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Choosing a private Residence (Part 3/3 on Alzheimer's care)

22 February 2008
Bonnie Sandler, S.W., The Senior Times - February 2008

This article is the third of three discussing care for a loved one diagnosed with Alzheimer ’s Disease/Related Disorders, from home care to choosing a care facility

The decision has been made. You’ve chosen to place your loved one in a private residence. Now what?

There are all sorts of guides listing private residences, in which residences are categorized by geographical area, level of care, religious affiliation, amenities, and price range. The Senior Times has an excellent guide listing the amenities and basic information on the residences who advertise with them. But not all residences have the budget to advertise, and they shouldn’t be overlooked.

You hear of a residence that has a reputation for good care from a friend or health-care professional, but upon visiting, you find the facility unappealing. You make some calls and visit a few more places only to find yourself more confused.

Sometimes families are in such distress about immediately placing a loved one that they make hasty decisions only to have to move the individual a second time. For example, language can be a barrier to socialization and communication with staff especially when dementia is involved. Sometimes a residence is chosen based on location but the match is not right.

There are times when a second move is inevitable, even with the best plan. Needs and circumstances change.

The evaluation
A healthcare professional should evaluate the individual to determine the level of care. This could be done through your doctor, hospital, CLSC, or privately. This objective evaluation should include valuable input from the family and other health professionals, if relevant. The assessment should cover medical and emotional needs, social abilities, religious affiliations, language, family situation and preferences, budget, long term planning and more.

The role of placement counselors
You may have to visit several residences before you choose the best option. How do you choose which ones to visit? You may want to engage the services of a placement counselor, but even this takes research because there has to be a match between the placement counselor and the family. Giving you a long list of possibilities is useless. You need personal attention both for you and for your loved one, someone who takes the time to understand your needs. You might just ask a good friend who can be objective and who knows your loved one, or a friend or relative who is a healthcare professional.

When you visit a large private residence you may meet with a rental agent. Prepare a list of questions and put your detective hat on.

Language and stimulation
If you are told that the residence is bilingual and the split is 50/50, hang around, sit with residents to see what language they speak, and listen to the staff converse.
Check out the activity calendar. Is stimulation provided? Is there a fostering of independence when possible? Is there queuing?
Mingle with the residents. Is your loved one’s range of function similar to theirs? Look at what’s on the shelves: decorative items or tools for activities for the residents?
How are rooms decorated to assist the individual to locate theirs? Are there history/memory boxes for each resident?
A memory box is placed outside the door of the resident’s room and includes items from their lives that will remind them where their rooms are. There could be photos on the door.

Food and flexibility
Visit during mealtime. Is the fruit canned or fresh? Are vegetables served at each meal? Will your loved one’s favorite foods ever be served? How much attention is there to accommodating individual dietary needs and likes and dislikes?
How much flexibility is there in catering to individuals? Is the schedule for bathing flexible? For meal time, are seats assigned? How is medication distributed? What are the rules?

Safety
Is there security? Video cameras? Call bells? Remember that call bells are only good if the resident knows how to use them. Night checks? What is the staff to resident ratio? How many night staff?
You may be told that nursing care is available at all times. What exactly does that mean? There are different levels of nursing care, from RNs to PABs. Find out the specifics. Is there a visiting doctor? How often? How much staff is on duty during each shift? Is a log book kept of changes in habit or changes in behavior for the family to be well-informed?

Assisted living could be defined differently in each facility. Leaving persons with dementia alone in their own apartments in a residence is questionable. It may look like their own home with more security but the reality is that dementia is a progressive disease and further care may be necessary. If no one is monitoring them daily, who will make that decision? They should not be in a crisis situation where they may fall and not know how to call for help, may cause a fire or may wander out of their apartment in a state of confusion. An overnight receptionist in a building of private apartments can not meet the needs of someone with Alzheimer’s Disease.

Making the match isn’t always easy. Plans need to be tailored to each individual.

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Bonnie Sandler

Residential Real Estate Broker, Housing Consultant for Seniors

514 497-3775