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Villa
Assisted
Living
Come see what makes us exceptional! Samantha Rundle, Director of Villa Assisted Living
How to Have the Conversation about Moving to Assisted Living
What is assisted living?................................................. 3
Questions about your loved one……………………… 3
Signs it may be time for assisted living........................ 4
Local assisted living facilities………………………... 7
What to watch for while researching…………………. 8
Cost comparison............................................................ 10
How to apply for Medicaid........................................... 11
Important paperwork…………………………………. 11
Tips for having the conversation................................... 12
What the Villa has to offer............................................. 13
Villa admission criteria………………………………. 16
Admission process……………………………………. 18
Resources……………………………………………... 19
What is assisted living?2 | P a g e
Assisted living is part of a continuum of care that emphasizes maintenance free housing, personal care assistance and health care services for people who need minimal assistance with every day activities in order to maximize independence, dignity, privacy, choice and safety.
Upon entering assisted living each resident is to receive individualized services based upon their needs. It is important to remember that assisted living serves as a bridge between living at home and living in a nursing home. Assisted living residences provide multiple services that may not be any longer available at home, but are typically not allowed to provide a level of care that matches that of a skilled nursing facility.
There are many myths and misconceptions attached to the term assisted living, some being: you are not allowed to drive your car when in assisted living, assisted living means dependence, you can’t have a pet, you can’t have overnight guests or that assisted means everything is done for residents.
These are false because one purpose of assisted living is to provide a safe housing option for those who need assistance, but are still capable of directing their care and living independent lives. When looking into assisted living facilities you should expect to find an atmosphere where your loved one will:
Be treated with dignity and respect Maintain privacy Be informed of services available Continue to manage personal funds Be able to bring personal possessions from home Be able to participate in activities both within the residence and out in the
community Be able to participate in their religion of choice Continue to control their health-related services such as family
physician/dentist/etc.
What questions should be asked when considering assisted living?
Can my loved one stay where they are with more outside or family help? Is that available?
How much assistance does my loved one need? Can they move in with family or someone close to them? How willing are they to move? Does my loved one have cognitive impairments that indicate he/she would be a
danger to self or others?
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Signs to watch for that will assistant you in answering the questions above.Big-picture signs:
Have there been any recent accidents or close calls? This can include recent falls, medical scare or a fender bender while driving.
Did a recent illness turn into something worse because your loved one didn’t seek medical care?
Is there a chronic condition that is worsening and increasing your loved ones need for help?
Are the skills needed to live independently — dressing, shopping, cooking, doing laundry, and managing medications becoming too difficult or not being done?
Up-close signs:
Sometimes the clues aren’t always visible from a distance. Give your loved one a big hug and you will be surprised what you learn through touch.
Is there a noticeable weight loss or gain? A person who is having trouble getting out to shop or remembering how to cook can lose weight. On the other hand they can snack on unhealthy food all day instead of eating set meals.
During your hug do you notice anything different about the person’s strength as they hug you back? Also watch to see if your loved one can rise easily from a chair and maintain balance upon standing.
A close hug can also reveal if there is a strange body odor and obvious change in personal hygiene habits.
Is there a noticeable change in their appearance? Are their clothes clean? Someone known for crisply ironed shirts may now be wearing a stained sweatshirt because they lack the dexterity for buttons or managing an ironing board and iron. A formerly clean-shaven man with an unkempt beard may be forgetting to shave or how to do so.
Social signs:
Does your loved one still get out for lunches and outings with friends and visit with neighbors or participate in religious activities as they used to? Does he or she keep a calendar of appointments?
Has your loved one dropped out of everything that used to interest them? A library card gone unused?
Are there times when they stay locked away in their home instead of going out? If your loved one does this, are they willing to consider a home-safety alarm, a personal alarm or daily calling device?
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Financial signs:
Are there various piles of mail lying all around the home? Finding lots of mail scattered around raises concern about how bills, insurance and other matters are being handled. Piles of mail can also be a potential tripping hazard.
Routine business letters from banks, creditors and insurance companies is not worrisome, but have you noticed mail referring to overdue payments, overdrawn balances, or other concerning events? Also watch to see if newspapers are being delivered and ignored or if the mailbox is overflowing as it has not been checked for a period of time.
In the stack have you noticed any thank-you messages from charities? Even those who have always been fiscally prudent are vulnerable to sending money to charities if they are having trouble with thinking skills. Some charities hit up givers repeatedly and your loved one may not remember having donated the first time.
Do you see a lot of crisp, unread magazines? He or she may unknowingly have repeat-renewal subscriptions they don’t need or even desire.
Driving signs:
Take a drive with your loved one if they still drive and watch for:
Nicks or dents on the car. If your loved one fastened their seatbelt. If he or she is self-policing while driving. Are they able to drive with conversation or the
radio on as they used to? Are they avoiding certain routes or driving at night? These are signs a change has occurred and they are aware.
Signs of dangerous driving. Is he or she tailgating, drifting from lane to lane, going far below the speed limit, reacting slowly to lights or cars or mixing up the gas and brake pedals?
Warning lights. Check the dashboard as you ride along. Does the car have sufficient gas, oil, antifreeze, wiper fluid?
Kitchen signs:
Are their stale or expired foods in the fridge or cabinets? Watch for mold and sour smelling food.
Are there multiple of the same item in the cupboard? Someone who may not remember from shopping trip to shopping trip what they have at home and may purchase ketchup each time they go; leaving 10 bottles in the cabinet.
When looking into the freezer is it full of TV dinners? Many people buy them for convenience sake, but TV dinners do not make a healthy diet. It also helps to know if he or she is getting more takeout food than they used to.
Check the appliances in the kitchen to make sure they aren’t broken and unable to be used.
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Are there signs of fire? Look to see if the stove knobs are charred, bottoms of the pots are singed or if any of the potholders edges are burned.
Around-the-house signs:
Is there a lot of clutter throughout the house? This may be a little more obvious if the person has always been a neatnik.
Does the housekeeping appear lax? Watch for spills that haven’t been cleaned up, cobwebs, bathroom mold or thick dust as signs.
Pet-care and plant-care signs:
Inspect the houseplants. Are they dying, dead or just gone? How are the animals of the house? Common problems are dogs with long nails, cat litter
boxes that haven’t been changed lately or dead fish in the tank. Poor grooming, overfeeding and underfeeding are other red flags.
Caregiver’s signs:
As a caregiver how are YOU doing? While this decision to remain in one’s home is not primarily about you. Your own exhaustion can be a good gauge of a decline in older adults’ ability to care for themselves. If your loved one’s need for care is wearing you out this is a major sign it’s time to start looking at other options.
How is your loved one’s emotional state? Safety is crucial, but so is emotional well-being. If someone living alone is riddled with anxieties or increasingly lonely, then that may tip the scales toward a move.
Don’t be afraid to get input from your loved one’s circle. Talk to old friends and close relatives to get their sense of how this person is doing. Pay attention to comments that indicate ongoing concerns about like, “She quit the book club.” “Has he had that heart test yet?”
With appropriate permission, talk to your loved one’s primary doctor about your concerns and get their suggestion as to if they feel they may be appropriate for assisted living.
Local Assisted Living Facilities
Villa Assisted Living – Good Samaritan Society Hastings931 East F St
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Samantha Rundle, [email protected]
Edgewood Vista – HastingsTerri Monroe, Executive Director2400 West 12th Street402-462-4633terri.monro@edgewoodvista.comwww.edgewoodseniorliving.com
Homestead Assisted Living – Hastings1116 Sycamore Avenue402-461-3841http://midwesthealth.ppi.net
Kensington-Evergreen Assisted Living - HastingsWendy Buhr, New Resident Services233 North Hastings [email protected]://kensington-evergreen.com
The Heritage at College View – HastingsTrish Kokesh, Senior Living Consultant1100 North 6th [email protected]://heritage-communities.com
What do I watch for while researching assisted livings?Services and Activities
Does staff assist with medication administration?
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Does the facility use a specific pharmacy? If so, does the pharmacy participate in my loved ones Medicare Part D prescription drug plan?
Are there professional nursing services on site? Are the services of a physical, occupational or speech therapist available? Does the residence provide bed linens and towels? Is there laundry services provided? Is there a beauty shop on site? What activities are available? Is transportation provided for medical appointments and is there a fee? Are there resident councils and how often do they meet?
Staff
What training and qualifications are required for staff and do they have on-going education?
Observe staff and resident interactions. Was staff courteous and respectful? How many staff is on each shift? What are the staffing positions?
Cost and Fees
What is included in the basic monthly rent and is there a fee for levels of care? Does the residence have a written rate sheet? Ask for a copy. How often do the fees change? Is there a security deposit? How much is it and is it refundable? Is there a pet deposit? How much is it and is it refundable?
Dining Services
Does the facility accommodate special diets? Does a Registered Dietitian review the menus? How often do the menus rotate? Are residents allowed to have guests for meals? Is it okay for residents to eat meals in their rooms?
Living Space
Are there common areas for resident and family use? Are the rooms furnished or unfurnished? Can residents have overnight guests? Is there an extra charge?
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Is there storage space available? Is there an extra charge? Can residents have automobiles? Is there assigned parking? Is a garage available
and at what cost? Is security provided? Are pets allowed? What are the requirements to have a pet? Is there internet access?
Licensure
Is the resident licensed? How often is the facility surveyed by the Department of Health and Human
Services? Ask to see the last survey result.
Safety
Does the facility have a fire sprinkler system? Are there smoke detectors? How often are fire drills conducted? Does the facility have an emergency preparedness plan? How are emergency and evacuation plans reviewed with residents? How are the doors monitored?
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Services & Amenities Base Rate (Including Level I Care)
Villa Current Home Other Facility
Mortgage/Rent $3,350
Month of Meals Included
Property Taxes Not Applicable
Property Insurance Not Applicable
You can have a better view of senior living with a lifestyle comparison. The Villa has A/B, C, D & E size apartments at varying rates and a Level of Care I, II or III will apply to each resident. For this example a C
size room (median size) and Level of Care II (median level) are used.
Cost comparison
Recommendation for how to apply for Medicaid
If living at home is no longer a safe option, but finances do not allow your loved one to pay private pay rates applying for the Medicaid program is an option to help. Each resident in the state of Nebraska that has Medicaid Waiver is required to pay $669 for room and board per month and the Department of Health and Human Services will create a budget based on income
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Services & Amenities Base Rate (Including Level I Care)
Villa Current Home Other Facility
Mortgage/Rent $3,350
Month of Meals Included
Property Taxes Not Applicable
Property Insurance Not Applicable
to determine if any additional dollars need paid to the assisted living.
To apply for Medicaid you may go to www.accessnebraska.ne.gov, the Nebraska Department of Health & Human Services Site. On the first page you will click on English and be directed to the next page. On the right side of the page in a menu of option titled Other Useful Links click on Printable Forms and then click on Application for Nebraska Medicaid for Aged and Disabled:(MILTC-64.) This form is needed to determine eligibility for those over 65 or disabled and/or applying for a disability determination.
Print this form and fill out in entirety. If something does not apply please mark NA or DHHS may think you missed a part of the application. Be as thorough as you can.
When complete fax the application to 402-471-9209. Keep your fax confirmation that the fax was sent and received. After DHHS gets to the application they may contact you for more information and will do so through the mail. It is important to watch for these notices as they are time sensitive and may request additional verification.
Seeking Medicaid WaiverAfter Medicaid eligibility is approved by the Nebraska Department of Health and Human
Services, the assisted living facility you have in mind that accepts Medicaid Waiver must contact Midlands Area Agency on Aging as they are the department that can approve someone for Waiver (assisted living) services by completing an assessment. Once the assessment is complete and your loved one is approved for services they can begin the move in process.
Important PaperworkAn important piece of searching for the right assisted living is to have all the necessary
paperwork for your loved one organized and easily accessible. It is a good idea to purchase a small binder to act as your portable filing system; which should contain the following items:
Power of Attorney documents Medical records (physician information) Current list of medications Copies of all insurance cards (front and back) Bank account information Copy of life insurance policies Pet records, license & registration information, and veterinarian contact information Funeral plans
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Tips for beginning the conversation of moving to assisted living
After you’ve done your homework it is time to sit down with your loved one and have the talk. It’s better to start talking about options sooner than later for various reasons. You don’t want to have to make hurried decisions if a crisis situation arises such as a fall or other medical emergency; which will limit your options when the time comes.
When talking with your loved one tell them how you feel instead of what they should do. By telling your Mom or Dad what they must do and how to do it will only put them on the defensive. In order to have an open, caring conversation, express specific examples of things that, out of love for them, cause you to worry about their daily care, health and safety.
If met with resistance, remember that your loved one is holding onto more than a house. They fear losing their independence to the degree they will deny any need for help, even if they know otherwise. Help them through this by acknowledging their feelings and encourage them to talk and offer input on finding the senior living option that is best for them and will maximize their independence.
Take the lead and present the information you’ve gathered focusing on the benefits of the features, but remember the decision is theirs to make. Tell them you would feel a lot better if they would at least become informed on their options and openly participate in the discovery process. Not only tell your loved one about assisted living, but help them imagine what life could be. Use statements like, “Imagine not having to carry the wash from one floor to another.” “What would it be like to have your meals prepared for you every day?” Take the positive benefits of assisted living and pair them with the struggles your loved one is having. After you have presented the information gathered let your loved one process what was said; which won’t happen overnight. Most likely it will require more than one discussion and devoting the time to really listen to what your loved one has to say.
As you process through the process make sure to give yourself time and space to get used to the idea of your loved one moving to assisted living, without guilt. Just as parents breathe a sigh of relief when their children leave home, but at the same time miss them dearly, allow yourself to go through conflicting emotions. Life will be different for them and in many ways different for you, but remember that life will keep evolving and hopefully in assisted living they will have the care they deserve and give a few more years independent and out of a skilled facility.
What does the Villa Assisted Living have to offer?12 | P a g e
Facilities and Services
Level One Services are included in the base rate of each suite and there is no additional charge
Apartment Features
Currently remodeled suites in four layout options Upgraded kitchenette including refrigerator, microwave, abundant storage, stainless steel
sink, vinyl floor Earthy paint, carpet and vinyl tones Spacious carpeted living area with window and shades Fire detection and sprinkler system Telephone outlet in living area and bedroom Cable television provided in living area and bedroom Secured WI-FI LivingWell@Home Sensory Technology (to track motion and detect routine) Roomy private bathroom with sit-down shower, detachable showerhead, emergency alert
button and vinyl floor Generous carpeted bedroom space with ample storage Individually controlled heating and air conditioning; separate units for living area and
bedroom Built-in locked storage cabinet Communal storage room available Small pets welcome
Meal Service
Three meals per day, seven days a week Restaurant style meal service Rotating Spring, Summer, Fall and Winter menus Resident offered choice of main and alternate selections each meal Evening salad bar options available Snacks available Tray service available when ill Coffee, water, variety of juice, tea, hot cocoa, and broth available 24 hours a day Guest meals available
Housekeeping Service
Weekly light housekeeping: dusting, vacuuming, bathroom and kitchenette cleaning Daily emptying of trash
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Weekly scheduled flat linen service (includes clean bed linens and change of bed) Daily fresh towels delivered to each apartment
Resident Services
Full-time Activity Director for social, recreational, physical and religious activities Private mailbox in mailroom Transportation to five local medical appointments Coin free laundry room for personal use
Resident Enjoyment
Monthly Echoes Newsletter concerning entire Good Samaritan Village Monthly Villa Newsletter for residents, family and friends Beauty salon Shoppe includes:
o Self-serve ice creamo Libraryo General store o Popcorn machineo Café seatingo Board games and cards available
Plentiful common areas and family wings located on each wing Billiards room Wellness Center with telehealth technology, NuStep and big screen television Scooters welcome
Maintenance Services
Paid utilities Maintenance of grounds, courtyards, building and appliances Storage space available
Security Services
Keypad entry Campus patrolled by Security Secure Care ankle transmitters available
On-Site Healthcare Services
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24 hour Medication Aides Registered Nursing oversight and consultation Vital sign monitoring Personal emergency response system Handicap accessible
Level Two Services are charged in addition to base room rate
Medication administration (not including insulin administration or oxygen) Use of whirlpool once a week Bathing assistance (up to one bath and one shower or two showers per week) Minimal assistance with dressing (assistance with less than two items) Weekly scheduled laundry (up to two loads)
Level Three Services are charged in addition to base room rate
Insulin administration and/or glucometer checks as a type of blood sugar monitor Ted hose application and/or removal Oxygen maintenance/assistance Assistance with dressing (more than two items, excluding full dressing) Incontinence care/incontinence program reminders Dementia or reminders
Additional Service Options
Respite Care
Admission Criteria Qualifications Must be 55 years of age or older
Mobility: Must be capable of moving about independently, able to seek and follow directions and able to evacuate independently or with minimal assistance in case of emergency. If a resident uses an adaptive device such as a walker, cane or scooter they must demonstrate they can use it safely.
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Nutrition: Resident will be capable of self-feeding with minimal assistance (opening cartons, etc.)
Grooming: Resident will be independent in personal grooming, oral care, including regular bathing and appropriate dress or require minimal assistance (tying shoes, buttoning shift, etc.).
Medications: Two Options Available:o Medications can be set up and administered by staff and overseen by the RN.
When we administer the medications all meds come from the Village Pharmacy.o Self-administration is permitted upon appropriate nursing assessment and
physician approval. If self-administering a resident can get their meds from any pharmacy of choice.
o If staff administers medications that come from the Veterans Administration System, they must first be sent to the Village Pharmacy to be packaged. There is a fee to set them up that charged by the pharmacy and is the resident’s responsibility.
Toileting: Resident will be continent of bowel and bladder, able to self-monitor, control and maintain incontinence & incontinence products in a safe and sanitary manner or be able to arrange for assistance. Staff should not have to change wet bed linens on a frequent basis.
Mental Status: Will be free from acute mental illness that exhibits destructive, aggressive or violent behavior towards self or others. Will be able to reason, plan and organize daily events but may require occasional direction or frequent reminders of daily activities such as mealtimes.
Safety: Resident will be capable of recognizing and understanding or responding to staff direction regarding the health and safety concerns of all residents, staff and visitors.
Assistive Devices/Equipment: Any specialized assistive devices or equipment needed to meet the resident’s needs must be provided by the resident.
Temporary Conditions: If a resident becomes ill we will deliver room trays to them. If the resident has a temperature they must remain in their room until back to their normal temperature to prevent spread of infection to others. If they are not better within three days we request they see their physician. If they have a hospital stay and transfer to Perkins short term we will hold their room as long as possible (depends on MAAA) or the resident can elect to pay the monthly rent privately.
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Permanent Condition: If a resident can no longer meet the requirements of assisted living we refer to skilled care.
Staff: Medicaid Aides cannot provide complex nursing interventions. A person whose condition is medically complex, unstable or unpredictable, may not be able to reside at the Villa. Many times I completed a negotiated risk agreement regarding any concerns such as falls, dementia, etc.
Role of the RN: o The main role of the RN Consultant is to develop, motivate, listen to, support &
correct staff, as well as to monitor and direct medication administration. Within the Villa the RN Consultant completes the Functional Living Assessment tool for all residents on admission and on an ongoing basis according to state regulations and facility procedure; formulates the resident service plan to address needs identified and evaluates effectiveness on an ongoing basis, emphasizing independence. The RN Consultant communicates with physicians; ensures resident needs can be met by the AL staff, identify residents who can safely administer their own medications, receive and shares information with direct care staff, assists with resident & family education and provides in-services in health related areas for universal workers.
o Per Nebraska regulation assisted living RN Consultants are not to assess residents on a routine basis; examples of this would be listening to lung sounds, looking at a rash or assess swelling in the legs, etc. At the Villa residents are responsible for directing and monitoring their care just as they did prior to admission. It is up to each resident to determine if they would like our staff to contact family, make a doctor’s appointment or request an ambulance. However, in the event our resident cannot consent to an ambulance (unconscious or unable to speak), we will notify the ambulance.
How to Become a Villa Resident1. Complete in entirety the Senior Living Application & Background Check
Authorization (If a Power of Attorney is in effect right now the application and all important documents must be signed by the applicant and the POA).
2. For private pay residents a $500.00 deposit is required. If Medicaid we have to verify Medicaid eligibility before approving the resident and refer to MAAA (Midlands Area Agency on Aging) to approve for Medicaid Waiver for Assisted Living.
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3. Must have our RN do a Functional Living Assessment to determine AL appropriateness, as well as a Self-Administration of Meds Assessment. The RN will then send for a Health History and Admitting Orders from the physician
4. Residents have to have a current TB skin test completed.5. Upon move-in all medications must be brought to the RN for processing. This also
includes any medication they will keep in their room such as Tylenol, cough syrup, etc. Any time family brings any of these items in we have to know about it in order to track it by state regulations.
6. It is important that any clothing that is brought into the Villa be marked by staff prior to sending the laundry to be cleaned if laundry service is provided by the facility. When a resident purchases new clothes or receives clothing as a gift they need marked to ensure they are identifiable by laundry and find their way back to the resident.
7. The Occupancy Agreement and all admission paperwork will be completed with the Director.
8. Upon admission the resident will receive a key for the apartment, security lock-box (in the room) and a mail box key. An emergency response pendant will be issued to each resident and is to be used for emergency purposes.
9. If a resident decides to leave the Villa we request a 30 days written notice of intent to move.
10. If a resident moves within a month they will be refunded for each day not in the building.
Resources
American Health Care Association. (Year Unknown). Choosing An Assisted Living Residence: A Consumer’s Guide (PDF). Retrieved from www.ahcancal.org
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Bowen, P. (Year Unknown). Golden Years Changes: Ten Questions To Consider when Moving a Parent into Assisted Living. Retrieved from http://www.goldenyearschanges.com/
Good Samaritan Society. (2007). Assisted Living Pre-Admission Questionnaire (PDF). Retrieved from Good Samaritan Society Portal
Spencer Scott, P. (2014). 11 Signs It Might Be Time for Assisted Living. Retrieved from https://www.caring.com/articles/moving-out-relative-question
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