Thought I'd share with you a few of my observations over these past 6 months.  We've all had friends that have told us of the trials, challenges and joys of having older parents.  Over the years, Brian and I have listened, hugged and consoled many of our friends that have lost parents or begun navigating the journey of elder care.  Little did we know what they were really doing.  It's one of those things in life that no matter how well you listen, unless you are in the same boat, you really have no understanding of how this affects your life as well as the lives of your family members.

Last August 29th, we got a phone call from the Independent Living Campus that Brians' Mom has resided at for over a decade.  She decided to move there in her 60's and was very content in the fact that she had made the right decision that would transpire into the right care for her as her needs increased.  She had her own apartment, could come and go as she pleased and was comforted in knowing that quite a few of her friends were also transitioning to this type of living arrangement.  She was also very proud of the fact that, in her view, she had put things into place that would make the next steps easy for all of her kids.  She even bought into the Lifetime Rights program so that she would always be guaranteed a place in the assisted living building and if needed, the nursing home/rehab facility.  These were all her decisions.  While she told us of her desires in person or via letters, we really didn't give it much thought at the time due to the fact that she was a very independent, strong woman.  Little did we know that this would later be considered our 'quiet period'.  

Mom had been having some problems over the past couple of years.  She knew that her balance was not as good as it had been and with us watching, she did what she wanted to do when it came to dealing with the medical things in life.  While we didn't always agree, we also respected her decisions.  Back in 2001, she asked Brian to be in charge of her finances when the time came that she felt she was ready for someone else to handle this.  She also had many talks with me about becoming her POA for Healthcare.  All of the paperwork was in place and we all felt that we had a handle on things.  Little did we know.

The phone call came from the Chaplain of the facility.  Mom had been found in her Independent Living Apartment.  From her schedule as well as her very well known daily routine, it was determined that she had been down for a few hours.  We would have questions later as to why it took so long for someone to take a minute and go see why she had not shown up for her normal activities.  When someone did find her, she was determined not to be transported to the local hospital.  She had gone this route after a minor stroke in 2009 and unfortunately, the local facility usually always ended up having the patient transported to another bigger facility via ambulance 30 miles away.  It's one of the things residents that live in rural areas know will happen no matter how new or good their local hospital is.  Add in the fact that this is not a large population area and you can imagine the challenges when it comes to medical facilities.  People don't realize that if you don't have a large resource of trained people, you can't handle everything that comes into your facility.  

Due to her having suffered another stroke, she had spent most of that time on the floor of her apartment with a head injury due to her fall.  We can't imagine how scared she must have been, yet still had a hard time comprehending why she didn't scoot herself to the phone and push the button for help.  It was obvious that her ability to make common sense decisions was lacking at that time.  She spent 4 days in the hospital and was discharged to the nursing home/rehab area of the local retirement community that she had lived in.  We spent those days down there observing and getting used to our new roles.  We had all of the paperwork with us and talked until we were blue in the face with any one that would listen to us on what her wishes were and who we were.  In the end, it didn't really matter.  We would spend hours at her bedside in the hospital to see the 'doctors' and finally realized that you never knew when they were going to show up.  Usually, there was more than one, since hospitals now are using what they call, 'hospitalists'.  That means that your primary care doctor doesn't come to the hospital to see you, you get random doctors that work for the hospital and then the reports are sent to your primary care physician.  And yes, lots of things get lost in the communication between all of these people.  It's frustrating and you soon learn to be on the defensive when it comes to anyone walking into the room and deciding what is best for her.  Not a good place to be.  This is when we started to realize that being able to follow through on her wishes was going to take a lot of diligence on our parts.  It also brought to our attention all of the cracks in our medical care.  While it's hard to place blame on just one thing, it's obvious that we have a lot of problems that no one is addressing.  Common sense, at least in our view, is not being considered  a part of the solution for those making the rules.

Over the next few weeks, I'll be talking about some of the challenges that we faced and are still facing.  Mom wanted to write a book on all of this, but, as we looked into what was available out there, we decided that our goal was to try and get information out to those that are in the same situation, not make money or start another organization or support group.  That is another whole quagmire once you start looking for help and answers.  Lots of organizations out there as well as medical professionals.  All of them with different opinions and 'tips'.  Again, you need to rely on your common sense.  You also need to keep the communication lines open with all of the family members that are involved.  We are now seeing that by being a part of Moms' journey, it's turning out to be one of the best ways to cement those family relationships and know your relatives in a way that you never thought possible.  

As Mom always says, 'Carry On and Be Brave'.  It's going to be fun to hear her perspectives on some of her journey and with her permission, I'll be sharing some of that with all of you.

Have a great week!

 Just when you think that you know what you are doing, the game changes.  As we started growing into our roles of the Elder Care World, we found large pieces of our puzzle missing.  While your first instinct is to go to the source and try and get the answers, we found that most of the time, there was a lot of stuff that we weren't being told.  

We would ask Mom, but also learned quickly, that her world consisted of just trying to get her shot at using the shared bathroom.  We also learned that we needed to keep her world as stressfree as we could.  So, we started to document what we were told and kept asking for actual copies of charts and rehab notes.  Unfortunately, we were not able to always get these things.  While you can blame the parties involved, you also need to navigate your way to finding the answers and information.  Here's one of the ways that we were able to bypass the holders of the keys and still find out what was going on.

If at all possible, try and establish a positive relationship with those that are in the know.  In our case, we had some fantastic CNA's as well as a couple of really good nurses that had direct daily contact with Mom.  You first have to figure out who's really there for the right reasons and then see how open they are to actually communicating and trusting that you won't blow their cover.  We had some family members of other patients tell us their tricks and some of them were pretty humorous.  Once you realize that all of you are in the same boat, you grab your life jacket and start swimming.

You get to a point where you also realize that you can't react to every little thing.  Believe me, in our case, this took a while.  After all, your primary responsibility is to make sure that your parent is being taken care of.  When you see how much it's costing them, you sometimes wonder who came up with this scenario.  Luckily, for us, I was able to spend over 40 nights in local hotels over a period of 4 months and witness how all of this works.  It was exhausting and much time was spent just trying to figure out the best way to achieve the desired result.  Add in the fact that Mom would let us know what was not working and the emotions of the whole thing can lead you down the wrong path.  When you have to deal with trying to track down little things that go missing in her world and then deal with making sure that the appropriate medical care is really being done, it will drive you nuts.  Everyone has their own opinions and agendas.  Including the family members that are involved.  We looked at the options of where she could go were, but also had to take into consideration that she had lived in this community for over 60 years.  At what point do you decide to upset their world in order to make yours more livable?

One of the best tricks that we finally found after months of frustration when it came to just exactly what was being done to or for her was the Medicare.gov website.  Mom gave us permission to log in and gain access to her medicare claims.  I did call Medicare to see what we needed to do in order to get access and was told that even though we had POA Healthcare and were Trustees of Financial, Medicare will not send any mail to our address since they use the patients' latest tax return via the IRS to establish the correct address of where to send claim information.  Really?  It was on my list to take her to a Social Security Office and get her address changed for all mailing to ours, but, when you are dealing with having to drive 30 miles to the nearest office (again, remember, we are in a rural area!), you find reasons not to venture on this journey.  Mom, at this time, had broken 3 bones and was just recovering from major hip surgery to repair that area from her latest Fall at the nursing home.  She was already in a fragile physical state and didn't need to be loaded into a vehicle for another trip.  

At the time, I also thought that we were probably weeks away from her being mobile again.  So, our decision at that time was to put it off until she was better.  Little did we know at that time, that our window was closing due to the upcoming health challenges she would face.  We opted instead to have all of her mail forwarded to our house in Wisconsin.  After about 4 months, we received a letter from Social Security as well as Medicare that they were informed by the Post Office that her mailing address had changed.  Thus, we would now start getting these summary updates on the claims.  A new way to fix the problem!

By getting on the Medicare Website, we were able to see claims that were filed within about 2 weeks of something being done to Mom.  Once we got over how expensive some of this stuff was, we started to learn how to check the billing codes to ensure that whomever was doing something to her wasn't trying to overbill her.  This is another area that you will spend hours looking at.  Get a cup of coffee and plan on at least 10 hours a week if your loved one is hospitalized, getting therapy or residing in a long term care facility.  There are great websites online that will walk you down the billing codes world.  Of course, for every one that you find to be questionable, you will have to contact the facility or company that sent it in and request an explaination.  More time spent on not being focused on your parent.  At this time, Brian, his sister and myself started figuring out who was going to be responsible for doing what.  It was now too big of a monster for just one person to take on.  Now, you know why you need to be keeping those good relationships going with the family members.  It only takes one of them to upset this apple cart or decide that they don't have time to do any of it.  Thus, you see the emotions and backlash come out within the family circle.  In our case, we decided that we were not going to go down that road.  Besides, none of us had time to even think about how we really felt when it came to who was doing what.  

We learned a more complete story of just what was being done (or not being done) to Mom via all of these claims.  We saw claims from medical professionals that we had never heard of and wondered why we weren't even told of their existence.  If you can't get people to explain just what they did or why to you, don't pay the bill!  This gets their attention and they will usually then take the time to let you know why they are in the long line to get paid.  Once we were able to contact all of them via our info. from the Medicare Website, we were able to give them our address so that they could start sending the bills to us.  If they sent them to the nursing home, Mom would just put them in a drawer somewhere and forget to tell us that she had received them until weeks later.  More communication is needed when it comes to what mail your parent is getting while a resident in a facility.  It's just common sense to know that if the return address is a medical facility, the family should probably be sent the letter.  Right?  This happened to us in 3 different facilities in 2 different states over a 6 month period.  Amazing.

Our most frustrating bills/claims were from ReHab.  You know that they have to send in 'progress' forms in order to continue to get the medicare payments.  We were not able to get copies of these 'progress forms' at one place until we moved her to another facility.  You know that the elderly patient only has 100 days of medicare coverage for Re-Hab.  We didn't fully understand this until late in the game.  Another error on our part based on the fact that Mom is now on her 5th broken bone and just got done with another major ortho surgery.  We also didn't know that PT, OT and ST are billed in 'units'.  Each unit is 15 minutes long.  A patient can literally be signed up for Physical Therapy, Occupational Therapy and Speech Therapy for 3 hours a day.  Start adding up these costs after the 100 days benefit period is over and you find yourself wondering who is making these decisions and why aren't they responding to your questions.  Good Luck!  Don't get me wrong, there are a lot of advantages to a lot of patients to participate in the Therapy programs.  But, for some, common sense needs to kick in and the realization made that it's not in their best interest.  Luckily, for us, Mom made the decision.  

  Mom made the decision after her last broken bone a couple of weeks ago here in Wisconsin, to stop all PT, OT and ST.  It was quite obvious that once they got her back up to using the Walker with assistance, that this would increase her potential to fall.  Add in the fact that Mom is determined to do things her way and that also adds to the problem.  Even if a Call light is within reach, some elderly will not use it.   The cycle was glaring, the observation to all of us was late.  Another lesson learned.  You also need to watch out for this in the hospital setting.  Her Ortho surgeon followed protocol and ordered it.  We tried to call and talk to him and could not get a response until almost a week later.

Even if the patient has an enacted POA for healthcare, they will tell you that if PT, OT or ST goes to the patient and asks them if they would like to try moving a bit, if the patient says yes, off they go.  We resorted to writing her wishes of no therapy on the hospital room board and they still took her if we weren't there to intervene for her.  Nothing like going to the PT dept. of a hospital and announcing that you are there to pick up your Mom who has refused all PT.  Took me a few minutes to find her and as I was getting her into the wheelchair for the trip back to her hospital room, the PT person acknowledged that they had seen the note on the board, but they asked her anyway if she'd like to go move a bit and meet some new people.  Of course, she said yes! 

 Again, no one ever called our phone number that was up on that board also.  I've done a search on Physical Therapy websites for articles on how to get elderly to participate in therapies.  Consumers should read some of these.  The antics used to get the person to agree to go are in my opinion, not doing the right thing.  Again, the bottom line is money.  Having a PT, OT or ST dept. within the facility is a guarantee of thousands of dollars for their bottom line.  When you see how much money Medicare spends in this area alone, it's no wonder we are in the current situation that we are.  There needs to be more oversight on how these funds are spent and what the advantage to the patient is based on their physical state and prognosis.

We've had pretty good luck with most of the hospital nurses.  Once they realize that you really are concerned for the patient and they've brought you in yet another change of sheets for that sofa that you've been sleeping on the past few days, they are usually pretty good about letting you know what is going on.  Just make sure that you are talking to a real nurse and not a student that is doing their clinicals in the hospital.  We all knew to keep an eye on what IV bags were hanging on the pole for Mom and if a new medication was added, we kept up with what it was and if there were any side effects that would happen to her based on what else they were giving her.  When she broke this last bone (again due to a fall while using the walker and not pushing the call button), we found a week after discharge via the medicare website that there was a total of 7 different doctors that had been in to see her.  Surprise!  I'm now in the process of calling each one of them to find out why and how exactly I'm supposed to get a non-transportable person to their offices for all of these follow up appointments.  

We did come up with a plan to address this.  I checked with her long term care nursing home that she was tranferred to due to her new medical needs to see if we could utilize their physicians that were either part of their staff or their Medical Director.  We've learned that yes, we can have them contact these doctors and coordinate Moms' care by communicating with each other and sharing lab results that can be done 'in house'.  Needless to say, since Medicare will not pay for private transport to all of these places, this is a good solution for Moms' current situation.  At least, we think it is.  Next week, it could all change again.  Depends on what happens next.  Don't you just love surprises?

Have a great week!

 Boy, did we learn a lot on this subject.  After Mom was admitted to a nursing home/rehab facility, we had to figure out what to do with her current independent living apartment.  Add in the emotion of things and this can become a whirlwind of questionable decisions for families.

In our case, we were all under the impression that Mom would only be in the nursing/rehab facility for a few weeks.  Just long enough to get her back on her feet.  We contacted the person in charge of the Independent Living Units with the intention of moving her stuff into a storage area until we could figure out what was going to be next.  Unfortunately, we decided to go to the next step and move all of her stuff into her new Assisted Living Apartment at the same complex.  We were on the fence as to which way to go since we knew that there was a chance a unit would not be available upon her dismissal from the nursing/rehab area.  But, since she had signed up and paid for 'Lifetime Rights' several years ago, we also knew that the current rent that she was paying on her apartment was way below what was now being charged.  That's probably the best benefit of her enrolling in the Lifetime Rights agreement 13 years ago.  In Moms' case, she saved thousands of dollars over those years.  

The Assisted Living units were much more in rent.  But, we figured that since she would be moving into that area in a few weeks, we might as well get this done.  It was Labor Day weekend and the remnants of Hurricane Issac were raining down upon us.  We had also left Wisconsin not realizing that we were going to be moving her to another building.  Being in a small town, the resources for help were limited.  So, we decided to use our vehicle and start moving.  This is when we all realized just how much one little lady can get into one small apartment.  It was astounding!  Every drawer that we opened was packed.  The closets were almost inaccessible.  What we thought would be a few hours turned into 2 days.

We were also trying our best to consult with Mom as to what she wanted and what could be thrown out or donated.  Of course, she wanted all of it.  So, after going through what we determined to be necessities and throwing out the 'garbage', we finally got her moved in.  Took another couple of days to get it all unpacked and put away.  Our goal at that point was to try and put things in similiar places to where she had them in the old place.  We went ahead and hooked up the phone again and opted to hold off on the cable service until we had a better idea of when she would be moving in.  Here's what we learned in hindsight after jumping the gun on this.

We probably should have just left her things in the independent living apartment.  As it turned out, she never did move into the Assisted Living Unit and we paid the higher rent for 3 months.  We could have saved ourselves a lot of time and just left things as they were.  So, when you find yourself in this situation, think about the possibility of your elder not moving to Assisted Living.  It's very possible that they will skip this step entirely based on their medical needs.  While your emotions are telling you to take care of things like this, you may be moving too fast and not even know it.  We did permanently change her address to ours at this point since none of us were going to be down there on a daily basis to get the mail.  

When you get to the point where they are having you sign the 'lease', remember to read the fine print.  Make sure that you know what their policy is if you are going to be vacating the unit.  Usually, if it's due to a death, they will forgive the rent.  Ask them!  There are some places that will continue to charge the family/estate until they get the unit rented again.  This could take months depending on the need in the area.  This is also a good time to find out what services are covered and what are additional.  There are so many different plans at these places.  You can easily double your monthly rent fee if they don't include the basics such as, assistance bathing, meals, meds supervision, ect.  If you need to make a notation on the lease, do it.  Once you sign it, things discussed verbally are forgotten.  Get a copy and make sure that they have your contact info. as well as any copies of legal papers such as the POA for Healthcare, Trustees for Financial, ect.

 If, for some reason, the POA for Healthcare is not activated (all states have different rules), type up a statement requesting the facility contact you on any new things or changes that are being done for your Elder.  Have the Elder sign it in front of them and request that it be part of their file.  This will then give you a baseline to start with should they decide not to let you know what's going on down the road.  Keep in mind, that some states will allow the Elder to rescind the POA Healthcare even if they are no longer competent to make that decision.  It's just another way for the facility to get out of having to keep you updated and a great way for them to add more services (costs) at a later date.  Are we having fun yet?

There are some places that may try and pressure you into moving too fast.  We were lucky in that we had an exceptional Admissions person for the Independent/Assisted Living Units where Mom resided.  But, we've also heard some stories from other families of high pressure tactics used to get the families to sign up for services or living arrangements when the resident is still in the nursing/rehab/hospital stage.  While it's unfair for places to do this, they are also looking at their bottom lines.  Think about what you really need at the time.  It may save you a lot of money that is needed in the future.

As we were packing up her things to move her to Wisconsin last December, we realized that this was the time to start asking immediate family members what, if anything, they would like.  We knew that her new place was going to be limited on space and also realized that some of her things, she would never be using again.  This can be a very emotional stage for everyone involved.  Keep in mind that you are going to have some that just don't want to deal with any of it and others that may decide that they want everything.  Again, we were lucky.  We all worked together on this part and everyone was happy.

 We also brought Mom over to the place as packing was starting and asked her what she wanted to take.  She had readily agreed to move to Wisconsin and we really admired her for making that decision.  After all, we were taking her out of her world of 60+ years.  We paid close attention to her emotions and even if we knew she was not going to be needing those gardening gloves, when she started telling us the story of how she had used them over the years, into the box for Wisconsin they went.  

One week before Christmas, we rented a U-Haul trailer, packed Moms' stuff in it, made sure that she had a few days to say her goodbyes and  headed for Wisconsin.  She rode with Brian in his car and they followed behind me, towing the U-Haul.  We will always remember that ride.  There were a lot of emotions as well as relief in knowing that we would no longer be 4+ hours away from her.  She got to take a good look at the flat lands of Illinois and wasn't too impressed with the white stuff on the ground as we made our way into Wisconsin.  One of the grandkids had gotten her a Cheesehead button for her coat.  Even though she's a diehard Bears fan, she wore the button proudly and told everyone that she saw on the way that she was now a Cheesehead.  Keeping your sense of humor and remembering to see the good stuff during these times is a big priority for everyone involved.  

We had found a great place in Waukesha for her to move into the following day.  Our kids had taken time from work and also recruited additional help to get her things unloaded and moved in.  One of us stayed with Mom at our house while all of this was going on.  Having a fragile elderly person in your house for the night is akin to bringing a new baby home.  In our case, we have 14 steps to the main level of the house.  We knew that Mom couldn't climb those stairs, but our youngest son was waiting in the driveway with his deskchair when we arrived.  Seeing how gently he and Brian moved her from the car to the chair and then proceeded to carry her up the front steps to the house was another moment etched in time.  It's the little things that will get you on this journey!

The following morning, we loaded her in the car and drove her to her new 'home'.  The staff was waiting for us and made her feel welcome.  Of course, when we got her to her new 'digs', she began to tell us where she wanted things.  After a few days of unpacking as well as many tours of the new facility, we could tell that she was going to be just fine.  Little did we know that we still had a few surprises coming our way.  More on that later!

Have a great week!

 You've tried to get information on what is going on with your Elder.  You've sent emails, made phone calls and still aren't getting the information that you are asking for.  What do you do?

This is a tough one.  As consumers, we know that we should be looking up the State History of these facilities.  But, when you look at the ways these places are inspected and licensed, it's another game of bureaucracy and wasted time from our point of view.  Add in all of the paperwork that these facilities are now required to fill out and in their defense, would a complaint with more paperwork really help them to fix the problems?

Let's look at where some of these places are located.  If you are lucky enough to live in a major metropolitan area, chances are, there are a multitude of places to look into.  If you live in a more rural area, several factors come into play.  

Major Cities have tons of resources as well as qualified personnel to staff these facilities.  Add in the fact that the pay is pretty competitive and it's pretty easy to weed out the 'not so good' ones.  Rural areas don't have it as easy.  You have limited personnel, few facilities and it becomes a situation of 'he said, she said' on just how good some places are.  It's also a family thing!  If Great Grandma stayed at a place in her later years, odds are that other family members are also going to carry on that family tradition.  

Here's the way that we made the decisions that we did with Moms' input.  None of us lived in the same town/state that she did.  One of us could actually take the time from work to go down there and stay an unlimited number of days as needed.  Add in the costs of hotels, meals, gas, ect. and you now have a situation of one part of the family getting slammed financially, emotionally and physically.  Yet, someone has to be there to check on things and see Mom.  You've reached the point in this process where she can no longer do this on her own.

Over the last 6 months, we've seen a multitude of places and talked to numerous Directors of 'something'.  We've also seen the difference between those places that take Medicaid/Title 19 patients and those that only take private pay.  If you are meeting with an Admissions Director and the first question they ask is, 'How much money do you have?', think twice about going any further.  If the prices aren't posted and they are writing the 'costs' on a piece of paper for you, odds are they are making it up as they go along if they know how much money is involved.  You need to remember that this is a game for some of them to see how much money their facility can lock in to.  I know that sounds harsh, but reality sometimes is.

Let's say that you've now reached the point where you are spending your nights fretting over the lack of information you are receiving on just what is going on with your Elder.  You've tried the 'being nice' route.  Sent emails and made phone calls.  Yet, you are still not getting the level of communication you are looking for.  At these prices, someone should be answering your questions! 

We've heard so many stories from other families on this subject and yet, the facilities still don't get it.  We've had situations where some of the medical professionals affiliated with places have told us or other families to file a complaint with the state and seriously look at moving their Elder to another facility.  When you hear something like that, it certainly doesn't help to ease your stress.

All states have different rules on filing complaints and the timing of them.  The decision that you have to make is do you really want to expend valuable time doing this?  Is it going to help your Elder?  Is it going to fix the problem?  Try and get the facilities' chart notes to see what they are saying that they are doing when it comes to the family requests.  You may be surprised to see that their story is totally different from yours.  You are dealing with a business that knows how to play the game.  You don't even know all of the rules of the game yet.

All that it takes is for one person at a facility that is 'in charge' to decide how to handle situations.  When that person is wrong and it ends up affecting the care of your Elder, you need to act.  Filing a complaint takes time and if what is happening is not healthy for your Elder, you need to step in and get the ball rolling to make other arrangements.  You will also run into this problem when a facility that verbally told you upon admission that 'they can handle any type of medical situation or need' decides that your Elder is now too much for them to handle.  If you are in an Assisted Living situation, one of the clues that you may have a problem is if they now ask that you hire a private CNA for 1 or more shifts due to the needs of your Elder.  This is one way for them to 'price' you out of the place and get you to move your Elder someplace else.  

Remember how friendly everyone was when you initally came in the door asking about availability?  It's just like buying a car.  Once you sign on the dotted line, they've got you.  There are many ways as well as reasons these things just don't work out.  Finding a good fit for the Elder as well as the family is not a one stop deal.  The unfortunate thing is that you really don't know what you are getting into until your Elder has moved in.  

Ask to talk to other family members of residents.  There should be a Resident and/or a Family Council at the facility.  Go to one of the meetings.  I know that in most of these situations, you don't have the extra time to do all of this stuff.  But, go into these places with your radar up and listen to that little voice in your head if you are seeing red flags.  I went into one place for a meeting with the Admissions Director and the first thing she said to me was, 'Can you smell anything?  See, we pass the smell test."  Wow.  You may pass the smell test, but how good is your quality of care?

By all means, take the time to look at the State Complaints.  Ask the person that you are meeting with how they addressed these.  How did their last few inspections look?  Why were they fined?  How did they 'fix' the deficiency?  If a facility has no complaints on it, don't assume that means that they are that good.  Depending on where they are, it may be a situation of no one complaining because there's no other place to go.  Some States have lots of complaints via their websites, others, very few.  It all depends on how many staff they have and what the state budget is for their office.  

The best thing to do in any case is to take your time, show up at odd times and watch what is going on with the residents, what happens at night?  Look at their staffing levels.  Keep in mind that most inspections by the State are pre-arranged with the facility.  Of course, they are going to have their fancy duds on.  They were expecting company!

Knowing that you are putting an elderly person into a place is a lot like dropping your child off for their first day of school or daycare.  The elderly person may not have the capacity to verbalize what is going on.  Putting your trust in strangers is probably the biggest leap you have to take in this situation.  Trust your instincts and pay attention to what's going on.  If you have a doctor that is affiliated with the place, ask them what their opinion of it is.  Look at the how long the staff stays employed there.  Lots of state websites have this information on them.  If there's high turnover of staff, that's a big red flag.  

Take the time to google/search the facility on the internet.  If you enter complaints followed by the name of the facility, this will usually take you to the best information.  With the advent of the internet and websites, anyone can make a place look great.  Pictures of pretty rooms and smiling faces are plentiful and can be posted with ease.  What's the real story?  Do all of us a favor and if you do find that 'perfect' place, tell the rest of us!  There are some true gems out there.  You just have to get through the pile of rocks to find them sometimes.

Have a great week!