Saturday, August 6, 2016

Decision Time - Six Months

Yesterday I again visited Mill Creek. I did not take any of the pricing or building information with me. Just a clipboard with a few notes. I am now an experienced observer instead of some one needing to solve a serious and poorly described set of problems.

We came to Provision Living at Columbia six month ago. It had just opened. There was no waiting list. We then moved to memory care two months ago.

My wife has adjusted to that last move. Our apartment and the activity areas are no longer separate places to her. A few days ago she blocked the apartment door open and went back and forth between these two separate spaces. She only did that on one day.  Later, I did the same thing to see her response. She did not like the door to be blocked open. [I now need to write up how she communicates when she cannot put things into words.]

My wife has now settled in. The house is sold. She is now aware of this but has not been able to say anything about it. The financing of our residential care is still unsettled but no longer a major concern (going broke gracefully). She is also unable to respond to this.

The tinsel and awe of these two sites have now worn off. Money and structure have receded behind people, and how they interact. It is the dynamics of these sites that keeps them from being just impressive and very expensive hotels. [We learned at a lecture on hearing that “normal” is what you have experienced in the past 90 days.]

I actually felt comfortable visiting Mill Creek this time; sort of like being at home again. There was a group painting in the activity area. We chatted and I shared my experience with old paint, on my pants, coloring my cloths and the cloths for another person in the laundry.

We compared programs and activities. We discussed the timing of moves. We visited similar areas within the three-building complex, and the related benefits, of having all of this in three buildings and in one three-story building of comparable length.

We discussed the problems these two sites have in getting into full operating status with the labor market in Columbia, MO. The same ads with sign up bonuses from $1,000 to $5,000 have now run for months. Both sites must be very selective in who they hire at all levels of skill and experience. Employees must protect both the lives and property of residents. Both sites have the latest in training programs to promote “resident oriented" services.

Resident oriented programs such as The Eden Alternative, Best Friends, and CARES Dementia Care for Families are the opposite to hospital “patient” oriented programs. Do what the resident wants and can do rather than what an administrative order dictates to the patient by the clock. Provide an environment for the resident to thrive ($6,000/mo) rather than a space in which to cure the patient to go home ($600/da).

[Memory care areas are now smoke free to the extent that there is no smoking on the property. This means addicts drive away, smoke in their cars and return with their hair and cloths fully saturated with old stale tobacco smoke. Employees are also provided with free counseling on breaking their addiction; with very low results. The leader in breaking addiction (and in effect producing a free bonus pay raise) is the University of Missouri medical center, which no longer even hires nicotine addicts.]

The accommodations at Mill Creek are comparably spacious to Provision Living when making a direct comparison of a separate space for each of us, and less expensive (memory care and independent living, $8,800/mo at Mill Creek). Providing these same services in one memory care studio apartment makes them the least expense ($6,800 at Provision Living at Columbia).

The severe back problem that landed us in Provision Living is now gone and what remains is responding to the ever developing daily exercise program. My wife has now settled into memory care. Our three-month respite has lasted half of a year. We both have new friends we share activities with (both residents and employees).

This presents a dilemma not of our making. If Mill Creek had opened sooner, we may well have landed there and tried assisted living with memory care daycare; the same thing we tried here, and after a few months found was not working anymore. This situation is the scary part. Any decision, however carefully it is made, can need to be reconsidered in the future. Living as a couple makes this more difficult than for a single person.

(I found there is a review process; daily, weekly, and monthly; built into the staff routine, at both sites, so everyone working with each resident knows about changes in health and behavior.)

Independent advisors repeatedly tell us to “Stay the Course”. To move now means a new beginning on another unknown path. Staying the course also ends the stress of continuous indecision.

In summary, it has taken me six months of living in residential care and many visits to Mill Creak to actually have the background with which to appreciate the similarities and differences between residential care sites. Mill Creek and Provision Living are just two different flavors of super premium ice cream.

Both depend upon what Provision Living­­­ calls radiant personnel to create the family atmosphere within their structures. It is more than that; it is having the time and patience that a watchful grandmother has to instruct, play with, correct and spoil a grandchild with no one’s feelings ­­getting hurt (called diversion and distraction on site).

My best advise for those who can plan ahead is to make a practice of a weekly outing to a residential care site. Then revisit as needed to feel a comfortable fit. We did this. On the first visit, take the tour. On later visits join the activities with the residents. We did not eat all three meals, but I would recommend that; to observe and visit with the residents and become more familiar, and as a result, learn to be more comfortable yourself.

Secondly, be a friend with employees and residents; we all live here. To really work, you must be a part of a functional “radiant” family. Things happen. I have a matching set of grey t-shirt and shorts. And in the laundry this morning my wife’s white pants have red spots all over, and on a bath towel; someone’s lipstick she picked up.

Out of the shower and late to the noon meal. The pair of grey shorts has red spots too. We now know that not until things are in the washing machine are they safe from having something inserted day or night. My wife roams freely day and night now that she has the entire unit in her domain.

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