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ALF's and what type to choose
Posted: Sunday, February 28, 2016 1:48 PM
Joined: 2/1/2016
Posts: 16

Looked at 3 ALF's this week...trying to get my ducks in a row before the need becomes an emergency.  Went to one that has wander guards in place but felt like my Mom was not ready for a place like that, kind of gave me a sick feeling when I was there.  Went to another that was a SNF (which was full up right now) and again it didn't quite feel right for her right now.  Went to one that knocked my socks off (like I would move in there myself right now!) but they don't have any wander guard in place and I worry that if my Mom started wandering I'd have to place her somewhere else. I've heard it's really bad to move them from one place to another.  Any advice???


Thanx in advance....

Posted: Sunday, February 28, 2016 2:39 PM
Joined: 9/26/2012
Posts: 560

Short answer: keep looking

We looked first at the geographic limits of how far we were willing to travel regularly, and which hospitals/doctors they would have in that area.

We had both parents, so looking for a situation that suited both was a priority

I would be sure that the care level they have matches your LOs current needs and 1-2 years future need. We found an ALF with a memory care unit that suited both of my parents and was close to our home and workplaces. They do not have skilled nursing so when my dad needed that level of care, we had to move him. I am still happy with the level of care for mom.  She was able to have stability, they have good dementia training and a stable work force. It is secure (codes on doors and alarms), and has about 30 residents.  She is able to have a homey room with some of her furniture and favorite knick knacks.

If you are looking at regular ALF for someone with dementia, I would only consider someplace with a memory unit when the inevitable downturn happens.  Just moving to a new place might be enough disruption that regular ALF will not work out.

Good luck on your search.

Stephanie Z
Posted: Sunday, February 28, 2016 4:37 PM
Joined: 12/15/2011
Posts: 4218

Hi Turtlebug,

     sewingmom is right. Keep looking. Just one caution though, be careful of the facilities that "knock your sox off". Many spend a lot of money to look almost like hotels to impress family members, but the staffing levels can be poor with high turnover and little training. Here is some information about find a facility:

Finding a Memory Care Unit:

When you start to look at nursing homes or ALFs, begin with a call to your local AD chapter and get a list in your area.

You can also go to: Guide to retirement living where you will get free information on nursing homes in your area.

Then go to the government site called Nursing Home Compare and get the results of their last surveys so you can get some idea of the quality of their care.

 You can also do a search to see if your state has a site on Assisted Living Compare. Some states do.

When you select some, do a search along with the word lawsuit to see if there are or were any significant problems that crop up.

Do select at least 3 to look at. DO NOT expect nursing homes to look like  ALFs. The decor will be less attractive, but in a good nursing home with a dementia unit, can provide excellent dementia care along with meeting any physical care needs.

Once you have picked one, you will want to visit at least 3 times. Once during meals to see what the residents are eating (see if you can eat there as well), once on the evening shift, and once during activities to see how many people attend or have other things of interest available to do.                      

Questions to ask a nursing home. (From the Florida Agency for Health Care Administration 

  • When was the facility last inspected?
  • What deficiencies were cited, if any? Ask to see the last inspection report.
  • How many residents does a nurse care for during a day, evening, or night shift?
  • How many residents does a nurse's aide care for during a day, evening, or night shift?
  • What arrangement does the facility have for medical services such as doctor visits and specialized equipment and therapies?
  • What transportation arrangements does the facility have for the residents?
  • What special training does the staff have?
  • What are the policies for deposits, refunds, and bed holds?
  • How does the nursing home safeguard against loss of residents' personal belongings?
  • How much advance notice does the facility provide before increasing charges for regular or additional services?
  • What types of activities are included in the facility's social program? Ask to see the activity calendar.
  • Does the nursing home have a program to limit the use of physical restraints?
  • What are the designated visiting hours? Can exceptions be made for special needs?
  • When and how often the facility performs assessments for attaining Information regarding the resident, including information for the Minimum Data Set (MDS)?
  • What are the procedures for Preadmission Screening and Resident Review (PASRR)        
  •  Hope this helps,
  • Stephanie Z


Posted: Sunday, February 28, 2016 5:12 PM
Joined: 5/7/2014
Posts: 270

Yes choose carefully.  After a few months we learned the ALF we selected for my MIL could not meet her needs.  She was not ready for their memory care section, but they are incapable of seeing or meeting her needs at this intermediate stage.  Shortly after moving in she began refusing to allow housekeeping in.  They allowed her to refuse and when we visited we found a very dirty apartment. She only goes down for the evening meal and does not participate in any of activities offered.  We are now in the process of moving her to a facility that serves only Alzheimer's clients and understands their needs.  Repeated meetings with the staff have resulted in no changes.  My MIL's current facility looks like a beautiful hotel, but that is the best thing I can say about it. They made a lot of promises to us before she moved in, but they can not or will not provide the care they advertise.
Mimi S.
Posted: Sunday, February 28, 2016 6:53 PM
Joined: 11/29/2011
Posts: 7036

Look for an Assisted Living with on on-site memory unit. Many provide, at an additional charge, those in between services that might be needed until she needs most of the services in the locked unit.

Do visit several times, some of those unannounced. Get a list of programs offered..once or twice, plan to stay for a few hours and just sit in a corner and watch. Is there a patient advocate? Speak with that person.

Do check state agency. How many reports, serious? What was done? Caregiving veterans say: the sooner the better.

King Boo
Posted: Monday, February 29, 2016 7:22 AM
Joined: 1/9/2012
Posts: 3013

I visited over 27 facilities.  They all had a different feel, different care levels for the same title, and different quality of care.

You will have to visit until you find the "best fit" for your loved one, that hopefully has the ability to absorb progressing care needs.  If there is a good facility near you that has Assisted Living, Memory Care and a skilled nursing facility, look long and hard at that.  Care is expensive, and if your LO hits spend down and Medicaid many such facilities, particularly non-profits, will have a benevolence philosophy and take care of your LO even if they have run out of funds.  There are admission criteria often, for a certain number of years of private pay, but you can get a lot of bang for your buck this way, if it is a good care facility.

I HATED what a observed at many fancy, well decorated facilities.  All the money went to impress the family members who were admitting; care was sub optimal sometimes.  Also be aware we tend to over-estimate our LO's abilities; choose for their worst day, and choose for accelerating  care needs.  What is their trigger point for asking a resident to leave for a higher care level?  You don't want to find out that AL only works for 6 months, and you've spent your money below the required minimum needed by a MC/SNF facility.

When moving is unavoidable due to accelerating care needs, it must be done.  My LO moved with little upset and no progression or increased confusion. 

Posted: Monday, February 29, 2016 9:38 AM
Joined: 2/9/2015
Posts: 566

Hi -- I agree with King Boo to start at the low point of your mom's days and also think about what would happen with progression, rapid or slow, before or after the move.

When I started looking my mom was living at home by herself in another state, we were just starting some part time in home care.  I started looking just for knowledge in a very limited geographical area that she was familiar with and had lived in many years.  I felt that if I went beyond that, I might as well move her to my state.  I had local contacts who helped me screen out places by their personal knowledge.  I didn't like what I saw, especially considering that I would still be supervising long distance and there was no family locally, and the one place that might have been a possibility I got some bad information about and it didn't have any continuum of care (no MC unit at all).

I also started looking in my own geographical area.  I looked at a range of places.  The situation was complicated in that mom would have to move directly from home to another state facility. We were actually head towards moving her into independent living with outside caregivers (well-provided for is my mom) when mom took a very precipitous decline and went to 24 hr care in her home for safety -- and was very difficult about that, and then she started obvious behaviors which I now understand are on the wandering spectrum.

We had to move her to MC.  I chose a new place that was very close to my home from an upscale brand which had a very good reputation (through friends), immediate beds, and mom was able to get a two room suite, and they would take her as a direct move.  It was a disaster -- for many reasons.  Mom was moved on an emergency basis to an all dementia facility that I had looked at months before and been shooed away (with support and recommendations) as probably not a good fit.  At the time mom moved there it was the only fit and I was really glad I was already familiar with it.

Now, 8 mos later, I am still looking at facilities, with very good knowledge of what my mom's issues are, but I'm not finding yet a better fit for residential.  I am also looking at skilled nursing as I have time so I know what is out there.

  Her place has locked (combination) neighborhoods with real garden courtyards (not cement pits) and a large common area, also locked to the outside (operated by reception).  They have wanderguard capability but don't use wanderguard because the alarms disturb the residents.  No skilled nursing as defined by my state, but will age residents in place.

You can't have too much knowledge of what is available.  And if you see something you like, seriously consider getting on a waiting list if you think a move is likely in the next year.  Find out if there is a reservation fee, if it is refundable, etc.

Find out what parameters determine if a resident can stay -- where my mom is, with visiting nursing if necessary, she allegedly can stay as long as there is no feeding tube, IV, etc.  In Illinois, if you have more than two ADL indicators (not including dementia) you cannot be in assisted living. 

I found meeting with the Alz Assn social worker (for a very reasonable fee) helpful in making a plan for the long distance move/placement.

Posted: Monday, February 29, 2016 10:36 AM
Joined: 2/1/2016
Posts: 16

Thank you for all of your suggestions and experiences.  I have 3 or 4 more places to look at and plan on doing just that this week.  I guess my difficulty is that my mom is in that intermediate stage so it's hard for me to look forward, not knowing how fast it's going to come.  Hopefully I'll find the right spot.  The ALF that so impressed me is only a year not too many critiques out there.  I'll ask a lot more questions from now on.
Posted: Wednesday, March 2, 2016 10:36 AM
Joined: 2/1/2016
Posts: 16

Looked at another ALF this week, dropped in and saw the lunch procedure.  It has 10 Medicaid beds and so is overseen by the state to a different least that is how they described it to me.  I was impressed that they have an RN on site 24 hours a day, have an aging in place system, have an OT and PT onsite.  It is bigger than I'd like and kind of maze like but they said the have aids wandering up an down the halls constantly and know the look of someone who can't find their way.  They invited me to bring my Mom for lunch and a tour, which we are doing tomorrow.  Am hoping she'll agree to a weeks stay so I can have a small vacation.  She liked the weeks menu and some of the activities scheduled, like bingo, quilting bee, ice cream social etc.  Keep your fingers crossed for me!   Does it sound like I am on the right track???
Posted: Sunday, February 10, 2019 12:10 AM
Joined: 7/16/2018
Posts: 8

Stephanie Z, great info.

Perusing the forums and ran across this. Thanks for posting this back in 2016!

Posted: Sunday, February 10, 2019 9:37 AM
Joined: 12/4/2011
Posts: 17061

What training is mandated. Initially and ongoing. Look at their training program. If they can not show it to you move on.
Posted: Tuesday, February 12, 2019 9:20 AM
Joined: 1/17/2016
Posts: 884

All I saw was February so I thought I was answering someone.  As this was originally posted in 2016, it appears that this person is no longer around.  Hopefully they worked things out.
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