Contact the Long-Term Care Ombudsman office, which might be a state office or a local branch. Here in California, the Ombudsman office maintains lists of licensed homes and does inspections.

It's a good start.

Here is a link that might be useful: LTCO

My mother-in-law is at Emeritus in Southern CA. They also have places in the Portland area. We have been happy with her care. It's clean, the food is OK (bland and soft), nicely decorated, lots of activities which people can do or not. It does not have a bad smell. But most importantly, the people who take care of the guests are friendly and competent and never seem to resent requests for help. That is so important.

I would suggest your mom and another person (your aunt? you?) visit three local places. You should be able to judge which one you like the best. By the way, if they have levels of care into nursing, that's the best way to go, because as we age, we all will need more help and care, not less.

Also, you might be in touch with Oregon's Aging and People with Disabilities linked below. I noticed on the left of the page some links which might be helpful.

Good luck.

Here is a link that might be useful: Oregon

You might also check with your area agency on aging. They usually have people who know about the local facilities.

First visit as many as you can. Then do the smell test. If it smells turn around and walk out. Word of mouth from friends.
The ombudsman office too. Is it a place you would want to stay. Food would my loved one like it? How far is it from your home or your sisters. Does the doctor have any recommendations? Just a few of my thoughts.
Good luck on your adventure and yes it is an adventure.
Mary

When we had the same predicament with my mother, we asked friends, co-workers, etc.,then visited the places personally. We found the perfect place for her....more like a suite in an upscale hotel, meals were served in a dining room, and she had the same person looking after her.

It was a small chain, and later was absorbed into a larger corporation.

We found the hard way that personal recommendations are far better than government/ social agencies.

I am just a lurker here, post occaisionally on the Cooking Forum. We went through this with my Dad a year ago. He was in a rush to get the move over with and only visited one place before he signed up. The care is great - the food was horrible, but is getting better. We found out after the fact that he could have stayed there for a trial weekend - which would have been a great idea. Once you narrow your choices down, I suggest you see if any of them offer such a thing.
Jane

If it smells weird, of urine, or meds... walk out. If the people are tied up in their wheel chairs, walk out. If there is no talking, or friendly smiles in the dining room, walk out.

With other words, go check out the facility!

Moni

I am just a lurker here, post occaisionally on the Cooking Forum. We went through this with my Dad a year ago. He was in a rush to get the move over with and only visited one place before he signed up. The care is great - the food was horrible, but is getting better. We found out after the fact that he could have stayed there for a trial weekend - which would have been a great idea. Once you narrow your choices down, I suggest you see if any of them offer such a thing.
Jane

sadly money seem to be on the list for better places..

IF your dad was in the service and served during wartime your mother may be able apply for housing funds...

second, friends....that can help a lot...

and yes cleaniless is huge! but staff is just as important...esp the official in-house dr...they are often at odds with primary care...

also asst living isn't as asst as one is led to believe...for instance if she's on oxygen? she has to be able to do her own prep. so look into nursing facilities as well...

Our number one was several different doctors all recommended the same facility, it was brand new, it is absolutely beautiful and state of art. My sisters who are there in the area visited it and others and sat down and spoke to the people there. We have had a few instances, but it was new and they got it together pretty quickly. Mom likes it there and we see she is being well taken care of and is very clean. We have all been there when meals are delivered and they are great and they sit with her and feed her so she doesn't choke. A lot of one on one time is essential.

So I would say talking to the doctors that are in the area is one of the best methods, where would they put their loved ones.

Each facility has their own criteria as to who they will allow to stay in assisted living. I used to work at a nursing home and some of our residents had been at assisted living, but their level of care requirements changed and they had to move to our place. AND, we had some short term people who could not be reasonably safe as they had been, but were perfect fit for assisted living.

Food will almost always be the biggest complaint, with the residents and their family members. Visit during a meal and speak briefly with a few residents, smile and ask how they are doing. Check out the activity calendar, talk with one of the activity people and see if you can determine if they really enjoy their job. Ask some of the current residents at a prospective facility how long it takes for maintenance requests to be addressed. Many of those day-to-day issues can make a place right or wrong.

In today's society, many long-term facilities send out satisfaction surveys on a regular basis to family members and residents. Ask to see the results of the last two surveys (you don't want anything personal, just statistics). If the place you are considering doesn't do that, then you might wonder why that doesn't happen.

Jim

Most of these are now run by corporations -- not necessarily bad or good -- just the fact. Check for any sanctions at any of a group's facilities. How long have they been in the business? What's the percentage of Medicaid patients?

If this is a graduated program where people move from assisted living into nursing care, don't just look at the pretty parts in assisted living -- which is what most people do. Be brave. Tour the skilled nursing care portion of the home. How often is the home inspected by the department of public health? Records of inspections? Problems rectified and re-checked? Are there any *unscheduled* inspections? What is the staffing ratio? How often does a supervising physician visit? His credintials? His financial relationship to the home?

What are the credentials of the person in charge of the home's care, and of the staff members? What are their policies for dealing with complaints and crises? What is overnight staffing?

I'd ask any nurses you know for recommendations before I'd ask doctors. When is a doctor in a nursing home? ER personnel will have observed the condition of patients coming in from homes.

Look closely at the residents. They should not be in sedated stupors. They should not hesitate to answer honestly (fear retribution) if you ask them questions. Do you see FAMILY visiting the facility? (Best 'inspections' known to man!) Can family visit 'whenever' or are there set hours? If you ask questions of employees in an interested, non-threatening manner, do you get 'corporate-speak' or thoughtful answers?

These residences are primarily businesses with shareholders -- not to say some aren't providing excellent care, but they all have a bottom line to meet. While you may 'get what you pay for', don't take it for granted. Don't rely on an overburdened public health department either.

When I see how many of these exist -- and the growth -- I wonder if we will ALL spend some of our lives 'in care'.

Follow up comment:

There a many Assisted Living Facilities that do no accept Medicaid. I believe that most insist on private funds.

If your mother has any reluctance to this move from independent living to assisted living, then you might need to get her primary care provider involved. That medical person just might be the one to 'convince' your mother that this is the right thing to do. She might think that this is going into a nursing home, it isn't. Assisted living is just that, it if for folks who need some assistance with their ADLs (Activities of Daily Living), which could include grooming, dressing, toileting, etc.

Many older adults believe that their family is putting them away. You will need to spend a lot of time letting her know that she will flourish in this new environment. If she goes in with a negative attitude, then that is what she will maintain for a long time and you might end up feeling guilty about what has happened.

See if a trusted friend or neighbor can come with you whenever you do the visiting. That kind of support means a lot for the elders. It is not just family telling her that it will be OK, it is someone she likes and trusts.

Jim

i hope we havn't scared you, but both asst and nursing homes, have pretty much the same problem...not enough qualified personnel...or the staff is overwhelmed...that's one reason we've allowed fil to remain at home with incoming care (and his primary care dr agrees) we were very lucky to find a moderate priced and loving care-giver...although fil can be a pistol, lol...

Jim makes some excellent points. I didn't mean to overwhelm you with possible negatives. My MIL improved greatly once she went into a graduated-care home from her lonely apartment.

My mother, however, bought into a retirement home and shortly afterwards needed skilled nursing care. I discovered that the home was fronted by some well-meaning religious leaders, but actually run for-profit by a large corporation. The nursing facility was a shambles. When I dug into it I discovered that the person in charge of it was a convicted felon with no degree or experience in nursing care. The MD affiliated was a disciplined but not removed quack-with-a-license. I moved my mother to a REAL skilled nursing facility -- and got headlines in the papers.

Oh my! I wasn't able to get back to this until now and I'm so happy to see the replies. I'm on a quick lunch break--subbing at a school up the street-- so I'll read all these when I get home.

Thank you!

Had to put my Dad in an assisted memory care. There were 3 different levels of care there. Good thing. He lived for 9 months there.
Before I chose that spot I visited several homes, without letting them know I was coming. That way you see what really goes on. They let me leave my Dad there for an afternoon and lunch to see how he handled it. Went quite well I must say.
Of course, I was a pro by that time as I had to put my Uncle, Dad's brother, into one earlier that year in a different city.
Surprise visits are the way to go.
Kathy G in MI

Had to put my Dad in an assisted memory care. There were 3 different levels of care there. Good thing. He lived for 9 months there.
Before I chose that spot I visited several homes, without letting them know I was coming. That way you see what really goes on. They let me leave my Dad there for an afternoon and lunch to see how he handled it. Went quite well I must say.
Of course, I was a pro by that time as I had to put my Uncle, Dad's brother, into one earlier that year in a different city.
Surprise visits are the way to go.
Kathy G in MI

Don't let us scare you. This is a big decision for the entire family (spouses and children included!!). Making the transition can be troublesome and nerve-wracking.

You feel that there is an immediate need. Whatever happened that made you sit up and address this has probably been around for a while. Don't feel guilty about this, it happens to many families. Some have talked about it beforehand, but others just don't want to confront the issue.

Another person who you might want to consult is an attorney with some experience working with elders. Make sure that an appropriate health care power of attorney is in place. Make sure that a proper will has been filed. Those things, if they haven't been talked about before, can bring more stress on everyone involved. However, it must be done. If you don't do it now, when will it happen?

OK! I'm off my soap box. Thanks for listening.

Jim

My mom went into assisted living this last April~~she was really forced into it by her social worker at the Kaiser hospital and a soicial worker through the county, she lives in. It just had to go that way or my mom would not have gone, her living conditions were horrible and she was nasty as hell to me~~so I backed out and let the SW's handle it. As soon as she was settled we all went there~~we love the place, of course she hates it. It is clean. neat, no smells, everyone not matter what time of day you go are so nice.

It is owned by a big corporation, it seems that one corp bought the other out~~so there is a transition going on. As other posters have said~~food is a big complaint for her. I told her it must be hard for the chef, whom I have met. To make food for so many folks on special diets~~her health has so improved there, it has made her more sassy!

She had to go through an adjustment period, she will always be sad how she was made to leave her home. There just was no other choice;(

Had to do this for my aunt a few years back. A couple of things to keep in mind.

Be sure you ask enough questions so that you know the TOTAL cost. One place sounded very reasonable--until we added up the al a carte charges (dispensing meds, laundry, etc etc etc). The facility we did choose was a little more expensive on a monthly basis, but those things were all included, so it was much CHEAPER in the longrun.

You want to make sure the facility will keep your loved one as long as needed. Can she stay if she needs nursing care? hospice? the assisted living place my aunt was in promised NOT to toss her out, even when she needed more care. In the end, she did end up on hospice for a month and the home was wonderful about her care. (It was NOT a nursing home, but just assisted living--so that was much more reasonable--about $4500/month compared to 9000-10,000/month for a nursing home).

Also, see if you can track down some of the medical professionals who visit the home, but don't work for it. Therapists, hospice workers, etc--people who professionally visit many of these places. One hospice nurse told me that she'd told her family that if she ever needed care, the home my aunt was in was the only one she wanted to be in.

Also, if your mom's in a hospital, or rehab, talk to the social worker there--they've got a lot of info about these places, and can offer help.

Good luck. I know how difficult this time of life is. It's so hard, after relying on our parents, appreciating their independence all our lives, to then turn around and have to parent them.

Just one last note--as to the food. It's ALWAYS going to seem bland and uninteresting to us. With so many people to feed, so many medical conditions to deal with, so many tastes to satisfy, the staff really can't make vibrant, spicy, interesting dishes. As long as it's nutritious, and nicely served, you're coming out ahead, I think.

Well, here I am. And it seems we've jumped over the need for assisted living and are considering nursing homes now. You won't believe the reason for her sudden decline in health: Restless Leg Syndrome.

She has outlasted all the meds and the Oxycone she's been on for years does nothing anymore, all of a sudden. This is severe restless legs, no rest nor sleep at all when it gets going, which is 24/7 without meds, (one has to walk and walk and walk until there is relief from a medication.) So the only thing left to her is Dilaudid and it's nasty stuff. Though it stops the need to move, her legs are so wobbly she can barely use a walker, though she was using a cane and walker a few weeks ago. The constipation is hellish and sister had to take her to the er for help. I won't tell you what happened after that, but it wasn't pretty. I was hoping they might hospitalize her for a couple of days, but no luck--sister didn't think to ask.

Anyway, it's a miserable situation and we now need to find a nursing home, which is even more worrying. She's so defeated at this point that she won't protest, she was even the one to suggest it. I will re-read these replies and send them to my sisters as well. I do have a relative through marriage who is doing his residency in the ER so perhaps he may steer us one way.

I thank you from the bottom of my heart. It's tough.

Still, check on the assisted living in your area. My aunt needed a LOT of care, and even at that, wasn't being charged at the top level (meaning she was only average). You might be surprised how much care is offered by some of the assisted living places in your area. I'd investigate EVERY option, and not limit yourselves. And still ask the same questions I suggested above--about the al a carte issue.

Don't go off the deep end yet. My wife is a gerontologist. I asked her to peek at your last post.

I told her what I was going to write and she said yeah!

Typically, RLS is a difficult problem to deal with. Many primary care providers don't have enough information to deal with it appropriately. Often, they refer to neurology, which is OK up to a point. I am not coming down on specialists, they are good, but they don't always look at the entire body and the ramifications that arise from the course of treatment that they prescribe. That goes with many specialists, not all of them.

ER people are smart and know how to act in situations that define life or death. And, they can take care of non-emergency situations that should not wait for a day or two until one can be seen by another provider. They are good people, but dealing with RLS and pain meds is not their thing.

If your mother's primary care provider is not adept at dealing with issues that are prevalent with our elders, then ask for an immediate referral to a gerontologist (MD, PA or NP).

I agree with azzalea, do not rule out Assisted Living. The price is right if they will accept your mother. Start making phone calls now, it might take a few days for you all to get things together enough to make the appointment there. Admission to a nursing home must have a doctor's (some states might allow an NP or PA to do this) complete physical prior to the actual admission. Medication dosages will be checked and only after a decent conversation with the provider, should there be any recommendation of admission to a skilled nursing facility.

This should not be entirely your relative's decision, get knowledgeable people directly involved. I'll guess that your sister was flustered with the situation. Don't go off the deep end!

Jim

I don't want to 'practice medicine' here without a license. LOL I wondered if any doctor had tried your mom on non-narcotics -- like Cymbalta or Abilify. DH gets RLS when he goes off Abilify, even though he takes an insignificant amount daily (1 mg.). His MD cannot figure out why this teeny amount is useful to his mood, nor why removing it causes RLS.

I have to remember to take stool softeners whenever I am prescribed something even as low-dose as Tylenol-3.

prune juice became my mothers best friend

Today is a new, and better day. She was in such rotten shape yesterday and is much improved today. It's soooooo hard not to be there and to leave everything to sister. Sister cares much, but doesn't have a ton of patience. I talked to Mom this morning and slowly approached the subject of where to live. She really wants to go to a care home down the street from my sister and I'm not sure how to check it out, other than a visit. (Yes, a surprise visit is a good idea.) It's a crime that these places aren't rated and I don't know whether inspections are open to the public, and how hard they are to find.

Chisue, I've thought of you and your husband a lot lately. Mom was put on Wellbutrin to counteract depression the narcotics bring, and that was a pain getting there. The "fabulous" neurologist" put her on another one at first that caused severe nausea as well as.....worse rsl. Way to go, big doctor--It took me 5 minutes of surfing to find out that drug increases symptoms. The neurologist has been of little help as well. I asked ds to ask her regular physician about Abilify, but he was against it, even though I told her what you had told me--I'm afraid I've forgotten the reason. At this point, I don't think we can mess with the meds too much as we try to get her more stable.

Azzalea and Jim, thanks for the suggestions. You're right, I think she will be ok in assisted living. Sister really has been such a trooper and had to deal with a whole lotta unpleasantness yesterday. I have to not let her make a snap decision, which is a little tough because she's the one who is doing all the work. We all love our mom dearly and want what's best for her, for sure.

Susan, prune juice is always a good idea but didn't do the trick this time.

I'll keep you posted, if anyone is interested. THANK YOU again, for all your help and suggestions.

Public Health records are...public.

Our Senior Center has a trained social worker. These people get to know what's what in the community. Is there a Senior Center in Portland that could help you narrow this down?

When our DS called yesterday I mentioned your problem vetting homes. He has worked as a paramedic with an ambulance company that had contracts with nursing homes. The paramedics are IN the homes frequently to see conditions. (Sometimes just taking residents to appointments in hospital -- not all emergency cases.)

DH just had a good idea: The fire department paramedics would have some handle on this. You could at least ask at the station near the home your mom is considering. Does that home have a 'trial residency'?

The mental health of caregivers is an important part of our society. Although most people believe that applies to caregivers for folks who have memory loss. There are other people who have the problem.

Your sister, although not a direct caregiver, needs lots of support from many people. This type of crisis can be so draining that she might not make proper decisions.

Please get others involved. Give you sister a bit of a break, both now and later. Show support with a thoughtful, personal gift now, even if you cannot be there in person to assist.

Jim

I so agree with Jim--being the person who has to be the hands-on caregiver--making decisions, doing the running around (yes, even when they're in a good care facility, there's still a lot of work for the caregiver--shopping, medical appts, etc).

And Chisue mentions something I forgot to. Most homes have a program where a person can go there temporarily--when their family goes away on vacation, or in many cases--to try the facility out before making a contractual commitment. Whatever place you decide upon, however good it looks to you, I'd strongly recommend that she go in as a 'visitor', just to make sure the fit is right--that gives you the option of making a change if it's immediately obvious one's needed.

And the best to you and your family, believe me, I've been in your shoes--was the main caregiver for mom (who stayed in her apt, so I had to make the arrangements for help to come in, shopping, etc); aunt in a facility--different responsibilities, but by no means less work; and my mil had Alzheimers, so that was another skill set we were required to learn. It's never easy to have to parent a parent. And no one ever really prepares us for it, do they?

A few years ago, my sister and I had to find an assisted living place for my Mother who was in her 90's. My sister knew of a very nice one, about 15 miles from me. She had in laws in it before and knew about it. It was very nice and you could fix your own meals if you wanted, or go to the dining room 3 times a day. Laundry and house cleaning was included. They assisted with the bath if needed. I was even able to spend the night there when Mother had a medical problem. They gave her medications when she needed them as long as we had them counted out in holders. The food was really good and when I spent the night I got my breakfast free. We also had a fairly large birthday party with women family members there and had the same lunch as the rest did. We did at that time only have to pay $5.00 each. This place was rather expensive and the rates slowly kept climbing. You had to pay out of pocket. Then Mother could not even stay there and went to a nursing home in the hospital, that nursing home was pretty nice, with a regular hospital room. When the hospital built a new nursing home, they had to leave the hospital and go to the new one. We did not like it as it had two people per room and it was so crowded, you could hardly turn around. It was clean and had a nice dining room and the food seemed good, it was just crowded.

Sue

This is all so good to know. For the next few weeks, Mom will be staying with sister while we figure this all out. Sister is not rushing--so relieved. Younger ds is visiting next weekend and I will go up soon after. I know it'll work out, though Mom is getting rather depressed about it all--expected. Merci. I'm thrilled to have so much "reference material" here and will probably involve a Kaiser social worker.

My dad is in an assisted living facility for dementia patients. Hospices may have hospice patients in assisted living facilities or provide palliative care to residents. If your sister knows a hospice nurse they will be able to tell you the best facilities. Recommendations from hospice nurses is how I decided on where to place my dad. My dad isn't in hospice care, but I work for a hospice & asked the nurses which were the best facilities in town. We have been very happy with his facility.