Touring Assisted Living - What questions should I ask?

TheCatWantsOut

I am going to start making appointments tomorrow to visit Assisted Living places for my Mom. I have never been to an Assisted Living place before. What questions should I ask? What should I be looking for?

Quilting brings calm

What is the community fee ( a non refundable deposit ) . What notice is needed if they need to move out!

Ask what services are included in the monthly fee. What services cost extra and how much.

24/7 staffing? nurse on duty at least some of the time?

activities? Transport to local doctors?

Pay attention to how the staff interacts with residents as you tour. Do they stop and say hi? Do they smile at them? Does the common areas look clean and tidy and decently maintained? Is there places for the residents to sit - residents like to sit where they can see what’s happening in the lobby or outside on nice days.

towhee

ratio of personal care staff/CNAs to residents

type of staff training, how long they can work at facility without being trained

staff retention, turnover- also do they keep the same staff working with the same residents,

what would make them no longer be able to care for resident, i.e. behavior, increased level of care, etc.

how many residents per medtech (or whoever is dispensing medications) - if it is more than 25 or at the very most 30, that is not good.

check to see the meals they serve, especially Sunday supper (last meal of the day) That can be the worst one.

harshedbuzz

TCWO-

Are you using the term "assisted living" euphemistically? She may do better in a MCF where staff will be more plentiful and dementia-trained. Activities and programing will also be designed to make a PWD feel successful.

My aunt's daughter chose AL for her mom when she could no longer care for her. My aunt was still getting around, quite verbal and becoming iffy on hygiene. At the AL, medication was managed and the was a daily well check. Meals were optional, so if a resident didn't show because they didn't know it was time to eat or because the were sick or had wandered off, it didn't raise any alarms. Most of the people in AL were folks who just needed a little help dressing or with transportation-- they did not have cognitive impairment as a rule. The ladies there quickly realized my aunt wasn't able to keep up with their conversations or activities and were quite mean to her. I would say she was even bullied. She didn't last there long. She had a fall in her studio suite breaking a hip and wrist sometime after lunch and was only found the next day when her meds were delivered to her room.

If you truly, want AL make sure they have an option for moving her into their own MCF when things are no longer working. Dementia is progressive, even if she can be ok in AL now, she will still need to be moved again.

I toured over a dozen places for my dad. This is what I would look for-

1. Close to me. Once a person is in care there is a potential for ER visits for falls, UTIs, etc. When the MCF transports by ambulance, your LO rides solo. You want to be there as the ambulance rolls in.
2. If your mom doesn't have nearly unlimited assets, she may need Medicaid as a safety net. Many MCFs operate under a business model where a family is expected to privately fund their LO's stay for 2-3 years before converting to a Medicaid bed. Getting into a Medicaid bed directly can really limit your options. Once I was aware of this, I stopped touring non-Medicaid facilities.
3. Avoid those places that cherry-pick their residents for the pleasantly befuddled. Often these are corporate free-standing beautifully decorated facilities. Often they are recommended by "A Place for Mom" and will pay upwards of a month's fees if you sign up on their referral.
4. Look for staff retention and training. This is much more critical than decor. Ask about training-- Naomi Feil, Validation, Teepa Snow are good answers. I used to check out the employee parking lot and nixed any places that had really beat up cars in it. Dad's facility paid a bit more than most and it was reflected in the quality of the staff.
5. Specific to you-- do they have a protocol for smoking. Most don't allow it at all and will suggest doing a smoking cessation patch on placement. My aunt's AL allowed it, but it was very controlled, and violators were asked to leave after a second offense.
6. It's a good idea to ask about situations under which your mom would be asked to leave.
7. Ask whether a resident can age-in-place (i.e. die there) and at what point would family need to engage private help or hospice services for their LO.
8. Ask about pricing. Dad's was a flat fee room & board although you could make a side arrangement to have them provide incontinence supplies. A few of the places had a tiered pricing scheme where your fees were based on "level of car"-- you'd pay more based on the number of medications you take, incontinence care, 2-person lift, etc.
9. Look into their daily routines and schedules. If they have activities listed, observe a few. Ask about staffing-- dad's scheduled their aides so that the 2 aides working his hall (8-10 residents) on the first and second shift split the weekend off so there was generally someone he knew/knew him there when he was awake. This continuity of care was better than when he was in a SNF/Rehab where it was like the wild west on the weekends.
10. Check the food. Most places serve a heart-healthy diet that is sort of meh. Often the main meal of the day is at noon, so if you tour around five and see soup and sandwiches for dinner don't be put off. Dad's facility's food wasn't great, but they were quick to indulge him if he didn't care for the initial offering. Don't want meatloaf and mashed potatoes? Tomato soup, grilled cheese and a salad materialized in minute. Choice really mattered to him. I also brought him lunch and portions of his favorite meals which staff would heat for his lunch of dinner.
11. Watch interactions with staff and residents. Try not to be put off by the disheveled appearance of those who are further into the disease progression.

TheCatWantsOut

Thanks, all of those are very helpful suggestions. I hope I can be half as thorough as the above posters.

On the question of Assisted Living vs. Memory Care, I'm not sure. To me it seems obvious that Mom is both miserable and in danger, and either accommodation would be better than what she has now. But then the hospital evaluates her and releases Mom to go home by herself.

Maybe I'm way over-reacting and the problem is more with me than her.

For now I will do the due diligence on my end to try to get POA documents for her to sign and make a plan for Assisted Living / Memory Care should it become an option.

TheCatWantsOut

I'm very grateful for the guidance and support provided by those on this forum with respect to Assisted Living. I moved Mom into a place yesterday. It was a brutal 7 hour drive (including stops) but to Mom's credit she did very well, all things considered. I ended up choosing a place that was on the higher end price wise (more on that in another post) but in addition to the helpful hints given above there were two criteria that I used to differentiate one Assisted Living from another.

1. This place has Independent Living, Assisted Living, and Memory Care on the same campus. From my observations Mom's condition is about mid-way along the Assisted Living spectrum. Eventually she will need Memory Care, having that co-located obviously makes things logistically easier but also I feel more comfortable with a facility where the staff have experience through the whole progression and presumably can advise from a position of having seen it all.
2. The residents seemed genuinely happy. Of course I only observed the residents that were out in the public spaces, not the ones who are presumably farther along and in their apartment more. But those residents I saw were talking, laughing, enjoying the sunshine, etc. And the staff didn't seem jaded. I suspect some of what I saw was the Independent Living population, but still having that environment seemed very healthy.

That all being said, Mom has been there for less than 24 hours and I am still extremely worried. My biggest concern is that she will not comply with the rules about smoking. They have a designated smoking area outside, far from the entrance. It is too far for her to walk with any regularity, and I can't imagine her going out there at all in inclement weather or if there is snow. The staff told me there is one other person in the building who smokes but I have a feeling he is a casual smoker. Mom's smoking is not just an addiction, it is what she wants to do and it's also a compulsion. She might light ten cigarettes an hour. I just don't know how that is going to play out. I'm really worried.

jfkoc

You want to know precisely what the training program is. Do not accept "we have our own". Get a copy of the contract and also a copy of the state license.

harshedbuzz

@TheCatWantsOut said: "My biggest concern is that she will not comply with the rules about smoking. They have a designated smoking area outside, far from the entrance. It is too far for her to walk with any regularity, and I can't imagine her going out there at all in inclement weather or if there is snow. The staff told me there is one other person in the building who smokes but I have a feeling he is a casual smoker. Mom's smoking is not just an addiction, it is what she wants to do and it's also a compulsion. She might light ten cigarettes an hour. I just don't know how that is going to play out. I'm really worried."

I would be worried as well. It sounds like you have found a facility that meets your criteria so I would take proactive steps to avoid her being asked to leave. At my aunt's AL, they held the cigarettes for residents at the security desk near the exit to the patio-- if a resident wanted a smoke, they were given 1 or 2 from their stash before going out. This agitated my aunt, so the PCP who oversaw her care put her on a nicotine patch to stave off the physical aspects of wanting to smoke.

We had very similar issues with dad and alcohol-- he was obsessed. None of the recommended strategies like non-alcoholic wine or watering it down was successful around this. His geripsych started him on Wellbutrin in an attempt to activate him out of the apathy that upset my mother. It did nothing for the apathy, but it had a huge impact on his urge to drink. Wellbutrin is marketed under the name Zyban for smoking cessation and in combination with another medication for binge eating. I would encourage you to try this.

HB

Quilting brings calm

I have also heard that Ozempic ( diabetes/ weight loss) seems to be helping with keeping addictions at bay. That medication is injected, but there is a similar medication in pill form.

I would get her a nicotine patch as soon as possible.