Look for an arbitration clause in the admissions contract which waives your right to sue in case of abuse or neglect. https://www.aarp.org/caregiving/health/info-2017/trump-nursing-home-arbitration-fd.html

Thank you for that, Beagles.

I'd want to know about staff turnover -- how long have the caretakers been working there? I'd like to know what they pay their staff, but not sure they;d tell you. Turnover is terrible in the industry and places that pay better and value employees will have happier employees who in turn take better care of the residents. Places with higher than average turnover probably have more problems than just lower pay, though lower pay will cause folks to come and go as soon as they get a better paying job. Ask workers you see how long they have been there. Notice whether family members call them by name, etc.

Apropos to the last point, weigh proximity very heavily. After certain moderate standards are met, the most important thing by far is how often family members visit and interact with not just the patient but the staff. Choose a facility that makes it convenient to drop in often.

All states audit these facilities. Read the audit reports.

Ask random people who work there, in various roles, how they like their jobs, how they like the company they work for. The answers can be telling.

https://assets.aarp.org/external_sites/caregiving/checklists/checklist_assistedLiving.html

Visit at different times. Ask pointed and direct questions about staff turnover. Try to talk to residents and various staff members, eat a meal or two there, trust your instincts.

Print out the checklist and take a copy with you on every visit. They will all run together if you don’t have written notes. Accept the fact that despite your due diligence the choice may not be right. We had to move my mom to a different facility after a year because she just wasn’t happy. She is much more content in her new place (for now LOL). Best to you as you make these decisions.

My dad had to spend a couple of weeks in short term rehab after a hospital stay, so my sister (a nurse) and I toured several facilities. I researched several in my folks’ community and narrowed down the choices prior to making visits. I was more in tune with the aesthetics of the facilities and she was focused on the what she referred to as a “nursing vibe.” The team approach worked well for us and we felt that between the two of us, we were able to make the best choice for our dad. If you have a friend/family member who is in nursing, I would definitely ask them to help you with your search.

Visit at different times and speak to the other residents there. They live there and will tell you what's going on. Also, eat a meal on one of your visits; most places will let you purchase a meal. I'm in nursing homes and assisted livings all the time (I work with people who want to go home) and the two biggest complaints I hear are how long it takes to answer the call button and the quality of the food.

As mentioned earlier, be sure to check out those state audits. They will reveal a lot that you will never see. It's rare to find an audit with no deficiencies but there is a difference in not having some sign posted and excessive pressure sores. Good luck!

We checked the audit reports first to narrow our search, then visited the top 3 on our list. First choice had no beds and since we were under the gun to find a place within a couple days went with #2. It was further away for my brother to visit (I lived out of town), but my cousin visited her mom there 3 times a week and agreed to be another set of eyes.

When we placed my grandmother in an assisted living (she was in memory care unit), we went mainly on references/word of mouth by others who had dealt with her facility (had family members there). We liked the small "villas" which if I remember correctly only 14 patients could be in a villa (you had the choice of private or shared room), the grounds and the planned activities, transportation, etc. The villas gave more of a homey feel - definitely not a "nursing home" feel. She rec'd excellent care, I honestly never had to worry about her care. She felt very secure there and it became home. It was close enough for my sister and I to visit often. Another big plus, not for my grandmother but others - they allowed a patient (in some, not all villas) to bring their pet! What joy that brought some of the patients. Excellent food, laundry, etc. Units were redone every so many years (painting/wallpaper, flooring, decor, etc.) which was also nice. My grandmother spent almost 6 years there and at the end we were able to bring in hospice and keep her in her same villa which was wonderful for her - it truly had become her "home".

Tina, that sounds so nice!

Tina, that does sound nice.

Selecting a Memory Care facility is one of the hardest things you will ever do. We used a professional who had pre-screened facilities for us & we could rely on her having thoroughly vetted them. It made our decision less worrisome. We looked at 3 options & selected one that only had 20 residents. It was located in a senior living facility & the memory care residents had access to many of the services offered to the other seniors. I.e. My mom was able to have her hair done & get manicures as they had providers come in. There was an RN present 24/7; they went on outings, had their own outdoor patio & garden; therapists who worked with them to preserve mental skills and a terrific staff to resident ratio with wonderful, caring people. Sadly, like so many others with Alzheimer's, my mom deteriorated & passed away. We were very happy with the care she received.

Definitely eat a few meals there. I hear my parents friends complain about the food in nursing homes and meals on wheels a lot. A lot of the problems come when the food service is farmed out to an outside contractor to save money and they aren't good and aren't accountable to the residents and staff at the nursing home. Same thing happens in academia with food service, there are good companies and bad ones, but the best I have experiences were run by in-house staff.

Are physical restraints ever used. Are medications ever given without family consultation. can your parents keep their own doctors and specialists or do you `have to use those of the facility.

I didn't read all of the responses, but replying after seeing you are in AL. We are in central AL. My maternal grandmother was in Fairhaven (Eastwood Mall area) for almost two years. It was wonderful. She started out in a one bedroom studio, then was moved to the hospital section when sick/before she passed away. Her husband/my grandfather (Alzhiemer's) was going to move to Fairhaven also, but deteriorated during hospitalization and went to another facility.

Do NOT use Brookdale. I read and heard horrible things about it after the fact -- My mother was in Brookdale all of 5 days. She fell morning 1 and 3. No bed alarm, no side rails (they said it was illegal due to confinement. I still don't get that!). She fractured her arm the second fall, went home for hospice and never got out of the bed again. She passed away 6 months later.

We used Home Instead Senior Care (Bham AL, Dan Pahos is the owner) and they were wonderful. Also can't say enough about Alacare. (Hoover/Vestavia- Jefferson Co location). Both of these companies were fantastic. With Home Instead, Dad requested two specific caretakers from Home Instead, once they were there a few times. They each worked 3 days a week, then had a floater on Saturday. Sometimes the same person, sometimes not. Alacare also sent the same nurse(s), so everyone was familiar with Mom and the caretakers.

Towards the end of her life, she was placed in Aspire (Vestavia location just off Hwy 31/I65). There are only a few long term care beds. I don't know about Memory loss patients, but worth calling if you're nearby. They opened another location recently behind Grandview Hospital and know several that have moved their loved ones to that location.

bothell as good advice.

My Alzheimer's grandfather was a sundowner. Dad explained in length this issue. He would get his furniture, etc moved in only for my parents to be called to "come get him" when he had his first episode. Deposits/payments were returned, but the cycle was draining. I'm sorry I do not remember the names of the two nursing homes. He ended up in a nursing home (bedridden), but I do not remember the name. It was off I65, off exit 242/252? The tank farm exit.

If you're in the Bham area, I talked to the admin and went to view the nursing home behind St Vincent's. She forgot our appt and we ended up walking out. They have two locations and this one had just been opened. It was nice/clean and secured. I can find the name, if you'd like.

Ask about their fall stats. Also ask patient to nurse ratio, and patient to CNA ratio. Dad selected Brookdale, and after her falls I did internet searches. There are website with specifics on falls, ratios but you have to hunt for them.

Good luck with your search.

My MIL was in this one in Centre, AL.

http://www.cherokee2013.com/

Allison and Sherry, sorry for the confusion: by AL I meant Assisted Living (though with freezing temps and an inch of snow this weekend, Alabama is sounding pretty good!)

Just the same, all your comments are helpful! We have Brookdale here, too, as well as Home Insteads.

Interesting that you Dad was asked to leave because he's a sundowner. Aren't most people with Alzheimer's or dementia?

A lot of places won't use restraints, but I didn't know that extended to bedrails. We use such a system at home, because Mom is likely to get up before someone can get to her to help. (Even my dad can look at the sign that says "Call, Don't Fall", read it aloud, tell me what it means, and start to swing his legs over the side of the bed. )

Yes, my MIL was a sundowner. I am pretty sure my BIL told me that it is a federal regulation about the restraints. There is only a narrow set times they can be used.

Oh well, you can look at their brochure and see what they offered.

Here is the Medicare link to compare nursing homes.

https://www.medicare.gov/nursinghomecompare/search.html?

YEs, it was a nice place. We were forced to place my grandmother in AL at the time because my mom was terminally ill. In her case we used care-givers and kept her at home (along with hospice) and it was the best decision - for both of them. My grandmother's facility did not use restraints (that we ever saw), but she never progressed beyond the lowest level of care (her Alzheimers did not progress once she was placed on medication). I will say that the beds they have (unless you bring your own) are lower to the floor in case of a fall.

Oops! So sorry. Don't be fooled by the south. It's getting too cold too soon!

It was Mom's father that had Alzheimer's. My dad helped her look at places since it can be overwhelming.

Tinam61, Brookdale did not lower the bed either. Once she was home, bedrails stayed up. In Aspire they were also up. I don't know why Brookdale had an issue with side rails. She woke up, didn't know where she was and didn't remember to press the call button. Even an assistant at Brookdale said to me she didn't know why they did not put an alarm on the bed, lower the bed or put pads on the floor around the bed after she fell the first time. Other caretakers said the same thing when we told them what happened. We never wanted her restrained or over medicated either.

W`here my mom is they take their own beds mainly because of comfort levels. If bedrails are required that is a family discussion. So far, they are not needed in my mom's case.

My MIL lived on her own until recently; now she is living in a very nice assisted living. We just brought her there after short hospital stay. She has not balked for which we are grateful. She is a very formidable woman, and we expected lots of difficulties and complaints. I think the dementia and the short hospital stay have caused her to forget about her most recent home. She is content which is a relief. She is 101 and has progressing dementia and very poor hearing.

Bpath, in MIL's case, meds have been prescribed without our knowing. We are going to work with the management, so we will be consulted. MIL can select her own physicians, but it would be up to us to transport her to their offices. The assisted living works with doctors from a well known practice in our area, so we are okay with using them. I have to say this experience has been a learning curve for our family. The assisted living residence does not expect us to be involved but is very open to working with us.

My mom is in a memory care facility. One of the questions was the ratio of residents to caregivers. They also have 24 hour nursing and we are allowed to visit any time of the day or night. We visit often. We have had good meals with her but she still insists the food is awful. It's the complaint heard most often. I don't know if the elderly lose some of their taste buds or if part of it is because of medications they take. I know my mom is in good hands when we aren't there but it's still difficult.

Older people do lose their sense of taste` and their sens`e of thirst.

In my state, no restraints/bed rails, trays on wheelchairs can be used. Sounds wonderful, no? Until one has someone with Alzheimer's who throws herself out of wheelchairs and beds etc. My friend had to be moved to a neighboring state in order to not sleep on a mattress directly on the floor and not continue to hurl herself from a wheelchair.