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?
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. .
No matter what time of day I visit, it is calm and pleasant.
Stop by at meal times, earlyish in the morning, just before bed.
God Bless and you ae Lucky to have your Mom. Mom passed away last December from her Own at Home Lung Cancer No Care.:((
1.Care coordination: Staff collaboratively assess, plan, and provide care that is consistent with current advances in dementia care practices.
2.Staff knowledge and competency: Staff have the qualifications, skills, training, and education to assess and provide care for a patient or resident population with memory impairment.
3. Activity programming based on abilities: Staff provide activities that match the patient’s or resident’s cognitive ability, memory, attention span, language, reasoning ability, and physical function.
4.Behavior management: The organization emphasizes the use of nonpharmacological interventions as an alternative to antipsychotic medications.
5.Safe and supportive physical environment: The organization modifies the physical environment to promote safety and minimize confusion and overstimulation.
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.
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.
be difficult to find in some areas but are a wonderful idea. We found
one for my mom and she is doing awesome. It is a home- like next door to you- and the homeowner takes in residents to live there with them.
There are CNAs who come in, the Nurse comes in, the Doctor comes in.
It is just like home, with care. Regular facilities, I understand, the ratio is
1 CNA to 20 residents. In the Personal Care Home, it is 1 to 3 residents.
It is a "family" setting. I hope you can find a good one in your area. I
found ours on a list provided by the care manager.
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!
I am so sorry that you are having to go thru this....it is tough!!! I just went thru it with my Father n law. To find a good place takes a lot of prayer, research, visiting and talking with family members and residents. Once you place her then there needs to be a lot of you visiting at unexpected and various times. I don't know where you live but I am in Foley Alabama area. I found that the facilities actually range by the functional needs of the patient. When you interview the staff and talk to the marketing director draw your on conclusion if that facility is a good fit for her and for you. With my Father n Law the first place said "oh yes he will be great here". "We have high functioning people here with Sun Downers and we know how to handle them". In less than 3 weeks they are telling me to get him out of there! I had to hire sitters to stay with him until I could find the "right" place. Again, it takes lots of prayer, research, common sense and good judgement! I found a place that he has been at for 3 months and it is working out well so far. Praying that you will have the wisdom and gain the knowledge you need to find the facility that works best for you both.
https://www.medicare.gov/nursinghomecompare/search.html
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.
The other thing to do is contact one of the services in your area that helps families find the right placement, there is bound to be at least one big enough to be easy to find, make sure they don't charge the family/patient for their services, in mom's area anyway they don't and you can decide after that initial consult as to weather or not you want to continue working with them or have gotten enough info from them to do the rest of the leg work on your own. The service of course has facilities it works with (pays them) most so you may not get all the options but you will get a good road map. If your LO is getting VNA/at home nursing or PT services they usually have a social worker who will come out and go over options with you as well and the other option is often the state or county/town agency on aging or elderly services (maybe connected to senior center), her primary's office might have someone to help with this too if they have a large elderly clientele check all of these out because while there will be cross over you will also get various views and information, suggestions, each person will have had experiences with various facilities and this is what they do so it makes for great info gathering and direction. Then after getting an idea of the possibilities and real option for your situation go visit them, talk to families and residents, really spend time noticing things as your given the "tour", talk to the people who work there as well as the director or whoever they set you up to talk with. Have a list of questions that you ask each place you visit and then jot down any you come up with for a specific place after your tour or first visit, facade or not you will get a gut feel for whether or not a place might be a fit when you walk in, just like visiting a collage campus. We did this with rehab facilities for Mom after her stroke and I am so glad we made time for it. Then maybe dig deeper into your top choices and take mom to visit and or do a respite week if they offer it to see how it works for her and help her adapt to the place and idea before it's decided. Give her some ownership of decisions or at least the impression she has some control and made the choice.
Reach out to the available resources around you but don't limit yourself to one or what they suggest. It's work and it's overwhelming especially if you don't break it down the process but for me increasing the likely hood of finding the right situation and easing the transition the first time is well worth the work. Just remember, you are not alone in feeling overwhelmed by this, I think most of us have and do feel that way throughout the process of caring for an aging LO. Lot's of positive energy coming your way!
Thereafter, vetting these places and seeing how they operate is key. I'm more than happy to give you a list of ones I've vetted, in my almost 20 years of Eldercare.
Feel free to message me
Try this site and search for license and deficiencies for your state.
http://dph1.adph.state.al.us/FacilitiesDirectory/(S(ip1xtdq0omnwy5452zszhvu3))/default.aspx
I used this for my state and it helped tremendously in finding the best care. Noting tho... not all things are reported.
Check a small home board and care. It was recommended by my mom’s doctor and after I interviewed and toured a few, I just knew which one was the right one. I, thankfully, was correct.
Just a thought and it is an added expense but it helps and brings peace of mind.
I was given an actual person who became my mentor he looked in my area and I went to visit those places with his recommendation.....it was nice to have somebody on my side and understanding
I actually got the phone number on this site
Mom did end up staying in a place that was recommended by “a place for mom”, near my home for three years till she passed away in March.
good luck to you and your family
Sissy
I went through something very similar with my mom last summer. She was in the hospital, then this seemingly friendly and helpful buzzard from a "nursing home/rehab/ memory care" placement swooped down in our hour of need, ie, time for discharge, and mom ended up in XXX Manor. I felt very much taken advantage of.
There was pilfering among the residents; an unpleasant general smell of urine; the bedclothes were worn out as was the bed. The bathroom in the shared room was tiny and uncomfortable. Someone usually was screaming all.day.long.
It was a locked ward for dementia etc inside a nursing home. Frankly, it was just depressing, and my brother and I felt like we were in a George Romero movie with zombies. There was even a lecherous old man masturbating on the back "porch".
(These behaviors are not out of the norm for people with dementia. What is happening is that there is not enough staff to re-direct and watch over people, and there are too many residents for the number of staff members, which creates chaos.) Ditto on the incorrect medication list; insufficient staff to manage all aspects of care. There was a lot of roaming around. Unpleasant to say the least.
Also, be careful what you sign when you are tired or stressed out. I unwittingly signed over my mom's SS payments, and then I had to untangle that. That page was in the middle of a bunch of other pages....
By chance, the lovely place she ended up and where she is now was right next door. Go figure.
Back to your question. If you need to enlist family or professional help, do it. Gather your list via Google. Then ask yourself these questions.
Can we afford it?
How far away is it? or what is the best place that is closest to me?
What services do they offer?
How many resident live in the Memory Care unit?
Is it clean and cheerful? (You will have to visit to determine this)
Is the staff kind and responsive? (Again, answer this during your visit.)
You can get in touch with a social service agency in your area, or an agency that deals with elder issues, and ask for someone to help you. I've mentioned before on this blog that the Jewish Federation of America will help anyone. You can also ask any member of the clergy for recommendations to either find someone to help you with your search or assist you with the actual search.
TNtechie's comment (and several others) was/were great! List all your questions and concerns. Check out and compare places, what they offer, cost, what is included in the cost, what extra charges might be, etc. Highlight the ones that interest you and then check them out. Bring your list, ask a lot of questions, take notes. Wander around after your "interview" if they allow it (if not, I would cross them off the list!) Ask questions of various staff and if possible family members of other residents. Visit the places that you feel have potential (those MOM would like, not necessarily you!) several times, at different times of the day to see more of what goes on. Your initial visit might be "prearranged" and therefore offered at an "optimal" time, so go again unannounced - morning, afternoon, mealtimes, etc.
Online reviews *can* be helpful, but I don't put a lot of store in them - what might be 5 star for someone might be 1 star for someone else. I find more people tend to complain than those who praise places. Although there might be for-profit places that are okay or even good, do consider the non-profits. The home based places might be good, I have no experience with them, but if you have those as an option, check them out too.
Also know costs vary even in similar areas, but very much so from one region/state to another. From postings in other threads, the NE (including the wider NY/NJ area) and CA seem to be among the more expensive. However, you'll have to inquire as to what is covered in the cost quoted. In our mother's case, the regular monthly fee includes all and up to one hour of personal care (i.e. if she needed help showering, etc.) After that, the cost increases per hour at some hourly rate (even if she needed only 15 min!) So far the only "extra" we have been charged is for deep carpet cleaning when she can't get undressed fast enough to use the toilet :-( One brother checked into a place nearer to him in the south, and questioned the higher cost here - I had to check it and found that the $ he was quoted was for the room only - everything else provided was ala carte (bathing, cleaning, laundry, medication, etc.)
We checked 3 places based on location. One didn't really give us a good tour or "interview" and I was not impressed with the set up. Another was more expensive even going with a double room/shared bath (she wouldn't like that but could get private room, for even more $!) Also, the front rooms looked out over a parking lot and 4 lane highway - nope! The one we settled on was non-profit, in the process of rebuilding, so we had to wait and hope it would be nice (couldn't view it at the time.)
As for items that "disappear" - unfortunately this does happen. There are no locks on the MC rooms. Never leave anything of value there. Clothing, bedding, etc should be done separately for each resident, but I have seen clothing show up in her drawers that are not hers! Pictures should be hung (hopefully out of reach) or kept securely in an album to protect them (not 100% safe.) The hearing aid issue I can relate to. Often she wouldn't be wearing it (I find it on end table, under or in the bed, etc), would forget she even wears one, battery would be dead, etc (also stone deaf without it.) Worst fear came true when it went through the laundry. Lucky for us her 3 year insurance was available, so it cost us about 275 - this one is chargeable so I have them "manage" it now (and bought 2 for same ear so we have 1 spare.
MANY thanks for responses.