A Family Talk
--- Whenever possible, have a family meeting to determine everyone’s thoughts and feelings about the need for finding help for your loved one. It is immensely important that everyone is on the same page as much as possible. This will be stressful enough without the threat of family infighting. (See: “Is it Time?”)
Mom and Dad
--- If medically possible, talk with Mom/Dad about the situation and your concerns. Don’t be surprised when the view of their own safety and medical needs is different from everyone else’s.
--- Consult an Elder Care Attorney. (List of Elder Care Attorneys) It will be crucial that someone has a Durable Power of Attorney for Healthcare and Financial needs. If you do not have a DPOA and Mom/Dad is not mentally competent to make decisions (and not cooperative) you may need to seek a Guardianship. That is expensive and takes time.
--- Educate yourself about Adult Family Homes. (See: Adult Family Home Description & Chapter 388-76 WAC ) I have placed this after the first three suggestions because #1, #2, and #3 all need to be done regardless of what the family’s choices are.
--- Contact a qualified Registered Nurse or Social Worker (See requirements for qualified assessor and list of qualified assessors). An extensive nursing assessment and preliminary care plan is required before an individual is admitted into an AFH. (see requirements for this assessment, sample assessment and careplan) This assessment should work for any AFH admission. (An updated assessment is also required annually or if there is a significant change in the client's condition.) The cost is usually between $250 and $400 for the initial assessment and less for the update. After you have received a copy of the assessment, thoroughly discuss it with the assessor. You need to understand the client’s needs from the eyes of an objective medical professional. If the client is medically complex he/she should probably not be admitted to an AFH unless that home’s provider is an RN or LPN with appropriate training and experience to meet the client’s needs, OR the client is on Hospice. At this time you also need to have the assessor qualify what specialty training the AFH needs to have to care for your Mom/Dad. If the client has dementia, mental illness, or is developmentally disabled, then the appropriate specialty designation will be required. Part of this will depend upon exactly what the primary medical reason is for seeking long term care.
List of Needs
--- Sit down and make a list of Mom/Dad’s primary medical and safety needs. The nursing assessment should cover this in detail. (i.e. Is there a need such as an injection that will require a RN/LPN home? Is this a one or two person transfer? Hoyer Lift? Up at night repetitively necessitating awake, working staff?) Whatever AFH you end up choosing, the primary needs must be met first. Now make a list of issues and wishes that if taken care of correctly, will give a nurturing quality of life to your Mom and/or Dad. (i.e. Wants to take their cat or dog along? Wishes a private room with private bath? Hates eating fish? Loves the Mariners and cheers the games on TV? Loves to be outdoors in good weather?) The better the picture of the client that an AFH provider has, the better chance you have of the placement working well.
--- What financial restrictions are there, if any? At $5000 per month, how long will the money last? (I randomly chose that amount as an example. You may well find an appropriate home for anywhere from $3000 per month to $7000 per month or more depending on the client’s needs. It is always about caregiver time and the cost of their real estate.) The first thirty days after admission either the AFH or the family can say it is not working without penalty. After the first thirty days, it is a thirty day notice for discharge. If at some point the client is going to need Medicaid, know approximately when that will be happening. (Consider contacting an Elder Care Attorney if you already have not.) Most AFH’s will place in the initial contract that they will accept Medicaid after a certain period of private pay time. You need to know how long you can manage private pay to utilize that clause. Is there long term care insurance? Know how the policy reads, as some companies will exclude AFH’s (rare), may have reduced daily rates for AFH’s, or require a RN/LPN provider.
--- What geographic area will you need to look? All the AFH’s listed in Aging Safely can be located by searching by selecting a city. Remember that the right home is ALWAYS more important than the geographic location.
Now it is time to refer to Aging Safely’s Adult Family Home List. Look through your requirements and plug them in as “Search Criteria.” If this placement is urgent then you will need to limit your search to homes that have a listed vacancy. If you have some time, you may choose to look at homes that do not have a vacancy at present, but will consent to wait list you. Look through the homes that come up under your specific search, and decide who you will look at first. This will need to be done by appointment with the provider. Try VERY hard to limit your search to no more than 4-5 homes. You are going to be very tired and confused after a day or two of looking at Adult Family Homes. More than 4-5 homes and you may be absolutely frustrated. Follow your instincts and don’t forget to do DUE DILIGENCE! The adult family home's last Washington State survey must be available for you to read. Washington State's Residential Care Services county offices manage the licensor for individual Adult Family Homes should you wish to communicate with RCS.
There are a myriad of questions you can ask the AFH provider and staff. (See: AFH Visit Checklist) Figure out what is MOST important in your Mom/Dad’s case and concentrate on those. You can always go back and ask more questions when you think you have decided on a particular home. If you really feel you have found the right home, ask what you need to do to get the room. AFH’s frequently have multiple requests for an available room. It is usually first come, first served as long as the client and their family is appropriate for the home. (See: Discharge Checklist & AFH to AFH Transfer Checklist).
Competent providers will never mind your calling and asking about the history of the AFH. Persevere, ask the right questions, and do your due diligence. Good providers have confidence in the care of their clients.
And finally, remember you can call us for help.
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