First tour of a MC facility - advice appreciated

eapayne1

Tomorrow, for the first time, I tour a MC facility for my mother.  I admit that I'm a little nervous because this is such a big decision.

I've researched general questions to ask the site director: levels of care, available staff, security, meal accommodations, housekeeping services, physical and cognitive therapies, social activities, and so on.

Any additional questions you would recommend that I include on my list?  Areas of the facility I must be sure to see?

Thank you in advance.

Vitruvius

1. How long have existing staff been there. 

2. What would be a reason why your LO would be asked  to leave.

3. Can your LO stay until the very end. Ask how many are bedridden, if zero maybe they turf them out to a SNF near the end.

4. Observe if all residents are out of their rooms and engaged.

5. Try to go at a time when they are supposed to have activities, make sure they aren't just parking them in front of a TV. It's hard to tell if you go at mealtime. If you do go at mealtime see how many are being hand fed, ask if those feeding are employees or outside aides hired directly by families. 

6. Ask to speak to the activity director to make sure there is one and they are aways there. 

My DW was recently rejected from moving into an MCF just days before it was to happen. I would be very careful about what you tell the MCF about your LO's condition. The MCF will try to get from you any information that may indicate that your LO might become a "behavioral challenge".  From very benign things I said about my DW, and her type of dementia (an FTD variant) the MCF extrapolated that at some point she may be more work than they wanted to deal with, although her neurologist wrote a letter stating her variant would not likely develop any behavioral challenges they still declined her.

Good Luck, I'm sure others have more advice.

M1

I would ask if they have onsite medical services (such as visiting nurse practitioners) and Hospice, or how they handle hospice needs.  I would also ask about other onsite services (not just hair, which most do, but things like podiatry).  

Most will give you a large packet of information--fee schedules,  sometimes room layouts and diagrams, perhaps a monthly calendar of scheduled activities.   You're going to want to know whether rooms are furnished or not.  Going at mealtime or during an activity time is a good thing so you can observe the level of engagement.  Going late in the day is never a good idea (sundowning).

eapayne1

Thank you for your input.  I appreciate it! 

MN Chickadee

You've received good advice. I would add that the sales/tour guide people will often have a set piece, you have to dig into whether it's true. Talk with the aides a bit without said sales person. Ask how they like it, how often they have to work over time, how long they have been there what tricks they have for getting an ornery person to shower or take meds. Spend some time just sitting there and observing daily life. Talk to other visitors and family members. They usually will give you an honest opinion of the place. Now facility is perfect but I got a general sense from family members which ones were solid that guided my gut feeling on narrowing down the list.  It may be hard with covid, some places are discouraging family from gathering in the public areas, but you might catch people coming and going in the parking lot. Also inquire about how much training in dementia the staff have. You want a place where everyone from the nurses to the housekeepers to the culinary staff have gone through dementia training. A well trained staff are going to provide better care and be more equipped to handle unusual challenges. 

Having medical professionals who visited was a god-send in later stages. Our facility had a nurse practitioner who specialized in the elderly and did rounds every week so she became mom's primary care provider. They had others who came in like PTs, podiatrists. They were able to do labs like blood draws right there on site. This saved challenging trips out for appointments and also gave me a direct line of communication with her PCP which is hard in a regular clinic where there is always a game of telephone with their nursing assistant. I could just show up on Tuesday mornings when the NP did her rounds and talk to her directly. 

May flowers

I would check about their Covid policies too. Our facility did not confine everyone to their rooms during Covid outbreaks, they just limited visitors and tested residents. They still were able to gather in the commons area and especially outside in the sunshine which was so important to their mental well-being. They ended up with only a few that got sick and no deaths.

In the facility they were moved to (after the first MC flooded) had Covid go through and everyone was confined to their rooms for 3 weeks. It was horrible - we saw my FIL on Amazon echo and he was so distraught being isolated like that. He went downhill substantially. And that round ended up with many getting sick and several dying.

I would maybe ask if they allow Amazon echo or something in their room so you can check in on them. This has been a lifesaver for many. One friend of ours caught that their dad had fallen, and called the facility to let them know.

eapayne1

Thank you!  This is great information to have.  I wouldn't have thought about a lot of this input. So it is very much appreciated.

jfkoc

Probably chiming in too late but....get a copy of the contract and their state license. Also get specific info on initial and ongoing training program.

Vitruvius

In addition my state has a website where you can look up all inspection reports and citations for all MCFs.

Jo C.

One thing that most people are unaware of, is that all care facilities have inspections.  By law, the facility must make the results of the last inspection available to anyone who asks.  When visiting care facilities for my LO, when pretty much deciding on which facility was the preferred one, I always asked with tact and politieness to see the last inspection report.  It was always provided.

One thing one must know when reading such reports is that every single facility will have "deficiencies."   It is a matter of degree, so do not let deficiencies rule the day. Severe deficiencies will be noted as such.

Also ask about compatability of roommates; if the initial assigning of a room has severely incompatible roommates, when a different bed becomes open, can a change be made?  This became a significant problem for my LO as her roommate was a very obstreperous person and made things very difficult.

If a person cannot get to the dining room to eat due to illness or other limitation, what is the policy re that.

If a resident is unable to remember and get themself to an activity, will a staff member get the resident and guide them to the proper place?

Ask what the family can do to make things easier for staff and the loved one.

The biggest, most important question to ask is, in what sorts of situations would a resident be asked to leave.  That is important.

Also, some MC are licensed as an ALF model; others may be licensed as a NH model; ask what would happen if a resident was unable to ambulate freely - do they allow walkers, canes or wheelchairs?  Also, if a resident becomes incontinent, do they accept that?

If medications are to be adjusted or a new one prescribed, does the RN notify the family first before moving putting the changes into play?

If there is an accident, which hospital ER is the resident usually sent to?  How quickly is the family notified?

J.

HollyBerry

Chiming in a little late, but maybe this will be helpful to someone else.  We moved my mom here, from another AL facility in another state, and learned some things that will be helpful when I have to look at MC for my partner.

Spend some time in the spaces your LO will be living in.  Where do people spend their days?  do they just sit in front of a blaring TV all day?  do staff take them to other places in the building/campus for activities?  how do they decide who participates in things?  Does MC participate right along with others, or are they always separate?  Do they ever get outdoors?

Visit a few times if you can.  Make one of those visits at "prime time" for family visits, usually Saturday or Sunday afternoon, and note the type and level of family involvement with residents.  Visit at mealtime during the week and share a meal if you can.  Participate in or observe an activity.  Remember the salesperson is going to show you the best possible view of life at their facility, but also remember that you will be paying them a LOT of money and you should be able to schedule several visits to make a good decision.  You are not being a pest.  You are a potential customer of a very expensive service.

Do meet with nursing staff, possibly even in the context of a team meeting if possible.

The view out their window DOES make a difference!  See the actual room your LO will have.  What will they see?  what will they hear?  who will hear them if they call for help, or don't call for help?

The best advice I got from a friend who had been a nurse in long-term care was "choose the place that YOU can get to easily and that YOU will feel good about going to."  That was excellent advice.  My mom was 12 miles and 16 minutes away.  I made that trip many, many times, was able to do many of my own household errands in her community, found places to walk my dogs on the way over there, etc. Those things made it a lot easier for me to get there a few times/week. Do consider the toll it will take on you to go back and forth. 

My biggest ally in my mom's time at this facility turned out to be the Activities person.  They suggested signing her up for music therapy and art therapy groups, which she loved.  They sent me messages when there was an evening activity that they though we'd enjoy together.  When we were comparing facilities, I looked at the actual calendar for the week/month (not what's on the website as an example) and if it was just church and sports, I knew it wasn't going to be a fit. Look at the calendars for AL as well as MC and see where/if they intersect. 

Also consider the labor market in your community and its effect on the staff turnover rate.  In small-town New Hampshire, the facility had very little turnover while my mom was there and an amazing group of very caring staff who had been there for years.  In Madison, WI the labor market is incredibly tight for health care at all levels and there is a LOT of turnover.  Great people move between positions at a number of different facilities, and there's a lot of competition for the good nurses.  Do a little local sleuthing to find out how the staff feel about your top picks of facilities, and WHY they feel that way.   

Edited to add:  ask directly about what insurance is compatible with any extra services they offer.  I would have chosen a Medicare HMO if I hadn't learned that their PT/OT in-house service was not part of that plan.  Instead we went with a PPO plan so she could receive services on campus.  Ask about pharmacy as well.

As hard as it was to find a good AL situation for my mom, I know it's going to be 1000 times harder to find MC for my partner when the time comes.  My heart is with the OP (original poster) as you set out on this journey.