I Think It May Be Time

Norma W

DH and I feel it's time to move our LO to memory care.  Her care needs are beyond what we can handle, mentally, physically and emotionally.

Starting to look at facilities in our area.  For those of you who already have a LO in a home, what should we look for?  What kinds of questions should we ask?  What was your experience moving your LO from their home to a facility and what should we expect?

Not sure how the process goes.  We have an appointment with her neurologist but that's not until the end of next month, unless we can get in early from their cancellation list.  I figure we'll pick out a place and start from there.

Thanks in advance.

Emily 123

You might want to go out to your state's social services website and see if inspection reports are out there. When you read them look for how the issue was addressed and was it fixed during the next inspection. This should also show what the facility is licensed to provide.  As an example, here's Virginia's. https://www.dss.virginia.gov/facility/search/alf.cgi

Then ask the facility what they do if something doesn't pass inspection.

My neighbor's both had family or friends with dementia, so they could tell me places they had liked or heard good things about. Pastors and folks at church are helpful too. Ask around.

If the money runs out will they transition your loved one to Medicaid in place, or will your loved one need to move?

Covid policies.  Visiting policies

Staffing--daytime/nightime/weekends.

What determines the transition from AL to MC?  What behavior gets a person removed from the facility?  If there's an emergency in the middle of the night what happens (usually this is a call to 911 and transport to local hospital).  What determines the move from AL/MC to Nursing home?  If mobility--1 person or two person assist?  A lift?  Can they support a purred food eater?  Can they support a person that needs assistance feeding themselves? (my mom's place will do hand over hand, but will not feed them if they can't at least do that.) You will want this confirmed by the nursing director--staffing is short and you want to make sure that they can do what they say they can do.

US news & World report had a checklist that was a good place to start, as did the Alzheimer's website--I kind of cobbled questions together from what I found online.

When you visit-is it clean?  Are the residents clean? Does it seem calm or chaotic? If you see family members around, pull them aside and ask how they like it. 

Don't forget to look in to care homes if that would be a good fit.  Good luck!

MN Chickadee

Expect the transition to be rough but eventually they settle in. Adjustment doesn't happen over night. It was an extremely difficult time for us, hard transition, lots of guilt and grief on my part and anxiety on the part of my LO.  But eventually it became obvious it was the best choice for my mom and the rest of the family. She has done really well with the high level of structure and care and is doing better now than she would have at home. 

I started by getting a list of all MC in my area from my county Agency on Aging (your area probably has one, or call your local Alzheimers Association for a list.) I narrowed it down a lot just by calling around and asking some questions, got the list to about 10 and toured most of them.

Things to ask about include 

-staffing ratios

-is there a nurse 24/7 (our first place did not have one on site at night, they called a triage nurse off site if something happened. This worked in the earlier stages of dementia, was terrible in stage 6 and part of the reason we moved my LO.)

-staff training in dementia care

-what could force your LO to have to move, what happens when they progress to a higher level of care - feeding assistance, hoyer lifts, 2 person assist, hospice etc. 

-do they accept Medicaid if that becomes a need

-is it locked (believe it or not I toured two memory cares that were not locked and it looked like a nightmare waiting to happen....)

-I would taste the food or at least look at it

-do they get people outside, either for outings and/or walks and sunshine

-Covid visiting protocols (hopefully not a concern for too many more months with everyone in LTC and staff getting boosters) 

-activities calendar, do they have a staff person for activities or life engagement, make sure the activities actually happen.

-I used say talk to staff to see if they have a few long term staff. Until 2019, some turnover was inevitable but most good places had some people with longevity. But Covid has really turned the industry upside down and I'm not sure that's a useful or relevant metric at this point in time. 

-Most importantly talk to other family members there. If there are none when you tour then hang out in the parking lot and see if you can catch a couple people. They will usually give an honest opinion of the place. Some facilities have family councils (now mandatory in my state of MN) so if a place has one you could ask to speak to someone on the council about their experience. 

Word of mouth is often the best way to narrow down places to start, ask around at the hair salon, church, clubs you are part of, neighbors to start your search.  There are definitely gong to be some that have a great reputation around town and some with bad reputations. Some places are hard to judge by the cover as it were. They may have worn furniture and carpet but have excellent staff, because that's where they put their money. Others have fancy amenities and beautiful decor but sub-par care. You really have to evaluate in depth. 

Less important questions that may not matter in choosing a place but you will want to know eventually things like do you need to provide incontinence supplies, do they order prescriptions and have them delivered, is there a visiting physician who does rounds there, podiatrist, hair cuts on site, what if any furniture or linens are provided etc. Good luck Norma.

Norma W

Thanks for the info.  Starting to call places to arrange a tour.