Whether we're looking into some additional in-home care or a more significant change in
lifestyle like moving to an assisted living facility for ourselves or on behalf of a parent or other
senior loved one, it often is the first time we've put much thought into the concept. The idea of
a senior loved one's lifestyle changing to the extent they need additional help can be an
emotional issue which makes it difficult to engage in rational evaluation processes.
Senior Resources and News has a few tips for you to follow when considering and assessing
the various levels of additional care available for you or a senior loved one, including our
exclusive rating system question-tree, S.E.R.V.I.C.E.S., which helps you comprehensively
evaluate an Assisted Living Facility (ALF) or Adult Foster Care Home (AFCH).
At first blush it would seem that choosing an in-home care service would be a very simple
process. Afterall, the service is being provided in the home which you or a parent are already
living in; the adjustment process seems negligible.
However, there are some issues to think about so you don't end up having to engage several
services in a row to find the right fit. A rapid change in care givers can add a great deal of
stress to the life of a senior.
Medical or Non-Medical: Will the client direct help with their medication? If yes, then an
in-home service which is authorized to dispense medicine will have to be considered. If the
client merely needs help with being reminded to take medication, a non-medical service will
suffice - and probably offer lower rates.
Licensing: Check with the appropriate state regulatory licensing agency to make certain the
firms you are considering have a current license. Some states offer information about any
complaints or disciplinary actions levied against licensed in-home care agencies.
Freelance vs. Agencies: Clearly, you want a reliable, experienced care giver for yourself or a
loved one. In many cases an independent care giver can be obtained through classified ads or
a referral, but in many states, independent care givers do not have to conform to the same
standards states require for agencies. With a licensed agency, there is no question that the
care givers and the service are insured, trained and have some degree of experience. Also, if
state financial aid or grants are offered in your state to partially offset the cost of in-home care
for qualified individuals, many times this funding is exclusively for licensed agencies only.
Compatibility: The vast majority of in-home care services offer free assessments - an event
where an in-home care representative comes into the home, interviews the client and family
members and discusses the agency's qualifications and a possible care plan appropriate for
the client. The assessment event is a time for you to directly interview the agency as well. Try
and determine if the way the representative characterizes the agency seems compatible with
you or your loved one. Do they stress the importance of providing the same care giver as much
as possible? Are they observant during the assessment? Try a simple test like laying out an
extension cord in the room where it is a trip hazard before the visit; if the agency representative
points it out as a fall danger and recommends changing it, it is a safe bet that their care givers
are equally sensitive to household safety issues.
Costs: As we mentioned earlier, a non-medical agency is likely to offer lower rates than an
agency authorized to dispense and administer medicine. Don't forget to find out about an
agency's minimum appointment time, cancellation or reschedule policies, deposit requirements,
payment policies, etc. Make certain you understand all the rules of engagement.
Moving from your home to an Assisted Living Facility (ALF) or Adult Foster Care Home (AFCH)
increases the necessity of making the right choice when evaluating this lifestyle change option.
Afterall, moving your entire household into new surroundings is a large undertaking; you don't
want to do it several times in quick succession because you didn't take into account all the
elements needed to make a sound choice.
Senior Resources and News has developed a decision-tree we call S.E.R.V.IC.E.S. to use as
an informal checklist when evaluating an Assisted Living Facility or Adult Foster Care Home.
Staff - How busy is the ALF or AFCH staff and administration? Is the ratio of staff to residents
adequate? What kind of turnover does the facility have?
Environment - Is the overall ALF or AFCH environment compatible for you or a loved one? Is
there a lot of noise? Is the Assisted Living Facility or Adult Foster Care Home close to a
convenient bus line, the library, church, shopping, relatives and friends? Is the outside of the
facility set up for resident enjoyment? (e.g., gardens, scenic decks, etc.)
Research - As we mentioned before, check the facility's licensure with the appropriate state
regulatory agency. Make certain it is current and, if this information is available, whether the
facility has received any disciplinary actions or formal complaints. Ask for and check references.
Visit - Make certain you subject each Assisted Living Facility or Adult Foster Care Home you're
considering to a thorough visit. Is the facility designed and well laid-out for its residents'
needs? Does the staff seem happy and professional; do they interact professionally with the
residents and each other? Is the facility clean and neat? Does the overall decor and ambiance
seem compatible with you or a loved one?
Infrastructure - Is the facility wheelchair accessible? Are the bathrooms set up for senior use
with toilet and shower safety rails, toilet seat risers, etc.? Do the hallways and pathways have
Communication - Effective communication starts with the initial conversations with family
members about the need for additional lifestyle assistance. It continues with communication
with physicians and facility administration and staff about needs, expectations and obligations.
Make certain the management style and culture of the facilities you're considering match up
with you and your family's collective communication style.
Economic Issues - Make certain you fully understand all the service and cost factors for each
facility you're considering. What services are included with which fee structure? Are there
additional services available for added fees? Are the services customizable within the flat fee
structure or is it a fixed suite of services whether you need them or not? What are the payment
and refund policies of the facility? Do they have a rate increase policy? Does the facility accept
Medicad or transfer to Medicaid when eligible?
Services - Does the Assisted Living Facility (ALF) or Adult Foster Care Facility (AFCH)
provide transportation? If so, is it a set transportation schedule or can it be privately
scheduled? What are the specific Activities of Daily Life (ADL's) the staff helps with? To what
extent? (e.g., bathing help or shower standby?) Are religious services held at the facility? Are
pets allowed? Does the facility maintain visiting hours? Are there provisions for special dietary
needs? Is self-cooking allowed? Can personal food be stored safely in the centralized
The most important things to consider are comfort and safety for yourself or your senior loved
ones. The lifestyle transition from complete independence to some forms of assistance, no
matter how slight, are difficult to adjust to. Just like carpentry, when you're evaluating an
in-home care giving service, assisted living facility or adult foster care home, it is best to
measure twice and cut once!
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