave us a tour she knew the names of the residents and participated in their care (she let a resident into the courtyard and then notified staff of his location). At a Sunrise the marketing person knew he couldn't answer some questions and had the head of nursing meet with us. At another Memory Care facility the marketing person seemed to be a hard sell over the phone but she had jury duty on the day we toured so we met with head of nursing and executive director, the exec dir seemed to be steering us away from the facility, thinking that the highly structured day would not work with L.
You want to ask how long the average length of service the hands on caregiving staff has and staff turnover statistics. Generally not a good sign if they have high turnover.
Observe the residents and their abilities...one facility we looked at had a small memory unit (about 15 people) and all were very far along in their disease (or heavily medicated) because they just sat like zombies on the couches and chairs. And they were all quite old, easily into 80's and 90's. That was not a match for my then 58 year old hb who was ambulatory, continent and quite alert and cognitively functional.
As paul advises, staff to resident ratio is very important - by law they have to post the number of staff by profession (RN, LPN, CNA, Health Aide) each day. Many facilities typically decrease their staff at night and I found that in memory units many residents sundown and need more attention during afternoons and evenings. If there is less staff during that time the residents don't get the attention they need.
Ask how they handle emergencies. How often does a doctor come in and do you have the flexibility to use your own physcians, if you want. Ask about medications...can you provide them or do you need to use the facility's supplier. When dh was in an ALF for respite, we had to use the facility med supplier because they required that medications be in a blister pack and our prescription drug plan did not provide blister packs. and our plan would NOT pay for the meds because the supplier the facilityused was not an approved supplier. Can get very expensive.
Ask under what circumstances will your husband no longer be able to reside at the facility. Many of the places I toured said they would no longer keep him if he required a 2 person transfer or was not partially ambulatory. Or they would no longer keep him if he went on Medicaid. Also ask how they handle someone who is combative or aggressive. Most places call 911 and send them to a psych facility. Also ask under what conditions they would NOT take him back . When DH eloped they refused to take him back because "they could not keep him safe".
Make sure you get all of the details regarding payments - community fees, monthly fees, fees for added care and services (hair cuts, laundry, etc), supplies (pull-ups-can you supply your own). Also discuss if any of the payments would be partially or fully refundable. When dh eloped after 2 weeks and they refused to take him back, the facility had been paid for the full month. My attorney had to convince them to pay back the 2 weeks because they would not take him back.
Speak to family members who are visiting and get their input about the facility and care their loved one receives. And it is necessary as paul mentions to bring someone with you - it is very helpful to have another set of eyes and ears.
As to blister packs, this is usually required by law if the ALF administers the meds. I believe this is to prevent staff theft of meds. Every facility I saw had a pharmacy but you could use your own pharmacy. The ALF pharmacy would package your drugs into blister packs for a penny per pill.
Paul, that was not our experience but that was 5 years ago, but I'm sure there have been changes. There was no on premise pharmacy at the time, and it was contracted out to an independent supplier and we never received an offer to blister pack our meds. It does underscore the differences in ALF's...although my husband's history is similar to your wife's (before he escaped from the ALF) no ALF would accept him into the general community even though he was very functional physically and mentally (we did daily crossword puzzles at the time and he got them all right)...they required that he be placed in the locked memory care unit, which of course means he would not be able to give himself meds. Yes, blister packs are required by law if the ALF gives the meds for at least 2 reasons- #1 so they can keep track of how many meds have been given and #2 to see if any have been stolen.
Of course at the time only 2 ALFs were even willing to take him. Even with this recent rehab stay in a NH for his broken knee, they refused to put him in the general population due to his hitting me 5 years ago...it didn't matter that he's been home with no incidents for almost 5 years, all they looked at was his original history and advised me that in order to "keep him safe" he had to be in the locked dementia unit. He has never been able to be evaluated on his recent history only the one incident from 5 years ago and that's why I will keep him home until he or I die.
Going back to the original question, someone should ask about medications at an ALF and if you can buy yours elsewhere and can they blister package them. And if so, for how much.
I am surprised about the ALF being fixated by an event 5 years ago. My wife hit me 5 years ago and served 2 years probation for it (record now expunged). I had been upfront with all of the ALFs I visited and this didn't seem to matter much to them since we had not seen high levels of anger in the past 2 year.
Some more question: do they allow for the residents to wander around inside? The Memory Care ALFs I visited were designed to allow for wandering and allowed for wandering in a secured outside area running around the building. Some ALFs do not allow for the wandering.
How do they handle situations when a resident is violent or delusional?
How large are the common areas and dining rooms. I consider large dining rooms to be a negative, the less noise and overstimulation the better. A very large ALF with a single dining room might be a bad thing.
Do they allow pets (if you plan on one)? Do they allow animal visitors? Do they have therapy animals visit?
Smoking rules? This just came up today with someone's mother, in this case she smokes often so having an accessible smoking area is important. You might want no smoking at all.
Does the room have its own fridge (usually a mini fridge) and kitchen sink. In my wife's room the bathroom doesn't have a sink but there is one just outside the bathroom and L uses it to wash dishes. Some places do not allow fridges because of the need for staff to inspect them frequently.
Do they allow microwaves?
Do they provide furniture? What do they provide. In my wife's case they provide sheets & blankets for twin beds, towels, toilet paper, paper towels.
Does each room have its own thermostat that can be controlled by the resident.
How high a level of care do they provide? Will they feed a resident who cannot themselves? Or a resident who cannot transfer themselves from bed to wheelchair? Or who cannot move under their own locomotion (this might include electric wheelchairs). Think of the future and ask what could force a move from ALF to a skilled NH.
What behaviors can force someone to be moved out.
Will your spouse have the freedom to leave the building and grounds on their own.
Do they use a speaker system to make announcements to the residents (meals, activities). My father's Independent Living apt did that and it was very annoying, it would have driven L crazy.
How often do they check for the whereabouts of each resident. One place was 1 hour, unless they were outside, in which case it would be every 15 minutes. I've heard stories of someone looking for their spouse and it took hours to find him.
I know some of these seem to be sniggling details but might be important to our spouses. I got different answers to these questions from different ALFs. I won't say what is right or wrong, but what is best for our spouses.
These are excellent questions ---I will be printing them off for future use! One can't be too well prepared where their healthcare and our finances are concerned.
The Memory Clinic yesterday was very cosmetically appealing- a new facility bright and cheery, but there was something that didn't seem right. Perhaps it was the marketing rep. was rather young (early 30's) and was more interested in a sale than correct placement. The previous facility I toured was nice, but older (not the bling or glam). At the older ALF, the marketing rep. showed more concern and empathy also. She was older (mid 50's), but appeared more upfront about "issues" and costs. I didn't feel rushed during the tour/interview as I did in the previous one.
Also, Paul how many times did you visit before you felt comfortable with placing L there? I am glad that L is doing well and I hope that the hourly + phone calls will diminish soon!
I feel so very overwhelmed this week. The struggles of placement (or not), daycare, finances, VA paperwork is making my mind spin in all directions. Thank God I have this site and its caring members who take time out of their day to answer and respond! I am so sorry that you are here, but grateful that you also have this haven of support.
I am sure that yesterday was a difficult one for you, and I wish you and yours a successful transition. May you have some peace and rest knowing that your loved one is being well cared for.
Try to find some family members of a resident(s) and question them. When my Dad was living at an ALF, a woman approached me in the lobby and asked how I liked the place and the quality of the care. (She was thinking about moving a parent in there.) I thought that was a pretty smart technique--the marketing people will paint an unrealistic picture of most places. That's their job!!!!!!
Lullie, as Marilyn says it's the marketing persons job to paint the wonderful picture of life in residence in their facility. This may be unfair but based on my experience 5 years ago, none of the marketing reps really cared if the facility was a fit for DH, they only wanted a sale. The directors of nursing, however, were very concerned that they could care for him and meet his needs while keeping him and the other residents safe. Out of the 6 facilities I toured only 1 would accept him. His age (58 at the time), physical health and strength, and recent aggression made him an unsuitable candidate for most facilities at the time.
I really don't know what the future lies ahead regarding a memory clinic for husband , but I am in the process of lining up all possibilities.
Main objective and goal: I would like to to have in-home care and hospice (if possible), but should a SNAFU arise I won't have to make a rushed decision in placing him. I will have the time to locate the must suitable facility. Because of his rapid decline ---non-stop in 1 year without leveling out I feel pressed for time in paperwork etc. Actually I feel like "the rat in the trap" story however; now my other paw is captured.
All the feedback has been so excellent. I believe that other members here will find this topic helpful too! Thanks to all
Between myself and SIL we saw 8-10 ALFs. We visited the one we selected only once, probably should have visited more, but we visited it together and we both have very positive feelings about it. Plus the room we wanted, balancing cost vs size, was available and L was ready to move to make the move. I didn't want L to spend to long at home thinking about moving to a ALF.
One problem is that they are shorted staffed at the upper levels. The Exec Dir is also doing the work of the sales person and another manager. But most of the staff have been there for a long time and overall low turnover. I think a problem at this specific place is that it is part of a chain and it is one of the smaller facilities. While there is little benefit for most staff to move to another ALF in the chain, higher level staff can probably make more money by moving to a larger facility in the same chain.
Looking at multiple ALFs was important to me. I really like the first one I saw but after seeing other ones I realized that it didn't meet L's needs and that the transition would probably fail (rooms too small, no ability to leave facility, residential only neighborhood). This was a memory care only facility and L would have been to able for it.
After reading all of your posts, I think the time has come to at least start looking and asking questions. He is past alf, I think, but hopefully a long way from nh. You have opened my eyes wide open. Bonnie