Shopping for a memory care facility? Take the long tour

May 25—Shopping for a memory care facility for a loved one is a daunting and high-stakes task — one that typically comes when emotions are running high.

Jeff Pitman, a Santa Fe attorney who represents victims of nursing home abuse and neglect, and Vickie Sands, the former director of patient care at Pacifica Senior Living in Santa Fe, say there are plenty of steps families can take to make the best choice.

They say memory care shoppers should tour several facilities — and take the scenic route.

That should include the rooms, dining areas, kitchen and anywhere that hosts activities. In a combination assisted living facility, the tour should also include a trip to the memory care unit.

"They want to see everything that is offered by the facility," Pitman said.

Do a security check: Pitman advised families to look for signs in the memory care unit the area is secure.

Is it on a separate floor from other parts of the facility? Is it behind a locked door? Does it have its own dining room? All are signs that memory care is treated differently than assisted living or other services.

"That becomes its own little community," Pitman said.

Get a feel for the place: You don't have to be an experienced health care worker to pick up on the vibe.

"How do you feel in your gut when you walk in? If it smells good, looks good and you've got a good feeling, then you can go from there," said Sands, who left her position at Pacifica because of what she described as a culture of putting profits before people.

Sometimes there are unpleasant surprises, but for the most part, Sands said, you should be able to walk into a facility and tell whether you feel comfortable with it.

"If I walk into a facility and it stinks or the residents are nasty looking or dirty or hanging out the side of a chair or crying and nobody's addressing them," she said," those are the things I look for that tell me to run in the other direction."

At the end of the day, "don't believe what you hear — believe what you see," she said.

Look for quality of life: It's important to know how memory care residents spend their time.

"What activities do they have?" Pitman said. "Where do they have them? Who can participate in them? Do they have outings where they can get out of the building?"

Look for signs that residents are engaged, whether reminiscing, listening to music or even doing crafts. A facility without programs should be a giant red flag, Pitman said.

"You're paying for more than just three hots and a cot," he said. "If it's just, 'Watch TV' ... that's just warehousing people. That is not giving them qualify of life."

Sands advised families to observe other residents' condition and mood.

"Do they look clean?" she said. "Do they look happy? Because if they're not happy, they'll be the first to tell you."

Learn the chain of command: Shoppers should try to get a sense of the leaders and hierarchy of a place.

"They should ask them, really, what's the structure, from top to bottom," Pitman said, adding visitors should ask how long the executive director or the administrator has been there.

"You want to try to avoid a place that has a lot of turnover," he said. "That's a red flag."

Ask whether there is a director of nursing or a director of clinical services, and what the medical staff situation is.

"Is there a nurse in the building, and if they're there in the building, how long are they there?" Pitman said. "Who is in charge of people on the weekend?"

Visitors should ask about the director of the memory care services, specifically, and what their experience is with different types of dementia.

Answers to those questions will give prospective residents valuable information about how things work and "who is running the show" on a normal day, Pitman said.

Ask who the owner of the facility is, and how often they're at the building.

"The mom-and-pop places are usually a little bit better run because they're in the building," Pitman said. "It's a different level of commitment to the community and to the property."

Watch the rank and file: The leadership may call the shots, but staffers are the ones who do the hands-on work.

Pitman said people should ask about caregiver qualifications, including whether any are certified nurse aides. The state doesn't require that, but some facilities have more stringent internal requirements.

Find out who administers medication, Pitman said, and that person's level of training.

Ask leaders about staffing ratios, both during the day and during overnight shifts. And find out how long staff members have been there to get a sense of turnover.

"If they've worked there a long time, that's usually a good sign," Pitman said.

When he's taking a deposition, he said, he usually asks staff whether they were trained on the New Mexico Administrative Code, which provides some regulation of assisting living facilities. It's telling to see how people react to those questions.

Sands also advises families to observe how alert and attentive staff members are.

"Then look at the staff," she said. "Are the staff happy? Are they busy, or are they sitting around on their phones?"

Ask about after hours: Try to get a sense of how things run at night and on weekends, when visitors are less likely to be present and the bosses aren't there.

"If somebody is injured, is there a nurse or is there a doctor they can call?" Pitman said. "Is the procedure that they just call 911?"

Find out, too, the protocol for a resident who's incapable of deciding whether they should go to the hospital, either due to memory issues or an injury. Does the staff call the power of attorney or a nurse?

"That's the scary part, right?" Pitman said. "If your loved one is injured, what happens then?"

Read before you sign: No matter how great a facility seems, Pitman said, do not sign an arbitration agreement on admission. He noted the practice, which is becoming more common, hobbles legal recourse for families if something goes wrong.

"They don't understand that they're waiving their right to a jury trial," he said.

Continue monitoring: Careful observation shouldn't end after a facility is chosen.

"The one thing I highly recommend is that people visit as often as they can," Pitman said, adding visits should come at different times of the day and days of the week.

"All of these facilities, they know who visits, they definitely pay attention."

Family members should never be shy about documenting and reporting any problems, preferably by email, Pitman said, both with the facility and — should the situation demand it — with state authorities.

"A lot of people are afraid their loved ones will be retaliated against if they raise issues, but they still have to do it," he said. "Any good facility will be grateful to know about what's going."