Getting back to the information of caring for the elderly.
I thought it would be helpful to clarify the types of facilities that are out there. There are many levels of care. My long term project which, I'm sure someone will beat me to completing, is to make a check list or guide for families to follow when they find themselves in crisis. I can't even count the number of phone calls from people I have received in my career, overwhelmed people, looking for answers not knowing where to begin as their loved ones decline or become confused and wander off and it is no longer safe for them to live independently. The family members are emotionally torn, frustrated, and frightened.
Laws and regulations differ from each state, they also differ from each facility in the state so the information will be broad but hopefully can shed a little light.
First type of living would be an independent living arrangement, like a retirement village. The requirements are people have be over a certain age to qualify. Most are apartment-style, people can come and go as they please. They offer a few services like bus transportation to the grocery store and outings. Some offer meals, maybe 1-2 meals a day. They have become very trendy having on-site gyms and swimming pools. Almost all will have emergency call lights in place in the rooms just as an added bonus of safety. This type of arrangement is perfect for elderly people who want the hassle-free living of not having to take care of a huge home, yard work, snow removal. It is a way to keep the independence of living alone, but with a little more security and piece of mind.
The second type would be the Assisted Living environment.
This type of facility is designed to maintain as much independence as possible for the resident. Assisted living regulations are very minimal. Each facility puts their own policies in place as to how much assistance they are going to provide. There can be no skilled nursing interventions in an assisted living setting. What does that mean? Any person residing at an assisted living facility must be medically stable. Nurses monitor but can not act on situations as they would in a skilled (nursing home) setting. Skilled interventions, such as wound care would require hiring nurses from an outside agency like the Visiting Nurse Association. The basic rule for assisted living is the resident must be able to get themselves to meals and feed themselves. When these tasks can no longer be performed, the resident and their family has the choice to keep them at the assisted living facility and hire outside people to come in to assist them (which is extremely costly) or move them to a higher level of care.
The cost for assisted living varies. Some facilities will charge the resident by how much assistance they are requiring. It goes on a point system. A monthly evaluation is done, usually by the nurse, and scores are added up. The score is then found on a pricing chart. Other assisted livings will charge a set rate. Most assisted livings in the midwest are between $3,000 and $4,000 monthly. Shopping for an assisted living facility would probably be the most challenging as asking the right questions on how much assistance they provide would be tough. Some will deal with issues such as incontinence, diabetes, behavior issues and some will not.
There are assisted living facilities which focus on memory support. They follow the same guidelines as a regular assisted living facilities but they will usually be secure units. With memory support, Alzheimer's disease and the different types of dementia the facilities understand there are certain things that come with those specific needs. Incontinence, behaviors, cueing from staff to perform activities of daily living (ADL's). Memory support units are usually higher in price on the assisted living scale because they offer personalized care and the staff gets specific training in dealing with these residents. It is a more structured environment and activities are focused on keeping the mind stimulated and active.
The last type of facility is the Skilled Nursing Facility (SNF). The "Nursing Home." This type of environment is for when assisted living is no longer suitable. The resident has become medically unstable requiring care that certified nursing assistants and skilled nursing interventions. The CNA's may have to assist in feeding and toileting, the nurses to monitor blood sugar levels or wounds. The SNF is usually the last stop. A sad statement, but true. There are too many reasons to list why someone is admitted to a skilled facility, and I have seen nearly every one.
I have worked in all environments mentioned above, except the independent retirement village. I know they all provide a much needed service. They all have good and bad examples of how things are supposed to be. I've been lucky in my career to have been associated with caring people. People who really strive to provide the best care possible. Reputation is huge in this business. If you are ever to visit, or are ever shopping for placement for a loved one. I tell people to look at certain things.
1) Look at the outside of the facility, is it trashy or not well kept. Good places always keep everything, even the outside in tip top shape.
2) Tour the facility. Take a big wiff...does it smell like urine?? Look at the carpets, any spots or fraying. If the facility smells the residents probably do too.
3) Introduce yourself to staff. Some people find this uncomfortable, but see how you are received. Warm, smiles, handshake? Ask them how long they have worked there and get a feel for their reaction.
4) Watch interaction with staff and residents, are there kind words, smiles, warm touches. Are the residents just sitting staring into space or is staff involved in something, even if it is conversation.
5) Look closely at the residents. Are the men clean-shaven. Look at fingernails...are they clean and trimmed? Are people in clothes that match or is their lunch spilled down the front? Is there bed head ?? (One of my pet peeves BED HEAD!!)
6) Ask a lot of questions. Ask when their last state audit was and the results. Most facilities are listed on web sites with the outcomes of most recent audits. Have a list of your loved ones most important needs and make them explain how they will meet those individual needs.
7) Ask about visiting hours. Every facility I've worked at had an open door policy and family members could come day or night to visit. This should be the case, this is your loved ones home you should be able to visit whenever you like.
We all have a common goal, and we know it's all for our future good.
-Marta Kristen-
Don't encourage such behavior please.
