What is the most important factor when choosing an AL/MC facility?

Jerome Likes Pie

As we continue to research and tour a handful of AL/MC communities, we are evaluating a number of aspects through our RFP of questions, one-on-one questions with various management personnel, tours of the communities, reputations in the industry, etc.

I understand that each Alzheimer's resident has specific needs and there are different stages, but I am curious what you place as the top priority when selecting an AL/MC facility. (My LO is stage 4 and we are hoping she can start in AL and move to the MC.)

For example, I understand that the staff to residents ratio, training, turnover, professionalism, etc. is critical, but for the communities that seem to have great staff, many fall short on facilities such as roomy quarters, common areas for socializing, watching live entertainment, dining, light fitness, church, etc.

What is your or your LO's top priority in making this important decision?  Thanks.

John2.0.1

I believe that the most important thing is to be close enough that the family caregiver can be there frequently and quickly so that all staff know that you could pop in at any time. Also to know first hand how your LO is doing and if needed services are being delivered and if service needs change. Communicate with the bosses about issues. Don't blame but say this is what your LO needs.

I recall having a lot of concern that my mom does not get enough fluids. I made an issue out of making sure they keep a glass of water where my mom mainly sits because mom has great difficulty reaching the sink and getting the water to her place without spilling it.

I've observed that now mom always has water available.

star26

I would choose the quality of the staff and care over the amenities and appearance of the facility (as long as it's clean). At the AL & MC level, this is what is really going to determine the success of the placement now and in the future.

King Boo

Ideally, a skilled nursing facility too, that allows for complete progression of the disease, while spending your money all at one facility for ease.  Particularly if spend down for Medicaid is anticipated.  Get complete benefits.   You are less attractive to a  new facility with no money.  Many CCRC's will take a long time resident of 3 plus years into their nursing home on benevolant Medicaid care if you have met their entry requirements. Not all.  Ask about their 'unofficial' policy.  No one will put this in writing because things can change.

Spacious living quarters are not indicated for a PWD.  Smaller, more contained = less stress for them, less spots to loose things.

Church can be worked around - hire an aide, or perhaps the facility will permit an AL person to ride with IL to services if they are safe.   My MC PWD rode the regular facility bus to church until he was too physically debilitated.  Flexibility on the part of the facility was an indicator of excellent care.

You don't need a full spectrum of activities; just some that are of interest or appropriate for YOUR person.  I spent a ridiculous amount of time researching this, when my LO had never, ever been into special activities and socializing. 

Proximity helps with your long term stress.  However, I placed at 30 minutes away because it was the place that was the best fit.  If it had been a toss up, or close, closer to you is better.   This is going to go on for years and years.

Rescue mom

Staff is by far most important to me, my mom was in ALFs and MCs. Those other amentities very quickly, and sadly, become of no interest or do not matter to the resident. They are used to “sell” the place to families, who may want to believe their LOs still see such things like they do, or the LO used to. But by the time most enter MCs (and some ALs) they can no longer “appreciate” them like we do.

Ditto to everything King Boo said.

 Common areas, places to watch entertainment, do not need to be fancy at all, most residents don’t notice. Big rooms are not needed, it’s more work and confusion for PWDs who can’t handle many things. Just having some activities, and more important, having staff who will encourage them to do appropriate activity—many have little interest, or very short-time interest, in activities)  are more crucial.

harshedbuzz

I believe it may have been King Boo (and dayn2nite2) whose advice I followed when selecting a facility for dad. I toured a dozen.

Things that were important to me-

1. Staff.staff.staff. 

Is turn over low? Are all staff appropriately trained? It's not a bad idea to tour on a weekend to see what the weekend people look like, too. Dad's MCF had his main caregivers working Sun-Thurs/Tues-Sat so he always had a familiar person on hand; the was no weekend B team.  Are activities engaging and actually happening? Dad wasn't much of a crafts person, but he enjoyed music and the DON would send him a note inviting him to the musical activity of the day.

2. Potential to convert to a Medicaid bed.

3. Reasonably close mattered to me. I actually drove past something like 10 facilities on my way to the one I chose which was in my uncle's hometown. At best it was a 25 minute drive.

That said, I feel the single most critical piece is selecting the proper care level. It's often said here that by the time a family is ready to agree to an AL placement, that cruise has left and MC is likely needed. I can't say that's your situation, but it is something to consider.

When my older aunt's daughter could no longer provide care, she enlisted the help of her SIL (POA) and another aunt to help get mom placed. (Backstory- my cousin is deaf but went to oral schools as a kid; she and her mom came to ASL later in life. With dementia, the aunt lost her fluency in signing; my cousin's speech was never great and lacked the sort of vocab needed to be an ideal reporter of function. Cousin did a lot of support and scaffolding before placement) Aunt ended up in a hospitality model AL which was a disastrous fit for her. She got help with meds and dressing in the am and at bedtime, but the rest of the time she was left on her own with the assumption she'd come to meals or activities if she was hangry/interested. Only she didn't so family went at least daily to escort her to lunch and drop her at whatever the afternoon activity was. Activities were geared toward folks who had not had a cognitive shift, so my aunt struggled and gave up. Other residents recognized she had dementia and either ignored her or were unkind. It wasn't pretty. 

That said, I can appreciate how difficult it is to place a beloved parent in a MCF after seeing residents whose disease has progressed further and who are engaging in behaviors you aren't seeing yet.

jfkoc

Staff...contract....license

Stuck in the middle

Location is number one to me.  Frequent short visits are better than occasional long visits, and unannounced visits are primo.

Staff/patient ratio is important.  Regardless of the quality of the staff, there needs to be enough of them to get the job done.

They are all "clean" to some minimal standard, or they'll lose their license.  However, they all smell, a urine/Lysol aroma that arises wherever large numbers of bedwetters gather.  The smell is stronger in places with low staff/patient ratios.

Expect change.  Like the restaurant business, staff can get new jobs by turning into a different driveway, and ownership changes frequently as well.  Plan on being the squeaky wheel.

zauberflote

Jerome, you are very much more organized than I was. I live in a fairly "sprawled out" metro area, and we were renting a temporary home when Mom moved to my city. We didn't know where or when we'd buy, so "central location" was paramount to me. 

I only toured two-- a large, well-established and well-regarded continuing care place, and a very small "all-in-one, age-in-place" one, in which the resident kept her room until she required skilled nursing or Medicaid. 

The memory wing of the large place horrified me. Crowded,  a hall a mile long-- and the "courtyard" was small and entirely paved. 

The smaller place had the same population, but the halls were wide and well-lit, and unlike the AL Mom was currently at, had laminate floors instead of creepy no-pile smell-ridden carpet. The courtyard had a huge roofed verandah and plenty of grass, shrubs, flowers, herbs, small trees, and the venerable sugar maples on the other side of the building were nice too. 

We went, on gut feeling, with the smaller one, and awful as it may have been, I beat Mom to the ER nearly every time, and that had been our goal. The staff, few as they became over the months as the place struggled, loved their charges, which counted for so so much. 

I was pretty miserable, as can be seen from some of my early posts here, but at least I was centrally-located-miserable. 

I am going to be touring lots of places just to check them out for when I may need something. The security of having 24/7 staff can't be over-estimated if you're an anxious type like me. 

dayn2nite2

My mom went to an older NH, not because she needed skilled nursing, but because it was run well.  My priorities were:

1.  Location.  It was 5 miles away from my home and I could visit frequently.
2.  Clean.  Very clean.  No odors, floors and furniture in good repair, rooms and bathrooms clean.  These were semi-private rooms because my mother was being admitted Medicaid-pending.
3.  Tenure of staff.  Most of the staff had been there for years, anywhere from a few years to 20 years in some cases.  They treated the residents as family, even the difficult ones.  
4.  Quality of food.  There were 3 different dining areas.  One for independent eaters.  It was in an area just off the common area of the home.  Another room was for people who needed more supervision in eating (encouragement, assistance with cutting food, etc).  The third area was for those who needed a lot of assistance (special diets, being fed, close monitoring of how much they were eating).  The meals were all the same (even pureed) and all very HIGH quality food.  Holidays were "special" and I will swear that much of the food was made from scratch.  They also encouraged, especially for holidays, if you were coming and wanted to eat with your LO you could order a meal and one would be given to you so you could have dinner with your LO.  I enjoyed many a meal and enjoyed eating and visiting with the ladies at my mom's table.  I got to know them quite well.

Those were my priorities.  I cared much more for the care provided than the physical structure.

The NH was an old mansion converted to an 82-bed NH.  Large living area with old stone fireplace (turned off), a large porch with rocking chairs to look out over the front of the property.  It was in a residential neighborhood near a lake.  They put wind chimes on the porch, there was a path you could walk or take your LO in a wheelchair on.  Was it "old?"  Yes.  Clean?  Yes.  Were there fancier facilities?  Yes, but I knew someone at a "fancy" facility who was left in her room all day because when they would ask her if she wanted to do XXX she would say no.  At the NH, they would say "come on XXXX, let's go and play Bingo" and just grab that person and away they went.