Foleydaughter Asked June 2019

How do you find a GOOD memory care facility/ nursing home?

Hi all.
First, thanks for the advice so far.
HOW do you find a good memory care facility?

Mom has had some medical issues, culminating in me calling 911. She had diarrhea thanks to enema given her just before discharge from a hospitalization for a blood clot.
She needed changing and was fighting me tooth and nail. She got a brush from the bathroom vanity and was hitting me with it while sitting in her wheelchair in a pool of waste.
I was a wreck.
Got her to hospital (bless the 911 crew) and told staff she needed placement. She had been hitting me and this was it.
She wound up someplace awful!
The hospital arranged placement, and when we got there, the staff literally snatched the medication list the hospital gave me on discharge. I had taken photo with cell phone so I would have it with me. (This is important later.)
The unit was locked and I made a point to visit daily. I did not observe a lot of staff interaction with patients.
On the plus side, she was getting physical therapy and was managing her walker and wheelchair better.
Had to be alert that her clothes did not go missing. Was doing her laundry at home because I had heard of trouble with patients' things at other places.
Mom told me at one visit that one of the staff "pinched" patients who vexed her. As I was not sure what was happening, I filed it.
Then there was another patient on the unit, a young man with some sort of mental disorder. I saw him masturbating out in public. The female patients were afraid of him. Then family photos I had put in mom's room kept disappearing. I would mention it, the photo came back, only to vanish a day or so later.
I filed this as I was told some residents "shop" other's rooms.
Had a meeting with the staff and we went over progress, medications. I specifically asked about the Xarelto mom has been prescribed for the blood clot. I was told she was taking it.
THEN mom's $3,000 hearing aid disappeared. Arrived for a visit and she could not hear me. Without it mom is stone deaf. I immediately alerted the only nurse on the floor and several aides.
To say the response was lukewarm is an understatement.
I went to the director of nursing's office to discuss what was happening. The aid was found, but every time I came over, it was locked up in the drug box.
Made the decision to bring mom home. When I got her med list from the facility, no Xarelto. She had not been getting it for two weeks.
On the plus side, the antidepressant they started her on has eliminated the hitting.
BUT two days after discharge she was back in hospital with gastritis. The diarrhea was incredible. The blood clot was reforming. The gastritis was due in part to blockages in abdominal arteries, something the Xarelto was supposed to help.
She's home now, Things are better. But the writing is there. I am partially disabled and don't know how long I can handle her.
How do I find a GOOD facility for mom?

34 Answers

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No long-term care home is as good as their PR materials and sales manager claims it is: this is the sad truth. The ones that 'seem' best have invested a lot in their lobby and in flashy decorative items. You definitely can judge the cleanliness, so start there. And try to eat the meals the residents will eat; food is a major issue for residents. Often it's not that healthy, not fresh and tasty. Notice whether aides are engaging with residents, whether residents seem happy, alert.

Try to avoid the huge for-profit chains of care homes. If you can find a faith-based place these may be a little better. But in the end you will need to be your mother's advocate. In my experience, the more care the person needs (and over time more care will be needed), the less ideal things get because none of these places and I mean NONE has enough staff to give residents the care and attention they need as they become more dependent. They will tell you that they meet the state's staffing standards and they do, that is the underlying problem. The states' standards are woefully low. Forget about those CMS five-star ratings; it's all relative and CMS doesn't do a great job of monitoring the quality of care that they mandate.

I'm sorry to be negative but the biggest factor in ensuring good care is your new role as your mother's advocate. You will find aides who are very caring; but they are run ragged and are often exhausted themselves, so they may not consistently give the kind of care they would like to and that you want for your mother. Work with them, let them know you appreciate all they do, and make sure management knows when they are doing a great job and when someone is not. Get to know other family members and work together with management for high quality care. All the best to you and your mother.

Helpful Answer (11)

good point. Below I post that my mom wound up in a rehab that was not necessarily the best, though we found out not the worst either. The good thing is was very close to my house and my brothers house, so we could go there both freqently and unexpectedly. You find the staff gives your LO better care when they know you are around more or could be around more. Sad, but just human nature I guess.

(4)

Next time, tour facilities by yourself as you are able. Do not count on anyone else. Use your eyes, ears and nose to help you decide. Observe staff-patient interaction. Is the staff attentive, pleasant and kind or abrupt, loud and hurried? Does there seem to be enough staff around and do they seem busy tending to residents? Or, are they conversing among themselves at the nurse’s station? Are there a lot of unanswered buzzers going off? Do they smile and great you? Do the residents in the hallways seem well-cared for and clean? Are the rooms clean and bright? Does the facility smell clean? An overpowering odor of “bathroom” or disinfectant that pervades the facility is a red flag.

Trust your gut. When you tour a facility, you will be able to tell in a few minutes if it’s a good one or not. After you place her, visit at different times of the day and different days of the week. Get to know the staff. Call care meetings for her regularly and ask for a monthly rundown of her scripts.

Good luck. Let us know. .

Helpful Answer (10)

You made a good point, we walked into 2 places, sniffed and looked around the foyer and left.

(6)

Oh my gosh! How have you stayed sane?? I'm so sorry for you! :(

Adult Family Homes, are seriously, the way to go. My Dad went from assisted living (fell & broke his ankle). From the hospital, a couple of my siblings thought that the "memory care" (why don't they just call it what it is "Alzheimer's Unit") facility that was connected to this assisted living, would be the 'real deal'. NOT!
Residents come & go in others rooms, residents propped in front of the TV all day, residents are zombies during meals. My dad stayed there for 3 days before we got him the heck outta there. (me & my sisters have a name for this "asylum". We call it the "house of horrors"). HORRIBLE. I feel sorry for the people that have to live in this environment.
Anyway, get your Mom outta there. Please research Adult Family Homes, in your area. My Dad FINALLY is living a in loving, caring environment. Yes, expensive (his LTC insurance pays some). Yes, there goes our inheritance but we've MUCH have him live clean, secure, peaceful, happy in this adult family home we found.
I wish you the best!

Helpful Answer (7)

tf110862, I had not heard of "Adult Family Homes", but I live in a rural area. Glad you were able to find a suitable place. We did also, 2nd try because she needed wherever was available when she was discharged from the hospital. While she was at the first, we had some time to search, and found a MC smaller place that I'd stay anytime. They had a place a week later, so a friend and I moved her immediately. By the way, not all who need MC, have Alzheimer's, thus the name.)

(0)

My brother and I toured 15 facilities, narrowed it down to 2, we toured again and had lunch there, asked a bunch of more questions and made our decision. We also checked all client reviews and most important went to the state site as they have to, by law, post all violations and the conclusion of any violations.

Helpful Answer (6)

Dolly you have done what you can to ensure your family member is in a good place. I hope you realize that those websites that post violations and corrections never tell the full story. Even client review may not tell what you need to know. Get to know the families of other residents and hear what they have to say. Band together to move management in the right direction. Good luck with your efforts.

(1)

I started my search online going over the websites and what different ALs & MCs said they offered; reviewed room and/or apartment sizes, looked up inspection problems, I called and/or emailed requesting more information including staff and resident turnover rates, death rates, and whether a resident could stay if they eventually needed Medicaid. If the facility didn't provide most of the requested information I marked them off my list. Then I made a ranked list of places to actually visit. I did my first visit and meeting with the admittance director at lunch and discussed Dad's challenges and how MC would handled them, then came back and observed morning routines, and a check late afternoon. Once I identified places where I thought Dad would be safe, I considered what amenities were offered that my Dad would appreciate. Interesting to me was in my area, what I considered the "better" facilities were not the most expensive ones. The most expensive ones not only had the most consumer complaints, they also had the most state inspection problems.

Helpful Answer (6)

We worked with a social worker at a local geriatric agency to find my Mom's AL. She was excellent knowing the ins and outs. We had already scheduled a visit to one place and she said to make sure we visited the memory care, because we might have some concerns. We probably wouldn't have at the time (because Mom only needed AL), but did at her suggestion. And it was problematic. She knew because she sees all the places.

Helpful Answer (6)

Hi Foleydaughter -

Sorry you're going through this. It can be really hard to navigate for our parents.

In reading your letter, it's not clear if your mom needs skilled nursing or memory care. Has she had a thorough cognitive evaluation? Does she actually have dementia and, if so, what stage?

Memory care facilities come in all shapes and sizes. Some are stand-alone communities, while others are part of a continuum of care that starts with Independent Living, moving through Assisted Living and then Memory Care or Long-term Care if needed.

We've had my MIL in three different Memory Care communities and none of them worked out, mostly the way her Alzheimer's is progressing, she doesn't know she has dementia and she can't tolerate the MC environment. In the end, she's in AL with a night-time caregiver to make sure she sleeps. The AL community allows her to move and engage with people and activities as she desires during the day.

Most important is to determine what your mom's needs are for medical care, management of dementia behavior, social interaction and leisure interests. Then start researching communities in your area to see if there are any matches. And get ready to pay quite a bit of money.

One of the most critical pieces to this is staffing. It is essential that a community have enough staff to meet the needs and care requirements of their residents. This care includes medications, self-care, feeding, activities. Especially on the weekends. It doesn't matter how pretty a place looks if there isn't enough staff to adequately take care of residents.

A good place to start is with any elder services her community has. They may be able to provide you with a list of MC communities. From there, you can research them and tour any that seem like they would be a good fit. Visit at all hours of the day if you can. Especially on weekends, because staff often call off, activities aren't as available as during the week and although families often visit on weekends, it can get lonely and boring once those visits are over.

Regarding the medication list - my MIL has been in the hospital twice in two weeks. Both times, the medication list from the HOSPITAL was wrong. We had to correct it before she was discharged, and then correct it again at her community. I don't know where the drop-out was with your mom's Xarelto, but my advice there is to always, always check the hospital's medication list for the dosage and duration of each medication. And then make sure you're checking it twice/month at any community she lives in.

Wishing you all the best.

Helpful Answer (6)

I have been through this process a couple of times in the last two years now and feel for you. It seems the hospital suddenly decided to discharge then the Social Worker dictates where you LO will go, without giving you enough time to check out options. I have learned to always verify the SW choices, not that they intend to give you bad information, but I have in fact received bad information from them in the past. They act hurt that I don't trust them now, and its not that I don't trust them, but I want to verify their choices on my own. The SWs have many clients to satisfy - the hospital, insurance company, in addition to your LO. You are the only one to work solely for your loved one.

This past time I reviewed online reviews (which cannot always be trustworthy either as some one had a bad experience once and bash the place like its the worst ever) and call and ask friends whose parents have been in them.

My mom got in a rehab last time which wasn't the best, but only one open at the time her insurance covered, but we found out from other patients there it was not the worst in the area either, there were ones worst.

I think bottom line is there are no perfect ones. You try to avoid the really bad ones.

Helpful Answer (6)

Exactly, references from people who actually have LO's at these facilities is the best way to found out. And you hit the nail on the head: it's really more about avoiding the bad ones. Sadly, the good ones often equal $$$$$$$

(1)

I went on FB and asked for friends/family in my area to PM me names of places nearby that they had positive experiences with and/or negative experiences. Then I called “A place for Mom and spoke with a consultant and asked them for places rated well in my area and things to look for. Then I did some online homework. Then I took a week and visited a ton of places and started narrowing it down. The next week I took DH on the weekend to check my top choices. We were not pressed for time, just doing our homework. 4 mos later we were able to strike while the iron was hot and got them in to an independent living with assists available-medication services, meals, housekeeping, transportation, etc. 18 mos later they were ready for AL. We were able to get them in to a place only 5 min from our house that had been my first choice place. After only a month in AL it became clear to the staff and us that MIL actually needed MC, not AL. She and FIL were fighting constantly and she was threatening him. The place they are in has separate houses that each house a max of 12 people. They are set up with individual bathrooms, and a large community bathroom with roll in shower for those who need help. They have a nicely furnished living room, dining room and large kitchen. The AL buildings have 2 staff members at all times and the MC has 4-5 depending on the capacity of residents. They provide activities also. It’s very nice and we couldn’t be happier. When we had to separate them, MIL moved 2 houses down, so he can walk down to see her daily.

Helpful Answer (6)

Wow. This is difficult. I would recommend visit as many as possible before placement and not just one visit, if possible, to try to see how things are going during different times of day on what would be her unit. It's very hard. The SNF my Mom was in during her last yr. was pretty bad. We had to hire sitters to be there . Could only afford 4 hrs/day. Still she had 3 very bad falls & staff totally missed symptoms of a stroke which delayed hospitalization. Sometimes I don't know where they find their employees. And this place was pretty highly rated. If not for the sitters who were very attentive, and positive and friendly, her stay would have been totally negative for me. At the same time, I wasn't physically up to having her at my house. Sometimes you just have to do the best you can. In my heart, I know Mom would have understood. BTW She was at an Assisted Care Facility prior to that for 2 yrs.. We would find her Imdur on the floor in her room (3x) Her cable box was stolen, 3 necklaces went missing. They practically never brushed her teeth. When I visited, I really ended up with direct hands on care/work while I was there, doing things that staff should have done but didn't. It wasn't a relaxing visit like it should have been. So my sister & I started visiting other places. I think I went to at least 6 facilities. Finally chose one I liked a lot & even though it was going to cost more, we made the decision to move her. Then 1 week prior to her move date, she had a massive heart attack & lung clot (probably due to a spike in blood pressure as she wasn't always getting her meds) After hospitalization & amazingly surviving, she required SNF & could not move- in to the AL facility that we liked. Had to make do with the SNF & sitters compromise, and she lived about 14 more months. We were always blessed that Mom's behavior was always pretty good, except for some delusions. Hang in there. It isn't easy for any of us, as people are living so much longer now and there are more "older" children with their own health issues taking care of their parents

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How do you find a GOOD memory care facility/ nursing home?

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