Practical preparation for MC

Vitruvius

I would like some recommendations for the preplanning needed for the placement of a spouse in MC. I have seen little to no discussion about the actual logistics of placement. Several of you on this forum have recently placed your LO and I hope you will take the time to respond. I’ve posted several questions in the past and not gotten much response.

I suspect I will be told that I have already answered some of my own questions but even a confirmation would be welcome.

Wardrobe

• How much clothing did you designate to stock the room?  One week, two weeks?  Did you make an inventory to use to regularly recheck the stock?
• Did you tag the clothes with their name?  If so, how?
• I have read here that clothes often get mixed up between residents. Did that affect your choices of clothes?  Comfortable and moderately priced seems logical.
• All similar clothes for familiarity or a wide variety?  DW needs a lot of guidance in selecting an outfit as well as help changing. I generally just pick out things for her, maybe giver her  binary choices. How does the staff of an MCF handle this?

Furniture 

• Some of the places I’m looking at require you to provide your own furniture. Some would provide furniture but they were somewhat worn and not at all like the stuff we have in our home, so would not be familiar looking (we have modern IKEA stuff). I don’t have too much spare furniture, what did you do?
• What type of bed did you get?  Regular or hospital type? Size?

Mementos 

• What kind of mementos did you provide?  Photos, albums, etc., originals or copies?  DW is currently quite casual with originals and has inadvertently damaged some photos (“showing” them to the dog who then proceeds to mangle them.)
• Do you plan to rotate things to keep them fresh or not for consistency?

Stuff

• What other kind of “stuff” did you provide?  DW is now heavily into hunting and gathering. Do I provide odds and end for her to fiddle with or will they just end up spread out all over the MCF?
• I now provide her with costume jewelry as she is really into wearing necklaces, often 4 or 5 at once, even to bed. I plan on providing those without worrying too much about them disappearing. And will restock them as necessary. (Sadly I decided to squirrel away all the stuff that really meant anything to her as some fragile ones got damaged and others started to disappear to places yet to be found.)

Technology 

• The last piece of technology that DW can operate independently is an iPad, but I had to remove the passcode as she could no longer remember one. DW uses it only to “read” the news, she can no longer play any games or watch things. Even reading is pretty much just a mechanical process without meaning.  I encourage her to read out load and she often reads the same paragraph over 20, 30, 40 times. But it keeps her occupied. However I am concerned that an iPad would quickly disappear and without a passcode would be very vulnerable. 
• TV. I can only see a tv used when I came and we could watch something together as she is unable to operate one independently. Did you provide a tv? DW is not really engaged by tv but watches with me mostly to do something with me.
• Cameras, Amazon echos etc.  I’m tech savy, but not inclined to this.  It seems if I need surveillance, I picked the wrong MCF, but I’m not sure. Thoughts?

Guidelines for staff

• I think I’ve read here that folks provided MCF staff with a binder of guidance.  Things like current routine, preferences, brief bio even. Sounds like good idea, did you do that and did they make use of it?

Any other insights on placement planning? For now I’m just talking about the logistics stuff.  I understand there are whole worlds of legal and financial preparation, I think I have those under control. Of course there is emotional preparation, but I will never be properly prepared there, and I’ll save those questions for another time. 

Your feedback would be invaluable to me as I feel we are getting closer to the time placement needs to happen, both for her and also for my well-being.

ladyzetta

This is what I took when I placed my DH in MC. Each person is different so wants and needs will also be different, so I hope this helps.

Wardrobe.    I marked my DHs cloths but yes, they will wind up in other rooms. I found they got mixed up on wash days and also as residents visit each other's rooms. I put comfort first for my DH I took sweatpants and some of his favorite shirts. I only had maybe 5 outfits of each but I would always replace as needed. I also replaced his under cloths as needed. Don't take anything expensive my main thought was comfort. I just put his initials on with magic markers. His roommate also wore the same size so I never knew whose cloths he would have on. As long as he was clean, I did not care. The aides helped him get dressed and as far as matching things everything went with gray sweatpants. For ladies it will be different, but I saw many ladies dressed in whatever they put on and it was all good. They were beautiful. 

Furniture.  I took my DH recliner and a nightstand and used a bed they had there it was a twin size. I took my DH blankets and bedspread and his pillow. I also took a TV and a TV table. I donated it all to the facility when my DH passed away. 

Mementos.   I hung pictures on his side of the room of all the kids and grandkids. He recognized some and different ones at different times.  I would ask him who they were just to see how his Memorie was and I never told him he was wrong. I never moved anything around. 

Stuff.   Remember what ever stuff you take in will be all over MC. The only things I took was the hunting magazines that he got in the mail, but he lost interest in those. Just remember you don't want to take in anything that will upset your DW if it winds up in other rooms. Also, if she is walking around the MC halls with pretty necklaces on the other lady residents might like them as well. So, you would need to talk to the aides to see if this would be an issue. I never saw this being an issue, but I don't remember seeing jewelry. You said your DW is into hunting and gathering, the other residents are as well.

Technology. I had a TV in the room for my DH he did not know how to control it but the aides knew what channel he wanted it on and always made sure it was there. I gave them a list and it was changed a few times each day. If I was not there to change it they did. If youir DW does not like TV maybe she would like the music channels. I would not take a cell phone in and I am surprised at the facilities that allow that. Just read all the threads about problems that cell phone cause in MC.  And you are right if you think you need a camera in her room she is in the wrong place. 

Staff guidance.   It would be helpful for a little guidance but nothing too strict, it is easier for the aides if everything and everyone works together. My DH was on his own schedule as far as his dressing and his shower ect, just like they all were but I did not expect anything over and above. I was very pleased with the way everything worked for everyone.  I spent a lot of time there and once you feel comfortable all will be well just give it time.   

I hope this helps. Any more questions just ask. Thanks, Zetta 

Sadlady

Thank you ladyzetta: Your response to Vitruvius' query helped me as well!

Beachfan

Hi Vitruvius,

You seem to have all the basics covered where pre planning for a MCF placement is concerned. I can offer a few bits of information on the topics you have listed.  My DH has been in placement since November; he is in a stand alone facility that only cares for Alz/dementia patients, cottage style residence with a maximum of 16 patients.  All rooms are private with a bath.  As for wardrobe, the facility provided a list of suggested items, 6-7 days worth.  I found “nursing home” quality, iron-on, pre-printed name labels for his clothing. 3 months in, I think he still has all, or most of his own clothes, but he has “inherited” some interesting items.  I don’t bother to try to sort it out at this point.  His clothing is primarily easy on, easy off, elastic waist pants, comfortable and moderately priced.  It’s all mix and match as he can no longer select clothing, so whatever the caregiver grabs is the “OTD” as the kids say (Outfit of the day). Some of the residents shuffle around in pajama sets all day. Whatever is comfortable and preferred is acceptable.

A bed, chest of drawers, nightstand and easy chair are provided by the facility; residents may bring their own furniture if they wish. (I have seen an odd chair or two, a TV, but most rooms are sparsely furnished as residents don’t spend a lot of time in their rooms anyway.)

Each resident has a collage type frame outside their door; families are invited to post photos of family members, etc. for display.  I chose family photos and photos that would depict DH’s past- -his extensive coaching career.  Some residents just have random pictures of scenery or animals or postcards, nothing too personal. 

I didn’t provide much other “stuff” as DH is so compromised at this point that objects/mementoes mean nothing to him.  There are no technology items that DH can still use; there are two TV’s in common areas of the cottage. Many items are kept in a secure closet for safety reasons (shavers, electric toothbrushes, grooming supplies); I’ve not noticed any residents who have jewelry or many personal items in their rooms.

I should note that DH is solid stage 6 and does not require much in the way of creature comforts at this point.  He is clean, well fed, clearly loved by staff and I have learned to appreciate that he is safe and content in his present “home”.  

Probably the most beneficial item that I provided was, as you mentioned, a guideline for staff with his routines, likes, dislikes, background, immediate family - - anything I thought might be helpful by way of introduction.  I meant it as a brief summary; it turned out to be 4 typed pages! However, it is clear that every caregiver in his cottage as well as ancillary staff read and appreciated my “manifesto”.  (I had filled out pages of standard information requested by the facility prior to admission, but this document provided a much more personal profile of DH.)

As for emotional preparation, there is no answer.  DH no longer knows me, the kids, the grandkids, our home.  I was slipping away and knew I needed someone else to care for him so I could care for me.  It makes placement a little easier, but it still hurts.  I wish you well with your decisions and planning.  

harshedbuzz

My mom and I placed dad in a MCF towards the end of stage 6. She struggled with the decision leaving the logistics of the move to me. The whole experience reminded me of sending my son to sleep-away-camp the first time. My answers are below. 

Wardrobe

• How much clothing did you designate to stock the room?  One week, two weeks?  Did you make an inventory to use to regularly recheck the stock?
  
  How laundry is done may impact your decision. If the laundry is done communally and in industrial washers you may get by with a week's worth. If you plan to DIY, there needs to be enough to last between visits with extra for accidents. At dad's, laundry was an optional activity for residents, so they did laundry individually each week (unless there was a serious accident) and in HE Maytag washers- we had about 10 days worth on hand. One caveat, because laundry was kind of a side job for aides who were doing hands-on caregiving, loads often sat a while before being folded so things were wrinkled.
  
  We did check on stuff, sometimes things went missing ("shoppers") and sometimes there were mix-ups. 
  
  
• Did you tag the clothes with their name?  If so, how?
  
  You need to label everything. Clothing got labeled mostly with fabric name tags- sewn in is best, but iron-on is easier. I did tags- near the label, on clothing, underwear, linens, throw blanket. A Shapie or laundry marker could also be used; I used these on things like his socks, dentures/case, hearing aids/case, the inside arm of his glasses. I used P-touch labels on framed photographs and other decor items. Fine jewelry doesn't go to MF, find a similar costume piece if you must but don't send anything you would be upset to lose. 
  
  
• I have read here that clothes often get mixed up between residents. Did that affect your choices of clothes?  Comfortable and moderately priced seems logical.
  
  This happens. Laundry mix-ups and also the residents who wander into unlocked rooms for a little "hunting and gathering". Dad had one neighbor who walked off with his slippers routinely and another who took a portrait of my mom on the regular. 
  
  My dad was quite the dandy prior to dementia, but by the time he was placed he was in sweatpants mode. He seemed to develop some sensory issues around clothing as the disease progressed, so mostly his clothes were sweats, dorm pants, tees, fleece zip-ups. I chose clothing for comfort and ease for the aides who would be dressing him and caring for his clothes. 
  
  There were a couple on women in the neighborhood whose families managed their clothing. One lady dressed so beautifully that I assumed she was an administrator who worked there. A "garanimals" approach works well- dad's choices were pretty casual but I bought with an eye to every piece working with every other piece so at least things matched or coordinated if he needed a new top because he spilled soup on the first one at lunch. Mismatched clothing makes my eye twitch. 
• All similar clothes for familiarity or a wide variety?  DW needs a lot of guidance in selecting an outfit as well as help changing. I generally just pick out things for her, maybe giver her  binary choices. How does the staff of an MCF handle this?
  
  I chose mix and match and familiar. A big part of this will be related to stage of the disease. My aunt went into MC in stage 5 with mobility issues and initially socialized with the AL folks and went on day trips, so she dressed like she always did until she progressed further and her clothing became simpler and more comfy.
  
  Dad's staff typically helped dressing and offered binary choices as a way to engage. 
  
  Furniture  

• Some of the places I’m looking at require you to provide your own furniture. Some would provide furniture but they were somewhat worn and not at all like the stuff we have in our home, so would not be familiar looking (we have modern IKEA stuff). I don’t have too much spare furniture, what did you do?
  
  Dad's facility offered a choice- BYO or they'd supply dorm style basics. Since we got dad into MC using a fiblet that it was a temporary stint at an "upscale rehab facility" I opted to use their stuff and add nicer linens. If you don't have extra furniture, picking up something from Ikea that she'd like or even something from ReStore/Craigslist would make sense. 
  
  I wouldn't bring anything too good. My guardian aunt brought a gorgeous Stickley chest to her sister's MCF and they trashed it leaving food and drinks and even used Depends on it while changing. I was a little sad about it as I recall my aunt buying it on lay-a-way over 2 years with a plan to move it Maine when she retired there. When we'd go to lunch or shopping we'd often stop in to visit the chest.
  
  I also wouldn't bring too much stuff. After my dad passed, I went to the MCF to collect the things my mom wanted back. DH and I left with a couple of moving boxes; on the way home we passed an MCF where a couple like us were packing a U-Haul with a massive breakfront, canopy bed and wing chairs and they just looked overwhelmed. 
  
  
• What type of bed did you get?  Regular or hospital type? Size?
  
  Dad's MCF supplied a twin bed that was very low to the floor. It had a freakishly good mattress on it- so good I found out what kind and replaced DS's bed with the same. Had hospice been brought in before he died, they would have supplied a hospital bed as part of their services. Sometimes when my mom would visit, they'd nap together after lunch. They were tiny people, but still a full size would have been more comfortable. 

Mementos 

• What kind of mementos did you provide?  Photos, albums, etc., originals or copies?  DW is currently quite casual with originals and has inadvertently damaged some photos (“showing” them to the dog who then proceeds to mangle them.)
• Do you plan to rotate things to keep them fresh or not for consistency?
  
  I had blown up (poster size) two photographs I had taken of the greens at his original golf course (in the same town as the MCF) and hung them as decor in his room. Over time, we added a 10x12" framed picture of my mom (a copy) and a 30x36 picture of my sister and myself which I had to take down because it triggered hallucinations. 
  
  His MCF had a shadow near each resident's door that we put old family snapshots in. We did add a couple of things- throw blankets, an Eagles mascot pillow pet during the Superbowl, but mostly kept it simple.

Stuff

• What other kind of “stuff” did you provide?  DW is now heavily into hunting and gathering. Do I provide odds and end for her to fiddle with or will they just end up spread out all over the MCF?
  
  Hopefully your MCF will be offering activities which may redirect this behavior. Dad's MC had things they offered people who had a need to fiddle- activity aprons, dolls, robotic animals. They also did a lot of walking about the halls visiting the birds, fish and each other. Count of anything you bring disappearing.

• I now provide her with costume jewelry as she is really into wearing necklaces, often 4 or 5 at once, even to bed. I plan on providing those without worrying too much about them disappearing. And will restock them as necessary. (Sadly I decided to squirrel away all the stuff that really meant anything to her as some fragile ones got damaged and others started to disappear to places yet to be found.)
  
  Smart move.

Technology 

• The last piece of technology that DW can operate independently is an iPad, but I had to remove the passcode as she could no longer remember one. DW uses it only to “read” the news, she can no longer play any games or watch things. Even reading is pretty much just a mechanical process without meaning.  I encourage her to read out load and she often reads the same paragraph over 20, 30, 40 times. But it keeps her occupied. However I am concerned that an iPad would quickly disappear and without a passcode would be very vulnerable. 
  
  Yeah, an iPad would walk. I wouldn't bring it. When dad was in MC, my mom had the local newspaper and "The Week" delivered to the facility. I think it made him feel special to get mail. My nice sent him cards as well. 
  
  
  
• TV. I can only see a tv used when I came and we could watch something together as she is unable to operate one independently. Did you provide a tv? DW is not really engaged by tv but watches with me mostly to do something with me.
  
  I'd say no to the TV given that she isn't independent in using it. At dad's MCF there was a philosophy that each neighborhood unit was like a home- kitchen and TV/living room with 10 bedrooms. They discouraged TVs in the bedroom suites because they wanted to foster socialization and also controlwhat shows were being watched as some content can be triggering for some PWD. 
  
  
  
• Cameras, Amazon echos etc.  I’m tech savy, but not inclined to this.  It seems if I need surveillance, I picked the wrong MCF, but I’m not sure. Thoughts?
  
  We didn't do any of these things. My niece had tried Facetime with my dad a few times and he just couldn't engage with the person on his screen. A few times it actually upset him. My mom and I were able to make sure dad had a visitor daily, so I didn't feel I needed spy technology. 

Guidelines for staff

• I think I’ve read here that folks provided MCF staff with a binder of guidance.  Things like current routine, preferences, brief bio even. Sounds like good idea, did you do that and did they make use of it?
  
  Much like DS's camp, the MCF gave us a 12-page questionnaire covering these sorts of things. They asked about a brief bio, a family tree of sorts so they'd know who was who, hobbies and occupations, military service, favorite foods, what strattegies have worked- or not- at home.

Any other insights on placement planning? For now I’m just talking about the logistics stuff.  I understand there are whole worlds of legal and financial preparation, I think I have those under control. Of course there is emotional preparation, but I will never be properly prepared there, and I’ll save those questions for another time. 

The emotional piece is difficult. Mom and I both found the time leading up to placement much worse than after dad was in MC- even during the first couple of weeks when he was angry and agitated. For me, this was the hardest part.

I would suggest coming up with a fiblet to get her there. The staff at the MCF can help you around this- they may have suggestions on timing and such. We brought dad at the start of afternoon snack (ice cream for the win) and a movie matinee- the activities director swooped in and had him introduced to two of the more chatty residents before shooing us away. 

It might make sense to bring someone with you if that's doable. The drive home and empty house are hard on the heart. I drove my dad and after had mom stay for dinner before bringing her home.

I also visited with her the first couple of weeks. We didn't stay away for a few weeks as some places suggest. Dad had enough bandwidth to be really angry with her and excoriate her if he had no witnesses, so I made sure not to leave them alone. When mom started to visit solo, she initially limited the visits to the more public areas of the building to avoid getting verbally abused. Dad was a pretty tough customer; but he did settle in much more quickly than I expected. 

Your feedback would be invaluable to me as I feel we are getting closer to the time placement needs to happen, both for her and also for my well-being.

Wishing you smooth sailing and you go forward. I found my parents relationship improved when mom could go back to being a wife instead of the PITA caregiver insisting on showers and medication. 

JoseyWales

Thank you Vitruvius for asking this, and for eveyrone for sharing on this thread. It's been on my mind as I prepare to place DH, hopefully within the week.  I keep walking around the house thinking about what I should take.

Beachfan

Josey,

Thinking of you often.  Hoping all goes well and expeditiously.  

*Sorry to have crashed the original thread*

David J

You’ve gotten some great advice so far, and I can only reinforce a few things:

I didn’t label her clothes, at the suggestion of the MCF. They collect laundry in a bag and her CNA washes everything and brings it back. It helps that the same CNA cares for her most of the time. My wife dressed very well her entire life, and has an extensive (and expensive) wardrobe. At first I was concerned about ruining or losing some of these items, but then I realized that it doesn’t matter. I have no use for these items, other than clothing my wife. If someone else at the MCF ends up with some, Ive got plenty more at home. Twice per week I collect clothing for dry cleaning, since the MCF only does machine washing. As time has gone on, my wife’s fashion sense had wained, and comfort has become the main clothing objective. Cheap, stretchy pants and baggy shirts. 

I first placed my wife in MCF for respite while I had surgery. By the time the respite was over, I knew permanent placement was overdue. So I did not bring much from home at first, and she seemed comfortable with the furnishings provided by the facility. I have since brought some of her favorite framed art, the bed covering from our bed at home, and other small items that she might recognize. She never acknowledged any of these things and I don’t think she recognises these things nor associates them with home. 

For reference, my wife is solidly in stage 6.