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Where Will Mom Live?

Posted Dec 14 2008 10:09pm

During the last couple of days I’ve been staying with a family, spending time with their mother. Throughout this time a lot has been going on and based on my observations, our discussions and their preferences, the family has decided she will be going to a personal care home tomorrow.

Most people talk about independent living, assisted living and nursing home communities and many prefer the bigger institutions for a variety of reasons. For those who don’t, there is another long term living arrangement not often spoken about; my guess is it’s because people don’t have much experience with it. It is the personal care home (defined as an unlicensed assisted living facility of 3 or less residents). Most are more affordable than in-home 24 hour care and most are financially comparable or less expensive than other long-term care arrangements. Just as in any long-term living community, each personal care home is as unique as the owner. A friend of mine owns a few and I was just in one of them the other day.

It was dinner time when I walked in and it felt like I was at my grandmother’s house. I loved the smells of food cooking, hearing the dryer running in the background with that nice laundry smell and the normal sounds of living in a home. The peacefulness felt good.

There are a few unique things about the care in Jonea’s homes. Along with her geriatric experience, she has many years in the hospice world and is a wound care specialist. She also applies her knowledge from the complimentary medical arts, bringing in western and holistic modalities to the symptoms that present during this time (this blending is a growing field called Integrative Medicine ).

What I really love about her homes is a person stays in the same place from the minute they arrive until their death. There is no moving around from facility to facility based on the changing levels of care that are inevitable at the end of life. If they decide to change rooms, the move is a few feet away and the environment stays the same. This is how many personal care homes are, you stay in the same place as you age, what they call ‘age-in-place.’

The quality of care in any of the long term situations is dependent on the organization of the facility, the daily schedule of care, how they are able to tend to each person’s individual needs and from my experience, it is in the quality of the lowest paid and often the most poorly treated employees in the place—the CNA s (certified nursing assistants).

The CNAs spend the most time with each resident. They are the ones that get them up in the morning, tend to their toileting, bathing and grooming needs. They get them dressed for the day, feed them and keep their rooms tidy. They are the ones that are responsible for making sure that a person’s briefs are changed regularly and that the briefs are removed from the room as soon as possible and taken to a utility room. The tenderness and time given to a person is of course dependent on the one who is in direct contact with them. The time the CNA spends on each resident is dependent on the schedule of the day and how many residents are in their care that particular shift.

Another important consideration is the state ratings of facilities; and in my experience, if the ratings are more or less similar; the more valuable information comes from other residents and families. And one of the easiest ways to differentiate places right from the beginning is simply how does the place smell? If you smell urine or feces throughout then turn around and walk out. It is that simple. I don’t care if the place is highly rated, if you smell this it is an obvious indicator that the most basic issues are not being adequately addressed. It is usually because they are understaffed or their ratio of CNA to resident is too high. Know that most CNAs I have worked with take pride in their work and do their best to provide the best quality in care.

Walk where the residents actually live, not just in the beautiful dining and common areas. Watch the CNAs work; observe their attitude. Talk with them and take in how you feel when you are in their presence. Know the turnover rate can be quite high because it is a specialty where people are very much underpaid for the work they do; but go ahead and ask a couple of the CNAs how long they have been working there and if they are treated well. Visit the places where you are seriously considering a couple of times. Whatever consistencies you notice are most likely what it will be like most of the time.

The ratings, the amount of complaints filed with the state, the experience of the residents and families, how a place smells, the energy of the CNAs at each individual location, how fast the medical staff is moving…these are a good place to start in your search for a place for mom.
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