FINDING A SWEET SPOT

             FOR THOSE WHO FACE THE ISSUE OF THE BEST FACILITY FOR YOU AND YOUR LOVED ONE :

            Such a complex issue; much to consider.  The first factor, geography, is likely to reduce the base of candidates to a relatively small set, though some caregivers moved to be close to the selected facility.  In a city like Salt Lake City, there are many candidates.  

            Referral is a valuable starting point.  Talk with medical people you know.  Contact the Alzheimer’s Association and other similar organizations.  Then visit several places, repeating those of interest.  Bring a friend or other relative along, as they are likely to be less emotional about such a move.  

Cost could be the most important consideration.  The “best” choice is otherwise connected to these aspects:

 People, services, programs, and building in that order

            People.  Learn all you can about the staff, both from the report of their administrative staff and from careful observation of some duration.  What is their training and experience?  Ask some of them why they work here and what their training is.  Do they look reasonably happy?  Watch their interaction with dementia patients.  Are they calm, patient and supportive?  Or impatient and irritated?  Do they understand how to interact with the patients?  Does kindness pop out?  Do not overreact to one incident as every facility will have some troubling moments, nearly every day.  It is important that all of the staff have training and experience with dementia—from receptionist to cooks to cleaners—not just CNAs and Nurses.

            And it is useful to know, from a CNA particularly, what their responsibilities are.  How many patients are assigned to them?  What do they manage with each patient?  Eating, toileting, bed time, etc.  Ask them about activities for patients and their training/experience for dealing with problems, such as angry outbursts.  There is no doubt that de-escalation, calmness, and creative lying (see blog) are essential elements of managing these events. Who supervises and trains CNAs and other staff?

            Services.  The essential services center on maintaining health and life. 

Who deals with medical issues?  Who administers drugs?  What physician is often there or available quickly?  There are falls and other medical issues that happen often for the residents.  We have had many!  Are there many residents who are apparently heavily drugged?  The best physicians are skilled at managing difficult patients without suppressing all behavior.

            And closely connected are questions related to the treatment spelled out in your loved one’s Advance Directive for Health Care and the accompanying POLST (Physician Order for Life Sustaining Treatment). The physician and nurses should be well informed about these documents and what they would mean for your loved one in a medical emergency.

            Obviously having clean rooms and all areas of the facility is important.  As is the food service, in terms of cleanliness and quality of meals.  Eat there yourself (post-Covid), as allowed or just observe what the food is and how eating is managed by staff; there are likely to be residents who do not feed themselves any more. 

            Activities. What activities are there for the residents?  Hopefully more than TV or recorded music for most of the day.  There should be interactive events—from singalongs to verbal activities, preferably more than just talking to them.  Do they hire entertainers to come on a regular basis?  What kinds of activities for birthdays?  For holidays?  Are there outings on a regular basis?  Are there some daily physical exercises?  Are there some mentally stimulating activities?  Who is in charge of activities?  In a moderate to large size facility, there should be a full-time director of activities.

Opportunity for family members to be involved with their loved one?  Can the family have a gathering in a room with food, etc.?  How is visiting managed for the main caregiver?  For other family members or friends?  There should be an openness to people visiting. 

            Building.  Last in the priorities, but it should not be neglected.  Cleanliness, of course.  And security too?  Presumably the facility has learned how to prevent escape; also how to monitor visitors to prevent problems coming in from outside.

Very important is the size, openness and nature of the enclosure of residents.  Do they have spaces for walking, if that is possible and important for them?  Are there outdoor spaces available in appropriate weather?  I have visited places where residents were very confined; the locked-in area of the building was quite small.  Beverly would have been unhappy to be in such limited space for most of her time until recently.  Now, she is confined to a wheelchair so she cannot really move, so this is less of an issue.  (Post-Covid) Visitors can now wheel her around the facility, which will be happy for her. 

Your loved one’s condition.  And the nearly imponderable issue that is still fundamental.  What is the functioning of your loved  one who has dementia?  What is the diagnosis?  How advanced is the process?  What are the side effects of the disease, besides memory and confusion?  Among the likely issues are physical violence, extreme sadness, strong anxiety, wandering?  I know of multiple cases where the dementia patient was impossible to manage in one facility, yet was well managed in another, as a result of effective medical and behavioral interventions.  And cases where the dementia patient was so drugged, only to come to life in a different facility.  Of course, sometimes it may be necessary to be heavily drugged.  Ask many different people in every facility how they deal with patients like your loved one.  What can you find out about how the physician and medical team manage these difficulties?  How is the staff trained to deal with aggression or whatever is a fundamental problem for your loved one?  And talk directly to Nurses, Aides, and anyone else.  It will be hard to get truthful, adequate answers, but if you don’t try, you will definitely not know.

Questions to try to find an answer:

            The marketer/administrator tells you a cost.  What are the extras to add on?  Laundry, TV, radio, incontinence pads, etc.

            What is the medical support?  Physician?  Nursing?

            Cleanliness!!!

            Are the residents you see reasonably dressed?

            Do the staff seem to connect to the residents?  With their families?  Does the staff seem to know anything about the residents and families?

            Are there grab rails in bathrooms? Hand rails in halls?

            Are there residents walking in the halls?  And is there enough space for walking?

            Does each resident have a care plan?  And are there regular care conferences for family members?

            Are there plenty of activities in group rooms?  Entertainment, not always TV?

            Is there supervised daily exercise?

            What are the trips by company bus outside of the facility?

            What is the food like?  Food and drink choices?  How are those who cannot feed themselves helped?

            And your senses will inform you a great deal.  The looks, the sounds, and the smells are important—for you and for your loved one.

            And what is your loved one’s diagnosis and functioning, as it fits in with this particular facility?

            Finally, remember that this may be long-term, which relates to cost.  And to the reality that moving to another place is complicated.  Make a wise choice, as it could be years.