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There are many questions and considerations requiring diligent research before selecting either an assisted living or nursing home for your loved one. 

In my book, One Caregiver’s Journey, I describe the lengthy process my cousin and I traveled to find an assisted living facility for our aunt.  She had been evicted from the independent living apartment where she lived for over 20 years because she frequently smoked while she wore her oxygen.  We were given the notice to vacate and a month to find another facility.  She also had advanced macular degeneration and was losing her sight. It was becoming very difficult for her to prepare meals and the stove presented a safety issue.  The absolute first consideration is to ask lots and lots questions at the facilities we visited. We diligently read the fine print in the contract before agreeing to any alternative care.

Our aunt was on Medicaid as well as Medicare, so we turned to her county case administrator for assistance.  We were given a list of facilities to consider and visit. In a two-week period, we visited forty facilities before finally finding one that would be compatible for her social and medical needs.

Some were stand-alone homes where a limited number of residents had an assigned bedroom and shared a communal area like the kitchen and living room. Some were actual facilities with several floors of individual apartments.  

In my book I strongly advise the first consideration is to let your eyes and nose be your guide in the search. 

*If a facility smells of anything other than good food coming out of the kitchen, leave. 

*If there are no smiles on the faces of the facility residents, leave.  The first impression is how are the residents treated and how clean is the facility. And ultimately, if they are happy. 

*Be vigilant if residents are sitting on old, torn furniture in a room with nothing but chairs, a couch, and a blaring television that no one is watching. The tv is their caregiver in those situations.

*Be vigilant of the residents themselves.  You would not want an elderly frail woman in a facility where men with memory issues could potentially overpower them.

*You need to ensure that people caring for residents in a home situation are licensed to provide care.

We also toured many traditional assisted living facilities.  Our same principle of eyes and nose was applied equally.  Many were no better than the houses. We discovered that additional costs were applied to care.  If a nurse had to help with personal toilet care, there was an additional charge of $.50 every time they helped pull up someone’s pants after using a restroom.  There was an additional charge if they made the resident’s bed. These services are added to the base rate and charged to the resident monthly and the cost of care quickly accelerates. Family members who are listed as being responsible also get a copy of the bill. We have no control over how many times someone uses the bathroom in any given day – this additional charge structure is a red flag scam.  You expect your loved one to receive the care you agreed to when the contract was signed.

The county administrator called and said she had been made aware of a vacancy in a new facility. We made an appointment and were met by the facility administrator who was open to all of our questions. We settled on this relatively new facility operated by a religious organization.  Our aunt was able to attend daily Mass each day before going to breakfast.  She soon realized that she had common acquaintances with other residents and quickly formed a social circle. The facility had a large outdoor common area where residents could sit and watch the male residents as they tended a garden. The nursing staffing pattern was fairly consistent all week.  Most facilities have skeleton nursing shifts on weekends.  Her room was comfortable. We were able to move in her bed, dresser, two chairs, a table and her television. There was a large bathroom and small kitchenette with a microwave and refrigerator. There was no additional charge if she wanted to eat three meals in the dining room. For the time she was there we never had any questions about her safety and were permitted to visit whenever we chose to do so.  Eventually her health declined, and she required more skilled nursing care.  The subsequent facility was chosen with the same diligence and recommendation from her assisted living facility.  She passed away a month after being in the nursing home.

I am often asked why I chose to care for my mother for ten years in my home. She did not have the medical issues of her sister. My brother and I were always aware that she might not be able to stay with me.  She passed away in her bed in my home at the age of 102.  When faced with the idea of placing her in a facility the reality was that I would spend the bulk of my days with her since she did not trust strangers and did not like being alone.  But I had been trained to provide care and experience in what was required to choose the right facility should that have arisen.

Pick up a copy of One Caregiver’s Journey at Amazon, Barnes and Noble or most online retailers. It was written over ten years and is a journal of the realities of the changes and challenges of being a caregiver.

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