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Happy New Year from Spring Arbor

Joseph Coupal - Thursday, December 28, 2017

Spring Arbor, Richmond, VAHappy New Year from Spring Arbor. We would like to thank our patients, friends, family, and community for allowing our business to be part of your lives in 2017. We wish all of you a wonderful and prosperous 2018!

If we have had the pleasure of being your choice for senior living care, we hope that we provided the highest level of customer service, patient care, and met all of your needs. In the coming months if you find yourself in need of the services we offer, we hope you choose us again in 2018.

It is our sincere wish that in the New Year you are surrounded by warmth, family, and friendship and that 2018 brings you good health and prosperity. From all of us here at Spring Arbor we hope you have a safe and exciting New Year.

“We all come home, or ought to come home, for a short holiday – the longer, the better…” ~ Charles Dickens

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Aging Parents and Holidays: Look For These Red Flags

Joseph Coupal - Monday, December 18, 2017

Spring Arbor, Greensboro, NCVisits with aging parents often are a wake-up call this time of year. Perhaps you haven't seen your loved ones for some time and when you do, it's startling. Aging can be a gradual process for some but for others, the changes accelerate so fast it shocks those who haven't seen them in months.

If you visit your aging loved one, notice these five things. Any one of them is a red flag. It can be a warning to you that help is needed and a serious discussion is mandatory if you want them to stay safe. Don't wait for your loved one to bring up a need for help. Too often, they can't face it and are in denial. Many older people are terrified at the thought of being "put in a home" which they see as a form of imprisonment. Loss of control over their lives is the fear. Those living alone are especially vulnerable as day-to-day, no one is watching. When you see one or more of these signs, it's time to step in.

1. Unusually unkempt appearance. Forgetting to comb one's hair is one thing. By itself, it may not mean much. But dirty clothing, lack of basic hygiene, failure to notice grooming and personal appearance are a deeper problem. If a parent was always fastidious and you see a change, don't dismiss it as unimportant. It is a signal that something has changed.

2. Inability to track the conversation. An aging parent who was, in the past, able to participate in a discussion about current goings on or any more serious subject and now can't keep up or follow what is being said is showing you signs of cognitive decline. There may be several explanations for this, but it is not normal and not "just getting old". Normal aging does not cause us to lose intelligence.

3. Repeating one's self over and over again. Older people start to lose short-term memory when dementia is developing and short term memory loss is a classic sign of cognitive impairment. If your loved one keeps asking the same question you just answered or tells the same story six times an hour, you have a warning that could mean dementia is in process. Your loved one needs a doctor visit to check it out. If you can, accompany your parent so accurate information can be given the the examining doctor.

4. Unsteady on her feet, recent falls. If your loved one seems wobbly on her feet and is holding onto the furniture to get around in the house, you are seeing a big red flag. Falls are unfortunately common among elders and are often the trigger that leads to injury, hospitalization and loss of independence. Perhaps she needs a walker or cane. An evaluation by her physician and a physical therapist can avoid what your aging parent dreads most: losing the ability to be on her own.

For more information on senior living communities for aging parents contact Spring Arbor.

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forbes.com


How to Handle Parents' Signs of Decline

Joseph Coupal - Friday, December 15, 2017

Spring Arbor, Richmond, VA Earlier this week in our blog we gave signs to look for when visiting aging loved ones this holiday season. Today we are addressing how to handle those signs of decline.

The issues explained previously are the four most common signs of age-related decline that long-distance caregivers experience during visits with their loved ones, but there are others to look out for.

While you may want to keep things light during the holiday season, do take this opportunity to address any red flags that you observe. Collect any necessary information while you are in town to avoid added frustration and confusion in the event of a crisis down the road.

The Initial Conversation

First, have a heart-to-heart conversation with your loved one about their present circumstances and both of your concerns. Suggest making an appointment with their primary care physician for a complete health assessment. The results of this evaluation will help you both determine what next steps are necessary to keep your loved one safe, happy and healthy.

Identify Supportive Resources

If possible, pay a visit to the local Area Agency on Aging or department of human services for information on resources and services available in your loved one’s community. It may be difficult to get in touch with these offices around the holidays, but it is still worth reaching out, leaving a message and researching the services they offer.

Sit down with your loved one to create a current list of people they interact with on a regular basis. This list should include friends, neighbors and clergy whom you trust to keep an eye on your loved one and can contact in the event of an emergency. Double check their addresses, telephone numbers and email addresses, and be sure to share your own contact information with them.

Prepare a To-Do List

Now is the time to begin compiling a to-do list to be implemented over a period of future visits. There are three categories to this list: medical, legal and financial.

You’ll want to develop a complete medical record for your loved one, including their health conditions, prescriptions and their doctors’ names and contact information. This is extremely helpful for you to have on file, and your loved one can keep a condensed copy on hand for both routine appointments and medical emergencies.

A financial list should contain all of a loved one’s property ownership, debts, income, expenses, and bank account and credit card information. Should you need to assume control of their finances over the short or long term, this list will help minimize confusion and ensure all their bills are paid on time.

The legal aspect of this to-do list is possibly the most important. There are vital documents that must be obtained to ensure you can access your loved one’s medical information, make health and financial decisions in case they become incapacitated and administer their estate. If they have not already done so, it is crucial for your loved one to meet with an attorney to draw up medical and financial power of attorney documents and a will. You should have access to these documents and other important information, such as their social security number, Medicare information, insurance policies, the deed to their home, and their driver’s license.

These preparations may seem excessive, but it is better to be over-prepared than caught off guard when a loved one’s care needs suddenly increase. Throughout this process, remember to empower them to control their own life as much as possible. You may receive some resistance, but remind your loved one that sharing this information and pursuing supportive resources will enable them to remain independent and safe in their own home and give you added peace of mind as you return home from your holiday visit.

For more information on assisted living for your loved one, contact Spring Arbor.

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agingcare.com


Signs to Look for When Visiting Aging Loved Ones this Holiday Season

Joseph Coupal - Tuesday, December 12, 2017

Spring Arbor, Greensboro, NCOf the estimated 34 million Americans who provide care to older family members, 15% live an hour or more away from their care recipient. This means that a significant number of caregivers rely on regular telephone conversations and check-ins by other closer-living relatives to gauge an aging loved one’s well-being.

Unfortunately, age-related decline can happen quickly, and in many cases, seniors are skilled at concealing new and worsening problems. For many of these families, holiday visits are the only opportunity for them to observe a senior in person, so it’s important to pay close attention to their physical and mental health and their living situation.

During this year’s holiday gatherings, be sure to look for the following warning signs that a loved one may need some extra help at home.

Weight Loss

One of the most obvious signs of mental or physical ill health is weight loss. Possible causes could be cancer, dementia or depression. Seniors may also experience reduced energy, which can make it challenging to shop for and prepare a nutritious meal and clean up afterwards. Furthermore, all this effort can seem especially unnecessary if they live and eat alone. Certain medications and aging in general can also change the way food tastes. If weight loss is evident, talk to your loved one about your concerns and schedule a doctor’s appointment to address the issue.

Changes in Balance and Mobility

Pay close attention to the way your loved one moves and how they walk. A reluctance to walk, changes in gait or obvious pain during movement can be a sign of joint, muscle or neurological problems. If your loved one is unsteady on their feet, they may be at risk of falling, which can cause severe injury or worse. If you notice changes in their mobility and coordination, make an appointment with their doctor to discuss options to keep them safe and mobile, such as pain management, physical therapy and mobility aids.

Emotional Well-Being

Keep an eye out for changes in your loved one’s moods and behavior. You can’t always gauge someone’s emotional state over the telephone, even if you speak daily. Look for signs of depression and anxiety, including withdrawal from social activities, changes in sleep patterns, loss of interest in hobbies, and changes in basic home maintenance and personal hygiene. The latter can be an indicator of dementia or other physical ailments like dehydration, which often happens to elders in the winter months and can be serious. If you notice sudden odd behavior in your loved one, such as confusion or agitation, be sure to seek medical attention. These are common symptoms of a urinary tract infection (UTI), which is prevalent in seniors and easily resolved with antibiotics.

Home Environment

Attention must also be paid to a senior’s surroundings. For instance, if you discover excess clutter and piles of unopened mail while visiting, it indicates a problem. Take a walk-through of their home while you’re visiting to see if they are keeping their house to the usual standards. Be aware that sometimes the signs of trouble are a bit subtler. Scorched cookware could indicate that your loved one forgets food on the stove or in the oven, and an overflowing hamper could mean they don’t have the strength and/or desire to do laundry. Check the expiration dates on their prescriptions and over-the-counter medications and try to determine if they’re taking their medications as prescribed. You know your loved one and their habits best, so go with your gut if something seems off.

Later this week in our blog, we’ll discuss how to Handles Signs of Decline.

For more information on assisted living for your loved one, contact Spring Arbor.

#HowYouLive

agingcare.com


When Your Aging Parent Does Not Want to Move

Joseph Coupal - Monday, December 04, 2017

Spring Arbor - Richmond, VAIt can often be very difficult when a parent in need of care refuses to leave their home. There are no magic strategies or tricks for persuading an aging parent to move, but adult children should ask their parent to "indulge" them by visiting an assisted living facility.

One psychologist says, "most of us are more likely to change our position and lifestyle if such a transformation is of our own choosing.” “Placed under duress to change, we typically resist, regardless of the soundness of the other person's advice."

And when a parent continually refuses to entertain the idea of moving? The child needs to back off for the time being. But don't give up; seek other ways to raise the issue again.

Unfortunately, sometimes things have to get worse to get better. It may take the parent falling, being spooked, or having the electricity turned off because they forgot to pay the bills for the realization to dawn that they can no longer safely reside in their home. Even then, it may take the strong urgings of health care providers and extended family members for the parent to accept the inevitable.

If the parent begins to show signs of warming up to the topic, you need to emphasize the parent's right of self-determination but also urge action. Structure the conversation in the following way:

Tell your parent: 'I can't make decisions about how you should run your life. It would make me feel better, though, if we could go together to look at some possible assisted living facilities so that you're better informed about what choices are available. Would you be willing to humor me in that way?

If there is a willingness on the parent's part to visit an assisted living residence, you should proceed immediately to set up visits at local senior care homes and point out that most of these facilities will allow an aged individual to try living in them for a week or a month before the person has to decide whether to sell his house and stay in the facility or return home. Experts say that can be the extra bit of comfort that can make the difference for many hesitant seniors.

For more information on assisted living homes, contact Spring Arbor.

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APFM


In North Carolina You Can Retire like a Vanderbilt without Spending Like One

Joseph Coupal - Monday, November 27, 2017

Spring Arbor, Greensboro, NCBack in 1895, the breathtaking Blue Ridge Mountains, a comfortable climate and low land prices inspired the Vanderbilts to buy up 125,000 acres of North Carolina wilderness and build the Biltmore House, the largest estate in the U.S. The same factors that attracted this wealthy family continue to make North Carolina popular among retirees and second-home buyers today.

But the Tar Heel State offers a little bit of everything, geographically and culturally. Retirees who prefer to live by the sea can find 300 miles of barrier island beaches, two national seashores and idyllic villages in the state’s eastern region.

North Carolina also has some great college towns, including Chapel Hill, Davidson, and Durham. And dynamic city living can be found in fast-growing Charlotte, which has been undergoing a restaurant renaissance, and the Raleigh-Durham-Chapel Hill-Cary vicinity, dubbed the “Research Triangle” due to its high density of high tech companies.

For anyone on a fixed budget, living costs in North Carolina can be fairly friendly. Overall, the state is 3.7% cheaper than the national average. State income taxes are also to 5.8% flat tax.

For more information on senior living communities in Greensboro, NC contact Spring Arbor.

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marketwatch.com


Holidays With Aging Parents

Joseph Coupal - Monday, November 20, 2017

Spring Arbor, Richmond, VAThe holidays mean different things to different people, but for most of us, they are very much about family. We’re likely to see our aging parents and relatives over the holidays, and if they are lonely, or beginning to have trouble living independently, the holidays can be a difficult and stressful time. If we approach this time with our parents with both a positive and proactive attitude, we can make our visit joyful for all.

The CHEER plan stands for

  • Check
  • Help
  • Empower
  • Enjoy
  • Reminisce

It is a plan that can help you make the most of your time with aging parents and loved ones over the holidays.

1. CHECK on your older loved one’s well-being.

Especially if you haven’t visited in a while. When we see someone every day, we may not notice health changes because they happen gradually. On the other hand, when we visit seniors whom we haven’t seen in a while, it may be starkly obvious that they need help. If you’re visiting your parents in their home, check their refrigerator and pantry to make sure they’re eating fresh, healthy food. Survey the overall safety of their home, assuring that smoke and carbon monoxide alarms have batteries, and that the rooms don’t have fall hazards. Even if you don’t visit your older loved one’s home, you can watch for health issues involving chewing and swallowing, mobility and gait, mental clarity and vision. In a Huffington Post article, A Place for Mom’s CEO, Sean Kell, outlines more advice about how to take stock of a loved one’s health and well-being over the holidays.

2. HELP your loved ones stay engaged.

Seniors who live alone can suffer from depression due to limited mobility in the winter months. Be inclusive and invite older relatives and family friends to your celebration, offering transportation if they need it. Older loved ones may need emotional support during this time. Make sure they are comfortable and not overburdened with preparations. If an older loved one seems lonely, take time to listen. Are they missing family members who have passed away or the way things used to be at holidays of the past?

3. EMPOWER your loved one to live independently.

While helping is important, it’s also important that our older loved ones have the knowledge, support and tools needed to live independently when our visit is over. If you are concerned about your loved one’s safety, teach them skills that help to compensate for deficits. Also make sure there is a local support system for your loved one, and set them up with resources to help them stay safe at home, such as meal delivery services, mobility devices and medical alarms.

4. ENJOY your time together.

After you have ensured that your older loved ones are safe and happy, relax and focus on making the most of the holidays and your time together. Encourage group activities to get your family moving; dance to some favorite tunes or take an evening stroll through the neighborhood to see the lights. By all means be merry, but be mindful that alcohol may dangerously interact with medications.

5. REMINISCE with loved ones.

Many of our fondest memories from childhood and youth are episodes from holidays past. Allow older loved ones to get nostalgic and reminisce over the holidays and about the holidays. Even seniors with advanced memory loss retain long-term memories, and may be able to speak vividly about a Christmas more than 50 years ago. Get out photo albums, family videos and holiday music that bring the past to life for elderly people.

For information on assisted living, contact Spring Arbor.

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aplaceformom.com


Should You Downsize in Retirement

Joseph Coupal - Thursday, November 16, 2017

Spring Arbor, Greensboro, NCOne method for freeing home equity for other uses is to downsize your home as a part of moving. Downsizing could mean either moving to a smaller home, or moving into a similar-sized home in a less expensive community.

The arithmetic is fairly basic. If you’ve paid off your mortgage and live in a $300,000 home, and then sell it and move into a $200,000 home, then $100,000 of your home equity has been freed for other uses.

Another possibility is simply to sell your home and then move to a senior living community. Renting frees up home equity and provides more optionality and flexibility to make more frequent moves before settling down.

When analyzing the decision to rent or buy, you’ll need to consider factors such as the loss of build-up in home equity and its subsequent growth (or loss) and savings on property taxes and other types of home maintenance.

As a part of downsizing, you could consider moving to an assisted living community which may be less expensive because of the amenities offered and provide organized activities and social support.

For more information, contact Spring Arbor.

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Excerpts - Forbes


Choosing Memory Care: A Checklist of What to Look for, What to Ask

Joseph Coupal - Friday, November 10, 2017

Spring Arbor, Richmond, VAChoosing the right residential care facility is hard, and choosing the right memory care facility is even harder.

Here are some questions to ask to help make the decision easier. As with any residential facility, try to visit at least once to get a good sense of what the facility is really like, not just what the facility's advertising says about it.

This checklist supplements the more general assisted living checklist by asking memory-specific questions, so be sure to print out both to take on tours.

The basics:

  • Is the facility able to accommodate people at all levels of dementia, or only at specific levels?
  • Why might a resident be asked to leave the facility?
  • Who assesses residents' health and cognitive functioning? How often is that assessment repeated?
  • Does each resident have a formal, written plan of care?
  • Does the facility help with all ADLs, including bathing, toileting, and eating?

Layout:

  • If the facility is part of an assisted living facility or continuing care retirement community, is the memory care section separate from other areas?
  • Is the memory care area all on one level?
  • Are the residents' rooms private or shared?
  • Is the facility laid out with circular hallways so that residents aren't frustrated by cul-de-sacs?
  • Is there an enclosed, secure outdoor area with walking paths?

Safety:

  • Does the facility feature even, good lighting in hallways and common areas?
  • Does the facility feature nonslip floor surfaces in all rooms, including bathrooms?
  • Is the interior and exterior of the facility secure? What methods are used to keep tabs on residents and make sure they don't wander out of the building or off the grounds?

Orientation and comfort:

  • Are doors and rooms labeled clearly, both with words and pictures, to help residents orient themselves?
  • Do residents have "memory boxes" outside their rooms to help them identify the right room and to help staff members get to know them better?
  • Are the colors used throughout the facility bold and unpatterned?
  • Does the facility feature good natural or faux-natural lighting in residents' rooms and common areas?
  • Is the facility generally pleasant, clean, and peaceful?

Staff members:

  • What kind of dementia-specific training do staff members have?
  • Do staff members seem to know each resident's name, personality, and background?
  • Do staff members seem kind and attentive to residents' needs?
  • What is the staff-to-resident ratio?
    • The ratio should be at least 1 to 7, especially for later-stage dementia.
  • Is there an RN, LVN, or CNA on staff?
  • How do the staff members deal with difficult behaviors, like aggression, mood swings, and sundown syndrome?
  • What is the facility's policy on the use of restraints -- both physical and chemical?

Food, activities, etc.

  • Do residents seem to enjoy the food?
  • How does the facility encourage eating among residents who are uninterested in food -- or how does it encourage residents who tend to overeat not to be unhealthy?
    • Studies have shown that contrasts, like brightly colored plates, can encourage people with dementia to eat more.
  • Will the facility cater to special nutritional needs or requests?
  • Does the facility offer spiritual or religious services that your loved one would enjoy attending?
  • Does the facility allow pets? Does the facility have any of its own pets?
  • What activities are offered to residents? Do they seem like they would engage your loved one?
  • Does the facility offer regular exercise sessions for residents who are physically able to participate?
  • What resources are available to engage residents' long-term memories?

For more information on memory care, contact Spring Arbor.

#HowYouLive

Caring.com


Assisted Living Checklist: What to Look for, What to Ask

Joseph Coupal - Tuesday, November 07, 2017

Spring Arbor, Greensboro, NCHunting for assisted living can be hard. After all, you want to make sure you find the best place for your loved one -- and it also needs to be clean, well run, and within your price range. You need to get a good sense of what each community is really like, not just what its advertising says about it.

Still, the process doesn't have to be intimidating or overwhelming. Here are three simple steps you can follow to help narrow down the choices to the perfect community. First, you'll do research online and by phone. Then, you'll tour to see what each community feels like in person. Finally, for the communities you like best, you'll want to follow up for more in-depth information.

This is a checklist you'll come back to over time. Print one for each community that you're considering. As you learn more, note your observations.

1. Assisted Living Research Checklist

Online Research

Start with online research to find facilities near you or your loved one. Caring.com has a nationwide directory of assisted living communities or you may be able to find facilities listed in the phone book or through word-of-mouth recommendations. The Departments of Health and Human Services for each state are also good resources for finding facilities. These questions can help narrow down the options:

  • Is the location close to shops, doctor's offices, a pharmacy, and other important places? Try some of the features on Google Maps to explore the neighborhood virtually.
  • Is the location convenient for family and friends to visit? Google Maps can help you figure out driving distances to and from the community.
  • If the facility is not in your town, are there hotels nearby for when you visit the area? Use Trip Advisor to search for area hotels.
  • Is the neighborhood generally considered safe, or is there a high crime rate? Crime Reports, Trulia, and Neighborhood Scout have tools to help you evaluate neighborhood safety and crime rate.
  • What are others saying about this provider in Caring.com reviews?
  • Can you find any information about the provider through the Better Business Bureau or your local Area Agency on Aging?

Phone research

The first time you speak to providers on the phone, find out whether they're currently accepting new residents. If not, ask about their waiting lists. It's worth keeping in mind that families often put their names on waiting lists at several facilities, so the list may be shorter than it seems. Don't hesitate to put your name on a list just because the waiting time is significant. You also want to ask questions early on about how expensive the provider is. Pricing for assisted living can vary significantly based on your loved one's needs, so this may not be the time to pin down specific pricing. That said, it is wise to ask general questions to determine whether a provider is way out of your price range.

  • What types of payment are accepted, and/or do they have programs to help residents afford care?
  • If there are any negative online reviews about them, what is their response or explanation?
  • When do they offer tours, and how long do tours last?
  • What will they show you when you tour -- will you have a chance to try the meals or meet with residents?

2. Assisted Living Tour Checklist

Experts say that the most important part of making a decision is listening to your gut instincts. Even beautiful facilities with huge advertising budgets can be cold, dreary places, while older facilities with a little missing paint can be cheerful and happy. Going for a visit -- or several -- can help you determine if the community will be right for your loved one.

Figuring out how to tour is a little more difficult, especially if your loved one is not very mobile or if you live out of town. It may be worthwhile to tour several facilities before bringing your loved one to see the two or three you think might be best. Or ask a friend or family member to tour facilities (and take copious notes and photos).

Geriatric care managers can also help find the best assisted living facilities for older adults -- they often know a great deal about all the care options in their town. Caring.com has a directory of Geriatric Care Managers across the country.)

Before your visit, review your checklist. Underline or circle the questions you care most about. Cross off any that aren't relevant to you.

On the way in

  • Is the neighborhood quiet and pleasant?
  • Is there easy parking outside, including handicapped spaces?
  • If your family member will be bringing a car, is parking provided?
  • Is the building's exterior clean and attractive?
  • Are the grounds attractive, with plants and trees?
  • Is there a safe, enclosed area where residents can walk and socialize?

The greeting

Most tours start in someone's office or in the lobby -- the director of marketing or another staff member will spend time talking to you about the community in general. He or she should be asking you questions about your needs and what you want to see, so the tour can be tailored for you.

  • Do you like your tour guide?
  • Do you feel that he or she is listening to your needs and questions?
  • Do you feel pressured in any way, or like someone is "selling" you?
  • Does the tour guide speak only to you (the adult child) or does he/she make an effort to include your loved one?
  • Are you able to talk to staff members other than the tour guide, either in a formal session or informally during or after the tour?

The walking tour

While you're walking around, don't worry about checking things off. Instead, pay attention to what you're seeing, hearing, smelling, and feeling in each of the spaces. Try to talk to different residents and staff members, not just the director of marketing. This will help you get a fuller idea of what the community is really like.

Common spaces:

  • Are the common spaces in the community pleasant and appealing?
  • How many rooms are there where the residents can spend time with each other and with visiting family members, and can you imagine your loved one using these common spaces?
  • Are hallways well lit and easy to navigate, with handrails for safety and plenty of room for wheelchairs?
  • Are there shared pets in the community (such as dogs, cats, miniature horses, fish, or birds)?
  • Are there plants, and do they look well cared for (free of dust and well watered)?

Residents' living spaces:

  • Do most residents have a private room or share a room?
  • Is it possible to view all the different types of rooms available?
  • Does each room have a private, handicapped-equipped bathroom, or is there one shared bathroom?
  • Are residents' rooms personalized with photos, mementos, or other possessions?
  • Is there adequate closet and storage space?
  • Is there good lighting and are there attractive views in each room?

Food:

  • Are the dining rooms clean and attractive?
  • How many meals per day are provided?
  • Are there snacks and, if so, how and when do residents get them?
  • Can the community cater to specific dietary needs or special requests?
  • Can the residents bring food back to their rooms, and/or are there kitchens in the rooms?
  • Can visiting family members join the residents for meals?
  • Do the residents seem to like the food?
  • Can you taste the food or come for a meal to try it yourself?
  • Is there a private room available for family celebrations or private family dinners?

Activities:

  • Is there a posted, varied schedule of activities, and are there any activities that you think your loved one would participate in?
  • Do the residents have any scheduled interaction with the outside local community, whether because volunteers come into the community or residents go on regular outings?

The pitch

You can expect the tour to end in the tour guide's office or in a common space. At this time the tour guide will likely ask you questions and answer any you have. You'll also probably hear "the pitch" -- the tour guide will be promoting his or her community as the best choice for your loved one. If possible, ask for a moment to review your checklist before or just after this conversation. Check off all the items that were addressed and all the questions that you've already had answered. If you're still interested in the community, go ahead and ask any of the remaining questions that you want answers for, or plan to ask them in a follow-up phone call or visit.

3. Assisted Living Follow-Up Checklist

For any facilities where the initial visit was positive, here's how to follow up:

Surprise visit

Pop in for an unannounced visit in the next week or so, potentially in the evenings or on a weekend. If everything looks just as pleasant as it did during the tour, that's good. If the atmosphere is completely different, it might be worth considering other facilities. And if the staff won't let you in other than during a tour, it might be a signal that you should look elsewhere.

Documents to request

It's a good idea to get as many of the following documents as possible. They can help you compare the fine details of one facility versus another.

  • Sample admission contract
  • A copy of the Resident Bill of Rights
  • A copy of the most recent survey results from state regulatory inspectors
  • A recent list of weekly activities and events
  • A recent weekly menu of meals and snacks

Follow-up conversations

Schedule another visit or phone call to ask these more detailed questions about costs, care, and services.

Costs:

  • How much will assisted living care cost for your loved one? The answer will be different depending on your loved one's needs, so allow ample time for this conversation. Be sure you feel the staff understands your needs and is communicating the answers clearly.
  • Does the cost include any special move-in fees or fees for services, such as laundry?
  • Is there an extra charge for transportation to doctor's appointments or outings?
  • Under what circumstances might costs go up?
  • How is the community funded, and is the funding stable?
  • Will the community help with the paperwork involved with getting Medicare, Medicaid, V.A., and other sources to pay for care?

Staff:

  • What's the ratio of staff to residents?
  • What's the staff turnover rate?
  • Are background checks performed before hiring staff? If so, when and how?
  • How much training do staff members have?
  • What does the facility do to avoid staff burnout and/or retain great staff members?
  • Is there an RN, LVN, or CNA on staff?

Care plan:

  • Is an initial assessment of needs conducted and a written care plan developed? Who's involved in developing the care plan? How often are the needs reassessed?
  • What specific care is available from doctors, nurses, physical therapists, occupational therapists, and others?
  • Who handles medication management, and how well trained are they?
  • Is the facility affiliated with a hospital or nursing home if more care is needed?
  • What medical emergency procedures are in place?

Other questions:

  • Are residents required to have renter's insurance for their units?
  • Is housekeeping for units provided -- and included in the price?
  • Are barber and beauty services provided -- and included in the price?
  • Are pets allowed?
  • Are there religious services on the property or nearby?
  • Are visits to the residents allowed at any time, or are there set visiting hours?
  • Are residents allowed to have overnight guests, such as a family member from out of town?
  • How does the community accommodate private time for couples if only one spouse is living in the community?
  • What is the facility's policy on sexual interaction between residents? A good facility will have a written policy in place.
  • What is the facility's emergency preparedness strategy -- do they have a backup generator or evacuation plan?
  • Does the facility have an adult day program? Sometimes older adults are more comfortable moving into a facility if they've already spent several hours having fun with some of the residents.
For more information, contact Spring Arbor.

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