Take the advice of many families who have gone before you on this journey: don't wait for a crisis. You will be limited in your time and options and will not be able to investigate as thoroughly as your would like. Be proactive rather than reactive: it will save you time in the long run and will give peace of mind to everyone involved.
Step 1: Finding the Appropriate Level of Care: Skilled Nursing or Assistive Living?
The first piece of advice I usually give people beginning the search into long term care is to take a step back and make sure you are truly looking at the appropriate level of care. Both Assistive Living Residences and Skilled Nursing Facilities play an important role in the health and safety of our elderly. Knowing which level best suits your loved one's needs, socially and medically, will help you concentrate your efforts on the type of facility you really need.
A very helpful service that most Assistive Living Facilities (ALF’s) and Skilled Nursing Facilities provide is a complimentary evaluation. It may be a great way to make sure you are headed in the right direction. Having the experts tell you their opinion and give you their insights can make your family feel unified in their decisions and searches. The assessment is usually free and without obligations. I suggest that you ask the most highly reputable and long-standing assistive living facility in your area to perform this evaluation. Remember, it is important not to accelerate the level of care faster than your loved one needs it.
While there are many elderly people who require the more intensive medical and rehabilitative services provided in a Skilled Nursing setting, many families may not realize that much of what is provided in a nursing home can also be found in an Assistive Living Facility. For example, Assistive Living Facilities managed by The Hamister Group, Inc. have gone above and beyond New York State regulations by providing nurses in the building, 24 hours a day, 7 days a week; these residences can therefore meet the needs of seniors that would normally not be admitted to other ALF’s. Many Assistive Living Residences provide comprehensive services, such as housekeeping, laundry, linen, 3 balanced meals a day, medication management or administration, and a lively recreation schedule; this level of care may be a perfect match for someone who can't live independently, but doesn't require all that a Skilled Nursing Facility has to offer at this time.
Step 2: Referrals
Once you are sure that Assistive Living is the proper level of care for you or your loved one, get a list of facilities in your area. Referrals can come from many different sources: your local senior center, the social work department at an area hospital, the Alzheimer's Association, and your yellow pages directory are great places to start.
First, trim the list down according to location. Just like in real estate, location plays an important role in your choice. If the facility is too far away for you to see your loved one as often as you’d like, then it might not be the best fit. A general rule of thumb is to look within a fifteen mile radius of your home or work. This should leave you with a number of choices, given the fairly liberal search area, without being too limiting.
Also consider how long that particular operator has been in your community. Those that have been in existence more than ten years usually have demonstrated to the community that they deserve your faith and confidence. Do the owners live in the same region of the State as the facility? Regional owners are usually held to a higher standard of accountability and tend to be more concerned about for their reputation.
Step 3: Inquire by Telephone
Pre-qualifying calls to the Admissions department should be your next step. You need to ask the following important questions:
- Do you have nurses 24 hours a day, in the building? (You may not need it now, but it is a great source of comfort when an emergency arises or if your family member declines)
- Do you have recreational programs that are scheduled after dinner? (Who goes to bed at 6:00 p.m.? (You want your loved one active!)
- What is your staff turn-over like? (The more long-term employees, the better.)
- What openings do you have? (This is most important in a crisis situation)
- Are there choices at meal time and are your meals prepared on site? (Seniors really appreciate a say in their day-to-day life. Homemade meals and menu-style dining, both of which we have at our residences, mean a great deal to someone who may be losing some choice in other areas of life.)
- Does your facility help manage or administer medication? (One of the most important details in maintaining a senior's health is proper medication management by well trained staff.)
You should get a preliminary feel of the facility from these calls. Was the receptionist happy to help? Was the Admissions person knowledgeable and ready to meet your needs? Were there call bells going off in the background? That might be an indication that staffing numbers are inadequate. Could you here a lot of paging? Intercom noise can easily confuse a senior with some memory loss. Were you invited to tour at your convenience? They should arrange tours according to your schedule.
Step 4: Visits
You should ideally visit at least 2 or 3 facilities. On your first visit you should make an appointment with the Admissions representative: you have a better chance of getting clear information on which rooms are available and when if you meet with the appropriate staff member. This individual should also give you the most accurate financial information and specific instructions on what paperwork needs to be filled out before moving things forward. The appointment should give you an overview of services, cost, accommodations, and most importantly, what to do next, if that is your facility of choice.
I also suggest that you make a second, unexpected visit. This will give you the opportunity to see what happens after hours or on weekends. At our residences we welcome walk-in tours with open arms. Many families want to get a picture of what our residences are like when we are not expecting company. There should always be someone available to show you around and give you general information. Just remember that the Admissions representative may be the only one who is able to explain exact availability and rates.
Step 5: Make a Checklist during Visits
Since you may be looking at more than one building, it is a great idea to take a checklist so that you can keep you observations organized and bring written information to any family meetings you might have concerning the placement of your loved one. Below is a list of services and amenities that may make your family member’s adjustment to new surroundings a little easier.
Location:
- Easy to get to for people who will want to visit there?
- Are there hospitals close by?
- If you plan on maintaining a doctor or specialists in the community, are they easily accessible?
Grounds:
- Are the grounds well maintained? Manicured grounds are indicative of the general maintenance of the whole property.
- Are there covered places to sit outside, safely, securely? Seniors love to sit outside and visit; covered porches and gazebos are usually a hit.
- Is there a covered portico that you can drive up under to pick up your loved one in bad weather?
Reception Area:
- Were you greeted quickly?
- Was the receptionist pleasant and happy to help?
- Do you see families, staff, and residents interacting in the lobby?
- Is that area welcoming?
Admissions:
- Do you get a specific answer when you ask a specific question?
- If the people with whom you are speaking cannot answer your questions, do they find someone who can help?
- Does the Admissions representative introduce you to other staff members?
Resident Care:
- Will they tell you their staffing ratio for all 3 shifts?
- Are there NURSES in the building at all times, 24 hours a day, seven days a week? Some residences have nurses on-call 24/7, but not on-site. Be sure to clarify this.
- What kind of staff training and orientation is required?
- What is staff turnover rate?
- Do residents look well attended? Notice little things: do their pants match their shirt? Does their hair look nice and groomed?
- What type of care can and can't they provide?
Accommodations:
- Are rooms neat and tidy and well kept? Look behind things and in corners...that tells you a lot!
- Are there choices in rooms?
- What happens if finances change down the road?
- Can you bring personal belongings?
- Can residents go out overnight for special occasions?
- How often are laundry, linen, and housekeeping done?
- Are the rooms are truly home-like?
Recreation:
- Do they have a calendar?
- Are there activities throughout the day and after 6 PM?
- Is there a great deal of variety in the activities?
- Can family participate?
- When you observe an activity, is the staff enthusiastic and up-beat, trying to get residents involved?
- Do they actively encourage participation or just post a calendar and see who shows up?
- Are there activities that stimulate ALL the senses?
Dining:
- Most importantly....are there choices for all three meals?
- Can the kitchen handle special orders?
- Is all the food prepared on the property?
- Are snacks available throughout the day?
- Does someone make sure each resident makes it down for each meal?
- Are special diets available?
- Is there a private dining room for family get-together's?
- Take a look at a meal, or better yet, ask to come and have a meal with the residents. Rate the food, the atmosphere, and the service.
And finally . . . go with your gut. Your initial feeling is likely to be the most accurate!
The Hamister Group, Inc. is a long-term care and hospitality company with a 30-year reputation for excellence. For information on its assistive living facilities, see www.heatherheightsgroup.com. For information on assistive living management services, see http://www.hamistergroup.com/assistedlivingmanagement.html.
Please feel free to contact us us you have any questions : news@hamistergroup.com
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