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Email: ghaddock@eztransitions.com

Adult Care Homes – Assisted Living – Memory Care

Which is best for you?

 Adult Foster Homes

Adult Care Homes in Portland (aka Adult Foster Homes) are residential homes which have been licensed and generally provide a private  bedroom, a private or shared bathroom, meals, and care and services for up to five adult residents. The homes are regular homes located in residential neighborhoods. Each home has a single operator who sometimes employs additional caregivers and employees; often the staff are family members. All staff have experience and receive training, but do not necessarily have a specific medical credential. Some homes are operated by registered nurses, physicians, or other medical professionals.

Adult Foster Homes are homelike with common living areas, home cooked meals, interaction with the operator’s family, and the opportunity to socialize with the other residents. A resident’s friends and family may visit regularly. The operator’s children may be present in the home.

Adult Foster Home care typically includes assistance with bathing, dressing, eating, walking, getting out of bed or out of a chair, personal hygiene, using the toilet or incontinence products (such as adult disposable briefs), medication management, and memory or behavior support, such as repeated reminding for a person with dementia, or distraction for someone who is overly focused on a negative thought. Laundry service is provided. Residents typically need to be independent at night, although some homes can provide limited assistance at night, such as assistance to the bathroom, or repositioning someone in bed. Many homes offer assistance for those with mild to moderate dementia.  Some homes have been custom built as Adult Care Homes with widened hallways and doorways, roll in showers, and large living areas which allow for easy wheelchair maneuverability. Others are modest, established single family homes which may have been remodeled to various degrees to accommodate residents’ needs.

Adult Care Homes sometimes allow the person needing care to bring a pet. Smoking may or may not be allowed outside, and if it is, then often in a covered area. In many homes, multiple languages may be spoken, although the operator and other staff are required to be able to speak English. If the person needing care speaks a language other than English, it is often possible to find a home with a care provider and possibly other residents who can speak that language.

Adult Foster Home residents generally do not own or drive a car. If able, they are free to leave the home during the day. Tri Met Lift is a service which provides transportation to persons unable to ride regular public busses due to a disability or disabling health condition.

The majority of Adult Foster Care residents live out the remainder of their lives in the Adult Care Home they have selected. Many homes can provide complex, extensive care because of the training and experience of the providers, and support from visiting nurses. Hospice services can be put in place to support someone who is near the end of life. If 24 hour skilled nursing care is needed, a resident may need to move to a nursing home. You can expect that a significant increase in needs will trigger an increase in the monthly cost of care.

Adult Foster Homes in Oregon  are licensed by County Aging and Disability Services. The Program licenses homes which serve the elderly, younger disabled individuals, persons with Developmental Disabilities, or with Mental Illness.

When should an Adult Care Home be considered?

Adult Foster Home care could be appropriate when any of the below are true for the person needing care.  They may require assistance when they have, or need help with, the following:

Advantages of an Adult Care Home

Adult Care Home Operators and other staff

The Operator, Resident Manager and all other staff of an Adult Care Home must be adults in good physical and mental health. A criminal record check is run on all staff, frequent visitors and regular occupants (not including residents) of Adult Care Homes. Staff who are left alone with residents in the home must be able to read, write, speak, and understand English. The Operator and Resident Manager must be at least 21 years old and have documented experience (varying amounts depending on the position and the classification of the home) providing care to elderly or disabled persons. Other caregivers must be at least 18 years old.

Adult Care Home operators need at least two years of verifiable, full time, hands-on care giving experience in a professional setting, such as an Adult Care Home, Assisted Living Facility, or Nursing Home. Many operators have been in business for several years or more, and have extensive experience meeting a variety of needs. Some operators or another care giver in their home may have a medical credential such as Registered Nurse, Certified Nursing Assistant, or Certified Medical Assistant. In addition to hands-on experience, the Adult Care Home Program requires that the operator complete a variety of trainings and tests before being licensed. These include an English competency test, a 32 hour basic training course, and a qualifying test. Continuing education is required at an average of 14 hours a year.

What does it cost to live in an Adult Care Home?

Adult Care Home residents either pay using their own funds (private pay) or receive assistance in paying a portion of the payment from the Medicaid program (public pay). Private pay rates in adult care homes fall into an average range of $2,000 to $4,000 per month. That rate includes room, meals, services, care and assistance with needs such as dressing, bathing, toileting, eating, walking and getting out of bed or a chair. The rate is established by the individual operator and may be lower or higher than the average range given above. The rate goes up if the operator determines that a resident’s care needs have increased. You will need to discuss the private rate with each individual operator. You will want to look over the private pay contract carefully. Be sure to find out if the operator will allow the person needing care to stay in the home if they run out of funds and need public assistance. (Medicaid). The operator’s policy regarding this should be in the contract. Do not rely on a verbal commitment from the provider; make sure that this provision is spelled out in the contract. It is unpleasant to have to move someone out of a home they are comfortable in because they cannot afford to pay the monthly charges.

What is Medicaid and how does it factor into the financial considerations?

Medicaid is a federal program which apportions money to the State to help pay for care for those who qualify in a variety of care settings, including an Adult Care Home. The person needing care must qualify financially, and must also have their care needs assessed by a Medicaid worker to determine whether those needs are high enough to qualify for the Medicaid program. A screening by phone can help determine whether or not a person needing care should apply for the Medicaid program. You may call the Aging and Disability Services helpline (Social Services) for more information.  (Find your county under “Help Sources”).

Touring the Homes or Facilities

We will typically identify 2-4 homes which appear to match your needs most closely and give you names, addresses and phone numbers. You should call each operator to confirm that they still have a vacancy and make an appointment to see their place (If you need transportation, we can help). Include the person needing care in these visits whenever possible. This decision affects them more than anyone else involved. We will have already described the needs of the person needing care to the operator. When you interview the operator during your home tour, let the operator ask you questions about the person’s needs and answer them to the best of your ability. You may be tempted to conceal unpleasant or embarrassing information regarding the person’s behaviors or habits. You will save everyone involved time and trouble if you include any potentially unattractive information somewhere in that initial conversation. The operator may surprise you by having experience in accommodating that particular need. If you and the provider conclude that it would be an appropriate place for your senior, they will discuss their contract with you.  This, you should read and understand.

Whenever possible, (and sometimes it is not) it may be important for the person needing care to view more than one home, participate in making a choice, and to have the final say in the selection process. Others who are important to the person seeking care need to participate in the selection process as well and “buy off” on the final selection. The more people in that person’s life who support the choice, the more likely the new living situation is to be a success. If the person needing care is having a tough time deciding on a home, ask the operator if it would be possible for the person to come by a second time for a meal, and to visit with the other residents in the home.

Assisted Living

Assisted Living is defined as the new housing and health care alternative combining independence with personal care in a warm, dignified, community setting.

The Assisted Living Federation of America (ALFA) defines an assisted living residence as a special combination of housing, personalized supportive services and health care designed to meet the needs – both scheduled and unscheduled – of those who need help with activities of daily living.

ALFA members subscribe to a 10-point philosophy of care:

Assisted Living currently has more than a million Americans living in an estimated 20,000 assisted living residences. Oregon has many fine assisted living facilities for individuals with very diverse needs, from relatively independent seniors and other adults, to persons with advanced stages of Alzheimer’s Disease and other forms of dementia, developmental disabilities, physical disabilities, mental illnesses, traumatic brain injuries, alcohol and drug addiction, and those in the correctional system.

Assisted living residences can range from a high-rise apartment complex to a family residence to a converted hotel. Residences may be free standing or housed with other residential options, such as independent living or nursing care. Non-profit or for-profit companies may operate them. There is no single blueprint, because consumers’ preferences and needs vary widely. Units may vary in size from one room to a full apartment.

Assisted Living in Oregon is licensed to protect the elderly and set standards of excellence. Most providers and their staff have special training as a result either of state requirements or company policy.

Residences must comply with local building codes and fire safety regulations. ALFA believes the most successful regulations are consumer driven, balancing the safety concerns we all share with the consumers’ desires to retain their independence and freedom of choice.

Assisted Living Services typically provided in assisted living residences include:

Assisted Living Costs vary with the residence, room size, and the types of services needed by the residents. Monthly basic fees can range from $2,000 to $6000 based on the place and amount of care required – generally less than the cost of home health services and nursing home care. A basic assisted living fee may cover all services or there may be additional charges for special services. Most assisted living residences charge month-to-month rates, but a few residences require long-term arrangements.

The cost of Assisted Living is usually paid by the Residents or their families generally from their own financial resources. Depending on the nature of an individual’s health insurance program or long-term care insurance policy, costs may be reimbursed. Federal assistance for assisted living residences has been limited. If financially qualified, residents who receive Supplemental Security Income (SSI) or Medicaid may receive a form of an additional payment from the state under a Medicaid waiver programs to help pay for assisted living services.  There may also be Veterans benefits available.

Memory Care

In 2011, it has been estimated by the Alzheimer’s Association that 5.4 million people have Alzheimer’s Disease and other forms of dementia. Dementia is a multi-faceted disease with no real cause, and unfortunately in most cases, no cure either. The burden of caring for a loved one with dementia often falls on the shoulders of an unpaid, untrained care giver trying to do their best to provide the care needed for the patient and in some cases for themselves.

Is it Dementia?

Forgetfulness is often a normal part of aging. Misplacing reading glasses, forgetting names or having a lot of “senior moments” is nothing more than an annoyance for many aging adults. However, this is not the case of everyone. If your loved one’s forgetfulness is compounded with such things as complications completing mundane tasks, problem solving, understanding spatial relationships or change in mood and behavior then it may be a more serious form of memory impairment. If you suspect that someone you love is suffering from a form of dementia, contact your primary care physician for a screening. Medication is available to help with the symptoms and may slow the progression of the disease.

With the disease becoming more prevalent, many senior living settings are dedicated resources to caring for individuals with poor cognition. From Assisted Living Facilities to Adult Day Care Programs, there are several options to provide safe, secure and nurturing environments for adults with memory impairments.

If you are helping to care for someone with memory deficits this guide is intended to help inform you of the options that may be available for someone with dementia

When is it time for long-term care?

Although many are able to care for someone suffering from Alzheimer’s or other forms of dementia at home, it may come to a point in the disease process that makes home care unmanageable. With the variety of home health services that are available, this may be delayed; but in some instance, placement is warranted. Some questions to consider when deciding if long-term placement is right for your loved one include:

MEMORY CARE SETTINGS

Adult Foster Homes

With only up to 5 people to look after, an Adult Care Home operator with help as needed, can provide close supervision and support. Many dementia care residents plateau with their care needs and can live in the Adult Foster Homes for relatively long periods of time in a happy and caring environment. In fact, often the smaller, homelike environment around them is much easier for them to adapt to rather than larger institutions. Mild, moderate to severe dementia can often be handled very well here. Typically there is a system of security in place. Cost is typically calculated to be a product of the needs of a resident.  If residents become violent or develop various anti-social activities where they might be a danger to themselves or others, then it may be appropriate to seek a full Alzheimer’s care facility.  We have some good ones in the Portland metro area.  Please ask.

Assisted Living Facilities

Assisted Living Facilities (AL) are designed to assist individuals who may need help with their day to day tasks, but do not need the extensive nursing care provided by skilled nursing facilities or nursing homes. Many ALs consist of small, efficiency apartments and some are larger double-occupied rooms.  They are staffed with nursing aides who are able to help in bathing, dressing and grooming and medication management. Facilities also offer structured socialization opportunities. This may also be a good choice for couples who want to remain together but simply cannot care for each other because of health limitations.

For those with mild to moderate dementia, assisted living facilities may be a good choice for individuals with memory impairment without fully relinquishing independence. When choosing an assisted living facility for someone with dementia, be sure to identify some important factors:

Secure Areas: Some assisted living facilities are designed with the mild dementia patient in mind. Entire wings or even buildings may be designated for individuals suffering from memory impairment. They often provide more supervision and security than the rest of the facility. These communities are staffed with caregivers who are accustomed to the impulsivity and poor safety awareness exhibited by many who suffer. The staff is trained in how to respectfully and humanely redirect the resident back to the appropriate activity or location.

Rehabilitation Programs: Many memory centers will also offer programs designed to slow the progression of this degenerative disease or alleviate symptoms associated with dementia like agitation and aggression. Sensory stimulation, cognitive therapies, physical and occupational therapies are all included in these types of programs. There has been a lot of positive research regarding alternative therapies such as music, art therapies which tend to help reduce agitation, although no long term benefits have been identified. Most therapies and programs are performed in group settings which allows for greater supervision of the residents as well as the socialization that is needed.

Cost: Most assisted living facilities are paid for with private funds. The average cost of assisted living varies from state to state and depends upon the service selected by the resident. Medicare does not cover the cost of assisted living facilities and rarely does Medicaid. There may be some state programs or even federal programs, like the Veteran’s Aid and Attendance benefits that can help cover the cost.

Specialized Alzheimer’s Facilities

These facilities have nurses on staff and may actually provide hard-core care when Alzheimer’s gets really difficult.  This is a much improved social environment over the typical Skilled Nursing Facility. Specialized activities and a thorough understanding of safety and needs are usually obvious.  Alzheimer’s Facilities usually have a much higher staff ratio than a typical assisted living and feeding the residents, wheeling them in wheelchairs, full incontinence and other difficult issues can be handled here. Ask us about costs.

Skilled Nursing Facilities

Skilled Nursing Facilities, also known as nursing homes, are often the choice of last resort. Usually, if a person needs permanent placement in a nursing home, the supervisory care needed exceeds that which can be offered elsewhere. Many of these patients are exit-seeking or are more difficult to redirect. Some people with dementia may also develop aggressive behaviors which can pose a threat to themselves or those around them. Others simply are no longer able to perform most or all of their activities of daily living and need a higher level of care.

If you are considering placing a loved one with dementia into a skilled nursing facility, there are several factors to consider, including:

Secured Unit: With exit-seeking behaviors being one of the biggest threats to a patient with dementia, many facilities offer secure units that are kept locked 24/7.These units are generally smaller in nature and are accessed by staff and visitors with authorization. They should be inclusive areas with their living areas, activities and dining all within the secured areas. Some facilities also offer secure courtyards or outside areas in order to give their residents the opportunity to spend time in the fresh air while maintaining their safety.

Day Programming: Many skilled nursing facilities will provide patients with dementia programming throughout the day designed to help keep their minds active, lessening the symptoms of sun downing and hopefully slowing the progression of the disease. If you are considering placement in a skilled nursing facility, be sure to find out if they have structured daily activities for their patients with dementia.

Psychiatry/Psychology Services: Many facilities will have visiting specialists who are trained in caring for the psychological needs of those suffering with dementia. Because dementia and Alzheimer’s is such an individualized disease, it is often trial and error before the right medication regimen is established. It is important to have the advice of specialized caregivers available to help develop and maintain such programs.

Cost: The cost of care in a skilled nursing facility is expensive. Unfortunately, most residents with dementia do not qualify for Medicare or insurance benefits. Medicare guidelines require a 3-midnight hospital stay in order for a benefit period to begin and then patients must meet certain criteria such as a need for intensive nursing care or rehabilitation in order for the federal program to continue paying. Some dementia patients may initially qualify upon admission, but quickly become what is known as custodial care. If a resident is in a skilled nursing facility under custodial care, private funds or medical assistance will most likely be required to pay for outstanding balances.

Skilled Nursing vs. Assisted Living vs. Adult Care Home

The question now becomes, “What does my loved one require”. There is sometimes only a fine line that separates an inappropriate resident from one facility or another. Let us help you.

Here are some questions to consider when deciding on what level of care your loved one may need:

Is 24/7 supervision necessary? Since nursing homes offer 24/7 nursing staff, a resident who requires more supervision may fare better in a nursing home than an assisted living. Remember that residents in an assisted living facility often reside in private apartments where it is more difficult to provide 24-hour supervision.  However, supervision is much better in an Adult Care Home in a home-like environment.

Is the resident easily re-directed? If the resident can be redirected to an appropriate behavior without much effort, an Adult Care Home or an Assisted Living Facility maybe a good choice.

Is the resident able to perform most or all of his/her activities of daily living? If the answer is yes, an Adult Care Home or an Assisted Living may be an ideal setting for someone who can perform daily tasks but suffers from memory impairment.

Is the resident able to communicate his/her wants and needs? Again, if the answer is no, a skilled nursing facility may be a better option. The inability to communicate may threaten the safety of someone living in a private apartment or suite, but everyone is different.  We should talk about it.  Give us a call.

Adult Day Care Programs

In light of the fact that many Americans are trying to “age in place,” adult day programs are becoming more and more popular. These programs provide day care-like settings for adults suffering from many ailments including dementia and Alzheimer’s Disease. These programs are geared for participants who need supervision or socialization while their primary caregiver works, runs errands or just takes a break from their duties. Some programs are accredited by Medicare and Medicaid and can provide the same services as a skilled nursing facility without the overnight stays.

Some skilled nursing facilities that offer dementia programs may also offer day programming opportunities. Usually the program is held within the dedicated dementia unit and participants interact with a facility’s permanent residents.  There are also Adult Day Care places unaffiliated with skilled nursing facilities.

Traumatic Brain Injury Programs

Traumatic Brain Injury centers specialize in the care of patients who have memory deficits as a result of a traumatic injury or stroke. Most of the patients are younger and the onset of the injury was sudden. These facilities are few in number as compared to skilled nursing facilities or assisted livings and stringent criteria must be met for admission. Most of the patients involved in programs are in need of increased safety awareness and help with short-term memory loss. Some of their symptoms, such as poor memory, poor decision-making, impulsivity and disorientation, mimic those of dementia. The hope for many is for some of their cognition to be regained, but the outcomes are individualized and full or even partial recovery may not be possible.

SUMMARY

For all of the options listed above, entering into the setting armed with as much information as possible is the best line of defense. This very well may be the hardest decision you will ever make and touring the facilities will help make an informed decision. When touring any facility or program, here are some questions to consider:

The transition from home to an Adult Foster Home, an assisted living facility or a skilled nursing facility is sometimes difficult. Do not be surprised if your loved one is agitated, confused and persistent about returning home. This is common and will most likely subside as they become acclimated to their surroundings. Speak with the nurse or administrator about visitation guidelines or suggestions during those first few days. You may find that some facilities will ask that you not visit until the resident has had the opportunity to adjust to his/her new surroundings.

Most memory care centers will not only focus on the well-being of the resident, but also that of the family. Be sure to ask if there is a support group that is hosted at the facility or one which they can refer you to. These groups will help ease the guilt and hopelessness that may accompany the transition. If you have questions about the resources available in your area, contact the Alzheimer’s Association.

Choosing a long-term care setting for your loved one may be the most difficult decision you will ever need to make. We have put this together to help you make an informed choice and find the best possible care for someone suffering from memory disorders.  In any case. . . . . .we need to talk.