Elder Care Abuse: How to Know and When to Act

January 23, 2012 By Leave a Comment

Elder abuse is something that occurs in the United States more frequently than many of us know.  According to Elder Abuse Daily in 2010, there are almost 6 million elder abuse cases every year.  This estimate demonstrates a growth since the American Psychological Association reported in 1999 that an average of over 2.1 million elder abuse cases occur every year.

According to the U.S. Administration on Aging, elder abuse is the, “knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.”  The administration states that these are the common abuse types:

  1. Physical Abuse is the infliction of “physical pain or injury on a senior, e.g. slapping, bruising, or restraining by physical or chemical means.”
  2. Sexual Abuse is the “non-consensual sexual contact of any kind.”
  3. Neglect is “the failure by those responsible to provide food, shelter, health care, or protection for a vulnerable elder.”
  4. Exploitation is “the illegal taking, misuse, or concealment of funds, property, or assets of a senior for someone else’s benefit.”
  5. Emotional Abuse is the infliction of “mental pain, anguish, or distress on an elder person through verbal or nonverbal acts, e.g. humiliating, intimidating, or threatening.”
  6. Abandonment is the “desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person.”

According to the National Institute of Justice (NIJ), emotional abuse, financial abuse, and neglect are the most prevalent of all elder abuses.

Unfortunately, elder abuse is not a crime commonly reported.  The National Center on Elder Abuse estimates that 83 percent of elder abuse cases never get reported.  According to a 2009 NIJ research report, the majority of the elderly’s abusers are people they know.  Through surveys, the NIJ found that the elderly are most likely to underrepresent abuses:

  • That happened more than a year ago.
  • That they did not report them to the police.
  • If the abuser was not a stranger.

Sadly, the unwillingness of the elderly to properly represent or report these abuses is detrimental; the majority of elders surveyed by the NIJ had been abused over a year ago, had not reported the abuse to police, and knew their abuser/s.

How to Protect the Elderly from Abuse

In order to protect your elderly loved one from abuse, you must:

  1. Ensure he/she is in a quality elder care program.
  2. Do research.
  3. Ask the elder care facilities that you visit for their state survey reports.
  4. Visit, inspect, and ask questions.
  5. Ensure that your chosen facility has a proper staff-resident ratio. According to the Health and Human Services (HHS), 90 percent of nursing homes are understaffed. Nursing home staffs spend less than 3 hours total with residents each day (HHS) despite about 4 hours being what the government and expert recommendation for patient care each day.
  6. Check on your loved one frequently.Visit your loved one as much as possible to ensure he/she is receiving sufficient senior care.
  7. Physically check your loved one for signs of abuse. A list of abuse symptoms can be found on the NIJ website.
  8. Know your loved one’s rights as a resident. You can view these rights on the website below or by asking your loved one’s care facility for a copy of your state’s “Resident’s Bill of Rights.”

About the Author: Amber Paley is a guest blogger and article writer specializing in elder abuse prevention. Amber spends much of her professional life writing about abuse in nursing homes.

Photo credit: pedrosimoes7

Filed Under: Assisted Living, Legal & Financial, Quality of Care Tagged With: ,

A System for Selecting an Assisted Living Community

December 19, 2011 By 5 Comments

As you have likely learned through reading our blog posts and your own life experiences, the transition to assisted living is a stressful and emotionally charged period of your life. It’s also likely an incredibly scary and uneasy part of your loved one’s life.

In previous posts, we’ve shared information to help prepare you for this moment – the time when you and your loved one will select an assisted living community.

Visit our previous posts for resources on what to look for when researching and touring assisted living facilities. This information can help to convert a chaotic and often panic-filled situation into a calm, thoughtful and logical decision making process.

Now let’s discuss how to select the right assisted living community for your loved one:

Comparing the Finalists
By now you should have collected detailed information on several assisted living communities. You’ve had good and bad first impressions of communities, people, insurance companies and all the things that run hand-in-hand with this transition. For reasons both known and unknown to you, you’ve probably also excluded several communities.

When trying to find a community for my mom, my sister and I looked at many communities before ultimately making a decision. We struggled to find a technique that enabled us to make a decision that satisfied three criteria:

1. Compare all communities across the same attributes

2. Give some attributes more weight than others

3. Deliver an objective, measurable final selection

Why were we so formal? Because we knew that we had put every ounce of our souls into finding the best community we could. We didn’t want to ruin a decision by injecting too much bias into it..

Choosing Attributes
We decided on six attributes on which to make our community selection. They are:

  • Location: the geographic location of the community; proximity to family, friends and shopping; amenities of the community and size/ layout of the apartment.
  • Staff: experience of the executive team; friendliness of the dining room staff; staff treatment of residents and their observed interactions.
  • Activities: activities calendar; personality and demeanor of the activities director; amenities related to activities including transportation, game rooms and other entertainment.
  • Quality of care: the experience of the nursing staff; proximity to fire, hospital and emergency services; rehabilitation rooms and quality of the therapists.
  • Cost: total monthly cost of community at the level of care required for my mother.
  • Gut feeling: you have instincts for a reason. Use them.

Over the last several years, I’ve shared this list with many people and validated that it addressed the vast majority of families. Now that you have a group of attributes against which you can measure your finalists, let’s add a measure of importance to each one.

Weighing Attributes
Different things are important to different people, and you’ll likely have strong feelings about the relative important of one attribute over another. This is called weighting.

Weights are applied by giving each attribute a percentage from 0-100%. Those attributes you deem most important receive the highest percentage weight. The total of all attributes must equal 100%.
It’s important that you apply weights to the attributes before you begin ranking your community finalists. This will enable you to minimize unnecessary bias before the score process.

Ranking Final Communities
Now that you have removed the unnecessary bias from your decision, you can score each community against the others. The score will occur for each attribute above. You will likely find communities will be a leader in some attributes and a follower in others. This is normal.

Armed with this system, you will be able to sift through all of the information you’ve gathered and decide on a community that will meet your loved one’s and your family’s needs.

Photo credit: winnifredxoxo

Filed Under: Assisted Living Tagged With: , ,

New Gallup Research Profiles Caregivers in the U.S.

December 12, 2011 By 3 Comments

Have you ever wondered whether there are other people out there like you, balancing caregiving for an elder or disabled loved one with a full or part-time job?  New Gallup research sponsored by Pfizer and ReACT (Respect A Caregiver’s Time) provides demographic information about U.S. workers who are also caregivers.

To answer the question above, you are not alone. An estimated 17 percent of U.S. workers do double-duty as caregivers for elderly or disabled loved ones or friends. Overall, 16 percent of working men and 20 percent of working women are also caregivers. The majority of these caregivers (22 percent) are between the ages of 45 and 64 years old. The age group least represented as both workers and caregivers are 18 to 29 years old.

Infographic from Gallup Management Journal.

 

Caregivers are represented in every major demographic group, with 17 percent of  working whites, 21 percent of working blacks and 20 percent of working Hispanics also providing care. The research shows a correlation between income, education and caregiving. As income level and education level increase, the propensity for a worker to also be a caregiver decreases.

What is the Cost of Caregiving?
The intention of the Gallup research is to highlight how effective U.S. employers are in addressing caregiver needs and what the hidden costs of caregivers missing work are to those employers.

Infographic from Gallup Management Journal.

Below are some findings about the types of benefits working caregivers receive and the cost of caregiving:

  • Less than half of U.S. employees have access to assistance programs where they can discuss any emotional stress that comes along with balancing caregiving and their jobs.
  • Only 27 percent of U.S. workers who are also caregivers have access to support groups or health counselors who can answer any questions about providing care.

Gallup also takes a look at how each type of initiative, from vacation days to flex time and counseling, can impact caregiver absenteeism. Organizations that provide counseling to discuss caregiving options such as assisted living and nursing homes, may see an improvement of 1.2 fewer work days a year missed by caregivers. Support groups will reduce caregiver absenteeism by 1.1 days a year, and paid vacation by one day a year. All of the other options, including unpaid vacation, sick leave and flex time, will make an impact of less than one day per year in a caregiver’s schedule.

Conclusions
Studying ten benefits for caregivers who work full or part time, Gallup finds that if U.S. employers offer at least 8 of these 10 caregiver benefits, it can reduce the cost of caregiver absenteeism by 23 percent of its current level, or $5.8 billion dollars.

The research concludes by offering suggestions for small, medium and large businesses about caregiver initiatives that can have the most positive impact on employees and the bottom line. To review the complete findings, visit Gallup’s Management Journal.

Photo credit: Images_of_Money

Filed Under: Caregiving Tagged With: , ,

An Elder Care Conversation About Senior Activities Done Right

November 28, 2011 By Leave a Comment

During my research on assisted living communities and elder care, I met a woman whom I consider to be the model activities director. Her name is Terri Glimcher and she is the Life Enrichment Coordinator for Emeritus Senior Living. In addition to her duties at Oak Park Assisted Living in Clermont, Florida, she also serves as a trainer for many other local communities. If her techniques were universally adopted, this chapter would be completely unnecessary.

I’ve spoken to Terri several times during the course of my research, as she is a true expert in her field. She gets it!

To reword our discussion would not serve her great work justice, so I’ve included the entire transcript of our discussion.

RYAN: Thanks for spending the time with me, Terri. The work you’ve done at Emeritus has been amazing.
TERRI: Thanks for the kind words.
RYAN: Let’s go ahead and get started. What is your role at the company?
TERRI: I am the Life Enrichment Coordinator for Summerville at Oak Park Assisted Living, an Emeritus Senior Living property in Clermont Florida. I am also on the marketing team here at Oak Park.
RYAN: Sounds like a lot of hats! Being a marketing guy from a previous life I know what you’re going through. I’d like to focus on the activities portion of your responsibilities. Would that be okay?
TERRI: Sure.

RYAN: What is the role of “activities” in an assisted living environment?
TERRI: Great question! Activities play a very important role in assisted living. It is very important to keep the mind and body challenged and stimulated throughout the day. More importantly, however, is the socialization that comes with activities. It is very important for your loved one to feel connected in their new residence. Activities will help to do this. Activities also help the resident continue to enjoy many things they used to do. This consistency helps with the overall transition to assisted living.

RYAN: That makes a lot of sense. I know it was tough for my mom to transition to assisted living, because she was so active before.
TERRI: What did she do?
RYAN: She was involved in women’s club, some charities and card parties with her lady friends. She missed all that when she got into assisted living, as she remembered what is was like before her stroke.
TERRI: That sounds tough.

RYAN: It was. Anyway, let me ask you another question. What do most assisted living communities do wrong with regard to activities?
TERRI: I only know from many that I have observed that they do not meet the needs of ALL residents. They focus on the mainstream population and often have activities that people with special needs such as physical, visual or hearing cannot participate in. In my community, we make sure that adaptive equipment is in place so that all residents can participate in any activity.
RYAN: That great to hear…
TERRI: I also firmly believe that the residents should have choices in their schedule, which is why a resident council should be in place. This is their home and activities should be available at all times for residents to participate in as a group or individually. That piece lacks in many communities. Another important factor is that the assisted living community should be connected to the local community. Many times residents feel isolated because their whole world revolves around the community. The community is very open to seniors and it is a great way to keep them connected.

RYAN: Your approach sounds really unique. What have you planned that is unique?
TERRI: I really believe that most of my activities are unique in that age never plays a role in what I plan. We are always involved in a community service project of some kind. My knitting class made baby hats for the neonatal unit at our local hospital. We donated 150 hats. They were also involved in the Give a Kid a Backpack Program here. The residents hand-craft a beautiful teddy bear to go in each backpack received by the children. We have made soldier caps that were sent to Iraq, we raised money for breast cancer awareness and many more. Seniors enjoy giving back. They feel a part of a bigger picture.

RYAN: That’s really amazing. This is the kind of thing that probably makes a big difference to the residents. It seems like having a purpose is often missing for many of the assisted living residents I’ve met.
TERRI: Absolutely. In talking with the residents, I learned that not working and not having responsibilities was the hardest part for them. In hearing that, I came up with a list of jobs within our building and held a huge job fair for the residents. Each resident who wanted a job came down dressed up, filled out an application for the position, and was interviewed by me. This gave them a chance to tell me about their former careers and what it was like to work when they were growing up. It was wonderful. They all got the jobs they applied for — floral committee, taking statistics, welcome committee, sending get well cards, watering plants etc. I can tell you that for three years, every one of them has taken their job very seriously. We are a family here, and it takes a family to make it work. They receive $100.00 a week funny money and shop at our General Store.

TERRI: I also started the Bridging the Generations program with all the local high schools. This is ongoing for three years now. The high school kids come to Oak Park and are paired up with the residents. They do projects together, cook together, etc. We celebrate holidays with the students. I bring the residents into the high school so that students learn about the aging process. The students play their instruments for the residents and work on their science fair projects with them. The residents are truly mentors for these students. We have been recognized by the Orlando Sentinel many times for outstanding programs here. One of our greatest activities was “Biker Day” at Oak Park. A local merchant brought their Harley’s to Oak Park. Each resident dressed up in leathers with headbands and posed for pictures on the bikes. We sent pictures to the families saying “And you thought your loved one was at home knitting!” We got a huge response of laughter from all involved. It was a blast!

RYAN: (Laughs) That sounds incredible. You really owe yourself a pat on the back for such great work! Can you please send me a picture of Biker Day? That sounds awesome!
TERRI: Sure, no problem.
RYAN: So, in your opinion, how have the residents benefited from those unique activities?
TERRI: The residents feel a part of the community. They truly see that they make a difference. They are loved and respected by so many people in this community. The merchants come here to do activities with them. The local florist does flower arranging, Home Depot does workshops with them, Ritters Frozen Custard makes sundaes here, and we have a merchant that sets up a fruit stand in our lobby with fresh fruits and veggies that the residents can choose at no charge. They feel very connected. It’s not just being part of their residence, but still maintaining a sense of community. That is important factor in maintaining good emotional health.

RYAN: Very cool. How do you mix physical and cognitive activities?
TERRI: I do a lot of physical and cognitive activities. I run a cooking class. We have measuring, kneading, peeling, cutting, those are all good ways to combined both physical and cognitive. We bowl and golf both in the community and out. The residents keep the score. We play twister with word games. Scavenger hunts, walking club, following a map to the destination. Most of the activities have both components as a part of it.
RYAN: I really appreciate your spending so much time with me. I am learning so much. I have a couple more questions if that is okay?
TERRI: Sure, happy to spend the time with someone who’s so passionate about it.

RYAN: Thanks! Ok, so what would you recommend from an activities perspective to readers evaluating assisted living communities?
TERRI: I think it’s very important to ask a lot of questions. You want to make sure that there are activities going on all day that include, physical activities, crafts that include a product that the residents can take to their rooms, outings, and cognitive activities. You want your loved one to be able to make choices in his or her schedule. A big component is to find out how they will help your family member connect when they first come in to the community. “What can you do to help my mom or dad connect if they do not want to come out of their room?” You should also make sure that there are outings outside of the community and that there is community involvement consistently. If people are sitting in the lobby with no activity, chances are that is the way it will be when your loved one lives there. Look for resident participation – talk to the residents. They are the best indicators of what truly goes on in the assisted living community. They will tell you if they are active or not. Stimulation is very important. If you don’t use all your faculties, you begin to lose them. Make sure each and every part of your loved one is being challenged daily.

RYAN: Last question. Do you have any other advice for the readers?
TERRI: Take the time to look around at different communities. Talk to residents; request a report from the Department on Aging for the state survey of the community. You can request it from the community as well. They have to show it to you. That is the law. This will give you the information on any violations the community has had. It covers resident care as well as dietary issues. This is an important piece of information to have. There are agencies that are able to help with the cost of assisted living. If you are a spouse of a veteran or a veteran yourself, there are ways to receive help. Look in to all options before making your decision. Remember, this is your family member’s home. It should not have a community feel but the feel of being home.

Terri’s activities plan is not the norm, although I wish it were. However, it should serve as an example of the kinds of things available to your loved one.

Unfortunately, many assisted living communities follow our typical day example rather than the fine example Terri has described. Do not be lazy about finding a community with good activities. It is a major social and emotional outlet for your loved one.

Photo credit: visual.dichotomy

Filed Under: Assisted Living, Quality of Care Tagged With: , , ,

Senior Care and The Importance of Staying Physically and Mentally Active

November 21, 2011 By 9 Comments

Before Mom got sick, she was an active lady. By active, I don’t mean she walked every morning. Rather, she was involved in almost every woman’s club in town, dedicated time to fundraising and countless local charities and took a deep level of interest in her family’s lives.

I vividly recall the first community I visited. As the admissions director walked me through the amenities during the tour, I drifted thinking about whether my mom would be bored there. I asked the admissions director what their most unique activity was. She responded: “armchair exercises.”

She proudly told me about the activity and suggested that I stay 30 minutes for the start of the next session. I was intrigued, so I stayed.

Slowly a few residents arrived, most of them with the help of a community caregiver and a wheelchair. Once seated in a semi-circle, the activities coordinator began walking the residents through a number of arm and leg motions.

The concept was solid. The problem: the activities director either didn’t notice or didn’t care that the residents weren’t participating. Many residents had a scowl on the face, evidence of the fact that they did not want to be there. Others went through the motions as best they could.

I remember thinking to myself when I left the community: armchair exercise is not an activity!

The point of my story is not to be sarcastic, but rather to illustrate something important. Activities represent an important part of your loved one’s day. They should be engaging both physically and mentally.

Being physically active can prevent and help treat many of the most common chronic medical conditions associated with old age. Physical activity is one of the most important steps older adults can take to maintain physical and mental health and quality of life. Yet today, more than 60% of older adults are inactive – and this number is probably much higher for residents of assisted living communities. Many are sedentary, physically unfit, and experience disability from chronic medical conditions as they age.

Community administration and staff members hear many reasons from residents as to why they are not active:

  • It’sboring.
  • It doesn’t feel good.
  • It makes my arthritic joints hurt.
  • It takes too much time.

However, they need physical activity more today than they care to admit. In fact, without physical exercise they will continue to suffer the loss of strength and stamina.

Walking groups and physical activity programs can help residents become and remain active.

Strength training is recommended for all adults, but it is a vital link to health for older adults. The reason is that strength training prevents sarcopenia, the muscle deterioration that comes with aging, and also helps maintain bone mass. “Stronger people have better health outcomes,” noted Dr. David Buchner, Chief of CDC’s Physical Activity and Health Branch and renowned Gerontologist. However, some elderly people avoid physical activity and become sedentary out of fear of falling and fracturing a bone. Dr. Buchner added that emerging data indicate that physical activity can prevent falls by improving strength, balance, and endurance.

Keeping Young at Heart aerobic activity, which is cardiorespiratory or cardiovascular endurance activity, is also important. It keeps the heart strong, lowers blood pressure, and relieves anxiety and depression. Even when the activities in a program such as this one are too strenuous, older adults can obtain significant health benefits with moderate physical activity, such as walking or gardening.

“We need to make physical activity part of the daily routine for older adults,” said Dr. Buchner. To that end, you should search for a community that has an active, diverse fitness program. Or, should the community you select have less-than-desirable physical activity programs, become instrumental in developing them.

What about Mental Fitness?

A large-scale study of women aged 65 and older found that cognitive decline was least common in those who were most physically active, while a large-scale study of men aged 71 and older found that those who walked less than a quarter of a mile a day were nearly twice as likely to develop dementia as those who walked more than two miles a day.

Basically then, aerobic exercise appears to improve higher cognitive functions (planning, organization and working memory) in the elderly. Another way physical training may help cognitive function in the elderly is by increasing their confidence in their abilities.

A small 14-day study found that those following a memory improvement plan that included memory training, a healthy diet, physical exercise, and stress reduction, showed a better performance on a cognitive measure controlled by this brain region, and participants reported that they felt their memory had improved.

The memory training involved doing brainteasers, crossword puzzles and memory exercises. Diet involved eating 5 small meals daily (to prevent fluctuations in blood glucose levels) that were rich in omega-3 fats, low-glycemic index carbohydrates (e.g., whole grains) and anti-oxidants. Physical exercise involved brisk walking and stretching, and stress reduction involved stretching and relaxation exercises.

Photo credit: brad montgomery

Filed Under: Assisted Living, Quality of Care Tagged With: , , , ,

3 At-A-Glance Guides for Assisted Living

November 14, 2011 By 2 Comments

There are many details involved in choosing an assisted living facility that will work for your loved one. The process involves navigating the terminology and verbiage of health insurance policies and also figuring out what a day-in-the-life would be like at a facility.

Here are three at-a-glance guides to help illustrate what long term care insurance is, clarify key insurance terms and show what a typical day at an assisted living facility should look like.

1. Long Term Care Insurance

You may hear a lot about long term care insurance, but how do you know if it is the right choice for your family? Below we’ll outline the target market indicators for long term care insurance, to help give you a better sense if these types of policies would be a good fit for you.

Who needs long term care insurance?

  • People who have assets they want to protect
  • People who want to maintain their financial independence.
  • People who are concerned about having a choice in the quality of care they will receive in the future.
  • The average age of people who buy long- term care insurance is about 65.
  • Married people with assets of above $100,000 (not including a house).
  • Single people with assets above $ 50,000. Otherwise a client would probably deplete their assets before the insurance kicks in, making them eligible for Medicaid.
  • Since women live longer then men,they have a greater chance of ending up in a nursing home. According to a 1997 study by the Health Insurance Association of America, half of all women who live to age 65 will need a nursing home at least once during their life, compared to about one- third of men.

2. Key Health Insurance Terms

Insurance is a major factor in today’s eldercare system. I advise you to contact an insurance advisor who specializes in working with older adults and their families. Here are some basic terms you’ll need to be familiar with:

  • Medicare: A federally-funded health program administered by the Department of Health and Human Services. It is available to all Americans over the age of 65. It is made up of two parts.
  • Part A: This is available to everyone, and covers inpatient care and some aspects of in-home care.
  • Part B: This is optional and requires a monthly premium. It covers many outpatient services.
    Both Part A and B include deductibles and co- payments, and exclude certain services. You may choose to purchase Medigap insurance to cover the “gaps” in coverage by Medicare.
  • Medicaid: This is also known as Medical Assistance, and covers health care services for low-income Americans. Funded by federal, state and local governments; this program requires that applicants meet stringent income and asset requirements. While it covers some inpatient services in hospitals or certified institutions, it rarely covers in-home care.
  • Secondary Insurance: Purchased privately, these policies do not cover long-term health care costs, and rarely cover long-term in-home care. This insurance is designed to supplement Medicare.
  • Long-Term Care Insurance: Such a policy covers both in-home and residential services (including nursing homes) over an extended period of time. Often prohibitively expensive.

3.  A Typical Assisted Living Schedule

When you begin to tour assisted living communities, pay attention to the daily schedule of activities, as physical and mental stimulation will help keep your loved one happy and well.

Planned correctly, activities will become the cherished part of your loved one’s day. To set our frame of reference, let’s look at a typical assisted living day from the perspective of the resident:

  • 6:45 – 7:30am: Have breakfast and receive assistance for a shower from the aide that I’m already comfortable with
  • 7:30 – 9:00am: Make my way down to breakfast. An aide will assisted me to the dining room if necessary, and the medication technician will provide my medications for the day.
  • 9:30 – 10:30am: Morning exercises in the activity room include some stretches, leg lifts and rubber band exercises.
  • 10:30 – 11:30am: Choice of a scenic drive or reading a book by the fireplace. If I take the scenic drive, the van will be wheelchair-accessible.
  • 11:30 – 1:00pm: Lunch and return to my apartment to rest for a while.
  • 2:30 – 4:30pm: Different things happen on different days. During a week, I’ll usually see education presentation, musical performances or craft demonstrations. Nothing is required if I am tired.
  • 4:30 – 6:00pm: Dinner.
  • 6:00 – Bedtime: Evenings can bring visits from family and friends, outings in the community van, or quiet time at home.

Photo Credit: Jan Krömer

Filed Under: Assisted Living, Legal & Financial Tagged With: , , , , ,

People to Meet on Your First Community Tour

November 7, 2011 By 3 Comments

Meeting new people has never been a problem for me. But when I arrived in the parking lot of the first community, I found myself very nervous. I spent many hours on the Internet looking for the right questions to ask, the right people to meet, what safety metrics to ask about, etc. I met with the admissions director, took a tour and was back in my car 60 minutes later. I saw the entire community and even met a few of the staff members. I still had no idea of why that community was better or worse than any of the several I was planning to visit.

While I summarized our plan in the last blog, it makes sense to add more detail regarding the people you need to meet during each of your initial community visits. Your first community visit will be overwhelming. Assisted living is just like any other business. In the world of assisted living, beds are products and the goal of the admissions department is to sell that product.

Unless you arrive prepared, you’ll leave with nothing but a sense of completion and a shiny new brochure. What you won’t leave with is any useful information that will help you either eliminate that community from contention or move it on to the next round of consideration.

Try visiting during the week so you can get a feel for the full staff level. When you visit your short-list a second time, you can validate the weekend team.

Who You Need To Meet

When you set up your appointment, make it clear to the admissions representative that you’d like to meet with several members of the staff. I’ve listed below the ones I believe are crucial to meet on your first visit.

Admissions director: The admissions director will likely be your primary contact at the community. At many communities, this person is also responsible for sales and marketing. As such, you should expect an upbeat conversation with little or no negativity. The admission director’s primary role is to fill the beds (product) in the community, but they more than likely care a great deal for the people they place in the community. That being said, expect to get the pros, but not a complete picture of the cons during your discussion. I do recommend that you leverage this person’s knowledge of the staff to learn more about their backgrounds.

Activities director: The job of the activities director is to provide entertaining and stimulating activities for the residents. The demeanor and attitude of this person is tremendously important. Their patience, creativity and tenderness can make a world of difference in residents’ daily lives. Find a grumpy one, and your loved one could be looking at days of old movies and bus rides. The following chapter discusses the right way to implement an activities program.

Registered nurse: Assisted living communities are not required by law in all states to have a registered nurse (RN) on staff during some portion of the day. The RN will likely be the one to follow up with your doctor if your loved one is not feeling well, and they’ll also be the one to call an ambulance. Spend some time with the RN to clearly understand his/her hours. Get a feel for their philosophy. At all costs, avoid those who have that “tough it out” attitude.

Medication manager: The medication manager (also called a “med-tech”) is responsible for getting all medications to your family member on schedule. In assisted living, residents are usually not allowed to keep medications in their rooms – over-the-counter or prescription. Spend some time with the medication manager to understand their experience and communication skills. Make sure the night shift med-techs have the same training and language skills as the day shift.

Physical therapist: Depending on your family member’s ambulatory skills, the physical therapist may, or may not be, of value. Aside from my mom herself, the physical therapist had the most impact on her recovery and ongoing mobility.

Most communities have a therapy room, and you should visit it. If you time your visit in the morning or early afternoon, you’ll likely get to see the therapist with one of the residents. Speak to the therapist to get a feel for the experience they have working with seniors. If you family member has a specific condition, make sure they have successfully worked with that condition. In the case of my mom, it was important the therapist have experience helping stroke victims learn to walk.

Head chef: The head chef is responsible for planning the menu and managing the chefs who cook it. Look at the menu and ask how they plan for sodium, cholesterol and sugar-restricted diets. It always struck me as odd that with many older people suffering from heart disease and diabetes that chefs would serve food that I wouldn’t eat myself.

Executive director: The executive director has ultimate authority over all aspects of the community. They are also the one responsible for passing on and maintaining records for state health inspections. The executive director should have a deep and profound connection to helping the residents. You’ll run across executive directors that are all business. While it’s obviously important to take a business approach to the community, make sure this demeanor doesn’t come at the expense of the patience and compassion required to make the residents happy.

Don’t Forget the Residents

The biggest barometer of a community is the residents themselves. Pay close attention to the way residents interact with each other and with other residents. If you notice a group of residents in front of the TV with no real engagement in the show, ask questions. This could be a sign of a disengaged activities director.

It is also perfectly reasonable for you to speak to the residents. As I mentioned, you’re unlikely to get honest answers about the quality of the community. In fact my mom has told me on several occasions that residents feel pressure (perceived or not) to not speak negatively about the community. So, take their words to heart, but with that proverbial “grain of salt.”

Photo credit: Sahaja Meditation

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Interviewing Assited Living Administration and Staff

October 31, 2011 By 5 Comments

Unfortunately, my mom was very weak and sick when she moved to assisted living. As such, she was unable to participate in the selection of an assisted living residence. While many will have their loved one with them during the selection process, the process is still the same.

My older sister Teresa, whom I deeply admire and trust, came out from Baltimore to evaluate potential communities and add some emotional stability to what I knew would be a draining process.

I had several high-level criteria in moving my mom to assisted living:

  • Close enough to visit regularly and quickly respond in the event of an emergency
  • Physical and occupational therapists who would aggressive rehabilitate my mom from her stroke, muscle loss and weakness
  • Community administration who had extensive experience and low staff turnover
  • A clean community with amenities that would provide my mom pride in residency
  • A first impression that residents were happy and well cared for

While our final decision had much more detail that you’ll identify on your own, we used these five objectives as screening tools for the 10+ properties we visited.

For the first round of visits, we followed a pretty simple plan that we felt would expose us to the above criteria in a time-efficient manner. We took the following plan of action at each community:

  • Met with the admissions coordinator to get a tour of the community, activities calendar and price schedule.
  • Toured the community to verify amenities, cleanliness and get an overall impression of the happiness of the residents.

(NOTE: Since then, I’ve heard from many in the industry that many residents are afraid to say anything bad about staff or a community due to fear of retribution. You may find this technique less than beneficial for getting good feedback.)

  • Spoke personally with the physical therapist and occupational therapist in the therapy room to understand the course of treatment they would take with my mom. The physical and/or occupational therapist(s) must have several years of geriatric experience.
  • Spoke personally with the nurse to verify medication management and basic procedures in place in the event a resident becomes ill. This includes verifying the medication room was clean and organized, as we wanted to avoid medication mix-ups.
  • Spoke personally with the executive director to verify experience, staff turnover, hiring procedures with background checks and to validate the health and safety inspection record.

It took us several hours per community to follow our above plan above and validate whether the community met our high-level criteria. With each new community we visited, we picked up some little detail that we applied to the ones we’d already visited.

We narrowed the list down to three communities which we felt satisfied our criteria, ranked in order of preference. For each of those three communities, we did the following:

  • Visited the community during lunch or dinner to check the quality of food and observe the residents in a more casual environment. We paid close attention to the interaction between residents and staff and residents and each other.
  • Shared my mom’s medical records with the admissions staff to ensure they had the capabilities to support my mother’s specific issues.
  • Had unscripted discussions with the admissions director and executive director to get a better impression of the staff and their ability to provide for my mom.

After this round of investigation, the decision became clear. All three communities met our criteria. But through longer conversations, we ultimately developed a sense of trust with the admissions director and executive director at one of the communities. They had a sense of emotional attachment to the residents that I didn’t feel at the other communities.

When I laid down that night, I was calm. I knew that we had executed a thoughtful plan.

Photo Credit: TheBusyBrain

 

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More Tips for Finding Assisted Living Communities

October 24, 2011 By 2 Comments

In a previous blog post, I discussed some of the early steps you can use to start creating a list of potential assisted living communities for your loved one.

Here are some more tips for finding potential communities and narrowing down the list to the right facility that your loved one can call home.

A recommendation from a friend or other reliable source about a community can go a long way in this early screening process. Don’t hesitate to ask around. After all, you’re about to begin a long and detailed journey – one that ultimately affects the happiness and general well-being of your loved one. It’s best to tap every resource you can!

As you begin to tour communities, your head will be racing with questions, reactions and things you notice from one community to the next. I recommend you buy a spiral notebook, writing questions and comments before and after you tour each community.

Deciding on the Right Assisted Living Community

After you tour a few communities, you’ll find the details blend together and your memories cease to different each tour. Some will eliminate themselves quickly. Some will make the final cut. In the end, you’ll need to rely on initial impressions and your notes to make that all-important decision on the community best for you and your family. Choosing the right assisted living community is a challenging task. Whether you are searching for yourself, a family member or a friend, you’ll want to make sure that the assisted living community is able to meet the physical and safety needs of the prospective resident.

At the time of her stroke, mom lived in North County San Diego – about 50 miles from me in Orange County. For almost 6 months after her original discharge, she went back and forth between skilled nursing and the hospital. At the time, it seemed like a good idea to keep her close to friends who could come and visit her while I was as at work. I was down to visit 4-5 times a week, mostly after what was a 50-60 hour work week.

Choosing the location of an assisted living community will likely be the most important decision you make. For anyone, a move away from familiar surroundings can be stressful experience. Combine that with the emotional drain of accepting assisted living, and it’s easy to imaging the challenge your loved one is facing. You’ll likely be leaned upon frequently during this difficult adjustment period.

Here are a few things to consider as you choose the location of the community:

Make the commute easy. During the first weeks and months of assisted living, you will likely be the closest friend and confident for your loved one. If at all possible, choose a location that is close to your home and/or other family members that can regularly visit without negatively impacting their own responsibilities. Your loved one will look forward to your visits – even count on them. Make sure you are close enough to stop for a quick visit – even if it’s a short one.

Don’t ignore the “nice” neighborhoods. It would seem that nicer neighborhoods would charge a premium. While it may be the case in some places, don’t take this for granted. I called or visited almost every place in a 15 mile radius of my house and all were about the same price. On a whim, I called a beautiful community near the beach – complete with ocean view – and it turned out to be the exact same price as communities in some of the less desirable neighborhoods in the county. Don’t let your lack of a phone call cause you to miss a great opportunity.

Match town size and options. Your loved one likely came from an independent environment where they could come and go as they please. Whether it was shopping at the mall, dining out or playing cards at the Senior Center, they had options. Make sure you locate them in an area that has a similar set of options to the area they came from. The transition will be less of a contrast and it will be easier to get them back into the swing of things.

Always remember what Andrea Arambula told me: “people rise to the challenge.” Because of our situation, I was faced with the need to make a quick decision: should I put my mother in a skilled nursing community or assisted living? In skilled nursing, she’d be by far the most advanced of any of the patients, though she still needed a lot of physical therapy. In assisted living, she’d be the least mobile, but would be on par socially with far more residents. With some encouragement from the admissions director, my mom and I chose the latter. She’s a fighter, and neither of us has ever regretted the decision. She certainly rose to the occasion.

Photo Credit: stevendepolo

Filed Under: Assisted Living Tagged With: ,
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