Residential personal-care home

How do we determine whether or not a senior is ready to move into a more supervised environment instead of living alone? The decision to move a senior will hinge on 2 very important questions:

• 1) Is the senior physically and mentally safe in their current living arrangement?
• 2) Can the senior perform their Activities-of-Daily Living (ADLs) safely and without assistance?

Activities-of-Daily Living (ADLs) is defined as basic daily tasks such as cooking, eating/drinking, ambulation/transfer, bathing, dressing/grooming, toileting and taking medications safely. If the answer to both questions is "no", then it is time to moved the senior to a better, safer environment.

Tran's Senior Oasis is licensed by the Texas Health and Human Services (HHS) as a Small, Type B Assisted Living Facility; however, because this is an actual house and not a building/facility, it is also referred to as a residential personal-care home.

How are residential personal-care homes different from large assisted living facilities (ALF) and traditional nursing homes?

Residential personal-care homes are the best setting for seniors who need minimal to moderate assistance with activities-of-daily living (ADLs). Seniors with mild to moderate dementia thrive in this environment because there is down time and enough stimulation to keep them safe, active, and happy. Staff members are available 24 hours to give direct patient care with ADLs and keep them company. In general, there is no increase in monthly fee for an increased "Level of Care" after admission unless there is a major change in the senior's physical, behavioral, or cognitive function. There are traveling medical services such as visiting physicians, podiatry, and dentistry which eliminate the need for healthcare appointments out of the building. Seniors who reside in this environment have the ability to "age in place" or stay at the facility if their needs are met. What this means is seniors may not need to move to another facility or institution when they further decline.

Seniors who reside in large assisted living facilities tend to only need minimal assistance such as meal preparation and light duty housekeeping for their rooms. Three meals are provided daily which removes the need for seniors to prepare meals; however, seniors must be independent- cognitively and physically capable of performing all their ADLS. There are many opportunities for social interaction and transportation is available for medical appointments and outings. Staffing is available for some services during the day but limited or no staff is on duty at night. In most cases, seniors will still need to make arrangements for personal medical and health related appointments. The monthly cost for this type of setting is very reasonable on admission; however, it can increase dramatically when there is an increase in the "Level of Care" and charges for the "a la carte services" (laundry, medication reminders, etc) are added as these services are needed to keep the senior safe and independent in this setting. On many occasions, a private sitter (paid by the family up to $20/hr) will have to be utilized to keep your loved one safe and cared for. In this situation, the family will pay close to $5,000 or more to keep their loved in the large assisted living facility. All the while, family members will still have to make daily visits and continue to stress and worry for their loved one's well-being. When seniors require a higher level of care and the facility does not have a special unit to meet their needs, they may need to move to a residential personal-care home or a nursing home.

Traditional nursing homes tend to care for seniors with multiple medical issues requiring skilled nursing care with medical observation and management. Often times, these seniors are totally dependent and require "total care" with their activities-of-daily living (ADLs) and have limited mobility or are bed bound. There is 24-hour nursing and direct patient care services along with medical providers to manage their health and in-house rehabilitation needs. The cost of residing in a nursing home may change monthly based on the senior's need for extra supplies and medications. Seniors in traditional nursing homes can "age in place" or stay as long as their needs are being met.

The three distinguishing factors among the three types of settings which will help you decide on the best setting for your loved one are-

• 1. Cost of Care
• 2. Staffing (Staff-to-Patient ratio) and Staff Retention Rate
• 3. The Environment (intimate home versus facility)

Cost: Keep in mind that in the Austin/Round Rock areas, the average cost is approximately $4,000.00 per month ($40,000.00 to $55,000.00 each year) depending on type of room (private or semi-private room) selected for your loved one to live in a residential personal-care home. In comparison, the cost of a nursing home placement is about 30% more (depending on the medical diagnosis and type of room) and for large assisted living care facilities it can cost 20% more (depending on type of room and "level of care") when compared to residential personal-care homes.

Staff-to-Patient ratio: Residential personal-care homes have the best staff-to-patient ratio (1:6 or less) compared to nursing homes (1:20 or more) and large assisted living facilities (1:12 or more). The significance of this concept is that your loved one will have more personalized-care with this excellent low staff-to-patient ratio.

Another strong indicator of the type of quality care being delivered at a place is the staff retention rate. In residential personal-care homes there is generally a "low turnover rate" which means staff is retained as employees with the company. The caregivers or staff members tend to (for a lack of a better word) "age" with the seniors. In fact, many caregivers are employed since the home was established. Having a consistent caregiver for your loved one is an effective and therapeutic strategy in terms of giving care. Furthermore, a family owned and operated business tends to foster a more close, respectful, and loyal relationship among the owner and the caretakers. This positive and nurturing energy carries over to the tender loving care each senior receives. There is a strong sense of communal commitment, stability, and happiness when the retention rate is low in a working environment. Compared to the high turnover rate at the nursing homes and large assisted living facilities, the "high turnover rate" means staff is not retained as employees with the business, is often influenced by the corporate American culture and an "all business approach" which translates to a new caregiver each month who is responsible for delivering care to seniors. Hence, inconsistent staff members are more likely to struggle with delivering basic yet competent and compassionate care to your loved one.

The Environment:

Residential personal-care homes feel, look, and smell like a home! With home-made meals, comfortable furnishings and the same staff members makes for a warm, peaceful and loving environment. Due to the low number of residents in a personal care home, each senior can easily form friendships and enjoy companionship with other seniors and staff members. Staff members caring for seniors around-the-clock ensures that staff is very familiar with each senior's baseline (physical, emotional, and cognitive functions) and will be able to give safe and effective care. Additionally, minor medical emergencies can be managed in-house under the direction of a medical professional or organization (home health). It is truly a family environment and family members of those seniors have peace of mind that their loved ones are cared for very attentively 24 hours a day.

Large Assisted Living Facilities are often beautifully decorated however; seniors often feel alone and lonely once they retreat to their rooms for the day. There are many activities planned throughout the day and social outings but the senior must make the initiative to participate. When there is a medical emergency, families will need to help manage the medical crisis. As the senior needs more help, the price will increase due to the increase in the "Level of Care". In this setting, family members will still need to frequently monitor their loved one's well being.

Nursing homes tend to be impersonal with many seniors, staff members, and visitors all moving at a rapid pace each day which can be very overwhelming for seniors. The environment tends to be busy and loud with call bells chiming, cleaning equipment running throughout the day and undesirable odors ever-present. Seniors residing in this environment can get "lost in the system" unless family is present daily. Due to the high number of seniors living at these homes, there is inflexibility in the care schedule (bathing, grooming, toileting, eating). In this setting, family members must frequently monitor their loved one's well being.

The final question you will need to answer is "What type of Quality of Care and Life does your loved one deserve and need? The benefits of a peaceful, calm environment coupled with the same staff members who will pay more attention to your loved one often yield a higher quality of care and life for your loved one. This phenomenon can only happen at residential personal-care homes.