Staff
How many people are on the day shift and afternoon shift? In a typical 6-bed home, there would be 2 staff on during the day.
What are their roles? The caregivers in the day are responsible for providing all activities of daily living as required for each individual, such as dressing, showering, toileting, and eating. They also do the cooking, cleaning, socializing, and offer activities and exercise.
What about nursing staff — RN, LPN, or other? All homes are overseen by an RN (per state requirement). Some homes are owned and run by RNs or LPNs, but the general care staff are Certified Nursing Assistants (CNA) or Home Care Aides (HCA) as required by the state of WA. Most homes also offer a home doctor who makes house calls, should a family wish to sign up with them. You can also keep your own PCP; the option is there.
How many people work the overnight shift? Normally one. In some cases two will be available at all times, depending on the needs of the current residents. Some homes have "awake staff" — a staff member who works the night shift and is up all night to attend to residents and do other tasks in between. All homes have night staff, but at some homes staff don't necessarily stay awake all night; rather, they do rounds and respond to call buttons and motion sensor alerts. Whether a home has awake staff or night staffing depends purely on what is required to care for the home's current residents.
What training is required of staff members? Per WA state requirements, staff must have continuing education along with a certification such as CNA or HCA. Caregivers could also potentially have specialty training that is diagnosis-specific, such as dementia training and mental health training. They must be fingerprinted, background checked, and TB tested. They are nurse-delegated (trained for specific tasks associated with current resident needs) by the RN attached to the home, per WA state legislation.
How long have staff been employed here? This is home specific, and it's a good question to ask when visiting or ahead of a visit. Some homes will have longevity with staff and others will have had some staff turnover. There is certainly turnover in caregiving staff across all care settings — hospitals, skilled nursing, and assisted living — in addition to AFHs.
Who provides or leads activities? Some homes have designated activities staff who come in to do small-group and one-on-one activities and socialization. Other homes have the caregivers provide this as part of their daily routine. Some homes have outside musicians come on a regular basis, which is a nice touch.
Who delivers medications and prescriptions? The care staff deliver medications per doctors' orders and are delegated to do so by the RN who oversees the home. This delegation (training) is required by the state of WA and is updated quarterly. All medications are documented when delivered to the resident on the MAR (Medication Administration Record). Medications are delivered to the home by a specific pharmacy that receives the prescriptions, bubble-packs them for each resident, and delivers them to the home along with the MAR forms.
Who prepares the food? The care staff cook the food, serve the residents, and assist with eating if needed. Within this smaller environment, they're able to tailor meals to individual likes and preferences, especially at breakfast.
Facility
How long has the operator been in the AFH business? This varies from home to home. Some have been in business for a couple of decades and some for a year, but even those who have only recently opened their own homes likely have years of experience working at a home prior to opening their own.
What are the sleeping arrangements — one or two per bedroom, or more? Most homes have mainly private rooms. A few homes offer a shared room (two people of the same gender sharing).
How many bathrooms are there? This varies home to home. Some new-build homes will have a private half bath for each room; some only offer shared bathrooms since residents are always assisted while toileting (even if it's just a stand-by assist), for safety.
How many showers are there, and are they tubs or shower stalls? How many showers will be home specific. There will not be bathtubs, and almost every home offers roll-in showers with shower chairs, grab bars, and similar features. Showers are always assisted for safety.
Was the building built specifically for AFH use? It's a mix between purpose-built AFH-specific homes and remodeled homes that have been modified for use.
Is there room to walk for exercise? This is home specific, as some homes are larger than others and some have outside areas (decks and so on) that are larger than others. Staff will do various exercises during the day, such as "sit and be fit" or range-of-motion exercises, as appropriate for the individual. Some homes will take a resident out for a walk if staffing and weather allow, but more often it's the family who will assist in taking their loved one out for a walk or outing. Sometimes residents do laps of the hallways, depending on the configuration of the home.
Is the yard area locked to keep residents from wandering? Home specific.
Are rooms or exterior doors locked to keep residents from wandering? AFHs have alarms on the doors and can utilize motion detectors or alarm pads, but they cannot lock individual rooms, per WA state law. In addition, and again per WA state legislation, exterior doors can be locked, but not in such a way as to prevent escape in an emergency such as a fire. With the smaller environment and layout of the home, caregivers are able to see what residents are doing and can redirect if someone is looking to exit. That said, if a person is actively exit-seeking — constantly trying to leave — an AFH may not be the right environment. Staff can do a lot, but they can't guard the door 24 hours a day.
Daily Life
What does a typical day look like for residents? This can vary slightly from home to home, but here are some guidelines:
- Wake up: Homes can start getting residents up and ready for the day starting as early as 7am, although if a resident wants to get up earlier or later, that's their choice, and caregivers are normally flexible on this.
- Breakfast: As residents are ready, based on when they like to get up, breakfast is the most flexible meal of the day — generally starting around 8am, though this can vary slightly per home and resident.
- Morning: Perhaps some exercise or other activity, changing per resident needs, wishes, and routine.
- Lunch: Around 12 noon.
- Afternoon: An activity might be offered; some residents like a nap after lunch or some TV time.
- Dinner: Usually around 5pm.
- Evening: A movie might be offered, and staff prepare residents for the night with hygiene (washing up, brushing teeth, etc.).
- Bedtime: Per resident wishes and their regular routine. Some residents like to go to bed at 7pm and watch their own shows or listen to music, while others like to stay up until 10pm or later — caregivers try to keep to a schedule for each resident.
Are residents assisted with clothing selection and dressing? Yes.
Are residents assisted with brushing teeth and combing hair? Yes.
How often are residents bathed or showered? Normally twice per week, but this can be more if the resident desires or requires. A sponge bath is given daily.
Are nails trimmed regularly? Fingernails are kept clean, trimmed, and filed by staff. Toenails are normally cared for by a visiting podiatrist who comes to the home on a regular schedule.
Is toileting assistance provided? Definitely.
Financial / Policy
Is there a move-in fee? Mostly no, but a few homes do require a move-in fee. Homes are on a month-to-month basis. A few homes ask for first and last month upon move-in, and as mentioned, a few have a move-in fee — amounts of $1,500, $2,500, and even half the monthly rate as a one-time non-refundable move-in fee have been reported. This is still more the exception than the rule, though it has become somewhat more common in recent years.
What is the daily rate for Alzheimer's patients in late stages? Homes don't normally quote a daily rate; rather, a monthly rate is set based on the RN nurse assessment required by the state of WA. The range is roughly $7,000–$12,000, depending on the home and level of care, with most falling somewhere in the middle. A few homes will be somewhat negotiable.
How is the rate determined? Based on the assessment completed by an RN qualified to do the AFH-specific assessment, as required by the State of WA, along with the pricing structure specific to an individual home.
Are payments expected in a form other than check (e.g., bank withdrawals)? There is no particular expectation or requirement as to the method or form of payment. A person may pay by check or auto-pay, as they wish.
Have you ever asked someone to move out of your AFH? This is a good question to ask of any home you're considering.
If so, under what circumstances? The main reason a person would be asked to move would be if they were a danger to themselves or others and the issue couldn't be resolved — again, a great question for any home.
What is the policy on visiting or taking a resident out for lunch or a walk in the park, for example? Many homes have an open-door policy for family members to visit as they wish. Homes will sometimes ask that family not visit during mealtime, as it can distract residents from eating and getting proper nutrition. Some will ask that visitors avoid early morning or late evening, since that's when residents are being toileted, washed, and readied for the day or for bed — though homes can be flexible for specific situations, such as a family member's work schedule. This is somewhat home specific and a good question to ask. As for taking a resident out for lunch, walks, or other outings, homes are generally fine with that. They'll suggest you give them a heads-up so they can have your loved one ready, appropriately dressed, and medications in order, but it's not a problem.