In March, 2013, I knew that the time was approaching when I would place my wife, Clare, in an Assisted Living Residence (ALR). I did considerable research and chose eight ALRs that I thought would be good choices. Clare and I then went, together, to meet with the admission directors and tour each ALR. I brought along a checklist with questions about ALR daily activities, staffing, meals, etc. That September, Clare was admitted to an ALR.
This past winter, as Clare was becoming increasingly anxious, I had to hire a personal aide in order for her to remain in her ALR. At the same time, I began checking out nursing homes because as her anxieties increased, her active participation in ALR activities decreased. Clare's participation in the ALR's many daily activities was my main reason for keeping Clare in her ALR, but Clare was no longer enjoying many activities or she was too anxious to even remain in the activity room. In addition, personal aide costs, not covered by my long term health care policy, were increasing substantially each month as Clare was requiring more daily personal aide time.
Just as when choosing an ALR, I did my research and met with the admission directors at eight nursing homes. During my tours I also asked questions of charge nurses and other personnel in their dementia units. Following is a list of my questions. Hopefully, this list will be helpful to other caregivers when considering nursing homes for loved ones with Alzheimer's. My first two questions were actually asked on the phone when setting up tours. Answers to one of these two questions caused me to remove several nursing homes from consideration and there was no need to arrange for a tour.
1. Does your facility accept people with Alzheimer's who are still ambulatory? A number of prospective finalists were removed from my list due to responses to this question. Many nursing homes in my area do not have separate lockdown dementia units. As a result, I was told that until Clare was in a wheelchair they would not accept her due to the possibility of her wandering away from their facility.
2. Does your facility accept people with Alzheimer's who have anxiety issues? Most admission directors said it would depend on their evaluation of how serious those anxieties were, but some said they wouldn't accept anyone with moderate or severe anxiety issues.
3. Do any of your patients have or need personal daily aides to assist them with ADLs (Activities of Daily Living) such as toileting, bathing, or dressing? (None of the nursing homes I visited said that Clare would need a personal aide.)
4. Can I see a copy of your activity calendar for this month? Who leads these activities, a recreation aide or a volunteer? Would Clare be able to attend activities in other parts of your facility?
5. How many R.N.s are onsite 24/7 in the dementia unit? How many aides?
6. Are rooms private or semi-private? What is the monthly cost?
7. Do monthly fees increase as patients' needs increase?
8. What are the visiting hours?
9. How many Alzheimer's residents do you have in your unit?
10. Do you have a number of residents under the age of 80? (I asked this question because Clare has early or young onset Alzheimer's and now, even after dealing with this disease for 8 years, she is still only 69.)
11. Is there a waiting list for rooms? If yes, if I placed my name on that list and I passed when the room became available, would my name remain at the top of the list for the next available room or would I go back to the bottom of the list?
12. What would be the reasons, if any, for discharge from your facility?
13. If a patient needs to go to the hospital, what hospital do you use?
14. Do you have a portable x-ray machine on the premises to hopefully avoid some unnecessary trips to the hospital ER? ( Clare has been sent by ambulance to a hospital ER several time in recent years to rule out possible broken bones due to falls. A portable x-ray machine indicating that no bones were broken might have made some of those hospital visits unnecessary.)
15. Do you have a psychiatrist onsite?
16. Does your facility have rooms available for families to have small parties or holiday get-togethers onsite?
I also asked a few other questions that relate to Clare's personal situation. I hope some readers will find this list helpful.
If you would like me to respond to questions or comments about this article, please email me directly at firstname.lastname@example.org. All of my columns on The Huffington Post may be accessed at www.huffingtonpost.com/allan-s-vann. You can learn more about my journey with Alzheimer's and read my articles published in caregiver magazines, medical journals, and in major newspapers at www.allansvann.blogspot.com.
My next blog post will be in 2 weeks. Tentative title ... "An Alzheimer's Spouse Just Not Ready to Move On."