Red Flags?

yarnball · May 10

I have made the decision to place my Mom in a MC facility. She is no longer safe at home and needs 24/7 care. We all work so living with one of us is not an option. I am visiting facilities this weekend. They show your their best, of course. What are things I should be on the lookout for that might give me pause. Are there specific questions or info you recommend I get during this initial visit?

I also appreciate your prayers for our family. As all of you know, this is an incredibly difficult journey. Someone here said, "You're not doing it TO her; you're doing it FOR her". I'm hanging on to that. Mostly, I just want to run away to another time and place where I don't have to make difficult decisions. God's peace for all of you.

harshedbuzz · May 10

I toured about a dozen places for dad ahead of finally convincing mom it was time.

My first caveat would be to consider whether mom might outlive her assets and require Medicaid assistance. If this is your reality, don't bother touring places that don't take Medicaid. Often there's an expectation at nicer places that a PWD will be self-funded for 2-3 years before converting to a Medicaid bed and priority will be given to those residents. Waiting lists for MC can be long in some communities, this is especially true to those entering on Medicaid directly. In some states, Medicaid will only pay for SNFs, not MC so you'll want to tour places than can provide both.

I would ask if they allow residents to age-in-place. Many MCFs do serve the continuum of stages, so if you want to avoid moving mom a second time ask whether this is possible. Also, ask under what circumstances family would be expected to provide additional aides for their LO. This sometimes happens in later stages when a PWD needs more hands-on care; sometimes bringing hospice on board can meet this need without spending additional money.

Ask what sort of training staff gets and about staff turnover. Ideally you want something like Teepa Snow or Validation as dementia-informed care. IME, a facility that takes care of its people tends to attract better staff. When I was shopping, I checked the employee parking lot— the nicer the cars the better the staff seemed. Dad's DON was very accommodating of staff; he picked them up on snow days if they didn't like to drive and allowed their school aged children to hang out in the activity room on the odd school holiday.

Ask about pricing strategies. Is there a community entrance fee? Is the pricing tiered or one-price-fits-all? What is included? Dad's covered pretty much everything but incontinence products, medications, and social outings/take-out lunches but I've heard of families having to provide their own toilet paper which then goes missing. If it's tiered, make sure you understand what would lead to a higher cost— one place I looked at charged extra based on the number of meds administered, 2-person lifts, incontinence care, laundry, hand feeding. Also ask about pricing if mom was hospitalized long term. FWIW, we asked mom's CELA to look over the contract before we signed.

Be honest about any behaviors mom might have. You don't want to sugar-coat how challenging she is and then find it's a bad fit. Ask under what circumstances a person would be asked to leave and what that would look like. If someone requires a stay in a geripsych unit, do they accept them back or no?

Ask about what services come into the facility. Dad's MCF had a geriatric specialist who could become the residents' PCP if family desired which meant not needing to take them to appointments for most things. They also had a visiting podiatrist, geripsych doctor and hair stylist. They also had affiliated PTs, OTs and an SLP that could come do consults and work with residents as well as phlebotomists and traveling X-ray techs.

Ask about what a typical day looks like. Check to see that the listed activities are actually happening and appropriate to mom's level. Ask about weekends— do they have activities or no? How are the staff positions filled? At dad's his main aides on each shift worked one weekend day so he rarely had an aide who didn't know him well.

Check out the food. Often lunch is the big meal of the day, so don't be put off if dinner is something simpler. Also check how flexible they are about food. Often dad didn't like his lunch entree and was immediately offered a soup and sandwich.

Ask about laundry. Some places use a commercial laundry which can be harder on clothing and lead to disappearing items. Be sure to label everything. Everything— dentures, glasses, hearing aids, decor items, etc. Dad's MCF did laundry as an activity in the unit for those interested. Some families preferred to do it themselves.

HTH-
HB

mabelgirl · May 10

Once you have decided a place it is important not to visit on a regular schedule. Varying the times and days.

Prayers for peace of mind .

harshedbuzz · May 10

@mabelgirl Good point. I did this for touring at my top choice.

yarnball · May 10

https://alzconnected.org/discussion/comment/208728#Comment_208728

This is all SUPER HELPFUL info and exactly what I was hoping for. Thank YOU for sharing!!

psg712 · May 10

Agree with all of the above. Just want to say that I can totally relate to the feeling of wanting to hide somewhere and avoid the hard decisions! Prayers for peace. No place is perfect, and there will always be some feature or person that isn't to your liking. BUT if you find a place with leaders and staff who genuinely care about the people they serve, that is a huge blessing.

concerned_sister · May 11

HB - I really appreciate you offered such well thought out advice. Seems to me that should be permanently saved somewhere.

frankay · May 11

Also ask about what happens when your LWD is unable to stand. Does the facility use a Hoya lift? I found that many places do not and when the LWD reaches that stage they must leave.

concerned_sister · May 16

https://alzconnected.org/discussion/comment/208728#Comment_208728

@Jeanne C. Could you post this to the New Caregivers Help group re placement discussions?

Rob's Daughter · May 21

Just trust your gut. I toured many places and cried when I left them all except for one. It was a hard decision, but I sleep better at night knowing my parents are safe.

KatsEye · August 23

> @harshedbuzz said:
> I toured about a dozen places for dad ahead of finally convincing mom it was time.
>
> My first caveat would be to consider whether mom might outlive her assets and require Medicaid assistance. If this is your reality, don't bother touring places that don't take Medicaid. Often there's an expectation at nicer places that a PWD will be self-funded for 2-3 years before converting to a Medicaid bed and priority will be given to those residents. Waiting lists for MC can be long in some communities, this is especially true to those entering on Medicaid directly. In some states, Medicaid will only pay for SNFs, not MC so you'll want to tour places than can provide both.
>
> I would ask if they allow residents to age-in-place. Many MCFs do serve the continuum of stages, so if you want to avoid moving mom a second time ask whether this is possible. Also, ask under what circumstances family would be expected to provide additional aides for their LO. This sometimes happens in later stages when a PWD needs more hands-on care; sometimes bringing hospice on board can meet this need without spending additional money.
>
> Ask what sort of training staff gets and about staff turnover. Ideally you want something like Teepa Snow or Validation as dementia-informed care. IME, a facility that takes care of its people tends to attract better staff. When I was shopping, I checked the employee parking lot— the nicer the cars the better the staff seemed. Dad's DON was very accommodating of staff; he picked them up on snow days if they didn't like to drive and allowed their school aged children to hang out in the activity room on the odd school holiday.
>
> Ask about pricing strategies. Is there a community entrance fee? Is the pricing tiered or one-price-fits-all? What is included? Dad's covered pretty much everything but incontinence products, medications, and social outings/take-out lunches but I've heard of families having to provide their own toilet paper which then goes missing. If it's tiered, make sure you understand what would lead to a higher cost— one place I looked at charged extra based on the number of meds administered, 2-person lifts, incontinence care, laundry, hand feeding. Also ask about pricing if mom was hospitalized long term. FWIW, we asked mom's CELA to look over the contract before we signed.
>
> Be honest about any behaviors mom might have. You don't want to sugar-coat how challenging she is and then find it's a bad fit. Ask under what circumstances a person would be asked to leave and what that would look like. If someone requires a stay in a geripsych unit, do they accept them back or no?
>
> Ask about what services come into the facility. Dad's MCF had a geriatric specialist who could become the residents' PCP if family desired which meant not needing to take them to appointments for most things. They also had a visiting podiatrist, geripsych doctor and hair stylist. They also had affiliated PTs, OTs and an SLP that could come do consults and work with residents as well as phlebotomists and traveling X-ray techs.
>
> Ask about what a typical day looks like. Check to see that the listed activities are actually happening and appropriate to mom's level. Ask about weekends— do they have activities or no? How are the staff positions filled? At dad's his main aides on each shift worked one weekend day so he rarely had an aide who didn't know him well.
>
> Check out the food. Often lunch is the big meal of the day, so don't be put off if dinner is something simpler. Also check how flexible they are about food. Often dad didn't like his lunch entree and was immediately offered a soup and sandwich.
>
> Ask about laundry. Some places use a commercial laundry which can be harder on clothing and lead to disappearing items. Be sure to label everything. Everything— dentures, glasses, hearing aids, decor items, etc. Dad's MCF did laundry as an activity in the unit for those interested. Some families preferred to do it themselves.
>
> HTH-
> HB

Hi HB,
Brand new to site. How do I save your post or share your post with family??

mpang123 · August 23

Thanks KatsEye for your post. I will use your guideline for choosing a facility for my dad.

harshedbuzz · August 23

@KatsEye

Since you don't need to be signed in to access the site, you could email or text a link to the page.

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HB