Assisted-Living Facilities?

Anyone have a parent or grandparent (or aunt or uncle, for that matter) in assisted living? You know, pre-nursing home?

• How does one afford it? I assume they do not take insurance or Medicare.

• Do they let you take your pet with you?

• Do they tend to have kitchens/kitchenettes?

• Do they force you to listen to small cheerful children sing?

• Do they force you to “interact with the other residents” if you don’t damn well want to?

• Are family members allowed overnight visits—how independent are the apartments?

• How long do the waiting lists tend to be? (Goodness, maybe I better get myself on one now!)

My grandmother just moved into one in Jersey, and my other grandparents just moved into a very different one in Florida. They come in many, many flavors and levels of care. I just visited my grandmother in Jersey on Friday; her room is sort of like a combination of a hospital and a hotel. She got to bring in some of her own furniture, and she has a fridge, if no cooking facilities. (For most people, it’s an attempt to divest them of the hassle of taking care of daily housekeeping. But at least she can have a glass of juice or whatever if she feels like it.) The place is hideously expensive, and residents have to show 5 years’ worth of fees in the bank, in escrow I believe. Lucky thing my aunt is filthy rich, at least by my family’s generally middle-class standards, but it’s still been a subject of much contention between her and my father. There are lots of activities and medical care on premises, but I believe everything is optional. Meals are taken in a rather nice communal dining room. I believe after the 5-year escrow runs out, they will take Medicare/Medicaid or any long-term care coverage you may have, but realistically most residents don’t make it past 5 years.

I haven’t seen my other grandparents’ new place yet, but I understand it’s more of an apartment-style setup with more privacy. It’s small, but they still have somewhat of a kitchen if they choose to use it. This place wasn’t quite so hideously expensive, but then they are at the lowest level of care, and it’s possible to be bumped up as the situation requires. I’m told one could shave overnight guests if one wanted, but there isn’t much space. There are, however, extra apartments on-site which can be rented out for guests, but they’re basically as expensive as hotels, so I don’t quite see the point.

None of my grandparents had pets, so I have no clue about that. I imagine some of the apartment-style places might allow a cat or small dog or something.

Obviously, that should be “have” overnight guests. I have no idea what their policies on shaving are.

Eve, my girlfriend just set her mom up in one. She had a stroke many years ago (and uses a walker), and her sister gave her the boot last summer. She has a one-bedroom place. I believe she has a full kitchen and she can dine with the others or dine alone. They have a van that takes them shopping. I believe they have minimal health care, i.e., wellness checks and maybe Rx supervision. I’ll be seeing her next week. Is your mom looking into this kind of set-up? I can get the scoopage and e-mail you (who knows? It might be a chain!)

I’m surprised the more apartment-like one was less expensive. I wonder if that also has to do with what facility owns and runs it, and where it’s located?

Anyone familiar with Sunrise Assisted Living? They have 90-some facilities nationwide.

http://www.wescanric.org/index.html

My great uncle lived at Westminster Canterbury for about 10 years, which was perfect for him because as he aged and became increasingly infirm he could move from independent living, to more assistance, to the nursing care facility.

They costs are extremely varied, depending on the level of services that you want. The web site gives a breakdown of living spaces, from garden apartments to 3,000 sf houses.

At least at Westminster, you could interact or not depending on your own level of comfort and interest.

Sorry, no pets (IIRC)

Yes, for overnight guests (if you have space).

Wait list was rather long, but they are expanding.

Your results may vary.

Partly, but I think it has more to do with the lower level of care provided. Staff are, I believe, the most expensive part of an arrangement like this. But then real estate within commuting distance of NYC is a lot more expensive than most places in south FL.

My son works in an assisted-living home. If you are thinking of putting someone in one of these places, here are some things to think about:

It doesn’t matter what you pay for the services, you’re loved one probably won’t get them unless you make frequent and unannounced visits to the facility to check up on it. You will be immediately branded as an asshole and a troublemaker by the staff, but do it anyway.

The people taking care of your loved ones generally are paid between $8-$10 per hour. There is no incentive to work hard because raises are few and far between and the work is backbreaking. Unless the employee is dedicated to this as his life’s work, he isn’t going to willingly walk someone around or change their shitty diapers.

Medications are dispensed by one of these same workers who has been through a course for the purpose. My son does this. He was chosen for the job because he sees this work as a calling and intends to pursue a nursing degree. You may not be so lucky with the person dispensing your meds.

Nurses are in short supply. The good ones are working in hospitals, ERs, or making big bucks as roving strike busters, or are providing private care to wealthier clients. The people taking care of your loved ones have no special training for what they are doing, other than what is provided by the care facility.

This is the scary reality.

State regulatory agencies are understaffed and cannot be on top of abuses all of the time. As I said, your best move is to make frequent visits and complain loudly and bitterly if your contract isn’t being fulfilled.

The standard of care is extremely varied between facilities.

  1. When you visit, talk to the people who live there. Find out how happy they really are.

  2. This is one case where a lawyer is worth his or her weight in gold. Have one go over the agreement. Make sure you know what you are getting. Believe me, you need it. It is worth the money.

My friend’s mother was in a facility that bled her dry, where she fought constantly to get the minimal level of services that she was promised. On the other hand, my wife’s parents are in a facility that delights them. They love the food, the people, and the care. My aunt is in the same facility, and she loves it as well. So it does work sometimes.

So choose carefully, choose well, make sure you know what you are getting.

My grandmother is in one and we’ve had excellent luck with her facility. The quality of facilities and care varies greatly - we were lucky to live in an area with oodles of facilities (south central Pennsylvania) and were able to shop around a good bit. We’ve also been very active in her care. The problems that we’ve had along the way were addressed quickly.

We chose a facility that had a full range of care available. Once she was in (we didn’t have to wait At All), she was in for good (unless she chose to leave). In our case, this involved chosing a facility that had a dedicated dimensia nursing unit - and thank Og we did. She started in a very independent apartment setting, though we always had her meds supervised. In her facility, meds are dispensed by an LPN. She’s progressed through the levels of care - and having them all at the same facility definitely helped with transitions when she was cognizant to them. At this point - it’s just easier for our family as we know the system and have a good amount of confidence in the facility.

We opted for a religously affiliated facility (Mennonite) - but this had nothing to do with the decision. When we were looking, these tended to be a bit cheaper. Other than knowing that there was a chapel in the corner of one floor, and a pamphlet that gave contact info for every religion that had services in the area, there’s been no contact with religion. Socially, she stayed away from the Group Activities but became friends with a few people along the way and would play cards / watch TV / sit in the dining room with them.

All in all, we’ve had a positive experience with the realm of Senior Care Facilities. Her general health decline has resulted in us all signing pacts to put each other out of our misery before we ever get that far - but at least we’re happy with her facility.

Fuck.

Am I allowed to say “fuck” in MPSIMS?

What about this private-care deal, rather than assisted-living? Does that involve someone moving in with you and stealing the family silver with one hand while giving you Watchtowers with the other?

My best friend’s husband is a private care nurse.

One of his most notable clients was E the Nazi.* Man had been rendered into a respirator-dependant quadraplegic** by an auto accident. Paid for all his own nursing case, in a home that he owned. Because he paid the bills he called the shots.

Well, if you’re going to be disabled, assuming you have the money, this seems a pretty comfortable situation. But, very important, there was nothing wrong with E’s mind***, just his body. Someone with dementia would not have been able to manage this situation. E, however, not only acted as employer of his aides, and managed his own affairs, he also worked full time to pay for it all.

More commonly - folks with in-home care have “home health aides” come around. These can vary from minimum-wage drudges who are not very bright and of questionable ability to take of the themselves, much less another human being, on up to actual nurses who, yes, view caring for others as a calling, actually give a damn, and provide fine care. Of course, the latter tend to cost more.

  • “Nazi”, in this case, is not hyperbole or exaggeration, merely a description. E really was a Nazi. Not only had a picture of Adolf in the living room, he had his Hitler Youth memorabilia and some WWII medals to prove it. Nothing “neo” about this guy.
    ** We’re talking here about someone so crippled he makes Christopher Reeve look pretty independent.
    *** This is, of course, assuming that holding discredited notions involving racial bigotry is not a sign of mental illness. Oh, don’t get me started…

My grandmother lived in such a place from… oh… about 1978 to 1983

Some do, some don’t. You must ask. I have no idea how my grandmother afforded it, being to young at the time to be interested in such matters.

I suspect not - definitely, you need to ask. My grandma had no pets.

In grandma’s case, yes.

No.

Grandma socialized briefly when she first moved in, then found a close circle of friends and kept to them afteward. The degree of socializing was entirely up to the resident

For grandma - she had a studio, no room for overnighters.

No waiting list for grandma - but that WAS nearly 25-30 years ago!

When grandma moved in, she basically had a studio to herself with housecleaning services. Cooking and medical care were available, but she did not require them at first. As time went on, having assistance after a surgery, or someone to help her read her mail when her vision really started to deterioate was very helpful. The security was good - after her death none of her possessions turned up missing. She had her own furniture and keepsakes. Grandma genuinely liked the place, had chosen it herself, and felt comfortable there. But, up until the last couple months, grandma was mobile and coherent - and her mind was sharp up until about two weeks before the end.

You have to really investigate where you’re going. Advice to consult a lawyer is very good. So much depends on the person - an elderly person who is frail but clear-headed and able to use the toilet is in a very different position and has very different needs than someone incontinent, bedridden, and suffering from dementia. In the latter case, a family member or friend really must advocate for the person or else bad things can happen.

In answer to your question about Sunrise Facilities, my grandfather spent the last year of his life in the one in Fleetwood, NY.

It was truly a lovely place, great people, and nice feeling when you went there. He started out upstairs in the regular part, with his own apartment, and care manager who helped him get up and dressed in the morning. There was tons of stuff to do, but it was all optional (including listening to the little children singing on occaision).

One of the nicest things I remembered is that there were lots of little places to sit down and visit, and you never heard the TV blaring (as sometimes happens in elder care facilities). He was part of an informal bridge club, even after his mental state deteriorated and he moved down to the “Reminiscences” unit (the Alzheimers’s unit).

It was a really, really wonderful place to visit, his care was great, the communication with the families of the patients was better than a lot of places and we even ended up having his memorial service there so the friends he’d made could attend.

I’m sure I sound like an ad, but Grandpa was in a few other places before Sunrise and it really made a difference in the last year of his life.

Well, I have a somewhat better story. My late grandmother spent her last 18 months living in a Sunrise home in Frederick, Md. The first six months she was in the regular residence, but as her condition worsened the staff transferred her into their more secure, more heavily staffed wing for dementia patients. We couldn’t have been happier with the employees, who took excellent care of her as she slipped ever-deeper into Altzheimer’s. Although various of us visited her at all hours of the day and evening, we never saw anything distressing, either with her or the other residents. I remember being especially impressed at their daily efforts to get every physically able resident up, bathed, dressed, and as active as they could be.

The place felt homey; over the years several people had left or gave their furniture to to the place, so it didn’t feel really insitutional - even on the secured floor.

I can’t attest to the finances, as my father handled them. I know it wasn’t cheap, but it certainly seemed well worth it. By the time she died, we felt so close to everyone that we held a memorial service in the home’s living room.

DaisyFace, I didn’t see your post - the “somewhat better story” was referring to some of the more frightening experiences above. Glad to know another family had good luck with Sunrise.

The Sunrise stories give me some hope . . . I just wish “Sunrise Retirement Community” didn’t sound so Soylent Green . . . I’ve asked for brochures and will make calls . . . Thanks.

Eve (who is planning to drop dead at 60)

Eve,

My Grandmother lived in an assisted living facility in Allendale, NJ for a while (right up the road from Ho-Ho-Kus). It was quite a nice place, and she had her own room. They had lots of activities that she declined to participate in.

Before that she was in an ALF in Florida for a long while.

I know my Aunt and parents spent quite a bit of time researching the subject of ALFs in northern New Jersey. I’d be glad to put you in touch with them if it would help.

Bill

To make ends meet, my son takes care of a disabled man and provides one-on-one care for him. He doesn’t live with him. If you are concerned about what is happening when you aren’t there, there are always the “nanny-cams”.

Pets are optional. More and more facilities are allowing them because research shows that they greatly increase the quality of life for their owners. Even an Alzheimers unit that I used to visit regularly allowed pets. Ask about this.

Try to find one with “continuum of care,” where you can move from an apartment (full kitchen, total indpendence if wanted) through nursing care in the same facility. It makes a big difference.

Insurance can be tricky. Some insurance policies will only cover skilled nursing care in a designated nursing home, some are more flexible. Talk to your insurance agent/benefits manager. Each facility should also have a staff person who lives to interact with insurance companies. Make friends with this person.

More and more facilities are being built with day care facilities on the premices, and residents are being encouraged to interact with the children (doing crafts together, celebrating birthdays together, etc.) on a regular basis. Again, this is because research shows that both the children and the elders benefit. However, this should be optional if your mother doesn’t like children.

Check the design. Rather than long, straight hallways (hard for seniors with walkers, mobility issues to go a long way) there should be short stretches of hallway and then a jog, or widening with chairs, books, a birdcage (a place to sit and rest and a reason to sit down that isn’t "I’m feeble). As much as possible should be on the main floor. There should be easy access to the outdoors, and the grounds should be easy to navigate. Check for a hairdresser, convenience store, post office on site.

When you visit, see if the staff greet residents by name. Talk to the kitchen help and see how long they have worked there. Ditto the maintenance staff. Visit at several different times of day. Just sit in the main lounge, in other places around the facility for a few hours and see what you observe.

Many places have extra bedrooms built into the facility for visiting family.

That’s all I can think of right now.