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Is Assisted Living For A Loved One A Viable Option?
Starting to think about assisted living?
We started pondering the idea of Mom living in an assisted living facility shortly after Dad died. Mom was only 68 at the time and in good health. She met with a financial advisor and purchased long term health care insurance. That conversation took place 22 years ago. Today, Mom is 90 and her home is in an assisted living facility in Massachusetts. She moved in a little over 4 years ago. We have learned a lot since then!
Planning to be done at least 5 years prior to needing Assisted Living
Planning should ideally begin long before assisted living is needed. There are multiple reasons why I suggest this. For this article, let's start prior to 5 years out. Meet with a financial planner and a lawyer that specializes in Elder Services. Assisted living is not inexpensive and the average person only stays in an Assisted Living Facility for 2 1/2 - 3 years. This figure was determined by a survey done by the National Council for Assisted Living in 1999. This hasn't changed much. According to a Social Worker who specializes in Elder Care in Massachusetts, that figure is now 2 years. After 2 years, the Elder may have passed or needs 24 hours a day, 7 days a week, skilled nursing. Thinking ahead to the possible need for more care, advanced planning is necessary. Those who don't have the financial means to pay out of pocket for 24/7 care and/or are thinking of possible Medicaid facilities, certain steps will need to be taken to protect assets. These steps need to happen 5 years prior in most States, 3 in others. Do take the professional advice you are given without delay! In regards to Medicaid and Assisted Living, most Assisted Living Facilities are private. They do not accept Medicaid. Only 19% of Assisted Living residents and 70% of Skilled Nursing Facility residents are able to pay with Medicaid.
You may now be wondering about the cost of these facilities. The cost varies greatly from State to State. In the area of Massachusetts, where my Mother resides, most of the facilities are approximately $6,000 a month. Skilled Nursing, approximately $14,000 a month! A staggering amount to most of us!
Should I use an agency to find a place for Mom or Dad?
We have all heard or seen the advertisements for agencies that will recommend the perfect Assisted Living Facility for Mom or Dad. This is what you need to know. Most referral agencies generally will not recommend a facility that won't pay them a finder fee. Money talks, it doesn't whisper! It's your loved one and by keeping priorities straight and being an informed consumer, you will make the right decisions.
What do I need to know before I visit an Assisted Living Facility?
Contact Elder Services in your State. Ask about licensing. Ask about ratings. Ask about inspections, are they done? How Often? Ask if there have been any violations in the facility you are thinking about visiting. Is there a website you can go to for the answers to your questions? A Google search can be a tough place to gather information for some States. Other States, it can be easier. In South Carolina for instance, the Department of Health and Environmental Control oversee licensing of Assisted Living Facilities.
Is the facility you are thinking about required to have a generator? This may sound like a stupid question! Just know a popular Assisted Living Facility on Cape Cod, Massachusetts left their residents in the dark and cold after a storm in February of 2013! It was wrongly assumed that they had one! In Massachusetts, only skilled nursing facilities are required to have back up generators, not assisted living facilities. You would think for the amount of money they charge, they would install one!
Is the facility equipped with water sprinklers? Sadly, there was loss of life during a fire at an Assisted Living Facility in Florida. The Facility was built before sprinklers were required.
Does your State require an RN to be on the grounds at all times? How many staff members does the State require to be on overnight? Are they required to be awake? Is there a Doctor on staff? If your State doesn't have licensing, you may not get the answers. In this case, do ask at your visit. Brian Lee, Former Director of Florida's long-term-care ombudsmen program was quoted as saying, "Assisted Living Facilities can be more dangerous than nursing homes." Doing your homework will help to ensure the safety of your loved one!
Tour time, come prepared!
When we toured some of the places with my Mother, they reminded me of a high-end apartment complex! Observe the grounds, are they nicely landscaped? Are there outside places to walk? Is there a place where residents can have their own gardens? Is there adequate visitor parking? If you pass guests on the way in, ask about their experience with the facility. Is their loved one happy living there? Would they recommend the facility? People are more than willing to share their personal experiences and you will gain valuable inside information.
As you are led on the tour, does your tour guide interact with the residents? Are the residents addressed by name? Is there adequate seating, benches, etc, on long corridors, in case a resident gets tired? Are there handrails? Are there elevators? Is it clean? How is the overall feel of the place? Do both residents and staff seem happy? Do they interact well with each other? What activities are provided? Is there enough activities to provide stimulation? Is there a pool? If yes, is it heated? What are the hours? Is there a lifeguard on duty? It may only be open for certain exercise classes. Is there a backup generator in case of a power failure? What is the response time for EMT's if they are needed? What is the staff to resident ratio? Ask for both day and night. Are there RN's in the building 24/7? Do the night staff have to be awake? Is there a Doctor in the building?
See the Dining areas. Is there more than one? Can you and your loved one try a dinner some evening? Meal time is the highlight of the day for residents. Often, a loved one missing meals at home is one reason why Assisted Living is considered. In the case of my Mother, I did feel relieved to know she was eating better than when she lived alone. She only wanted to eat if someone in our family was cooking for her! Does the facility cater to special meal requests, such as Vegetarian? Are the meals healthy with the option of low sugar or low salt? Ask some residents if they enjoy their meals!
After the tour has been completed, most likely you will be taken to an office or conference room to talk. This is where it gets real. Time to get out your pen and paper.
Go home and write down the answers to your questions and your overall opinions. Sleep on it. Assisted Living is not an decision to be made with haste. Discuss everything with your loved one and other family members.
Information You Must Have! The Conference Room Talk!
It all comes down to money. Assisted Living Facilities are mainly for profit, approximately 82% of them! They are big business in the United States, especially with the aging population.
First, make sure all your questions from the tour have been answered. Ask about the levels of care the facility provides and ask what is included in each level as well as the cost from one level to the next. In Massachusetts, according to a hospital social worker, Assisted Living Facilities only have to provide 45 minutes of care to a resident per day. This includes meal prep time! That's not a lot! Level one at my Mother's facility includes, 3 meals a day, safety checks, ( a nurses aide bops her head in every 2 hours around the clock.), some assistance with dressing, beds pulled back at night, assistance if needed with laundry (washer and dryer are in her apartment), and housekeeping comes once a week. Housekeeping lightly cleans the bathroom and the kitchen. They can not dust.(something might get broken.)They do vacuum and empty trash.
Level 2 provides more care and the cost goes up with each level. Ailing residents are cash cows. That's a fact. If an ailing resident needs a meal delivered to their apartment, that will be an extra charge. If an ailing resident needs help with medication, that's another charge per month, possibly $500.00 extra. Some Assisted Living Facilities only offer help with medication during the hours of 8 AM and 8 PM. A nurses aide is not allowed to administer medication.
Different facilities have different level or tiers of care. Be sure you understand what each level provides and what the cost per month will be.
Extras? Does the facility charge extra for packages to be delivered or meal delivery. If they pick up something from the store for a resident, let's say, the product Depends, how much do they charge? What is the mark up on the item? How much do they charge for a roll of toilet paper if the resident runs out? Do they provide a 24 hour monitoring pendant, or is there a charge for that? If they provide transportation to a Doctor's office, what are the charges? Some may only take residents if the destination is within a certain radius. Is Electricity, internet and cable included? If not, what are the extra charges. Be sure to ask for a list of anything that they can charge extra for.
Ask how often fees are raised and what type of advance notice do they give. What percentage is the fee raised?
Will your loved one have an evaluation and is the facility equipped and familiar with any conditions your loved one has? Remember, most of the staff is not trained to handle health issues.
Also, ask about eviction! Can they just kick someone out? What if a resident runs out of money? California is one State that requires a court appearance to evict a resident, most States do not.
What if your loved one wants to move out? What is the length of notice that needs to be given?
Does the facility allow hospice if that's the care needed for your loved one? How does the facility handle that in regards to move out notices. My Mother's facility does allow hospice. If a resident dies suddenly, 2 more months of rent is still owed.
Keep in mind Assisted Living is nothing more than a gap between independent living and sadly, a 24 hour skilled nursing facility or death; a harsh reality.
Final thoughts based on my personal experience!
It has been 4 years and 2 months since my Mother moved into an Assisted Living Facility. The choice was completely hers. She did not feel safe home alone anymore. She did a month trial stay which won her over. She enjoyed the book groups and her pampering. I felt relieved that she was being checked on every 2 hours and was eating regular meals again.
This past summer, my Mother's health started declining. She now needs care 24/7. Knowing what I know now, I wish we had done some remodeling of her home or moved her into a condominium. We could have had her long term health care pay for an agency to send help to her as well as take her to activities in the community. Her long term health care policy would have gone much, much further! They have paid out almost $300,000 at this point. Shortly, we will have to make some tough decisions. She has been happy living in her Assisted Living, but in my opinion, she could have had a gorgeous apartment with an ocean view and some part time staff for less money! At this time, she would need full time staff.
I wish I had comprehended that Assisted Living is the gap between Independent and 24/7 care. I wish I had really comprehended what it means to only have 2 nurses aids in the building at night. There was a period of time, after she broke a bone that she needed pain pills in the night. Only nurses can administer that. We did not trust her to take the proper dose so members in our family took turns sleeping over.
Ultimately, we all want our loved ones to be safe. I always assumed that assisted living meant safety. Unfortunately, that is or has not been true. Residents still fall and get hurt.
There are pros and cons to both staying in the home, renting a place or going the Assisted Living route. It's my hope that this hub helps you to make the best and safest decision for your loved one. Cherish the time you have together!