July 18, 2015 • By Dennis Beaver

For readers of this column who are a bit cynical, in view of the enormous cost to society from an aging population growing more infirm by the day, beset with dementia and Alzheimer’s, many are asking:

  • Why are more states considering Death With Dignity — also known as Assisted Suicide laws?
  • Is the answer compassion? Or, is cost the true reason?

In the mid 1970s a French priest, Louis Genton, who cared for the aged, warned a young American lawyer/journalist of a coming crisis:

“Medical science has promised immortality, telling death to come back later. In a handful of years, the cost of health care — just like pension obligations — will cannibalize massive chunks of a nation’s revenue, allowing infrastructures to crumble.

“But the Grim Reaper will have the last laugh, when sons and daughters, husbands and wives — entire nations — discover the challenge of caring for their immortal, infirm and aging population until that moment of blessed deliverance.”

Of course, until that moment of blessed deliverance arrives, the children and grandchildren of America’s baby boomers have the earthly concern of finding suitable care for aging family members, and it is anything but easy.

San Francisco-based elder-law attorney Kathryn Stebner cautions that, “While information available to the public about assisted living facilities is getting better, there is still not a great deal of information enabling good choices.”

‘You are entrusting the safety of a loved one to unknown people’

“Finding a good assisted living or nursing home for mom or dad requires visiting the facility and online research to learn if they are licensed, and if so, have they gotten in trouble with the appropriate state licensing bureau,” Stebner points out.

“In California, you can search: Community Care Licensing for a list of all licensed facilities. Also, an excellent resource is California Advocates for Nursing Home Reform.

“While there is a great deal of data for skilled nursing, an enormous lack of information online for assisted living makes personally visiting the facility absolutely critical.

“Your readers need to remember that they are about to entrust the safety of loved ones to an unknown group of people,” she underscores.

12 key points and questions to ask

Stebner lists 12 key points, “which will help families understand just how important their evaluation of the facility really is and questions which need to be answered.”

  1. Staff is the key to everything, especially those who are engaging residents in a variety of activities which helps keep them healthy. If you see people sitting in a corner in wheel chairs and no one interacting with them, this is a bad sign.
  2. What is the staffing ratio? How many staff per resident?
  3. Does the facility change staffing when people with higher needs are there?
  4. Does the facility staff to acuity — does it make staffing decisions based on how sick the residents are? Or does it make staffing decisions based only on the number of residents?
  5. What kind of activities does it have for residents, and are they documented? Does it document changes of condition, if a resident is eating, falls, reacting poorly to medications, or having appetite changes?
  6. Does it have either an LVN or an RN, and if so, are they on call or on premises, and if so, when?
  7. How much does it spend per day per resident for food? $2.50 per person would raise a red flag.
  8. Has it been cited by the state for regulatory or legal violations?
  9. Is this a secured facility? Are the doors and windows locked? This is especially important for family members with dementia.
  10. Is there a fall prevention program?
  11. Is this a large, corporate-owned facility, or is there an independent owner? This is important because you want people who can make decisions affecting your loved one here and now, not three states and two time zones away.
  12. Trust your nose. If the place does not smell good, this means they are not cleaning common areas or residents who need it. Having an adequate amount of staff for the resident population is critical.

Visit at different times unannounced

“Drop in at different times of the day and evening unannounced, which shows that you care about the welfare of your family member and are involved,” Stebner. “I just cannot stress that enough. Just walk in when they are not expecting you and look around.

“Never, never, never ignore complaints about the way your loved one is being treated. There have been many cases of sexual abuse, especially of dementia residents, many of whom told their family members but weren’t believed. So, please, investigate everything,” Stebner urges.

You and The Law recommends spending time on her website,

Dennis Beaver practices law in Bakersfield and enjoys hearing from his readers. Contact Dennis Beaver.