You know you love your mom or dad (other loved one) and you want what’s best for them. But, there are so many questions rolling around your head that you don’t quite know what to do. Does mom need some assisted care? Will she be offended? Is Dad’s memory getting worse? Is he forgetting to take his medications? My life is so busy with my own life/work and family that I don’t have the time or the energy or the know-how to take care of grandma? Can we afford care for gramps? My parents culture always took care of their family, but today’s world we just don’t have the time or resources to adequately care for our elderly loved ones. What questions am I supposed to ask in seeking help for my parents? These are some of the frequently asked questions I receive from families.
Below are some statistics showing the trend of seniors and the need for assisted living.
The generation of Americans born between 1946, the end of World War II, and 1964. It has become the largest generation of Americans born in U.S. history. There are 75.4 million Baby Boomers (as of 2015) and growing by the thousands daily.
Typical Resident - The typical resident is a woman about 87 years old who is mobile, but needs assistance with approximately two to three activities of daily living (ADLs). Percentage Of All Residents By Age Groups: In 2010, 54 percent of assisted living residents are 85 years or older; 27 percent are 7584 years old; 9 percent of residents are between 65 and 74 years; and 11 percent are younger than 65 years old. Gender - Seventy-four percent assisted living residents are female; 26 percent are male. Number of Residents - More than 735,000 people nationwide are living in assisted living settings.
We are living in a world with an increasing senior population. Today’s world requires having a 2 family income or, many are single, and this makes it very difficult for a family member to stay home to care for our seniors. If our loved one lives alone, it’s difficult to have the time after work to visit him… or, we worry if he is safe, or is he in danger of falling? Is he taking his medications? Is he eating properly? Or can he cook for himself? On and on the questions swirl which leads to anxiety and worry on our part.
Fortunately, society adapts to the ever changing landscape and the need for elderly care has grown immensely the past decade. There are many assisted living communities popping up all over the place. We’ll get to “how to choose an assisted living facility” in the next section. But, I want to touch on some specifics that you should consider in deciding what your mom/dad needs.
When making a decision to move your loved one to a facility…, consider these tips on knowing when it’s time:
1. Exhausted, angry, bitter or feeling resentful about providing care? Don’t burn out or snap at your loved one. You can’t fully care for someone else if you’re not caring for yourself, too.
2. If you’re losing sleep because you are worried that Mom left the stove on, or Dad wandered out in the cold at night, don’t wait for a crisis to happen before taking action. In the case of dementia or Alzheimer’s, when confusion increases and memory loss begins to impact their safety and ability to manage simple daily tasks.
3. Feel like there aren’t enough hours in the day to help Mom with transportation to her doctor’s appointments, laundry, meal prep, and other tasks?
4. Missing your child's sporting events or date nights with your spouse on a regular basis? Can’t remember the last time you did something for yourself?
5. The condition of their home: Consider it a red flag when paperwork piles up or your parents aren’t paying their bills… or noticing that Grandma’s house is messier than usual, or that most of the food in the fridge has expired, or that she’s been wearing the same clothes for days because the laundry hasn’t been done for weeks?
6. Activities of Daily Living (ADLs): Body odor, soiled clothing, and significant weight gain or loss can all be signs that your parents need help with ADLs. According to the CDC/NCHS 2010 National Survey of Residential Care Facilities, almost 4 in 10 residents received assistance with three or more ADLs, of which bathing and dressing were the most common.
7. Chronic conditions that are getting worse: According to the same survey, almost three-fourth's of residents have had at least 2 of the 10 most common chronic conditions, of which high blood pressure and Alzheimer’s disease and other dementias were the most prevalent.
8. Socialization: Pay attention to whether your parents are isolated and are not participating in activities the way they used to, which can be a sign of depression.
9. Medications: Your parents may not be taking their medications, possibly because they’re forgetting to take them or even order them in the first place.
10. Accidents and falls: Problems with safe driving or walking are a major cause of concern for seniors living on their own.
While there is no set number of criteria that indicates it’s time to move your parents to assisted living, We believe that the main concern is safety. If your parents can no longer safely live independently, it’s time to talk about assisted living.
How to Choose An Assisted Living Community
Choosing assisted living for yourself or a loved one: it’s one of the biggest purchases you’ll ever make in life, and not just because of the cost. Though there are similar considerations when buying a home (location, style, affordability), you’re also “buying” assistance with personal care, meals, housekeeping and laundry services, and some level of — or access to — medical care. Add in the reality that many spend their final days, months or years in this setting and you’ve got one very difficult decision on your hands.
That’s why it’s so important to take your time, to thoroughly explore the assisted living communities in your price range and desired destination before move-in day. It’s best not to make this tremendous decision overnight after a medical emergency or care crisis, even though that’s what often precipitates this transition.
When you are considering an assisted living community for your parents or loved one, it is important to know how much you can expect to pay so you can budget for your loved ones appropriately. The cost of joining an assisted living community varies upon several factors which typically include
Geographic location of the facility Size of accommodations selected Level of care required Additional amenity and service fees
The Census Bureau estimates that, on average, the per-diem rate for assisted living in a private room is about 60%-70% of the cost of a similar-sized room in a nursing home. This is a strong point for assisted living facilities. Besides, the fact that the smaller facilities such as the 6 Bed facilities are usually in residential homes and this makes it much more preferable to living at a home vs. a nursing facility where one can get the feeling of living in a hospital.
Ideally, most seniors would prefer to stay at home and hire in-home care. Mom/Dad would be at home. There is a positive benefit to this as most everybody would like to be around familiar settings...and if other family members are at home it could be a benefit for the elderly one.
However, while they feel more at home, it may cause stress to other family members...and there still is a safety risk. The risk of fall is great due to the wrong flooring/carpet or certain furniture layout or a lack of safety bars etc. There is a familiarity of the home and sometimes the obvious isn't so obvious. This could lead to a trip to the rehabilitation center which comes with greater costs.
The other issue of having in-home care is the higher cost of care. Most assisted living facilities have a caregiver around 24/7. The cost of 24/7 in-home can easily be over $10,000-15,000/mo.
Costs vary nationwide for assisted living facilities and from county to county. In California, prices range from $2,500 to $17,000 and you can expect for adequate care in the $5,000+ range, give or take a $1,000 depending on the needs of the resident. Typically facilities offer either a month-to-month lease or some offer one-year leases that may be renewed. Residents of assisted living communities can typically expect a 4.28% annual increase in their base rate. (Note: minimum wage increases each year... which is extremely costly for these businesses). Your loved one has housing, full meals, laundry, social activity, 24/7 care & security, all for a reasonable cost.
An Important point to make regarding 6 Bed Facilities (RCFE's), most RCFE's work with Doctor's/Nurse's and other Health Care Professionals including Hospice Services & Hair Stylists etc., that make In-Home Visits. You can have Peace of Mind, knowing that your loved one will get adequate medical care when needed as well as many of the other needs without worry!
Most of the larger facilities (above 12 beds) usually charge a higher monthly base fee than a smaller 6 bed facility due to having skilled nursing/doctor, pharmacist, cooks, janitors etc. which must be placed on the payroll… much like a hospital. The larger facilities also may charge a non-refundable “community fee” which can range between $1000-$5000 which covers administrative expenses and the cost of room renovations between residents.
While it’s common for families or seniors to prefer larger rooms, it’s important to remember that the entire facility becomes a resident’s home. In addition, if your parents have mobility issues, which could contribute to a higher risk of falling, you should minimize the amount of walking between rooms that is required.
How Can Families Pay for Assisted Living?: There are several sources of funds commonly used for paying for assisted living: Private funds, Long-term care insurance or sometimes Veteran’s benefits. Private funds can come from personal investment portfolios, like 401k plans or Individual Retirement Accounts (IRA). Many people sell their homes, using equity that has built up over their lifetime, to fund their time at an assisted living facility.
Seniors who do not want to sell their home may consider paying for services through a reverse mortgage, where long-time homeowners essentially borrow against the value of their home.
Medicare will not pay for Assisted Living and Medicaid may pay a small amount but you’ll be limited in your choices of where they are accepted and where they may live.
Regarding Levels of Care: Either upon admission and when residents require assistance with activities of daily living (ADLs), an assessment which forms the basis of a care plan that outlines the level and frequency of supportive services that will be provided.
More than half of all seniors residing in assisted living communities require help with preparing meals, managing their medications and bathing. The other common ADL’s are dressing, toileting, transferring and eating. It’s a combination of usually those 6 ADL’s determines the extra cost. Be prepared, realize that as your elderly loved one age's, they need more assistance. This is not an area you want to be “chincy” with your money. As aging slows down activities of daily living, it requires someone else to give more of their time, effort and care for your loved one.
This leads me to talk about something very important. CAREGIVERS. There are many factors to evaluate in finding the right spot for your parents and that is what this report is all about, to give you educational information to help you make an informed decision.
We have a motto on our business marketing which is our belief... “To Care For Those Who Once Cared For Us is One of The Highest Honors.” This has always been our belief and standard which we instill into our caregivers. We have excellent caregivers that really do care. They watch over your loved one as if he/she is family...and that is what it should be in a home or facility. This, I believe is the biggest and strongest advantage of a smaller bed (6) facility over a larger facility (over 50 beds). There is a 6:2 ratio of caregivers for a 6 bed Residential Care Facility for the Elderly (RCFE) vs. a 16:1 ratio for a larger assisted living facility.
The caregivers in a larger facility care what they are doing...it’s just that they have too many residents with limited time to give that same amount of attention and care… The 6 Bed RCFE caregiver usually knows the nuances of the resident more intimately because they have more time and attention by directly being involved with your loved one.
While I believe that a senior gets better care and attention in a smaller facility, there are concerns that you need to consider when looking at smaller facilities. Because they are smaller, some of them are not doing business legally. One is to check if their license is current. It should be posted in an obvious place in the facility. Are there any citations/infractions? You can look up www.ccld.ca.gov to find this information. "A" Citations should be a red flag and highly questioned. "B" citations should be asked about but they are usually minor in nature.
Do they have enough staff each shift to meet all the needs of their residents? One caregiver per 6 residents can be inadequate. Do they carry liability insurance for your protection? Are employees being covered by Workers Compensation? Are employees being paid at least minimum wage? If they are not being paid based on the current laws laid out by the Labor Board, then the facility owner/administrator may be facing serious financial penalties which are high enough to shut the business down and that would leave your mom/dad without a place to live.
A final thought, and this is just my opinion based on 35+ years of running a couple of businesses and being in a serving position for all those years as a Doctor, if the boss isn't running things on the up & up, or paying their staff legal wages, I believe that the trickle down effect of their leadership spills over to the caregivers. If the caregivers pick up this lax attitude, then that is the level of care that they'll give to your loved ones.
Emergencies: All facilities are required by law to give a certain level of care at all times and that is including emergencies. Most facilities understand what to do in an emergency. If you have a concern, just ask the administrator how their facility handles such occasions.
Eating healthy is very important for seniors as their digestive system doesn’t assimilate the vitamins and minerals as when they were younger. Most facilities offer good food. The larger facilities hire cook's so the meals are usually healthy with a good variety. In the smaller facilities you should ask about the food that is prepared and served. It may not be the most nutritious...just the cheapest. If you have a facility with less than one caretaker it adds a lot of stress to prepare a meal in between giving care to all the residents. With 2 caregivers as we have, there is always a caregiver for the residents while the other prepares the meal. We serve 3 healthy nutritious meals with fresh fruit and vegetables, desert... and snacks in between if so desired. Residents do not have to eat every meal offered at an assisted living facility. However, in most cases, monthly fees will not be reduced if a resident chooses to eat fewer meals. In an effort to provide services which enhance a resident’s well-being, facilities recognize the importance of proper nutrition and hydration. In fact, a poor diet is frequently the cause of health problems for seniors living alone in their own homes.
The opportunity for social interaction throughout the day is another important reason for providing three meals as part of a healthy lifestyle. If, however, a resident is ill and cannot eat in the dining room, they can have a limited number of meals delivered to their apartment at no cost or for a minimal charge.
Security is another important factor. Most places are pretty secure. The 2 biggest issues would be the neighborhood the facility resides and what I’d refer to as ergonomics. If the neighborhood is not a safe area, you will have to factor that into your decision making.
What I mean by ergonomics is, is it safe for the resident to move about without a lot of obstacles that may cause them to trip and fall such as a bad carpet/flooring? In and out of entryways... are they safe? Secure? Does the facility have an alarm system? Proper locks on medicine cabinets etc. The environment should be clean and safe.
Visiting Hours: While visitors are usually required to sign in and out for security purposes, there are no restrictions on when family members can visit residents in their home. After ‘business hours’, the exterior doors to facilities are locked. Most places will accommodate a visit if you talk to them.
Activities: Getting older doesn’t mean that you can’t be active. Some facilities have an activities director which help lead them in group or personal exercise...either mental, physical or both. This is important to stay active and it creates community with other residents. We have an Activities Director that comes in and works with our seniors as a group and individually...and many of our family members join in with the activities. Most of the larger facilities will not work individually.
What If Your Elderly Loved One Hates Their Assisted Living Facility?
After spending so much time and energy finding the right assisted living facility for your loved one, you want to see him content and well cared for. You want the transition to be seamless.
Unfortunately, life doesn’t always work that way. You think you’ve found the perfect fit for your loved one, only to discover he’s terribly unhappy. What now?
Here are five steps you can take if your senior loved one hates their assisted living facility.
1. Look for assisted living red flags.
If your loved one is having problems with assisted living, the first thing to do is find out why. Does she dislike the new sounds and smells, her new neighbors, the new routines? Or is it something more serious, like being treated poorly? It’s important to distinguish between typical adjustment issues and concerns that signal real problems with assisted living staff and care. If you suspect elder abuse, contact the facility’s long-term care ombudsman immediately to file a report and work out an appropriate solution for your loved one.
2. Give him time to adjust to assisted living.
If your loved one is not in danger and is not being abused in any way, give her time to get accustomed to her new home. Transition is often challenging; a few days or weeks are typically not long enough to make a complete adjustment. We find that most residents are adjusted within 2 weeks but may be 6 weeks. While a good assisted living facility will work hard to help your loved one engage with the community, the change won’t happen overnight. Moving a senior from place to place could do more harm than good, so it’s wise to take a wait-and-see approach.
3. Spend time together.
Moving to assisted living should not mean that your loved one loses contact with you and with the outside world. If she feels like she has been dropped off and left to fend for herself, she will feel resentful of her new environment, no matter how wonderful it might be. Visit your loved one in assisted living, and spend time with her like you used to. Your familiar presence could help her feel more comfortable and at home in her new surroundings.
4. Consult a geriatric care manager.
If your loved one has continuous assisted living complaints and you can’t figure out what’s best for her, don’t go it alone. Consider hiring a professional geriatric care manager or case manager, to help you navigate the sometimes-confusing world of senior living. The case manager can help you determine what’s really going on with your loved one, and help you find the most appropriate facility if a change is needed. If your loved one isn’t adapting, most likely the administrator/staff are well aware of it and talking with the administrator will work with you to find another location. Our approach would be to assist you to help find the right fit for them and we have several senior placement services we work with to assist and guide you. 5. Take care of yourself. If you’ve done all you can and your loved one’s unhappiness persists, recognize that the problem is out of your hands. While you are her advocate in assisted living and you need to make sure she’s being properly cared for, you are not responsible for her happiness. Her happiness is her choice. Do your best to maintain the relationship, but respect your own boundaries. Give yourself permission to take care of yourself, too.
Feelings of Guilt or Relief?
Let’s talk about you for a moment. Many family members carry a sense of guilt when it comes to placing a loved one in an assisted living facility. You feel you are not taking care of your mom/dad as you’d like to or maybe how they project onto you their desire for you to take care of them. Or maybe you have a sibling who disagrees with your decision to place your parent into a facility. There are a lot of emotions that can swirl around in your head. But you have to focus on what is the most reasonable and responsible decision to make. Focusing on what is best for them is the main goal of your decision. You may not have the physical, mental, emotional capacity or the time to adequately care for your parent.
Hopefully, once you are satisfied with placing your loved one in a safe, secure environment you can experience a feeling of relief and peace!
Here is what you need to do for a Personal Tour of our facility at Grand Villa in Escondido and a Consultation regarding your loved one with Daniel and Laura Malchow to answer specific questions regarding your loved one.
Call Laura at: 858-231-3933
Checklist for Visiting an Assisted Living Facility
Just as you would tour a potential new home before purchase or tour a new school before enrolling your children, so to should you visit the assisted living facilities that you are considering for your parents or loved one. Photos and promotional descriptions on a website cannot replace the firsthand experience of walking through a facility and observing the staff and residents for yourself.
Because you will likely be visiting several facilities before selecting a one for your loved one, we recommend bringing a checklist which will help you document your observations of the community. This way you can better compare communities since you might forget details when making a decision several weeks later.
In addition to the questions that we list below, be sure to add others which are relevant to your loved one. Here is a checklist which you can print and take with you.
Name of Assisted Living Facility: __________________________________
Date of Visit: _____________
As you approach the facility:
1. Is the primary entrance on a low-traffic street? 2. Is the community in well maintained? Fresh paint, nice landscaping, clean sidewalks and patios? 3. Are the doors easy to open and close for those with mobility issues?
As you enter the lobby:
1. Are residents engaged in activity or sitting/sleeping in the lobby? (it's common for many Residents to nap after a meal) 2. Is the lobby inviting in terms of décor, smell and overall appearance? 3. Are you welcomed by staff and asked to sign in? This is often a good security measure.
During your tour
Are a variety of options available at each meal? Diabetic options if applicable? Healthy options? Is there flexibility in meal times? How many meals are offered per day? Are you invited for a meal? What is the average age of the residents? Do the common areas look well maintained? Are fall prevention measures in place, such as the carpet is level or beveled and any steps are well marked?
Ways to confirm the facility is in compliance with state laws:
1. Is the facility’s license posted in a readily accessible area, such as the lobby or near the entrance? Is the facility’s latest inspection report posted? If you ask to see the facility’s inspection reports, what is the response? Does the administrator provide the reports or dismiss your request? Oftentimes the inspection reports must be made available upon request. Does the facility post how and where complaints against the facility may be registered or the telephone number of the state ombudsman office? Are the evacuation routes displayed? How often does the facility conduct fire drills?
1. What services are included in the monthly rent? What services are extra? 2. How are care levels determined and how is cost assigned, i.e. is care assigned on a point system and each point corresponds to a dollar amount, or is it based on the number of hours care is required? 3. Does the monthly rent increase each year, and if so, what is the average increase?
1. Can residents age gracefully in this place? Is the facility equipped to care for residents if they develop Alzheimer’s or Dementia? What is the staff to resident ratio, not only during the day but also at night? You don’t want your loved one to feel ignored if staff don’t have time to provide one-on-one attention when it’s needed.
Additional Considerations to Keep in Mind:
Smaller facilities are often better, particularly if mobility is an issue. Consider the entire facility as your loved one’s new home because social interaction will be an important component of daily living. Are there gathering areas or places where your loved one will be spending time? During a tour, pay particular attention to whether the Administrator and/or other employees interact with and refer to residents by name regularly.
So, here it is again for what you need to do for a Personal Tour of our facility at Grand Villa in Escondido and a Consultation regarding your loved one with Daniel and Laura Malchow to answer specific questions regarding your loved one.
Call Laura at: 858-231-3933