What care and services are provided in Assisted Living?
Most Assisted Living Facilities work in partnership with family members, advocates and health care providers to understand each of their resident’s individual and changing needs. This enables them to personalize care.
A typical Assited Living Facility provides:
- Personal assistance with daily needs like bathing, dressing and grooming
- Housekeeping and laundry
- Three nutritious meals prepared fresh daily, plus snacks available throughout the day
- Dining assistance and special diets
- Medication management and daily monitoring of health status and changes in physical, mental, emotional and social functioning
- Transportation arrangement for medical and dental appointments
- Planned activities and social events
- Choice of private and companion rooms
- Highly trained staff on site 24/7
Why is this so emotionally upsetting to my elderly loved one(s) as well as our family?
Many factors effect us emotionally. Among those that elicit strong responses from us are change, relocation, preconceived ideas and conceptions, as well as feelings of guilt and frustration. Let’s now examine in detail each of these characteristics.
Preconceived Ideas and Conceptions
Another misconception prevalent today is that our elderly can be a burden with the increased need for care and attention. Today, with a growing elderly population, enhanced sensitivity, knowledge, and professional care with regard to aging is producing some very attractive alternatives. Each person has a right to enjoy their life, without the stigma of being a “burden”.
Feelings of Guilt and Frustration
Without a doubt, guilt and frustration are two of the biggest emotions people experience with respect to caring for, and dealing with, their elderly loved ones. More important, these feelings are shared by the very ones they are caring for. Today’s lifestyle is hectic and fast-paced. It is crammed with events that require decisions that are not easy to arrive at. That doesn’t have to be the case anymore with facilities like Ivy Ridge and Apple Ridge.
Now, instead of perceiving the experience as “putting mom or dad in a home”, Ivy Ridge lets you see it as “Mom or Dad’s new home is a million dollar residence with a beautiful courtyard. They get to enjoy the service of caregivers, cooks, maids, gardeners, and chauffeurs”. More importantly, they are under the care and supervision of professionals who can recognize and satisfy their needs 24 hours a day – at an affordable cost.
I understand the aging process in general, but specifically what is going on?
However, it is difficult to determine, and research has not been conclusive, as to which changes are a normal part of aging, and those that are the result of disease, and/or risk factors (i.e. poor diet, improper medication administration).
The following are common functional and cognitive changes that occur with aging:
- Memory impairment
- Slower cognition
- Changes in sleeping patterns
- Decreased visual and auditory acuity
- Poor gait and/or posture
The elderly individual in our society experiences “losses”. These losses can usually include losing the opportunity to work, losing a spouse, losing a home, and losing the ability to perform self care. Without access to proper support systems and coping mechanisms, many of the elderly are left to adjust to these losses on their own.
The staff at Ivy Ridge and Apple Ridge pride themselves on providing a strong support system to assist our new family residents in dealing with these events. We know it is very important to meet these psychosocial needs. This not only provides a sense of well being to our family residents, but also reassures their own family that their needs are being met. This leads us to the process of determining where do we go from here.
The way in which the “tasks of aging” can be successfully completed, must be taken into consideration in the formula for “Where do we go from here?”
A few of the tasks are:
- Adjusting to decreasing physical strength
- Adjusting to retirement
- Adjusting to the loss of a spouse
- Establishing an association with one others in one’s age group
- Adapting to social roles in a flexible manner
- Establishing satisfactory physical living arrangements.
How does the changing role of the elderly in society affect the decision making process?
One of the biggest challenges faced in our society as we age is that of changing roles. Our roles change throughout our lives, but the change becomes accelerated as we age. When we reach old age, society expects us to move over and make room for the new. We are expected to, and usually do, retire and prepare for the “golden years”.
The Disengagement Theory is one in which the maintenance of a balance in society is maintained by a mutually beneficial process of withdrawal between society and the elderly. According to this theory, older people desire, and are happy with this withdrawal. This theory helps society as a whole begin to identify aging as a complex process that is extremely individual.
What is Dementia?
Dementia is used as a generic term for a host of mental disorders. It must be noted that “Dementia” is not a disease, it is a syndrome. There are however, many diseases that can cause primary dementia.
Some of the more notable include:
- Alzheimer’s Disease (described in its own section below)
- Multi-infarct (vascular) dementia
- Mixed Alzheimer’s with multi-infarct
- Pick disease
- Parkinson’s Disease
- Senile Dementia
Of these diseases, Alzheimer’s, Parkinson’s, and Senile Dementia are perhaps the most recognizable and prevalent. For that reason, each are described in greater detail in their own sections.
Secondary Dementia (20% of all dementia) is related to some other cause or disease. It can be treated if the underlying cause is discovered.
Those underlying causes can include:
- Substance abuse
- Vitamin B12 deficiency
- Poor nutrition
- Metabolic disorders
- Cerebral diseases (e.g. tumors, multiple emboli)
- Pseudodementia (often related to undiagnosed depression
The symptoms of dementia include impaired cognitive function, memory loss, impaired speech, poor abstract thinking skills, impaired perception, emotional changes, and behavior manifestations.
What is Alzheimer's Disease?
Alzheimer’s Disease is a progressive degenerative disease of the brain now considered a leading cause of dementia. It affects an estimated 2.5 to 3 million persons in the U.S. The incidence of the disease increases with advancing age, but there is no evidence that it is caused by the aging process.
The average life expectancy of persons with the disease is between five and ten years, although many patients now survive 15 years or more due to improvements in care and medical treatment. The cause of this disease has not been discovered, although palliative therapy is available. The ability of doctors to diagnose Alzheimer’s disease has improved over the last ten years, but this remains a process of elimination and final diagnosis can be confirmed only at autopsy.
Alzheimer’s Disease is a neurological disorder that results in the destruction of vital cells within the brain. The destruction occurs in the outer portion of the brain (the cortex) which is responsible for higher cognitive function. The destruction of these cells results in the symptoms associated with the disease.
The degenerative process of the disease is progressive, getting worse over time. The symptoms of Alzheimer’s are cognitive decline, and are seen eventually in all cases of the disease.
These symptoms include:
- Decline in the perception senses. This results in the loss of the ability of interpreting sensory cues and relationships between objects, self, and the environment.
- Decline in the patient’s attention span and ability to concentrate.
- Decline in the ability to understand spoken or written language. This also causes difficulty forming words or expressing oneself orally or in writing.
- Decline in memory. This will cause poor awareness of one’s surroundings, and poor retention of, and retrieval of memories. Long term memory usually remains intact the longest.
- Poor emotional reaction, causing inappropriate reactions to events as well as exaggerated responses.
- Decline in the ability of abstract reasoning and judgement. This causes problems in following sequences, forming concepts, and reaching conclusions.
What is Parkinson's Disease?
Parkinson’s Disease is a slowly progressive disabling affliction. It is marked by tremor and increasing stiffness of the muscles. The disease affects more men than women. It is most likely to develop after the age of 35. Approximately 200,000 cases are recorded every year in the United States.
The disease results from degeneration of the basal ganglia, an area of nerve cells that are located at the base of the brain. The chief carrier of nerve signals in this area is the chemical, dopamine. This chemical is usually severely deficient in Parkinsonian patients. The cause of this deficiency is not known, but the discovery in 1983 that the chemical MPTP ( a by-product of a synthetic form of heroin) could cause similar damage suggests that Parkinson’s disease may have an environmental origin.
Symptoms of the disease include:
- Excessive salivation
- Poor coordination
- Faulty body balance, tremors, and muscle rigidity
- Shortening of muscles along the front of the neck tends to bend the head and spine forward
What is Mild Cognitive Impairment?
Mild cognitive impairment (MCI) is an emerging term for an intermediate stage between cognitive changes of normal aging and dementia in elderly people. While normal aging is a gradual decline in cognition, MCI refers to cognitive impairment beyond that expected for age and education, but does not meet criteria for dementia. As the population ages and longevity increases, physicians will increasingly see patients experiencing memory loss, so learning an approach to states such as MCI is now warranted.
The diagnostic term mild cognitive impairment refers to early, nondisabling cognitive disorders that do not meet the criteria for dementia. Although many researchers proposed a variety of criteria, the Mayo criteria are the ones most applied in the literature.
- Self-reported memory complaint, preferably corroborated by an informant
- Objective memory impairment
- Preserved general cognitive function
- Intact activities of daily living (ADL) with minimal impairment in instrumental functions
- Not meeting criteria for dementia
Making the distinction between normal impairments of aging and impairments that do not represent dementia requires considerable clinical judgment that may differ among assessors. Challenges remain for lack of a uniform quantitative or systematic definition of functional impairment. The Clinical Dementia Rating (CDR) scale has been used in research studies and has proven to be a valuable instrument for the definition of functional impairment; however, for practical clinical application, it is too time-consuming. –
See more at: http://www.clinicalgeriatrics.com/articles/Diagnosis-and-Treatment-Mild-Cognitive-Impairment#sthash.g6TlaGb3.dpuf
What are ADL's?
ADL stands for Activities of Daily Living, i.e. activities performed on a daily basis. They are essential to maintaining physical, mental, and social health and hygiene. These basic activities include dressing, bathing, brushing one’s teeth, combing your hair, feeding, and toileting.
Usually, the inability to perform certain of these activities on a daily basis results in a relocation to an “Assisted Living” environment. Each family must access the items and assistance required in determining which alternative is applicable or appropriate for their family resident.
What are the different types of care facilities?
There are three basic alternatives to private residency, depending on the physical, mental, and social needs of your loved one. Additionally, that person’s own preferences and financial standing are key factors that must be included in the equation. It is important to involve the elderly in the evaluation and decision making process to the maximum level of their capacity. The “change” and transition in living environment goes much smoother if they feel or perceive that the decision is partially or totally theirs. Let’s examine the alternatives with respect to living arrangements for our elderly loved ones.
This is the least supportive of the alternatives. The facility or building units are not licensed for care unless they have other levels of care within the organization. Most of these types of organizations consist of small apartments, studios, or rooms where the residents live on their own or with their spouse or roommate. Meals are usually served in a common dining area, usually at specified times. The monthly fee usually includes some or all meals and light housekeeping. Residents are responsible for bathing themselves, grooming, and personal daily care, including administering their own medication. Additional “in home care” can be arranged outside of the facility, but this can become rather expensive. The rooms usually have panic or call devices in the rooms for an emergency. However, these facilities do not usually assign staff to physically check on the residents day and night.
These types of retirement communities are a sensible solution for active independent seniors who primarily feel the need for companionship, desire social activities, and want opportunities to interact with individuals with similar interests. As you would suspect, this alternative requires a senior to be in reasonably good physical and mental condition.
Residential Care Facility for the Elderly (RCFE)
These facilities are licensed and regulated by the State of California. All Administrators must be certified and maintain a continuing education program. The staff must pass health and criminal record checks, which includes fingerprinting. The fingerprints are submitted to the Department of Justice for review. The staff residents are trained and certified for First Aid. The staff also undergo a regular training program in client care and responding to emergency situations.
Smaller facilities caring for 2-6 residents are usually referred to as “Board and Care” homes. The larger facilities that handle anywhere from 10 to 200 patients are usually termed “Assisted Living” residences. The rooms, private and semi-private, are licensed for ambulatory and non-ambulatory use. Ambulatory is defined as unsupported walking, or walking with a cane. Non-ambulatory covers walkers and wheelchairs. In these types of homes, the resident cannot be totally bed ridden. However, this restriction does not cover the short periods that may be necessary for treating a cold or the flu.
RCFE’s are not medical facilities. They do however, provide custodial assistance with Medication Administration under a Doctor’s prescription. Improper usage of prescribed, as well as over the counter medications, can be of serious risk to the elderly. In addition to providing transportation (when it is not practical for the family to do so) to scheduled doctor and dentist appointments, most RCFE Administrators work closely with the Home Health Specialists who can provide a wide range of medical and social services to their residents.
In addition to 24 hour care and observation, RCFE’s normally have a higher staff to resident ratio then Independent Living or Skilled Nursing Facilities. Many will allow the families to furnish the sleeping quarters to give the Elderly a feeling of possession and individuality. This also helps to eliminate that “institutional” feeling, and gives them a stronger sense of “being home”.
With the large divergence and personalities of the respective facilities available, a personal inspection of these residences is a must prior to making a final decision. We at Ivy Ridge welcome you, and extend an open invitation to you. Come see for yourself, how we can meet the needs of your family resident, and give you the peace of mind that comes from making a sound, informed decision.
Skilled Nursing or Convalescent Care
Skilled Nursing institutions are usually large with 60 plus beds, and two beds per room. they are very much like a hospital, and are fairly regimented. Although the staff tries to make the stay pleasant by allowing the families limited decoration of rooms rights, it is still primarily a medical facility. A physician has to prescribe this level of care prior to admission.
The patients (in contrast to residents) are usually frail, bed ridden, or under restricted non-ambulatory status. There are many situations when this level of attention is necessary on both a short term, and long term basis. However, once the acute medical needs are met, the other alternatives are far more beneficial from a quality of life standpoint.
How do I make the right decision?
First and foremost, you need to make an inventory of the physical, mental, and social needs of the loved one in question. Remember to factor into the equation your loved one’s unique personality. Get them involved in the process to the level of their capability. Recall that the more involved they are in the decision making process, the better the transition will be when it comes time to implement your plans. Consult with their doctor if the transfer is following a medical condition.
Another excellent source of valuable information is support groups and organizations on aging. An Ombudsman is another great source of information to help you determine your course of action. Don’t forget friends and peers who have already gone through this process. They can provide you with a wealth of insight and help you steer clear of the obstacles they encountered.
One of the best tools you can utilize is a check-off list or survey when you tour a particular care home. We have included a model of one at the bottom of this section, and suggest you print it out and use it to help you in your decision. Keep in mind while using this tool, do not be afraid to also listen to your heart. So often, our minds are trying to synthesize all the information, while our hearts are already telling us exactly what that information is pointing to. Trust your intuition as well as your data.
It is vital that you physically inspect the facilities you are considering. Inspect them with your mind, your eyes, and your soul. Is that place one that the family and the loved one can relate to as “home”? Are the other residents compatible in needs and level of care? Be bold, ask the hard questions of your tour guide. At this point you need straight forward answers, not salesmanship. You can learn much from the Managers or Administrators from their manner of presenting their facility, to how they relate to their residents as they guide you through the facility. These people need to be professionals, dedicated to the care, comfort, and happiness of the elderly they are responsible for and to. Make every attempt to develop a feel for the environment and attitude generated by the facility, the staff, and the other residents.
Ask for references from the facilities under consideration. You should be able to talk directly with family and residents who made the decisions you are now facing. See how they feel about those decisions with hindsight as an aid. Now is not the time to be apprehensive or timid. Be bold, you WILL make the right decision.
What are the financial aspects of this type of health care?
The cost of long term care is significant, and little assistance is available through Medicare or other health insurance. If the elderly’s income is not sufficient to cover the monthly expense, it usually has to be supplemented by either savings, the conversion of assets, or assistance from family residents.
In some cases long term care insurance has already been put into place and may now be utilized. Other sources that can be tapped into include life insurance policies, annuities, and reverse mortgages. Each person’s financial status is different. You should explore your options with your attorney, CPA, or insurance agent.
There is not a formal industry wide rate structure for care and living quarters. Rates for RCFE’s can vary from $1500 + (SSI) to more than $4,500.00 per month. Rates are usually based on the physical aspects of the facility, staff to resident ratios, services offered, and the elderly’s level of care requirements. The latter can only be determined during a Pre-Admission Evaluation by the facility’s Administrator.
There are however, three common methods used in establishing a rate:
- Flat Rate
- Tiered System Based on Level of Care
- Fee for Service
Let’s briefly examine each of these aspects.
Under this method, every resident pays the same rate, regardless of their diagnosis, level of care requirements, or specific quarters provided. This method is simple, and does not require monthly statements. Family residents can easily project the expenses on a long term basis, and the plan works well if all placements are congruent. The disadvantage to this is that it can be unfair to those residents who use very few services. These residents are essentially subsidizing the care of those who utilize many services.
This pricing method is based on varying levels of care, based on resident need. In other words, the fees change in relation to personal care requirements and the services rendered to meet those requirements. Embedded in each tier are basic charges for room, meals, activities, and housekeeping. You may recognize this system as a “menu” style of plans offered. It may be described in their pamphlets as “Service Plan A”, “Service Plan B”, or termed “Basic”, “Catered”, and “Deluxe”. Fundamental to this method is the concept of paying for what you use. The more services needed or consumed, the more the expenditure. The disadvantage to this is if the resident is placed in the wrong tier, they could be either overcharged for their true level of needs, or undercharged but not receive the level of care required.
Fee for Service
This fee structure charges each resident a base rate for room, meals, and housekeeping. Each and every personal service is then charged individually. Some facilities use “Fee for Service” to prevent sticker shock when families are shopping for care. An advantage to this is no subsidization for care of others, or for services that are not utilized. However, if fees, instead of needs, is the driving force for individual care provided, this can become a major area of conflict between the facility, the resident, and the family. Another disadvantage to this arrangement is the inability to project and budget the actual monthly expenses that may be incurred. This can become a problem when families are relying on somewhat “fixed” incomes.
Be familiar with the admission process in advance. This will help make the transition smoother and faster. It has to be thorough. Here are some general guidelines.
- If your loved ones are not able to make decisions for themselves, get started on the Durable Power of Attorney. At some point, you will need this document and someone will have to make some very responsible decisions regarding your loved ones’ care.
- Arrange a tour of the facility and meet the administrator and the care staff in person. Use a checklist of all your questions and concerns.
- Start the assessment process by arranging a meeting of the new resident and the Administrator of the facility. They need to be able to meet and physically assess your loved ones. so they can evaluate their physical condition, mental state, medication and medical history. The assessment process is an important step in determining if your loved ones are a good fit for a facility, and that the facility is a good fit for them. Be open and honest about all the background information you are providing regarding your loved ones. .
- If you decide a particular facility is the right place for your loved ones, you can determine a move-in date. Prior to move-in, you will need the following documentation, as well as additional information that the facility or State requires:
- Physician’s Report (LIC 602A). The physician’s report form must be completed and signed by their physician. It documents the loved one’s physical condition, mental condition and TB-clearance (tuberculosis).
- Emergency Contact Form. This details the family emergency contacts. Who do we call in case of emergency? Who is the primary care doctor? Which hospital do you prefer for us to take them to in case of emergency?
- Admissions Agreement form. This includes, among other things, a description of all items and services included in the basic rate, facility policies and procedures, conditions for termination of the agreement, and a copy of residents’ rights.
- be sure to arrange that a supply of your loved one’s medications is available prior to move-in.
RCFE Facility Checklist
Quality of Care and Service
- Do residents appear well cared for?
- Are the residents well groomed, e.g., (shaved, clean clothes, nails trimmed and hair done)?
- Is there a written plan of care for each resident? How often is the care plan reviewed and changed?
- Does the facility offer programs and/or services which meet your particular care needs.?
- What is the system for distribution of medication? Are bulk medications divided at the facility? If so, is it done by a registered pharmacist?
- Does the facility have access to doctors, hospitals, home health agencies and adult day health care services?
- Does facility arrange for transportation to medical services? Charges?
- Are there clear procedures for responding to medical emergencies?
Quality of Food
- Does the food appear and smell appealing? Are fresh ingredients used?
- Do residents seem to be enjoying the food?
- Are residents receiving the assistance needed in eating?
- Are meals served at appropriate temperatures?
- Do menus offer an alternative choice? How often are menus changed? (Ask to see a copy of the week’s menu.)
- Can the facility meet special dietary needs?
- Are nutritious snacks available?
- Is fresh drinking water available?
- Can guests eat with the residents on occasion? Costs?
- Does the facility make provisions to serve residents in rooms? Costs?
Quality of Social Interaction
- Are residents interacting with staff and/or each other?
- Are residents occupied in meaningful activities?
- Does the facility have a planned activities program? Are activity calendars posted?
- Is there a designated Activity Director who coordinates activities?
- Do outside performers or groups regularly visit the facility?
- Are there planned trips outside the facility?
- Are pets allowed? Does the facility have pets?
- Are residents encouraged to bring in some of their own furnishings?
- Are religious services offered at the facility?
Quality of Participation
- Are residents and family members involved in assessment and care planning?
- Are residents and family members involved in roommate selection if desired?
- Do residents have an opportunity to provide input into menu and activity planning?
- Are there procedures for responding to requests for information and complaints?
- Is the Ombudsman Program’s poster and telephone number posted?
- Does the facility have a residents’ council?
Quality of Staff
- How long has the key staff been working at the facility, i.e., administrator and assistant administrator, activities coordinator, cook, and nurse consultant?
- Has there been a recent large turnover in key staff?
- How many direct care staff are there for each shift?
- What is the turnover rate among direct care staff?
- Does direct care staff understand and speak English?
- What special training do staff receive in working with persons with dementia?
- Do the administration and staff know the residents by name?
- Does staff take time to talk with residents?
- Do administration and staff interact with residents in a respectful way?
- How long does it take for staff to respond to a resident’s request for help or to a call light or bell?
- Does the administration have significant healthcare background, both formal education and experience?
Quality of Environment
- Is the overall décor pleasant and homelike?
- Is the environment clean and odor free?
- Is the facility quiet or noisy?
- Is the temperature comfortable?
- Does the building seem safe and free from dangerous hazards?
- Are the residents’ rooms, hallways, and common areas well lighted?
- Are floors not slippery and are carpets firm to ease walking and to prevent falls?
- Is the dining room pleasant and inviting?
- Are common areas, bedrooms and bathrooms accessible to wheelchairs and walkers?
- Are bathrooms conveniently located?
- How many residents share a bathroom?
- Do bathrooms, showers and bathtubs have handgrips or rails?
- Are call lights accessible to residents?
- Is there privacy in residents’ rooms?
- Is there any place to have a private conversation? Is there a separate room for small private meetings or meals?
- Is there a bedside table, reading light, chest of drawers and at least one comfortable chair for each resident?
- Is there adequate space for clothing and personal belongings in each room?
- Does the facility have extra storage space for residents’ belongings?
- Are there outside sitting and walking areas for residents?
- Is there a fenced yard?
- Is there a designated smoking area? Is smoking allowed?
- Is there a disaster plan posted? How often does the facility hold drills?
- Is the facility close to family and friends who will be visiting most frequently?
- Is the facility near public transportation and major freeways?
- Is the facility convenient to the resident’s doctor? Home health agency?
- Is the facility close to a hospital?
- Are family and friends welcome at any time or are there strict visiting hours?
- Does the facility have a good reputation in the community?
- Will they give you a list of references?
- Are residents and/or family members willing to talk with you about the facility?
- How did the administrator and/or staff treat you when showing you around?
- Did they answer all your questions to your satisfaction?
- Do you feel that the administrator and staff are people you can work with and communicate with honestly?
- How would you or your loved one fit in? Is this facility compatible with your lifestyle?
- Can you imagine yourself or your loved one living here?
- How did you feel when visiting the facility?
- Do the estimated monthly costs (including extra charges) compare favorably with other facilities?
- What is the cost of upfront fees, e.g., assessment, community fees?
- What services are included in the basic rate?
- What is the cost for extra services? Levels of care? How is the need for extra services or higher levels of care determined?
- What have been the average annual monthly costs increases in the past?
- Are the costs and payment schedule clearly described in the admission agreement?
- Are the total monthly charges affordable over time?
- Will the facility give you a copy of the admission agreement to take home and study before making a final decision?
- Is the facility calm and quiet?
- Does the facility use soft music and/or natural scents to create a soothing atmosphere?
- Is the facility well lighted? Adequate natural light?
- Are there complex patterns on carpets or walls?
- Can staff easily observe the facility’s common areas? Is there a video surveillance system?
- How does the environment promote resident functioning, e.g., a picture of a toilet on the bathroom door?
- Does the facility have a wander alert system?
- Is there a locked or secured outside area for walking? Is there an area to walk inside the facility in inclement weather?
Philosophy of Care
- Is the facility’s philosophy for caring for persons consistent with your beliefs?
- Does facility provide services to persons at all stages of the disease process?
- What conditions or behaviors determine whether a facility will retain someone as they age in place?
- Is dementia care provided in a separate unit or as an integrated part of facility services?
- Is the facility’s philosophy and practice of handling “difficult behaviors” compatible with your views?
- Does the facility provide psychosocial care in addition to basic care?
- Are there activities specially designed for persons with special needs?
- Do activity programs operate throughout the day?
- Are activities individualized for each resident?
- Are there other residents who would provide a source of socialization?
- Does facility provide nutritious finger foods?
- Are water and decaffeinated beverages available throughout the day?
- Does the facility do periodic night checks?
- Number of staff who are awake during the night?
- Does a person(s) with special knowledge and training coordinate the assessment and care planning process? What is that person’s experience?
- What role does direct care staff have in the care planning process?
- What role does the resident and family or legal representative play in the care planning process?
- Does a person(s) with special training plan and coordinate the activity program?
- Does the activity coordinator design customized activities for each resident?
- Is staff assigned to work with the same residents?
- What is the ratio of direct care staff to residents at each shift?
- How long has the longest employed employee been employed?
- Specifically, what type of training do staff receive in handling difficult behaviors?
- Who supervises staff? What are their qualifications?
- Is one or more key employees an owner of the business?