Monday, July 7, 2014

Top Ten Things When Choosing an Assisted Living Community

You and Mom have decided together it’s time to help her move to an Assisted Living Community.  Now that you both have made that difficult decision, what do you do next?  How do you know which community is best for your parent?  Below you'll find listed the TOP TEN THINGS to look for in an Assisted Living Community.  This list is by no means the total of what to look for – but certainly will give you a start in your search.

1.   State licensing

Assisted Living Communities are not nationally regulated and in some states don’t even need licensing.   Research your state and find out what the criteria are for a licensed facility. Do your homework to see if that community meets your standards and those set forth by your state. 

2.   24-Hour In-House Registered Nurse Oversight

The care in an Assisted Living Community is often provided by certified nursing assistants (CNAs).  You want to know who is overseeing that care, whether they are qualified, and if they are available to your loved one and to you.  Serious health care decisions are being made daily in an Assisted Living Community.  You want the person making those decisions to have the appropriate training.  Get the name of the Registered Nurse (RN) who oversees the community and speak to them. Make an appointment if you need to.  Even better, some Assisted Living Communities have physician relationships featuring on-call doctors who make regular visits.

3.   Medication management procedures

Most seniors will be taking medication, possibly several different kinds.  You want to know how this medication is administered and who will be making sure your family member receives the proper medication. This can actually mean “watching” to make sure the medication is taken not left by the bedside.  Is the pharmacy program overseen by a registered pharmacist? Is the medication administered by the RN or a medical technician? It should be. If your family member has multiple physicians, they each can be prescribing lots of different medications.  Do NOT depend on your regular physician to oversee the possible interactions that can occur.  Make sure that all doctors and the facility have a complete list of medications. To avoid negative drug interactions, this list should be reviewed with the facility and doctors after each medical visit involving a change in prescriptions.

4.  Make an unscheduled visit

How does your house look when you are expecting company?  What about when you are caught unaware?  A top Assisted Living Community will be running as if company is coming every single day.  Is it clean?  Does it smell fresh?  Is there enough staff? Don’t be afraid to show up unannounced.  After all, your parent may be living there soon.  If on your visit they ask you to “come back another time when someone can give you a tour” or won’t take you through the entire community, that is a sign.  Always ask to walk through the ENTIRE community to see how things are humming.  There may be a “sample room or residence” that is set up to look like the Hilton.  Ask to visit actual resident residences – three different ones is a good rule of thumb.

5.  Talk to staff

These are your caregivers – the people that will on a day to day basis be interacting with your Mom or Dad.  Are they personable?  Are they neat and clean? Are they friendly and open? Do they seem knowledgeable?  This is more than a simple “hello”.  Stop and inquire – 
“How long have you been working here?”  “How long have you been a CNA?”  “What is your favorite thing about working here?”  “If you were the boss what would you do to make things run more smoothly?” Speak with the staff that you pass in the hallways – not just those introduced to you.  Also ask to speak to someone from food service and ask the same questions.

6.  Talk to residents

These are the people who actually live here and they will love talking to you. They may also be your most honest resources.  Make a point to speak to most of the people you pass, and ask them direct questions.  “How do you like living here?’   “How is the food?” “Do you feel like the staff is responsive?”  “Tell me about the in-house nurse, Name.”  “What is your favorite activity at the community?” "Who leads the activity programs here?"  “What would you like to see changed?”

7.  Eat a meal with Mom or Dad

Ask for a menu and order a meal. Most communities will have a month-long menu.  Ask if they have arrangements for dietary needs such as diabetic, low salt/no salt, heart healthy, and so on.  You may want to ask for their daily budget per resident for nutrition (they do have a budget for their food service and they do know what it is). This can tell you a lot about the quality of the food. Do they offer snacks during the day? If so, what type, and is there a regular schedule for snack delivery?  “What if my Mom doesn’t like the menu choices for the day – what happens then?” Find out.

8.  Compare pricing

The most expensive does not always equate with the best care.  Also, in most cases, quoted prices are negotiable.  Most communities will tell you they are full or almost full with a wait list.  You’ll know if this is true when you walk around the community – do you see empty rooms or residences? If the door is closed but there is no name on the door, the room is vacant. This can affect price and negotiation since the facility's objective is to run at full occupancy.  Ask for a written list of their pricing so you can compare apples to apples.  Does the quoted price include all base elements of the Assisted Living program (rent, food service, housekeeping, most activities, and transportation)? Also make sure that you are comparing care prices as well as base rent.

9.  Understand Care

An Assisted Living Community is designed to offer care for your Mom or Dad’s activities of daily living (ADLs). These include bathing, dressing, eating, continence, medication management, and ambulation.  Your family member may need assistance with one, two or all of these ADL functions.  Price depends on the number and level of ADLs that your parent requires. This may be in addition to the base price for room and board. This price for care can also change over time as the needs of your loved one change.  Assisted Living Communities are designed to offer assistance to seniors – they are NOT a nursing home.  Understand that should your Mom need further assistance that involves 24 hour nursing supervision she may no longer be able to stay in an Assisted Living residence (nor would you want her to).  Incidences that might change the game from Assisted Living options to Nursing Home or more advanced care could be but are not exclusively: IV therapy, ambulation issues that involve more than one person assistance, serious continence issues, loss of cognitive functions, wandering, and dialysis.  Understanding what the function of an Assisted Living is and is not is important for making the right choices for your family member.  Equally important is knowing that if your loved one's condition should change, it may mean that you will need to change their living arrangement.

10.  Listen to your Intuition 

Your heart will tell you a lot about an Assisted Living placement. The most important element of all is your INVOLVEMENT!  You will be the advocate for your Mom or Dad’s appropriate care.  If the best choice for your loved one is an Assisted Living Community, your close proximity and involvement in their care the most important element. Certainly, staff and management of Assisted Living facilities are important trained assets – but YOU are family and your family member is depending on you to be their voice.

Leave any questions or stories in the comments!

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