How to Choose an ALF

Questions to Consider When Choosing an Alzheimer’s Assisted Living Facility

Finding a facility for your loved one can be a daunting task. It is a highly emotional decision compounded with a myriad of uncertainties. To help you in your search for the perfect facility for both you and your loved one’s needs, we have prepared a small set of questions that we feel are important to ask all facilities (including ours). These serve as a good starting point to understanding the facility’s approach to Alzheimer’s care. For full disclosure we have included our responses to each question as well in italics.

There are many different building layouts for memory care facilities, ranging from small homes that have been retrofitted to house multiple residents, to very large facilities that take care of 20-50 residents. Choosing a layout that suits your loved ones need is an often-overlooked aspect when searching for the right community. Layout is critical because it is one of the few things that a resident will interact with on an almost constant basis. A proper building layout should be intended to facilitate socialization, reduce confusion and promote staff vigilance. Items to consider are: are the common areas easily accessible for somebody with memory issues, are there too many areas where a resident could get lost or confused as to where their room is, are there too many residents in one area. All of these issues will have an effect on how a resident will become acclimated to their new surroundings.

Georgetown Living carefully researched the best building layout and occupancy for providing memory care to our residents. We chose to only care for 16 residents in each home, thereby allowing each person to receive individualized care without the confusion of too many residents. The lack of interior walls allows residents to see all of our common areas from any given point in the building. This significantly reduces confusion and thus promotes more social interaction. The room doors are color coded to help remind our residents of where their room is, so it enhances familiarity. The interior wandering path is a loop, thereby promoting very safe wandering. Lastly, the building layout prevents our residents from getting lost in the shuffle as our staff performs all of their normal duties (laundry, medication administration, charting) among the residents.

This may be the least obvious question to ask, but is still quite important. Speaking with the management team of the facility will give you a window into the general direction of the facility. The leaders of the facility/company naturally project their own vision of dementia care onto how the entire operation is run. Do they have experience with dementia care? Are they passionate about caring for those with Alzheimer’s/dementia? Are they always accessible to resident families? These questions can help you to know where the heart of the facility lies, and gives you insight into the overall care of your loved one.

We at Georgetown Living have chosen to solely specialize in dementia care. We are not a large corporation that does assisted living and dementia care. We are a family-owned, yet professionally run, facility that wants only to provide the highest level of care for those with Alzheimer’s Disease and dementia. Our management staff and board of advisors have invested a significant amount of time into the research of the disease as well as innovative measures to ensure that we deliver the highest quality of care for those with dementia. Alzheimer’s and dementia care is our passion.

The unfortunate nature of the disease is that every individual will advance at a different rate and in a different manner. It is very important to know the facility’s policy on how to handle the progression/worsening of the disease. Below are important questions to ask about the facility’s ability to adapt and will help you get a feel for how the facility treats advancement of the disease.

  • Is staff trained to handle if the resident requires help in a wheelchair (transferring from bed to chair)?
  • Is staff trained to handle total assistance when it comes to bathing?
  • Will staff aid in the feeding of the resident if they are unable to feed themselves?
  • Is staff trained on managing the agitation that occasionally presents itself during the disease process?

Georgetown Living believes in Aging in Place. Aging in Place means that barring any additional severe medical condition, we will take care of our resident through all stages of their dementia. Our staff is trained to provide all mobility assistance, will bathe and groom residents who must remain in their beds, and will always take the time to ensure that every resident is fed and hydrated. We at Georgetown Living believe that you should be proficient in handling the entire progression of the disease, not just the early stages of Alzheimer’s/dementia.

You may see some facilities that have the label “Certified Alzheimer’s Facility”, whereas others do not have this designation, even though they may care for those with Alzheimer’s Disease. The differences are not immediately apparent. The State of Texas requires facilities that provide assisted living to obtain an Assisted Living license. This means regulations involved with the nature in which the physical building is constructed as well as how the facility is operated. In addition to this license, some facilities opt to obtain an additional license to become known as a Certified Dementia Facility.

Being a Certified Dementia Facility involves more regulation and guidelines than a non-certified facility. These additional regulations touch on issues concerning the construction of the facility and with how the facility is run. For instance, caregivers and managers of a Certified Dementia facility are required to have rigorous initial and regular training in Alzheimer’s and dementia care. Furthermore, Certified Dementia facilities are required to develop activities particular to those with Alzheimer’s/dementia, whereas non-certified facilities are not. Certified Dementia facilities are the only facilities that are allowed to have an electronically coded lock down door, whereas non-certified facilities are only allowed to have doors that open after a bar has been depressed for a certain amount of time (delayed-egress doors).

Facilities with the label “memory care” or “memory support”, these facilities may not be certified by the State to care for those with Alzheimer’s Disease/dementia. The reason is that the State of Texas prevents all non-certified facilities from using the words “Alzheimer’s” or “dementia” when advertising their services.

Georgetown Living is a certified Alzheimer’s Facility. We, as a family, decided to obtain this more difficult designation because we felt the more rigorous oversight and regulations were consistent with our motivation for starting Georgetown Living. We have chosen to exclusively specialize in Alzheimer’s and dementia care and we felt our designation should reflect this.

Staffing is arguably the most important issue when it comes to resident care. Simply put, it is impossible to deliver consistent care without qualified, conscientious and numerous staff members. When visiting or speaking with facilities, it is important to inquire about their motivation behind staffing. In addition to the questions below, some important things to ask a facility would be their staff retention and how they handle the schedules for caregivers (i.e. consistency).

We understand this significance and thus place quite a bit of emphasis on this facet of care. Each staff member, from chef/cook to caregiver is hand-selected from a large pool of applicants. We employ only those individuals who intimately agree with our philosophy of care. This includes compassion, patience, empathy and professionalism.

Staffing ratio is incredibly important when it comes to any assisted living setting, but is even more important when it comes to caring for those with Alzheimer’s Disease. The State of Texas does not have a set ratio of staff to resident for assisted living facilities, and instead opts for a more nebulous claim of enough staff to properly care for the number of residents that are present. Given this ambiguity there is quite a bit of variation with the ratio of staff to residents between facilities.

Our staffing ratio is tailored for the ebb and flows of our resident’s condition. During most waking hours our staffing ratio is typically held at 1:5, and this does not exclude our administrative, activity or nursing staff.

There is no minimum formal degree or certification requirement for those employed as caregivers for facilities. However, there are requirements on the necessary training that a person has prior to working for a facility. This should include formal instruction as well as on-the-job training (one of the important differences between a certified and non-certified facility is the approach to dementia training). Questions to ask are not only how a facility maintains state compliance when it comes to staff training, but also how they exceed the minimum guidelines on a routine basis.

We take great pride in our staff training. We of course adhere to state guidelines when it comes to the necessary topics and methods of training. We then take it one step further. As we believe nothing can replace hands-on education, we heavily utilize on-the-job training so that a new staff member fully learns our methodology of care. Staff training does not end there. We continually educate our caregivers on specifics regarding resident care and Alzheimer’s Disease throughout their tenure with us. This is accomplished through mandatory monthly training meetings as well as review of current literature regarding caring for an individual with dementia. We place a heavy emphasis on redirection techniques (the ability to head off any agitation of our residents, a common occurrence for those with dementia).

Activities are crucial for the assisted living experience. They need to be consistent and represent a variety of difficulty so that residents of all levels can participate. Remember, there is more to life than just bingo. Activities should be tailored for those with Alzheimer’s. Inquire about the types of activities that the community provides and even ask to sit in on some. Keep in mind that it is a home, and not a summer camp. It is important for residents to remain stimulated but not overly stimulated. Just like you enjoy having downtime in your home, so too do residents.

We at Georgetown Living understand that activities for those with Alzheimer’s need to be different from others, therefore we provide a variety of activities targeted at all cognitive levels. Some are simple while others are more complex. The benefit of a more intimate facility is the ability to change, create and develop activities specifically for each resident. We tend to focus on activities that promote social interaction and those that have a physical motion component.

All types of facilities have their strengths and weaknesses. It really is a personal choice. At Georgetown Living we are fond of saying that the decision for an Alzheimer’s Assisted Living facility should come from the gut. Right when you walk into a facility we believe you form the correct impression of whether it is the perfect place for your loved one. Some people enjoy the streamlined efficiency of a large facility. Others prefer the comfort of a private home as it emulates what their loved one has lived in all their life. It truly is a personal decision.

We intentionally decided to keep both of our buildings “small.” We target only 16 individuals in each building. We believe that this represents the perfect size to promote social interaction while still providing a sense of camaraderie among the staff and residents. From the standpoint of space, our community allows for safer wandering and exercise than a conventional home, but still feels comfortable and intimate. With this number of residents, we are able to spend time with each resident on a daily basis so they become part of our family and not just a face. Also, our revolutionary design of our community allows for a decidedly home-like feel. On the flip side, the professional atmosphere and amenities allows us to be highly proficient in the manner in which we conduct our business. It is our opinion that this size and layout is the optimal manner in which to care for those with dementia.

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