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Senior Living

2001-10-01 17:43:00

Alzheimer's and care

Question: My husband is suffering from Alzheimer's. We have been trying to place him in an assisted living facility. Some will talk to us and others will not as they say he will need more care than they can give. We are now wondering whether the assisted living facilities that said 'yes' will be able to provide enough care. Is an assisted living facility going to provide enough care for him throughout his illness or should we be looking into a facility that is specifically for those suffering from Alzheimer's? 

Answer:  Assisted living allows for several levels of care based on an overall assessment of the resident. These levels are based on increasing medical support and can go up or down based on regular assessments. Some assisted living options can provide care for residents with Alzheimer's or other dementia symptoms. Often, they offer special training for employees to meet the needs of dementia residents. It is to the credit of the assisted living providers who advised you that they were not equipped to care for someone with Alzheimer's. Due to the individualized progression of Alzheimer's, and aberrant behavior that often comes in later stages, specialized Alzheimer's care residences were introduced in Kansas in 1986. Since then, the number and types of Alzheimer's residences have grown as more information has become available regarding caring for persons with dementia. Some residences offer an integrated setting where persons with Alzheimer's or other dementia are part of the general population of the retirement community. Other residences use a segregated approach by providing a designated set of apartments for their residents with dementia.Your question indicates you've taken the first step to develop a list of prospective residences in your area. Contact your local Alzheimer's organization, Alzheimer's support group (if you aren't already in a support group), Area Agency on Aging or other senior service organizations to connect with others who have gone through the assisted living residence selection process. From this, you'll develop a good list of top prospects.You should visit each of the prospective residences. There is no substitute for observing how employees interact with residents, the overall maintenance of the residence and the feeling you get when you're there. Good times to visit your prospects are late afternoon, mealtime and when the medical director makes his/her rounds. Late afternoon visits may give you the opportunity to see how staff interacts at a time of day when residents and staff may be a bit fatigued from the day's activities. Meal times will tell you about the way employees interact with residents, especially those who have difficulty feeding themselves. You may also observe the quality of the food being served. Additionally, observe to see if the foods served are appropriate for residents' abilities. That is, if a resident has trouble handling silverware, are they served finger foods to maximize their independence at meal time. Many residences will welcome you to join them for lunch or dinner along with your tour. Ask to eat in the dining room that serves the area in which your loved one will reside. If you're able to arrange your schedule to visit when the medical director is conducting rounds, you may have the opportunity to see how he/she interacts with residents when going through the halls and with the nursing staff.  Plan to make a second visit at a different time of day to those top two or three prospective residences.Your question indicates at this point, you may be mainly making phone inquiries. Asking some of the questions listed below will give you a better overall sense of how a provider approaches care and the provider's ability to furnish appropriate care for a person with Alzheimer's or other dementia.Things to ask an Administrator or Director of Nursing:Ask about licensed nurse staffing during the evening and on weekends. (If there aren't licensed nurses on duty at these times, this may indicate the residence may not be prepared to handle the potential problems such as wandering, that come with Alzheimer's and other dementia.)What kind of training do employees receive? What kind of continuing education do they receive as new information or methods are developed for assisting and supporting dementia residents?What is the staff turnover rate? How often are residents checked during the day?  How are medications monitored?What process is used to identify that a person is progressing into a new level of Alzheimer's in order to address whether care levels need to be changed?Is there a policy addressing residents with behavior problems? Does it include discharging the resident?What is the policy on wandering and how safe is the environment?  Does the environment allow for maximum autonomy and safety? Is there a safe, secure outside area residents can go to during the day when the weather permits? Questions to ask an administrator, marketing or admissions coordinator:What are the costs of care and what is included? Are there additional charges for special services, such as incontinence care, laundry, physical therapy, speech therapy or occupational therapy? What are your options for payment?Are there any limitations on when you can visit your loved one? Can residents bring furnishings from home? Ask to see an activities/events calendar to see the quality and quantity of planned activities for residents. In Kansas, all assisted living providers are licensed. Those providers that also have a health care residence are surveyed regularly. You may want to request a copy of the most recent survey. Free standing assisted living providers are not yet surveyed regularly, but this is being addressed by the state and will someday be available.As you visit each location, you'll be looking for interactions between employees and residents. Look for the level and quality of the interaction with the residents. Do staff appear to care about the residents?  Do the residents appear to be comfortably dressed in such a way as to maintain their dignity? Do people appear happy? Are residents restrained in any way? Does the building appear safe? Do you see cleaning equipment in the hallways where it could be hazardous?  Do you see grab bars and handrails appropriately placed? Does the building look and smell clean? What is the noise level - chaotic or sedate? Your tour should include seeing a typical resident's room. Does it look personalized or institutional? Ask for references you can contact and ask about their experience with the assisted living provider. As you're on tour, does the person who's giving the tour excuse herself to assist with a resident if needed?  Staff should be putting their residents first, but if it's happening constantly along the way, this may indicate a staffing problem.If your loved one is still in a cognitive state where they can participate in the decision, try to take him/her with you. Ask in which location he/she feels most comfortable. If there are other family members who should be part of the decision, be sure to include them either touring with you or in the discussion of the options for your loved one, in this case, your husband.Use your instincts. You know your loved one better than anyone who will care for him. Does the residence "feel" right?  Do you think he will be comfortable here? Do you get a good feeling about the place as a whole?Timing is a consideration. Often, the best care providers have waiting lists. Are you willing to make a decision now as a temporary solution and get on a waiting list for a residence that appears better able to handle later stages of Alzheimer's? You also need to look at costs. Which of your top choices can you afford?Ultimately, you and other family members, if any, need to be comfortable with the residence you select. Asking lots of questions, using first-hand observation, talking with others whose loved ones live in the residences you're considering, and tapping into your own feelings about the residence should enable you to make the best decision for your husband's care throughout the stages of Alzheimer's.