My mother is 91 and we’ve been told she has developed dementia to the point that she can’t live alone. We tried Home Health Care and Meals On Wheels and within one week she cancelled both of those. I got a call from the social worker on the case telling me she was referring the case to Adult Protective Services. We spent almost 2 weeks here in Utah last time making arrangements and now a week later we are back.
What questions should I be asking when interviewing potential places to house her? What should I look for when I go in the facility?
How is a skilled nursing facility different from a nursing home or assisted living?
I am totally clueless how to go about doing this - and I’ve got to do it Monday or face the wrath of Adult Protective Services.
I am sorry you are having to face this - I know it’s difficult.
In your mother’s case, one of the main things you need to be looking for is security - how easy is it for a patient to just walk out of the place? Some places are set up to handle dementia patients while others are not, and this should be the first question you ask.
Assisted living is more for people who don’t want the trouble of maintaining a home anymore and comes in various ranges - from meals served in the room to formal dining rooms, from medication deliveries to nursing assistance. These type of places vary widely in what they offer but the ones I know of really aren’t suitable for your mother’s needs. And they can be VERY expensive - when we were checking them out for my father-in-law a few years before he passed away, most of them wanted a very hefty non-refundable moving in fee - as much as $250,000 in one instance. That was in addition to rent, etc., and if he had died the day after moving in the money was theirs.
Nursing homes/skilled care facilities vary widely in quality. You want to look to see if there are staff members available to the patients - or are they all behind a desk? Are there activities for the residents? Is there a physical therapist on staff? Is there a beauty shop? A chapel (if your mother would be interested)?
Make an appointment with her doctor and ask for his recommendations - both for facilities to check out and ones to avoid. If she is a church member, some of the people in her church may have suggestions.
Is it necessary that she stay in Utah? Are there other family members nearby that will visit? Is it possible that a residence could be found closer to you? Visitation is very important when someone has their residence taken from them - she may be angry, and you will need to work through that with her. It will be easier to do if you can visit often, and not leave her feeling as though “they took my house and just dumped me here to die.”
Good luck. I hope you can find a great residence for your mom.
Cadolphin, these situations are always tough. I wish you the best luck in finding a good facility your Mother will (come to) like.
When I was a paramedic in Pittsburgh, my company worked exclusively with long-term care facilities. The ones I would have trusted to care for a relative always had a good list of activities for the residents. From what I could tell, activities were the first thing to be cut for budget reasons. They are expensive and (to the mind of bean counters) have little to do with the health of the residents. So, if you have a facility with a good record of group activities for residents, they will almost assuredly have a good record in everything else.
Otherwise, for your mother’s specific needs, what Snakescatlady said: security. Find out what specific policies the facility has about dementia patients. Some facilities have special dementia wards or wings. If you are at a facility that has one, find out what their policy is on when a patient should be placed in the ward. From my experience, specific wards are for patients who have deteriorated behaviors to the point that they are a danger to themselves or others (which is quite a step from just calling off Meals on Wheels).
To my knowledge, a “skilled nursing facility” is simply just a fancy name for “nursing home.” Hopefully, someone can come along and correct or verify me on that.
An assited living facility generally refers to something in between a “retirement home” (which may have a kitchen in a resident’s living quarters) and a nursing home. May facilities even have wings where one is an “assisted living wing” and another is a “skilled nursing wing.”
This site may help clarify the definitions, and its home page seems to have some good resources that may help you.
My only advice is to find a place that not only suits her present needs, but her future needs, as well. It’s too disruptive to place her in a facility which might be fine for now (a live-in facility with minimal assistance, for example) and then have to move her again in a year because she needs more assistance hor more security. Each move is traumatic and will be hard on her physically.
To add to what JustAnotherGeek said, try to track down someone from the local ambulance service. They’ve probably been to most, if not all, of the nursing homes in the area and can give you their first hand impressions.
Why don’t you start w/ the Adult Protective Services, they should have lots of info.
on options. You should be able to tell within a very short time if they are a competent
caring organization, or just a bureaucracy going through the motions.
If they’re the former it will save you a lot of time and trouble, if the latter you’ve only lost a few hours of your time.
Hi Cadolphin - I’m sorry to hear about your situation. I can only offer a bit of advice, though.
My husband and I went through this a few months ago when his mother got too ill from her cancer to live alone. We had a week that her physician would keep her in the hospital to find an appropriate nursing home. Her doctors and social services make the determination about what level care she required, and the insurance company gave us a list of facilities that would be covered. Social services is really helpful in pointing you in the right direction when it comes to finding out what’s available.
The best advice we got was to NOT make appointments for homes. We went en masse (Husband, me, and my in-laws) to the homes, said why we were there, and paid attention to what goes on when they’re not expecting a visit from a prospective “customer.”
It’s a frightening and often really sad experience. We looked at a LOT of homes that were just terribly depressing. We did find one that we all felt comfortable with, and my mother-in-law was happy at. (Although she only stayed a few weeks, we ended up moving her into our home under hospice care because of distance and her short time left.)
Please, email me if you need to talk about it. I’ve done this three times now. Really, the actual “what to do” isn’t nearly as bad as the surrounding feelings of doubt/guilt/fear. But it’s manageable.
Snakescatlady did a great job above in summarizing the differences between skilled care and assisted living. We have both in our facility as well as an excellant Alzheimers unit. Our Alzheimers unit is totally secure, you need a code to exit. They have thier own seperate activities staff to keep the residents busy.
I won’t go into all the details because everyone above has done a great job. I’ll just add that I’m sorry for your situation, and I wish you luck. I’m just glad you care enough to care! We have actually had families bring in thier “loved ones” for day care on the alzheimers unit, and never return for them, like dumping a dog at the pound. :mad: We call adult protective services in those cases.
I just wanted to add that finding a place near family is important too. My experience has been that residents who have visitors fare better than those without.
Check out the smell of urine in the facility. There will undoubtedly be some urine odor, but an overwhelming stench means people are not being cared for properly.
I have spent over 10 years in geriatric care and can say a few things.
I second the whole comment about Recreation, but in general often Recreationists are a bit “Mary Poppins-on-uppers”-ish and so don’t judge by the recreationists themselves, but more on quality/quantity of programming. What about weekends?
Who dispenses medications? Registered Nurses, Practical Nurses, unlicensed staff? Make sure the medication dispensers are licensed. Are there Registered Nurses on duty 24 hours a day? What kind of training do the unlicensed staff (opten called Care Aides, Nurses Assistants, Personal Support workers, or the like have? Do they take a vocational college course? On the job training? Or hired, shown the ropes for a few days and set off?
Do the residents look good? Are the men shaved? The ladies groomed? How often do the residents get baths? Does a hairdresser operate there, or come in on a regular basis? Take a peek at a resident’s fingernails… are they ragged and dirty? Neatly trimmed? Polish on the ladies nails? Are there lots of gloves and other supplies around? Do they arrange for things like podiatry appointments or have a specially trained foot care nurse or chiropodist come in?
Do the staff seem to actually talk to the residents? Is the staff happy? At meal times do staff have an idea how people take their coffee, if they like butter on their veggies or is the food just placed in front of the residents…everyone gets cream and sugar, no one gets butter. Look at the food especailly for minced or soft diets. Does it look and smell good?
If there are any other questions feel free to ask.
My WAG is that it’s similar to a rent security except much larger, to assure that the place still makes a profit if the family drops of Grandma and skips town leaving no forwarding address.
Another possibility is that it’s similar to the way some continuing care communities work, wherein you’re actually buying the unit, as you would in a condo community, and the monthly fees are not rent but fees for the various services provided. Except in the case of the nursing home or assisted living facility, these services are of course much more costly.
BTW, the Medicaid site mentioned earlier is an excellent one for comparing such places, and finding out in advance which ones do and don’t have ongoing problems.
After having looked at a few and heard about some others from the inside and the outside, look for happy residents out in the hallways or parlors visiting each other (not mutually watching the same tv), a step-down facility where they can care for a broad spectrum of abilities, security and safety (grab bars, call buttons, resident check-in, resident sign-out/in, evacuation plans clearly posted), walker and wheelchair friendly flooring and floor plans, benches or chairs in longer corridors fro people to sit and rest if they need to. Actually eat some of the food to see how it tastes and ask for a month’s menu to see if they are seving the same fishsticks every Thursday, or if fishsticks only happens once a month. What someone else said about on-site services like hair salon, podiatry, PT and/or OT. Also ask an administrator how the staff is screened since they will have access to the patients money/checks/credit cards in their rooms. Your mother may not realise that her checkbook is gone before someone has cleaned out her bank accounts. Tell a staff member about your mom’s interests or hobbies or past career and see if the staff member can tell you what activites may interest your mom or who else in the facility had a similar career/hobby/interest. Then you will know that the staff members actually care about the residents, not just care for them.
The one time fees I’ve discussed are buy-in fees that fund the common areas and equpiment in them. You rent your room and pay a lump sum for the parlor and parking lot. It is a way to pay off the construction costs without making the monthly payment too high for most people to afford. If you are planning on a short stay, the higher monthly payment is preferable, if you are planning on a longer stay, the lump sum will actually save you money. I’ve only ever heard of newer chains of assisted living/nursing facilities having the lump sum up front.
Kathy says thank you for all your responses. We’re both awfully worn out, as you can imagine, but she wanted to let you all know how much she appreciates you and your thoughtfulness and knowledge in this rough time for both of us.