The Tour Continues: Assisted Living Facility 1

Continuing the research... yesterday afternoon, drove to Assisted Living Facility 1, a small group home (15 beds) in a quasi-rural section of the Maryland DC suburbs.  Am not sure what to make of it.  There were several attractive features - in particular, it doesn't feel like a hospital.  Nursing homes, no matter how you dress them up, feel like hospitals.  This was more of a bed-and-breakfast.  Much more relaxed and home-like.  So - is it better to put him in a bed-and-breakfast of death, as opposed to a hospital of death?  Hard to say.

Apart from the obvious advantage (he might take to it better), there was something about it that left me uneasy.  The home, along with its four sister homes, is run by a founder-owner.  Let's call her Mrs. Q.  Mrs. Q, who was a half-hour late to our appointment, is a very quiet, very charismatic figure.  She's an emigre - was a professor at home, but couldn't find a matching job here and started the homes out of a sense of mission.  Extremely dedicated and quite serious.  She seems genuinely devoted to the work and the patients, but there was something generic about her answers - she talked about the need for flexibility but, unlike my tour guide at Nursing Home 3, didn't illustrate or demonstrate any.  Strict rules - there's a sign on the door that tells you not to visit if you're coughing or sneezing; no animals allowed indoors since patients might trip over them.  Sensible but very cool and very cautious.  Baroque music playing over a sound system all the time - she says it calms the patients, which makes sense to me and seems innovative but also easy and low maintenance.  The staff are reverent about her - they talk about Mrs. Q in a hushed way ("I'm sure Mrs. Q will be along soon to meet with you").  There was something faintly cult-like about it.  When I left, I found her enormous black Mercedes parked next to my car.  Nice ride, and I'm sure she works hard and she's entitled to travel in comfort.  But there was that cult thing again...

She's a strong advocate for assisted living as opposed to nursing home care.  At one point she looked at me significantly across the table and said, "Wherever you decide to place him, don't place him in a nursing home.  I don't know how you feel about directness but I'll tell you directly, if you put him in a nursing home he'll be dead in six months."  She may be right - but it also seemed over the top.  Of course, there's also the perverse part of me - the part that's beyond the end of its rope - that wanted to jump up all eagerly and say, "Really?  You promise?"  But I had the sense it wouldn't be a good idea to try that angle.  No appetite for black humor there, or for other shades of humor, now that I think about it.

I don't know.  She's not wrong - I'm worried about how he's going to react in a nursing home when he's not caught up in group activities and he's just in his room in his hospital bed with all the other inmates parked in the corridors.  The group home was more like a home, or at least a decent inn.  I'd rather live in surroundings like that, and he probably would, too.  As to the number of patients - a small setting could be an advantage or a disadvantage.  Will he be overwhelmed by all the faces in a nursing home (Mrs. Q suggested this) or irritated by confinement with just a few people in the group home, like one of Browning's monks? 

As to quality of care, the group home is surprisingly capable.  They can handle anything up to acute intervention - if he needed a ventilator, for example, they'd have to relocate him to a nursing home, but in the absence of that, he could live in the group home all the way to the end of his Alzheimer's.  People do.  They have a hospice relationship, so he could transition to hospice in place.  Costs are lower - and yes, that's still a consideration.  On the other hand, if he winds up bedridden and in need of heavy nursing care, we'd probably have to look at nursing homes, so I'd be moving him in two steps instead of one.

Bottom line is, I like the idea of a small group home, but I'm not sure about this particular one.  I have two more to see, and one more nursing home, and then I'll have finished the first round of the tour.  Maybe somewhere along the line I'll find the same originality I found at Nursing Home 3.  As of the moment, I'm more open to assisted living than I expected to be.  But Nursing Home 3 is still in the lead.

Comments

[Jennifer Stone]

I've been enjoying following your tours of the facilities. When we placed my dad I only had the opportunity to visit a few facilities because we had to do an emergency/rush placement. I remember when I first visited a nursing home and I never thought in a million years that I would ever want my dad there, it felt just like a hospital, cold and sterile.

We ended up placing him in a wonderful assisted living facility that was designed just for memory care patients. Unfortunately he didn't last long there (I think about a month) and ended up in the nursing home that I first looked at. I'm not sure they were monitoring his medication as closely as they should have, maybe because of staffing? I think this is one of the most important things to look at, what is the staff to patient ratio and what are their qualifications.

While the nursing home takes excellent care of him, he has deteriorated very quickly there. A blessing maybe??? So her assessment of that may be somewhat true but I found it disturbing that she would even say that to you. Especially since no matter what you do he will deteriorate, there's nothing you can do to stop it. It sounded like a scare tactic.

Good luck and no matter which place you choose hopefully it will be an easy transition.

[Alan G. Ampolsk]

That's what worries me about the ALF's I've seen. The atmosphere is great and they say the right things, but the staff doesn't seem to have the right intensity. I'm not sure they're going to intervene enough, or in the right ways. So as harsh as the nursing home seems, they may be better. If he deteriorates quickly, well, I agree that that might not be the worst thing in the world. My feelings about Mrs. Q haven't improved over time. I'll keep an open mind - but not that open, and not for too much longer...