Assisted Living is a term used to describe a senior living environment that provides help with activities of daily living such as: bathing, dressing, medication management, etc. Assisted Living Communities or care homes also provide meals, housekeeping, laundry and linen service. The type and frequency of these services depends on your care level and how much you are willing to pay for services. Shop around because there are a variety of services offered depending on what you're looking for and your budget.
People are often confused by the terms: “Assisted Living Community” and “Assisted Living Home” also known as an “Adult Care Home” (ACH). Both are licensed in the state of Arizona and both have certified caregivers on staff.
An Assisted Living/Adult Care Home is licensed for 10 people or less. An ACH may have a nurse on staff, but in most cases there is a Nurse Practitioner who visits the home on a weekly or monthly basis to see the residents, update medical charts and in some cases order medication. There is usually a house Manager who oversees the daily operation of the home as well as certified caregivers who work shifts so that there is a caregiver on duty 24/7. The number of caregivers varies depending on the home, but a good rule of thumb is 2 caregivers for 10 residents during peak hours and 1 at night. Often times the caregivers are responsible for housekeeping, laundry and cooking, but that is not always the case.
Some ACH's offer activities such as music or art classes, religious services or family/holiday events. Generally an ACH is pretty low key and quieter than a larger Assisted Living Community. An ACH offers fewer amenities. Some people prefer this type of environment and it is a personal decision based on your needs and taste.
An Assisted Living Community is much larger than an ACH. A community can be 30 residents up to several hundred depending on which your prefer. An Assisted Living Community is also licensed and they may have one or more nurses on staff as well as certified caregivers round the clock. Nurses update charts, provide medication management and many times have an in house wellness clinic in addition to one or more Nurse Practitioners who visit the community on a regular basis. In addition most communities have a more employees including an Executive Director, Chef, Cooks, Waitstaff, Housekeeping & Maintenance staff as well as various levels of management.
Assisted Living Communities offer many amenities in addition to meals, housekeeping, linen and laundry services. Most have transportation to doctors, shopping and pharmacies. Many have a movie theater, fitness center, pool and hair salon, etc. The list goes on and on and varies by community. Some of the larger communities resemble a 5 star resort!
The decision to choose a larger community or a smaller adult care home depends on your situation and budget. I encourage families to tour a few places and talk about it as a family before committing to either. Moving to assisted living is a big decision and the hope is that you chose a place that is a good fit for your family so you don't have to move again. Keep in mind that if you choose a larger Assisted Living Community, you may think it's perfect, but if your family member is living there and isolating themselves in their room, it may be too overwhelming for them. You will be paying a lot of money for amenities that they may not care about or use.
As always I recommend using a local placement agent to assisted you in your search. They can suggest an appropriate assisted living option based on your feedback. They will set up tours for you and walk you through the process.
Ideally, the holidays should be a “Season Of Joy”, but that is not always the case especially for family caregivers who are dealing with a loved one who has dementia and living in a secured memory care community or care home. For these families the holidays are often a stressful and emotional couple of months.
Many times the family caregiver feels pressure to do it all: visit frequently for hours at a time, help with shopping, pitch in with extra care when they can, have their own celebration at home, etc. Sometimes this feels like running on a hamster wheel! It's exhausting for caregivers and may make it impossible for them to get the rest and support they need. In many cases the family caregiver is the one who ends up getting sick and landing in the hospital.
One thing family caregivers need to keep in mind is the need to make time for themselves. I've listed some tips for caregivers to manage stress and hopefully bring some “Joy” back into their holidays:
Instead of visiting your loved one on the actual holiday, why not visit the day before or the day after? Most communities don't have their celebrations on the actual day and you can use this to your advantage. Trying to check someone out of memory care on Christmas day to bring them back home to a house full of relatives, commotion and noise is stressful for everyone, especially YOU, the caregiver.
Consider visiting with grandchildren or a small group of family members before the holiday or the day after. If you have a large family, break your visits into smaller groups. You may want to visit when there is a musical performance or special meal. Bring along some old photos to spark memories of holidays past. Because people with dementia have no short term memory, it's more familiar to talk about the past which your family member can usually recall in great detail.
Perhaps you want to put up a tabletop tree, menorah, nativity or other family decorations that you've had for many years. You might consider baking a pie, cookies or holiday treats from an old family recipe. You may have religious traditions that have been part of your holiday celebration for many years that you want to continue as part of your celebration. These rituals, traditions and memories are the “glue” that bond families together.
However you choose to celebrate, keep it simple and upbeat. Remember, visits don't have to be long...quality rather than quantity. Visit during the time of day when your loved one is going to be refreshed and ready to receive visitors. Don't visit at 4 in the afternoon when your family member is tired, hungry and may be experiencing “Sundowners”. Try not to disrupt your loved ones usual routine because that structure makes them feel secure. If you know that they are done with breakfast at 10, don't show up at 9. Visit at 10 and plan to stay for an hour or so. Talk about family memories and what the holidays mean to you. Bring up relatives and friends from the past who are living or not and talk about the good times you shared.
If you're feeling sad, depressed or overwhelmed, reach out to friends and family. The Alzheimer's Association has a helpline that provides support and information 24/7. Their number is 1.800.272.3900.
If you are a family caregiver taking care of someone at home, you may be even more stressed. If you feel you're ready to discuss placement options, reach out to me. I'm happy to listen and go over options with you. Remember, there is never a charge to families for my services.
To all those family caregivers out there, THANK YOU FOR WHAT YOU DO! Thank you for advocating for your loved one and being there for your families. It's not an easy job, but so important!
Happy Holidays and all the best to you and your family in 2020!
Simply stated, “Plan B” is a back up plan in the event of a crisis or emergency. Many people live independently for years and then something happens and they end up in the hospital and/or a skilled nursing facility and are unable to return home. That's when I get the call that goes something like this, “My mom is getting kicked out of rehab tomorrow, what do I do?” Unfortunately there is no single right answer because it depends on the situation.
In order to react in this situation it's best to be proactive BEFORE you're in a crisis situation. If you've done your research and looked at the various options available and also included the person who needs care, then the decision should be clear. This makes for a much easier transition. Keep in mind that no one wants to figure out Plan B when they or their family member is in crisis and under a tremendous amount of stress.
I recommend talking with your parents or if you're thinking of a Plan B for you and/or your spouse, have a conversation and figure out what will work best not only for you, but for our family as they will most likely be visiting and participating in your care.
Consider the following when putting together your “Plan B”: How will we pay for a care? Keep in mind Independent, Assisted Living, Memory care and Behavioral Health communities are NOT covered by Medicare, but are private pay. There are funding options such at VA Aid and Attendance and ALTCS ….IF you qualify. It's best to speak to a local, reputable Placement Agent to discuss your options.
TIP: Have your paperwork in order as soon as possible:
POA, Living Will, Advance Directive, etc.
What type of care do we need? Options Include:
Living with Family
Adult Day Care
In Home Care with professional caregivers
Moving to an Independent or Assisted Living Community
Secured Memory/Dementia Care
Behavioral Health, etc.
Again, speak to a local PLACEMENT agent who is familiar with the options and can serve as a resource to help you find the best fit for you or a family member.
How much time do we have to make this happen?
Again, it depends on the situation, but usually it's a week or more, I would advise 10 days to be on the safe side.. If you're moving to a community, then you need doctor's orders which may or may not require a doctor's appointment. A current medication list is required as well as a TB Test. In most cases it's best to also have your Powers of Attorney in order and that includes: Medical, Financial, Healthcare and if dementia is an issue, it's also very beneficial to have a Mental Health POA. In some cases you may also have to give 30 days notice at your current community or apartment, Plan ahead and add in a some extra time in case things don't go as smoothly as you would like.
*If you're in crisis and try to rush the process it will not work! Any community who will accept you without proper paperwork, medications and documentation is not reputable and if you move there, you may find you're not getting the care and services you were promised.
The Final Decision?
Reach out to your resources: Placement Agents, Marketing Directors at Communities, your Physician, Social Workers, Case Managers, and anyone involved in you our your family member's care. Ask neighbors and/or friends who have been in your situation and gather as much information as you can, but ultimately go on your gut instinct. You have the honor and privilege of making this decision for yourself or a family member and you should feel good about it!
If you have questions about this topic or would like more information on local resources to help you develop a “Plan B”, give me a call. Robin Coats, Tucson Senior Placement 520.373.0349
Many people mistakenly believe that Dementia and Alzheimer's are two separate diseases. In fact, "dementia" is the umbrella or overview of all the symptoms: Short term memory loss, can't find the right words, repeating things over and over, getting lost, can't follow directions and numerous other symptoms.
There are many diseases that cause Dementia such as Vascular Dementia, Lewy Body Dementia, Alcoholic Dementia, etc. Alzheimer's is the most common disease that causes Dementia. All forms of Dementia are a roller coaster of good and bad days with symptoms getting progressively worse over time. As the disease progresses, people lose their short term memory and most often are fixated on the past. They may not remember what they had for breakfast, but can describe their childhood in great detail. In simple terms, the more they progress in their disease, the further they go back in their minds. It is very common for someone in mid/late stage Dementia to look for their parents, to talk about events they experienced in their childhood and focus on past events because that is what is familiar to them as their short term memory has faded.
You may also hear someone has a diagnosis of "Behavioral." This is not the same as Dementia. The definition according to HealthGrades.com: "Behavioral symptoms are persistent or repetitive behaviors that are unusual, disruptive, inappropriate, or cause problems. Aggression, criminal behavior, defiance, drug use, hostility, inappropriate sexual behavior, inattention, secrecy and self-harm are examples of behavioral symptoms". When someone is classified as Behavioral, they may have a history of Schizophrenia, Bipolar Disorder, or other mental disorders. In some cases their behaviors may be caused by medication or other factors. If the behavior is something new, then it is very important to have a "psychological evaluation" to determine what is causing the behaviors and in some instances they can be managed or reversed.
If someone has a Behavioral diagnosis, they should not be in a Memory Care unit. A memory care unit is a secured environment for people with Mild Cognitive Impairment (MCI) or any form of Dementia. If someone is Behavioral, they need care that is different than what is offered in Memory Care and should be receiving specialized treatment for their behaviors.
When seeking a senior living community, its always wise to pre-plan so that in the event that you or a family member needs to move to Assisted Living or Memory Care, you've already seen a few options and have an idea of one that will be a good fit. No one ever thinks they will end up in the hospital and not be able to return to their home, but it happens frequently, so it's best to have a "Plan B' rather than leave that task to your friends or relatives. It's much easier for everyone if the decision isn't made under stressful circumstances and if possible, that you involve the person who will be moving.
To help you in your search for a community or care home, I recommend using a LOCAL "Placement or Referral" Agency. The local placement agents are professionals who have been in the industry, are familiar with the various options and have resources to help you select a community as well as help make the transition to senior living as stress free as possible. They will preview communities for you and set up appointments to tour and possibly have lunch or participate in an activity if desired. They will ask pertinent questions and help you select the appropriate community not only for your loved one, but one that works for your entire family.
There are many factors to consider when selecting a senior living community or care home such as: budget, location, proximity to a hospital, nursing staff, caregiver to resident ratio, visiting hours, services offered, amenities, quality of food, etc. Most Referral Agents DO NOT charge you or your family for their services, however, if they place you or your family member, then the community or care home pays the referral agency a commission.
Local agents are familiar with the various options for senior living as well as the management teams, which communities have had good surveys, special rates and/or promotions, etc.
Keep in mind that if you go online to search for senior living, often times you end up caught in the web of one of the large corporate companies. These corporate (national) agencies don't operate the same way as a LOCAL referral/placement agency. Their agents are located across the country and handle an entire region. Their job is to answer your call, ask a few questions and then provide you with a list of options in your city that may or may not be close to your location. In most cases the agent has not set foot inside any of the buildings that they're referring you to. They will provide you with a list of their "Partners", meaning the communities or care homes that pay them for referrals. They dispatch your name, phone number and information about your situation to their partners who will proceed to bombard you with phone calls and/or email communication. These large national companies charge their partners upwards of 90% of the first months' rent for providing a list. The agents don't set up appointments or accompany you on tours.
Using a local referral/placement agency or a national one is up to you. If you desire more personalized service and a partner to act as your advocate, then local is the way to go!