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We're moving our loved one into a home. I want to know a few things to watch out for and perhaps the right questions to ask while we're there!

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Talk to the residents! Have lunch there and talk to them. They will tell you want happens behind the scenes when no one is around. I wish I did that. Nice and clean for a while then ants crawling all over the bathroom. Food is horrible. Not a restaurant, more like frozen food cooking.

And... All ALS are not the same. Some have different licenses, and limits on the care that they can provide. Check Medicare.gov for reviews.
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Reply to TinyDancer
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Beautiful lobbies give a nice impression to visitors but that is lost square footage to the residents so be careful of that - it is things like that you must watch out for

What is covered in monthly fees? - like depends, vitamins, soap, shampoo, skin lotion - if you buy then how do they make sure that only your loved one uses them - these extras can add up

What are the recreation facilities or physio or dietians? - these things keep up a resident's abilities to a maximum that they can do - even bingo has a person organizing their thoughts & matching numbers & letters

Look at a place with open eyes - I saw 1 place that had a special tub room with a tv for the more reluctant bathers - another called the tub room 'the spa' which seems so much gentile - it is just things like that which makes a difference in the long run
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Reply to moecam
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I only did one visit to a facility as my sis had gone to several and then picked her favorite - said they told her mom was a perfect fit (but that is coming from the sales person at the facility).
My mom had issues that are common among alot of elderly - a spine the shape of a "S", she was currently recovering from a broken pelvis from a fall (using walker), issues with blood pressure (potential future falls) and dementia (only short term memory) and no appetite, so would skip all meals if something wasn't in place to make sure she would eat (many meds result in no appetite), and my mom had advanced macular degeneration (eye disease - she was close to legally blind).
I would look for functionality - the place my sis picked was beautiful and decorated - but it had an open stairwell, the floor changed often (cant see & walker - meant potential fall at each change/bump of the floor) and much of the floor was stone/hard for falls. The living area had lovely furniture - but none of it functional as in sturdy (vs sink into) and good arms on the seating to assist with standing - which is all needed if there is any issues with back/spine.
Healthy Meals - are also important - low salt, fresh fruits & veggies...the place we visited did the meals like a restaurant, but the options were things like burger & fries, chicken fingers & French fries - there really wasn't any healthy items on the menu. Diet is very important for everyone(my mom liked all food so was easy to have her eating healthy).
So #1 - don't trust a sales person :)
Look for functionality and health over beauty.
And moving is going to be hard on them - so pick a place that will be able to accommodate any future health issues that may arise after she moves in.
My mom never wanted to go to a facility - siblings wanted her to go, but I stood by my mom's decision. We hired a social worker who specialized in the elderly and would be the voice for my mom. She thought with my mom's issues (and explained how it is important to determine what is hearing, vision or memory issues), she would be better staying in her home and having in home care. It pissed off the siblings, even though the social worker idea and the one we used was my sis recommendation....But the social worker was a godsend to me - as I became my mom's primary caregiver at home and had someone to help with decisions....so maybe find a social worker to help as well - they can evaluate your mom's needs and make recommendations for a facility/inhome care resources/elder attorney.....etc...as that is what they do for a living. Good Luck!
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Reply to LadyDi18
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When looking for a place for my father I would ask family members how they liked the facility and how the resident liked the facility. I know this sounds weird but I would go by the smell of the facility. If it smelled like urine I knew the residents weren't being adequately taken care of.
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Reply to ebgranny
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Some ALs are filled with people whose needs far exceed what staff can properly provide, make sure they can give the level of care required and reevaluate periodically, you can't always trust what the administrators promise. Ask about staffing levels on evenings, weekends and holidays; are there regulars there or are they part timers who don't know the residents? If there is a facility doctor ask how often they are actually on site and how quickly they can be reached if there is a problem.
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Reply to cwillie
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Lots of good answers already. If you can find a long-term care home that is not part of a for-profit chain, that's better. Even that will not guarantee great care. You can make a list of all the things to look for when you visit, and indeed you should look for these things people have mentioned. But please realize that regardless of what you are told by the person who shows you around, no matter what the website says about great person-centered care and about all the wonderful activities: YOU need to visit as often as you can and be an advocate for your family member. Because there will never be enough staff to provide the wonderful care you're promised; resources are stretched thin in the best of places (often to ensure profits for the shareholders who own these chains). Here are a few things I'd ask:

Does the home have a Family Council? Not simply a resident council but scheduled time for families to meet with managers, nurses, and representatives of the care staff. If there is a FC, you can bring your group concerns to management, and this will have more weight.

What percentage of monthly income is spent on food? I was shocked to learn that where my family member lives only five percent of the monthly income was spent on food--and food was a huge sore point with these residents, lots of dissatisfaction.

How many staff are on duty for each shift? This may vary depending on resident census. Not the best staffing plicy but the one used by most homes, alas. The home will tell you that they follow state guidlines and this is probably true. It's just not enough to ensure good, attentive care,especially in memory support homes.
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Reply to minstrel
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These answers sound more like a nursing home than ALF.
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Reply to Mary1934
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Check around. The facilities charge differently for what they do. The way prescriptions are handled, who does the doctor visits, what the family is responsible for paying for in addition to the The facility costs. Really dig into it because they do have their own way of doing things. other advice is send nothing of value with her. Take the wedding ring, no cute jewelry, no cute clothes, limited shoes and clothing. You can change the clothes on a weekly basis or monthly basis to give variety. You need to go randomly for visiting. The caregivers, staff, will treat your mother better if they never know when you’re going to show up. Check on the little things. If they’re not changing the hearing aid batteries or not even putting the hearing aids on. Cleaning the glasses, etc. if she Does not move much, you must check her for bedsores on a very regular basis. The caregivers will only give as good of care as what they can not get in trouble for. I kid you not. There are very very few caregivers that give 100% quality service. Most of them are looking for a quick buck and easy work, in a sense. So sorry to tell you the bad news. Good luck.
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Reply to Lizhappens
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Anything above room and board cost extra. To save money I went to bathe dad a few times a week and he was
able to take own meds. (Medication administration was an extra $600), but when he started falling a lot at night and couldn’t take own medications the cost went way up and it was less expensive to move him to a
residential care facility where he could get closer attention. But he had a good 1.5 years in the assisted living facility.

I’d say don’t go by the price quoted over the phone. Brookdale has monthly specials the don’t tell you about until you are serious. My dad got $1000 off per
month forever.

Best wishes!
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Reply to SofiaAmirpoor
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Hello again, dorgot one thing, Do they allow external ressources to come in for your loved one. Some only allow their personnel ( toenails nurse etc).
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Reply to Letmelearn
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Hello, here a a few things I wish I had asked before when I chose a place for my mom and others I learned along the way. Do not ask "are there activities", ask the exact timeline of the daily routine and ask to see the schedule for the activities. Compare the menus and are they open to adjust to specific preferences, type of tea, yogurt and fruits for dessert instead of sugary ones. What is included kleenex, toilet paper etc. What does "weekly housecleaning"exactly consists of. How are clothes washed ? Three of my moms favorite wool sweaters and a vest that she recognised were destroyed by hot water wash and dryer on hot also...Even if clothes are washed separately for each resident, sometime some end up in other ladies closets and the towels seem to vanish on a regular basis but sometime some that are not hers appear. At what temperature are the roomk kept and aslo important how is humidity is controled. Last summer , because mom turns her ac off, it got so hot she became dehydrated. This winter it is a bit cool in the room but humidity is below 20%. Not the best for dry itchy skin. I baught an humidifier but the staff does not refill it and as soon as it stops, the levels drop very fast. Are there automatic emergency lights in the bathroom, not just the corridors or the rooms, last summer a major break in the equipement made it so that the rooms and bathrooms became totally dark, many fell and hurt themselves. It was in the evening before bedtime, they we watching tv, in the bathroom etc. If they mention doctor 24/7, what does that really mean? On premises or on call...Do they come to see patients in need if it is a week-end or at night ?Where mom is, the doctor was on vacation last winter when she needed a prescription. The first solution offered was to take her to a nearby clinic...during flu outbreak and very cold weather on icy sidewalks... Ask the turnover ratio of staff. Is it always new personel...why...How long will they keep you loved one,who decides and what are the procedures for the next step. Can you ask the caregivers to use her personal favorite products ( soap, shampoo, moisturiser etc) perfume ( very good sometimes for olfactive memory) . Who will cut her nails ( hands and feet ).
Hope some of this helps, but mostly I hope you find a place and staff where it will put you at peace as much as possible.
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Reply to Letmelearn
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Read the book, Being Mortal: Medicine and What Matters In the End, by Atul Gawande. It will change your perspective about Assisted Living and give you a lot to think about along with practical questions to consider.
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Reply to texasrdr22
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Make sure it s a continuum of care facility. Assisted living, memory care and nursing home, at a minimum, on the same campus if not in the same building.

And if she runs out of money do they accept Medicaid? Do they have Medicaid beds available? How long must she private pay before Medicaid would kick in?

Medicaid is usually only available in nursing homes, in most states. If she needs a nursing home in the future will you have to move her again?

What are their policies on evicting a resident? Yes, it happens more often than we all know. My mom, in memory care, became a danger to herself and others and was kicked out. She was on hospice at that time. Hospice recommended a smaller care home where all residents had been kicked out of their previous facilities. Yes, it happens. And it was cheaper!

The smaller facility was much better suited to my mom. It was her last residence as she passed after being there about five months. They also allowed hospice to come in for the residents there. Another important consideration in choosing a facility is if hospice is allowed. Not all do.

You may want to call a well reputed hospice to ask about their recommendations for a facility.
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Reply to gladimhere
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LexiPexi Jan 13, 2019
Some very good suggestions.

Thank you for taking the time to write.
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Look 'ahead down the road' a bit.
We had my 92 yr old mom in an assisted care place (which was all-inclusive price per month- no add on prices) and she loved it there - but now she needs memory care and government aid. The AL place that she was at did not take any Medicaid or Medicaid Waiver ( except VA benefits) ... while a 'sister' facility of the same ownership a few miles away DID take gov. aid. (Just as resort-like.)
Would have been nice to know that from the get-go, and had mom at the other place to start with. There was a minimum requirement of 1 year stay at full monthly rate before they accepted gov. aid.

Assisted care places are wonderful - BUT if there are any "forgetfulness" issues or transferring (w/c to bed, for example) issues beginning... those places are only 'assisted'... and are not licenced or staffed like a memory care or nursing home would be. Don't expect the AC to "babysit"/ look after closely your loved one. Showers can be refused. They can stay in bed all day watching TV if they so choose to ( certain behavioral stipulations apply in the contract for safety, of course)... but it is like having your own apartment ... with a bit of help.

Watch out for huge entrance fees (sometimes they pool those fees in a general benevolence fund for others who need it) or proof that one can pay full rent for more than one year (One place I called had a three year full rent requirement... for more wealthier people, I guess...)
Mom's AL place had a $2,000 deposit and first month's rent. That was it. (Compare to $15,000 entrance fees out there...)
She had a beautiful up to date studio that was huge - with a front living room, kitchenette, bathroom with shower and a back bedroom. Everything was included. No added "levels of care". (A bargain if loved one needs more ADL assistance)

Call around. Visit LOTS of places. Waiting lists can cost thousands to be on (refundable only if you don't move in there) ... but some places (just as nice) have openings (immediate or in a few months) without any waiting list fees.

Everyone will be on their best behavior when you take a facility tour; but check out room sizes... individual room thermostats? ...hallway sizes (roomy and light filled?)... how new... how dated... what kinds of activities do they offer besides bingo... do they offer free alternate menu offerings, do they charge extra to eat meals in room or not? (all- inclusive places top everything in my opinion...) etc...

What is nice is a month-to month rental with a 30 day notice of vacating/ moving. No binding contract, which is great as things can (and do) change quickly over a few months for loved ones.
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Reply to RedBerryFarm
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LexiPexi Jan 13, 2019
Thank you... You gave me some ideas to add to my check list.
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• Pick an AL that is near to whichever sibling will be checking in the most.
• Go for a visit without your LO. Describe to the salesperson exactly what your LO can and cannot do for themselves. Be very forthcoming, don't sugarcoat anything.
• On the tour: check out the finishes and furnishings, do they look reasonably well kept up? Does the staff look engaged with the residents? Do residents look like they are engaged with each other?
• Ask what level of care they will handle. Can you LO age in place there? Some ALs only handle very basic ADLs. Can your LO get PT, imaging, blood work, podiatry visits...in-house? The more that can be handled there, the fewer visits to doctors offices.
• If it's a concern, ask what happens when your LO runs out of money.
• Ask to visit with your LO and have lunch in the dining room (maybe even with a resident) or come to a happy hour or other activity. If they refuse this, it's a red flag and they better have a very good reason why you can't.
• Get them to assess your mom. They should offer to send their nurse to do it wherever your mom is and should be able to get it done within a couple of days, often same day. The assessment will tell you exactly how much her care will cost. If you're looking at multiple ALs, have each one do an assessment, don't assume they will all assess the same.
• Once you've made a decision and are ready to reserve an apartment, it can't hurt to ask if there are any special offers (reduction in community fee, reduced rent for x months, etc).
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Reply to IsntEasy
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LexiPexi Jan 13, 2019
Thank you for taking the time to write and giving me your suggestions.
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Assisted living is not covered by Medicare or medicaid in my state. And it's exactly that- assisted, sometimes assisted only if resident asks. It is self pay and anything ancillary is not included in room and board . This situation is ok as long as the resident is able to speak for themselves and does not suffer from too many issues that may require attention that honestly, they don't have the staff or equipment to handle. My friend was sent to AL in June , she had several issues preventing her from being home alone , dementia among them. The first month was ok,I visited often as she had no one else, her POA was out of state and bought whatever sunshine the AL sold him . Soon after, there was an " incident" that involved a hospital stay with rehab to repair a previous hip surgery. After that hospital stay, she declined rapidly, incontinrnce, inability to do anything for herself , including eating unless I sat with her and kept telling her to eat. She was a fall risk, used a wheelchair when she " remembered" I thought her Dr would have recommended a nursing home at this point as she absolutely needed more care I came upon her once using a tray table as a walker, in bed soaked in urine and yet another time , covered in feces. Another hospital stay soon followed, hospice was called in, as long as hospice is being used, AL can keep her there and continue to suck her money without being able to provide the care she needed when hospice was not there. They would just wheel her into the dining room, park her, she didn't eat, was becoming disruptive to other residents. It seemed AL left all up to hospice, who at best was there at her side about 2 hrs a day. She was on her own the rest of the time unless I was there. She would just get up any time the mood struck her, AL can't use alarms or even bed rails. I knew she was going to fall, just hoped somebody would find her. And yes, the fall came, apparently was going to use the bathroom, details sketchy. I came the next day to visit, hospice was there, filled me in slightly. She was a mess, totally incoherent, combative, in some pain from the fall, had a cut and bruise on the side of her head. Hospice said her vitals were good , they came as soon as AL alerted them of the fall. What I saw was a different story, gurgling sound, couldn't swallow, absolutely no reason left. I was there as 2 nurses tried to administer Tylenol crushed up in applesauce, a no go. Can't use an oral stringe, she had to eat it off a spoon. Why the Dr did not order meds for this end of life time period, I don't know. My mother had been in a NH , on hospice, there was a list of things they could do to make her more comfortable as issues cropped up. This poor woman suffered, the next day an aide looked in her room, thought she was sleeping a quiet resident is a good resident. Hospice showed up at their usual time only to discover that she had already passed at some point. I guess the point is , assisted living has its place, but be vigilant and in contact with the Dr, he/ she are the ones driving that bus. In my friends case, her primary care dr was also the dr that visited the assisted living facility, therefore, I truly believe he just left her in their care since he was in cahoots with them. She absolutely needed to be in a NH! More expensive, but they spend your money also then go to Medicaid . If she had lasted longer, AL would have kept her until the $ ran out, then transferred her to the county run nursing home.
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Reply to Friendtotheend
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shad250 Jan 13, 2019
Of course dr and AL were together. If she had gone to NH her dr would not be able to follow unless he had an agreement with NH
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When I was made POA for long time friends of mine who had no children or close relatives, I started visiting assisted living places to see what they were like, especially the memory care parts. Only one place had memory care apartments large enough for a married couple and they had to be together, otherwise the wife was looking for her husband. Once I found the place, it took me 2 1/2 years to get them to go. The husband, with short term memory issues, could not understand the changes happening to his wife, who had frontal temporal dementia. She finally got bad enough that she needed 24 hour care and to save money, I was able to convince the husband to move to the one bedroom apartment I had selected for them. When the facility's nurse came to evaluate them before they moved, she gave me advice to act on that very evening regarding the wife's needs and then guided me each step of her decline, including how much longer she was likely to live, when to start hospice, etc. After the wife died, she continued to guide me about the husband. He sees a doctor once a month who comes to check on all the memory care people and adjusts medications as necessary. If I have any questions, I ask the health care providers and they delve into his records to answer them. They are watching all the people living there and making notes on any changes and all the staff members are charged with that responsibility. If they notice a change, write it down and turn it in! High standards that give me assurances I found a good place for my friend. He is 92 now and in good physical health, just can't remember things. I felt lucky to have found a place that gives the care they promise. I was told he would never have to leave. They care for them until they die. When he runs out of money after 18 months of regular pay, they accept whatever public financing is available, so I don't have to worry or consider another move. He's been there 3 1/2 years now, so no worry about that.
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Reply to JohnnyJ
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Careful with meds! Make sure that parent can use their own pharmacy/insurance not what the Assisted living facility uses. It will be bubble packed and very costly.
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Reply to daughter1952
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The best advice I can give you which was already mentioned is to ask everyone you know (or people who know others w/parents in homes) about the facility their parent or grandparent is in and how they regard the level of care. We hired and initially trusted an independent care coordinator and put my dad in a place she highly recommended. It turned out to be a disaster. We moved him ASAP but not before he got very sick and took a sharp mental decline. Also i found the official Medicare/Medicaid rating system to be 100% unreliable. (They may have improved in the last 2 years after an investigation and article by the New York Times.) Finally all the places are understaffed and could use more nursing assistants on any given shift. That’s a reality you have to live with.
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Reply to Violet521
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I selected an AL facility for my mom based on the assurance that she could get help getting dressed and be transported downstairs for coffee anytime after 5 am (she was an early riser) and that she would be bathed three times a week, her bedding would be changed weekly, etc. Sounded good when presented by the marketing person. It came to pass that these things did not happen regularly, the caregivers were not able to adhere to the schedules because of always being short staffed. I heard this excuse for two years, it was a constant battle with the director to get what we paid for. Also note that caregivers are just that, they are not there to keep your LO entertained. At this place, they were not allowed to spend time with a lonely resident or to help look for a lost item in the room. Huge turnover and always short staffed.
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Reply to kwyattearp
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For me, it's all about the CARE and the FOOD. Show up and watch.
Make sure both are good or it will be miserable.
If your loved one can still walk and speak up for her/himself, that's even better.
Once that's not available, assisting living facilities becomes more challenging [from my experience].

All the best to you and your family!!
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Reply to Savitaa
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Try to get her on Medicaid as soon as possible...find an elder lawyer who can guide you. Mom's nursing home was $13,000 a month....show up at different times with out them knowing.... horrible places we have to put our loved ones, but sometimes we don't have a choice....
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Reply to DiamondAngel14
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My dad was a resident of CBRF-community based residential facility that specialized in memory care. It was brand new and 3 miles away. They have a bit of a different philosophy that this is their final home and I believe did more care than a traditional assisted living. Dad had a room with his own bathroom. They had two nurses, activity director and plenty of aides. Every day I visited there was a lady cleaning. It was very clean, fresh smelling, sunny and had indoor and outdoor spaces.
The facility used a point system and as dad’s dementia advanced and health declined his cost did increase.
I could talk with staff about dad’s care any time of dad and would be notified about their concerns. Always doing staff training and they have now built another facility next door as they have established an excellent reputation for care.
See if you can take with other people who have family members at the places you are looking at they will have the best information.
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Reply to wi57twin
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LexiPexi Jan 13, 2019
Excellent suggestions. Thank you.

What is a CBRF community? I'm not familiar. (I'll try to look it up.) Do you mind telling me which state you live in.

We live in Paradise Valley, Arizona - next to Phoenix. There doesn't seem to be a good solution. I've looked at both larger facilities and group homes. The patient to caregiver ratio is not good. The best is 2 caregivers to ten patients daytime / and / 1 caregiver to ten patients at night. My 74 year old husband has Progressive Supra Nuclear Palsy (similar to Parkinson's-stage 4), dementia and is clinically blind (all from agent orange - Viet Nam). All other health is excellent, so he could live for a number of years. His family have all live to their 90's and 100's. I need a backup plan for him - should something happen to me. Currently I have a little part-time help - so I can go grocery shopping, doctor's appointments for me, etc. In home care - for our area is approximately $15,000 a month for 18 hour care. We can do that for a while, but not forever.

Thanks for your answer it was helpful. Any other comments / suggestions are welcome.
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If I had to do it again, I would not choose assisted living for my mother who had alzheimers. Memory problems and the facility chosen did not jive.
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Reply to GranJan
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You are getting some good answered here. I will add to them.

I fill my mom's daily pill boxes to keep costs lower. I live close by about 30 minutes. Sometimes she needs an emergency pick up of meds. If you live too far away consider emergency runs for essential meds. Also consider proximity to doctors if you do the driving

To avoid extra fees, I purchase incontinence supplies, including disposable gloves. I frequently use online services to deliver goods to the home. Las may charge double if they have to supply.

As far as searching for a home, consider the vibe over costs. Small and cosy works well with residents with walkers. Wanderers may prefer large open rooms. Ensure the level of security that is needed for wanderers.

Are hallways dark or bright. I have seen some places that encourage privacy with all room doors closed. It reminds me of a rat maze when residents need to move from meals to activities. Others leave doors to rooms open to get more daylight in the halls.

Also check to see if there are levels of care. Just in case a higher level is needed, are you willing to help with moving? Sometimes changing facilities means new enrollment fees.

Remember that clients move in and out all of the time. Some will be very alert and others very confused. Avoid that consideration and look at the physical layout, the extra fees, and if activities are interesting.
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Reply to MACinCT
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Our AL works by a base monthly charge, and other things are added on. Medicine administration is $500/mo in our state, delivering a meal to the room is $3.50, unless on a 3-day doctors' orders to stay in room. Checking physically on the patient is extra, watching or helping to the dining room, small things - so ask for a list. Food is good but often too salty - we have to stay on them constantly although they say yes, low salt. If it's your mother and she is sex-sensitive, tell them you want to request only female aides in her room - or not. I generally like our AL over the past 3 years. Good luck.
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Reply to amitebird
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If you have been to a Time Share sales presentation, you will know what to look for in terms of assisted living.

There is a "buy-in"( about double the monthly fee). The medication may or may not be included in the monthly fee. Just a reminder your parent's current medical plan may or may not pay for it. So, get ready for a sticker price shock. Most assisted living centers get their medication from a specialty local pharmacy with one outlet that doesn't deal with generics that is open from 9-5 Monday through Friday.
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Reply to donkeehote
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Chloe99 - We went through this 4 years ago when mom was no longer able to live alone and did not need nursing home level of care.

Research! You want to be certain our loved one is well cared for. Part of this peace of mind comes from understanding the rights of assisted living residents and the obligations of the assisted living community. But this task is made more challenging because assisted living communities are not regulated nationally like nursing homes. Instead, each state has its own laws, regulations and licensing standards for assisted living communities. I suggest that you familiarize yourself with your rights and the legal obligations of assisted living communities where you live.

Look for amenities that you know are important to your loved one. Read the reviews to find out what other residents think of the community. If possible, go together to visit the community that looks like a good fit, so you can get a feel for the place and weigh in with what your loved one thinks of it before a final decision is made. From my experience, you most likely will not be able to find a AL community that’s perfect in every way and one they will love right away, but you should be able to find one that provides features your loved one needs to be happy.
There are many sites that offer great information.
·       U.S. Department of Health & Human Services
·       Elder Care services in your state
·       AARP

Good luck.
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Reply to Autumn50
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It's also important to check with the AL about your LO's particular hobbies or daily habits. My father eats 6-8 small meals a day, including one around 3:00am so the MC with a 24 hour kitchen was a major factor. A great-aunt had a quilting hobby and some ALs wouldn't allow residents to have scissors or needles at any time. My cousins found a smaller home that would not allow my aunt to store her quilting supplies in her room (other than a quilting frame), but would bring them to her in the activities room or her room during the day.

Sometime economics or other care factors have to take priority in selecting a home, but when deciding between acceptable choices, considering these other factors can make our LO'a transition and acceptance of their new home easier.
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Reply to TNtechie
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Something a friend of mine is experiencing now is an assisted living home requesting pretty forcefully that the family provide private sitters for several blocks of time, like early mornings for getting ready for the day and evenings for getting ready for bed. This is an unexpected added expense on top of the monthly fee. You need a good breakdown of what all is included in the monthly fee, such as shower help, and other daily care activities, and if or when it’s considered too much for the staff. Then whether they handle it by moving to a higher level of care or wanting private sitters
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Reply to Daughterof1930
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