Photo used under Creative Commons from foodswings.
Come read Raya’s Paradise blog about assisted living Los Angeles.
Raya’s Paradise was featured in the Beverly Hills Courier, November 9, 2102:
Most people do not know the difference between a large assisted-living facility that may house 150 or more residents and a smaller board-and-care home.
Larger facilities are usually for more active residents able to enjoy all the community activities offered; and for those who can manage getting to and from the building’s dining room and common areas on their own. These large facilities carry the same license as the smaller board- and-care homes.
In California in the early 1970s, the residential care system was established to provide non-skilled nursing-based services to the elderly.
These homes are referred to as “Board & Care” or “Residential Care Homes for the Elderly (RCFE’s).” The governing body is the State of California, Department of Social Services, Community Care Licensing. These homes are not allowed to provide medical services. They can, however, provide assistance with all activities of daily living (ADL’s).
Board & care homes are smaller residential homes that afford a safe home-like atmosphere and comfortable and dignified care where residents can enjoy the living room, backyard, kitchen/dining services, homemade meals, personal attention and social interaction.
For those elderly who suffer from dementia, the small residential home can be an ideal setting because of the consistency in staff and constant super vision. Residents adjust faster and often do better than in the larger Assisted Living Facilities. Such a place is Raya’s Paradise, a residential care facility with five locations in L.A. and West Hollywood with 6-11 residents each.
“We make sure your loved one feels at home away from home,” says Moti Michael Gamburd, executive director.
“Our caring staff—many of which have been with the company for more than 18 years—provides personalized attention to each individual,” says Gamburd adding that the caregiver to patient ratio is 1:3.
While all are welcome at Raya’s Paradise, the company is known for its care of those with Alzheimer’s, other memory disorders and those who’ve suffered strokes.
“We offer a new approach to dementia and Alzheimer’s care,” says Gamburd “Our environment is designed especially for our resident’s to thrive.
“The activities they do together create opportunities to experience and feel accomplishment and satisfaction for completion of a job,” adds Gamburd.
“This team approach gives the security of knowing there is always a helping hand ready when they need it.” The daily routine has residents up for showers in easily accessible bath- rooms, followed by breakfast and a morning activity. Since some of the homes are near parks there are visits for those want ing to go by foot or wheelchair. Afternoons often see musical entertainment, like an accordion player and all holidays and birthdays are celebrated.
“We try to keep it as homey as possible,” Gamburd says. “There’s always something to do,” Gamburd adds, “like cards, puzzles, reminiscing, big band music or bingo.” More alert residents often help set the table or help with the home’s laundry to keep them engaged.
For an RCFE to accept a resident with dementia it must have a “waiver” from Community Care Licensing, as the Raya’s facilities do. The waiver means a variance to a specific regulation based on a facility-wide need or circumstances which is not typically tied to a specific resident or staff person.
Raya’s Paradise also has waivers to care for bedridden residents—”the building has to meet certain licensing criteria,” Gamburd reports.
Gamburd advises those seeking a board-and care home for their loved one to ask questions:
• If you are placing your loved one with dementia into an RCFE, you should be asking the administrator for a copy of their waiver for dementia care.
This will give you peace of mind knowing that this RCFE has the proper staffing, wander guards or other means to keep residents from wandering; and knowledge of how to manage their residents with dementia.
• Does this RCFE provide 24 hour “awake” staff?
Falls usually occur in the evening; and it is important that staff is awake and ready to help residents get to and from the restroom at night.
Many small board-and-care homes or RCFE’s, do not have a 24-hour awake staff. They may have a hus- band and wife who live in the home and are working 24/7.
Working that many hours is a daunting job and it is important that staffing is “fresh” and that they are going home to rest before returning to work.
Night staff should not be working somewhere else during the day and then coming to work at night at your RCFE. Raya’s homes have separate day and night staffs to provide compassionate, committed care.
Raya’s also caters to those not yet ready to move with its CARE (Caring, Assisting, Respecting Elders) program that provides in-home caregivers.
View or download the published article here:
Beverly Hills Courier Full page 11-09-12
Deciding to enter hospice care is never easy. Everyone involved in the decision may find themselves experiencing regret, sorrow, and confusion about what to expect. While issues of death and dying are always extremely difficult, knowing what to expect can help make the process a little more bearable.
Most know hospice as a form of care for those who are suffering from terminal illness. It’s more than just medical care, however, as clergy and social workers may be part of the hospice team in addition to physicians and nurses. Hospice helps patients and their families come to terms with this difficult event. The main goal of hospice is to make the final days of a dying person’s life as painless and comfortable as possible, while helping to bring about a sense of resolution.
One of the main qualifications in order to be eligible for hospice is that the individual must be expected to live for no longer than six months. In most cases, if the person requires additional time, their physician can extend their care. Hospice can be discontinued if the person receiving it begins to recover.
One of the first steps in going about retaining hospice services is to consult with the loved one’s primary care physician. You can also contact a hospice group or a facility, such as Raya’s Paradise, that provides hospice care. Once a hospice team is assembled, all aspects of the patient’s care will be considered and a comprehensive plan will be developed. This would include the patient’s comfort level, finances, necessary medical care and medication, as well as religious beliefs.
When determining whether hospice is appropriate, physicians will usually use the Karnofsky Performance scale. This is a set of criteria to help evaluate the patient’s general health in order to determine life expectancy. Common diseases that usually resolve in hospice include cancer and Alzheimer’s disease.
Some may consider opting for hospice to be giving up. This couldn’t be further from the truth! In fact, it takes a very strong person to be willing to accept help and support when it’s needed. This is not a matter of giving up, but more of doing what’s necessary at that point in time. Furthermore, by choosing hospice, your loved one will receive increased comfort and support, leading to more fulfilling and meaningful final months of life.
Discussing hospice is never easy. Nobody wants to be the first person to bring up the topic of death and dying. If you or someone you love is considering hospice, it’s important to realize that not saying anything could in fact delay hospice and cause unnecessary pain. Hospice is all about making the last stage of life as comfortable as possible. There’s no point in prolonging discomfort. Take a moment to begin the conversation now and you may help ease the suffering of a loved one.
For individuals experiencing memory loss due to conditions like Alzheimer’s disease, memory boxes can be a great way to help them recall their past, even if for a brief period of time. Memory boxes can be a collection of your loved one’s favorite objects from childhood or can even be items that capture the essence of a time. These projects can be a great way to reconnect with loved ones suffering from dementia when talking and other approaches don’t seem to have much of an effect.
Memory boxes work by capitalizing on a person’s senses in order to help trigger memories from long ago. They’re filled with objects that the individual can touch, smell, and see, with the hope that the person will be brought back to the point in time that they experienced such sensations. Sometimes these objects can be the only way back to a forgotten memory.
Setting up a memory box is easy. All you’ll need is a box of the size of your choosing and various items and objects that you’ll use to decorate it. This box is something that will carry meaning for you and your family member, and what’s inside of it will be more important than how the box itself looks.
Now comes the fun part. Any objects that your parent or loved one once owned or used in the past are fair game. Perhaps there is a ring, necklace, or other piece of jewelry they frequently wore before moving to assisted living. Maybe you have old photos of them in their prime that will help them recall a particular time period. Even something as seemingly trivial as a piece of fabric could spur old memories to the surface, just from the touch or feel of the material.
Once you have assembled the memory box, it is now time to present it. You’ll want the recipient to handle each object for some length of time, allowing their senses to respond. You can ask them to talk about the object, describe it, or simply free associate about any thoughts or feelings that the object brings up.
If you are feeling at a loss for objects to put inside the memory box, don’t despair. Other relatives may be in possession of objects that have significance to your loved one. If not, you can easily find objects on your own. A great start would be to visit a local antique or hobby shop. Here, you will find many different items from past time periods that will help bring your loved one back to a time when they were younger. For example, memorabilia from World War II could spark a story about the family’s victory garden.
There’s no set formula for putting together a memory box. Anything that carries meaning for your loved one should work just fine. This article has a few ideas if you’re stuck: How to Make a Memory Box.
Photo used under Creative Commons from Bunches and Bits.
Today, seniors enjoy a wide range of options to choose from when it comes to finding a place to spend their later years. Things haven’t always been this way. In fact, not too long ago, assisted living wasn’t even an option. Prior to the advent of these facilities, older people could only choose between staying at home under the care of a family member or a hired caregiver, or going to a nursing home.
Going to a nursing home was not something one wanted to do, as it often meant forfeiting basic rights, such as the right to privacy. Many times, residents were not permitted to have locks on their doors and would have to share bathrooms. The institutionalized setting and communal bathing and showering areas created an environment all too reminiscent of some of the facilities used to care for the mentally ill. To make matters worse, nursing homes were gaining a reputation for being places where the elderly were frequently mistreated, neglected or even abused.
Dr. Keren Brown Wilson, whose own mother lived in a nursing home, made it her life’s work to develop alternative means to care for the elderly. She was integral in the inception of the first assisted living facility, which would serve as a model for such facilities all across the country. One of Dr. Wilson’s major priorities when developing the assisted living model was to restore the privacy and dignity that were missing in the institutionalized settings of nursing homes. In addition to this, Dr. Wilson made sure that these facilities were adequately staffed with round-the-clock supervision and a more individualized level of care with one-on-one support.
This prototype for a new and innovative way to provide care for the elderly drew attention from many other organizations that then helped turn assisted living into a viable alternative for older adults looking to make the transition to a living situation that provided more support.
The need for supportive living accommodations for seniors is greater than ever, and fortunately, there are a variety of desirable arrangements available. Today’s seniors can choose from different types of assisted living facilities depending on the specific care they need, their budget, and lifestyle choices. Their options, rather than demeaning them at the end of their lives, can help make these years a golden time to enjoy the sunset of their days with few worries.
The desire to stay in your own home and remain independent as long as possible is a strong one. Unfortunately, as we get older we eventually reach a point where this is no longer viable or safe. How can you convince a parent that it’s time to make a move to assisted living, where they can get the support they need, and help them see the transition as a positive one? Here are several tips for having this difficult conversation.
Enlist the help of a medical professional. If your parent is like most of us, he or she will have a sense of pride regarding the ability to care for him or herself. This is completely natural, and the idea that one can no longer do this is a severe blow. It is for this reason that seeking the opinion of their doctor or another healthcare provider they trust can help to add weight to your suggestions when discussing the potential move to an assisted living facility.
Avoid potentially condescending sympathy. It is important to realize that, despite any health complications that your parent may be experiencing, your sympathy is not what’s needed at this moment. Of course, it is always nice to have compassion for your parent. Yet discussing the move to an assisted living facility can elicit feelings of powerlessness, and providing heaping doses of sympathy could make matters worse.
Approach your parent with respect. Treat your parent as an independent person capable of making decisions and deserving of the same respect and considerations as anyone else. There are some situations where maintaining this tone could prove challenging. Diseases such as dementia can greatly impair your parent’s ability to process and understand what is happening, and may force you to take on a more guardian-like role in such cases. The underlying idea that you can still treat your parent with respect and value his or her preferences still applies more than ever.
Emphasize safety. The number one priority and guiding factor in all discussions and arrangements surrounding a parent’s move to an assisted living facility should be their health and well-being. The more that you can bring this point into focus, the better the transition process will likely be. If, for example, your parent has fallen several times while unsupervised, resulting in hospital stays and broken bones, reminding them of this in a gentle and understanding manner may help them see the logic in making this transition.
Above all, listen. Listening may be all you need to do to help your parent accept the idea of assisted living. It’s very possible that he or she will want to make the move, yet also feels a need to express all of his or her resentments and worries about doing so. By listening, you will help your parent feel more understood and will also help make him or her more receptive to your own feedback.
There is no simple and easy way to discuss assisted living care with a parent. The process can, however, be an opportunity for you two to grow closer as you share your thoughts and feelings about the matter in an open and non-judgmental atmosphere.
Photo used under Creative Commons from www.stockmonkeys.com.
- The individual must qualify as being “chronically ill.” The Health Insurance Portability and Accountability Act of 1996 defines this as needing assistance with activities of daily living (bathing, dressing, eating, etc…) or requiring continual supervision at all hours of the day.
- Second, the ratio of the adjusted gross income of the person paying for care to the total amount of medical expenses must be greater than 7.5%.
- Finally, the resident’s care plan must be in accordance with the recommendations of a licensed health care provider (for example, a doctor, nurse, or social worker). Most assisted living facilities will automatically provide this and residents and their families will have official documentation that meets this requirement.
Unfortunately, there are some out there who will mistreat those who are vulnerable, including the elderly. At a certain point, it becomes elder abuse, and it’s one of the worst fears of those who have a loved one who is not fully able to fend for themselves. Elder abuse can be inflicted by a staff member in a residential institution, a fellow resident, a hired caregiver in the home, or even a family member. Our seniors deserve our gratitude and our respect, but a significant number of them are victimized and disrespected by the very people they trust. They cannot always do what it required to keep themselves safe.
Elder abuse is under-reported because so few of those who are harmed by it can speak out for themselves. Because of this, it is important that family members, assisted living staff, and friends know the signs and symptoms of elder abuse. Being able to recognize abuse is the first step to putting a stop to it. There are several types, including:
- Malnourishment – refusing to provide required food or water which can lead to serious medical problems, starvation, dehydration, and sometimes death.
- Physical Abuse – committing physically violent acts; punching, kicking, slapping, pushing, and pinching are a few examples.
- Sexual Abuse – committing unwanted sexual acts; molestation, harassment, rape, forced oral sex, and unwelcomed sexual language are considered forms of sexual abuse.
- Financial Abuse – refusing seniors access to their own money, stealing, or embezzling.
- Refusal of Medical Care – refusing them access to their physician, or refusing to provide them with their required treatments or medications.
- Psychological Abuse – verbal abuse, name calling, demoralization, refusing seniors access to psychological care
- Emotional Abuse – refusing them access to loved ones, telling them that no one loves them or wants to visit with them, making them believe that they are alone and utterly unloved.
- Neglect – not providing seniors with the necessary hygienic care (bathing, brushing their hair, changing their diapers), leaving them alone for long periods of time, not providing a clean, safe and comfortable environment (no heat or air conditioning, allowing for filthy living conditions), or allowing others to abuse them.
- Unexplained or poorly explained bruises, broken bones, burns, abrasions, and pressure marks
- Sudden changes in personality not explained by mental illness
- Tension in personal relationships with family, friends, or assisted living staff
- Unexplained withdrawal from activities that used to bring joy
Deciding whether to choose assisted living or home care is tough, and many emotions come up which influence the decision-making process. When you realize that you or a loved one needs some outside help, which option will work better? The answer of course is different for each individual and family, but there are certain considerations that tend to come up again and again.
Two of the key features of assisted living facilities are that they’re designed so that seniors can be as independent as possible while remaining safe, and that they provide services in a cost-efficient manner (since they are shared by several or more people). On the other hand, home care has the undeniable advantage of the senior being able to remain in their home and/or with loved ones.
However, the coziness of home care can also be one of its disadvantages. Having someone in the household with such extensive needs can be a burden for others in the family. We all want to feel like we’re doing as much as we can for aging loved ones, but caregiver burn-out is a real issue. Remember that before you can help others, you must help yourself: if you’re stressed or feeling negative, the senior in your life isn’t getting the best help. Allowing assisted living to take on the chores of daily care may allow you to spend the time connecting with your loved one and enjoying each other’s company.
Another major issue that you should consider is the cost of the two options. Assisted living can be a very affordable solution that gives you a lot of value for your money. Just about all of life’s needs are taken care of in one fee: housing, food, utilities, housekeeping, and social activities, plus the care and assistance that helps the senior get through daily life. Many feel that a lot of worries have been taken off their shoulders when they move to assisted living.
With home care, though, you’re paying on an hourly basis. The average cost of home care in California is $20 per hour, so that adds up quickly even before you throw in other needs like food and housing. Since you are managing home care yourself, you’ll need to have a plan when a hired caregiver cannot come in due to illness or any other reason. This can be addressed by using an agency, but the agency will charge higher-than-average fees for the convenience of knowing someone will always be there.
Again, be sure to take into account your individual needs. There are some situations in which home care may be more appropriate. Before committing to one choice or the other, do thorough research on the actual cost and make sure you truly understand your options. Then this challenging decision may become a little more clear.