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how to chose an eldercare facility?
Old 10-14-2018, 04:12 PM   #1
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how to chose an eldercare facility?

So the time has come to find a place for Dad.
I've had 3 attempts in the past at finding post hospital rehab centers (all part of nursing homes) in the past, 2 for mom and 1 this spring for Dad.
As an engineer, I did all the research/homework I could.

1st place we put mom in 5 years ago was an absolute dud (it's a 4star average google review!). We moved her to PlaceB... it was OK... then.

So I got dad into PlaceB for rehab this past spring and it was a disaster! (it currently has a 2.7star google average review).

Both facilities had been highly recommended by friends who had personally put their parents in both of them.

Google reviews are a joke. Reading the reviews you can spot where the facility directed employees to place 5star reviews - 10 reviews back to back of "the grounds are nice and the food is great".
Any place will have a glowing report next to somebody else's horror story.

I know of the typical "does the place smell bad?" tests when visiting a facility. Seems like every place "shows well" when I visit but its the lowest paid/highest turn over CNA/patient tech/housekeeping staff that determines the quality of care, not the pretty dining room.

You don't find out about staffing shortages and double shifts until you sit with the inmate and listen to the excuses of why it took an hour to respond to a call button.

So... how did YOU research/investigate/chose an eldercare facility??
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Old 10-14-2018, 04:20 PM   #2
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My mother chose her own and that worked out very well for her. I could not have improved on her choice.

For FIL, we did some looking around ourselves, one main criteria being that it would be close to his home so he'd know the area. Ultimately the elder care attorney we were working with informed us of an excellent place that had just opened a new apartment building, cleared out their 8-year waiting list, and still had about a dozen apartments left. We snagged one of those.

Market timing is everything.
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Old 10-14-2018, 05:18 PM   #3
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Sad to say, but the only true way to determine is either by an incredible reference or to try it out. Here are some of the things you can do:

One thing we did when looking for facilities was tasted the food. I think you can really get a good understanding of the quality of facility based on what food they are feeding the residents. One facility had food that I wouldn't feed my dog.

Another thing to note is how many people they have on staff during sleeping hours. Take whatever they say and subtract 1.

Find out how long their nurse and social coordinator have been there.

Good luck. It's not fun, and it's not cheap (my mom is $9771/month), but there ARE good facilities out there. They are just few and far between.
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Old 10-14-2018, 05:28 PM   #4
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A couple of other things. The place my mom is at isn't perfect, but another tremendous part of the facility is the one gal that does housekeeping in each room. That's her only job, and she does it incredibly well. Once/week my mom's room gets a thorough cleaning by this angel.

Also, we have a camera in my mom's room. We have never seen anything that has been concerning in her current facility, but her old facility wouldn't come in and check on their residents throughout the night (as is supposed to be procedure).

Another thing about her current facility is that they have a ton of volunteers that have been there for a long time. If you are looking at a facility that has volunteers, make sure to ask THEM questions. They know better than anyone, and will be honest.

Finally (and trust me on this), the parents with families that are nicest to the staff get WAY better treatment than the others. These people have very difficult jobs. Please be nice to them. It will pay off in spades.
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Old 10-14-2018, 06:10 PM   #5
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Ya, Google or Yelp ratings are useless and sometimes deliberately misleading.

If your state or county regulates these facilities, check for records of violations. Google search for elder abuse lawsuits. Ask a probate atty. in the area about the facility you plan to use.

The place we had dad in was expensive and looks great to the visitor ( one of the Belmont Village facilities). What happens overnight can be a whole different story.

See if the proposed facility will rent you a room for a few days and you stay overnight a few days before putting a relative in a facility. Also do this periodically after placement. It might be a real eye opener . If I had done this , it would have saved my dad from a lot of suffering.
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Old 10-15-2018, 05:15 AM   #6
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Also, we have a camera in my mom's room. We have never seen anything that has been concerning in her current facility, but her old facility wouldn't come in and check on their residents throughout the night (as is supposed to be procedure).

I'm sure the facility would not install a camera for privacy reasons but is there any legal reason the family (especially if they have POA as well as being the legal guardian) could not provide a camera they could use to monitor the room? I seem to recall it was not allowed in some facilities. Everyone in assisted living or nursing home needs an advocate that can monitor their parent and facility to ensure proper care is being provided. This is particularly important if they are in a memory care unit.



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Old 10-15-2018, 05:52 AM   #7
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I'm sure the facility would not install a camera for privacy reasons but is there any legal reason the family (especially if they have POA as well as being the legal guardian) could not provide a camera they could use to monitor the room? I seem to recall it was not allowed in some facilities. Everyone in assisted living or nursing home needs an advocate that can monitor their parent and facility to ensure proper care is being provided. This is particularly important if they are in a memory care unit.
If a provider allowed this, I'd be surprised. You are recording employees and licensed medical providers throughout the day/night. There would legally need to be a sign-off, where the provider gives up expectation of privacy, I'd guess.

With two in-laws (recently passed) in a facility for 7 years, we saw several changes in administration and employees. Moved through all 3 stages of care, and found the following to be helpful. 1) Personal relationship with local administration is a good thing to develop. 2) Regular contact with facility shows your interest, and has good effect on the staff. 3) Show up as much as possible. 4) Listen to your elders and what they have to say.
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Old 10-15-2018, 10:13 AM   #8
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Eldercare covers a lot of ground. Our CCRC has different levels, with accordingly different levels of care.

Independent living 69 units... meals, transportation, community living. Apartments.

Assisted living 49 units... add care for dressing, medications, and some measure of disability. Some mild early onset memory. Not nursing care although it is available.

Bounce-Back 49 units... temporary care, therapy and nursing for shorter periods. Full exercise facilities... Usually a few days to a month or more, for recovery from illnesses, operations, falls or broken bones etc.

Nursing home... 69 units... full 24/7 nursing... registered nurses.

Memory care...60 units Alzheimer's and Dementia.

All of these units are in a continuous string of buildings, and at all times nurses are on duty for care wherever it may be needed in an emergency.

This type of inclusive care is a growing part of more and more senior facilities.

As others have stated, an off hour visit to proposed facilities is a must, but I would go one step further, and arrange to talk with family members of some of the patients.

As to cost... It depends on the amount of care. In our CCRC, from about 30K/yr for independent living (except for personal belongings), covers all meals, TV, internet and basic transportation and use of meeting and therapy facilities.
Nursing home care (the most expensive) ranges between 70K and 80K/yr when I last checked...
.................................................. ............................

Living in a Villa (regular home, part of our complex) we get a chance to know people from all of the different facilities. And.... yes complaints... but not many and usually for things like having to wait an hour for get a manicure. Rarely do we see or hear of serious complaints. That's not to say that there are never problems... but the ones that do happen usually are for good reason like emergency care requiring more staff.
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Old 10-15-2018, 10:20 AM   #9
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If I had to do this now, I absolutely would have a webcam or 2 in the room. Might not be allowed in a semi private room. Might have to post a sign notifying those entering that video monitoring is in place.

Unannounced visits are a good quality assurance tool too.
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Old 10-15-2018, 10:22 AM   #10
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I just noticed some CCRC facilities in my hood, on the outside it’s look like a big apartment building. The only thing I noticed is it’s located in a very busy area with lots of restaurants. Maybe that’s the plus.
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Old 10-15-2018, 10:49 AM   #11
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What level of eldercare are you searching for; skilled nursing or assisted living? My sister and I have recent experience with both. In our area, I'd say that there is one skilled nursing facility to be avoided, and that the others are all relatively equal. The one to avoid is the only one that accepts Medicaid patients. As to the other facilities, I think the advice given earlier about getting to know the staff and visiting often is good. My perspective on the facility where Mom went into hospice really changed for the better after I spent 10 consecutive nights staying in her room.

With respect to assisted living, in our area timing proved to be the issue. We could not find any availability until this year when 3 new assisted living / memory care facilities opened up in our community. Two of them are by the same parent organization and they have a somewhat lower cost structure than what we had locally before. Suffice it to say that competition is a good thing We moved Dad into a private, 2 room apartment in a brand new facility and after a period of adjustment of about a month, he's doing really well. The cost for a 1 BDRM is $3,500. Skilled nursing is roughly twice that in our area.
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Old 10-15-2018, 11:01 AM   #12
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Some good advice above. Online stuff is nearly useless.

If I had to do it again, I would:
- Try to stay overnight a few days. Most places will let you "live" there.
- Failing that, visit a few whole days
- Try the meals. They'll give a few free, and pay for more if you must.
- Do some of their activities.

And... Most importantly... TALK to the residents and ASK THEM.

And not just the residents the management directs you to. Ask around. You may get some frank answers. Of course, this may not be appropriate in a late stage memory unit.

For Dad, we first went with one of the huge national places. It was OK, but not ideal.

For 2x the price, we moved him to an early stage memory care place. A small national chain. Frankly, it was wonderful. The most caring staff ever. We did it on feel. We visited frequently and got to know some of the residents. One resident was so "with it," we finally asked him why he was there. He was there because his wife was in the late stage unit next door, and he lived there to be near her. How precious. He opened way up about what it was like to live in a dementia facility without dementia! Thankfully, he helped us realize we found the absolute best place. I still am so grateful for the CNAs and nurses who cared for dad. Angels on earth.
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Old 10-15-2018, 11:27 AM   #13
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We toured several facilities 3 years ago. Our parents journey through dementia/Alz ended a couple weeks ago. One facility looked great. Brand new. HQ was across the parking lot. I was ready to move in myself.

I read the employee reviews on Glass Door. Very enlightening. Apparently the Director (top of the food chain) was changing out every 3 or 4 months. Big red flag. The unit also was padding charges as they swiped the key card to enter the room.

We found a family owned facility that had Skilled nursing into Memory care. My Brother & SIL visited 2x's a day at meals. I could go once every 2 weeks or so. Mom & Dad were compliant and not combative. So I think all that helped the staff.
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Old 10-15-2018, 11:57 AM   #14
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OP-

Don’t know what state you’re in but, I’d suggest these steps:

1. Search your state’s HHS/equivalent website for inspection records; read them, they are very revealing.

2. Find senior care advocacy organizations in your state (eg: CANHR & CALCRA in Cali) & read their literature/reviews.

3. Study facility’s rules (see 6.D in link below for Cali example).

4. Research facility’s financial soundness (see link).

5. After steps 1-4 above, visit a shortlist to inspect/interview in person as suggested in earlier posts.

This link is specifically for CCRCs but, is very applicable for your search.

CCRC Reference Material/FAQs

Good luck!
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Old 10-15-2018, 12:34 PM   #15
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Hi, I think it's somewhat of a crap shoot. I'd start by talking to friends/neighbors who might have had someone in a facility. As I walked the halls of the one my mom went to, I recognized many, many local (small town) family names on the residents' doors. Have lunch at the place. See what the food's like. See how the residents are treated. See if they are all on drugs to keep them stable (common in memory care units) - most seemed like zombies to me... Part of it will be cost, part may be location. Think about future care needs. Some places will allow residents to 'age in place', but others will kick them out if they need an IV, or some higher level of care. After my mom broke her pelvis, a national chain (Bro_kdale) would not allow bedrails for her bed to keep her from falling out if she tried to get up. She did fall, but fortunately, we had a mat placed on the floor to cushion the fall. Look at how many staff there are, how accessible they are, and how they interact with patients. The two sides of facility where my mom went were very different places (memory care side vs. assisted living side). My mom's facility steered us to their pharmacy, which charged much higher rates for drugs than a regular pharmacy. I would avoid this, and just have the drugs delivered by your regular pharmacy.

Best of luck and best wishes.
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Old 10-15-2018, 12:52 PM   #16
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Here is one of the problems... if it is SNF then they really do not care.... they have a list of activities but never have them... their sole purpose is to drain as much money from insurance as they can...


When my mom went they had her doing her therapy.... but then one day they popped up and told me she was finished... I said she can barely walk, what do you mean... we had to find a memory care quickly... the night before she was going to leave they called as they sent her to the hospital with a dislocated arm!!! Of course it was NOT their fault...



The hospital kept her because her salt level was severely low...



One of my sister is a nurse and knew people who had parents in many of these places... she always told me that NONE were any good, but we have to pick the best of the bad....


When trying to find a memory care it was hard... I talked to or visited about 30ish... only two stood out as good IMO... I was wanting to have her in assisted living, but did put her in memory care since she could barely do anything without assistance... now she has recovered nicely but still has medical problems... I am happy with the place she is at... the workers do not turn over like some places and there are only 16 residents....



Good luck with your search... one last comment though.... all of the ones I talked to had an up front fee of between $1,000 to $5,000 that is not refundable... so you do not want to keep moving them around unless you have too....
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Old 10-15-2018, 01:26 PM   #17
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I'm my brother's guardian after his stroke. He was in a skilled nursing facility (SNF) for 8 months until he was able enough to go home.

After visiting 4 places, I picked the place and it really was nice, BUT! I think no matter how well run or nice it is, you MUST make a pest of yourself! Keep in mind we loved this place and recommend it to others.

Early on, there were a few things that just weren't right. I think overall it's the sort of environment where the less you complain the more they let slide (late to change his clothes, left in bed too long, braces not put on correctly, late meals, laundry not done).

I dropped in every single day to check on him and made sure things went as they should. I was a true PITA, which is very unusual for me, but I was on a mission from God. (calm, polite but firm)

I could tell that there developed a "Ok, we better do this guy right or his brother will be all over us!" attitude. I suspect it's just built into the system. Under staffed they deal with the squeaky wheels and let those who 'just won't know' come last.

Sad but a fact of life.
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Old 10-15-2018, 01:41 PM   #18
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Here is one of the problems... if it is SNF then they really do not care.... they have a list of activities but never have them... their sole purpose is to drain as much money from insurance as they can...
Sorry you had that experience.

That was not the case at my brother's place.

Of course he was young and extremely willing to work at his therapies; I think the therapists liked finally having someone who really wanted to work instead of complaining how they were missing their game shows on TV.

See my other comment above. I think it varies a lot from state to state on how these places are run.

After reading some horror stories like yours I think I just got lucky in my pick.

They had some major screw-ups (like sending him to a hospital alone in an ambulance and not telling me) but the therapy crew was beyond exceptional and that is why we kept him there.
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Old 10-15-2018, 01:46 PM   #19
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I did the following when assessing dementia care facilities for my mom 1. Asked many hospital workers when she was admitted for a fall what they thought of different facilities 2. Asked her memory care team at MGH for recommendations 3.checked the state website for complaints etc 4. When she went for a short stint at one place for rehab, wasn’t good, was readmitted to the hospital - asked them for their recommendations to meet her needs 5. Went to one of the rehabs they recommended and it was great, would have been a good long term care solution but it was 45 minutes to an hour away for us kids 5. Asked them for recommendations

Other than the obvious patient care ratios/how long key staff has worked there/talked to key staff/looking at various web sites for reviews/getting recommendations from A Place for Mom, the process was the above to get her settled in a long term locked dementia care unit that meets her needs and that the entire family is happy with.
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Old 10-15-2018, 07:36 PM   #20
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Sorry you had that experience.

That was not the case at my brother's place.

Of course he was young and extremely willing to work at his therapies; I think the therapists liked finally having someone who really wanted to work instead of complaining how they were missing their game shows on TV.

See my other comment above. I think it varies a lot from state to state on how these places are run.

After reading some horror stories like yours I think I just got lucky in my pick.

They had some major screw-ups (like sending him to a hospital alone in an ambulance and not telling me) but the therapy crew was beyond exceptional and that is why we kept him there.



Oh, my mom did everything asked of her... I was told that a few times by her therapists... they said she never complained or tried to cheat on the moves... it just seemed that the higher ups did what was necessary to tick the boxes and move on...


We had one meeting of all the managers... some kind of required meeting... one of them said there were no wounds on my mom.. my RN sister said "NO"... she had a major wound on one leg... the lady did not want to change it but we insisted...


The person in charge of food said they were giving her milk every meal... my sister said "NO" as the workers just gave her juice... also, the food looked really bad... the manager did not want to change that either...


Once my mom asked to go to the bathroom and the attendant told her to just go in her diaper and she would clean her up... my mom did not want to do that...


There was one time a therapist put down she was not cooperating... but my sister happened to be there so we knew what happened... she was not to put weight on one leg... but the therapist kept telling to to stand on one foot and then walk... well, she did stand on one foot and then started to walk.... he never told her to just use the bars on put weight on that one foot... we complained that the instructions were followed and that if there was a problem to change the instructions as she is doing what was asked....


Another day I went in and they were cleaning up the carpet... seemed she had tried to get to the bathroom and fell and was bleeding on the carpet... BUT, they never told us she fell, never put it in their report that she fell...


RN sister said they do not because that would be reported to the state and they would look worse... so even the info at the state can be very wrong...


OH.. edit to add.... this IS one of the better facilities where I live and this is what we got...
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