Wednesday, February 25, 2015

Adult Family Homes: Commonly Asked Questions

All down the West Coast, and in other parts of the country, adult family homes dot the eldercare landscape.  In Seattle and surrounding King County, there are 1100 such care homes. 

They're little known wonders.  Two years ago I started knocking on the doors of adult family homes in my city.  As I met the providers, observed the caregivers and spoke with the residents, I grew in my admiration for this homelike setting.  I'd worked with seniors and their families for 18 years, but adult family homes were new to me.

Since then, I've spoken with clients who have had the following questions about adult family homes.

1.   Are caregivers in adult family homes adequately qualified?

Caregivers in adult family homes must pass the same basic training classes as those working in assisted living communities.  Those classes include coursework in dementia care, mental health and fundamentals of caregiving.

2.  What is the staffing level in an adult family home?

In Washington, the law requires at least one caregiver for six residents at all times.  However, many if not most adult family homes have two or three caregivers working during the day, with one available at night.  In assisted living communities, staffing levels are on average 12 residents to one caregiver.

3.  Can adult family homes care for serious medical conditions?

Yes.  The Law allows adult family homes to care for nearly every condition that a skilled nursing
facility can handle, with a few exceptions including  IV injections.

4.  Do adult family homes have licensed nursing staff?

Some homes are owned and managed by Registered Nurses.  All adult family homes have Nurse Delegators.  These are specially certified RN's who train the caregiving staff to do tasks that normally an RN does such as medication management, administering of creams and insulin injections.  These Delegating Nurses are on call for the adult family homes to problem solve, consult with physicians, and assess residents' progress.

5.  What type of resident is best suited for an adult family home?

People who are considered "fall risks" because they've fallen several times are particularly suited for an adult family home.  There are no long halls to navigate, and staff members can watch residents closely during the day.   At night, if residents can't push a call button, staff can place a pad with a censor on the floor near the bed.  If a resident starts to get up, the censor goes off quietly so the caregiver can hear and check in.

People with dementia, especially mid to late stage, do well in adult family homes. The quiet atmosphere and caring staff can be soothing.

6.  What elders might NOT be best cared for in an adult family home?

Elders who are cognitively intact and physically able and who crave social activities are better served in assisted living.

Do you have other questions about adult family homes? 

Tuesday, February 10, 2015

Eldercare Q-A: Mom has a new dementia diagnosis. Will she need memory care?

 Memory care.  When someone is diagnosed with dementia, their family ponders the possibility of the need for such specialized care. Perhaps you're in that situation.

The key is possibility.  Not everyone with dementia needs specialized memory care.

What triggers the need for memory care?  Behaviors like screaming, striking out at others, and behaving inappropriately, such as using a waste basket for a toilet, all indicate a need for memory care.  So does "exit seeking."  That's a term for someone who impulsively and repeatedly heads for the outside door of his home or assisted living community.  Another indicator of a need for memory care?  People with dementia who can no longer feed themselves.  There are others, but you get the idea.

If your parent has just been diagnosed, he or she doesn't likely need memory care immediately.  Often a smaller assisted living community may meet his or her needs during the early to moderate stages of the disease.  Your parent can retreat to his or her apartment when the stimulation of the dining room and social activities gets to be too much.  Caring staff can make his or her days go well.  And if the disease progresses to the point of needing memory care, they should be able to tell you.

In many assisted living communities nationwide, the memory care area is in the same building.  Often residents begin in the regular assisted living section, and then move to memory care if and when the need arises.

Another option for elders with moderate to severe memory issues is adult family homes.  These may or may not be available in your parent's state.  But if they are, they're a good alternative for many with dementia.  There's a high staffing ratio, often one staff member for three residents, and the small setting allows caregivers to keep a watchful eye over residents who are at risk for falls. 

If  your parent will need Medicaid funding, care options will likely be limited.  Often adult family homes and nursing homes are the only Medicaid-funded choices for those with moderate to advanced dementia.

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