Choosing Care in an Adult Family Home or Assisted Living Facility

Are you looking for housing and care options for yourself or another person? There are many things to consider, terms that may be new, and housing and service conditions to explore prior to making a decision. This Blog offers some steps to take and questions to ask to help you get the information you need to know if an adult family home or assisted living facility is the right option for you

If you or a loved one need more care than you can get at home, it may be time to explore residential care. Residential care is a term used to describe a home or facility where an adult can live and get help with care in a community setting. There are many residential care options that have become available over the last several years. Each type of residential care home offers different housing and care service options. It is important for you to understand the differences in residential options available and have a good idea of what services are needed. You can then match your needs and preferences with a particular residential option. This Blog describes two residential options: adult family homes and assisted living facilities. Both are licensed by Washington State. There are other non-licensed housing options not covered in this Blog, including retirement communities and continuing care retirement communities. More information is available about these options through your local Senior Information

What are Adult Family Homes and Assisted Living Facilities?

An adult family home (AFH) is licensed to provide housing and care for up to six adults in a regular house located in a residential neighborhood. The AFH may be run by a family, single person, or business partners. The AFH may also hire other employees. Some AFHs allow pets. In some homes, multiple languages are spoken. An assisted living facility (ALF) is licensed to provide housing and care to seven or more people in a home or facility located in a residential neighborhood. All AFHs and ALFs provide housing and meals (room and board) and assume general responsibility for the safety and care of the resident. Additional services may be offered, including: ¡ Varying levels of assistance with personal care. ¡ Intermittent nursing care (a nurse available on a part-time basis). ¡ Assistance with or administering of medications. Some AFHs and ALFs also provide specialized care to people living with developmental disabilities, dementia, or mental illness. This blog outlines six steps that will help you get the information you need to decide if an adult family home or assisted living facility is the right choice for you.

Six steps to finding the right home for you:

Step 1: Talk About Life Changes

The first step in making long-term care decisions is for everyone involved to overcome their reluctance to talk about it. Many people put off this conversation because they are uncomfortable or unsure about how to bring it up. The person needing additional care may be reluctant to admit their changing needs. Family members can have differing opinions about what should happen. Miles can separate concerned loved ones. No matter what the circumstance, fear and discomfort can leave everyone unprepared if a crisis occurs. Start talking now before an unexpected life crisis teaches you all the things you wished you had known ahead of time. Tips for Talking About Life Changes ¡ Set aside time to talk when everyone is rested and prepared. ¡ Do some homework and have some knowledge about what types of housing and care services are available where you live. ¡ The person requiring additional care and support should have a central role in determining what is needed and how it is accomplished. ¡ Allow each person to talk without interruptions or criticizing. ¡ Understand emotions are a big part of this discussion. ¡ Be patient with the amount of time that may be needed to get things out on the table. ¡ Remember, it normally takes more than one conversation to figure out what to do. Do not try to tackle too many issues at once. Many small steps are better than one huge leap that leaves everyone upset and more confused. ¡ Stay positive. It is normal to find change difficult. ¡ Allow everyone time to think about everything discussed. If helping a loved one – remember you are making recommendations not decisions.

Step 2: Review Needs

Carefully consider what care and help you, or your loved one, need. Make a list of medical, physical, and social needs. For example: ¡ Does someone need to do laundry and cooking? ¡ Is help needed to get to the bathroom or dressing? ¡ Are regular medication reminders necessary? ¡ What type of help is needed so the person can stay socially connected?

Step 3: Get the Information You Need

Much of the initial information gathering begins on the telephone. There are so many resources available it can be hard to know where to begin. It is helpful to know that it is a time consuming process for everyone. Plan accordingly. Who to Call Community Living Connections There are local Community Living Connections (CLC) offices throughout Washington State. CLC provides information about local senior services in the community. CLC staff can assist with such things as what services may be available and their cost, names and addresses of local adult family homes and assisted living facilities, how to fill out forms, and how to find out about what benefits you may have. CLC is part of your local Area Agency on Aging (AAA). To find the CLC or AAA office nearest you, go to www.waclc.org/connect. You can email the office directly, or find the local phone number. You may also call the statewide toll-free number at 1-855-567-0252. Home and Community Services If you think you may need state funding (Medicaid) to help pay for services, contact your local Home and Community Services (HCS) office. Call your regional HCS office and request an assessment. Phone numbers and locations for local offices are listed on back cover of this blog. Eldercare Locator If you are looking for information and live outside of Washington State, the Eldercare Locator is an excellent resource to connect you with local services. Call the Eldercare Locator at 1-800-677-1116. Full language service for 150 languages is available when you call. Or, visit them on the internet at www.eldercare.acl.gov.

Step 4: Get a List of Adult Family Homes and Assisted Living Facilities

There is a wide range of adult family homes and assisted living facilities in Washington State like Cascade Valley Adult Family Home. To begin finding the home that is a good fit for you or your loved one, visit: www.dshs.wa.gov/altsa/residential-care-services/long-termcare-residential-options. This list provides the phone numbers and addresses of the facilities in the area requested. It also lists what contract (if any) the facility holds with the State to provide care for state-funded residents. If you do not have a computer at home, check with your local library for access to one. Your local Community Living Connections Office, Area Agency on Aging or Home and Community Services office can also provide a list of available options.

Step 5: Set up Visits

Once there is a list of possible homes, you need to visit homes that match your needs. This point is very important. Visit as many potential homes as you can at different times of the day. Although setting up these visits may appear time consuming, in the long run it is worth taking this time to make the best decision. Visiting homes helps you compare the options available and get a good feel for what is available. Find out more about the reputation of each home you visit by: ¡ Asking a representative from the home you are visiting to: • Show you the last state inspection report. This report will give you insight into any potential problem areas of the home. Give you a copy of the disclosure form that sets out the care and services that the assisted living facility offers. Provide references or numbers to contact former residents or their family members. ¡ Viewing any history of complaints against a facility by going online to: at www.dshs.wa.gov/altsa/long-term-care-professionals-providers. Under the “Find an Adult Family Home” or “Find an Assisted Living”, reports will be listed for each facility. ¡ Contacting the local Long-Term Care Ombudsman Program for your area. Long-Term Care Ombudsman Program representatives are advocates for residents of residential care facilities. They work to resolve problems of individual residents and to bring about changes at the local, state, and national levels to improve care. They can be an excellent source of information

Step 6: Make a Decision

The following checklists will help you ask questions and get information to make your decision. Do not hesitate to ask as many questions as you need to make a choice that works for you. Although there are many questions here, the most important thing to ask is, “Does the adult family home or assisted living facility meet my needs?”

Costs and Finances

What is the basic rate for room, board, and services? (it is a good idea to get this information in writing)
- What services are covered by this rate?
- Are there other services available and how much do they cost? What are the payment policies?
- What is the refund policy if someone leaves before the end of a month?
- What is the policy for rate increases?

Administration and Staff

How long has the current administration been in place? Is there enough staff available to meet my needs?
Is there frequent staff turnover?
Is some level of nursing care provided (RN, LPN, Nursing Assistant)? How often is it available?
Who will help me with medications if I need it (e.g. reminding me to take them, opening the bottle)?
Can someone administer medications to me if I can not take them myself (e.g. applying medication to my skin, putting a pill in my mouth)?
Can someone help me if I need special care (e.g. caring for a wound)? What happens if I have an emergency? Can I get help right away?
Are staff suitably dressed, personable, and outgoing?
Do the staff members treat residents with respect
and dignity?
Do staff members treat each other in a professional manner?
What language does most of the staff speak?

Services and Activities

What type of help with personal care is available (e.g. bathing, dressing)? How flexible is the schedule for receiving help with personal care?
What, if any, transportation services are available? (e.g. medical appointments, shopping, religious services).
Will staff arrange for activities (e.g. hair appointment, concert)? How does the home support and accommodate personal hobbies? Are there regularly planned activities that I will enjoy?
Will I be able to attend religious services of my choice? Can I bring my pet with me when I move?

Surroundings

As I arrive, do I like the location and outward appearance?
Is the home close to friends and relatives?
Is the home on a noisy street? Are there shops, a library,
a park, or other amenities within
walking distance?
Is the home close to activities I enjoy?
Is the home on a bus line?
Is there an outside area to sit, walk, or garden?

Physical Setting

Is the floor plan easy to follow?
Are doorways, hallways, and rooms accommodating to wheelchairs and walkers?
Are there hand rails to help with walking and in the bathroom? Are cupboards and shelves easy to reach?
Are there nonskid floors and firm carpets to assist walking? Does the home have good natural and artificial lighting?
Is the home clean, free of odors, and well heated and cooled? Does the home meet my standards of cleanliness?
Is the home free from obvious environmental hazards?
Are the home’s rooms clean, safe, and adequate for my needs?
Will I have free use of common areas, such as the kitchen, activity rooms, toilet facilities, dining room, or grounds?
Can I smoke in my room or in common areas? What furniture is provided?
Can I adjust the temperature of my room? Is there a sit-down shower?
Can I have my own personal phone line or internet connection? Are emergency procedures clearly posted?
Am I able to lock my room and/or are there locked areas in each room for personal valuables?

Food

Is the food pleasing, nutritious, adequate, and attractively served? What if I do not like what is being served?
Can I cook in my room? Are snacks available?
Are there specific meal times or are they flexible?
Is there a refrigerator available to store my personal food? Will the home meet my dietary or cultural food preferences? Can I request special foods?

Other Residents

Do other residents socialize with each other and appear happy and comfortable?
Do residents speak favorably of the facility?
Do the residents look like people I want to live with?
How are room changes and roommate concerns addressed?
Is there a resident group that meets?
Do any of the other residents have a history of violent or other problem behaviors? How are these situations handled by staff?

Once a Decision is Made

Planning and information gathering does not stop once you have made your decision to move into an adult family home or assisted living facility. Moving is a major life change. To help ease the transition, use some of the same steps defined in the first part of this blog: 1. Talk through the changes that will need to be made. 2. Ask staff at the new residence for help with any questions you have. 3. Get any other additional information you need. 4. Make a plan of what needs to happen and when. Moving to an adult family home or assisted living facility can mean letting go of a lifetime of possessions and a familiar way of life. Some people are relieved and look forward to fewer responsibilities while others find it emotional. Either way, the person making the move needs the full support of family and loved ones and should have the central role in determining what happens and when. Once the move has happened, anticipate a normal period of adjustment. The first few weeks can be the hardest as routines get established and things become more familiar. It is important to discuss any concerns or questions with the adult family home or assisted living facility administrator. Be sure to ask for what you need. The staff may be able to make changes that will better meet what works best for you.

Thank you,

Glenda, Charlie and David Cates