1. Know what Dad needs. Get an independent assessment for ALF level of care.
You can’t begin finding the perfect ALF without knowing what Dad really needs. Many families start with looking at places a friend recommended or they’ve seen in the neighborhood. But, that’s just wasting time when you don’t know what will fit his needs. Knowing what “level of care” Dad needs will determine which facility (or services/area within a facility) can properly help him.
An independent assessment gives you a clear evaluation of Dad’s physical and cognitive status, ability to handle ADLs and IADLs (daily living tasks), and medical situation. This is best for you to have going into the process.
2. Get a handle on the finances. Determine Dad’s budget and understand costs of various ALF options.
ALFs come in a wide range of styles and prices. After knowing what Dad needs, the next factor in finding the perfect ALF is what he can afford. Just think about doing your own home search. You only look at houses within your budget range, so you need to be clear on Dad's monthly ALF budget.
This might be where a visit to Dad’s financial advisor comes in handy. Additionally, when understanding ALF costs and Dad’s budget it’s important to know what’s included. You can’t compare a monthly ALF cost to a home mortgage or rent. Of course, care is included. But, residents also typically get meals and don’t pay separately for most utilities. You can look at Dad’s income, assets and additional resources that might come from selling things like his home and car.
A care manager can help you tap into benefits programs to help too. Some of these might include VA benefits or specific Medicaid programs. There’s not one place to go to find all the benefits and eligibility can be quite complicated. Paying for some expert help up front can save Dad a lot in the long run.
3. Make a short list based on #1 and 2 plus other key factors.
The first two will narrow down your options. After that, don’t overlook the “little things”. You might want to hone in on a small area, especially if friends, neighbors and family will visit more often if it’s convenient. This can also matter if Dad still wants to go to his old church or other local activities.
What types of activities does the ALF provide? Do they offer outings? (And, remember, this is about what fits Dad’s personality and interests, not yours.) What amenities and facilities does the ALF have? Can Dad see his current doctors and is transportation there included? What limitations are there on the transportation?
Quality of Care
And, of course, one of the biggest factors should be the facility and staff quality. How will you find out about this? You should always review state ALF surveys/reviews. But, that doesn’t give a very complete picture. A care manager who has clients in local facilities and helps families with the transition process can give you an honest review. Unfortunately, this is one of the possible downsides of “free placement services”. These are available in some areas, and they’re paid by facilities when someone moves in. They may know a fair amount about certain facilities, but may not work with them all. And, they typically won’t have the same kind of experience after move-in with the day-to-day of clients’ lives in the ALF.
The process of creating a highly targeted list is essential. Over the years, we’ve had clients’ families tell us they’re flying into town to visit a huge list they found online. First, you will exhaust yourselves and get choice fatigue. Second, you don’t want to find yourselves “falling for” a facility that doesn’t fit for Dad. You may be tempted to try to make it work. Both of these may lead to an ALF decision you’ll be regretting in a couple weeks or months.
4. Visit and evaluate the ALFs.
Now that you have a short list, it’s time to visit the ALFs and evaluate. But, how do you clearly assess which facility is perfect for Dad?
Some of it will be look and feel. Like picking out a new home, you and Dad should have a good “gut feeling”. But, it’s a bit more complex in this case since you’re relying on care services. Here are a few pointers for a clear decision:
Come up with a standard list of questions and things to evaluate.
Your care manager can help with questions that might not be on your radar but tend to be important in ALF experiences. Make sure you’re comparing apples to apples. Make notes of what you find to review later. It’s easy to get overwhelmed or base your impression on the friendliness and sales skills of the marketing staff.
Visit at a couple different times of day, since staffing, activities, etc. can vary greatly (and do this across the board, again to get an apples to apples comparison).
On your return visit(s), you can also address questions you thought of after your first visit.
Consider the value of having a 3rd party along.
Even a friend who's less emotionally involved might offer you a different perspective. A care manager, in particular, will notice any little red flags (or good signs) and can help with asking questions, giving you feedback, etc.
Have a meal.
Food is the #1 area of complaint in many facilities. On the other hand, it’s the thing that can make someone feel most at home. Check out the menu options. Find out about dining hours, flexibility, dining room arrangements, etc.
Talk to a variety of people.
Your main point of contact will be a marketing representative. Unfortunately, that’s not who you’ll be dealing with on a day-to-day basis once you move in. So, it’s best to meet some of the other staff. And, talk to residents and families too. If your care manager has clients there, she may be able to arrange a chat with them about their experiences.
After visiting, take time to discuss the pros and cons. Look at the whole picture, and be clear on any doubts or questions.
5. Make the transition...go from good ALF to perfect home.
Even when moving to the perfect ALF, you need to plan so things start out on the right foot. Particularly since this is a huge change for Dad, the first impression matters most.
Review the contract and details of his agreement with the facility. Know what’s included, rules, schedules, etc. Identify the staff you need to talk to about various things. Introduce yourselves.
Make a plan for the move-in day. Think through details and ways to make this day less stressful for Dad. This includes arrival times, help getting the room all set up and ensuring Dad has everything he needs from day one. If Dad had a home caregiver, you may want to hire them to spend some time with him at the ALF the first few days/weeks at least. They can help with organizing and tasks, but also getting him to activities and accessing things he needs. A familiar face can be a huge comfort.
And, for even the best ALF in the world, you may run into some issues. Regular visits will help you spot any potential problems and keep an eye on things. Knowing staff and them knowing you makes all the difference. If you live at a distance or want a professional ro review the chart and advocate for Dad, hire a care manager.
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