When Your Parents Need Assisted Living – #5

If you are joining us for the first time, welcome. I am doing a miniseries on assisted living facilities. In August 2021, I had to find my mom a new place to live. My home, my abilities, and raising my grand-nephew with autism are not conducive to the kind of care she requires, so I set out to find the best place possible within her budget. Finding her a place to live is not an easy task, especially when you do all the looking by yourself.

In part 4 of this miniseries, I shared the private pay cost to move into an assisted living facility. It’s not cheap, and there are a lot of factors to consider.

Next steps

Today I want to talk about the pre-approval process. This isn’t like ordering a hamburger your way. There are steps you must go through when considering a place to live for your loved one. These steps need to be reviewed and considered.

If you read part 4, (link below) I shared that I set up a spreadsheet to track who I talked to and what each assisted living facility offered. Trying to manage all the information on a sheet of paper gets too confusing. The spreadsheet was a tremendous help, and it allowed me to eliminate the places that were not going to be a good fit for mom.

Once I narrowed down my search to a few places, I moved on to the next step – tours. I toured the few facilities I established as being viable options. I am glad I did because not every place you find online looks the same in person. I found that many websites have not been updated to reflect current conditions. Some assisted living facilities have let the maintenance of their facility dwindle. When you see this, you should ask yourself if their care for your aging parent has also declined.

When the tours were complete, we moved on to the next step – the pre-approval process. This is when your loved one gets more involved with the process because it requires them to complete a few things.

  1. Paperwork
  2. Physician form
  3. Interview

Holy paperwork Batman!

The amount of paperwork one has to read, and complete is tremendous. I remember when my mom received the packet from the home she chose. She called me up and said, “Net, there are 40 pages in this packet I need to read, initial and sign. My goodness, what if I wasn’t able to read these documents, then what?”

As her power of attorney, I would have completed the documents, but thankfully, my mom still has all her faculties and wanted to review all the documents. I told her to take her time, which she had lots of, and read each page, initial where indicated, and sign. She was welcome to call me or the sales rep from the assisted living facility if she had any questions. Fortunately for me, she only had a few questions and comments about the paperwork.

Those documents cover many items, and while some may not apply to your loved one, you still have to read them and sign off. It took mom a better part of a day to finish the process. Because she lived out of state at the time, she had to send the signed documents back by FedEx to be considered.

We’re not done yet

Next up is the physician form, which is called Form 1823. This documents the medical history of the patient. The primary doctor completes this form on the applicant applying for residence in an assisted living home. This form tells the director of nursing what the current health status is of the applicant so they can determine if their facility will be a good match.

Form 1823 doesn’t always require an in-person assessment with the doctor, but in my mom’s case, we did make her go to the doctor to get the form completed because she hadn’t seen a doctor in person in almost two years because of covid. There are multiple questions the doctor has to answer about the applicant’s health, some requiring they see the patient in-person to answer questions like blood pressure, heart rate, oxygen level, and other things checked for during a physical exam. Whenever possible go in person.

Once the doctor completes Form 1823, they send it back to the assisted living facility. The director of nursing reviews the information to make sure your parent is a good fit for their facility. This form also helps them determine whether your parent will need an elevated level of care. Elevated levels of care cost more money.

Once they review the form and determine your parent is a good fit for their place, they interview them directly. In mom’s case, they interviewed her over FaceTime because she lived in another state. They asked her questions about her medications and her physical abilities during the interview. They had her get up and walk around the room to see what kind of physical shape she was in, and they asked her to name off all her medications and their dosage. My mom is pretty with it when it comes to her mind, but not so good physically – her mind is good, her body is shot.

Before I forget

One thing to mention that most people may not be dealing with that played a considerable role in narrowing down eligible facilities for my mom was her nose. At first, several places welcomed the opportunity to take the next steps required in the approval process until they saw a picture of my mom’s face. Once they saw her picture, most places politely declined and wished us well.

My mom has been dealing with skin cancer for many years, and it has eaten 98% of her nose. Because her nose is wide open, most places declined because they do not have the proper license. Most cannot treat something of that nature because it cannot heal. It is not an open wound that skilled nursing can heal because the skin and tissue are gone. Before covid, mom saw multiple specialists for opinions on how to proceed. Back then, cancer had already taken away the tip of her nose and had started making its way up the bridge.

But as you know, covid hit and surgeries like hers were considered elective. Mom never got to have surgery, and through 2020 and most of 2021, cancer continued to eat away at her nose, leaving her with just enough to hold her glasses with the help of a strap that wraps around her head. Some have asked why she doesn’t get surgery now. My mom has done enough research now to know they would have to scrape out a good portion of her face to get to clean margins, and the pain at her age would be horrible. If that is what she chooses, I respect her decision.

Back to the topic at hand

Once your loved one passes the test and the form has been approved, it’s time to dent your bank account.

In part 6, I will go into the details surrounding the money. If you thought the rest was daunting, wait till you have to shell out the money.

I am very thankful the Lord opened up so many doors during this transition. I spoke to so many nice people who while they couldn’t take mom into their facility, did refer me to other people who might have been able to help. The eldercare industry is filled with compassionate people willing to do what they can to help the elderly. I can’t recall meeting anyone cold and disrespectful.

Finding a place for an elderly parent is not easy, but so many resources are available that make the process a little easier. It can be an emotional time for you and your parent, so make sure you take their feelings into consideration if possible and allow them to be part of the decision-making. After all, they will be the ones living there.


The Teaching Lady


When Your Parents Need Assisted Living – Part 3

When Your Parents Need Assisted Living – Part 4



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