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Occasionally we see people inquiring about how to choose a facility for their loved ones.



Many people on this forum have been through this process. Please share your knowledge on this topic. What factors were most important in your decision?



I found a couple of good articles on the AgingCare website.



One was on Seniors Housing Options for people with Dementia. The other was How to Choose a Long Term Facility: Tips from a Certified Nursing Assistant.

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Some people may feel that it is important to choose a place that is close to their home so they can visit more frequently.
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On a subjective basis for the elder involved it comes down to what is more important to him or her. My brother had a choice of a place with a great swimming pool, gourmet food the residents described as like being on a cruise, and a somewhat less cost at ONE place whereas the second had grounds full of lowers, more activities, better transportation, and a more cottage like living model with 14 residents per cottage arranged around a communal living room on one end and communal game room on the other end, whereas the place with pool and great food had a more hotel like rooms off hallways reached by elevator. So it is up to what matters. My bro no longer did any swimming but loved walking and gathering flowers for the breakfast tables. Then there was visiting, sitting and watching how much staffing, how staff treated people, chatting with people about staff and activities. Then there was looking at the papers. How complete they were in describing costs, whether or not medicaid could be used when funds were gone, what levels of care there were and what costs for them, what raises could be expected, was there choice of medical care through the place, how was transit to appointments, shopping, and so on.
It's a process. I wish you luck.
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cw,

Location plays a huge factor regarding selection of what is available.

I’m glad MJ found a great place.

You brought something to the forefront of my mind, would you place someone further away in order to have a better facility?
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Holy smoke MJ1929, it sounds like you found the holy grail!!!

Only people who live in places with higher population density and have good pensions or money set aside get a chance to comparison shop, those of us that live in rural areas have limited options. And in my part of the world there are wait lists, so the choice is often between the crappy place nobody wants to live in or waiting a couple of years for the nicer one.
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What everyone said; definitely look at a few places.

Something to look for , as much as it is possible, is the kindness of the staff and their turnover rate - or ideally, lack of turnover. I’ve learned that this can supersede other, smaller possible issues.

My mom’s in an MC that is quite small and as a result the levels of cognition are all mixed. This aspect looked awkward to me so I thought I’d move mom to another larger place post-covid. Well, over the covid years I got to see and know the staff and realized that nobody leaves. Like, nobody; the manager’s been there for 15 years, the nurses and activities people and cooks and cleaners..everybody sticks around. They treat the residents really well, they treat each other well, they really care! I’ve learned that kindness begets more kindness and as a result they do the best they can with what they’ve got and are always trying to improve. The residents are really well taken care of. A well-heeled resident of the attached independent living just gave them a grant and now they’re adding more activities for the residents and a few cosmetic improvements. The place is also as neat as a pin. The food is good. I could go on and on but you get the idea.

Caretaking is DIFFICULT and if you’ve found a place with near zero turnover, you’re onto something great. Knowing what I know now I’d prioritize staff morale over other possible issues. That place I was going to move mom? Would look great in a tour, had people separated according to cognitive levels, looked nice and shiny in a brochure…in reality much more problems due to their corporate structure and priorities. The small, tucked away MC was the ticket.

Good luck to you!.
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MJ,

You stated several important reasons why it is necessary to tour places before selecting one.

Thanks!
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I toured multiple memory cares for my mother before choosing one. The first was a place where one of my parents' friends had lived in their AL, but the MC was upstairs only, they had all the residents parked in front of a TV with CNN blasting away, and the head nurse who was giving me the tour was actually making fun of a couple of residents as she took me around -- "She thinks she's helping us at the place where her husband lives, but but she's too far gone to realize she lives here, too. HAHAHA."

Horrifying.

The second place was like a five-star hotel with all the bells and whistles, including a separate room for painting and art projects. However, once again, the residents were all crammed into a very small common area and parked in front of the TV. That one also had a resident who was a developmentally handicapped woman who was much younger than anyone else. Her parents lived in the AL part of the facility, so she was allowed to live in memory care even though that wasn't her issue.

Nope -- strike two.

The final place I toured took me through the entire facility, showed me THE room my mother would have, not an unrealistically furnished one, answered every one of my questions, and treated their residents with the utmost kindness and respect. I was allowed to talk to the caregivers, and I was pleased to find out that the TV was only turned on for thirty minutes after dinner each evening, and that was to show them an old movie -- not regular TV. They also had an enormous common room where all the residents spent the majority of their day, and the higher functioning residents were on one side of the room while the lower functioning ones were on the other side having their activities with the help of more caregivers. They didn't toss everyone in together, which I felt was extremely important for the residents who were still fairly high-functioning.

Families were welcome to visit any time during the day, and the place had two lovely yards where the residents spent time every day. They had new activities every 30-45 minutes, their days were very structured, and they also had music therapy and live musical performances, too.

This facility also held workshops on dementia and Alzheimers for anyone to attend, and they were completely transparent all the time. They were able to take care of my mother, including working with hospice, all the way through to the end.

All in all, I couldn't have asked for a better set-up for my mother, and I think she was as happy there as could be expected.
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Alva,

The place where your brother was sounds lovely.

This is how I felt about the last place that my mom called home. Her ‘end of life’ hospice care home was lovely. She was treated very well.

The hospice nurses and aides treated our entire family very well. I will forever be grateful that mom died peacefully.

I think it’s important for others to know how to select a suitable place for their loved ones. When people are going through a crisis they often feel lost and don’t know how to take the next step.

We were extremely fortunate to have a hospice nurse recommend the place where mom ended up being placed.
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How we were treated BEFORE choosing was important. There were also "needs and wants" to be considered. For instance, one place we looked at had WONDERFUL food, we were told by residents it was like being on vacation or cruise. Had a swimming pool. But the rooms were like hotel rooms. Individual and little sense of community, whereas the one my brother chose was a group of cottages, each housing about 14 seniors, rooms in a cluster around communal room. Very homey and home-like, with groups eating together but not HUGE groups. No pool but ground and while he no longer liked to swim, he loved walking the flower gardens, choosing flower for the tables every morning, and etc. We were well treated, and he had spent time there with his friend who was there, and knew how well treated he was, how well staffed they were. The paperwork we were shown was so complete. What raises to expect and when, whether or not they could go on medicaid after some years (answer was no), what medical was provided. What transportation and activities and what the levels of care were consisting of in cost and in needs they were indicated.
It's a lot. Some people like places like A Place for Mom to take you around to facilities and to see what, given your assets and wants might work best for you. Some don't, and consider them pesky and invasive.
It all comes down to what works best for the person looking for placement. Surely do wish you good luck.
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It can be confusing when we are faced with selecting a place. I appreciate everyone sharing their thoughts and tips on how to proceed.

It’s much easier to move forward armed with knowledge from people who have experience, rather than being blind without any frame of reference.
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Burnt,

Excellent tips!

Most people know that my mom and her older brother suffered with Parkinson’s disease. Mom’s brother lived in New Jersey.

Anyway, my aunt died long before my uncle did. They had five children. My cousins worked full time and my uncle insisted on staying in a large two story house alone. He couldn’t manage going up and down the stairs. He started living in the basement. He got a UTI and sepsis. He nearly died.

My uncle gave my cousins a hard time about going into a facility. He was a sweet man but could be stubborn at times. I think it was fear of the unknown about going into a facility that caused him to be so reluctant. My cousins didn’t give up. They knew that he needed full time care. Eventually, he came around and went peacefully.

One of my cousins knew a person that did caregiving. She told my cousin to look for a place that none of the staff were standing in the halls and constantly chit chatting. She also said all of the same things that you have pointed out.

My cousin took to heart what this woman told her and she found a suitable place for her dad. My uncle adjusted and lived to be 96 in his facility.

My uncle did receive hospice care just like my mom did during the final stages of Parkinson’s disease.
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Always look at the what the help looks like who staffs it. Talk to family members of residents who live in a place. They will give you a good idea about it.
Does the place appear clean? Does it smell? How do the residents look? Do they look clean and reasonably well cared for?
If you're putting someone in memory care located in a facility that offers other types of residential care as well, go and have a look at the memory care floor.
Most care facilities have very nice lobbies or common areas and they are no indicator of the quality of care a place gives its residents.
Never pay any mind to what the reviews are about a place. Nursing homes and memory care pay writers and publications to say good words about them. You go see for yourself.
Are residents enjoying activities that you can see? What does the food look like? Have a meal there.
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ArtistDaughter,

Both of the places that you chose sound lovely. I am sure that they provided comfort to your mom.

They sound very similar to the ‘end of life’ hospice homes that my mother and brother were in. These were actual homes as well.

I love that you were able to walk to your mom’s place. I find it so much more relaxing to walk than to drive.
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1. For assisted living I chose the facility my mom had wanted her mother to go to. There wasn't an opening then, but when my mom needed a place, I saw a sign out front that they had openings and I jumped on it. It was in my neighborhood. I could walk over every day to visit. It was very small with only 10 residents and in an old Victorian house with a front porch.
2. When she had to go to memory care during covid lockdown I looked for something similar. I found a place in another city. Her room had a large window for her to look out. It wasn't a porch like she'd had at her own house or the assisted living, but she could watch people walking dogs and wave to them. It was in a neighborhood setting.
3. When she needed skilled nursing, the most important things were to get her back close to me so I could visit every day again and where I thought she'd have good care. I eventually hated that place, but they all seemed very similar. Not enough staff.
4. I got a call from a place I had visited years before, also in my neighborhood, where there was finally an opening. They offered memory care and end of life care in their home. They had only one other resident to 3 caregivers, 1 of them a nurse. I put her on Hospice and moved her.

I was choosing for her comfort first, where she'd feel she was at home and not in an institution. Until skilled nursing she had adjusted well.
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FF,

Leave it to a man to make a decision due to food ! That’s so funny.

I love that facilities offer lunch to prospective residents. People do make connections with common interests such as food.

I do think people bond over food and music as well.
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NeedHelpWithMom, for my Dad it was the food. When Dad and I went looking for a senior facility, the place offered us lunch from their regular menu. Dad enjoyed the food so much he wanted to sign on the dotted line right away.

Of course, Dad had to like the apartment, which he did. And he was happy to learn the place had weekly housekeeping/linen service.

Dad also got approval to bring his morning caregiver, after she was vetted. That way Dad had a routine like he had at home.

Then when the time for Dad to move over to Memory Care, the only thing he was worried about was if it was going to be the same chef. It was :)
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Different people have different needs. There are various types of living arrangements for seniors.

There are ‘senior’ apartments for people who don’t have major medical issues. They are affordable for seniors. The rent is usually based upon the income of the residents.

Independent living is also for seniors who are able to care for themselves. Some have the option to move into an assisted living facility or memory care.

They offer shuttle buses to and from the grocery, pharmacy, doctor appointments, etc.

They have chapels for services.

They have an activities director and have schedules posted on bulletin boards for upcoming events.

Some assisted living facilities have units with kitchens but still provide meals served in a dining room or room delivery.

Some facilities have roommate options or private rooms.

What did you find most helpful when choosing a facility for your loved one?
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