Searching for the right MCF

wizmo

I find myself agonizing over choosing a memory care facility both emotionally (am I ready? is DW ready? feels like sending her to prison) and logistically (finding time just to perform the search, cost, location, sales tactics, etc.)

Thanks to numerous previous posts here I have some idea what to look for:

·        dedicated MCF community, not some extension of IL/AL/SNF unless there are other complex medical issues

·        staff training/credentials/turnover 

·        visit multiple times randomly to see what happens outside scheduled tour

·        probe other families, staff, anyone who will talk about their direct experience 

·        collect any available documentation - contract, license, state inspection report, admission guide

·        simple cost structure, ideally flat or basic/advanced tiers, not nickel & dime for itemized needs which are naturally going to increase due to nature of this disease

A “good” indicator is availability/wait list, unfortunately I don’t think we will be getting on the 1+ year wait list for the one place with stellar reputation.

Possible red flags:

·        sales pressure tactics reminiscent of used car dealer (act fast price incentives)

·        obvious lapse in maintenance (frayed carpet, not just stained) and hygiene (overpowering disinfectant or air freshener masking odors throughout the entire facility) - found both at one dismal place

·        apparent lack of staff presence (ALL the inside staff stations are vacant, didn’t see anyone except housekeeping and sales; it was not mealtime, sales said “attending needs of residents”)

·        employment listings have large number of openings

So far I’ve been to 9 places in 3 states.  All were depressing to see residents in later stages.

One place (a national business, probably largest in US) claimed they had a minimum age of 62 and my wife being EO at 59 would need "special approval". Of course, the sales rep would go out of his way to gain exception for us upon evaluation. This seemed completely artificial.  Same place changed their cost structure a month later from flat rate to room rate plus care.  Those gyrations are making me want to pass even though it is very close for travel and the rest of the place felt good on first visit.

As for timing, the main driver is burnout for me.  You all know the toll it takes.  We tried part time in-home help, DW just rejected/dismissed all strangers.  I know she will be better served by experienced staffers, will likely adapt better if she is placed before losing communication and social skills.

I guess I’m fortunate to have a number of choices living in a large city (Phoenix area).  For those of you who navigated this successfully what else made you feel good about your choice?

W

darcytg

Hi Wizmo,

Also navigating this space and your list of what to look for and do is deeply appreciated.

Thanks for sharing.

Darcy

Vitruvius

You have hit many of the important issues. Here were some others that influenced me:

• The ability to remain in the MCF until the bitter end. Ask how many residents are bedbound. Having a fair number was actually a good sign for me that my DW would be able to remain throughout her ordeal. I rejected one otherwise nice place where they appeared to cherry-pick their residents, they were almost all fairly mildly impaired. Ask whether your DW can stay until the end, and what would require her to be moved to another facility like a SNF. In my state the licenses for MCFs don't allow them to care for residents requiring certain medical supervision, that's understandable..
• Ask if they will hand feed and provide two-person assists for moving residents, and what they do if your DW is a fall risk. My DW's MCF does all this in the base price, other MCFs require you to hire an additional aide at your expense to do some of this. Some actually turf out residents who need two person assists.
• Observe the activities provided. My DW is sadly well beyond participating, but earlier she just barely could. Her MFC provides a live music program and other activities 7 days a week, the performers often engage with the residents, much better than a boom box session. Many MCFs I looked at had very reduced weekend programs but dementia patients have no concept of "weekend".
• Ask if they will provide special diets. My DW progressed through regular meals, then "minced and moist" and now puréed, which they hand feed her.
• Ask how their services integrate with hospice. My DWs MCF has a number on hospice, including her. The MCF keeps up all care and uses hospice as an addon rather than relinquishing care to the hospice.
• You don't need a glitzy place, where money is spent just to impress the families, but as you noted, having a well maintained place expresses a certain pride and financial stability to me.

That's all I can think if right now.

Beachfan

Everything that Vitruvius mentioned! My DH passed in April after 17 months in a MCF and I wouldn’t change a thing. He may not have passed in our home, but he was “home” when he passed. Good luck with your research. Hopefully it will pay off and you will find peace in the end.

Dio

In addition to the above, I'd recommend working with a reputable local (not national) senior care placement agency. If you're vetting different states, work with an agency in respective locale. Their services are free. They get paid by the chosen facility upon placement. Give them your requirements. This will save you time. I chose not based on glossy aesthetics but the overall atmosphere and mood between staff and residents, and cleanliness. (Some places looked like a posh spa. Beautiful and pleasing to the eyes and nose. But I'd rather their money is spent on getting good staff and training. I doubt that DH in his state of mind cared much about staying at a spa or not. Some other places reeked of industrial strength cleaners...ew! No go here for me.) I chose based on so many factors, but the initial draw was the moment I walked in, I felt a sense of peace and comfort and the scent was fresh and clean. I observed how staff interacted with the residents and found them to operate like a family would...addressing each other by name, lots of hugs and laughter, and even wheelchair bound residents seemed happy. Except for a few residents who were sleeping/napping in place, everyone else was lively and engaged in whatever activity was scheduled. The whole environment seemed strange because it contrasted so much from some of the other facilities I had visited that were downright depressing. It was such an eye-opener, that a harmonious (almost happy) place is possible which gave me a shot of hope. I also saw residents in hospice care and one who was near end of life. This closed the circle of what to expect. I also opted for an all inclusive care rate instead of facilities that nickled and dimed for each care or supplies provided. And yes, I had to be placed on a wait list for each of the top two prospects.

Suggested additional questions:

• What's their emergency (medical and/or natural disaster, fire, etc.) protocol? If your LO is sent to the ER, or gets admitted, what is the process upon discharge?
• What is cause(s) for eviction and under what circumstances did MCF have had to evict someone? What are your options at this point--do they help/offer solutions?
• Do they have RN or LVN on site? Do they have a visiting doctor your LO can sign up with?
• What's the most difficult resident they've encountered and how did they handle the situation?
• What are visiting hours (mine is open 24/7)?
• How does facility handle resident's privacy? Do they regulate visitors and/or coordinate with your consent? (For me, this was very important.)
• What is their annual rate increase? (If it's a chain, the answer may default to the parent company's across the board decision, so the local MCF will have no say in the matter. Personally, I prefer locally owned facilities and knowing why they're in this business gives me a clue on their approach to care.)

Best of luck! Good facilities are out there.

harshedbuzz

@wizmo

I toured as part of my Plan B should something happen to my mom who was dad's caregiver at home. I toured a dozen places and came up with a top 3. When mom was finally agreeable to placement, I had took her to my top 3 options. Dad wasn't accepted by her first choice because of the potential for behaviors which goes with one of his dementias. Do you have a friend or family member who could vet places for you to weed at the duds and then just tour the nicer places?

I suspect the place that has an age-limit does this to avoid accepting men with early onset who may seek sexual partners in MC or who are physically robust enough to seriously injure someone. We had an incident where a male resident climbed into my aunt's bed. They we constant companions during the day and he believed she was his wife. This kind of incident is obviously upsetting to the families involved, so many places just don't accept "younger" men into their communities.

I would ask at what point you would be required to provide private aides or bring in hospice to assist in your DW's care if she is going to age-in-place there.

If there's a possibility that your wife might need Medicaid at some point, I wouldn't even bother to look at places that don't accept it when you can no longer self-pay.

HB

Tony484

Be careful about "outsiders" waiting lists, meaning the waiting lists of those MCF's associated with assisted living facilities and whose waiting lists give priority lists to "insiders". We did our due diligence several years ago and found two excellent facilities, and paid to get on the waiting lists, but.... The BUT is that for each, we were at or near the top of the waiting list by the time the need for placement became clear but the residents in the associated assisted living facilities always got to "jump the line" when they needed to transition from assisted living to memory care. For example, on a Friday, we met with an MCF director, developed a care plan and figured out pricing, and by Monday the room had been taken by an "insider" resident of their assisted living facility. By a couple of weeks after that, we had been pushed from #1 down to #3 on the true waiting list, meaning that two other assisted living residents had been put in line in front of us for a memory care unit. This is apparently routine, and while it was mentioned several years ago when we were first looking, the claim was that once we needed memory care, the wait would be about 1 to 3 months. I don't know if that claim was based on ignorance or ???, but for whatever reason, we are back at square one, and in desperate need of a quality facility in an area where those are few and far between.