What to Look For at MC Facilities

egilhuly

While I'm hoping to not need it soon, I want to get "my ducks in a row." I'll be touring a number of MC facilities within the next couple of weeks. Other than the usual (patient to staff ratios, Med staff, etc.) What red flags should I be looking for? Any questions you wished you asked? Any help or guidance is greatly appreciated.

Bluebird

I have started looking at Memory care facilities for my husband although I hope it will be a couple more years before he needs it.
A few things I have asked is what activities do they have and how often. I don’t want my husband just sitting doing nothing. One place I checked told me they had 3 activities a day. When I asked what they were they were they said breakfast, lunch and dinner, another words they didn’t have any activities for the residents.
Do they have a doctor who can come in to check residents.
Do they have a dentist who comes in when needed.
How often do they bath residents.
Do they have someone who will cut the residents hair.

sandwichone123

What kind of training does staff have with dementia?

CindiEC

Most facilities have a “salesperson” who shows you around and asks what you are looking for. Nothing wrong with that but realize this person usually does not interact or care for residents. Be concerned if during the tour they rush you through or avoid certain areas. If possible spend some time sitting in a common area and observe the residents and the caregivers.
Really check over the contract. Some contracts have clauses very favorable to them Some have a base price but many add on fees

Good luck

Bluebird

https://alzconnected.org/discussion/comment/239508#Comment_239508

Should we have an attorney look over the contract?

CindiEC

https://alzconnected.org/discussion/comment/239510#Comment_239510

it couldn’t hurt. Especially if there are parts that seem hard to understand.

harshedbuzz

@egilhuly

You are so wise to look now and get your Plan B lined up. I would also encourage you to tour a couple of SNFs as well in case you are called upon to find one for short-term rehab after a hospitalization (for either of you) or if your DH needs at placement are beyond what a MCF will accept. Most MCFs require self-feeding and ambulation on admission even if they allow residents to progress beyond that as they age-in-place.

When I was looking for my dad, I started by asking people in the area if they had any recommendations. Because there was the potential for dad to outlive his assets, with mom as a community spouse, I limited my search to places that accept Medicaid. Since I'm in PA, that would mean a transfer to skilled nursing as Medicaid doesn't fund MC here.

I toured a dozen places for the exclusively self-pay to the state veterans home to CCRCs and free-standing MCFs that offered only that. Some thoughts—

Don't be overly distracted by decor which is meant to impress family members. A little lived in is OK as it's clean. Better for money to be directed to training and retention which will impact the PWD. Ask about what sort of training they offer and ask the caregivers you see how long they've been at the facility. Dad's 7-3 aides had over 25-years combined experience at the facility.

I was told that this facility paid a little more and that staff was well treated. The cars in the employee parking lot were a bit newer and nicer than at other places.

Ask about employee assignments. Dad's MCF set up the schedule so that dad almost always had the same aides in his neighborhood (one of 4 halls with 8-12 residents). One worked Tues-Sat and the Sun-Thurs, so one of his regulars was on hand rather than having a weekend crew which tend to be transient.

In terms of activities, this may or may not be a huge factor if you plan to place your DH at a time when he's no longer very interested in such things. Dad's place had something going on from 9-noon and again from 2-5 and an evening movie or activity. They had a weekly lunch out for those interested and a weekly take-out lunch in as well. Activities included religious services, musical programing, crafts, chair exercises/walking, gardening and games.

Dad wasn't very interested in most, though he did like the live music. The philosophy of the facility was that each neighborhood was a home— residents were meant to sleep and rest in their rooms but be out interacting at other times. Each hall had a dining room, a TV/lounge and laundry facilities. Some of the women liked helping with folding laundry. Some residents liked to set the dining tables.

When you visit, make sure you do at a mealtime so you can check out the food and how meals are managed. The food at dad's place was kind of meh, not bad just institutional, but they were very quick to offer something different if he didn't like the entree offered. He was a late sleeper, and they graciously accommodated his preference to have a simple breakfast in his room later.

Ask about their pricing. Some facilities have a fee to join the community. Some offer a single fee per month while others offer tiered pricing that has separate charges for medication management, 2-person lift, incontinence care, laundry. Sometimes you're given a lower tier price and then almost immediately changed to a higher one which can feel kind of sketchy.

As about the circumstances under which a resident would be asked to leave. If a resident became aggressive, would they be sent to a geripsych for meds management and accepted back into the community? As about the circumstances under which you would be asked to provide additional caregivers— either a private aide or hospice.

Ask about hygiene care. In most MCFs residents are prompted to do things like brush their teeth, this isn't done for them. Most places are mandated to offer a shower 2x weekly, but some will allow residents to refuse especially in the transition period as they work to establish a relationship based on trust.

Ask about what you'll need to supply. Most places will require incontinence care products and toiletries (which will be locked up for safety). At dad's we also supplied towels and bed linens.

As about what professionals serve the facility and whether they're optional if you'd prefer to stay with a PCP. Dad's had a geriatrician, geripsych, podiatrist, mobile X-ray, phlebotomist, hair stylist/manicurist and preferred pharmacy. We used all. My aunt's larger CCRC had an optometrist and dentist as well.

We had mom's CELA read the contract before she signed it.

Bluebird— One thing I wasn't prepared for in touring MCFs was how overwhelmingly feminine atmosphere of most places. MC residents mostly women and activities are often skewed heavily that way. Dad's place tried to keep the men mostly together in one hall. But even there, the population is very fluid. Dad was one of 4 (out of a total population of about 36) when he moved in, but 2 of the men were gone in the first month— one to place nearer family and another to a hospital and then SNF. Dad died after 7 weeks, leaving only one man for a time. My first choice for dad was the veterans home, but the waitlist was 6 months, and we needed sooner. If your DH is a veteran, I'd encourage you to tour.

Good luck.
HB

Buggytoo

I'd ask about staff turnover. . . Like average tenure of care staff. Also ask about the MC's ability to manage complexity of cares up to and including death. Ask about average tenure of residents and reasons residents move out. Lots of departures usually means dissatisfaction with cares.

CindiEC

https://alzconnected.org/discussion/comment/239512#Comment_239512

all very good advice!

egilhuly

thanks everyone for the thoughts and suggestions - my question list has now grown much longer :)

Jazzma

Also check non-sponsored reviews, like on Yelp. People often write reviews when they're dissatisfied, so take that into account — you can also bring up issues cited there when you meet with staff. Recurring complaints (lack of regular cleaning, etc) can be red flags.

CampCarol

I’ve also been touring MC facilities, and if it’s a nice day, I hang out in the parking lot a bit and talk to visitors as they enter/exit. I ask them how long their LO has resided there, were they satisfied with the care, and what they would change if they could. Everyone I’ve approached has been happy to chat for a few, and they all gave me additional information. This has helped me to narrow down my facility choices.

Anna2022

https://alzconnected.org/discussion/comment/239512#Comment_239512

Thank you, @harshedbuzz - your comments are fantastic. I am making a list of everyone's comments that I will try to share later on. Thank you so much for your insight!

jfkoc

specific training…

Bluebird

I’m going to bookmark this thread. It has so many great things to look for.

Something else I have been checking is the results of state inspections. USnews and World Reports sometimes has the state inspection results.

harshedbuzz

https://alzconnected.org/discussion/comment/239689#Comment_239689

This is a good place to start. Especially in a situation where you need to select a post-hospital;ization rehab facility on the fly.

A couple caveats around this. Many of the metrics in these scores a self-reported and meeting them sometimes has consequences for residents— like if a facility wants to keep the number of patients on antipsychotics reported low, they may discontinue medication in someone who is benefitting from them.

Another piece to consider in looking at scores is that in many larger facilities, there can be some units that are higher quality than others. There's one well-regarded CCRC near me that is fabulous at hospice and long-term skilled nursing but just "meh" for rehab and memory care.

And finally, often when there is a newsworthy incident at a facility, the parent company well sell or rebrand it which gives them a fresh start. A lot of this went on in the post-COVID era.

https://www.cms.gov/medicare/quality/snf-quality-reporting-program/public-reporting

HB