For many adult children it is difficult to assume the responsibility of managing your aging parent’s needs as their health deteriorates. It is even more difficult to arrive at the decision that it will require more than they can provide to assist the parent(s) in sustaining a lifestyle that accommodates their condition. Both parent and child will eventually conclude that not only can they not maintain their current living arrangement, but they must move to a location where those other than adult family care givers can assist them. Though many elderly individuals come to this conclusion on their own, often it is necessary for the adult care-giver to initiate this train of thought.
Today there are facilities, most commonly referred to as an assisted living facility (ALF) that are licensed by the state to serve the needs of aging parents with trained staff and which provide professional medical attention for individual circumstances. If assisted living conditions are required then the next step is how to find the facility that best serves the needs of the elderly. Factors like medical condition, mobility and levels of independence need to be assessed for each elderly person but a decision must also be based on costs, location and adaptability over time or accommodating what the industry refers to as “Aging in Place.”
The facility chosen must develop a personalized plan that meets all of their needs and accommodates any disabilities they may have, while giving them the freedom to do what they can for themselves. Since each State has its own specific licensing requirements you will need to check that state agency that establishes criteria for ALFs to help guide aging parents and their adult children in this decision. A state’s Health and Human Services Dept. or Dept. of Health would be your most likely go-to source.
Whatever facility is chosen it must be one that elderly parents are in full agreement with. They are after all the ones who will be living there and how they perceive their new home is critical to their overall well-being. Being forced to live in a place that has no appeal to them but is based strictly on costs and conveniences for the adult children will create conflicts for their children and the facility staff. If both parents are still able to move about relatively easy and their cognitive skills have not diminished much, then an ALF with apartments available to them could be an acceptable accommodation.
Before even leaving the house to check a facility make some checks by phone, the Internet or through acquaintances who are or who know elders that live in an ALF. Prepare a list to evaluate each one under four broad categories: Financial, Health, Medical and Security.
– What are the rates and is Social Security and Medicare/Medicaid accepted?
– What additional fees exist that will be out-of-pocket expenses?
– Is their financing available through the facility if necessary, i.e., private funds become depleted?
– How does the facility bill for services?
– Do they provide a contract that is clear to understand and doesn’t speak in “legalese”?
– Are there entrance fees, security deposits or periodic dues required?
– Are any fees or deposits refundable should something happen that prevents an aging parent
from moving in?
– Are there separate charges beyond what the contract provides that elder residents are liable for like
phone and Internet service?
– Will there be rate increases over time and if so how are they determined?
– Is there a written care plan that addresses mental and physical stimulation?
– What services are available to assist a resident with health task, i.e., is there a care taker to assist with bathing, dressing and other hygiene needs?
– How clean is the facility and how is this maintained?
– How are meals prepared and is there a certified dietitian that plans them?
– If their physical condition allows, are their residences where they can prepare their own meals?
– Are personal diet and nutritional needs managed by staff as the need exist?
– Are snacks available and what sorts are they?
– What medical staff is available, what days and what hours?
– What are the standards for prescription drugs and is there qualified staff available to
administer them as necessary?
– Do they have assigned doctors or can residents use their own?
– What all is entailed under medical services and will these be covered by Medicare/Medicaid?
SECURITY AND SAFETY
– Is it a gated community?
– Are there adequate locks on all doors and windows?
– Are there easy to access emergency buttons in each room or will they be provided electronic
devices they carry with them?
– Are halls and breezeways wide and well lit?
– Are there handrails appropriately located on stairs and in bathrooms?
– Is there a plan of action for fire and severe weather? Is it clearly posted?
For a complete and thorough checklist you can go to the AARP website here and download an organized Active Living checklist that address all of these central points and more.
Once you have obtained this information, pick your top three selections and schedule appointments to do an on-site visit. Most facilities will arrange this between you and one of their staff; usually a marketing director who no doubt will present the facility in the best possible light. You may want to stray from the programmed route and see what’s behind walls and around corners that they are not showing you, provided there are no security warnings preventing you from doing so. Talk to some of the residents when you can and they’re out of ear shot with your facility host or other staff. Often clients don’t feel they can speak frankly when they’re in the presence of those who are assigned to take care of them. Inquire if they are satisfied with the facility and the way they are treated by staff.
The facility must feel inviting to aging parents so they will be more encouraged to leave the familiarity of their home. The ambiance of the facility must give them a sense of community. It should be aesthetically landscaped to be appealing to the eye and away from large industrial areas and high traffic corridors to insure minimal noise. A good facility will have plenty of trees and wide, flat walkways that lead to private areas they can enjoy away from the facility.
An ALF that allows pets would be something to consider if there is a cherished animal they want to bring with them. It should be in close proximity to stores and churches or provide an available mode of transportation for seniors that can no longer walk long distances or drive themselves. Check to see if there is staff or volunteer coordinators that arrange festivities around holidays and birthdays for the facility to maintain interests in social interaction. Once you have narrowed your choice down to a single selection do one more re-visit on your own to see if your attitude changes toward it.
This transition can be made a lot easier for all involved if time and care are utilized to accommodate the special needs and interest of the elderly. This decision must feel right with them inside and that their independence will not be unduly compromised. They are not unaware that they must adapt to a change in order to lead as a full a life as their health will allow. They are aware too that there is only so much that an adult child care provider can do while building a life and family of their own. Once they have come to this decision and the final location has been determined in a thoughtful and timely manner, the worries that preceded this move will more easily fade away for everyone.
AHRG: Residential Care and Assisted Living
Gray Times: Evaluating assisted living options: beyond the site tour