How do we choose an assisted living facility?
July 26, 2012 8:14 AM   Subscribe

Help with choosing assisted living facility?What do we need to know?

I did see the nursing home question from 2011, but wasn't sure if there might be GA specific resources or other things to think about.

My grandmother is 86 years old, and has lived alone since my grandfather died 5 years ago. She's recently been hospitalized and is very confused (we thought it was UTI related, but they think it is likely related to low levels of sodium and potassium). Her doctors have suggested that once she recovers, she move to an assisted living community.

Normally, she is coherent, but her legs hurt her, so while she can walk with a walker, she will not leave her house. She has someone come each morning for a couple of hours, and then my dad visits twice a week, but other than that, she's essentially alone except for phone calls and the occasional family dinner.

We think she would benefit from the social aspect of assisted living, plus, we're a little concerned for her health. She's in the hospital now and a social worker is coming by this afternoon to give us information on "skilled nursing" and "assisted living facilities".

None of us have ever done this before - any suggestions?

My grandmother does have personal funds, so money is not an immediate concern. We know that we need to visit a place and take a tour, and that we likely need to be a visible presence to make sure that she is receiving adequate care. My only experience is visiting my great-grandmother in a nursing home once she had Alzheimer's and the family couldn't care for her any longer, and visiting there was awful (as was living there, I imagine).

How do we convince her to go, if she doesn't want to? What do we look for?

posted by needlegrrl to Health & Fitness (11 answers total) 7 users marked this as a favorite
I'm in California, but I have a dad in assisted living and here is what I did:

- I got some recommendations from the discharge planner at the convalescent home where he was recuperating from a broken hip

I checked out a couple of places. Both looked and felt really nice - like private homes. However, one smelled immaculately clean and got a thumbs-up from a niece of a resident whom I happened to run into outside (if you can ever take advantage of coincidences like that, do!). I checked the licensing (easy to do on line) and ran a Google search to see if any complaints came up. None did. I also happened to walk in when the residents were eating breakfast and they were eating fresh fruit with their toast, eggs and cereal.

So that is the home I put Dad in and he's very happy; happier than with me, because he gets more company, doesn't have me yelling at him to please turn the damn TV down as I can hear it across the house, and he likes the home's cooking better than my spicy experiments.

I made Dad's room as homey as I could, with his own sheets, quilt, pictures on the wall, bookcase, etc. It doesn't look institutional - it looks like his own bedroom in a private home.

Now for some Georgia-specific links:

Assisted Living Regulations

Georgia Aging and Disability Resource Connection

Southeast Chapter of the National Ass'n of Professional Geriatric Care Managers
posted by Rosie M. Banks at 8:30 AM on July 26, 2012 [3 favorites]

I would leave the "convincing" job to the hospital staff; what finally got my mom into assisted living was that the doctor and hospital social worker were unwilling to discharge her to her home. I didn't have much to do with that, so for once I didn't have to be the heavy. Absent a judicial finding of incompetence, though, the final call is up to your grandmom.

In terms of looking for a facility, Rosie's hit on some excellent points - a few other thoughts off the top of my head:
  • If you like the place, bring your grandmother to the facility before she goes into it.
  • Review the facility agreement and the resident handbook.
  • The place should not force you or anyone else to be a guarantor of your grandmother's bills. You can be a "responsible party," meaning her bills go to that person as an agent of your grandmother. However, the responsible party agreement should make it clear that the agent is not personally on the hook for the bills.
  • Ask if you can have lunch or dinner at the facility. A "No" answer to this is a red flag in my book.
  • how are the rooms heated/cooled?
  • Evacuation plan in case of an emergency?
  • Try to meet the director and as many of the staff as you can.
  • Is there a doctor associated with the facility? If not, do they have a van that can take residents to their doctor's appointments? What's the fee associated with that?
  • Ask to see an activity schedule. Bingo? Trips out? Concerts? Exercise?

posted by Currer Belfry at 8:44 AM on July 26, 2012 [1 favorite]

I don't know anyone personally living in a home, but I do work with a lot of people who do and I visit them in their homes. I probably see more people in nursing homes, who need a lot more care and have a lot less independence, but I hope the principles would be similar.

The better homes I work in stand out to me because:
* They always have something going on, and always have somewhere quiet for the people that don't want to join in
* Activities are varied and age-appropriate - cutting and sticking might be a fun thing once in a while as an adult but it's not what you'd want to do every day
* Staff talk to the residents while helping them with things rather than gossiping to other members of staff across the room
* You only have to tell them something once and then it happens - I'm not sure how easy this is to judge from the outside
* The manager is involved in the everyday care, not just sitting in an office
* Meals are personalised - it's not just a choice of toast or porridge or nothing

Good luck!
posted by kadia_a at 8:54 AM on July 26, 2012

One more thought, one of the best homes I've worked in expected residents to help with small tasks around the home - things like setting tables or folding towels. This isn't exactly hard labour and it was always appropriate to the resident, but it helps the person keep a feeling of contributing and being personally useful.
posted by kadia_a at 8:56 AM on July 26, 2012 [1 favorite]

We moved my mother-in-law to an assisted living place a couple of years ago after researching the available options. Can't speak to the persuading part since she was entirely on board with it. I'd add to the excellent suggestions above - go and eat some meals there, ask around - is there a senior center in your community? Ask the social workers at the hospital for recommendations. What are the medical arrangements at the facility? Nurses' station? How are daily meds handled? Medical director? Connection with any local clinic? Is there a skilled nursing facility connected with the assisted living? Odds are very good you'll be back and forth between the two and a guaranteed available bed is a good thing.

Do they have a dementia specific ward? Assisted living can range from people who need a little physical help - which is where we started out - to people with full on dementia who cannot walk, feed themselves, toilet themselves, etc. A place that has a continuum of care is a win and will make your life simpler over time and be far less disruptive than having to move your parent again if they deteriorate further.

We chose the place my mother-in-law lived (she died last fall) on the basis of their excellent reputation, close ties with UM medical center - the medical director for the facility was mom's own doctor and his physician's assistant rounded there several times a week. The place was always clean, had lots of activities and a social worker who actively worked to help new residents engage and find activities. They also had fitness facilities and classes and encouraged residents to take advantage.

Single biggest disadvantage - and it was huge - was that their food was lousy. This is a big deal and will definitely lead us to a different choice if/when it comes up for my father. There were good reasons for the other place but it was a major quality of life issue, especially when mom's activities diminished due to major sudden loss of vision. So go eat there. Also make sure they're good with you coming and going whenever. And check their security for dealing with confused residents - all assisted living residents have to sign in and out where my mother-in-law lived - a good thing when people get muddled.
posted by leslies at 9:20 AM on July 26, 2012

In my state, we have a licensing agency for nursing homes. For those you are interested in visiting, it may not hurt to contact the agency and see if any complaints were filed against them and what the result was from those complaints.

You may want to check to see if your state also has such an agency.
posted by Atreides at 11:20 AM on July 26, 2012

If you can afford to hire a geriatric care manager to help with the process, it will be well worth the investment. A good geriatric care manager will have up-to-date information about the local facilities, and will meet with your grandmother to get a sense of what she wants and needs in an assisted living residence.
posted by Sidhedevil at 11:22 AM on July 26, 2012

My late mother-in-law was in a wonderful (well, wonderful for this genre of place) assisted living facility near Athens, GA, but that's a ways from Atlanta. It was sparkling clean, the staff attentive, and whenever we visited (different times of day, different days of the week), most of the patients were engaged with staff in one way or another. It had a small ice cream parlor and a beauty salon inside the facility, as well as a large gathering room and a small music room where a pianist comes in several times a week to hold "sing-alongs." My father-in-law found it after researching dozens of other facilities from Athens to Commerce and places in between by talking to nurses and the relatives of other patients in my mother-in-law's doctor's office (the doc that was treating her early-onset Alzheimer's Disease).

When my Dad had to be placed in Assisted Living (in Michigan, not GA), we started with a lengthy list given to us by his doctor. We started with the ones that were within a reasonable drive since Mom (in her late 70s herself) would be driving to see him every day. Her neighbor across the street saw her outside one afternoon during the process and while they were chatting mentioned that her husband had recently moved into Autumn Woods, one of the top choices on Mom's short list. She raved about the staff and facility, so we visited it a few times, researched it a bit (fully licensed, no complaints filed, etc, it was very near the hospital) so that was the final choice. Dad passed away a year ago, but Mom still goes to Autumn Woods twice a week to visit with the many patients she'd befriended while Dad was there. Normally she'd always hated "nursing homes", but she always says that this place doesn't seem like one.

So I'd say besides checking the obvious credentials, visit any places you're considering and perhaps linger around outside afterward and chat with other relatives who are coming to visit and get their opinions. As for getting Grandma to agree, that may be an uphill battle. In Dad's case it helped when we told him that Dr. X (his regular doctor, whom he trusted implicitly) recommended that he stay here for "a while" because he needed special care for the time being. Best of luck to you.
posted by Oriole Adams at 11:40 AM on July 26, 2012

Is your grandmother connected to a church? Pastors often spend a lot of time visiting different facilities to give communion to members and may have suggestions. If she has friends who have already moved to assisted living, consider that as well.

You mentioned that your grandma has personal funds - I recommend pricing out some different scenarios anyhow. Ideally, she'll be staying there for years, right? Be liberal in estimating medical costs - my relative got O2, respiratory therapy, and other treatments added to her care when she moved to assisted living because her health was being monitored more closely, although they were generally mindful of what Medicare would reimburse for.
posted by momus_window at 3:54 PM on July 26, 2012

You need to look at the ratio of patients to staff. Is there and RN on duty 24/7? Do the aids seem happy in their work (go in and observe them for facial expressions/signs of stress)? Call the state ombudsman and see if there have been complaints against the facility and if those complaints seem valid.

Just because a facility looks pretty/expensive doesn't mean jack if their level of care isn't decent. Talk to other residents.

Even if your gran has money, that runs out fast. Find out her Medicare situation and if she has more rehab days left, because there's a good chance she'll end up in skilled care again. The way that works is you get 90 days of skilled care per event. They'll move her to the facility's skilled care, so you need to know if their skilled care is decent as well, not just the assisted living.

Bona fides: I'm a nurse who has experience in the field.
posted by syncope at 5:55 PM on July 26, 2012 [1 favorite]

Response by poster: In case anyone else uses this thread as a reference - we need to transfer her to a rehab place first, and we checked those out this weekend.

Things that the one told us to ask about -

1. ratio of nurses to patients.
2. how often is a doctor available? (For example, one of the places we looked at is tied in with Emory, and they have doctors there 5 days a week - they may not be the doctor she is assigned to, but if she needs something, they can take a look at her. Other places had doctors maybe once a week.)
3. availability of after hours doctors?
4. visiting hours - some of them told us 9am-9pm, the one we like told us we could be there anytime, as long as we were mindful of physical therapy appointments and her roommate - we couldn't interrupt her sleep.

We did run into someone my dad knew at the one place, and he recommended it.

The medicare website also have ratings for some of the places - we checked out each location on there.

We did check out activities, watched people eating lunch, looked at menus and calendars. Hopefully she'll be transferred to the place we chose tomorrow, and then we'll start looking for assisted living places.
posted by needlegrrl at 7:57 AM on July 30, 2012 [1 favorite]

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