I am reading a lot of similarities to what I have been dealing with my mother for the past 1-1/2 yrs. I wish you luck - as it can be soooo trying! 1. I received plenary guardianship of my 65 yr old mother just over a year ago. Here in FL, I'd say it was a fairly time consuming and expensive route (excess of $5K). I was pushed into seeking this formal route (vs power of attorney) because everyone was concerned my mother would have tried to revoke the POW. Now I see that wouldn't have been an issue --- she believes everything I tell her regarding legal issues and isn't motivated enough to find out otherwise - so I feel that I should have stayed with POW and avoided the aggrivation (annual Guardianship plans, annual Accounting, petitioning for various fees, guardianship accounts, etc). It's costing about $3500 per year now. I have an appt with a separate Elderly lawyer - family friend - to get advice on medicaid planning and to see how long I really need to retain this "guardianship attorney". 2. Whenever I need to do something that I believe mom is going to be upset about, I just tell her that it is "court appointed". She doesn't recall the hearing - but I assure her it is true. 3. She too was a heavy smoker and drinker (the actual cause of her dementia - alcohol persistent dementia). But, somehow she completely FORGOT that she did either. Now she says she smoked "years ago" and that she used to "have a drink or two of wine - socially". Ha. But, her doctor did specify (in a letter) that the ALF not allow her to have alcohol - that it would interfer with her blood pressure and diabetes management. Shock. 4. I sought out a memory care ALF due to recommendations from the court (via the 3 person, court appointed Examinining Committee). I toured several ALF's with memory-care units and they each assured me that their entire staff had special training to deal with dementia patients. Right. They call me every time that they cannot get my mom to wash her hair, that she puts the garbage in the wrong place, she leaves windows open, she eats the wrong things, etc. For cripes-sake - why can't they take care of these things if they're so well trained? I'm glad your mom (MIL ?) is taking fairly good to her placement and is actually taking part in some of the activities. My mom was so isolated - and will have nothing to do with the "old folks" and their "stupid crafts and games" in her ALF. Too bad. Again - good luck to you. What a duty, huh?

My mother is currently in an assisted living facilty in Sacramento, CA. We visited several places before the move, and the care she is receiving is pretty much standard in the area. She has her own apartment with a good sized bedroom, private bathroom, small living room, and kitchenette. Her bathroom is equipped with a no-barrier shower & a corded call button is next to the shower & toilet. The toilet is a handicapped toilet. The bathroom sink has no drawers underneath, so it is wheelchair accessible. Her kitchenette has an apartment size refrigerator, sink & microwave. (Most of the places we looked at only provided dorm size fridges.) All meals are provided in the dining area. There are usually two choices for lunch & dinner, plus an additional list of alternatives. The residents can go to the local grocery store once a week to stock up on snacks, etc. The facility has activity rooms and washer & dryers on each wing. The facility has an in-house hairdresser, manicurist, & podiatrist. All medications are kept in the locked nurses' station. The aides administer the meds to each resident. The staff communicates with doctors if necessary. Residents can use the facility's pharmacy for prescriptions. In addition, all residents wear a GPS device, so in an emergency, they can press the button & the staff knows exactly where they are. Transporatation to medical appointments is provided. Regular, weekly housekeeping is also provided -- dusting, vacuuming, etc. Trash is emptied daily. Laundry is also provided, depending on the resident's wishes. My mother washes her own clothes but has aides wash her bedding & put her bed back together. Residents can have assistance with dressing, toileting, & bathing if needed. They can also have aides wheel them to meals, activities, etc. Obviously, all their medical needs are taken care of by aides. For example, my mother wears compression socks. Aides help her get them on each morning & take them off each evening. Aides bandage wounds, etc. Residents have many activity choices, usually about five different ones daily. In addition, two or three "field trips" are scheduled monthly. This facility also allows hospice for end-of-life situations. It is not a skilled nursing facility, so the staff won't manage IVs, injections, etc. However, private health aides can be brought in to take care of those issues. My mother has fallen a few times and the staff has arranged for her to be taken to ER. They communicate with me regarding her medications, etc. I hope this is helpful. If you have any questions that I haven't addressed, please let me know. Sue

Another good article. I always cringe when I hear someone say they've promised their parent that they will never place them in a nursing home. None of us knows the future. We have no idea how our loved one's health or mental abilities will deteriorate. It's unfair to the loved one and unfair to yourself to make a promise you simply may not be able to keep. My mother lived in two assisted living situations, but eventually she needed to move into a memory care unit. What the article says about staff numbers and incontinence care is true. As my mother's dementia progressed, she withdrew more and more from the planned activities. So she ended up spending most of her day napping or sitting in her apartment alone. However, once she moved to memory care, she enjoyed a day full of various activities. That was because the staff to resident ratio was better. The staff got everyone up & dressed and herded off to breakfast. Then they were ushered into the great room for activities. They never spent hours alone. All that to say that promising to keep a loved one out of nursing homes or dementia wards may not actually be in their best interests.

This is a wild and tumultuous free market. Many factors come into the building/offering of CCRCs. You MUST do a lot of research because if you make a mistake with your $$$$, nobody is going to come to your rescue and get it back. There are no real guarantees in the eldercare facility. First: Is the facility non-profit or for-profit? Non-profits rate better for care and lower staff turnover. But be aware that at any time, a non-profit can be bought by a for-profit corporation - in fact, many already have and this trend is increasing. This is not, repeat, not, to say that for-profits are always bad. Many are quite nice. Where we found the biggest difference was not at the Asst Living level, but at the Memory Care/skilled nursing (e.g., 24/7 care commonly called "nursing home" level care). At that level, the cost between non- and for-profits was noticeable. We're talking a $2-3K/monthly difference. Also, when staff turnover is high, care suffers at all levels. We've visited places where the daytime staff that one saw in the public areas were all smiles and welcoming, but at night the staff was indifferent and brusque - not just to visitors, but to residents! Cost is not as important as the type of social environment. "Like to like" should be the motto of these facilities. We investigated eight nearby full-service facilities for my MIL, and every one of them had a different social atmosphere. We did very intensive research and multiple visits, to ensure the one we picked would be the best for her while being a place she would enjoy the most. As most know from my other posts, we were successful. But it took months to achieve it. You can check a facility's inspection record through the appropriate state regulators. Ours are on-line and although it took a lot of time, it MUST be done. When I finished I had confidence the facility we chose was ranked third in the state and had only extremely minor issues, which were promptly corrected. So what is the cost? There are two big issues: one is the upfront buy-in cost; the other is the cost of 24/7 care. Due to state licensing requirements, most senior facilities find it easier to apply for an AL license for all their living units, rather than designating some as 'independent' and some as 'assisted'. For Asst. Living, we found little difference between the various facilities we saw. In our high labor cost state, "rent" ranged from $2800-$4000/mo., for smaller units that were either studios, junior studios, or 1 bdrm. Some had 1/2 baths, some had full baths. Not all had kitchens (we didn't want one; MIL had dementia so not safe for her to cook). Within Asst Living there were three levels of care, as determined by MIL's facility. The family can negotiate but it's the facility that decides what to charge extra for. Every facility is different but most have a similar type process. It can be expensive: MIL needed nothing more than daily medication help and weekly bathing assistance. That cost $900/mo. and was rated Level 1, the cheapest extra assistance pkg. Buy-ins vary enormously. With a larger buy-in you are paying for your monthly costs to never increase even if you need 24/7 care eventually. With a smaller buy-in if you need to move, your costs will be charged market rate. This may sound great but every facility we met with told us they raise rates 3-5% annually, every July, without fail. So if you go in at age 60, and need 24/7 care at age 85, what the facility is charging today will be more than double when you finally do go in. Will you have enough $$$$? And please, do not fall in with the common idea of "Well, at 85 I won't care, and I'll probably be dead anyway." My MIL was 84 when she went in. Imagine her shock to discover that among her three other tablemates at meals, she was considered "the baby"! People are living longer, and you might well be one of them. We're very happy we found a place that worked out so well for her, but it took effort on our part. I urge you not to short doing your research. Find a place that suits you, even if it is a little further from family. This is one of the most expensive decisions you will ever make, and you should never have to regret it.