Senior residential homes: Any good?

November 12, 2008 11:25 AM

Does anyone have experience placing a relative into a senior residential facility (at least I think that's what they're called)? These are private homes with several bedrooms, and usually a couple runs them. Also curious if they're government regulated (in Calif.). More information inside....

I've been looking into nursing care and assisted living homes for my mother, who has Parkinson's and can no longer be alone. We can only afford the most basic care at assisted living (and she needs more), and she'd have to share a room. Nursing care can be provided by Medi-Cal, but that thought seems so dire and institutional.

Her doctor brought up residential care, and recommended a facility where one of her patients lived. It's very close to me and I'm checking it out tomorrow. It's two large houses located next to each other, and a couple runs it. They provide meals, activities, bathing help, etc. I trust her doctor, but something slightly weirds me out about the idea of it not being this "official" facility.

Has anyone else had a relative living with this kind of care? Did you think it was good? Were there any shortcomings? Things to watch out for? And is there any government oversight of these homes? (I'm in Orange County, CA.)

posted by faunafrailty to health & fitness (11 comments total)

I can't speak for CA, but my grandma was in one here in Oregon. I don't know why, but up here it's called adult foster care for some reason. I've worked in assisted living facilities and adult foster care seemed about the same, if not a little better because there were fewer residents and it was more of a home-like atmosphere.

They're regulated up here, like any other health facility, so I wouldn't be surprised if CA has the some sort of regulation.
posted by fiercekitten at 11:46 AM on November 12, 2008

Yes, plenty of experience on that here.

Some considerations: What is the transition to the next level of care? Visit various homes in your area, spend enough hanging out to see what the staff culture is. Some places are much better than others, and the good ones can afford to be choosy. Demonstrate that your mother has a support system and will be visited regularly, this can really reduce the potential problems dumped on the staff, and is a factor in acceptance. Complement the director on the best features of the facility. In the case of a really good place that's "fully booked", you can sometimes get special short term admittance for two weeks, if she is being discharged from a hospital, as they get extra money from insurance for that period. If during that time the family is helpful and supportive, that can be a factor in getting to stay.
posted by StickyCarpet at 11:57 AM on November 12, 2008

Some places are much better than others

To be clear, it ranges from a dangerous circle of hell to a caring and friendly community.
posted by StickyCarpet at 12:01 PM on November 12, 2008 [1 favorite has favorites]

My mom, who also has Parkinson's, lives in that type of place in Northern California. She was also in a nursing home for a while after she had a knee replacement. There's a big difference -- the residential care facility is more home like -- during the day, she and the other residents are dressed and in their living room -- they eat meals together in a dining room -- etc... It doesn't have that "nursing home smell" if you know what I mean.

While it may not be the best place in the world to live, it is not bad either. It's affordable and more home-like than a nursing home.
posted by elmay at 12:06 PM on November 12, 2008

I can speak for CA. They go by many names but are often referred to as "residential care homes." They are thoroughly regulated, with regular annual inspections, plus other inspections to verify whether new regulations have been properly carried out. The owners are required to go through a rigorous licensing process, and must be up-to-date on the latest licensing requirements. This includes not only personal care for the patients, but detailed knowledge of administering medication, and understanding the many, many health issues particular to the elderly. It also includes complying with umpteen building and fire codes (such as electronic gating systems or wheelchair accessibility).

In my opinion, the level of care in these facilities is in fact better than in your typical nursing home, largely because residential care homes only have 6-12 (sometimes fewer, sometimes a little more) people to look after, while nursing homes tend to have many more (and often less employees per client to boot). Of course this can vary and you should definitely visit and make sure you are comfortable with the way business is run. You might try popping in without setting up an appointment ("I was just in the neighborhood and was hoping for some more information") to see what a typical scene would be at the home. Maybe visit a couple others to compare to the one that your doctor recommended. Things I would look for would include the state the other residents are in (if all of them are barely talking or too confused to carry on a conversation - which many are - then you may find that your parent would not be happy there - unless her Parkinson's has already brought her to a place where she would not mind that), the level of cleanliness (unfortunately, senior facilities don't tend to smell like roses, but some do better than others in keeping this under control), the size of the rooms, and whether other family is around visiting (frequent visitors really spruce up an environment for everyone).

I would also try to see (out of the corner of my eye) how kind the employees are with the residents. I think this is one of the most important things in a senior home, and something that is all too lacking - a little love goes a long way for many seniors. If your mother has a cat, see if the place would be willing to take it - these little things may be big to her - and rules vary. Pricing varies, but I'm guessing you should expect something in the ballpark of 3-4000 a month (maybe less, since you would be sharing). I'm sorry to hear about your mother. She is lucky to have you. Good luck!
posted by AwkwardPause at 12:11 PM on November 12, 2008

Here's just one anecdote: My father had just been admitted to a new such place. At six am I quietly entered and sat and read a book in his room. When breakfast was served no one got him. At 10 am I complained and was assured it was a first-time oversight. I tiptoed in at the same time the next day and sat quietly out of view. The same thing happened the next day, but when they saw me, someone scrambled to the kitchen to fake up a late breakfast. He was out of there that day.
posted by StickyCarpet at 12:19 PM on November 12, 2008 [1 favorite has favorites]

If the facility is regulated, it must be licensed by the state of California. You can check on that here. The state estimates that about half of all elderly people in residential facilities in California are living in unlicensed places; your description makes it sounds like the place you're considering might be one of them. Any place that accepts state or federal money (like Medicare or Medicaid) or is providing a substantial level of actual medical care will be licensed; if this facility only accepts private-pay people and mostly serves people with less-severe medical needs, then they may be less likely to go through the licensing process. Obviously, you get a certain level of security when the state is overseeing a facility. However--just to give you the other side of this somewhat-debated topic--there are some elder advocates who say that people should be able to negotiate the level of risk they are personally willing to take on from the facility they live in, and this sort of negotiation is less likely to occur in facilities that are tightly regulated by the state.

Have you talked to anyone at your local Area Agency on Aging? They're a really good resource for hooking people up with supportive services. You can find one through the Eldercare Locator. They don't charge for their services, and may have ideas that you haven't thought of, so I'd definitely at least try to find one near you to talk with.

I don't have personal experience with putting a family member into a facility, but I do have some background about the residential care/nursing facility field in general, some of which may be helpful. If I were in your position, here's some things that I might want to ask the facility I was considering using:

1. What sort of accessibility modifications have they made to the residence? (Is this just a house where they're taking in elderly boarders, or have they made a big effort to make the living environment safe?)

2. What sort of background do they have with this? Anyone in the house with medical training or nursing background? Do they see themselves as just providing living space and being non-responsible for any medical needs, or do they have a standing arrangement with someone (perhaps your mother's doctor?) to come into the house if someone needs care? Do they help people make and keep medical appointments, or is that something your mother (and you) would be totally responsible for? Will they be able to recognize if your mother needs medical care when she herself may not be aware? What do they do in those types of situations?

2. How much assistance do they provide with the activities of daily living (usually called ADLs)? This webpage gives a pretty good run-down of the types of things that you might want to ask about, like whether they help their residents with bathing (even things like just getting in and out of the tub), eating, dressing, and toileting. What sort of assistance are they currently providing to people who live there? What's the most assistance they are willing to provide? Anything they are not willing to do?

3. Are there triggering events that will lead them to ask your mother to leave the facility--certain things that they say indicate a resident has gotten to the point where they need more help than can be provided? For example, some facilities will take the first or second episode of incontinence as the point where they ask a resident to move out. This can be pretty heartbreaking for the affected person, who might not have realized that they'd ever be asked to leave, or asked to leave at a point well before they felt they needed more help.

Sounds like a tough situation; I'm sorry. I hope you find a good, safe, and caring place for your mom to live.
posted by iminurmefi at 12:24 PM on November 12, 2008 [1 favorite has favorites]

Here's another inauspicious indicator: Is there a bench outside the employee entrance, with a half full bucket of cigarette buts from staff breaks? Bad sign.
posted by StickyCarpet at 12:32 PM on November 12, 2008

In addition to iminurmefi's advice, you can ask for a copy of the home's Admission Agreement, which should have a lot of those details already included (as is required by CA).
posted by AwkwardPause at 12:37 PM on November 12, 2008

Thank you--these are all very helpful and have definitely given me some things to ask about and look for during my visit tomorrow.

I have spoken with different aging help people in the past, but that was mostly to find my mother in-home care. Now that we're past that stage, it might be helpful to contact them again for more ideas.
posted by faunafrailty at 2:48 PM on November 12, 2008

How sharp is your mom? Does she have pets? If you are asking your mother to move away from her beloved pet(s), even if you have all the best reasons on the world and she can no longer live alone and take care of herself, let alone pets, be prepared for some tough talks.

She may be of a mindset that she's only got X months/years left anyway and she should spend them with Fluffy and Mr. Whiskers. If you or another family member can take the pets and provide visits, that would be huge.

If she doesn't have pets, then that's one thing, at least, you don't have to worry about.
posted by Lesser Shrew at 3:43 PM on November 12, 2008