What questions should be asked when selecting Assisted Living Facility (ALF)?

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I am visiting ALF's in order to select a place to place my 94 (severe dementia) mother, and would love to have a checklist of the most important questions to ask when I go to each one. I notice that they don't freely give out information, vs. being asked to answer questions.

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My mother has a professional guardian, the guardian doesn't tell me anything. This guardian didn't know all my mother's things were missing after her rehab form a broken hip at the ALF. When I told the guardian she simply acted like it was no big deal. I mean everything was missing not just clothing,her facial products, large photo of my mother and father, luggage and more. Her nails are always filthy, her hair looks dirty much of the time. A few times my mother's eyes were oozing I told the guardian my mother needed a doctor to look at her eyes. The guardian told me to stop finding fault and think positive. Now that I have pointed out somethings, this guardian has limited my visits to my mother to 1 day a week and my calls to 2 days a week, she also said if I cause any more problems she will limit me more. My mother looks forward to my calls and visits. The guardian also told me I am over staying my visits. No one has said anything to me, the care workers all seem to like me. I asked the nurse there if there was a set time to leave. She said 8 or 9:00pm, I usually leave by 7:30 seeing that I have a 31 mile drive back home and don't like driving in the dark much.
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In the state of Alabama, no one that has been dignoised with Alzheimer's or severe dementia qualifies for ALF. The would have to go into a specialty care unit or memory care unit. These units seemed to be filled all the time and one can be put on a waiting list., and the only other choice is a nursing home. Sadly, from what I have seen, these residents are left alone a lot and only get daily care, and very little emotional care, which is why I opened Safe Haven Senior Family Home so that seniors can get all the care needed, and have love as well. Wish I could take them all in, but being a Residential care home, I can only take in 2 at a time, which is all I would want to so that I have time, and the caregivers have time to give them love, compassion, respect and company. They might have Residential Care homes in your area.
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@elnmrp - just reread your question and see that your mom has severe dementia. Another thought - are the exits locked or monitored so that she can't get out alone. Also ask them their emergency situation/evacuation. I found that here in Florida a lot of ALF's are high stories - why I'll never understand. Do they have a backup emergency generator to operate the elevator, lights and electricity should power go out for a long period of time. How will they get the residents from the upper floors - sometimes maybe 10 or more stories - out without a working elevator, a few ALF's looked at me with no answer; and no there was no emergency generator. That's a long way for seniors to walk down and what about those on oxygen who depend on electricity for oxygen over long periods. One ALF actually told me they will open all the residents doors so air will flow and will hand out flashlights. And this was a well known named ALF run by a supposedly great organization. Even if the resident isn't confused that will sure make them confused, agitated and scared. Another ALF, popular name and also run by well know organization, told me they would move them to their sister facility about 30 miles south. Sounds good, but for some emergencies, especially here in Fl. with hurricanes, if the facility where mom would have been had to be evacuated so would their sister facility 30 miles away - but that was their only alternative. As you can see I always play "the what if" game and come up with various scenarios with every situation (I was the emergency/project coordinator for my City - so I guess that says it all - lol) My mom was not someone who like to get involved in all the fluff stuff and she had me to take her to drs., groceries, etc., so I opted for a very small - 30 bed one story facility which was not fancy but had everything she needed. But that depends on the individual of course and their lifestyle. They had games, pizza parties, guest entertainers, etc., but it was more like a large family. I found there was more one on one between staff and resident and everyone there was happy and very well taken care of and they had a great evacuation plan. I know I'll be back with more as I think of them.
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Great ideas above. Definitely get all the levels of care and the costs associated and get a detailed written list for the individual that is going in (don't go by the "general list" - you'd be surprised how their definitions change); ask to see State Insurance & Inspections; have a meal there - this was a great time for me & mom to interact with the current residents to see how they candidly felt about the ALF. Go in to the facility around 7pm. Sales staff usually isn't there so you won't get the "fluff" talk & tour. You can see for yourself how the off-hour staff operates. One of the other things I would ask is: if the resident needs to go into the hospital for an extended stay does the ALF deduct the costs associated with care during that time. Remember now, the resident won't be at the ALF so the ALF staff is not providing care during the hospital stay. I found that some ALF's go with the agreed upon monthly rent & care costs, whether the person is there or not. Others will only charge the rent if the resident is in the hospital and will deduct the care portion for the period when the resident is in the hospital. That can be a huge savings if the resident had to go into the hospital. Also, if the resident develops C-diff (they get it from use of antibiotics) or other contagious conditions what is the ALF's policy. Some say they can stay at the ALF others say it's off to the hospital/rehab. And if they are allowed to stay at the ALF what is their policy regarding the resident. Are they confined to their room? Make sure that if THEIR policy confines them to their own room (remember c-diff can spread quickly so it's for everyone's protection), then YOU shouldn't be charged an extra cost for certain care costs during that period; i.e., food being brought to the room instead of resident eating in dining room; if resident usually goes to nurses station to receive meds and now can't leave room because of contagious condition, you should not be charged extra for having meds brought to room. And if there is a lengthy hospital stay, (for whatever reason) that's where you want to make sure you aren't charged for "care" since the resident won't even be there during the hospital stay. And get it in writing! Also watch to make sure that ALL staff uses hand sanitizer and/or washes their hands before entering resident's room, touching their wheelchairs, walkers, etc., this is how disease (especially the fast spreading C-diff) can go through the ALF like wildfire. I know I have more suggestions, I'll check my notes and get back to post again. Good luck!
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There's an excellent "consumer guide to choosing a high quality medical rehabilitation program" which might give you a head start on good questions to ask. I can't post the link here (it will be removed) but if you google that phrase in "" it should come up at the top of the list. It has questions to ask, a great glossary of terms, and checklists. I would also recommend medicare.gov's quality care finder which you can use to compare facilities. Lastly, check with the Family Caregiver Alliance; they have a ton of helpful publications.
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It is important to understand the levels of care and the costs associated with this care. Ask for copies of state inspection reports, inquiry about the owners and sponsors long term financial stability. Ask detailed questions about how all levels of care will be provided and what the facility can and can not provide. You should also enjoy a meal at the facility and try to visit the facility during after hours and on weekends. This is not an easy decision so hopefully you have the luxury of time to do your research. If not, you may want to seek the advice of an industry professional to assist you in this process.
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