As a caregiver we all dread when our loved one needs more care than we can provide ourselves.  We want our loved one to be able to stay in their home as long as they wish but often a fall, or other serious event makes it clear that additional help and supervision is needed.  Surprisingly,  most caregivers are in denial that this condition will ever occur;  as a result little or no preparation for this day has occurred –  what to do?   How do you evaluate options to give your loved one the best possible care?  What questions should I ask,  who should I talk to before making a decision on what’s best for my loved one

Let’s take the case of Marge,  a  90 year old Sarasota, FL resident whose husband Andy,  had died 3 years earlier.  Marge has her son and daughter who live locally in the Sarasota area,  and a second daughter who lives in the Tampa area who each help her continue living in the home Marge and Andy shared while Andy was still alive.   Marge likes living on her own but lately has become frustrated by forgetting things, then one day she lost her balance in the bathroom, fell to the floor and remained there for 4 hours as she could not get up.  Her children all agreed that she needed to move to an assisted living facility – but which one?  This evaluation needed to be done quickly as they were concerned she might fall again and really needed more support than they could provide since each had full time jobs.  

Here’s the list of questions and actions they used to find Marge the very best place for her to get the care she needed.  Perhaps this can be a foundation for your own evaluation; Marge’s children have a message to all caregivers – do this work  BEFORE  increased level of care is needed so when the time comes,  you’ll have the bulk of the work done and can focus on making a smooth transition

Questions/considerations when evaluating Managed Care facilities:

  1. Geographic location should be jointly made between the caregiver and senior – considerations include: close to children/family, hospital, friends, current doctors, etc.
  2. Based on the condition that the senior has,  if a progressive disease, does the facility have advanced care capabilities?
  3. Take a tour of  facilities that meet your needs – go during the day and show up in the evening –  this gives you a chance to see staff during the day and evening
  4. Ask for a copy of the contract that details all fee’s and rules for the facility
  5. How are the services billed – weekly, monthly, other?
  6. Are any activities prohibited in the Senior’s room?
  7. What is Pet policy? 
  8. Can I bring any furniture to provide familiar surroundings?
  9. Can I continue to see my current physician?
  10. If I have to go to the hospital for extended stay,  what is policy to hold my room?  Costs?
  11. What is facility policy on background checks for staff?   Is there a formal training program /certification program for caregivers?
  12. If higher level of care is required in the future for progressive disease (eg Alzheimer’s) does the facility have capability?
  13. Is there an RN  or other medical professional on staff at all times?
  14. Observe cleanliness of facility, friendliness and helpfulness of staff
  15. Observe the other residents – are they clean, happy?
  16. During your day tour – taste food,  observe social events – are residents engaged or distant?
  17. During your evening visit – evaluate the night staff
  18. Safety features – grab rails in shower/tub,  safety locks on windows, signs for emergency exits and routes, smoke detectors, emergency sprinklers,  working  call buttons.
  19. What is current occupancy rate – lots of available rooms may suggest underlying issues creating turnover

Talking to residents and their families will give you the real “lay of the land”….. try to get time away from your salesman (aka the “tour guide”) to talk to residents.  Remember anyone associated with the facility is attempting to get your loved one’s money and will always put a positive spin on any questions you have.   

Do you have a similar story with your loved one?  Can you add to the checklist above to help others make this difficult decision?  Please share what has worked for you! 


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