Assisted Living Basics
When the time comes for placement outside of the home, there is a lot to consider. Most important is to understand the physical, social and emotional care needs of your loved one. This information will help you filter the most appropriate communities while keeping in mind financial and geographic considerations in making your decision.
Assisted Living Terminology
Skilled Nursing Facilities, (SNF) – “Medical Model”. Services are provided by licensed medical professionals. Medicare and Medi-Cal are accepted for payment. People are patients.
Assisted Living – “Social Model”. These are home like settings ranging in size from 6 people to upwards of 100 people. Assisted Living is governed by the California Department of Social Services and the Title XXII regulations. Each Assisted Living Community has a license number that has been granted by the state and it is supposed to be visibly displayed. People are referred to as residents. It is private pay as Medicare/Medi-Cal does not cover it.
Community Size. Within Assisted Living, there are certain requirements that relate to size. For example, communities that have less than 16 residents are not required to have staff awake at night. The caregivers can sleep on site. Also, they are not required to have activities for their residents. This is significant if you have a loved one that gets up at night or someone with dementia that needs cognitive stimulation during the day. Activities are beneficial for everyone.
Memory, or Alzheimer's Care. The state requires communities that publically advertise they provide memory or Alzheimer’s care to provide dementia specific training to all employees. Communities that do not advertise that they accept dementia residents are not required to train their caregivers in dementia care. Beware of the trap of asking a community if they accept people with dementia. The smaller communities will tell you that they do, but their staff is rarely trained.
Secured vs. Locked Communities – Dementia communities that are secured have a delayed egress system that sounds an alarm after 15 seconds. A locked facility refers to a psychiatric facility for mental patients.
Employee Requirements for Assisted Living – All staff members must be fingerprinted by the Department of Justice. Their prints are kept on file to alert the community if an employee has a hit against his or her fingerprints. A physical and an annual TB test are also required. A community would be cited and fined if not in compliance with these regulations. Reputable home care agencies also follow these guidelines for their caregivers. Independent caregivers are not allowed to assist residents in Assisted Living if they do not have the above clearances.
Each community is required to keep a binder posted for public access to review any licensing visits from the State Department of Social Services. Any citations will be shown along with the community correction of the deficit. The Dept. of Social Services may be contacted directly at 650 266-8800 or 408 324-2112 to get a community’s history for the last 3 years.
Make sure that anyone helping you in your housing search is knowledgeable and experienced in the senior assisted living field. He or she should bring up questions that have not been answered in the tour and meeting. Do not ask simple yes or no questions. Get examples.
Obstacles to Moving a Loved One
- Feeling too overwhelmed to do one more thing, make a change or decision.
- Guilt over breaking a promise to never move their relative from their home.
- A spouse feels disloyal to their spouse; feelings of betrayal.
- Money saved for a “rainy day”, but feeling guilty about spending it on self, even for care.
- Guilt over one’s ability and/or limitations to provide properly for the person’s care needs; not being able to do more for them.
- Denial of the actual care needs of the person. Making excuses for their shortcomings.
- Fear of criticism or making the wrong decision. Fear of a loved one’s anger.
- Responsibility of actually making a decision for another person.
How will you know when it’s time?
The best way to evaluate when it is time for a move is to be honest with yourself if you are the primary caregiver or responsible party. If you’re always exhausted and asking “how much longer can I keep doing this?” it’s definitely timely to consider your options. Is your loved one safe in their current living situation?
Ideally, it’s best to look before you are in a crisis and forced to make a rushed move. Additional stress doesn’t make this process easier. I speak with people who admit they never would have selected the community they ultimately chose. Avoid regret.
Touring Assisted Living Communities
Step 1: Research Phase. Initial tours should be scheduled with each community. All decision makers in the moving process should plan to tour. The purpose of having an appointment is to have the undivided attention of the marketer to make sure all of your questions are answered. Have a prepared list of questions that you will ask each community so you can compare answers later. Do not bring or discuss the touring process with the “future movee”, as it will only create anxiety and resistance.
Step 2: Editing Phase. Narrow the list down to 2 or3 communities, then, do a drop in tour. Ideally, make it an afternoon stop if you did a morning tour on the previous visit. On a scheduled tour, the community puts its best image forward. It should be the same any time you are there.
- Did you get the same feeling of the community on each visit?
- Were the residents engaged?
- Did the residents appear friendly? Speak to residents you see and see if they respond to you.
- Was the care staff visible? Were the caregivers interacting with the residents or talking between themselves?
- Did you hear the residents called by their names? If so, how did they react?
- Did the activities match the schedule? Does the meal match the menu?
- Do you hear the sound of music, people talking to one another or is it pretty quiet?
- Visit for lunch and observe the residents. Are people talking to each other? Does the atmosphere seem enjoyable?
- Does your loved one look like the other people living there? Age, mobility, etc.
Step 3: Decision Phase. If your loved one is involved in the decision process, take them to only your 2 favorite communities. More than 2 communities can confuse as they blend together. Let the person decide which community they prefer. With 2 communities, one is a yes and one is a no. The move should happen in a timely manner or else the senior will become anxious, waiting and wondering if this is what they should be doing.
If the senior has dementia, they should not be involved in the decision process. Your loved one will be afraid of change. They worry about messing up around others and drawing attention to their confusion. They will put obstacles in your way, change their mind. He or she may tell you that you aren’t a good son or daughter, maybe that they even hate you. This is their fear talking. Nothing beneficial to the situation happens when they are involved. It only delays the process and causes more anxiety for everyone.
I have personally seen the successful side of seniors moving into Assisted Living communities. Residents usually improve because they are getting their medications regularly, eating better, getting some exercise and socializing. Seniors with dementia may seem worse initially because they are in a new environment without their familiar support systems. Actually, you are seeing them where they actually are in the memory journey. It just wasn’t obvious before because they used to only do what they wanted to do.
The focus on making a move should be on the senior’s Quality of Life. In which living situation will they have these critical quality of life factors?
- All the care that they need 24/7?
- Good nutrition and hydration?
- Physical exercise?
- Mental stimulation?
- Friends and socialization?
- Will you have the peace of mind knowing your loved one is safe?