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Warning Signs When Touring Assisted Living Facilities

Making the mistake of choosing a bad assisted living facility is a nightmare scenario for seniors and their families. Imagine living in a place where there are all sorts of hidden dangers to your safety that make it more likely you will have an accident, where the people around you are indifferent or even hostile, where you have no control or say in how to live. Your calls for help go unanswered, and when your family tries to advocate for you they get mired in arguments with the management. No one wants to make such a large commitment and then realize that they are stuck, even temporarily, in horrible living conditions. Some bad facilities can be spotted right away due to their deteriorating physical conditions and clearly depressed residents. But in facilities that on the surface seem just fine, there are other smaller signs you should look for that could be clues to larger problems. Many of them are listed below. Any facility that takes pride in providing excellent senior care should have these items covered.
  • Is the facility’s state license and a Resident Bill of Rights displayed in the lobby?
  • Where are smoke detectors located? They should be in rooms, hallways, and community areas.
  • Do the windows have safety locks?
  • Is there an emergency generator or some other way to provide electricity if the power goes out?
  • Does the facility have fire drills and are emergency plans easy to find?
  • What is the crime rate in the neighborhood where the facility is located?
  • Will the carpeting in the rooms prevent residents from moving easily with walkers or canes?
  • Handrails should also be plentiful throughout the facility.
  • Does the bottom step on stairs have recessed lighting or colored tape to make it more easily seen?
  • Have area rugs wandered so that they’re sticking out over the top step of the stairs?
  • Is the light in the facility adequately bright?
  • Is there a way to call for help in the bathrooms? Are there non-slip mats and handrails near the toilet and inside and outside of the shower? There should be a shower and not a tub, and the shower should have a seat where residents can sit if they need to.
  • Are there strong smells? A heavy cleaning chemical smell could indicate that the facility is trying to cover something up.
  • Ask to see an occupied room. Is it clean?
  • Is there a big difference between the atmosphere of the lobby and common areas and the rooms?
  • Try to listen to how the staff addresses and talks about the residents. Are they using the residents’ names?
  • How does the staff treat you? Are you acknowledged or ignored?
  • How does the staff speak to residents or to one another? If they are polite to you and to residents when in your presence, but rude to each other, that may be a sign of how they treat the residents on a daily basis. People can only be on their best behavior for so long, and if you don’t like how they act with people they are comfortable with you probably won’t like how they act once you’ve signed a contract and paid the entrance fee.
  • Do calls for help seem to be answered quickly?
  • Are there residents sitting alone in wheelchairs with no one to help them?
  • Are residents eating all their food at mealtimes?
  • Do residents seem happy, active, and social?
  • Is their appearance clean and well-groomed?
  • Are common areas being used?
  • Does the facility seem chaotic or crowded?
  • Does the facility seem open to visitors during your tour? Are you able to speak with residents?
  • If a parent and adult child are visiting the home together, does the tour guide make an effort to include the senior in conversations as well?
  • If you stop by unannounced, will the staff let you in?
  • What do you find when you research the facility through the Better Business Bureau, local agencies, or online? How does the agency respond when you ask them about negative feedback? Have they responded to negative feedback left online?
  • Look over the contract carefully. When can residents be evicted? What happens when they run out of money?
When evaluating an assisted living facility, be sure to not just take the official tour, but also make unannounced visits. First, stop by during dinner to observe how the residents interact with each other during the meal and whether or not they like the food. Then make another surprise visit on the weekend. During this time, you’ll be able to meet family members of the residents either in the common areas inside or the parking lot. You can get their candid opinion on how their loved one has been treated. Try to sit for awhile in an area that has a lot of foot traffic but is away from offices where the marketing staff or management might be. Just observe what goes on around you.
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Paying for Assisted Living

The biggest fear many have when making senior living decisions is what it will cost. The fees for assisted living facilities at first glance may seem quite high. Keep in mind though all that assisted living covers: housing, at least some meals, and help with your daily needs. Beyond assisted living and your medical expenses, you will likely need to spend very little, if anything. Assisted living is usually paid for using long-term care insurance, personal funding, or veterans benefits. These funds may be supplemented by social security. Long-Term Care Insurance Long-term care insurance covers services that help people who need medical or non-medical care over a long period of time. It will cover assisted living if you cannot perform two or more “activities of daily living” (ADL), such as walking, using the bathroom, or getting dressed. You may have to have an examination by a doctor chosen by the insurance company to be sure that you qualify. The benefit is often structured so that the policy has a daily limit, usually $100-$150, and a lifetime maximum, for example $250,000. Some policies have an elimination period, an amount of time during which you must pay for your own care (similar to a deductible). As you grow older, your premium is likely to rise since the older you get the more likely you are to require long-term care. If the premium rises beyond your ability to pay, the insurance company will likely offer a lower premium in exchange for reduced benefits. In some but not all plans, you no longer have to pay your premium once you begin using the benefit. Personal Funding Money to pay for assisted living may come from retirement funds like Individual Retirement Accounts (IRAs), pensions, or 401k plans. People also use the funds from the sale of their home. A home purchased 40 or 50 years ago will yield quite a bit of equity that can go towards senior care. If you are unable to find a buyer by the time you need to move, you may be able to get a bridge loan to help pay for your care. This loan provides immediate funding, which you then pay back when your house does sell. You can usually gain at least a few extra months to sell your home before you need to start making payments on the loan. If you don’t want to sell your home, there are other options available. You may be able to rent it out, thus giving you a monthly income. You may also be able to take out a reverse mortgage, where you receive money drawn against the equity you have in your home. You can receive this money as a lump sum, monthly payment, or revolving line of credit. Keep in mind that your spouse (or someone who owns the home with you) must still be living in your home for you to qualify. Also, the starting costs associated with these loans can make them quite expensive. With any of these financing options, if you have relatives who are in a position to lend you money in exchange for equity in your home, you may be able to come up with a similar arrangement privately, rather than borrow from a bank or other company. Consult with a lawyer to learn more about this option. Veterans Benefits Veterans benefits may be able to help you finance care in an assisted living facility, if you or your spouse served in the military. This is the Aid and Attendance tier of the Improved Pension offered by the Veteran’s Administration. You do not need to have any sort of injury related to your service, though you must have been on active duty at least 90 days and one day during wartime. You also must have less than $80,000 in assets. You’ll need to file the Veteran’s Application for Compensation and/or Pension (VA Form 21-526, Parts A, B, C, and D). A Note on Medicare and Medicaid First, you should know that some assisted living facilities, including Raya’s Paradise, only accept long-term care insurance or private funding. Also be aware that Medicare does not pay for assisted living as assisted living is not medical care but rather assistance with your daily needs (Medicare will pay for medical expenses incurred during the time you are in the assisted living facility, such as your prescriptions or visits to the doctor). Medicaid might pay for a limited stay (often 90 days or fewer), but even then, coverage is limited. In some states Medicaid pays for the personal care services you receive, and in others it pays for room and board as well. Medicaid does not currently pay for assisted living in the following states: Pennsylvania, South Carolina, Alabama, Kentucky, and Louisiana, though it is likely that there will be national coverage in the coming years. Finally, you may be eligible for tax deductions that can also help pay for senior living expenses by reducing your tax liability. You can learn more by doing research at www.irs.gov on the Elderly and Disabled Tax Credit and Medical Expense Tax Deductions, and on your state’s elderly care tax credits. You may also find it helpful to talk to an accountant.
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Evaluating an Assisted Living Facility

Your selection of an assisted living facility should involve both tours of the places you are considering and extensive conversations with those running the facility. Comparing different facilities to one another can seem overwhelming. Use the checklist of questions below to help you notice important details that can reveal the true quality of a facility and aid you in the selection process. Note that if you are evaluating assisted living facilities on behalf of a loved one, you should try to involve them in the process and get as much of a sense of their desires as possible. He or she is the one who will actually be living in the facility, and his or her comfort, happiness, and satisfaction is the most important outcome. In General
  • What is your gut feeling about the assisted living facility both at the beginning and end of your visit?
  • Do the current residents seem happy and satisfied?
  • If you are able to talk with residents or their families about their experience, what do they say?
  • What do you learn when you research reviews and other information about the facility online?
Environment
  • Is the facility clean and free of odors?
  • Is the temperature appropriate?
  • Does the environment feel attractive and comfortable?
  • How many units are in the facility?
  • Does the assisted living facility offer private or shared rooms, or a mix?
  • What common areas are available?
  • Will any features of the community pose a problem for your condition?
  • Are the rooms large enough to meet your needs comfortably?
  • What are residents allowed to bring with them when they move in?
  • What are residents allowed or not allowed to do within their own rooms?
Nature and Quality of Care and Services
  • Does each resident have a written care plan? How often is it reviewed and revised?
  • Who is involved when assessing the resident’s needs? How much say does the resident have?
  • How does the assisted living facility adapt as the resident’s needs change?
  • What services does the facility offer and how often are they provided?
  • Is staff available to assist the residents 24 hour per day?
  • Are special care units available, for example for dementia patients?
  • How often are meals served, what times, and where?
  • How much variety is there in the menu?
  • Does the kitchen accommodate special needs and requests?
Safety
  • Is the facility well lit and does it have clear signage?
  • Are there call buttons in the rooms?
  • Are there safety locks on the windows and doors?
  • Are there handrails in the bathrooms and elsewhere in the facility?
  • Is the carpet firm to assist with walking, and are there non-slip materials on the floor?
  • Is there an emergency generator or another plan in place for power outages?
  • What do the assisted living facility’s fire safety and security systems consist of?
  • What is the plan if a resident wanders off?
  • What is the plan for a resident’s medical emergency?
  • What is the hiring process for new employees? Is there a background check?
  • What are the policies about elder abuse and neglect?
Community
  • Would you or your loved one get along with the assisted living facility’s current residents?
  • How does the staff treat you?
  • How does the staff interact with the current residents? Do they seem to have a good relationship with them and know their names?
  • How do staff members treat each other?
  • Are residents chatting with one another during meals?
  • What organized activities are on the schedule? What activities do you notice taking place? Are they well-attended?
  • Are residents encouraged to attend activities?
  • How much interaction do residents have with the outside community?
Fees and Policies
  • Are you allowed to examine a contract? Does it clearly lay out all services, fees, and policies?
  • How much is the entrance fee and security deposit? Is the deposit refundable?
  • What is the monthly fee?
  • Is long-term care insurance accepted?
  • How does the assisted living facility bill for services?
  • What is the policy on late payments?
  • How are rate increases handled?
  • What if the resident runs out of money?
  • What are the rules for when residents must leave the facility? What are the most common reasons why residents leave?
  • How are refunds and transfers handled?
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Different Types of Senior Care

When beginning the process of choosing a senior living arrangement for yourself or a loved one, the many different types of senior care facilities can be overwhelming. What exactly do all these different terms mean? Which one is best for your situation? Below is an explanation of the difference among several types of senior care. Independent Living This arrangement is made up of individual homes or apartments for seniors who are basically self-sufficient, especially when it comes to their personal care. Seniors who are a fit for independent living can dress and bathe themselves and are still enjoying an active lifestyle. Residents have the option of cooking on their own and keeping their own car, though often meals and transportation to places like shopping centers, local parks, or the movies is provided. The key benefits of this type of senior care are extra security and emergency alert systems to bring help quickly (giving seniors and their families peace of mind), no need to worry about home maintenance tasks like mowing the lawn or cleaning the gutters, and a community with plentiful activities so that seniors need not fear being isolated or lonely. Independent living campuses often feature some kind of clubhouse, social center, and/or community dining. Some may even have pools or spas. The environment is designed to be friendlier to seniors than regular housing: for example, doors are wider, floors have non-slip surfaces, and stairs are kept to a minimum. One downfall to this arrangement is that seniors may be paying for more than they need. It’s more cost effective for them to live in a regular residence if they don’t want the extras that independent living communities provide and they already have an active social life and healthy network of support. Assisted Living These facilities allow seniors to maintain some independence and privacy while still getting help with daily needs. Seniors who need assistance with getting dressed, bathing, or remembering to take their medications are a good fit for this option. These facilities are designed for help to be very easily accessible at any hour of the day or night. In the past, seniors who needed this level of care could only choose between relying on family or a hired caregiver for intensive help or moving into a nursing home. Today assisted living has stepped in to fill the gap for seniors who have trouble with daily activities but do not need constant medical supervision. Assisted living is often cheaper than receiving the same level of care at home. The facilities can range from apartments or rooms to specially converted homes. The environment is inviting and comfortable with couches and well-decorated rooms, and sometimes features like gardens or fireplaces. Some if not all of the meals are prepared for the residents with attention to their dietary needs and preferences, and are served in the facility’s dining room. The staff will also provide social activities and foster a community. The relationships seniors can develop here among others who are their own age is one of the biggest benefits of this type of senior care. They are freed from daily worries and difficult tasks and can now simply enjoy their time. The facility will transport residents to medical appointments off-site and employ nurses to make sure the residents are getting the care they need. However, they usually do not have medical staff on duty at all hours nor are they supervised by a physician. Seniors who need a higher level of care would be better served by a nursing home. Excellent assisted living facilities know that independence and freedom are important to seniors, and try to maximize their residents’ ability to do things on their own as much as possible. The care should be personalized to your particular situation and take into account what you are still able to do and your own desires about your quality of life. Nursing Homes Nursing homes provide full-time medical care, and can only accept residents who have been referred to this type of facility by a physician. Seniors and their families can know that here medical help is immediately available with a nurse on staff round-the-clock and a doctor supervising the care plan. Nursing homes are in some ways similar to assisted living facilities in that they help seniors with their daily routines and provide meals and activities. The difference is that due to the medical needs of the residents they can feel more like a hospital than a home. Some find this environment unpleasant, and the mental toll can lead to additional health problems. At some nursing homes, receiving adequate care can be difficult, and the senior’s family needs to be highly involved to insure that their loved one is not neglected or mistreated. For most, the best choice is to avoid nursing homes until they become necessary, especially since the intensive care they provide makes them the most expensive type of senior care. It’s important that you choose a type of senior care that meets your medical and daily needs while not overspending for services you are unlikely to use.   Do you still have questions about the different options? The staff at Raya’s Paradise can help you determine if our assisted living facilities would be a good match for you or your loved one.
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Online news and blog coverage of the Sierra Bonita facility proposal

Several blogs and news outlets, including the LA Times took interest in and covered our proposal for Sierra Bonita: Follow the links below to read these articles at their sources: Curbed LA: Senior Living Facility On Sierra Bonita Still Breathing Curbed LA: No Mega Senior Living for Sierra Bonita Melrose Village Blog: Mega Senior Living Facility Turned Down Melrose Village Blog: Residents Concerned About Zoning Variance for Proposed Nursing Home Melrose Village Blog: Proposed Facility on Sierra Bonita Draws Controversy
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Raya’s Paradise featured on ABC News: Neighbors resist proposed assisted-living facility

Story by John North, KABC WEST HOLLYWOOD, Calif. (KABC) — They are fathers, mothers, grandparents and even great-grandparents, and they need 24-hour care. But people living in a Hollywood neighborhood just off trendy Melrose Avenue say they already have too many elderly-care facilities. And now they’re fighting back. Rose Katz turned 92 years old Monday. The kitchen table is filled with the desserts she will share with the other residents and staff. She lives in a home for people with Alzheimer’s disease and dementia in West Hollywood. It is a care home run by the same people who were turned down by the city of Los Angeles. They were denied a permit to build on Sierra Bonita Avenue. The builders, Raya’s Paradise, are appealing the denial. “They need special care that they can’t get on their own and that’s what’s being provided here,” said Robert Cherno, a land-use consultant. “It’s a homelike setting rather than an institution, and it’s the ideal setting according to several studies that have been done.” The West Hollywood home has been there 20 years and houses 30 elderly people. Sarah Rinde would be a neighbor of the proposed new home in Los Angeles. Her concern is a new facility would alter the character of the neighborhood. The builder, Raya’s Paradise, would construct a new facility. But they say it would maintain the local architecture. “I know that they need help too, it’s just, I love architecture. I see both sides,” said Rinde. It is not easy finding affordable residential care for Alzheimer’s and dementia patients. The city of Los Angeles has never before had an appeal such as the one filed because of the denial. Attempts to reach L.A. City Councilman Ed Reyes for comment on the denial have been unsuccessful. The appeal goes before the city council in two weeks. As the population grows older the question of where they are going to live becomes more critical. See the story on KABC’s website HERE. (Copyright ©2012 KABC-TV/DT. All Rights Reserved.)
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Can Coconut Oil be the answer?

From CBN TV: Researchers say the ketones found in coconut oil have slowed the progression of Alzheimer’s disease in some people and may actually prevent it. Click here to read the article and download information.   Transcript:
Can Coconut Oil Be the Answer?Lori Johnson: Steve Newports Alzheimer’s disease has slowed considerably. Some of his symptoms even reversed thanks to an unlikely treatment prescribed by his wife, Doctor Mary Newport a physician who runs a neonatology ward at a Tampa, Florida hospital. She became determined to help her husband after he failed the so called Alzheimer’s clock test.Doctor Mary Newport: He drew a few little circles and several numbers just in a very random pattern, didn’t really look anything like a clock and the Doctor pulled me aside and she said, “You know he’s actually on the verge of severe Alzheimer’s at this point, he’s beyond moderate”. So that was very, very devastating news. Lori Johnson: Doctor Newport began learning everything she could about her husbands disease. Doctor Mary Newport: It appears to be a type of diabetes of the brain. It’s a process that starts to happen at least 10 or 20 years before you start having symptoms and it’s very similar to type 1 or type 2 diabetes in that you develop a problem with insulin. Lori Johnson: In this case, insulin problems prevent brains cells from excepting glucose, their primary fuel. Without it the cells eventually die, but there is an alternative fuel, key tones which the cells easily except. Key tones are metabolized in the liver after you eat medium chain triglycerides, which are found in coconut oil. So Doctor Newport added coconut oil to Steve’s diet. Just two weeks later he took the clock test again and as you can see demonstrated stunning improvement. Doctor Mary Newport: I thought at the time was it just good luck? Was it a lot of prayer? Was it the coconut oil? And I thought well, we’re going to keep the coconut oil going. Lori Johnson: Then, 3 weeks later he took the clock test for a third time, and continued to get better and it wasn’t just intellectually, he also improved emotionally and physically. Doctor Mary Newport: He was not able to run, he was able to run again or he couldn’t read for about a year and a half but after somewhere around 2 or 3 months he was able to read. Instead of being very sluggish, not talking very much in the morning, he would come out with energy and talkative and joking and he could find his water and utensils. Lori Johnson: Doctor Newport documented Steve’s success in a book called, Alzheimer’s Disease: What if there was a Cure? She received this stake of thank you letters from other people who’s loved ones Alzheimer’s was helped after they followed Steve’s diet. While coconut oil is encouraging, there’s actually something much more powerful. A team of biochemists lead by Professor Kieran Clarke at England’s Oxford University have developed a key tone, Ester, that packs a punch ten times great than coconut oil. Kieran Clarke: It reaches quite considerably higher levels and you can get whatever levels you want depending on how much you drink. Lori Johnson: The problem is, they need millions of dollars to mass produce it. Kieran Clarke: Very expensive and so we can’t make very much of it ourselves and what we would like is funding so that we can actually scale up and make it but of course there is no real profit in manufacturing stuff like that. Lori Johnson: So until a high potency key tone, Ester, is available to the general public coconut oil is still a good key tone source. Just make sure it’s pure, non hydrogenated. Avoid any hydrogenated oil, which is the same thing as dangerous trans fat. Many people avoid coconut oil because they think it’s bad for them, but it’s actually very healthy. Dr. Beverly Teter is a researcher at the University of Maryland who specializes in dietary fats. She says years ago coconut oil was criticized for raising cholesterol, but scientists have since learned there are two kinds of cholesterol. Low density lipoprotein, the bad kind and High density lipoprotein which is very good for you and is the kind that coconut oil raises. Doctor Beverly Teter: So they put out the message that it increases the serum cholesterol but the truth of the matter was helping to profile of the serum cholesterol. That never has been corrected in the public press and I think that’s the reason people have the misconceptions about it. Lori Johnson: So, not only does coconut oil improve your cholesterol levels, Doctor Teter says the way it helps the brains of some Alzheimer’s patients can be extended to people with Parkinson’s disease, Amyotrophic lateral sclerosis, Epilepsy, Dementia, even Schizophrenia and Autism and one more thing, coconut oil is a natural antibiotic that also helps kill viruses like Human immunodeficiency virus and Herpes viruses. Doctor Beverly Teter: The coconut oil tends to keep the bacteria down so that if you’re assaulted with a virus, you’re immune system can concentrate on the virus. It doesn’t have to concentrate on 27 other bacteria that you may have been exposed to that day. Lori Johnson: So consider coconut oil to improve your over all health and perhaps even go so far as to stave off life threatening diseases. Lori Johnson, CBS News
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Happy New Year!!!

Happy New Years from all of us at Raya’s Paradise Board & Care facilities. Raya’s Paradise in implementing a new medication management system that will provide a safer and more accurate medication distribution. In addition, we will also increase the activities level for our residents which will include outings.
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Another annual inspection with 100% success, No Deficiencies!

Raya’s Paradise had its annual unannounced state inspection 08/26/2011. There Licensing Program Analyst (LPA) passed us with 100%. Raya’s Paradise, Inc. always strives to maintain the highest standards in all fields of service to make sure that our residents get the highest possible care.
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