Families often find themselves shopping for an assisted living in the middle of a family crisis. A loved one is in the hospital and the discharge planners want to place him or her in an assisted living as soon as possible. You have no idea where to start! There are agencies and resources to help you. Alaska's Aging and Disability Resource Center (877-625-2372) can help you find the services your relative needs wherever you live in Alaska. You can also download a list of the homes that the State has licensed at http://dhss.alaska.gov/dhcs/Pages/cl/all/default.aspx. When it comes time to choose a home, however, here are the questions you should ask and the things you should look for.
A. Always choose a home licensed by the state. There are small unlicensed homes, but you have no State agency overseeing the appropriateness of their services or the safety of their facility.
B. Be sure to visit the homes you are considering. Drop in unannounced more than once, preferably at meal time, so you can see what it is like when no one knows you are coming. Pay attention to everything you see, hear and smell. Does the home seem clean, in good repair and odor-free? Do the residents appear relaxed and happy? Are the staff pleasant to the residents and to you? Can the staff communicate effectively with residents? Does the food look nutritious and appetizing? Are residents with dementia encouraged to eat and drink if they forget?
C. Check out the home’s complaint history. You can call the Long Term Care Ombudsman at 800-730-6393 (907-334-4480 in Anchorage) or State Assisted Living Licensing to ask if there have been verified complaints or sanctions against the home.
D. Do talk to the home’s Administrator about the services the home provides and don’t assume anything! Here are some questions you should ask.
- How often is the Administrator in the home? If the Administrator works a full time job or manages four homes, she/he might not be in the home often enough to supervise staff or notice when and if your loved one needs more care.
- How many staff are on each shift? Are there awake staff in the home at night to provide assistance? How often do caregivers check on bed bound residents?
- What kind of training or certification do the caregivers have and how long are their shifts?
- Are there professional nursing services or a pharmacy on site?
- Does the home make medical appointments or arrange for other services?
- Does the home provide transportation or escort residents to medical appointments?
- How does the home ensure that residents’ prescriptions are filled and that residents take their medications?
- How does the home prevent residents with dementia from wandering away?
- Will the home purchase and prepare food consistent with your loved one’s health needs?
- What are the home’s grievance procedures?
- Does the Administrator seem respectful and willing to work with you?
E. Examine the residential services contract and fee schedule. Be sure you understand what is / is not covered in the monthly cost of care. Be sure the home accepts the type of payment (Medicaid, General Relief, or private pay) that your family will be using. If you are planning to pay privately for the cost of care, do not tell the Administrator how much you can afford to spend per month. Under what conditions would the home’s fees change and how would you be notified? Is there a security deposit? What is the home’s refund policy if your relative dies or leaves the home before the month is up? When you come to an agreement, do not pay the home until you have everything in writing.
F. Find out what the bedrooms look like and what you are expected to provide. Are the bed, bedding and towels included in the basic cost of care? Is there ample space to move a wheelchair or a commode in and out of the room? Does the resident have ample privacy in changing and dressing? Is there a chair to sit on? Can you hang pictures on the walls? Is there a call light or bell in place so your relative can summon a caregiver if needed?
G. Guests: Can residents have guests for meals? Are there guest rooms where a visitor might stay overnight? Is there a place in the home where a resident and guest can visit together privately?
H. How safe is the bathroom? Frail seniors are at risk of falling in the bathroom, so look to see if grab bars are installed in the shower or above the bathtub. Are they are securely fastened to the wall? Does the toilet have safety grab bars?
I. Involuntary discharge occurs when homes decide they can’t handle a resident’s changing health needs. Under what circumstances will the home decide they can’t care for your relative? Can they manage residents with dementia who become aggressive or who wander? Do they have enough staff to care for a resident who is completely bed bound and who needs help with transfers? Will they work with you to revise the plan of care (sometimes called an Assisted Living Plan) if your relative’s health needs change?
J. Just to be safe, ask the State Licensing worker if you can see a copy of the last licensing inspection report for the home you are considering. Call Licensing at 907-334-2492.
K. Kindness: The cleanest home in the world can’t make up for brusque, thoughtless caregivers. Do staff seem kind and gentle to residents?
L. Laundry: Does the home do it? Do you do it? Do residents in the home look like they are wearing clean clothes and have good hygiene?
M. Medicaid: If your relative qualifies for a Medicaid waiver, what does the care coordinator have to say about the homes you are considering? What will the home do if your relative no longer qualifies for the Medicaid waiver? If you place your relative in the home, be sure to keep a copy of the Medicaid Plan of Care which lists the services the home has agreed to provide. Hold the home to the Plan of Care.
N. Notification of emergencies: Will the home call you immediately if your relative falls or has a medical emergency?
O. Other residents: Do they appear to be people your relative will like or tolerate? Do any of them wander into other residents’ rooms?
P. Private long term care insurance: Make sure you understand what this covers, what documentation you need to demonstrate your relative qualifies for assisted living care, and who will submit bills.
Q. Quiet time: Many seniors like to take naps or go to bed early. Does the home respect their need for quiet?
R. Roommates: Will your relative have to share a room? How are roommates selected? What does the home do if they don’t get along?
S. Smoking: What is the home’s policy? If your relative smokes, where can he/she smoke and is it safe?
T. Talk to other residents in the home and, if possible, their family members. Do this without staff present so people feel free to speak honestly. How pleased are others with the home’s care?
U. Under no circumstances should you accept promises about the home’s fees and services without getting those promises in writing. The hospital may tell you they want to discharge your relative today, but take your time and be business-like about choosing a home. You will have to give 30 days’ written notice before removing your relative from a home and you will not get a refund if you leave earlier, so it is important to know what you are getting into.
V. Vacations from the home: What is the home’s policy if you want to take your relative home for a few days? Will the home be able to hold the bed? Will your payment source allow this?
W. Watch to see how often caregivers in the home interact with the residents who have dementia. Everyone needs loving words and kind touches. If residents with dementia are ignored because they can’t initiate social interaction, it is not a good sign.
“X, Y and Z” were not included because "A - W" already contains a ton of information to review. Remember that agencies are happy to provide you with information. If your relative is on a Medicaid waiver, the care coordinator should be a great resource. You might want to retain an experienced Family Law attorney to review any paperwork before you sign it. Above all, trust your instincts! If something feels “not right” about a home, chances are you are picking up on a real problem.