adult foster care home vs assisted living facility

*Ollie*

We moved my 80 year old mom in with us recently not realizing how impacted she was by dementia.   Talking to her on the phone a few times a week the past few years did not give me an accurate picture!  So here we are, 5 months later.  It is just my husband and I taking care of her and we are exhausted (we both work, have two older kids, etc etc).  Her needs are too much for the two of us.  My mom is very resistant to even going to centers that offer daytime activities for seniors so this transition will not be easy.  As we consider next steps, we are wondering what people's opinions/knowledge is about adult foster care homes vs an assisted living facility of some sort.   

Although my mom professes that she's not interested in making friends or being social, she will talk non-stop to us.  I can't imagine she wouldn't enjoy being around her own peers!  She does lack social skills at this point and can not pick up on social cues anymore so perhaps she truly isn't interested.   

I suppose I will visit a variety and go from there.  

SusanB-dil

Could you try a day-center?  May turn out she likes it.  It doesn't sound like she is independent enough for Assisted Living. Would probably have to go next-step.

mommyandme (m&m)

Maybe you could hire in help for the time being, might be a quicker solution for your immediate needs.

*Ollie*

I took her to a day center and she had no interest in the activities that were offered.   I've talked to her about that visit and tried to explain that that was just one place and there are others.  She can not really "discuss" things anymore.  So I am going to have the woman who drops in from time to time take her to a few.  No discussion!   It sure would help us if she would go somewhere a few times a week but like I said, she can't really be reasoned with at this point.

*Ollie*

We have someone who comes in occasionally and that certainly helps.  We are thinking of next steps as the occasional help isn't going to cut it soon!

Fairyland

I’m not sure what an “adult foster care home” is but it doesn’t sound dementia friendly. I’m planning to cajole my LO who is very early stages, into a “temporary” respite stay at a attentive assisted living, then say oops! Mom something happened so you need to stay a little longer-  so transition to longterm stay. She has no sense of the passing of time. Not sure what story/fiblet I will concoct, probably that I have to stay at my home longer due to my job/family demands, and/or the house needs some work, both are actually true. The main problem is she doesn’t retain that she doesn’t drive anymore, can’t use a cellphone, calendar, instigate and carry through any project like a home repair or purchase, maintain any friendships etc.

The facilities are well used to this ploy, and even have a move-in service to collect some furniture from the LO home, since I have to return to my own home thousands of miles away, to save me coming back in a month or less. The facilities I have in mind also have memory and other care on-site for when she gets worse.

She is not thrilled but seemingly will go along with the “temporary” idea, and I’m hoping the facility will cajole her to attend activities as they have promised. If she won’t, then fine! she can sit all day in her room and sleep-watch tv, same as now, at least she won’t be prey to the crooks and scammers who knock on the door, phone and mail her with “special offers”, and if she falls or has another stroke, won’t be lying undiscovered on the floor for long. 

I initially intended to move her nearer to me, but that has not worked out for a few reasons. 

harshedbuzz

Ollie-

Are you considering making mom a ward of the state with a court appointed guardian? I have a friend whose son currently resides in an adult foster care setting- he has a court-ordered guardian and is housed with an RN who oversees the care of individuals who have court-appointed guardians and have significant medical issues. DS has ASD, GAD and T1D- most of the other residents of the house are medically fragile with things like kidney failure, MS, etc.

She also sounds like a poor candidate for a hospitality-based AL based on your observation that she needs more than 2 adults can offer. She's probably more appropriate for MC with dementia informed activities and specially trained staff.

HB

*Ollie*

My mom def will not be a ward of the state.  I was under the impression that adult foster care homes could be a nice alternative to the larger and potentially impersonal assisted living facilities and may provide a similar environment but on a smaller scale.   I haven't actually visited one but that was my initial hit after checking some out online.   In addition, a friend who is a nurse and visits homes with seniors as well as the larger facilities, said that she's noticed the people who live in the home environment get much better care.   

Your point about her being in a place with staff trained specifically in caring for people with dementia is important though.   

jfkoc

Your major consideration must be finding the placement with the best training program for her now and in the future. I doubt that would be a foster home and truthfully most facilities have undertrained staff.

You can do staff training screening over the phone. Simply ask what program they use...ongoing. It should be a program that you can easily find online.

May flowers

Ollie, are you talking about the group homes? I used an agency that had in home caregivers as well as small group home settings which had just a few residents and better caregiver to resident ratios. I really liked the idea. If I recall, the pricing was less than in home and more than memory care centers. I would really want to vet them well for the reason they don’t have as many people coming and going - the one thing I liked about MC is we could come and go any time and had a code to visit after hours.

I also liked that they had an activities director whose job was to keep residents engaged all day with dementia-appropriate activities. Residents at my FILs facility were not left in their rooms all day, but were encouraged to hang out in the commons area, even if they didn’t participate. Every time we visited my FIL, he was with the group and he made friends. They even had a walking group for the more able residents like my FIL, that did laps around the outside of the facility.

*Ollie*

I like the idea of my mom not being able to stay in her room all day to watch tv which is what she would choose to do (and currently does unless we do an activity with her).   She does nothing independently anymore.  It sounds like a facility is more in line with what might work best for her, at least in my opinion.  She won't buy into it but that's a whole different ball of wax!

harshedbuzz

*Ollie* wrote:

My mom def will not be a ward of the state.

I didn't think so. Dementia brings a whole new world of terminology and acronyms to learn. 

I was under the impression that adult foster care homes could be a nice alternative to the larger and potentially impersonal assisted living facilities and may provide a similar environment but on a smaller scale.   I haven't actually visited one but that was my initial hit after checking some out online.

It sounds as if you are describing a board & care home. I live in a well-served community vis a vis medical care and care facilities. When we placed my dad, I drove by 10 places (and 2 more have been built) in the 20 minutes it took to get to my top choice and yet board & care are pretty unusual here. 

I would suggest you tour. This isn't something you can accomplish from the comfort of home via a phone call. It's a sales agent who answers the phone and gives the tour- you need to visit and observe meals, activities, resident/staff interactions and talk to staff and visiting families. Ask the aides what training they have and how long they've worked there. Watching them comfort a resident who is upset or non-compliant will tell you more about training than name dropping Teepa Snow. (btw, dad's MCF did use Teepa Snow and has sponsored webinars for staff and families which I did not know when I chose).Once you narrow down your list, you can visit on a weekend or at night and see if the standards of care have slipped. 

Most quality purpose built MCF are broken down into houses rather like Hogwarts. Dad's had rooms for 46 residents in 4 wings- each wing had 11 bedroom suites, kitchen and laundry room and a TV/living room. There was a large patio between 2 of the wings, a central area with a larger and smaller activity rooms, nurse's office and sun room seating. Staffing on first and second shift was arranged so than one of his main caregivers was always there. Two were off on Friday/Saturday and the other 2 on Sunday/Monday- there was no weekend only direct care staff.

In addition to the space being designed for PWD, the activities are designed to be engaging and failure-free for people who have not had a cognitive shift. This can be an issue in a hospitality model AL- activities and conversation with other residents is going to be set at too high a bar for all but those in the earliest stages of dementia. 

In addition, a friend who is a nurse and visits homes with seniors as well as the larger facilities, said that she's noticed the people who live in the home environment get much better care. 

It's hard to say. My grandmother (Parkinson's w/o dementia at that time) was in a board & care for about 6 weeks.  My cousin (POA) was sucked in by the "homey atmosphere" sales talk but very disappointed in how the place was run. Too much fast food, staff turnover and none purpose built facility which limited access for my grandmother. It might have been OK for someone who was just frail and old. 

The debate between which is best reminds me of the old comparison between a lady taking in 5 little kids and running an informal daycare vs a quality corporate day care with an actual developmentally appropriate curriculum, rooms broken down by ages and stages and staff with ECE degrees. 

Your point about her being in a place with staff trained specifically in caring for people with dementia is important though.   

Staff training matters. So does retention and pay. One thing I always checked out was the employee parking lot- dad's MCF paid a little more than other places and the staff drove cars I would be happy to drive. A few places I toured had must have put their resources into decor because the cars in the employee lot were older and a little more beat up. 

I like the idea of my mom not being able to stay in her room all day to watch tv which is what she would choose to do (and currently does unless we do an activity with her).   She does nothing independently anymore.  It sounds like a facility is more in line with what might work best for her, at least in my opinion.  She won't buy into it but that's a whole different ball of wax!

At the risk of pointing out the obvious, if you don't want her holing up in her room watching TV, don't put one in her room. Most of the better MCFs discourage in-room TVs for most residents. Dad's place had 4 TVs- one in each house- playing "safe" programs- sports, cooking, old sitcoms, game shows, etc and a bigger TV in the main activity room for a daily matinee with snacks. I didn't bring a TV for dad- he could no longer differentiate between real life and the plots of crime dramas and it only upset him. 

Dad wasn't much of a joiner, but his aides knew he enjoyed music and sports and would make sure he got out to those activities. The DON used to drop dad a note each day about the music event for the day and inviting him which he responded to. 

You'll probably need some sort of fiblet to get mom there. I wouldn't try to get buy-in or cooperation- you can't reason with a person whose brain is broken. I told dad he was seeing a new doctor about getting more fit and that the doc wanted him to stay for a time at a new high-end physical rehab center. He didn't like it, but appreciated that we were getting him the best available care. 

HB

MN Chickadee

You'll probably never get mom's permission or agreement on daycare or moving or anything, so forget that. Her brain is too compromised to see her own needs and deficits as most PWD are when they get to a point their families need more help. You will have to find the right therapeutic fibs and workarounds. It's rehab for that bad hip or to get stronger physically, it's a senior hotel, there's a problem at the house like a broken furnace so you can stay here a while. Rinse and repeat. Most PWD don't like it at first. They may pace, try to escape, get upset, call you all anxious. This phase does pass and they usually settle in after some time. I don't have experience with group homes; the ones in my area were not specific enough to a PWD. I know there are a few people on these boards who have had success with the group home model so it probably depends on your area. We used a memory care facility instead. The group homes did not have enough staff to run activities and the staffing ratio necessary for a PWD. Most were not even locked units so a PWD could wander off. The larger MC facility had aides, registered nurses, and activities staff whose sold job was to run activities, spend one on one time with residents, orchestrate spiritual care, and keep people's emotional wellness as healthy as possible.  In a good facility all these staff have had dementia informed training and will know how to handle someone who is resistant to activities. Activities included a range of things. Crafts, music, adaptive bowling, a golf cart ride, helping with baking, a therapy dog. The staff would get to know people and figure out how to get them engaged in things outside their room.

Jo C.

For my Loved One (LO) I screened both the small residential homes as well as larger facilities to see what would fit best.

I decided against the residential home care settings.  I found that there is no licensed nurse access; the caregivers were aides who were "trained," some inexpeirenced and trained on the job.  The daytime aides were only two to three for the five or six residents - some places had up to eight residents; that was for day shift.  Night shift had only one to two aides in place.  Did the aides stay awake?  Did they have outside visitors come in to visit at night?  No way to know what actually happened; there was not a lot of frequent ongoing staff oversight.

The aides in the residential care settings had to do ALL patient care - bathing, toileting, dressing, grooming, incontinence care; do the housework, do the laundry, clean patient rooms, change bed linens, do the cooking and meal setup and feeding, etc.  A LOT to be done.   They lack the special training and education needed for dementia management . . . AND the oversight inspections are not done by the RNs from state level as in other settings - their inspections for residential homes was done only once every five years and performed by a social worker.  Just did not work for me regarding quality of care issues on multiple levels.

Assisted Living not able to be done.  The person there is only "asssisted" and is alone in their room most of the time and there are so many pitfalls.

Memory Care carries better staffing, better oversight, better programs, has licensed nurse access, etc.  Even though your mother "refuses" everything you have tried and offered, the Memory Care setting may actually turn out to be a setting in which she will be more comfortable and the programs and activities more suitable for her - staff will also be better trained re dementia. Some MCs also have outside areas that residents can access and walk.  Memory care is also a confined area where patients cannot wander away. 

I ended up deciding on a Memory Care setting - it overall fit all needs better.

J.