ADULT CARE HOMES
Overview

Most seniors strive to stay in their own homes for as long as they can.  This can become difficult or unsafe for a variety of reasons.  When safety becomes an issue, adult care homes are a wonderful option to consider.  This writing is a brief overview of adult care settings, as well as a basic guide to help you select one, if needed.                                                                                              

An adult care home is a licensed care setting located in a residential neighborhood that provides care for its residents in a homelike setting.  Adult care homes provide services and care in the course of day-to-day routines and activities, and provide a safe and secure environment that is affordable.   In addition, adult care homes are required to meet a multitude of regulatory standards and are inspected annually to ensure compliance.  The owners, providers, and care givers have training and experience requirements as well.  Inspection reports and complaint histories are designated as Public Disclosure Records and are available for review at an affiliated county office.

Oregon adult care homes are identified as class or level 1, 2 or 3 homes.  Some homes are able to provide very complex care while others specialize in a particular area of care, such as ventilator homes.  The license designates the level of the home, which reflects the degree to which a caregiver can meet specific care needs; the higher the level the more prepared a home is to meet challenging needs as required by law.

Basic services offered in adult care homes include nutritious meals, medication assistance, socialization and activities, assistance with bathing, dressing, toileting and mobility.  Each resident has a plan of care which is developed and updated by the provider to reflect his current abilities and care needs.  The family and care givers may have suggestions regarding the care plan, but it is the resident’s choices and rights that remain first and foremost.

Guide

Before visiting any adult care homes, it is important to sit down and take a good honest look at what the “needs” and “wants” are.   It is only from this honest viewpoint that you can begin to find what you are looking for.   Be sure you consider the location of the home (for relatively easy access for those who really will visit) and the monthly costs.  At this writing, most adult care homes in this Tri-County area have base rates around $2,800 per month.  This varies a bit from home to home.  Most homes have a list of additional services that generate additional costs beyond the base rate.  For example, urinary incontinence care may carry an additional monthly cost of $150 to $250.   A typical price range for someone moving into foster care is between $2,800 and $4,800, but again, the rate varies depending on the specific care needs of your loved one.

You will be signing a contract with the home that you choose.  Be sure you read this document carefully and understand it.  One of the most commonly overlooked and/or misunderstood parts of a standard adult care home contract concerns terminating the agreement. 

For example, this issue comes up if a resident has such a significant change in his medical condition that he needs licensed nursing care around the clock in a nursing facility, or if a resident dies.  Both of these unfortunate situations do occur sometimes.  A typical contract will require a thirty (30) day written notice for a planned move and a fifteen (15) day paid period following a move.  These are standard arrangements in adult care homes, residential care facilities, assisted living facilities and apartments in the general community.

Please do not be personally offended or angry with the provider for following a standard business contract.

If you are concerned about finances and you are not sure if there are adequate funds to meet the monthly expenses, we suggest you consult with the Medicaid office in the county where the resident lives.  There have been numerous changes in this complex program, so be sure to consult with these experts.  They will have the answers you need.  The following county phone numbers are to front desk phones and you will be forwarded on to the appropriate person.

Clackamas County: 971-673-6604
Multnomah County: 503-988-3646
Washington County: 503-640-3489

Most people residing in long-term healthcare settings outlive their personal funds.  Be sure to talk with any home you are considering about how this would affect your loved one should this occur.  Ask the home if they currently carry a Medicaid contract or if they would obtain one if needed.  Ask if your relative would be asked to relocate.  These are important questions and answers in your decision making.

In Oregon, the Resident’s Bill of Rights affirms the individual rights of residents in this healthcare setting.  You will receive a copy of these rights at the time of admission.  You will also receive other information and forms, including a copy of the “House Rules,” which addresses topics such as mealtimes, pets, smoking, visiting hours, and the like.  Fire and evacuation drills will also be discussed.  These drills require resident participation and are performed monthly in all healthcare settings in Oregon.  You will also receive information about the Oregon Ombudsman Program, which is dedicated to protecting the rights of all residents in healthcare settings.   You will see a poster about this on the public postings board in each home identifying the assigned Ombudsman and phone number.   Weekly menus and other informative materials will also be posted there.

You will need to determine what level of care and level of home your loved one needs.  Read through the six categories of Activities of Daily Living and assess the extent to which your loved one will need help in each category.  

The six categories/activities of daily living (commonly known as ADL’s) are:

Nutrition/Diet/Eating
Dressing/Undressing
Personal hygiene/Grooming
Toileting                                                                                                           Mobility/Transfers
Cognitive/Behavior Management

Determine the degree of assistance needed in each category, following these guidelines:

Independent = Doesn’t require the help of another person to do any part the task.                                                                            
Assistance = Requires the help of another person to do part of the task.                                                                                  
Dependent = Requires the help of another person to do all parts of the task.

Level 1: The resident may need assistance in up to 4 ADL’s.                                                                                                             Level 2: The resident may need assistance in all ADL’s, and may be dependent in up to 3 ADL’s.
Level 3: The resident may be dependent in 4 or more ADL’s.

There are additional services that may influence the level of home, such as RN task delegation, medication administration routes, etc., (too many to list here).  This guideline is generally quite accurate.                                                   

Now that you know the level of home needed, it’s time to put your search plan together. Start by looking at the enclosed list of homes in the area you are interested in.  Make a photocopy of that page and turn it into a worksheet.  Next, begin calling the homes you’ve identified by location.  Ask if there is a vacancy.  If there is, move on to your specific questions, (see also our list of suggested questions).  The provider will have questions for you as well, including questions about the care needs of your loved one.  When you have finished your conversation, decide if this home and provider appeals to you enough to go visit.  If so, set an appointment to do just that.  When that visit is done, you will almost always have a distinct feeling (and usually within about five minutes or so of your arrival at the home) as to how suitable that home will be.

We recommend you continue this process until you have found three or four homes that you like.   At this point, contact the affiliated county office and go inspect the Public Disclosure Records for those specific homes.  Eliminate any unsatisfactory homes.  What you have now are some very good options to consider.  To make your final decision, we recommend you do an unannounced drop-in visit as your second and perhaps even third visit to any home you are considering.   (Please avoid visiting at mealtimes as a courtesy to all, as this would be quite disruptive.  Most homes have the typical mealtimes at 8AM, noon, and 5PM.)  This is also a good time to bring someone with you who can give you feedback and provide objectivity.  When you have completed these steps, you will have narrowed the options down to one or two homes that will very likely be a successful setting for your loved one.   If possible, allow your loved one to have a part in making this final decision.

Once the decision has been made, begin the actual arrangements for placement.  The provider will have forms for both you and the physician to complete.  They will also require a prorated payment from the date of move in to the end of the month.  (From then on payments are due on the first of the month.)  If there is a Power of Attorney, Living Will or other important legal document, the provider will want a copy of it for the chart.  You may begin moving personal and furniture items in on an agreed upon date.  It is best for everyone if this is done prior to arrival.

Adjusting to changes in health, home and life will be challenging for your loved one.  The first few weeks may be particularly difficult, so we recommend you visit your loved one by phone or in person frequently. 

We hope you have found this information helpful.  If you have further questions or just need to talk something through, please feel free to contact us at All About Seniors, Inc. / 503-659-3815.