There have been many challenges over this past year of my own father’s Glioblastoma brain tumor diagnosis. There are so many different topics to research and learn about when caring for your loved one. Sometimes we are lucky enough to find someone who has done a lot of the research for us and can lead us in the right direction, without re-inventing the wheel.
The struggles are many in this journey with brain cancer, but one of the hardest decisions was seeking out a care facility for my dad when the caregiving job became too much for my mom. We all wanted to do the job, but dad’s needs grew exponentially it seemed between June and September and by the time he was discharged from the University of Washington Rehab Program, here in Seattle, the reality of his needs became very apparent. We were educated about some of these options by the staff at the UW, but it was another specialist in our area that I had been given the name of that really put me on the right path.
Enter Abby Durr, Housing and Care Specialist from Silver Age LLC. Abby knew the area we were interested in quite well on the Eastside of King County. We talked several times on the phone and I gave her detailed information about my dad, his diagnosis, and his current needs. Abby set up an appointment with me to talk further about my dad and his likes, dislikes, and the type of facilities/homes I was interested in. Following our meeting, we toured three very different types of care facilities. I was able to get a first hand look at these facilities/homes and interview the owners/staff. Abby also asked questions and interviewed staff and asked many questions I wouldn’t have thought of.
Abby and I continued to keep in touch regarding my dad’s needs and timeline and eventually we settled in on a choice, an Assisted Living Facility near my home. Abby and I have stayed in touch since Dad has been living in his temporary home and she has come out to visit Dad as well. I spoke with Abby recently about my interest in sharing the importance of making the best choice possible for a loved one who is in need of more care. I asked Abby several questions. The first two of my questions and Abby’s answers are detailed below. I will follow up later this week with Part II of this topic.
1) What do you believe are the most important factors to determine whether a skilled nursing, assisted living, or private home care facility are the right fit for your loved one?
(Abby Durr) There are two parts to this answer.
First, you’ve got to start with careful evaluation of your loved one as a whole person. Look at the assistance your loved one needs through out the day and night and determine the level of skill needed by their caregivers. You also need to gain an understanding of their interests and ability to participate in activities and spiritual and social opportunities. Their financial resources are another major factor. The goal is usually to find a place they can stay long term (unless they are doing a short term stay) so their financial resources, or lack there of, and the care they may need in the future should be carefully considered.
When considering a care provider of any type it is important to evaluate the quality of care they are able to deliver. Staff to resident ratios for each shift, staff credentials and experience and initial training and ongoing training is extremely important. Management/owner credentials and involvement is equally as important if not more important than staff. It all starts at the top. Staff and management longevity can be a good indication of the care and involvement of the owners. Look carefully for signs of burn out. Make sure the staff are up and running before you move in. Steer clear if they say they plan to hire someone specifically for your loved one’s care. The care should already be in place and be proven. This is especially important at the smaller places such as adult family homes.Another important consideration at adult family homes is the quality of the relationships of the family members. If the owners are in a strained marriage the residents will feel the tension in the house.
The financial stability of the place is important. If they are financially strained they are more likely to cut caregiver hours or overwork caregivers with long shifts or too many hours/week.
Talk to residents and family members and look closely at their faces as you tour. Are they smiling and friendly? How do the staff interact with the residents and the staff interact with the staff? Does everyone know each other’s names? Do they seem to enjoy each other? Ask for references and actually call them. Ideally, talk to the family members of residents who lived and died at the facility. After time has passed family members are more likely to be able to reflect honestly and their fear of retaliation is eliminated. Of course there is the DSHS annual inspection results that are important to review and any enforcement letters that may be present on the DSHS website.
2) What are the benefits and drawbacks to each of the above types of facilities?
There is a tremendous amount of variation even within each type. I like to say, when you have seen one assisted living you have seen one assisted living. Even though two places are both considered an assisted living community one may be able to meet your loved one’s needs and another may not.
Nursing homes are typically ideal for short term rehabilitation after a broken bone or an illness such as pneumonia, they are also well suited for folks that need long term care who’s needs can not be met in other settings. Nursing homes can also offer more social and spiritual opportunity than some of the small adult family homes, but it depends on the adult family home. Nursing homes also serve many people with limited financial resources that are not able to stay in other settings. Assisted Living communities are best for those who desire a little more space for their belongings and can safely spend up to 2 hours or more unsupervised in their apartments. If someone cannot be left unsupervised assisted living is probably not their safest option. In my experience the average caregiver to resident ratio in an assisted living community is 1:16. Out of the sixteen that each caregiver is responsible for not all will need help, but even if 10 of the 16 residents need some level of assistance that caregiver will be running like the wind to try to follow the care plans of those 10 residents. In memory care communities the ratios can be closer to 1:7 but even 7 is challenging for one caregiver to manage well. I have worked as a certified nursing assistant in both settings and know the challenge well. Assisted living is perfect for those who are aware of their needs and can use a call button and wait for help to arrive. Assisted Living is not best for those who are at a high risk of falling. Adult Family Homes are sometimes the best environment for someone who is at high risk of falling or who requires constant supervision or attention. Many use motion sensors and pad alarms that most Assisted Living communities do not use). But when you have seen one adult family home you have seen one adult family home. Each home has a unique set of caregivers with varied experience, training, policies and family values.
Abby Durr, CSA
Housing and Care Specialist
Silver Age LLC
1693 NE Juneberry ST
Issaquah, WA 98029
I’d like to thank Abby for her time in answering my questions and for her dedication to not only her clients but to their entire families, in making this difficult decision along our journey, just a little bit easier. We felt more confident in our decision for my dad because of the research and background she had done on each place we had considered. It’s a very emotional decision for all involved and having an expert in this field is a valuable resource.