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My mom has been living in an apartment with our support (transportation, groceries, etc). But she's getting weaker and we all agree (her included) that it's time to move to assisted living. She's 93. Our best guess is she has 2-3 years left (but you never know) and we want them to be as good as they can be, which to me means finding the best place. We have 3 seemingly nice choices in our community. All relatively new and and all seem very nice. I've asked for input from others from friends and from FB community groups and I get such varying comments. "I'd never put my mom there, we had an awful experience. She was terribly neglected." to "That place was fantastic. My mom had a wonderful experience. Staff was great." - all about the same place at the same time. Etc, etc. I know I'm overthinking it and majoring in the minors. Any advice on how to make your best decision? My dad was in assisted living (different state) and skilled care nursing home for 3 years, so I'm familiar. He had dementia and had specific needs. It's harder this time with mom who doesn't have the specific needs and is very capable mentally. She's been declining physically the past few years so we see a trend. I would just appreciate any tips on how to make the decision and also how to effectively advocate for your parent once they are there. Also any ideas for keeping on top of things- I'd love to put in a nanny cam type of thing where you can just check in on her ... but I know, I know... over worrying, invading her privacy for my peace of mind, etc. Gosh, hard to let go of this. I know we can always move her, but as with many elderly, she hates change. Anyway, enough rambling. Thanks in advance for any help.

A lot of good advice here. I narrowed it down to three for my dad to look at - it would be great, since your mom's mind is good, to have her make the final choice. One thing to be aware of is that there are always going to be complaints - always. Even if it's a great place, it is not the home that they loved. The food is not cooked the way they cooked it. There are a lot of new people that they might love to meet, but are still strangers at first. And they are grieving for a life that they are leaving behind. I tried to remember this when I got frustrated ("I hate the food"), and be understanding that losing control of your life is difficult. So, if it's a pleasant, clean place that keeps your mom safe, provides activities and - importantly - a staff that is willing to actively help her adapt to the new environment, I'd say it's a good option. Another point - you can always move if it ends up not being the right fit. I wish you all the best.
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KateyG Nov 8, 2021
Thanks for taking time to reply Lisa. You raise so good points that are helpful. Especially you can always move... may not be what you want to do but it's not the end of the world. I needed to hear that.
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I think that people go in expecting certain things from am AL and when those expectations are not met, they complain. There are things that are still the families responsibility. A lot of people don't understand that staff sticks to schedules. That Mom or Dad is not #1. I also think the personality of the person has a lot to do with their care. My Mom was no problem so the aides took very good care of her. You get one who is a pain, aides tend to do only what they have to.

So for me, I would go see for myself. Are the residents clean. Residents seem happy. No smells. The staff friendly. Rooms bright and clean. The facility bright and clean. Maybe Mom and you have lunch at each one.
My Mom was in a small AL were the residents were not separated. So Dementia residents mixed in with people that still had their minds. There were some residents that I felt should have moved onto skilled nursing. Since ur Dad was in one, you know that ALs are limited in their care. They don't have the aides or nursing staff that skilled nursing does. Some families don't understand this and expect the staff to do things they are not required to do. People need to realize that Mom or Dad will not get that one on one care that they would give.
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KateyG Nov 7, 2021
Thanks for the input. Very helpful.
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My husband worked in customer service for an automobile manufacturer for several years, and I always remember him mentioning the statistic that a customer who's had a bad experience will tell nine people for every one person a customer who had a good experience will tell. It artificially inflates the negatives, so a company has to be that much better than you expect to overcome some of those negative reviews. I always take negative comments with a giant grain of salt, because those are the folks who'll go out of their way to share their bad experience while also not recognizing that their experience was likely unique to their situation.

Ask the places for references, and call them. Of course they'll give you names of people who are really happy with the place, so make sure you ask them to tell you something they weren't happy about and how the place handled it. Ask about the food -- does their LO like it? (That's huge, since meals are the highlight of their days.) Ideally you want someone whose loved one has been there for a while, not just a couple of months.

Ask about communication -- does the place communicate well about the LO's situation? Do they welcome visitors at any time? What level of independence do they expect from the residents, and do they make accommodations for varying levels? For example, do they encourage the residents to come to activities, and if they don't, do they just give up or find ways to get them out of their rooms?

Go with the vibe you get, too. I had to put my mom in memory care, and I looked at a place that on the surface looked spectacular, but they had all the residents crammed in front of a TV in a fairly small common room. They also had a resident who was developmentally disabled and didn't belong in a memory care, but her parents(!) were in the assisted living wing and they decided to put the daughter in memory care. Totally different needs from what a MC resident needs, and that takes away attention from the properly placed residents. I also don't like places that use TV as a babysitter, so even though the place was 1/4 mile from my house and looked like a five-star hotel, I didn't go with it.

Since Mom's still with it, definitely involve her in the decision making, too, but at some point, let go of the worries. You're smart enough not to put her in a dangerous or abusive situation, so trust your judgement.
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KateyG Nov 8, 2021
Thank you so much for taking the time to reply. I really need to hear this. I've been stressing so much about this... and your comments really helped me take a step back and put it in perspective.
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My mom has a private apartment in AtriaSeniorLiving. The reviews were/are great. They did have a staffing turnover with covid but now things are stable. Because mom does not share a room. I put a couple of Blink cameras in her place and also an Alexa Show. The Alexa show is really nice. I told it to speak slower and now mom can understand it. When mom tripped she said Help and it texted me. I was able to look at the Blink camera and see she was on the floor sitting and then I dropped in on Alexa and talked to her. Mom had a pendent to call for the staff but forgot so I was able to stay on the Alexa until someone got her up.
When interviewing the facilities/communities, I got all of the info and amenities like podiatry, hairdresser, PT in house, in-house doctor/nurse visits monthly, dermatology, psychiatry and I asked “what does mom have to do to get kicked out?” This helped me see the parameters. It is assisted living and they do have transfers to hospice if needed and a memory care unit if she begans to wander. I chose Atria because of the price, amenities, food is delicious, clean, friendly people no matter what job they do, and the entry fee is transferable to any Atria if we have to move and want mom to move…or if this Atria isn’t doing well (not likely but nice to not have to shell out more entry fees)

mom loves it, she is independent, she has wonderful tablemates, she has privacy and safety. The flu shots were give and it was apartment to apartment. I got a fax number (FaxBurner) so I can get messages and requests to the nurses staff in writing. I am involved when I need to be and they know my name. Mom and I will talk and she will forget to ask for a Tylenol. This allows me the ability to advocate for her via fax.

The list of “tools” I use have made mom’s time with Atria a good experience for her and me. I put events on the calendar for Alexa to announce to mom so she can have more activities in her life.

I recommend independence for mom in Atria. We lived together for 8 months before she moved to assisted living and I think she is enjoying her assisted living because it is hard for family members to live together. I get to be a advocate daughter and she gets to have privacy and independent. She chose this place out of the 3 I had scheduled for us to visit. It has been a good experience (except for the turnover of staff during covid). Most staff have been there 8 plus years.

I have items sent to her via Amazon and she gets her teas, dry mouth lozenges, creams. i got her a DVD player and the staff set it up for her.

She is checked on several times a day with trash pick up, medication management, and if she doesn’t go to a meal, they check on her. I am pleased.

All of this has been prayerfully done. Mom and I prayed about it and all the doors were opened for this place. I am glad she is happy with her home.
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KateyG Nov 10, 2021
So many great tips! I had not thought of Alexa show idea. I'll check that out. Thank you so much for taking the time to pass on your experiences. So very very helpful
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I’ve said this before on another thread. Worth repeating.

I’m a State Ombudsman.

Five Stars ratings Mean Nothing.

People with loved ones in a facility will mostly give you compliments about said facility. Otherwise, they would be admitting they put their loved one in a mediocre place.

The key is to stay proactive. Keep your nose into everything. Ask questions. Do not fear retaliation.
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KateyG Nov 10, 2021
Thanks! That's my gut feeling; good to have it endorsed by a professional!
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Yesterday I visited the assisted living home where my mom went when she first had to move out of her house. I wanted to thank them for the flowers they had sent and for attending the gathering to celebrate my mom's life. They were so welcoming at the door and invited me to come visit the other residents on occasion, saying they really missed my mom, but also my visits, and told me their special stories about my mom's sense of humor. If I were to go to the memory care home that she had to move to eventually, I know I would get the same response. Both places are very small and the caregivers have worked there for many years. There is practically no turnover in staff. At the very large nursing home that she had to be in toward the end I think I would be recognized at the front desk and maybe the head nurse's office in the wing my mom was in, but no one else would even take notice of me if I were to show up there. And I was there every single day for 4 months. I got her moved into another very small end of life home, an actual house in my neighborhood before she died. They too still greet me with warmth. I think the large facility has good caregivers and they do their very best, but the atmosphere was just so different in my experience and the large assisted living and memory care places I have visited over the years also felt to me impersonal. My mom was very much happier at the small places, even in the end of life home.

When looking for places over the years, one thing I made sure to look for was a view from a window in her room, where she could watch people with pets and see the weather and seasonal changes. And that detail was really important with covid, as I could have window visits with her, which was the highlight of every day for her.

The other thing I'd like to point out is that since your mom is still mentally sharp it would be good to know if others in whatever home you choose have the ability to be friends with her. At the assisted living place I visited yesterday, they mentioned that they had a professor there who had no one to talk to, since all the others have dementia and can't enter into the sorts of conversations he'd like to have.

Good luck with your search.
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KateyG Nov 10, 2021
Good points. Some I had considered and some I hadn't. Thanks for taking time to write. The view for the window on my list too, but after reading what you said I talked with mom about it (she had not mentioned it) and she agreed with you. So that's higher on our list. I think as her care increases a smaller home will be a better fit so looking at some of those too... just to have an idea of next steps. Very much appreciated.
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This was pre covid, so I don't know if it would still work.
But when we were looking, I scouted out several places on my home, did the tour and narrowed down the choices. My mom was very hesitant and it was a challenge to even get her to go look. So I knew I didn't want her to see anything negative, as that would really send her back to " just let me go home by myself and whatever happens, happens."

So I narrowed it down to 3, and we toured. We ate lunch and talked to the ladies. Got an activity schedule and attended one, and talked to more residents. The residents will give you the lowdown.

Since your mom is still with it mentally, ask her what is more important to her in a place. Where would her apartment be, is it far to go to dining room, activities.

In my mom's place they had a resident council, that came around welcoming new people, giving them advice etc. They would come around to new residents and get them involved in whatever was going on.

Every one has a line on what makes a place "bad". Food? Communication with staff? How fast maintenance happens.
Activities?

While there have some people around since she went to live there in early 2020, there have been a lot of staff changes both in hands on everyday people, and administrators. So you might want to base your decisions on more the policies and procedures than the actual staff as they might not be there in a month.

Clean and well maintained, with multiple opportunities to socialize, decent food, is more important than shiny new to me.

Now, I'd also look as to how they handled the covid crises, outbreaks, lockdowns etc
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KateyG Nov 7, 2021
Thanks. It is different after Covid- but we've done as much as we can. We have asked about covid protocols - it is surprising the differences. But most are pretty good. I appreciate you taking time to reply. I've talked with mom about what she wants... but you raise a very good point. I was going a bit overboard with what I thought was best. I need to lay out the pros and cons and let her make up her own mind. She's more than capable. And good point about staff changes. Glad you took the time to write.
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The best way is to BE THERE and to be there when you plan placement. You may ask about volunteer opportunities if you have the time. Or just sit, as I did, when I visited , watching the world go by. Observing over the lunch table as my bro's lunch guest. I am still in touch with some of those seniors two years after my brother's deaths. I know how good the staff is. They are SO good that, if they hear a phone ringing in the room of a senior they will pick up, go and get that senior from the community room to get the call. Some of the volunteer jobs I saw done were a.m. donut tray, dog walking, visiting, delivering mail to the cottages, and etc. I can now vouch for my bro's place whole heartedly. The problem with getting input from others is that some people live to complain, if you know what I mean. I am still in contact with my brother's place due to his ex being in care. I am amazed how good the care is.
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KateyG Nov 7, 2021
Thanks for the input. I agree with the BE THERE... you are so right about that. I like your volunteer suggestion too.. if you can still do that with Covid. I know most are not allowing guests at meals right now. But you can join them for meal in a private room. Sounds like your brother hit the jackpot with his placement. Thanks for taking time to reply
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At this stage and with all of her problems, the woman should be in a medical facility vs. you taking care of her. You have no idea what you are in for if you keep her in your home. The problem is with any place you put someone, you never know the whole story. Some people absolutely love these places and make lots of friends. However, you must realize that no matter where you go, they are going to be short-handed. They do their best but they can do only so much. I would go and physically sit there for a few hours and observe and talk to other residents before you choose. For me, living in assisted living is sheer hell (I can't walk) but I am l00% high functioning and am so lonely and bored. Almost all have dementia and it is useless to talk with them. Thank god, I still work two jobs at nearly 88 (51 years doing animal welfare work local to international and for l5 years I serve as a power of attorney). For me, I have learned I take care of myself 100% - I just live here. But for her, it would be a good place to be.
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KateyG Nov 10, 2021
Thanks for you input. It's helpful to hear from your point of view- much appreciated. That's a very valid point about having other resident's they can related to. Thanks!
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One reason that responses are so different is that expectations are very different. Another, of course, is that the needs and wants of the residents are very different. My sister's MIL wanted a social life and found one in her AL facility. Another older relative wanted solace and rest. Obviously they reacted differently to very similar situations.

I would suggest that you carefully analyze both your expectations and your mother's. Also consider what services will be important to your mother's needs. This involves her emotional needs as well as simple physical care. Write everything down in bullet lists. Also consider the attitudes you expect between residents and staff. "Gentle persuasion" to one person may be "aggressive" and "pushy" or "bossy" to another.

Even the concept of "neglect" is a very personal one. If you expect that staff will check in on your Mom every half hour or so but the facility only does a check if a resident misses a meal you will have some issues. Sometimes, for a person of your mother's age and medical issues it is better to pay more for a regular nursing facility rather than Assisted Living. In "Assisted Living" it is usually assumed that the resident is capable of most of the tasks of daily living and requires little monitoring or supervision. In nursing facilities there is more interaction between staff and residents. For my uncle, who required no medications, it was still a better choice to place him in nursing care because he had difficulties with motor skills and hearing problems that required a higher level of supervision/interaction.

Do discuss your preference for a nanny cam when you visit your list of potential residences. The staff can give you pointers on what they allow and what approaches have worked well for others.

Also, don't be too put off by those who will insist that all such places are horrible and not an option. They are simply wrong. Whatever bad experiences or (worse) unfounded prejudices on which they base their opinions, there are many really good facilities. Those people are not going to step in and take care of your mother when her needs become more than you can meet. You are taking the right steps. I only wish we had looked ahead and found a place for my Mom when she was still sufficiently "there" to make a sound decision. I know that our visits with Mom in her last 4 or 5 years would have been much more joyful if we had visited her in a nice, clean group residence instead of her increasingly dirty and disorganized home. The change will be much easier for your mom to accept now. We waited too long and when she really NEEDED residential care she was no longer able to understand what she needed.
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KateyG Nov 10, 2021
Thank you so much for sharing your insights. It's been really helpful and reassuring. It reinforces much of what I've been doing and thinking. I can't tell you how much calmer I feel after reading this. thanks
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