Searching for Assisted Living? Be in the Know!


Your mother can no longer live safely and independently in her own home, and you are searching for a suitable residence for her.  (Or, this might be the case of your father, grandparent, other relative or friend.)  Although she is basically in good health, she is frail and will need some assistance with getting bathed and dressed each day.  Someone will have to give your mother her medications, because her short-term memory has deteriorated to the point that she cannot remember to take them on her own.  Similarly, she will need meals to be prepared for her and someone to summon her when it is time to eat.

In Virginia, entities called "assisted living facilities" provide the types of "assisted living" services described above.  Licensed by the Virginia Department of Social Services (DSS), an assisted living facilities defined in the regulations as "any place, establishment or institution, public or private, operated for the maintenance or care of four or more adults who are aged, infirm, or disabled...."

The Long-Term Care Ombudsman Program often receives calls from families who want to know what types of questions they should ask when in the market for an assisted living facility.  Some helpful checklists have been developed which address features such as the safety, cleanliness, and layout of the building; the activities available; and respect for residents' rights.  The Long-Term Care Ombudsmen want to suggest some additional important questions to ask.  The following stem from our experience with people living in adult care residences.


Staffing

  1. What are the direct care staffing ratios on each shift, i.e., 7 a.m. to 3 p.m.; 3 to 11 p.m.; and 11 p.m. to 7 a.m.?
  2. If specialized services are offered, such as an Alzheimer's Unit, does the staff receive additional specialized training?
  3. Is there a licensed nurse on staff?  What days and hours does this nurse work?  (Assisted living facility regulations do not require any licensed personnel to be on staff.  However, most facilities do have a Licensed Practical Nurse or a Registered Nurse on duty for the daytime shift.)  Who does the staff consult regarding medical questions when the nurse is not on duty?  What does the staff do in a medical emergency when no nurse is on duty?


Accountability/Monitoring

  1. If my loved one needs personal care assistance such as medication administration or bathing, what assurance will I have that these services are being provided to him or her?  (For example, does staff keep documentation of any "special" service provided for which the resident is charged extra?)
  2. Who oversees the medication administration?  Will my loved one get reimbursed or be credited for unconsumed medications?
  3. If a resident has dementia and refuses medication, how is this handled?  Will the staff attempt to give the medicine a second time?  Is the doctor or family notified if the resident's refusal is ongoing?  What becomes of the medication?
  4. Whose role is it to note changes in a resident's condition and report them to the doctor?



Protection and Accommodations for the Cognitively Impaired

  1. Is the environment safe for cognitively impaired residents?  If my loved one now has or develops the tendency to wander or the need to take outdoor walks, can the home accommodate him/her?
    • Find out if windows have safety locks.  (This is particularly important if demented individuals live on the second floor or higher.)
    • Learn the locations of exit doors in the home and whether they are alarmed or monitored.  Observe where the exits lead--onto a busy road or a grassy expanse of yard, fenced or not, for example.


Payment Issues
  1. How are decisions made about changes in the level of care provided to the resident?  Can the resident or family contest this?
  2. Does the home accept auxiliary grant payments?  Auxiliary grants are state and local public assistance funds paid to the home to supplement a resident's limited income.  One can apply for a grant through the local Department of Social Services (DSS) and must meet certain income and resource criteria.  The home must accept the auxiliary grant and resident's contribution as payment in full.  Unfortunately, auxiliary grant beds are in short supply in Northern Virginia.

Room Assignment
  1. How big are the private and semiprivate rooms?  The DSS stipulates a minimum amount of square feet per person per room.
    • Consider how many of your loved one's personal furnishings will reasonably fit into the room.
  2. Are certain rooms reserved for residents who are paying under an auxiliary grant or other reduced rate?
    • Be certain to view that exact room before signing any contract.

 

Remember, when you are looking for a long-term care residence for your loved one, there is no such thing as a "dumb questions!"  Be certain that you understand all of the contract's terms, as well as what the home promises to do and what the home expects the family to do.  We highly encourage you to "shop around" by visiting more than one assisted living facility, so that you can make comparisons.

Should you desire a basic checklist (described above), or have any questions, please feel free to call the Ombudsman Program!


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