As published by the Austin American-Statesman July 25, 2014. The original story (paywall) is reproduced here for portfolio purposes only. This story accompanied a database of Central Texas nursing homes and assisted living centers I built with Christian McDonald.
Terri Vaughn took in her mother, Marie, in fall 2012 because Marie was showing signs of Alzheimer’s disease and couldn’t take care of herself.
During the next 18 months, Vaughn cut her work as an English as a second language instructor at the University of Texas in half. Marie spent five to six hours a day, four days a week at an Austin adult day health center, and the rest of the time at home with Vaughn and her husband, Ron Cockroft.
But as Marie’s condition progressed, Vaughn realized she was no longer able to give Marie the care she needed — Marie wasn’t sleeping, she was crying more often and repeatedly asking for her parents or her husband, all of whom have died.
“It happened pretty quickly because she had adjusted well when she first came to us,” Vaughn said. “We weren’t getting much sleep. … It just sort of became all-consuming.”
Like many families in the position of having to choose between providing for a loved one and maintaining their own lives, Vaughn and her husband decided to find a care home for Marie.
Central Texas has many elder care options: in-home care, adult day care centers, assisted-living facilities, continuing care retirement communities and nursing homes, to name a few. Finding the right fit can be a grueling experience but aging and disability advocates say that doing the research and asking the right questions will ease the process.
Annette Juba, deputy director of programs at AGE of Central Texas, said families always want to know what the “best” option is for long-term care. “It’s impossible to name just the best,” Juba said. “Picking a nursing home is a highly personal decision — what is the best for me might not be the best for someone else.”
Amanda Fredriksen, Texas AARP associate director of state advocacy, said often families are pressed for time to look for a home for their loved one. Some residents go straight from a hospital stay to a home or assisted-living center.
“It can be a bit of a crisis and you may not feel like you have the time to do the research and the due diligence that you might like to do,” Fredriksen said. “But it’s still important to check the stats.”
To help people shop for the right care senior care facility, the American-Statesman’s Nursing Home database links directly to the most up-to-date Medicare.gov and the Texas Department of Aging and Disability inspection reports. Each report provides details on major safety violations, complaints or licensing terminations in the past one to two years. By state law, the nursing home also must make these records available to anyone who asks. The government websites don’t update regularly and the most recent report from the facility could reveal deficiencies not in the databases.
The difference between the two most common long-term care choices, nursing homes and assisted-living facilities, is the amount of care and independence each type of home allows its residents.
Nursing homes, also called skilled nursing facilities, provide some of the most intensive 24-hour medical attention to their residents, who are often unable to care for themselves due to debilitating medical problems or severe cognitive impairment. Assisted-living facilities provide less care throughout the day and foster a more independent atmosphere for residents.
Looking for more care
At the adult day center, Marie had been able to stay active. She participated in pet therapy, listened to local musicians perform, played pingpong, walked around the gardens and Wii bowled. Vaughn wanted to give Marie a place to live where she could stay engaged for more than just a few hours a week.
“Mom likes things to look pretty, so I was trying to find something (where) she would like the environment,” Vaughn said. “I wanted it to be close enough to our home that we would feel comfortable going over there every day.”
In assisted-living facilities such as Colonial Gardens in Austin, where Marie has been living since March, residents stay in private rooms decorated with their own furnishings. Marie is even allowed a pet calico cat, named Snookie, cared for by the staff. At the center, there are still shared meals and activities, but the staff’s involvement in housekeeping and eating, bathing, dressing and medical assistance is lighter than in a nursing home.
Vaughn said her family made the decision for Marie’s care quickly, but not hastily.
Most aging advocacy groups suggest families pick a suitable price range and look for places in close proximity to their homes. The more that family members visit, the better the experience for the resident will be, and the more likely staff members are to pay attention to that resident.
Vaughn said she was looking at nursing homes and assisted-living centers with a price range between $4,000 and $6,000 a month, and was mainly looking at places that specialized in caring for residents with dementia.
Vaughn pays Colonial Gardens on a month-to month basis using Veterans Administration benefits from Marie’s second husband, who was a World War II prisoner of war, Marie’s Social Security and Marie’s life savings. Vaughn said it’s enough money combined for Marie to stay at the assisted-living center for two years, but then the family will have to decide what the next step is.
In total, Vaughn visited and revisited four facilities in the Central Texas area that met the family’s criteria. The assisted-living center at Colonial Gardens — with two houses, 16 residents to each house, and lush gardens — felt more like a home to Vaughn than a nursing home, but with all the same amenities, just more variance in her daily routine.
Vaughn also chose Colonial Gardens because it predominantly caters to people needing memory care for Alzheimer’s disease or other kinds of dementia.
Marie gets 24-hour supervision at Colonial Gardens. She can mostly dress and feed herself, Vaughn said Marie is physically capable except for some arthritis.
“She needs a lot of supervision because she doesn’t remember the appropriate things to do, or what she’s supposed to do,” Vaughn said.
Making the adjustment
Fredriksen said it’s important to ask if there is any leeway in the facility’s schedule. “It helps people to maintain a bit of control and choice in their life,” she said. “A lot of the anxiety that people have when they face an institution is ‘now I have to do what they want me to do when they want me to do it.’”
Some nursing homes and assisted-living centers have independent resident and family councils, or something similar, that allows families to help make choices and decide the best continuing options for care and to voice complaints of substandard care and other problems.
Frederiksen, of the AARP, said resident family councils can be an effective tool to help the facility meet the needs of residents and make it feel like a home.
“You can kind of balance what the facility needs to do to deliver high-quality care to everybody with the staffing they have and still and try to make the experience as comfortable and positive for everybody there,” Fredriksen said. “I think the family residents councils have the potential to do that … it’s important to ask if they actually have one and how active it is.”
Vaughn said that Colonial Gardens doesn’t have a formal caregiver council, but her family members have all the input they want. Marie has made friends there. She stays busy doing puzzles, exercising and watching old “I Love Lucy” shows. There are sing-alongs with musicians and nonsecular church services for the residents.
“The relationship we have with (Colonial Gardens) is really wonderful,” Vaughn said. “It just seems to be the right place at the right time… it all just seems to fit together.”
Since Marie has gone into care, Vaughn said she and Cockroft have more time to themselves.
“Before it was kind of like when you have a small child,” Vaughn said. “It’s easier to sleep at night not worrying about whether she’s going to get up and wander around.”
Vaughn also was able to take time off from UT during the summer to recuperate from her time as Marie’s caregiver and sort through Marie’s belongings. She’ll be going back to work full-time in the fall.
And Marie has adjusted to living at the assisted-living center.
“When I go to visit her she’s very pleasant and it’s just been a really good thing,” Vaughn said.