|1/10/2014 10:13:00 AM|
Start early, ask questions: Deciding on residential care
This is the first in a series on senior living to run during 2014. This issue, we explore evaluation of assisted living options while future articles will examine transitions, finances, wills, end-of-life care, nutrition and maintaining an active life.
|What to do when deciding on residential care|
|1. Start investigating early. Don't wait for a crisis or your decisions will be rushed. |
2. Decide if leaving your house will reduce burden and stress.
3. Get as informed as possible. Start with Oregon's Long-Term Care Ombudsman, 1-800-522-2602 or 503-378-6533.
3. Visit the facility several times. While the logistics of admission to a facility usually take place during business hours, weekend, evening, and even mealtime visits will give you a broader picture of the facility. Show up unannounced at some point.
4. Review disclosure statements carefully. When considering an assisted living or residential care facility, the facility has a legal obligation to provide a disclosure of the facility's policies to the prospective residents. These include billing method, policies for fee increases, staffing plans and other information that can be compared to other facilities you are considering.
5. Ask questions of key facility staff, not just the marketer. Who makes the food? What is the caregiver to resident ratio?
Thanks to medicine, most of us get old and frail before we die. That has given rise to a modern dilemma — can we continue living at home in our later years?
Experts in assisted living say it makes sense to start considering the possibilities far ahead, before a fall or a stroke forces a rushed decision.
"Most people wait until something terrible happens at home," says Angela Boweter, marketing director at Marian Estates in Sublimity. No one should be pressured to leave home, Boweter says, but everyone should start planning as soon as possible.
Boweter says curious seniors can give residential care a temporary try, keeping their houses and staying at a facility for six months.
Seniors may be able to stay in their houses longer with the help of in-home services. Aides offer bathing, companionship, nursing, housekeeping and shopping. Home-delivered meals can also be arranged. But eventually, living at home may not be safe. How does one know when it's time to move?
AM I READY?
Leaving a long-loved home ranks as one of the most devastating of life's events. The decision should not be taken lightly. But some people thrive after they leave the responsibility of tending a house.
"A person’s quality of life is the most important reason to consider moving from your house to an independent or assisted living community," says Stephanie Hertzog, director of sales and marketing at Calaroga Terrace in Northeast Portland. "Isolation and loneliness are great concerns for older adults living alone. One should also look for signs of depression, lack of exercise or mobility, poor nutrition, and any difficulty managing personal care."
Seniors should put their minds at ease when it comes to visions of being neglected in a sordid nursing home. Because of modern regulations, that is pretty much a thing of the past in the U.S., says Stacie Zuercher of Laurelhurst Village in Southeast Portland.
"Assisted living promotes good health," says Zuercher, citing the balanced diet, clean living conditions, medication help and activities for body, mind and soul.
"People still in their homes need to evaluate how they are living," Zuercher explains. "Is maintaining property a lot of stress and affecting health? In assisted living, you may have more time to visit your grandkids. At home, when the adult children visit mom or dad, they may spend the whole day cleaning or going shopping. In assisted living, they can sit down with mom or dad or go to Mass together or go to the park."
Seniors pondering a move should consider loneliness. At home, many spend all day in front of the television after a spouse dies. In residential care, people can eat and recreate together.
"If you are lonely and your quality of life is not what it could be, a retirement community could be fabulous," Boweter says.
WHAT LEVEL OF CARE?
After deciding it's a good idea to leave home, it's time to measure what kind of care is needed. Senior centers can vary in their offerings, from “independent living” (lowest level of care) to “assisted living” and all the way to “memory care,” the highest level for those with Alzheimer's and other kinds of serious dementia.
Even places that use the term "independent living" offer meals, housekeeping, maintenance, activities and events, transportation and staff available for emergencies. Those in assisted living can get those things and more.
"When a person needs regular, routine hands-on assistance with activities of daily living such as taking medication, bathing, dressing, incontinence, ambulation, as well as meals, housekeeping, activities and transportation, or if the doctor is requiring 24-hour supervision, then residential care or assisted living is what you are looking for," says Hertzog.
When assessing memory function, ask these questions: Does the potential resident remember recent events? Know what day of the week it is? Remember his/her home address? Remember words? Understand simple instructions? Find his/her way around the house/apartment? Speak in sentences? Recognize people that he/she knows?
Long-term care can be expensive. Some private health and long-term care insurance policies include coverage for residential care, assisted living, and nursing facilities. Medicare does not pay for long-term care. Medicaid may pay if the resident meets certain financial and medical criteria. The monthly rates for residential care or assisted living are typically in the $3,000 to $5,000 range. Alzheimer’s specialty care may be a little higher due to a higher staff to resident ratio and other services included.
The level of care needed will almost certainly change as time goes on. Continuum of care refers to the availability of additional services and care as someone’s needs may increase. Often, residents move from independent living apartments to assisted living and memory care. So it makes sense to choose a facility with a spectrum.
WHERE SHOULD I LIVE?
Once seniors decide on residential care, and gauged what level of help they need, they can start evaluating various facilities.
"Choosing a long term care facility is one of the more challenging decisions that a resident and family will make," says the website of Oregon's Long-Term Care Ombudsman. The office exists expressly to look out for seniors during this time of transition.
It's good to seek outside opinions about the facility. There is important information in the public domain, including inspection reports, protective service investigation reports, and any sanctions or civil penalties. Oregon's Aging and Disability Resource Connection is a good source for such information.
"Visit a lot of places," suggests Zuercher of Laurelhurst Village. "Pay attention to how you feel when you walk in. Look for communities that will work with your lifestyle, with family and friends nearby."
Of course, no place will feel like home at first, but try to pick up the vibe.
"A good community will have someone say, 'Come have lunch with us,'" Zuercher says, adding that an overly aggressive admissions agent is a bad sign. Don't give people like that your phone number, says Boweter of Marian Estates in Sublimity.
Boweter suggests that adult children tour various facilities first and then bring parents for a look. She then advises several visits, some of them unannounced. That will give a truer picture.
Boweter has questions to ask: Who prepares food? What is the caretaker to resident ratio? (It should be better than 1 to 15). Does the caregiver also clean the bathroom and other tasks? That should not be the case. What are rent increases like?
Making Oregon Vital for Elders, an Oregon non-profit, suggests that families evaluating facilities consider not only what is important FOR the senior, but what is important TO the senior — goals, beliefs, preferences and traditions. For example, a Catholic will want to have Mass available. If the resident has an independent streak, it would be good to choose a place with flexible eating schedules. Try to ascertain if staff support autonomy and choices, or seeks to pressure residents to convenience the work schedule. If the potential resident is gregarious, are their ample social opportunities?
Families should try to talk to the people who care for residents every day. Here are some questions to ask: How will you get to know my family member? How will staff accommodate my family member’s preferences? How will the staff share information about my family member with each other? How do you build a sense of community here? How are residents given a voice in decisions about how things are done?
Article Comment Submissions