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Successful Aging: The dilemma of finding a board and care home

Q. We recently had a terrible experience with a board and care home. My mother who has dementia was not cared for, although the staff indicated they had experience with dementia patients. For four days she was not bathed and was not approached to engage in any activities. Staff was not kind, compassionate or understanding. They wanted her to be medicated because she got up once during the night and the other night she didn’t want to go to sleep until 11:00 P.M. Mother is now at home with me. We are going try one more time. What guidelines can you suggest so we will make a good decision for my mother? L.K.

Dear L.K. I am sorry for your terrible experience and feel particularly sorry for your mother. Let’s begin by discussing board and care homes.

These facilities have four to six beds and are called residential care facilities for the elderly. If the facility has 16 beds or more, it is called “assisted living.” Both address non-medical needs and provide a room, meals, housekeeping, supervision, storage and distribution of medication as well as basic services to assist with hygiene, dressing, eating, bathing and transferring. Board and care homes are not required to have nurses, certified nursing assistants or doctors on staff.

The facilities or homes, often located in residential areas, are licensed and must meet care and safety standards set by the state and are inspected by the Department of Social Services, Community Care Licensing.

The difficult question is how to choose the one that will meet your mother’s needs. The best way is to visit three to five places at different times of the day, including meal times, according to the Alzheimer’s Association. It can be useful to take a friend on these visits who may be less emotionally involved and possibly raise points you haven’t considered.

Here are some tips to find the right housing:

Safety: Look for safety devices on doors. Are there motion detectors, monitoring systems, adequate lighting and non-slip floors?

Personal Care: Determine if the staff helps with what is called activities of daily living, such as bathing, dressing, grooming and toileting. Residents are supposed to receive help with these but that is not always the case.

Observe current residents: Check if residents are dressed, their hair is combed and their clothing is clean. Even look for clean, trimmed finger nails. Do residents seem content to the extent possible?

Activities: Are activities designed for those with Alzheimer’s disease or dementia? Do they reflect the residents’ personalities and hobbies? To the extent possible, do the activities help residents succeed in familiar tasks such as making their bed, dressing themselves or cleaning up their room? Are any of the activities outdoors such as walking or gardening?

The facility and environment: Determine if the home is designed to accommodate dementia behavior in terms of safety and easy navigation. Note that a calm and pleasant environment contributes to the well-being of the residents.

Staff: Ask if the staff has met state regulations on dementia-care training. Are staff members specifically trained in caring for dementia patients? What is their experience in dealing with difficult and disruptive behaviors such as wandering, emotional outbursts or “sundowner’s syndrome?” The latter occurs when the resident becomes agitated, confused and acts out during the evening hours. Also ask how staff burn-out is addressed.

Know your budget: The average cost for a room in a board and care facility may depend on its geographic location. According to the California Registry, the average cost in California for a shared room in a six-bed home is $2500 a month; for a private room it is $3500 a month. Inquire if the home accepts Social Security SSI (Supplemental Security Income).

What’s special: Ask what makes the board and care home special. Make a request to read the home’s mission statement to learn about their philosophy of dementia care. Determine if it fits your perspective and that of your family.

Audit report: Ask to see the most recent audit report. In addition to identifying the facility’s problems, it notes what problems have been corrected and areas that need improvement.

For more information see and go to residential care; scroll down to “care facility checklist.”

L.K., your job is a difficult one. Note there typically is an initial adjustment period to such a move. For the next move, consider taking things that are familiar to your mother such as family photos or a favorite pillow. Of course, you may have previously done this.

My best wishes to you in finding the right place. Your caring and thoughtfulness is right on.

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