At some point, particularly if your cared-for is of advanced age, changes will be required. Your cared-for may need increasing assistance that you just can’t provide and still hold on to a full-time job, or maybe you just can’t be there enough. Watch for these changes and get ahead of them. Too often people need to move to a higher degree of care/assistance when some crisis occurs, and that can lead to hasty decision making.

So, give some thought to these things now, and investigate options in your spare time (yeah, right, spare what?).

I’ve recently been evaluating assisted living facilities. Ultimately, so long as your cared-for is competent, it’s their decision and it will come down to what’s affordable and where they feel most comfortable. The latter is necessarily subjective, but is also the most important.

As caregiver, I think the most important thing you can do is to watch for red flags that might veto a particular facility. Here’s a list of things to consider or ask about:

• Security: are doors kept locked? Are visitors identified and escorted? How do friends and family gain access? Can anyone walk in off the street?
• Is there a disaster plan? Are arrangements in place to house residents elsewhere if there’s a power outage, HVAC failure, or fire? Does the facility have a generator and how often is it tested?
• If you keep in touch with your cared-for via electronic means, is Internet access available? Phone lines? How’s the cell phone coverage?
• What sort of medication management is available? Is there flexibility if your cared-for handles some or all of their own medications?
• Is transportation to doctor’s appointments available? If so, what are the limitations (distance, days, etc…)? Is there a charge for this?
• Are pets allowed? This could work both ways, depending on whether your cared-for has a pet they want to bring, or would rather not have small furry/scaly/feathery critters around.
• How many residents are there, and how many is the facility licensed for?
• How many staff are on site when? Pop quiz question: how many staffers are on site right now?
• Can the facility provide all the care your cared-for requires? Meals are probably a given, but what about assistance with bathing and dressing?
• What sort of activities are there to fill the resident’s days? Are there exercise facilities?
• Look around: are there exit signs? Smoke detectors? Is the facility clean, neat, and organized? Do the residents appear to be comfortable and well cared for?
• What’s the reputation of the facility? Is it well-regarded in the community?
• Who owns the facility? Many may appear to be local, independent facilities, but most are owned by larger companies that own and operate a number of facilities. This, also, can work both ways: a local, independent facility will likely be more flexible, maybe even cheaper, but may not have the resources of a larger organization. OTOH, a facility part of a larger chain will likely have more “disaster” options (nearby “sister” facilities) and more financial backing, but may be more subject to the machinations of Corporate America, like management changes and rules that might not be as flexible as one might hope.
• If you can, get a look at recent health department reports. My own state does not make this information available (I tried), but if you can get access, do so. Just keep in mind that one report doesn’t mean much. Look at reports over at least a year, looking for recurrent problems. I know from experience that the day the auditor shows up and wants to see a file restored from a backup, that’s the one time the tape will throw an error. If there’s something in a report, look to see that it was resolved.
• What mechanisms are there for a resident to call for assistance? Are pull stations located conveniently, and is a pendant that can be worn available?
• Is there a waiting list? If so, would space be available when you think you’ll need it?
• If your cared-for has to leave the facility temporarily (for a hospital stay, or vacation), will their space be held for them, and what adjustments to fees are made?
• How are emergency situations handled? What happens when someone falls?
• Is there a process to address concerns?
• What range of care is available? If your cared-for needs increasing levels of assistance, or nursing care, is that available at the facility in question, or would they need to move?

Again, your cared-for is the best one to decide where they’re going to be happy. You’re just looking to vet out the choices.

All the facilities I looked at provided respite care, where your cared-for could stay there for a week or so. This can be a good way to try out a facility, and may be an option if you, as care-giver, need to go on a business trip or something, or just need a break.

Finally, and maybe most importantly, don’t let your cared-for think that you’re just going to drop them off and disappear. Y’all have been working together for perhaps a very long time, and that needs to continue. If nothing else, you need to keep a sharp eye on things to make sure they’re getting the level of care they need (and you’re paying for). You’ll need to change your routines to accommodate regular visits and general staying-in-touch. Your cared-for will continue to need a “patient advocate”. There will likely be incidental things, like reading material, music, or a favorite food that’s not readily available, that you’ll need to provide. Take them out to dinner occasionally. Celebrate their special days. And, just be there for them.