02.02.11

Defining Levels of Care using ADL’s

Posted in Assisted Living, Assisted Living Facilities, Assisted Living Safety, Elder Care, Elderly Care at 1:21 pm by admin

How can a senior citizen determine the type of care he or she needs? This is not necessarily an obvious question. The elderly care industry has changed significantly in recent years. One size does not necessarily fit all anymore. In reality, it never did. Today, there are seemingly endless possibilities for care. And every senior is different. So again I ask, how does a senior know what level of care to pursue?

Let’s start with the most obvious criteria: medical help.

If your loved one needs full time care because of a serious medical condition, they will almost certainly need nursing home care. At very least, they will need a caregiver at home to be with them all the time. But what about those seniors who are not battling with a disease? What about those who don’t need that level of oversight? What about those who just require a bit of help during the day? Fortunately, there is a way that the senior care community thinks through this issue. They consider how a senior can perform activities for daily living.

What are ADL’s?

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Activities for Daily Living are those things that any healthy person does constantly during the day and never has to think about. They are essential activities that a person needs to be able to perform in order to live alone. They include things like eating, bathing, going to the bathroom, getting dressed, and getting out of bed. A person who cannot do these things by himself or herself should not be living alone. Assisted Living staff is able to help with these activities.

There is one other set of criteria called “Instrumental Activities of Daily Living,” or IADL’s. These are more complex activities that a person needs to do to function fully in society, but not necessarily for survival. They include traveling, preparing meals, cleaning the house, taking medicine, balancing the checkbook, etc. Does a senior have to be able to do these things alone in order to live alone? No. Family or professional caregivers can often pick up some of the slack for these things.

If your loved one is unable to perform many of the activities on these lists, you might want to check into assisted living options in your area. Assisted Living facilities are designed to care for these very issues. A person does not need to be seriously ill to live in an assisted living facility. These communities are for exactly what they say: to assist a person with their living. Help with ADL’s and IADL’s are what set these facilities apart from retirement facilities (which usually give no help with basic ADL’s) and nursing homes (which help with virtually everything, assuming that the senior needs help with everything.)

To find elderly care or assisted living in your area, enter your city name and type of care desired above, and get access to lists of facilities all around the country.

01.21.11

Therapy Dogs for Alzheimer’s Patients

Posted in Alzheimer's Disease, Assisted Living, Assisted Living Facilities, Assisted Living Safety, care at home, Caregiver, Elder Care, Elderly Care at 11:34 pm by admin

For patients and families struggling with Alzheimer’s disease in an assisted living facility or at home, life can be immensely stressful. Not only is there the emotional strain of losing memories and relational connections, there is the new problem of sudden, unexpected, and totally inexplicable outbursts. As one Alzheimer’s expert said, “When you’ve seen one case of Alzheimer’s Disease, you’ve seen one case of Alzheimer’s Disease.” In other words, the disease is unpredictable, making emotional outbursts all the more jarring. And while the family suffers from these uncomfortable moments, the senior in their care is obviously struggling more. After all, something is bothering them and unsettling them.

Fortunately, the emotionally complex and “jumpy” nature of Alzheimer’s Disease can be tamed–or at least calmed–in some cases, by something very non-medical: pets.

Before I go into specifics here, I want to draw a parallel between seniors with Alzheimer’s and children. Both groups are unable to care for themselves. The world does not make sense to either of them. Both can be drawn into their own world by the most trivial things… And both of them seem the world through “new” eyes. So it should be no surprise that senior adults with memory ailments respond so similarly to pets as children do.
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But don’t take our word for it. Check out this quote from an expert at the Mayo Clinic:

“A pet is a medication without side effects that has so many benefits. I can’t always explain it myself, but for years now I’ve seen how instances of having a pet is like an effective drug. It really does help people.”
Dr. Edward Creagan

Oncologist at Mayo Clinic, Rochester, MN
Quoted from DeltaSociety.org

Dr. Creagan is not alone in his perspective. Doctors and experts all over the country have noticed and written on the benefits of animals on a person’s blood pressure, stress levels, and overall sense of health and well being.

Therapy dogs, of course, help millions of seniors and disabled Americans every year. This includes seeing eye dogs, and dogs to protect the mentally challenged: people with downs syndrome, autism, and all manner of ailments that would cause a person to be more vulnerable to injury and attack. And more recently, medical professionals have begun to use therapy dogs for Alzheimer’s patients, with positive results. Many patients have a noticeable decrease in aggression, a lift in social skills, and on overall reprieve from depression that so often plagues them.

So, how can this work, exactly? Several ways. The first is for caregivers who care for a loved one at home. If the family dog or cat is still alive and still well-behaved, make sure grandma gets lots of interaction with her if the two have any kind of rapport. But these criteria will not match most people’s circumstances. So for those who sometimes put their loved one in respite care or adult day care, ask about pet therapy. Many of these facilities are employing the assistance of animal professionals for several hours per day. These can include people from the Society to Prevent Cruelty to Animals (SPCA). The nice thing about going through these types of groups is that the animals are generally going to be very well trained.

A well trained animal can be just the thing that an Alzheimer’s patient needs. Many patients come alive the minute they see their new “best friend.” Even those who are not prone to any kind of speech or purposeful expressions light up when the dog enters the room. Are they, at some subconscious level, remembering pets they used to have over the long course of their life? Perhaps they are. We will never know. But I suspect it is something simpler. I suspect that there is some instinct that is created into these animals. An instinct to protect and care for people. This is why therapy dogs work so well in so many environments. And this is also why they can put up with so much abuse (especially from kids! I could tell you stories…).

But I will leave the psychology to medical experts. I don’t know why so many seniors seem to react well to pet therapy, especially seniors who are suffering from one of the most baffling ailments out there. But they do. Many of them do! And if your loved one is suffering from any form of dementia, and all the loneliness that comes with it, you might want to look into the possibilities of pet therapy. Here is one place to start . For more info on assisted living facilities from Oregon to Florida, visit our homepage and being your search!

12.27.10

Seniors and Pets

Posted in Assisted Living, Assisted Living Safety, Elder Care, Elderly Care, Senior Citizen at 12:43 pm by admin

Healthy Seniors Owning Pets

Pet ownership has tremendous benefits for people in any demographic, given the right circumstances, especially senior citizens. Seniors who grow close to their pets are often happier and healthier than those who live alone. It is not difficult to see why. Pets become a source of real companionships for millions of people. They talk to their pet, they feel a connection with them. They feel protected by them, and they feel like they are never alone. And because their pet is dependent on them, they take responsibility for all kinds of things: feeding their pet, taking walks, cleaning up after her. All of these things can help the senior to get physical exercise that they might not otherwise get.

For seniors who are healthy enough to live alone, pet ownership can be a tremendous help. The biggest benefit might be the most subtle. Retired seniors can often suffer from a depressed state of mind that results in a loss of purpose. When they were working in their former careers, at least they felt productive. At least they felt like they were contributing to society. But when they retire, all of that can go away. A pet, however, brings the kind of responsibility to the table that can squelch those feelings. A senior who has to take care of a pet can quickly regain a sense of responsibility, which builds confidence. Add to this the comraderie and exercise benefits, and pet ownership might be a real no-brainer!
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When Seniors Can’t Care for Their Pets

But as a senior ages further and their health begins to go south, they might not be able to take care of their beloved friend by themselves. What happens then?

Fortunately, there are a growing number of elderly care facilities–from nursing homes to assisted living facilities to retirement communities–that allow pets, and able to help care for them. Of course, there are restrictions and fees involved, but the door is opening wider and wider as baby boomers need help but don’t want to abandon their friends. This is definitely worth looking into. Seniors can search for assisted living homes that will allow dogs, cats, birds, etc.

But more often than not, assisted living homes will not allow pets, for obvious reasons. Pets require additional hands, and additional care. That means greater expenses. So if you are unable to find an assisted living home that will take a pet, you might be left with some less attractive options:

1) Find a family member who can take care of the pet. This is a great option if the pet is small and manageable. But if we are talking about a bid dog or a less manageable animal, obviously, family will not be too thrilled.

2) Take an ad out in the paper or on Craigslist and find a good home for the pet. This is not a fun option for the senior, but it might be the best one. If they can’t manage their pet any longer, of if they are unable to take their pet with them to their next living situation, let them have a say in where their pet goes. They might be able to have a say in where their animal ends up.

For help finding assisted living or other senior housing, enter your info above, and begin your search!

12.16.10

Austin Continuing Care Communities

Posted in Assisted Living, Assisted Living Facilities, Assisted Living Safety, Elderly Care at 12:10 pm by admin

Austin seniors already have a lot of great options for senior housing. Perhaps you already know this. Maybe you have taken advantage of Austin nursing homes, Austin Assisted Living or retirement communities. But have you heard about Austin Continuing Care communities?

What is Austin Continuing Care

Here is the basic concept of continuing care in the elderly care community. Sometimes there is a downfall in senior care. It happens when a senior enters a retirement center in good health, but their health takes a turn for the worse. There are immediate problems and considerations, but the first is this: how can he be cared for in a retiremetn community that is designed to have seniros living independently? He needs the hands on care of an assisted living home, or even a nursing home now, but he is paying for an independent lifestyle.

This scenario plays out in other ways as well, such as when an assisted living resident has an injury and needs intense physical rehab. The problem is that assisted living facilities are designed to help seniors perform basic daily activities, but they obviously need help in a nursing home or skilled nursing hospital section. The problem, as you see, is obvious: you can sign a lease for one type of senior housing, but the needs of a senior can change very, very quickly, forcing them to end either end the lease and sign a new one, or pay for two types of care until they are back on their feet.
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Austin Continuing Care communities are helping to solve this problem. What are continuing care communities? They are, as some have described, a “continuum of care.” They are elderly care companies that have multiple levels of care onsite. They have retirement communities, assisted living sections, and a nursing home segment as well. The residents are fortunate to be able to shift into different areas on the campus as their needs demand it.

Austin seniors, then, can move into a continuing care community while they are healthy and active, knowing that if that changes, they can shift into assisted living or nursing care without signing a new contract. That is the big advantage. There is no need for them to end their current lease agreement and find a new company to work with. Austin continuing care communities are set up as one company. You sign a contract with them when you first move in, and it covers all the different types of care.

Some seniors choose to sign a contract that will last the rest of their lives, while some will choose a year or two years. Different companies have different policies. But the basic elements of Austin continuing care are the same. Are you looking for an austin continuing care community for your loved one? Here are some to consider:

Austin continuing care communities:

Summit at Westlake Hills
1034 Liberty Park Dr.
Austin, TX 78746
512-328-3775

Westminster Manor
4100 Jackson
Austin, TX 78731
(512) 454-4711

Longhorn Village
3204 University Club Drive
Austin, TX 78732
(512) 266-5600

If you need help finding other types of Austin elderly care, including TX Assisted living facilities around the state, use the gray box at the top of this post.

12.10.10

Should You Bring Grandma Home for the Holidays?

Posted in Assisted Living, Assisted Living Facilities, Assisted Living Safety, care at home, Dimentia at 4:45 pm by admin

Christmas time and the surrounding holidays are supposed to be easy opportunities for families to be together, reminiscing about the old days and making new memories. But for many seniors who live alone in an assisted living or skilled nursing facility, this season can be the most depressing of all. Families who have loved ones in elderly care homes, then face a serious question: should we bring your parents or grandparents home for the holidays?

For many, this is an easy answer: yes. Why leave your parent alone and sad when you live close enough to bring her into your living room? It seems downright delinquent and selfish to leave her there. And indeed, they are right. It can seem that way. But certainly, not every family ought to bring their aging loved ones home for any length of time. Especially the holidays.
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Carol Abaya of NewJerseyNewsroom.com took on this issue, advising families not to do it if the visit would induce more stress. to some, this might sound harsh, but I think she is right. Especially if there are physical dependency issues. Would it really be right to bring someone home if you are not able to adequately, or honorably, deal with these complications?

Abaya lists some questions to consider before making this decision. If your loved one gets easily confused, or is incontinent, for example, you should probably not do it. And if the drive from the nursing home is too long, it will likely not be worth it, either.

Here is the thing. If you as a family member are making a decision to do something nice, but you are doing it because you simply cannot live with yourself if you didn’t, that should be a red flag. The better question is this: Will bringing my loved one home be a blessing to her and the rest of the family? If you are unsure of the answer, be careful that you do not rush into a decision.

If you decide not to bring her home, that does not mean you have to ignore her, and it does not mean she must have a miserable Christmas. There are ways that you and the family can still make her holidays happy, even while she is in there.

Abaya recommends a couple of basic ideas, like visiting her, going to a scheduled lunch or dinner and making a video. I say, you should take it a step further. Make her feel like she is a part of the festivities even though she cannot be there. Visit her, yes. But bring her some of the Christmas cookies you had the night before. Have the kids come with you, and have her open a present from them. And remember to call her, too, during the events that she will miss. Let her hear the festivities, or even see them, if she is able to video chat.

The point is this: when grandma is in good health and good spirits, it is awesome to bring her home for the holidays. Sometimes, however, grandma would be more comfortable staying put where people know how to take care of her personal (sometimes very private) elder care needs. If that is the case, it is much better to bring a party to her, rather than bringing her home for the party.

For more info on assisted living options, use the box at the top of this page.

12.04.10

Help for Seniors Who Drive

Posted in Assisted Living Safety, Elder Care, Elderly Care at 11:48 am by admin

The issue of senior driving can be among the more emotionally complex in the elderly care world. We wrote about ways to approach this issue sensitively with our aging families members who need to stop driving altogether. But this description does not fit all seniors, of course. The fact is, there are many who are able to drive just fine, but whose reaction time and general skills are diminishing nevertheless.

With this in mind, I want to give a couple ideas for seniors to be able to stay safe and keep their skills fresh.
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1) Get more training to enhance your skills. This might seem completely over the top and unnecessary. If you are a senior driver, chances are, you have already been driving for more than forty years, so why on earth would you need more help? Well, the fact is, all seniors experience drop in their reflexes, their awareness, and over all attention to movement and detail. Everyone does. So what if you could find a way to make those abilities last longer and get stronger? There are ways to do this.

One of the most out-of-the-box approaches was presented by the Posit Science Corporation, makers of “brain training products.” They developed a software training system called “DriveSharp.” DriveSharp is a ten hour course that is disguised as a system of game-like training classes that are designed and proven to sharpen a senior’s ability to deal with visual movement. The group claims that the course can dramatically increase reaction time for seniors who go through it, helping them to brake much faster when they need to, and to “see” everything that is going on in front of them, including in their peripheral vision. DriveSharp retails at around $89.00, and comes with a money back guarantee. The testimonials look good, by the way.

2) Look for Specific features in the car itself. Today’s cars offer all types of options, and many of these involve performance and safety together. If you look carefully for ways to enhance the driving experience to give more safety and control, you will be seriously helping out senior drivers. Specific features that help include

  • Anti-lock brakes: Any person who has ever lived in an icy climate knows the dangers of breaks locking up, and the added safety of having an anti-lock brake system, which makes “tapping the brakes” unnecessary. This is great for senior drivers, who can often have difficulty doing this.
  • Stability control: A new development that helps drivers by making slight adjustments in steering when the car is beginning to slide. This helps the driver to remain in control of the vehicle, and is another great help for peopled driving in inclement weather.
  • Brake Assist: This is another recently developed system that helps a driver push the brake all the way down when a fast stop is necessary. Of course, frailer drivers such as senior citizens can sometimes struggle to brake fully, and this will help them stay safe
  • A bright instrument panel: Make sure the instruments are bright enough to be clearly seen by the driver. If they have trouble seeing what is happening with the vehicle, they will have a greater chance of getting distracted by them. But if they can see their speed and fuel at a glance, they can keep their eyes on the road.
  • There are more ideas on the AAA senior website. If you need to find TX Assisted Living, put in your city and care type in the box at the top of this page.

11.06.10

Alzheimer’s Disease: Elderly Care’s Biggest Challenge

Posted in Alzheimer's Disease, Assisted Living, Assisted Living Facilities, Assisted Living Safety, dementia, Dimentia, Elder Care, Elderly Care, Elderly Diseases, Senior Citizen at 4:57 pm by admin

Caring for Alzheimer’s disease is one of the least most difficult functions in the world of elderly care. Maybe that is because it is one of the most difficult ailments to understand. There are millions of families around the country who are struggling with it right now. For them, it is not just an issue of memory loss. It is an issue of perplexion and heartache.

The good news is that families no longer have to figure out how to deal with Alzheimer’s disease by themselves. There are countless ways for family caregivers to get help fighting this disease, while helping their loved ones to be comfortable and as happy as possible.

What is Alzheimer’s Disease?

Contrary to popular belief, Alzheimer’s disease is not just “common memory loss.” Yes, there is a sort of memory loss that can occur with age, but Alzheimer’s does not. Alzheimer’s is a form of Dementia. Dementia is a decrease of brain activity, not just in memory. Alzheimer’s is a particularly dangerous form of dementia. There are between 2.5 and 5 milion Americans who suffer from Alzheimer’s. And unfortunately, many of these people end up dying from the disease. Alzheimer’s is the seventh leading cause of death in America.

So what can a family do when their loved one shows signs of Alzheimer’s disease? Ultimately they have two choices: care for them in a home setting, or put them in a full time elder care community that specializes in memory care. It is not a good option to leave them to live alone, since Alzheimer’s causes serious problems in every day life.

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Alzheimer’s Care at Home

For families who are able and willing, home care is probably the best option for dealing with Alzheimer’s. That is because it is easier for dementia patients to be around familiar settings. Here are a few things to keep in mind if you are caring for a loved one with Alzheimer’s at home:

  • Keep the day full of activities. Make sure to include activities which are familiar to them. If possible, make connections with skills that they used to use in their career. If they get upset, switch to a new activity.
  • Form routines with those activities. Routines are extremely important for Alzheimer’s patients. If there are things your loved one would do every day, try to bring those in as well. Familiartiy is your ally.
  • Communicate with gentleness, calmness and brevity. Do not complicate the issue with confusing sentences. And do not let your own frustrations come through. That does not mean you should patronize, as if you are talking to a child. Just let your kindness come through in your patience and your clarity.
  • Utilize help services, for your sake and your loved ones. Cargiving is not easy in any situation, but especially when dealing with Alzheimer’s disease. If you are not careful, you may end up frustrated and burned out. So be sure to check into local respite care and adult day care services. These are often linked to long term assisted living centers. They can look after your loved one for any length of time, from a few hours to a few days. Remember, if you are not well taken care of, you will not be able to take care of them.

If you are not able to care for your loved one at home, you may want to consider an Alzheimer’s Care facility, also known as Memory Care. Memory Care units will focus on building routines, providing safety, and keeping your loved one comfortable. The staff at Alzheimer’s Care facilities are well trained to deal with the intricacies of Alzheimer’s disease, and will make sure you are involved in the process as well.

Finding Alzheimer’s Care Facilities in Your City

Are you searching for elderly care to help your loved one while they are suffering with Alzheimer’s Disease? Find it right here on this site, by putting your information in the box at the top of this page. Be sure to click the “Alzheimer’s Care” box before you click your search, and if you find a facility that interests you, be sure to request “More Information.” This is a totally free service, so be sure to get information from as many faciliities as you want, with no charge.

10.04.10

Choosing Elderly Care in Dallas

Posted in Assisted Living, Assisted Living Facilities, Assisted Living Safety, dementia, Elder Care, Elderly Care, Senior Citizen, Texas Elderly Care Services at 8:53 pm by admin

If you are choosing elderly care in Dallas, TX, you are in luck. There are dozens of excellent facilities around the Dallas / Fort Worth Metroplex. These facilities offer many different levels of senior care at many different prices. In fact, there are so many different choices in North Texas that it can be an overwhelming task to just look at a list of them and determine which would be best for you or your loved one.

In order to make the task simpler, here are a few easy steps to making an Assisted Living Decision in North Texas.

1.) Determine a Location

You might think this should be a secondary concern, but I believe location might be the single most important factor in helping your loved one make a senior housing decision. Is the family relationally tight knit? If so, make sure you find a facility that is close to home. If you live in Terrel, please don’t, for heaven’s sake choose an Assisted Living facility in Fort Worth. Sure, you might have the best intentions to go and visit every weekend. But the length of the drive will catch up to you, and you will start going less and less. So if at all possible, make sure you keep your elderly loved one close.
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In addition to family locale, be sure that your parent or grandparent is close to things that he or she is able to enjoy. For example, if they are still active and like to go shopping, keep them near shopping centers. Don’t send them out into the prairies. Is grandpa a sports fan? See if you can find a place that is relatively close to the Ballpark in Arlington. Day trips like baseball games might just prove to be some of the most precious times he will have.

2.) Kind of Care that is Offered

The specific kind of care that is offered by a Dallas Elerly Care facility will be tied to the resident’s medical condition, of course. This is obvious. But did you know that many Assisted Living facilities will specialize and adapt to your loved one’s medical condition? It’s true. In the past, there was pretty much just one level of professional elder care. People would either live at home, with family, or go to a nursing home. But that just isn’t true anymore. Today, Texas seniors can, like other seniors around the country, choose to live in a nursing home or a retirement center that will cater to their level of activity.

So, ask yourself: is grandpa able to care for himself? If so, how much? Does he require weekly medical checkups? Does he need help cooking meals or dong housework? Can he drive? Or better yet: should he be driving?

The answers to these questions are very important. Today, Assisted Living facilities can help out with all of those things. They can let seniors live alone (not like a nursing home at all) in an apartment or a townhome, while keeping medical staff right on hand, should anyone need care. Their staff is often very involved in the lives of senior residents. They help deliver meals and do laundry. They organize social events onsite. They organize transportation for shopping ventures, sporting events, or anything that drums up interest.

But of course, situations are not always so positive. What if your loved one is suffering from memory loss? From Alzheimers or another kind of Dementia? This can be a scary thing for a family member. But many Assisted Living facilities offer entire wings that are dedicated to caring for patients with memory loss. These environments are generally sealed off to prevent wandering, and are full of natural settings where your loved one can relax and enjoy life. Staff can help emphasize daily routines and help to stimulate brain activity.

So there is care for your loved one whether he’s in perfect health or needing end of life care. No matter what kind of care your loved one needs, rest assured: you can probably find a good fit in the Dallas area.

3.) Figure out Your Budget

Finally, costs will vary greatly for Assisted Living facilities. Lots of factors make the price fluctuate: Amenities, size of the apartment, location, etc. Generally (not all the time), Medicare will not cover most senior housing. Assisted Living facilities can be quite pricey. However, if you consider how much your loved one usually pays per month right now (mortgage, groceries, utilities, etc.), and subtract that from the monthly cost or the facility in question (or vice versa), I think you’ll find it much more evened out. Some retiring seniors even choose to sell their home when they move into and Assisted Living center, and that frees them up quite a bit to live without concern.

So, those are the three primary considerations for a person (or family) considering Assisted Living around the Dallas area: location, level of care, and cost. If you take these one at a time, I’m sure you’ll find exactly what you’re looking for very soon.

01.19.09

Finding Elderly Care In My Area

Posted in Assisted Living, Assisted Living Facilities, Assisted Living Referral Service, Assisted Living Safety, Caregiver, Elder Care, Elderly Care, Nursing home, Nursing home alternative, Senior Citizen, Taking Care of a Loved One, Texas Elderly Care Services at 12:03 am by admin

Finding elderly care in your area is quite difficult because facilities can be deceiving. When you arrive at an elderly care facility try to look past the fancy looking lobby and dining room chandelier. Watch how the workers are treating the residents, what kind of food is being served, and ask many questions about the care packages that they offer (bring a copy of our chart off our blog titled “Elderly Care Facilities Choice and Comparison”). Write down what they promise and keep any brochures. If you find an elderly care facility that seems to be what you are looking for, you can request a copy of the state inspection from D.A.D.S. (Department of Aging and Disability Services). According to chapter 552 of the Texas Government code you can request certain records as they should be open to the public. Also when looking for an elderly care facility for a loved one keep his or her interests in mind. Does he or she have a friend that lives at a nearby facility? Does he or she like gardens or activities? Does he or she want you to be close by to visit often? Good luck on your search for the right elderly care.

07.28.08

Hidden Camera

Posted in Assisted Living, Assisted Living Facilities, Assisted Living Safety, Caregiver, Elder Care, Elderly Care, Nursing home, Nursing home alternative, Senior Citizen, Taking Care of a Loved One, Texas Elderly Care Services at 1:01 pm by admin

So you put your parent in an assisted living facility. You purchase a care package that provides the amount of care that your parent needs. You see your parent quickly declining and you wonder if the facility is providing the care they say they are. You can be sure of it with a hidden camera. You can purchase a nanny camera then set it up at the far wall of your parents room facing the door. You can watch the tapes and see how often a care taker enters the room and how long they stay.

If you can’t afford a nanny camera, you can show up unannounced to visit your parent and look around the room for dirty clothes, see if the bed is fixed, check the soap in the shower and depends to make sure they are being used up. Keep the assisted living facility in check. You purchased a care package and they must provide it, no excuses.

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