# Hi I Run Several Assisted Living Homes and Want to Improve Them



## Windsurfer (Feb 18, 2017)

Hi,

I have 5, 10-Bed Assisted Living homes in the Phoenix, AZ area. They are residential homes that have been converted into senior living. We handle both assisted living and memory care.

I am not trying to promote the homes on this forum. I am trying to solicit feedback to improve them. Everyone who comes into my home practically says right away something to the effect of "I want to be with my family. I want to go home". Gradually they adjust over time, but it still tears at me.

So I am trying to help these people improve their health enough to go home. I realize it's a lofty goal but wouldn't it be great if at least some of them could?

To that end, I've hired a personal trainer to work with the residents. I'm also preparing healthier meals for everyone, such as more high-fat low carb meals. We are doing things like cooking with coconut oil which is supposed to help with Dementia and other issues. We've even had our first person go home since we started the program.

My question is, is this what people really want? I've read that people don't want their lives extended. Although we get great reviews from family members, I hear some of the residents saying they just want to 'get it over with' (die) because they have lost their spouse, or they are in a condition where it is just painful to live.

I would like to know - should I keep trying to work with my residents to help them become as healthy as they can? Or am I going against what they really want - to enjoy their time left and to just pass away? It's hard to ask this question directly. I can sense some family members think that if Mom or Dad lasts a really long time, they won't be able to afford the care. Then again, people tell me they love my efforts to help their relatives. 

Seems like a forum like this could give me better answers where people can post anonymously, than if I asked my residents and families directly.

Thanks in advance for any advice or perspective you could give. I really appreciate it.


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## Lon (Feb 18, 2017)

You are trying to do as a individual what many large corporate entities have been successfully doing for a long time and I frankly don't see how you can compete unless you have substantial resources.


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## Buckeye (Feb 18, 2017)

Windsurfer - I'm planning on moving to the Phoenix area as soon as I sell my house in Hawaii, so save me a spot! 

Mahalo


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## Aunt Bea (Feb 18, 2017)

It makes me sad that you weren't providing exercise programs and nutritional meals right from the start.

IMO people need to feel that they have a purpose, something to offer, no matter where they are living.  They need to feel a sense of community with the other residents and staff.  They need to feel needed and have something of value to do.

Without that even the nicest facilities are little more than warehouses or God's waiting room.

IMO the niceties and long list of amenities that most assisted living facilities tout in the brochure are more for the families than they are for the residents, it helps families feel better about the choices that they have made.

As far as getting well enough to go home in most cases these folks have no homes to go back to and do not have the resources or the will to start over.

I would be fine puttering around in an assisted living facility but if I had to transition to a skilled nursing facility I would just as soon skip it and head straight for the cemetery.

Good luck!


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## hauntedtexan (Feb 18, 2017)

My late wife worked as a nurse in nursing homes for 35 years and always wore her white cap there. This helped the residents realize that they were safe and cared for. She also, personally, put up every seasonal decoration to give the folks, not only a feeling of home, but a visual reminder of time as it passes. She believed that folks who were sick and tired of asking basic questions about environmental things where they lived, responded better to obvious visuals. The biggest danger to your residents are the "9-5'ers" who forget that people are their clients and they are only there for the paycheck. God bless you for your dedication to us "seasoned citizens"


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## Kitties (Feb 18, 2017)

hauntedtexan said:


> My late wife worked as a nurse in nursing homes for 35 years and always wore her white cap there. This helped the residents realize that they were safe and cared for. She also, personally, put up every seasonal decoration to give the folks, not only a feeling of home, but a visual reminder of time as it passes. She believed that folks who were sick and tired of asking basic questions about environmental things where they lived, responded better to obvious visuals. The biggest danger to your residents are the "9-5'ers" who forget that people are their clients and they are only there for the paycheck. God bless you for your dedication to us "seasoned citizens"



I hope your wife was able to enjoy some retirement time. I'm sorry to hear she has passed away. I'm working 25 years in a nursing home. It's such hard work and you are right, there are too many who don't do their job right and get by with it. Out on time every day. Just there for the pay check.


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## Windsurfer (Feb 18, 2017)

Lon said:


> You are trying to do as a individual what many large corporate entities have been successfully doing for a long time and I frankly don't see how you can compete unless you have substantial resources.



Thanks for the honest feedback Lon. I'm not sure what you mean. A lot of the large corporate 100-200 bed facilities seem to work as fancy apartment buildings with very nice dining rooms and meals. They have a great deal going. But I have a lot of families come into my homes because they like the 'family' atmosphere I provide with fewer residents. Think of the difference between a cruise ship and an Air Bnb.

The larger facilities are going after luxury. To just enjoy the days you have left in a really nice place. I am going after trying to make your loved one better. I am often half the price or even less than the big facilities. I just am wondering if people at advanced ages want to get better? Or are they worried if they get better they will outlast their money? Just trying to run the best business I can.


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## Windsurfer (Feb 18, 2017)

Hoot N Annie said:


> Windsurfer - I'm planning on moving to the Phoenix area as soon as I sell my house in Hawaii, so save me a spot!
> 
> Mahalo



Thanks so much Hoot N Annie. Would love to at least meet you when you come here. Of course I would rather visit you out in Hawaii I have a very extensive network in the Phoenix area to help you get settled wherever you end up.  Good luck with the move!


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## Ruth n Jersey (Feb 18, 2017)

I worked for 10 years as an LPN in a nursing home,another 6 years after I was married for public health where I cared for folks in their own homes. It seemed to me the people living in their own homes were far more happier than those living in assisted living facilities or nursing homes. I do think the wishes of the person should come first. I did notice that medications has so much to do with the condition of people. I have seen many people on so many medications at once that they were walking around in a fog. Once the drug list was straightened out, and many times some were eliminated, and one doctor was doing the prescribing, we were able to pull out of the home because they were doing so well on their own. A big problem with taking all these meds together was the high risk of falling due to dizziness. This risk was all but eliminated when the meds were straightened out.


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## Windsurfer (Feb 18, 2017)

Aunt Bea said:


> It makes me sad that you weren't providing exercise programs and nutritional meals right from the start.
> 
> IMO people need to feel that they have a purpose, something to offer, no matter where they are living.  They need to feel a sense of community with the other residents and staff.  They need to feel needed and have something of value to do.
> 
> ...



Thanks so much for the feedback Aunt Bea. I have only been running the homes for about 7 months. They had been cooking home-cooked meals when I took over, so the food wasn't very bad. I have been trying to get all the day to day operations down first. Now that I have things more under control I am working on improvements.

I don't necessarily think I will be sending people home in droves, but if I can make their lives easier for the days they have left, it seems like that would make them happier. I agree with you about many amenities. I go into a lot of other facilities.They have beautiful gyms and pools that nobody uses it seems. That's why I want to have someone like a trainer who will make people feel a little bit obligated to improve themselves. Is that the wrong attitude to take? 

Just want to do what's best for people, especially ones that are under my care. Maybe what I am doing will keep them out of that skilled nursing facility!


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## Windsurfer (Feb 18, 2017)

hauntedtexan said:


> My late wife worked as a nurse in nursing homes for 35 years and always wore her white cap there. This helped the residents realize that they were safe and cared for. She also, personally, put up every seasonal decoration to give the folks, not only a feeling of home, but a visual reminder of time as it passes. She believed that folks who were sick and tired of asking basic questions about environmental things where they lived, responded better to obvious visuals. The biggest danger to your residents are the "9-5'ers" who forget that people are their clients and they are only there for the paycheck. God bless you for your dedication to us "seasoned citizens"



God Bless you HauntedTexan and especially your late wife. She sounds like a saint! Working in assisted living can cause a lot of caregivers to feel burnt out. I try to rotate enough of them through that they don't feel that way, and have pretty good retention. I've found a lot of these caregivers feel like this job is a calling, and really do care. Like any business though, there are many who see the paycheck and nothing else.


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## Windsurfer (Feb 18, 2017)

Kitties said:


> I hope your wife was able to enjoy some retirement time. I'm sorry to hear she has passed away. I'm working 25 years in a nursing home. It's such hard work and you are right, there are too many who don't do their job right and get by with it. Out on time every day. Just there for the pay check.



Thank you for all you do Kitties!


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## Windsurfer (Feb 18, 2017)

Ruth n Jersey said:


> I worked for 10 years as an LPN in a nursing home,another 6 years after I was married for public health where I cared for folks in their own homes. It seemed to me the people living in their own homes were far more happier than those living in assisted living facilities or nursing homes. I do think the wishes of the person should come first. I did notice that medications has so much to do with the condition of people. I have seen many people on so many medications at once that they were walking around in a fog. Once the drug list was straightened out, and many times some were eliminated, and one doctor was doing the prescribing, we were able to pull out of the home because they were doing so well on their own. A big problem with taking all these meds together was the high risk of falling due to dizziness. This risk was all but eliminated when the meds were straightened out.



Ruth n Jersey - Thank you for your commitment to seniors. That was another reason I am trying to bring a better diet and nutrition into the homes. I see it all the time - lots of drugs and people walking around in a fog. I am trying to cut it down to one doctor and work with her to see if we can eliminate some medications. I am sure people would be happier in their homes. That is why I want to make them better - so they can go home!


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## Marie5656 (Feb 18, 2017)

*If you are having issues with memory care, best to talk with incoming residents while they are still cognitive, and able to voice their life choices.  I suggest the book Making Rounds With Oscar by Dr David Dosa.  He is a doctor affiliated with a Nursing facility, and talks much in the book about meeting with families and getting their input.  And do not forget the people who are seeing your patients on a daily basis, the nurses, aides, food service workers and even house keepers  May seem trivial, but aside from family, these folks know your residents best.  *


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## Lon (Feb 18, 2017)

I am 82 years old living alone in a apartment and when I reach the point of needing assisted living I could care less about FAMILY ATMOSPHERE My main concern will be my comfort, diet and entertainment & other than HOSPICE I can have what I want and need right where I am.


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## MJ4EMS (May 9, 2017)

I work in private medical transport, so I'm familiar with all types of senior living facilities. I want to reach out to you- Lon, because I'm concerned with some of your responses. I think you need to visit corporate run senior facilities or ask some of your acquaintances about them. I guarantee, that a small privately owned and operated business will treat you better than any corporate run facility. Take a moment to think about it. What is the goal of a corporation? You probably guessed it - to make money! The more the better! 
The individual who posted here, clearly cares about her residents, and not only that she is trying to get them back home! That's astonishing! Most senior facilities don't want you to go back home, because they lose.. here's that word again... money! I have nothing against corporations. They are in business to make as much money as possible. However, how does making money benefit the seniors they are caring for? 
Obviously it's your decision, on where you go. After everything I've seen, it's better to push yourself, stay as active as possible and stay living home as long as it's safe and you are able to care for yourself or with help from a caregiver or find a nonprofit or privately run facility that actually cares about it's residents. Good Luck to ya.


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## MJ4EMS (May 9, 2017)

Windsurfer said:


> Hi,
> 
> I have 5, 10-Bed Assisted Living homes in the Phoenix, AZ area. They are residential homes that have been converted into senior living. We handle both assisted living and memory care.
> 
> ...



Well done on what you are doing. First off, don't let the critics get to ya. I worked in home health for years and now work in EMS, so I have a lot of experience with senior facilities. Personally, from what you said, I think you are on the right track! It appears you are improving the facility as you gain more knowledge on additional benefits for your residents. 

I have never seen a corporate facility provide nutritional home cooked meals to residents or change the menu to benefit the residents. Every for profit corporate facility I have gone into, the food looks like the same food I got in high school from the cafeteria. Corporations have a singular goal and focus, which is... money. Whereas, a private facility will have a similar goal of generating revenue, they usually still bring a caring and personal approach to the facility. The owner has to answer to the residents and family members when things aren't done correctly or if corners are cut. 

Huge kudos on hiring a personal trainer! I also think your idea of bringing a family atmosphere to the facility is phenomenal.  When my grandfather was in nursing rehab, he consistently talked about going home. Whereas when he was in hospice, a facility that looked like a house, when he was completely lucid he never mentioned going home once. He even would tell me how much he liked it there. 

My tips - 
If you have residents who suffer from dementia and consistently ask to go home, it's because their surroundings are unfamiliar to them. They are already confused, so a new place just amplifies it. By asking family members to bring familiar items from home for them, such as blankets, picture frames, family photos etc, that might appease them. 

Music has a fantastic effect on seniors suffering from dementia. If you could figure out what they liked when they were younger, playing it might help comfort them. When I transport patients who suffer from dementia, I always play classical music for them. From my experience it really calms and soothes them. 

I also had a patient who was constantly crying out when anyone would come near her. I had to pick her up for a transport, so I first ran through the basics (introduction, company, where we were taking her), then I acknowledged her pain. I told her, crying out makes her whole body tense up, instead she should close her eyes and focus on her breathing. She did, and as a result barely cried out during transport. 

Going outdoors, has tremendous benefits on anyone's health, so if you have staff to take the residents outside, I would highly recommend that. 

A good staff to resident is also premium. Personally, I think facilities should have 1 GNA to every 4 patients. 

Encouraging residents to be active, to stay moving and engaged will also help them tremendously. Asking them to help out around the facility (if they are able) would be mutually beneficial (i.e have your housekeeper, give them a rag, and instruct them to dust their room, or wipe the windows down, while she cleans their bathroom). Offer to let some help with (safe) kitchen duties, no matter how small (i.e. wash fruit and veggies, apply seasoning to dishes, add pre-measured ingredients to a bowel, stir etc.)

Have an area with easy to open snacks, and a beverage dispenser with fresh water and fruit. 

Have 2 trash cans in a janitorial closet with a tight sealing lid- 1 for all soiled disposable underwear, and the second for soiled (washable) linen. It will make a huge difference and keep the place from having odors. 

Lastly, treat each resident as an individual. When I'm 85 I don't think I'm going to want to play bingo. I would much prefer to sit in the sun, listening to an audiobook with a glass of fruit water.

The big goal in senior care, should be to improve quality of life. It sounds like that is exactly what you are aiming for. Good Luck!


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## terry123 (May 9, 2017)

I lived in an assisted living facility for a few months recovering from a serious illness.  My goal was to go home which I did but there were some very nice things about the facility I was in.  One resident there formed a serious discussion group that met twice a week to discuss current events. I was asked to attend and really enjoyed the group.  There was a meeting each month for the residents to discuss the food and what we liked and disliked about it.  A lot of our comments were acted upon by the staff.  There were a lot of outings if you wanted to participate.  It gave me a chance to heal and get back home in about 3 months.  So I had a positive experience there but was glad to go home and be among my things altho you could bring personal things with you but I just wanted to be home.


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