Will Assisted Living be your choice?

a conversation about Assisted Living: It is much better than many believe.

As I sit in my small but comfortable home I look around at all my stuff and wonder about my senior years. This home is undoubtedly mine (well “ours”, my husband lives here, too). The décor is quite eclectic with flavors of New England (where we hail from), photos of family and friends and of the many trips we’ve taken. There are models of planes and boats which are my husband’s passions. Candles and plants live in every room. Our wine and cocktail glass collection from all of our trips is in the dining room buffet near our wine collection. And then, of course, there is my craft corner (occasionally used as the Dining Room) and our joint office area which occupies part of the Living Room. I know that when I’m a senior the odds are that one day I will have to leave my home in order to be cared for in some type of community or facility. My husband jokes that we’ll run away to the woods in our camper and “live on squirrel” meat. Thanks to long term care insurance, I don’t think it will be quite that drastic. But it’s good to have options.

I recently received an e-mail joke regarding a senior citizen moving to a facility. It goes something like this: A 90+ year old was moving to an assisted living community. He had lost his eyesight years ago and had recently lost his beloved wife. While sitting in the lobby of the community his daughter had picked out for him, he commented to a staff member who asked if he’d like to see his room, “I love it.” The staff member replied, “but you haven’t even seen it yet.” (a figure of speech, of course). The kindly gentleman retorted back that it didn’t matter if the curtains were lace or linen, or what color the quilt on the bed was. “I have already decided that I am going to love it here. When you get up in the morning you have a choice. You can decide if you will have a good day or a bad one. By deciding that I’m going to love it here I’m already better off.”
If only every senior felt this way.

I’ve lived in San Diego for 11 years now. Most of that time was spent working in assisted living communities. I’ve seen the small and the large, the poor, middle and the high end facilities. And I can tell you this, it’s not the décor that make the residents happy. It’s the staff, the attention that is paid to the resident’s particular needs and it’s also the residents themselves. I knew one lady who lived in a very pretty higher-end community who one day said to me that she “had been warehoused in a prison”. She was one of those residents that hardly ever left her room, kept her blinds closed much of the time (no matter how many times the staff would open them) and never appreciated all that her family did for her to make her stay as comfortable as they could. How I wished I’d had the magic words that would give her the attitude adjustment she needed. She was encouraged to come to the dining room for meals but refused. She was invited over and over to activities, but again she refused. She was a very intelligent lady who had the means to provide a private duty personal caregiver for herself. Unfortunately having that caregiver only encouraged her self isolation. If only the 90+ year old gentleman from the joke could have talked to her. Perhaps she would have changed her mind.

Wikipedia defines assisted living for us: “Assisted living as it exists today emerged in the 1990’s as an eldercare alternative on the continuum of care for people, normally seniors, who cannot live independently in a private residence, but who do not need the 24-hour medical care provided by a nursing home. Assisted living is a philosophy of care and services promoting independence and dignity.” All assisted livings and board and care homes in California are considered “Residential Care Facilities for the Elderly” and fall under the watchful eyes of Community Care Licensing which is a division of The Department of Social Services. http://www.ccld.ca.gov/ They are regulated by Title 22 which carefully outlines what can, shall and shall not be done in an RCFE. Title 22 is based on the state’s Health and Safety Laws. In recent years we’ve seen quite the acuity creep into assisted living. Each facility owner has the right to choose the type of care they will provide as long as it falls within the CCLD guidelines. Some are now more of a medical model than the social one it was originally designed for. I know that as we baby-boomers age assisted living, as is known today, will change even more. Having the right administrator at the helm of an RCFE is key.

Being an administrator for assisted living all of these years I know what to look for and how to choose the good facilities from the bad. No thing is perfect, but some communities are better at tending to issues than others. I visited Seasons at Villa Bonita last year (it's now under another name). I was impressed. The residents were here and there, fairly active for only 9 A.M. Although not a new property, the community was clean, free of smells and the staff all seemed to be content as they moved from chore to chore. The gardens were well maintained and attractive. I toured the entire property and talked to the Administrator, Joshua Bullen, about his values, policies and passion for seniors.

“Our product is people” was the first statement Josh made. This struck a good cord with me. He too has worked with both the low income and the affluent person. He has worked in other communities starting in a sales position to learn the ropes and worked his way up to administrator. That’s my kind of administrator. He has a passion for seniors that has served him well. He has taught others in the industry who work in sales. His philosophy is that “we’re not selling anything at all. We are consulting with these families. And if we happen to be the right fit then it’s not even a sale. The family at the end of your consultation will be asking you ‘how can we move into your community’. It’s easy to say but it’s a different thing to learn it and believe it. When families find that you’re not trying to offer them the next greatest deal and find a way to get them in by Friday, they are so happy and willing to work with you because they understand that you are being authentic. Families need people who are listening to their needs; looking at their financial situation; knowing the resources that are available to them; referring to people that I believe to be ethical and sincere in their business practices.” Josh and his staff have, in a previous community, earned a Quality Assurance Award for care and medication management. He knew of Villa Bonita and its history and was very excited about the prospects of working there when he was approached. He has since moved to Oakdale Heights in La Mesa.

Josh believes that the most important thing is that “when we hire” especially for care, dining and housekeeping positions, “I am not as interested in experience as I am in a passion to serve the people we work with. We can train people who are passionate about caring for seniors to do the work. As opposed to the person who says ‘oh, I’ve done this five times, I’ve been in this and that building’. But, do you care about the people you are serving? And so we hire for compassion, we hire for someone who’ll walk to work for seniors. And then we train that person. Are we right 100% of the time, of course not, but, we are getting better and better at hiring the person that’s passionate about serving our seniors.” He also believes in doing the right things for his employees insuring that they are happy, confident and secure. He even plays chef (hat and all) at the barbeque for his staff at occasional events just for them. Josh says that what builds a successful staff is letting them know that you are just like them, showing confidence in them, and also identifying talents and then empowering them. He loves to see his staff members promote upward into leadership positions. “Empowering people is huge!” One person cannot run these buildings. It takes a lot of people working together.

“The other thing that I am fanatical about is the medication program. We have a laser-like focus on training and whom we hire for our medication department. That is the most important thing that we do in our building as far as technical day to day service goes. Of course the most important thing is the overall care of our residents, but within that is the medication management. We feel that by putting in a culture of caring, and looking at the medication department and surrounding our seniors with people who want to be there, who want to care for them, those are the best things we can do to build this community to a premier property.” It’s all about the people who are in the building.

Both Villa Bonita and Oakdale Heights have a courtyard garden with fountain, large common rooms, over 100 apartments which include studios and one bedroom apartments. Villa Bonita had recently added the possibility of 2 persons sharing a one bedroom apartment for a more economical option. Josh states that these features are “a nice advantage to have”. But Josh then reiterates that the biggest thing that they look at is “the medication program, the care, the people that we hire – after all this is the most important thing that we do.” Villa Bonita is run by a small privately owned company and their rates at that time started at $2500 for a private studio with kitchenette. Although census/occupancy is important Josh feels that it’s more important for the families to make the right choice for the senior. “There are times when a resident needs a higher level of care and it really is the right thing for them to go into skilled nursing instead of being in or staying at assisted living.” The right thing is always the right thing. “At the end of the day the only thing that we have are the decisions that we’ve made and win or loose if we’ve made the right decision for these families than we know we did the right thing. That is much more important. Every day we need to re-focus ourselves and ask ‘did we do the right thing for this family’. I think we do.” Josh says his favorite word is “authenticity” and I believe him. He would love to find like minded administrators throughout the county to combine resources and be of even more value to the families they consult with.

In addition to the care the staff of Villa Bonita, Oakdale Heights, and other area assited livings, provides, they work with physicians that make visits to the residents on site along with other professional services that can make house calls. They also work with hospice when it is needed.

(I originally wrote this piece for a magazine about a year ago. Josh now works, interestingly enough, with a former colleague of mine as his marketing person. There really is something to be said for the 6 degrees.)

For more information on area Asssited Living communities contact
Starfish Resources*
760 522 6478
http://starfishresources.net
starfishresources@gmail.com