comparing long-term care facilities

DHVT

Looking a year or two ahead, when my wife may need to move to assisted living or memory care, she and I have visited a couple of the more expensive facilities in our area. Of course, they look wonderful -- modern, shiny, great food, etc. We were both impressed.

Then the social worker from our memory program told me that a lot of the bells and whistles are there, at least partly, as marketing devices aimed at family members. The real consideration is quality of care, and great care can be provided at a much more homey place. 

That raises the question, in reviewing available facilities in your area, how do you compare the care offered at each. She mentioned asking the admissions person how long the average length of employment is for staff, but that might be hard to verify.

Anything else to ask or try to find out with some online research? I know the state has an online list of complaints and their resolution, but that really just focuses on the negatives. I'd like to find out which few places have especially wonderful, caring staff.

MN Chickadee

Before the pandemic I advised people in your position to ask about longevity of staff, as this was a great metric as to what kind of employer they were; a good place to work usually translated to a good place to live but I am not sure it is relevant at this point in time. Covid has caused massive upheaval in the industry, and most places will not have long term people even though they may have 2 years ago and it isn't necessarily indicative of a problem with the facility, it's just the nature of the situation right now. Nurses and aides are in short supply and many left the industry in recent months. 

The shiny bells and whistles and amenities can indeed be more of a marketing aspect for the family. My mother's first place had worn carpet and old furniture and was homey and clean and sunny but not remotely fancy. The staff was wonderful and the reason we chose it. As her care needs changed and we had to move her, the new place is "fancier" but still has excellent staff. You do want to ensure they aren't putting all their money into fountains and furniture and not into staff compensation and training and activities. Not sure how much time you can spend inside them with covid right now, but if possible spend some time and observe how the staff interact with residents, how the food looks, make sure the activities calendar is actually happening, ask about dementia training. Most importantly talk to other family members about their experience there.  Usually they will give you an honest review. Word of mouth amongst your friends, neighbors, and groups is also valuable when starting out your search. 

jfkoc

Training...hiring requirement, starting, ongoing. You want the name of the programs used.

salary, benefits and turnover

carefully read the contract

carefully read license with state...it will say exactly what they offer

I would do all before you even visit. 

Agood source is word of mouth from a support group.

Things will change so you will have to refresh the tasks before actual placement.

harshedbuzz

DHVT-

In dad's case, by the time he arrived in a MCF, he had no f**ks to give about the fancy wallpaper, grandfather clock and chandeliers. I didn't take dad on any tours or signal to him that placement was coming. Why create anxiety around something over which he had no control. YMMV.

I toured a dozen which was more than I needed to. I would rule out any place that doesn't accept Medicaid unless you have almost unlimited assets. I would avoid places that cherry pick for the most tractable residents as you could be shown the door if your wife is uncooperative or goes through a phase of challenging behaviors.

My first choice came up a lot when I asked people who had had a LO in MC and was well regarded by members of the support group to which mom belonged. 

Things I asked about were training and staff retention. I asked the sales manager and random family members I came across in the parking lot. While in the parking lot, I checked out the employees' cars. The places with better salaries, training and staff retention had nicer cars in the employee lot. 

One thing I really liked about dad's MCF was that there was no weekend "B Team". Caregiving staff were scheduled to have Friday/Saturday or Sunday/Monday as their days off, so dad always had a regular taking care of him 7-11 which led to them really getting to know him. 

HB

Farm Gal

One thing I would do is to ask friends, family, parish nurses etc.  However one of the more important group of people to ask is the those in the Alzheimer's office in your area and the people in support groups for recommendations.  

The MC facility I would like to utilize for my husband (if I have to place him) is located in a small town 30 minutes away from us and everyone in the area knows how fantastic the nursing home, AL and MC units are for this facility.  

Good Luck!

ninalu

Hi DHVT,
Adding my reply to the great feedback you've received.

The two things that helped me most, when deciding for my mother:

- Recommendations from anyone that was already involved in my mom's care: the social workers and staff at her adult day care, the visiting nurses/PT/OT, the caregivers who came in from various agencies, the doctors/nurses she saw, the elder care attorney, elder care coordinators, neighbors who chatted to me about my mom, etc. People told me good (and bad) things about ~40 different facilities nearby, but (interesting to me) 2-3 were consistently at the top of the list. And in the #1 position was one of the least fancy ones. But it got first place for the quality of programming and care for dementia patients. 

- Location: close enough that I can visit often and easily. My threshold was < 30m commute time one way. I knew that our visits would get shorter as the months go by because she'd fatigue faster. Really, I just want as much time with her as possible. 

I also read about (researched online) and visited many places myself. I saw a lot of beautiful facilities with amazing amenities. I became aware pretty quickly that I was being "sold" an experience and therefore from the early stages of looking, I tried to get behind the sales pitch to understand what life was like on the inside - both for the patients and for the workers / care givers. 

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DHVT

A lot of very good tips here. I’m going to make a list of them for future reference.

I must say, I don’t know how there are enough wealthy families in Vermont to account for all the residents of non-Medicaid facilities. Those places seem well populated, and ours isn’t a particularly wealthy state.