Making That Right Senior Community Choice – Assisted Living or Residential Care

Helping families and seniors make the right senior community choice  is our focus at Care Service Options when it involves  Assisted Living(ALF) or Residential Care (RCF)  Both types of facilities/communities are great for seniors who are social and still active enough to enjoy the daily activities, outings and social interaction with the other residents. I focus much of my attention on what each facility has to offer for life enrichment of its occupants. I am looking for a diverse and flexible array of activities for all the different levels of cognition, as well as likes of their residents. What programs and options do they have in place for crafts, games, movies, current events and politics, spiritual, sporting events, parties, outside entertainers, outings and the list goes on… Most offer shopping, Dr. appointment transportation, pet services and beautician services. As I am walking through I look for clues in order to understand to which group of seniors this specific building would appeal to. Seniors who love the city are looking forward to go to the theatre or concerts and might not enjoy a country setting, while others are looking forward to walking in nicely landscaped surroundings or even on some short trails. Each facility will appeal to a certain group of seniors with similar interests. It is extremely important for them to be able to connect and not feel left out, otherwise they will not partake in the daily activities – but rather stay in their apartment.

As the seniors age-in-place – levels of care availability and staff-to-resident-ratios are of the upmost importance. Since no one can see into the future, it is essential to understand what level of care a facility is able to provide. Hospice at times can help manage, since the duration is generally short term.

Many seniors live for years happily in an Assisted Living or Residential care facility and when the need arises move to a higher level of care type facility, if needed. The focus should always be “quality of life first!” A good match would be when a wheat farmer from Eastern Oregon would want to move to the Tri-County area to be close to his children and ends up in a facility with other like-minded people. That’s what we do on a daily basis. We have matched WW2 vets, pilots with others who have similar interests, quilters with facilities who have a quilting program, just to name a few. That’s why we are known in some circles as “The Senior Match Makers”.

Money/finances … often play a central role in the placement of a senior. Many facilities are private pay only. Not all facilities have “a spin down to Medicaid policy”. It is vital to know the Medicaid status of a facility prior to placement, primarily if a senior has 12-18 months of private funding left. Facilities can and do change their policies. So just because you checked their policy when the move-in happened, that does not always mean that the same policies are still in place.

Do your home-work prior to deciding to visit facilities. It’s important to know the status of ownership. Over the last few years many local facilities have been bought out by large corporations headquartered outside the NW. The ones still locally owned and operated will have a long track record in the local community. It can make a big difference in the way a facility is run. Some policies and procedures in different regions in the country might not be a good fit in the NW.

By Monika with input from Michael-Ann after visiting Alfs & RCFs.

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A day on the Road evaluating Adult Foster Care Homes…

By the time I get into my vehicle I will have spent several hours looking at County lists and doing my mapping. I need to understand where all homes in each County or Zip code are located, to tell clients later, which major road each individual home is close to. One would think that families would first want to know which home could provide the best care for their family member, but that is only partially true. Geographic location ranks very high in order for family members to be able to visit often. Routing is very important to achieve this.

Each and every home is as different as any house in any neighborhood. When driving up to the home, I put myself into a client’s frame of mind. Does it look inviting? Are there plants and flowers seniors can enjoy? Maybe bird houses they can watch from their room. A nice front porch, or deck where seniors can sit and watch what’s happening in their new neighborhood. There is so much to check out, before I walk up to the front door, ring the doorbell – and hopefully looking at a friendly face, greeting me. I introduce myself and ask if this is a good time to tour the home and visit with the owner/care provider. If not – I’ll be back later when its more convenient.

 I carefully choose my time and not come during breakfast, lunch or dinner. There is so much to do in an AFC-home. All the cooking, showering and possibly feeding, changes of diapers and clothing – several times a day and evening. Possibly reading the newspaper to the seniors in the morning, helping to set up games, TV channels, etc. listening to their stories they want to tell and greeting families who have come to visit. Calling their physicians with questions and re-ordering meds for each individual senior. Redirecting seniors at times is not an easy task.  If it’s a full house there are the five birthdays to celebrate and of course the holidays. Sounds hectic? It certainly can be. It’s a 24-hour job 365 days a year.

Our “up-front-work” at Care Service Options starts by having visited all the homes and of course with the owners/care providers. While there – checking out the survey from their county were their home is located and posted on their bulletin board – next to their monthly menu and activity calendar, as required by the county.

 By asking pertinent questions and seeing interactions between the staff and seniors tells us, if these are the homes we want to recommend and put CSO’s name and 30-year reputation behind them. The matching of clients to the individual home, care provider and other seniors is just as important for each individual senior’s continued quality of life. 

There are 387 AFC-homes in Multnomah, 178 in Clackamas and 244 in Washington County. We have seen all of them and knocked on the doors of about 85% of all the AFC homes in those counties.

Next blog: evaluating Assisted Living and Memory Care Facilities.







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Finding Placement for Seniors Requiring A Gluten Free Diet Presents Challenges

Who would have thought – finding placement for a relatively independent senior on a gluten free diet on Medicaid spent-down – would be that difficult to find.

Mom was still in Arizona when we were contacted by her to daughters. Even so she was still mostly independent, they knew that Mom would not feel comfortable in an Assisted Living type setting, since she is not very social and would dread to have to eat her meals in a large dining room and also would not take part in activities and therefore stay mostly in her studio apartment. The family felt a smaller setting like an Adult Foster Care home would be just perfect for their mom. We forwarded some photos of Adult Foster Care homes so she could get an idea of homes, lay-outs, rooms. About a week before her arrival we started calling Adult Foster Care Homes we felt would be to her liking, in the area where both daughters could easily visit. In our 31 years in business we had dealt with all kinds of different diets, salt-free, diabetic, low-cal, etc., so how much difficulties would arise with a gluten free diet due to Celiac disease? We knew that with her private funding gone with-in 3 months and having to rely on Medicaid funding, that would cut down the percentage of homes willing to take her, since Medicaid funding is very low for a still rather independent person, since funding depends primarily on the care-needs. Now adding on top of that, having to purchase food items that are gluten-free and fixing special breakfasts, lunches and dinners for one person is cumbersome and costly for the Adult Care Home.

We ended up calling 55 AFC-homes in the Portland area – to find only 5 that were willing to do the special diet and the short-term private pay.

If we would not be “doing our work – upfront” by going out and visiting every AFC-Home in the PDX/Tri-County area and therefore be aware who might take more complex cases – then we could not stake our 31 years of reputation on being able to make a satisfactory placement for each senior. We always aim to finish with a win/win situation for all involved.

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Making the Right Choice for Mom or Dad – Palliative Care or Hospice Care

Monika Gärtner of Care Service Options, Inc.MonikaSeveral times a month we receive calls from children of seniors asking us “what’s the difference between Palliative Care and Hospice Care for mom or dad?” How do we make the right choice?” We hear it in their voices – how worried and scared they are. Most of them already know in their heart that they will have to make some tough decisions in the very near future – not for themselves – but for another human being, their own parent.

People who have dealt with chronic diseases over a long period of time, i.e. COPD, Lupus, Crohn’s, Alzheimer’s/Dementia, just to name a few, don’t necessarily associate those as terminal.

Sally – is in her late 40’s and has had Crone’s disease over the past 10 years. As it advances she will need additional care. That’s where Palliative Care can be a big help, since it focuses on supporting patients through education, pain management techniques and conservative use of medications – as she seeks active treatment and management for a terminal disease.

Bill – is in the later stages of liver cancer. His oncologist is suggesting to make Hospice part of the care team. The focus of Hospice care is typically care that is only initiated during the last six months of life, because most often it is realized that prolongation of life is no longer feasible and therefor is designed to make that time as peaceful and manageable as possible. The focus of care has shifted entirely to managing symptoms at the end of life, preparing patients and families for what happens at that time, and being guided through the end.

The biggest change in Hospice Care we have seen is that we see some patients go on Hospice, off Hospice and on Hospice again. Questions come to mind – is it due to new meds coming on the market to help prolong life, or patients rallying and therefore their time has not yet come?

That is why we recommend in some cases for families to let seniors know that just because they are going on Hospice, that it does not necessarily mean – imminent death within half a year.

I personally would want to hear that some people sign up for Hospice and get off Hospice – hopefully, I could rally for a while longer…

Palliative Care versus Hospice Care = Living with a lifelong disease versus dying from one. The main difference is time.


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Seniors are not a commodity. Let’s treat the whole person – not just their care needs!

“WE STRONGLY FOCUS ON CONTINUED LIFE ENRICHMENT” for our seniors. That’s not just a statement in our brochure – but one I will get on a soap box for. I hear seniors at Senior Centers often utilize the word “stability” i.e. security, dependability, reliability – with a sense of loss. In our “fluid” society it has become an oxymoron.

Most families we work with are committed to doing the best for their aging parent/family member to help them find the most appropriate care situation. Meeting their care needs is very important, but so is continued “quality of life”; that phrase will mean many things to many different people. Our seniors’ past life styles is what differentiates them – from each other. Did they live in a simple home, an upper/ middle class home, in the country, a small town or in a mid-size city, or in a down-town area of a large metropolitan city with its hustle and bustle – or in one of the Metro’s neighborhoods? Do they come from Eastern Oregon, the Valley or The Beach?

What type of life style did the seniors create for themselves and their family? Was it like coming home to a quiet oasis, or to a house-full of friends and neighbors and relatives?

Their past lives will greatly impact the present – and therefore, the choices family members make for placement for their parents’ “CONTINUED LIFE ENRICHMENT” needs to encompass CARE, QUALITY OF LIFE, LOCATION AND understanding of their FINANCES.

One type or size of care facility – do not fit all seniors, but why not CUSTOMIZE? The cost will be the same, but the outcome for the seniors will be much more to their liking and satisfaction.

Customization as out-lined here is not an easy process. Besides some additional knowledge about the senior’s personality, habits, likes and dislikes, a professional placement agency will also need a thorough knowledge of the unique traits and personalities of each and every type of care facility in the area they serve. Only then can an appropriate placement match take place.

Thank you for considering giving Care Service Options, Inc. a call @ 503-663-6556 (East-side) and 503-246-8604 (West-side).

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What Does A Word Mean To Us?

Ten or fifteen years ago the word “Dementia or Alzheimer’s” was hardly ever mentioned openly by seniors themselves, other than in the context of jokingly bringing up either “senior moments” or “senility”. It seemed taboo to really ask matter of fact – what is it really and how does it happen?

We – the children of seniors have come a long way. We can get information at the touch of a screen and if we are still at a loss of total understanding we’ll go to the next screen…

An 85 year old today would have been born in 1927. That person would have looked up the word “demented” in the newest edition of the 1976 Webster’s Collegiate Thesaurus – which gives the explanation as: insane, crazed, crazy, deranged, lunatic, mad, maniac, non-compos mentis, unbalanced and unsound. No wonder seniors do not want to ask additional questions. No one wants to be labeled as such.  There was a time when “cancer” was whispered and people were afraid to “catch it”.

They – the seniors will get explanations from the medical profession, where they talk about memory impairment or cognitive disturbances such as agnosia, apraxia, aphasia or disturbances of planning or ability to think abstractly and personality changes. I have set in on meetings like that and seen the glazed over look in the seniors eyes. And that’s where it stays.

Don’t get me wrong – I am not faulting the medical profession, whose job loads have often tripled during the same 8-hour day. Let’s bring some additional understanding about the seniors in our lives and how we their kids can get the information across to them by honoring the wealth of experience gathered in a lifetime. The human capacity to grow, learn and make a difference is ageless.

I’ll give you an example how it helped my dearest friend “D” of over 45 years in my follow up blog next week.

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Appropriate Senior Care Placement Requires Transparency

In order to provide seniors and their families with appropriate senior care options, Care Service Options, prefers in most situations to personally visit the senior needing care placement. This personal assessment is in my view an important step to assure that the senior is transferred to a setting that can truly meet the needs of the whole person and not just limited to their physical care needs. Therefore, yes, we do ask if at all possible that our visits be accompanied by a family member, friend, or another health care professional for the following reasons:

Transparency of the part of health care professionals is extremely important, especially when visiting seniors. Generally if the person who has requested the visit is is available (the family member, friend, or other professional) they are able to provide that transparent legitimacy that is so important today.

Many seniors are initially skeptical and frightened by strangers – and rightfully so – by people who knock on their door and want to be let into their home or apartment. The introduction by a family member/friend or health care professional can ease a seniors mind.

Even though most of the time the family member, friend or health care professional has spoken to the senior prior to our visit – the same question is always asked – who are you? Why are you here? Pretty standard questions, which tells me that the person is still engaged or depending on the tone of voice and eye contact – either frightened, very suspicious, or confused.

Of course – we’d like to be introduced and the reason given why we are visiting.

Seniors often find it comforting and reassuring to have that family member or friend present to help answer answer the assessment questions and even more importantly to help make sure their loved ones questions and concerns are answered or addressed.

An appropriate senior care placement is critical to the well-being of any senior.  Getting it right the first time around is extremely important since moving seniors around numerous times is not only traumatic, but also can be life-threatening in many cases due to the added stress.   The dignity and value of the senior must always be paramount in the mind of all those involved with the life and care of any human being.  Transparency on our part is only the first step.


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Our Seniors Deserve Functional Families & Care Placement Professionals

Dysfunctionalism, whether it be within our families, or within our communities, dramatically affects the quality of life of our seniors.  Seniors deserve better behavior from us.  It is time for a change!

You’ve heard the stories, or perhaps you’ve been part of a story.  Mom and Dad seem to be doing just fine doing their own shopping, getting their meals, living life.  Without warning it happens – the fall, the car accident, the broken hip, the report of confusion from the neighbors, the sudden trip to the hospital.  It’s become painfully obvious that it’s time for a change of pace and environment.  Now what?

Throughout Oregon, and especially throughout our Portland metro area, thousands of senior care options and services scramble for your attention – In Home Care, Adult Family Homes, Assisted Living, Residential Care, Rehab Centers (Nursing Homes), as well as the neighbor next door, or the friend at church who suddenly has all your answers.   Of course, doesn’t it seem that every family member suddenly has more love of mom or dad than you could possible conjure up?

Warning:  Work Together – Dysfunctionalism Leads to Inappropriate Decisions & Placement.

With that being said, suddenly you (and perhaps other family members as well) discover the list of Referral & Placement Agencies willing to assist you – for free.  Perhaps you were even handed a list by the hospital social worker.  Dozens seem to suddenly be only a phone call, or key-stroke away – all shouting the mantra in a growing pitch “Don’t make this important decision alone.”

Be Cautious:  Choose One (1) Agency – Be Selective – Be Honest – Work Together As A Family 

Why the warnings?  Recently in the State of Washington, a new law regarding Referral Placement Agencies (Washington HB1494) was enacted and will go into effect January 1, 2012.   As in Oregon, many Washingtonians discovered that these commissioned-based placement agencies were pretty free to do whatever they felt they needed to do in order to stay financially alive  There has been no oversight, no rules or regulations, no education or training requirements from the State.

The Internet seems to have also encouraged the explosion of online companies that scream at you to simply log in and give them your contact information before you receive any help – all so they can promptly outsource  your information via fax or a phone call to every facility in their database – irregardless if it is appropriate to your situation or not.  (Be wary of online placement companies that require you to log-in).  By flooding the local market with their calls and faxes, they feel they have “protected” themselves for some other agency getting your name and numbers to the facilities before they do.  Perhaps due to our stressed economy, many unemployed & former marketing or facility operators have felt it opportune to supplement their income by opening up a new placement “service”, resulting in their leaning on you for their survival -(Click here to read the story the Seattle Times carried last December).  Unfortunately, the senior and you become part of a placement game played out among competing agencies.  In many cases, especially with the large “nationwide” agencies, their representatives may have never even set foot in the facility they are referring you to.  Appropriate matching seems to have gone out the window in favor of making a quick placement.  Today Oregon has left Placement & Referral Agencies totally un-regulated.  You may even find some placement agencies online that refer to themselves as “state certified”, however, there is no such thing – there is no state-sanctioned certification at this time.

It is time for an Oregon change!  This time, Washington has given us an outstanding model to follow.

Yes – get help with your placement decisions .. But …

  • Choose One (1) locally-based professional agency.
  • Would they meet the quality & ethical standards set by Washington HB1494?
  • Consider seriously & inquire how long they have been in operation in the local area.
  • How often do they visit the facilities they provide you?
  • What is their screening process?
  • What goes into the selection of options they provide you?
  • What kind of follow-up takes place afterwards?
  • Are they a LOCAL Agency or part of a large francise?
  • Do they have ownership of care facilities (Yes there are some that also own their own adult family homes or residential care facilities – is this not a conflict of interest?)

Change for the benefit of our seniors requires at times that we look forward and work together as families, friends and as a State community.  Guidelines, even laws, sometimes need to be enacted so that you know we take seriously the commitment we make to seniors to provide a quality care system when they need it the most.

Seniors deserve the best from us – let’s get to work Oregon!

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Is Being On Twitter or Facebook or Being Found By Google Enough?

When you entrust a business you find either in the phonebook, or on the internet, with assisting you with the complexity of senior care, do you expect  and assume them to be a licensed business?  Adult Care Homes, Assisted Living Communities,  Retirement Homes, and Home Health Agencies all must have a valid current business license in order to operate in Oregon.   Those that help you through the maze of senior care options also ought to be a licensed and tax-paying businesses.

In short .. check out any senior placement service or agency that you find on the internet, Facebook or Twitter,  and find out if they are a licensed to operate as a business.  The Oregon Secretary of State – Corporation Division has an excellent registry and easy website to verify licensure.  (State of Oregon Corporation Division)

As people struggle in our economy, there are those that decide to re-invent themselves, and start a new business.  We applaud their willingness to serve within the senior care community, however, business ownership requires adhering to standard ethical business practices – and the start is usually getting a federal tax ID number, as well as a business license.

During the past two weeks, we have discovered some Oregon placement agencies that do not hold business licenses and yet cleverly and actively market via websites, and the social media – even using a marketing service (PR Newswire) to announce with their internet arrival.  Our issue is not with their websites or their use of creative internet marketing, but with their not following established licensing requirements.  Our question is quite simply, if they cannot follow state & federal guidelines, will you be able to count on them to expect and require care providers to honor and respect their licensing requirement – established for the safety and well-being of seniors?

Being on found by Google is not enough when we are entrusted with providing recommendations to you regarding the life and well-being of seniors.  There are values, standards and experience that matter and make a difference.

What are your expectations?  Is Facebook or Google placement enough?


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Care Service Options, A local Senior Placement Agency Seeks Opinions

Over 24 years ago, we at Care Service Options established our local senior care placement agency based on principles and ethics that we envisioned would endure the test of time.   Having come from a strong ministerial background as well as a strong community-based Oregonian upbringing, coupled with a high-tech employee-based Tektronix type philosophy, we worked hard to provide seniors and their families with a senior care placement service that would help match seniors with quality and appropriate senior care providers.  We looked for caring-spirited and responsive team-focused employees, while demanding the same from ourselves.  We were, and are, teamplayers with local medical and community-based senior related professionals.

In 1986, Senior Care in Oregon was developing as a model for the rest of the nationAssisted Living as a concept was beginning to take shape with small locally-owned companies;  options for senior care began to include care in family environments and homes referred to as Adult Foster Care;  placement agencies, such as Care Service Options, were few in number and locally owned.  Within the senior care community, there was a genuine spirit of working together within the local community to help enrich the life of seniors needing quality care. 

Although today the Senior Care landscape has changed, your opinion and your spirit still matter and can help chart the course for the next generation.  As we have seen in political events throughout the world when people decide that their voice needs to be heard, they can and do affect the outcome.  As large national Assisted Living corporations continue to expand, as the term “Adult Foster Care” has evolved to now focus more on large private rooms with private baths, rather than family-oriented enviroments,  and as new nationally francised-based senior placement agencies seem to burst upon the local scene almost monthly, it is imperative that your voice be heard.   In the weeks and months ahead, we will be seeking to hear your concerns and your hopes.  In a series of blogs we will address various areas of senior care.

In Part 1 of this blog series, let’s start first with you expectations of a Senior Care Placement Agency.

Last week we received a call from a new senior care placement national franchise soon coming to the Portland area, but headquartered in Arizona.   The franchise owner requested our help with a senior placement issue since their new franchize purchaser was not quite set up yet to start business and was not yet familiar with the senior care options available in the local area needed.  (Yes, their is a difference between “Assisted Living” & “Adult Foster Care” in Oregon)  This agency had been discovered and contacted online by a family seeking help.  A family member filled out a short online form which was forward to the out-of-state agency.  Although we respect this budding agency’s insight in reaching out to our local company with a desire to utilitize our knowledge and experience, their call also raised some important questions we now ask of you. 

What are your expectations of those you turn to for help when you or a family member need senior care?  What are your expectations of a Senior Care Consultant?  Do you expect that their recommendations will be made from their personal visitation and experienced-based knowledge of the care setting and care providers?  Is it important to you that they have met the care provider in an Adult Care Home?

Does it matter to  you the years of experience of the senior care consultant or their background?   Online certification as a “Senior Advisor” comes easily and may indicate the person’s desire to move into a new career path, but does their wealth of time and years of actual service representing seniors and their families matter to you?    Is their past experience as a marketing representive in a care facility, or their experience as a nursing assistant in a nursing home hold as much value to you as their reputation and years of responsiveness within the local senior medical community of doctors and social workers?

Many of the nationally-based franchised Senior Placement Agencies ask you to first provide your information online.  They then either forward that information to a local representative or they blanketly forward or fax your information to what they consider appropriate care settings.  The marketing department of the faxed facility is then requested to  contact you.  In those situations you can then expect numerous calls from facility marketing staff hoping to convince you of the quality of care they provide.   These calls can be persistent and frequent, even after you’ve chosen another facility or care environment.   Is this approach really helpful to you? 

Would it be more helpful to you to be able to personally talk with, (either via phone, in a coffee shop, in your home, or at the hospital or care facility) the senior care consultant?  What are your views regarding the desire and willingness of a consultant to  meet the senior needing placement?  Do you feel this personal visit can be helpful in making a more appropriate placement?  Is it important to you that the senior consultant you speak with has you and the senior’s best interest in mind ( not a facility’s)?  Are they to be representing you, or the facility?

Besides the above questions, there is also the question for some about the value of utilizing a locally-owned and operated placement consultant.  Does local ownership and committment matter or hold value to you?   Some contend that locally owned agencies are able to more easily work cooperatively and build trusting relationships with local social workers, hospital discharge planners, doctors, and other senior health care professionals.  This locally focused health care team approach may result in more appropriate senior care placement for the senior.  Does this local health care team approach hold value for you?

Senior Care in Oregon became a model and responded well to the needs of seniors and their families because of it’s dedicated and senior-focused and caring people.  As together we advance ahead, your voice is critical.   When you are faced with the tough decisions of quality care for your mom or dad, or a loved one, you need more than ever to be able to trust and depend on those you call upon for help.   Together we can continue to develop senior care models that are effective, helpful, caring and responsive to seniors. 

Make your opinion known.  If you email us, your opinions will be shared only if you give us permission to share your insights.   Appropriate opinions are also encouraged  in the “leave a comment” section below.

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