Consider these things about an Assisted Living facility

After hearing that I recently moved my own mother to an assisted living facility (ALF), a friend called to ask about my selection criteria. Given the choices in Mom's home town, the shear low number of options helped narrow the list. I was also lucky enough to have a classmate who works for the state and had some suggestions. I added our concerns in italics:

From Rena D, consider these things and your parents needs:
Transportation & Outings for business and pleasure We wanted to make sure that Mom could go and get some assistance without extra fees
Special diet and food preferences Mom has no allergies but should she have special needs these are met with no extra fees
Extra fees for services Some ALF's nickle and dime residents making financial planning impossible. We chose to move Mom to a one-price ALF because she needs so much help; if she were able to do more for herself then a fee-for-service ALF could be less expensive.
Activities, are these scheduled regularly?
Laundry for Mom, laundry is picked up weekly. I had to put her name or initials on EVERYTHING - socks, sheets, pillows, underwear. It's a pain but will ensure I don't have to replace anything. Some ALFs have daily or twice daily pick up for special needs but you must ask for that.
Staffing Ratio; is there a nurse in the building or on call? Mom's has at least one LPN on 8-5 and one on-call evenings and weekends.
What's included in the monthly rent? cable, phone?
Can you keep your own doctor or must you change? I would be very WARRY of any ALF that required a resident to change doctors. Unless there is some special need, the ALF should be able to work with ANY doctor.

One very strong recommendation: ALWAYS seek the opinion of your parents regular doctor before making a decision on a specific facility. Physicians know the conditions of patients and the type of care they get; they also need to have clear and easy communication with the facility. The physician might not be comfortable telling you past experiences but ask if they would move their own parent to a particular facility.

I had some concerns of my own:
Is there a private dining room where the family can gather with Mom?
Can she keep her own pharmacy? What must the pharmacy do to meet the criteria of the assisted living facility? Mom's ALF requires that all her meds are bubble packed and that the pharmacy deliver them. The family is also required to pick up and deliver any one-off medications. At first they told me we'd have to switch but Mom feels some loyalty to her old pharmacist so I asked if they could meet the ALF's requirements and they said yes. The ALF at first told me we MUST use THEIR pharmacy located in a city two hours away. Such a requirement reeks of conflict of interest to me so I pushed back and went with the local store instead. I promised that if it didn't work out after 3 months we could use their pharmacy but if I saw increases in the costs, we'd have to talk.
How easy is it to take Mom on an outing? In Mom's case, it's very easy, I simply sign her out. But she requires no special equipment or wheel chair. If she will be away more than 5 hours, I check with the nurses desk and they'll give me her regular medications so she stays on schedule. They trust that I'll give the meds to her. I don't know what they'd do if she were taking some highly controlled narcotic - that might be something to ask your local ALF since regulations might change from state to state.
Can I spend the night in Mom's room? Given Mom's epilepsy, I know there will be times when she needs me or someone to stay with her, plus, I just want to be able to hang out with her. Her ALF has a roll away bed that visitors can use any time. I can also join her for meals for a small fee.
Can Mom have food or a coffee maker in her room? Mom loves to play hostess and have coffee and treates at 3pm daily so she keeps these in her room. If she can keep up that routine and include some friends, it will feel more like home to her.
Can we join Mom for activities like bingo or concerts: This ALF welcomes family members for most activities. There are a few events where liability and safety are of concern (and thus the insurance company) like fishing where Mom might have to ride in their bus but we can meet them at their destination and join in.

Friendly insights help me be there for mom

One of my oldest friends just completed her Masters in Social Work and has been working as an advocate for some elderly clients. I asked for her advice and here is what she had to say. She knows me well enough to tell me to take time and just listen to Mom; I get so engrossed with my to do list that I neglect to take time to just BE with her and that's what she really wants.

From Gay L, Seattle, WA, April 17, 2009:

Sounds like you tried to do all the right things when you prepared to move your mom. I would just take a guess that part of your mom's pain in back and hips was probably stress which would be normal. It is a huge deal to move elderly from some place they are comfortable with to somewhere they know nothing about. And remember your mom has lived in the same house for many many years. That is hard also. Even if the move is needed. What I learned by visiting with the elderly women I spent time with is this. When they talk about being uncomfortable or scared or depressed don't try to fix it. Listen to them and acknowledge that it must be very hard. They need to talk about it with out somebody telling them why it is important. They know why, but they still feel like they are losing part of who they are. Grieving is a process in this and it is so important they are allowed to grieve.

The other thing I wanted to say was that there are sometimes support groups for people who are taking care of their elderly parents. These groups are for both those whose parents live in the adult children's homes or assisted living homes. Check with some agencies in the area to see if they have one. If not look into starting one. It gives people a place to come and talk about what is going on, the feelings around having to move parents, and everything else between diminishing mental capacity and/or physical difficulties. Your not alone and the care givers need support to deal with the guilt that sometime accompanies the process of doing what is right.
I will comment more later but hang in there and listen to her and acknowledge her feelings. She is scared and it is normal.

The decision is made.....Moving day April 15

I finally made the decision to move Mom to an assisted living facility and even set a date. Now come all of the lists that I need create to get things done and to deal with the emotions that we'll both feel. I have lists for the practical things to prepare and set up her apartment and also lists of the things we might feel and lists of strategies to handle the emotions. I'm not anal retentive or a control freak, it's just how I deal with things. I try to anticipate and then be prepared.

Last evening while gently telling her that the movers will arrive next Wednesday to take most of her things she was concerned about the long term. She's not prone to dramatics but bowed her head, talking and sighing at the same time, "Will I have to be there (big inhale) forever..?" She nearly moaned the word "forever"; it really made my heart heavy. No, I promised. And I mean that. If she hates it, I'll find another solution. I have no idea what that is but I'll find something.

As we get ready for next Wednesday, here is a list of my lists:
- things we need to do at her home so she feels okay leaving it
- things to take to the apartment, sentimental and practical items she needs to feel comfortable
- things to buy for her; that enable her to some things for herself (
- people to notify of the move

Now the questions:
- How does the new facility get her meds and how and when do I pay for it?
- Are they willing to use her existing pharmacy?
- Will they give her snacks with her meds to help her avoid heartburn?
- Can i spend the night in her room if she needs
- How do I make them all understand the symptoms of an approaching seizure?

What does mom need in assisted living?

Watching Mom over the past year, I tried to make note of things that make her happy or seem frustrating. Too often the list is heavy on the latter, but Mom keeps her sense of humor about it. Often she says, " Old age isn't for sissies.." or "It's tough to be gumhla". "Gumhla" is probably not spelled correctly but it's the best I can do. Mom tells me it's Norwegian or Swedish for "old" or "old lady", her grand parents and great aunts used the same term as they creaked about....

By building my list I hoped to capture things that would become helpful or hurtful in an assisted living facility. From these observations I created a list of things to look for in her next home:

• Are hallways long or short? How long must she walk to get around to things she'll enjoy?
• Hallways - narrow or wide? Can she, another resident and an aid pass each other easily with room to spare?
• How many elevators exist in the facility and are the numbers for floors easy to reach?
• Cabinets in the facility - low or high?
• Are individual appliances permitted in apartments or rooms? Coffee makers, refridgerators, microwaves, TVs, Stereos?
• How often do they come around for laundry? How do they keep Mom's things together or ensure they are returned to her?
• Can she go to breakfast in her pajamas? Is there a meal time dress code?
• Can she get her hair done on site?
• Is there a bathtub so she can get help for a nice soak now and then?
• What sort of outings does the facility have? Are there extra charges for these?
  
• How often do entertainers come in to the facility?
• Can I spend the night with Mom once she's moved?
• Can she control the heat in her room by herself?

More safety tips for elderly parents at home

Ah - a few minutes to myself in the afternoon sunshine... So I'll take the time to write a few more things that we've done to make Mom's home safer:

Turn down the water heater: Mom's skin is quite thin and so seems more sensitive to hot, cold, pressure and even rough surfaces. To prevent burns we turned down the hot water heater to 100 degrees. It seems cool to me but she's quite comfortable in the shower; the tub is not an option any longer since she can't get out of it.

Drawers and drawer pulls: We replaced the drawer pulls on Mom's cabinets and bedroom furniture so it's easier for her to open the drawers with swollen bent fingers.

Use easy glide drawers, automatic closing drawers or drawer stops: Innovations in cabinetry make for safer kitchens. See your local home improvement store for these gadgets that make for easier opening and closing.

Sort through drawers and remove heavy items and clutter: Remove heavy clutter and, if possible, move the most used things to the front of drawers. This prevents a situation where a heavy drawer is pulled out to far and falls onto the floor or worse yet, an arthritic foot.

Use rubber shower pads in the shower and out: We got a couple of rubber shower mats - the kind with the little suction cups on the back - and installed one inside the shower stall and on the floor where Mom walks most. This helps her get traction getting into and out of the shower. The mat we found - at KMart - has a sort of beveled edge so that it gradually rises from the floor, suction cups ensure it won't slip.

Use rubber shower pad between a bed and commode or potty chair: The same rubber shower mat mentioned prevents falls when Mom gets up during the night. Placed on the slick hardwood floor right where she steps out of bed to turn and use a commode.

Replace buttons with snaps or velcro: Mom can no longer slip buttons into button holes, arthritis has robbed her fine motor skills. I stitched all the button holes closed, applied large snaps to the garments then stitched the buttons OVER the top of the old button hole so it appears as thought she's wearing her usual button front blouses. Your local one-stop fabric & sewing shop should have tools that help apply snaps so you can save time stitching things together.

Making a safe home for mom

As my mom gets more frail due to osteoporosis and arthritis I've tried to make her home safer to reduce the chance of falls, bumps, bruises and minor mishaps. Her situation is complicated because she uses a walker due to a bum knee, is blind in one eye and has become gradually weaker. As she's aged we make adjustments to enable her to continue to do things for herself; often these are not attractive alterations but it's more important to make her home safe. We hope to help maintain her independence, dignity, self-worth and to help her feel that an aging body is not robbing her of self-control.

These ideas below are in NO WAY meant to be professional full-proof measures but are just a few things we did at my mothers home as adjustments to help her. To avoid getting sued, I suppose I MUST say: Try these things at your own risk. Consider your own knowledge on use of tools and hardware before trying to do it yourself. Don't attempt something you are not familiar with; it's better to pay a professional to do it right the first time rather than have incur more expense and disruption later.

Here is a list of things that my family and I have done around Mom's home:

Remove area rugs. This prevents tripping over folds and eliminates one more thing to clean. Even if the rug remains flat, it can be a trip hazard. Old folks often can't lift their legs high when they walk, they tend to shuffle. That small 1/2" rise is enough to catch a toe or heel and cause a fall.

Be sure cabinet doors close: Open cabinet doors are right at eye or knee level, if they hang open it's one more thing to bump into. Sharp or pointed edges can crack or break a bone if someone falls against it. We installed magnetized gizmo's to hold the doors closed. As mom got older the magnets were too strong and she didn't have strength to open the door so I applied tape to the magnets to weaken their hold; it was enough to keep the door closed yet Mom could still pull it open.

Stabilize appliances: Mom once lost her balance as she pulled the fridge door open; the whole thing began to tip over. Luckily my nephew was there and big enough to catch her with one arm and push the fridge back with the other (he's a 6'5" hunk with strong arms and back). We solved this problem by nailing a 2X4 board across the front of the fridge; my husband drove very long screws through the board and into the toe kick of the cabinets. We painted it to match the cabinetry so it's not ugly. Since many refridgerators are deeper than cabinets this might not work in all situations. Other options we considered were a metal bracket that attached to the side or top of the fridge and then to a stud in the wall or even a strap around the top of the fridge and attached to the wall. The 2X4 was the "least ugly" of these solutions and most acceptable to Mom.

Check other appliances for stability: Wiggle other appliances to judge their stability. Consider the stove or dryer - anything where your elder could hang one, lean or fall on the open door. Front loading washers are not as big a worry since their weight is mainly on the bottom of the appliance which makes it more stable.

Get appliances on the living level: Mom's washer / dryer was in her basement and the stairs were a huge worry for us especially if she tried to carry anything. We converted a linen closet to a laundry closet and moved these up stairs.

Secure other furniture to walls with brackets: cook cases, china cupboards, curio cabinets - anything that might be top heavy and fall over when used as a hand hold. All it takes is a small "L" bracket and a couple of screws. Or, move heavy objects from upper shelves to the bottom shelves.

Get a taller toilet: Often our elders have a hard time getting up from low seats. Given that, the bathroom poses a huge problem. They are alone, exposed and it's often in tight quarters. A taller toilet enables them to more easily raise up from a seated position, installation of a grab bar to pull with their arms can help even further. Other options like a "riser" - a plastic toilet shaped device that fits over the toilet - are possible but these are hard to clean which creates another set of issues. Don't get a toilet that's too tall or they can't get on it in the first place.

Bathroom hand holds: Install grab bars near the toilet, shower or tub. If you notice that they hold on to a towel rod to walk across the bathroom, ensure that it is securely fastened to a stud in the wall; don't trust the little 1/2" screws that come with the towel bars. After we noticed that the towel bar was loose, we replaced it with a real grab bar; it does double duty for towels and to steady Mom.

That's it for now - I have many other tricks and I'll share those as time permits.