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Merla

I'm

Daisie

I'm interested in this, too! Thanks for posing the question!

mabelgirl

Be sure to check the licensing agency for records of complaints and what the resolution was.
Visit your mom on an irregular schedule once she does get settled in.
I would have liked a larger room for my mom but felt the smaller size would be encouragement to get out and about. It also gives her less laces to hide stuff.

Although she has a kitchenette she’s at a point where fixing a real meal is beyond her. She just pushes buttons on the microwave as it is, if she even attempts. So for us the dining room was needed plus again a hope for more socialization.

Originally we had sought a small residential home with 6 residents but after evaluating a larger facility felt that was oddly better. At the residential home all but one of the residents seemed very drugged but at the larger one the residents were more active.

We’re just starting this phase of our journey to ALF. I just wanted to share my thoughts.

harshedbuzz

@Merla said:

1. Is a big or small facility preferable?

There are plusses and minuses to both. A larger CCRC will have more amenities and likely a larger campus, these would allow her to move through levels of care as her dementia progresses. A good one can be fluid about including someone in the earlier stages with AL folks if they're agreeable. Another option would be a combined AL/MC facility that would allow secure MC as needed but might include her in activities with less impaired residents. A purpose built MCF, which tend to be smaller, should have dementia training and is more likely to maintain caregiver-resident scheduling so mom's familiar with her carers and vice versa.

2. Does the size of the apartment or room really matter? Right now the only acceptable place near me has smaller rooms (350 - 450 ft) and only have kitchenettes (fridge). This place has a lot of big beautiful common spaces both indoor and outdoors. Is it better for people with dementia To have a very nice larger room where they spend a lot of their time (more like living on their own) or to have a smaller personal space and large common areas ie watching tv in the common area or reading a book on the terrace?

The philosophy at many MCF is that residents are meant to use their rooms as one would their bedroom at home— for sleeping and rest. Residents are encouraged to be out in the communal areas of the building most of the time. Social engagement is part of "Best Practices" FWIW. To that end, rooms are generally smallish, and some places discourage TV. Does your mom read? Dad could well into the middle stages, but he got little from it, so this is not a scenario I would anticipate given her repetitive questioning of your daughter.

3. Do things like walking trails and nice fitness rooms matter? My mom is very physically active, enjoys taking long walks, plays pickle ball, and does strength training. I imagined her at a place with a beautiful grounds where she could take walks. The facility I like has a tiny exercise room and is at an intersection with a moderate amount of traffic. She could actually walk to our house (1 mile away) but it's not a super pretty walk. Of all the things related to placing her in a facility, I think my biggest guilt would be if she couldn't be physically active. In my mind tor her this is worse than being on a locked floor. The facility is relatively small like 80 rooms so it's not like there is tons of space for her to walk around.

You might find a CCRC with room to walk, pickleball and a decent gym. Almost all MCFs are secure— locked. Most that have an outdoor space limit access to that space at least some of the time. Dad's MCF's gardens were closed in hot, cold or wet weather. Because residents outside need well-checks every 20 minutes as opposed to daytime hourly checks, sometimes the outdoors was off limits because staff was busy managing other tasks.

4. Is it preferable to have all meals provided in a common area or to have a apartment with a kitchen?

Again, this is going to be hugely dependent on the philosophy of the place. Most MCFs will offer meals in the dining room, at a table with others. Most places that have residents with dementia won't allow any cooking for the safety of all. Dad's aides would sometimes bring him breakfast or a sandwich to his room for him.

5. What type of activity programming should I look for? I don't see my mom as an activity type of person but maybe she would become interested.

Dementia-informed activities that are failure-free. At both dad's and my aunt's, there were a range of crafts, exercise, religious services, movies, games, outings, and music. Dad only liked the music; my aunt loved it all.

6. How do I evaluate the quality of memory care besides the staff to resident ratio? The one place I liked had two levels of memory care which are housed on separate floors from each other. The 2 memory care floors are identical to each other. I perceive this as a big plus since someone with relatively mild cognitive impairment wouldn't be with people with very advanced dementia but at the same time people with mild cognitive impairment would be treated appropriately and not just like someone in AL.

Also important is who those folks are in terms of training and experience.

I was also told that they assign specific staff to residents so the resident and staff members get to know each other well.

That is very appealing to me. At dad's MCF, they had the same 2 aides during 1st and 2nd shift so most of his care was with people who knew him. The aides split the weekend shifts, so he always had at least 1 aide he knew rather than a weekend B-team.

7. Am I placing too much emphasis on location and proximity to my house? I'm in a very busy stage of my life (2 young kids and a full time job), so I don't have a lot of time to spare to visit. I'm also unsure how the dynamic of bringing my kids to see her or bringing her to our house will go. My five year old was having meltdowns and being rude to my mom because she kept asking her the same questions. I will have a I have talk with my 5 year old about her grandmas condition when my mom moves near us. So given all this, I won't be able to visit regularly unless it's very convenient.

Proximity matters to some degree. That said, the place I picked for dad was about 22 minutes (12 for mom) away for me and I drove by a dozen other facilities to get there. It was the best fit for his needs and worth it. A friend of mine whose grandmother went into care, picked a place that was near where she worked which meant she could often drop in at lunch or before heading home.

however If I expanded my acceptable geography then there would be more options. In my mind I am thinking I could see my mom a few times a week to go on walks and have this take up only an hour of my day more or less if she is in a facility a mile away. However there is the possibility that this won't happen either bc of my schedule or because it take too much of my time or because perhaps she won't even want to do this.

I wouldn't plan on taking mom out until she's settled in. When I visited my dad, he was good for about 45 minutes. My aunt tired in even less time.

HB

fmb

@Merla

When you look into the complaint records with the state, try to keep things in perspective. Given the post-Covid difficulty in finding and retaining staff, especially CNAs, nearly every place has been cited for inadequate staffing at times. That does not mean that they are a substandard facility. A number of facilities have changed ownership and in-facility management, and the new owners/management have inherited a long list of citations for problems that are being rectified. This is the case with my DH's facility, which is currently under probationary certification but making great headway in resolving past issues with no valid unresolved present issues cited. His facility also recently had a barrage of very serious false allegations made by a disgruntled employee (who thankfully has been terminated for other causes.) She made totally unfounded claims including resident abuse, unsafe employee working conditions, and medication theft to the State, APS, the Long Term Care Ombudsman, OSHA, and others. Every one of these allegations must be investigated by each agency and publicly recorded. The ombudsman has been there interviewing residents and families at least twice, and the state was recently there for three long, grueling days. Ironically enough, because the State was there, a resident care skills training session had to be cancelled and rescheduled. This all adds a great deal of stress for management, employees, families and residents and further impacts the level of care the residents receive.

M1

Merla, I think you’re going to find (as I have) that you are going to have to personally fill in the activity gaps that you perceive for your mom. You’re probably going to have to show up to take her on walks. She may well lose the executive ability to do it herself and not get lost, and unless you can afford to hire a one on one companion who will do it, it’s going to fall to you. That’s likely the reality.

fmb

@Merla Just a few thoughts on your questions.

As long as she is ambulatory, room size does not necessarily matter. As she progresses, she may develop problems with mobility that require a wheelchair or even eventually a Broda chair and Hoyer lift. At that point you definitely would want more space.

When you visit facilities, try to come before the residents gather for a meal. See how many of them are in the halls or the activity room. Or do they all disappear into their rooms except for meals? Do the hourly staff (housekeeping, aides, etc.) you encounter make eye contact with you and smile? Do they seem to interact with the residents?

Paying more money for fancy surroundings and amenities does not necessarily equal better care. The best care DH received was rehab at a shabby, older building. Keep in mind that on the sales tour you are not likely to be shown the less desirable parts of the building nor see the more impaired residents, especially in assisted living. If a place appears 'sketchy', listen to your intuition.

Some ALFs are set up with a basic fee for the room and then additional fees for additional levels of care. Some families do not like this because their fees go up as their LO requires more care, but I look at is as not paying for services you are not using. DH is up to Level 4 (out of 5), and the additional fee is 40% more than the base room fee, but he requires medication management, incontinence care, a Broda chair, a Hoyer lift (requires 2 aides), and hand feeding in the special needs dining room - all services I would not want to pay for if he didn't need them.

I have not seen a MCF with a walking path, but many of them have fully enclosed courtyards. For their own safety, MC residents are not usually allowed outside by themselves, even in the courtyard. You will have to personally escort her on walks, I'm afraid.

I would definitely listen to the recommendation of friends with loved ones in AL/MC. When DH was in rehab, I learned a lot about various local facilities from the PTs, OTs and nurses who worked there. A facility may get good recommendations for AL but not so good for MC or vice versa. Try not to pay much attention to complaints posted in social media. Many of those are from families with unreasonable expectations or disgruntled former employees.

The distance you are willing to drive is up to you. For DH's first facility, I had drawn a circle with a radius of 30 minutes drive from my house. For his second placement, I had no choice. It was a matter of finding a facility that could handle his care (2-person transfer, permanent catheter) because Medicare was pushing for his release from rehab. His current facility is a 45 minute drive each way, and that gets very tiring very quickly.

Hope this helps. Just remember, no place is perfect.

harshedbuzz

@Merla said:

Do you think recommendations by friends who have parents in AL or memory care are valuable? A friend recommended against the facility her parents are at because the staff and manangent aren't good but the facility looks nice.

Maybe. Maybe not. Sometimes people have very unrealistic ideas about what is possible or struggle with their LO's decline and blame it on their surroundings or care. If the place is not on a friend recommends, why are her parents still there? I always talked to families in the parking lot; generally I got a balanced review— the good and the disappointing.

I looked at a big ccr and to me it looked like sketchy. And even this big beautiful facility didn't have the type of fool proof walking paths I envisioned.

There is no such thing as a fool-proof walking path in dementia. PWD have gotten lost looking for the bathroom in a home they built with their own hands and lived in for 40 years. Because falls are a universal risk at a certain age and because there is a risk, however small, of an assault by staff or another resident, walking paths are going to be within a line of sight for supervision.

I just can't quite imagine confining someone to a floor of a building or even a building and having this be their entire life unless they are extremely advanced. But this seems to be what happens.

Sadly, that is the reality. PWD tend to have very small worlds. As the disease progresses, the wants and needs of the PWD will change and they may feel safer in a smaller and less complicated space.

My theoretical plan was just to take her out for walks. It seems like it's good for people to get out for fresh air and walk assuming there isn't mobility issues. However, for reasons of safety there needs to be a foolproof walking path so no one gets lost. I haven't seen this yet in a facility.

It seems like maybe this isn't going to happen where you live. There are 2 CCRCs near me that have lovely natures paths adjacent or part of the community and a couple others that allow residents to walk into town. These would be available to families to escort a PWD from MC but not for the PWD alone.

The other potential fly in this ointment is your children. Are you up for ensuring the safety of a toddler, elementary-aged and a PWD on public paths? Will your mom be the sort of PWD who enjoys young kids or will she lose patience with them or resent them for deflecting your attention?

If you have POA, you could take mom's car and use it for your role as a caregiver. If you title it to yourself, be careful around "gifting it" should she ever need Medicaid this could be a problem. I had planned to do this with my mom's car, but she went and totaled it.

HB