Elder CareTips:
Mastering The Eldercare Maze™

February 1, 2006

Before there was such a thing as "assisted living" personal care  homes played a vital role in caring for older adults who couldn't live completely independently but who didn't need institutional care.  They were often known as "Mrs. Smith's house, where she has two boarders she watches over." Mrs. Smith was unlicensed, unregulated and usually not formally trained.

As our aging population has increased, and many families no longer live with or near their elders, the personal care home concept has become popular as a small and homelike alternative to the larger and more formally organized assisted living residence.

Depending on where in the country you live, personal care homes can be known as board and care homes, foster homes, residential care facilities, and even - just to add to the confusion - assisted living homes.

In general, personal care homes provide a non-medical living environment that provides a room, meals, varying levels of supervision and help with personal care needs (toileting, bathing and grooming, dressing, eating, supervision of medications). Personal care homes are not licensed to provide medical or nursing care.

Most states have some form of licensing or certification for personal care homes, but not all such homes are licensed or certified. Small homes with only two or three residents are often exempt from these requirements. Some authorities believe that as many as half of all care homes are not licensed or certified.

The unlicensed/uncertified homes may be difficult to locate because the regulatory agencies do not include them on their data lists. Word of mouth, local resource booklets, professional advisors, and the Internet are all means of locating personal care homes in your area.

Are there enough caregivers? There should be at least one
caregiver to three residents.

Is the home clean and neat? Check out the kitchen and resident
bathrooms.

Are all bathrooms equipped with basic safety devices such as grab bars, hand-held shower wands and shower stools/benches? Is the home free of obstacles, throw rugs, raised thresholds and steps? Are all doorways wide enough for a wheelchair to easily pass through?

Is the home over-decorated? Some newer homes are showplaces that could easily be featured in a home & garden magazine. That's lovely for a photo, but is it livable? If the residents must be wary of disturbing or breaking the decor, the home isn't resident-friendly.

Who is responsible for medications and what training does this person have? Where are medications stored? Who calls the doctor or the pharmacy for refills?

Are special diets available? Is the kitchen open to the residents at any time for snacks?

Are there organized activities? Are the residents ever taken out for recreation?

Are caregivers interacting with residents outside of meals or personal care activities? In a personal care home the caregiver who sits and chats with residents in the common area is providing valuable
socialization, particularly if the TV is not on at the same.

Does the residence use a physician or nurse practitioner who makes house calls? If not, who takes the resident to the doctor and, if they do, how do they report to the family?

Is there an evacuation plan in case of emergencies? Where will residents go if the home cannot immediately be re-entered?

Visit two or three times, if you can. When you find a residence you like, be sure to carefully review the admission agreement and any other documents. Remember that attachments, handbooks, or other documents may be just as legally binding as the "agreement."

In the category of fascinating websites this one is way up there. We've all wondered from time to time what, exactly, is happening to the brain of someone with dementia. A picture is worth a thousand words. After you've seen these pictures it may be easier to understand why a person with Alzheimer's, or Picks, or any one of the conditions that cause dementia might not be able to remember the answer to a question you just gave 30 seconds ago, or why their behavior has changed so drastically. There truly is no filing cabinet left in the brain to store information, as these pictures so clearly reveal. Keep this the Alzheimer's Brain site handy to show others who might not understand what's happening to your loved one.

If you have trouble holding a toothbrush, try wrapping the handle with a washcloth and rubber bands. Unlike foam, the washcloth can be tossed in the wash - which you'll want to do because it can get wet and icky. Keep a good supply of the cheap ones on hand.
 

According to a report in the New York Times on Jan. 16, concerns about cost have delayed the installation of automatic sprinkler systems in many older nursing homes. According to the Government Accountability Office more than 20 percent of homes lack such fire protection devices. This is something to be very aware of if you are looking at an older facility. If you don't see sprinkler heads, ask. I, myself, wouldn't consider a nursing home without a functioning sprinkler system.