Imagine the peace of mind you’d have if you knew your loved one was getting the care they needed, 24 hours a day, 7 days a week, 365 days a year. Imagine being able to sleep through the night knowing that if they needed something, someone would respond immediately.
You can have that peace of mind.
The Need for Care
As our loved ones age, their need for care increases dramatically. It often starts with a need for meals, housekeeping, and laundry. Then something happens, a fall maybe, and now their home is no longer safe. They need safe accommodations. They need supervision. It’s no longer safe for them to be alone.
As time goes one, they may need assistance with:
- Transferring
- Toileting & Perineal Care
- Bathing
- Incontinence Care
- Medications
- Feeding
Meals
One of the first signs that your loved one needs additional care is found in the kitchen. Is their fridge and pantry well stocked? Is the fridge clean and free of old and expired food? Are they cooking for themselves?
As balance and mobility decrease, it becomes increasingly hard to carry food or a cup of water to the table. To determine if your loved one can safely navigate the kitchen, you can conduct The Milk Test.
The Milk Test involves many steps that we do without thinking. In order to pour a glass of milk, one must:
- Open the fridge
- Remove the milk
- Close the fridge
- Place the milk on the counter
- Open the cupboard
- Remove a cup and place it on the counter
- Close the cupboard
- Remove the milk cap
- Pour the milk into the cup
- Replace the milk cap
- Carry the milk to the fridge
- Open the fridge
- Place the milk in the fridge
- Close the fridge
- Carry the cup of milk to the table
- Sit down at the table
If your loved one has difficulty with just one of these steps, they are likely not feeding themselves adequately. They don’t just need meals prepared for them; they need to be served their meals.
A combination of increasing physical disability and forgetfulness may mean your loved one also needs medication management.
Medication Management
If your loved one is unable to perform The Milk Test, they are likely not taking their medications as prescribed. They need someone to give them their medications throughout the day.
They also are in need of assistance with housekeeping and laundry.
Housekeeping & Laundry
Housekeeping and laundry is physically demanding. If your loved one cannot move, carry, pull, and push without the assistance of a cane, walker, or other mobility device, they need additional care.
At this point, your loved one’s care needs can be accomplished in a few hours a day. You can hire a housekeeper to come in for a few hours a week. But at some point you realize that their home is no longer safe.
Safe Accommodations
Most homes, especially older homes, were not built to accommodate the needs of the elderly. Stairs and front porch steps become unsafe to navigate. Doors and bathrooms are too small for walkers and wheelchairs. Showers are too small and have a ledge that needs to be stepped over. Carpet and rugs are a tripping hazard.
Rather than remodel, many seniors start looking at the many Senior Living Communities in Carmichael. The Senior Living Communities in Carmichael, such as Atria, provide safe accommodations and a number of necessary and beneficial amenities such as meal service and activities. They also may provide emergency assistance, housekeeping, and assisted showers, for an additional fee. These places range in price from $2,000 per month on the low end to upwards of $9,000 per month on the high end. Soon though, they will need care and supervision.
24/7 Supervision & Transferring
It might start with difficulty getting out of bed. It might come with a call in the night – your loved one has fallen. At some point, you will notice, or your loved one will tell you that they need more care. They are scared for their safety. Their hygiene is suffering. They may not be eating because going to the dining room requires too much effort.
If they are in Independent Living they will need to move. Even if they are in an integrated large facility, they may want to move (Board and Care style RCFEs typically provide a better staffing ratio at much less cost than the larger facilities).
If they are still at home, you may find yourself spending the night and even sleeping on the floor in your parents’ room because they are getting up during the night and you’re afraid of what might happen. It’s simply not safe for them to get up on their own. It’s not safe for them to be left alone for hours at a time.
As you become more involved in their day-to-day life, you notice a change in condition and bring them to the doctor. Perhaps they get diagnosed with dementia. Or perhaps, they are suffering from a urinary tract infection (UTI).
Perineal Care
Oftentimes, you won’t know when your needs perineal care until they get diagnosed with a urinary tract infection (UTI). Oftentimes, the only UTI symptom is the onset of dementia symptoms. The cause may be lack of hygiene.
Whether your loved one has been changing their own pads or briefs – or is still getting to the toilet – the perineal area is not getting or staying clean, leading to infection. Treating the UTI with medication is necessary. However, moving forward, your loved one will need someone else to keep the genital region clean. Which leads us to continence care.
Continence Care
Toileting Assistance
In addition to needing assistance with perineal care, your loved one may also need assistance with getting to the toilet:
- Reminding to go to the toilet
- Assisting to move to the bathroom
- Transferring to the toilet
In the case of a UTI, this may be happening as many as a dozen times throughout the night. Eventually, your loved one may become incontinent.
Changes
There are a number of reasons why your loved one no longer goes to the toilet. It may be because dementia has progressed to the point where they don’t know where the toilet is or they don’t experience or know what urgency means. It may be because they were bed bound for a period of time, there was no one to take them to the bathroom, and they became accustomed to not “holding it.” Maybe they’ve lost muscle control. Or perhaps getting to the bathroom is simply exhausting and/or takes too much time.
Regardless, your loved one now needs incontinence products and changes. Every two hours. Around the clock.
Two things can happen at this point. First, food and drink may be withheld to prevent your loved one from needing to be changed as often. Second, your loved one may be left sitting in their waste for hours on end.
Withholding food and drink has obvious repercussions. Your loved one begins to waste away. Infrequent changes can lead to UTIs and skin breakdown. This becomes a vicious cycle. UTIs can increase dementia symptoms; skin breakdown can be deadly. In short, the less they are changed, the more they will need to be changed. The care needs continue to increase.
Other Activities of Daily Living
Throughout the aging process, the care can increase from needing supervision only, to needing assistance, to needing full bed-bound care.
Bathing
Assisted showers are critical for both preventing accidents and UTIs. The shower is simultaneously one of the most dangerous places for your loved one yet not bathing puts your loved one at risk for multiple health conditions. Most falls happen in or around the shower. Most seniors’ care needs dramatically increase after a fall. Yet lack of cleanliness is equally as dangerous.
Your loved one will initially need someone within arm’s reach while bathing. As mobility decreases, they will need more and more assistance in getting to the shower and in being bathed. Eventually, going to the shower may become impossible, and your loved one will need to be bathed in bed.
Oral Care & Feeding
Did you know that some of the bacteria residing and proliferating in the deep pockets of the gums increase dementia symptoms? Oral care is critical for maintaining quality of life and at some point your loved one may need reminders and assistance setting up their toothbrush to needing someone else to brush their teeth and scrape their tongue. They also may eventually need someone else to feed them.
The Cost of Caregiving
You’d do anything for your loved one. You may have built an additional dwelling unit (ADU) on your property for them to live in. You may be visiting them daily. You may have moved into their house or moved them into yours. Or you may “just” be fielding an overwhelming amount of phone calls. Regardless, you’re not sleeping well, you’re not doing the things that brought you joy, you’re irritable… you’re mentally and emotionally exhausted.
You may naturally fall into the caregiving role because you care so much. But caregiving comes at a steep cost and as caregiving needs increase, boundaries get blurred and you may feel as though your life is slipping away.
The Physical Cost
The physical cost is the most obvious. When your loved one needs 24 hour care, someone must be there all the time and that someone is you. Sure, you’ve hired a caregiver to come in a few hours a week so you can go grocery shopping. But your time is no longer your own.
As they need more and more attention through the night, you’re no longer sleeping. You’re gaining weight but you can’t go to the gym. You’re too tired to cook healthful meals. But you put it off because you’re just too tired and you’re take care of yourself later.
The more the care needs increase, the more physically demanding the work becomes. Many caregivers say that when they are through taking care of their parent, they will need to go into care themselves. All the turning, and lifting, and assistance required is incredibly physically demanding. And you’re already exhausted.
It would be better if you could just do the work and be done. But it’s not that easy. You’ve got to convince your loved on to participate and that’s the hardest part of it all.
The Mental & Emotional Cost
Self Neglect & Unwilling Participation
“It takes me four hours to convince her to take a shower.”
“He gets violent when I try to change him.”
“She curses me.
It might be different if your loved one were a willing participant in his or her care. If they were grateful for all you are doing and giving up for them. But often they are not. It’s not just that they are physically or mentally unable to care for themselves; they don’t want care.
They don’t want to be clean. They don’t want to shower. They don’t want to change. They don’t want to eat that. Even though it’s exactly what they asked for 20 minutes ago.
Making it even more difficult is all the old patterns in your relationship. They think you should listen to them and not vice versa. They mow down your boundaries.
You’re in an impossible situation where NOT making them do the things that they hate could be charged as criminal neglect. So you make it happen and you put up with it. You’re resilient. There’s a reason it’s you and not your siblings providing the care. If only someone understood what you’re going though it would be a little better.
The Social Cost
Caregiving is incredibly lonely and isolating. At first, when it just requires a few hours a day, it’s doable. But then you can’t physically leave. You can’t go see your friends or go shopping or go for a walk.
Loneliness increases when friends and family tell you to take care of yourself. To go to the gym. To get away. But they aren’t offering to come “babysit” so you can get away. They are telling you to put your loved one in danger. And you just can’t do that.
Instead of being a source of renewal, socializing becomes increasingly frustrating, disappointing, and discouraging. And you’re already frustrated, disappointed, and discouraged.
It’s somehow worse when you hear, “Let me know if you need anything.” You literally need help with everything. But you know they aren’t really offering to take over – to be “you” for the day or even to do a few loads of laundry. No one has the knowledge or capability to really take over. If you take them up on their offer, things will slide and it will be even more work the next day.
But loneliest of all is hearing, “you should just…” “Help” in the form of advice is worst of all. You don’t need advice. You need more of you.
So your friends disappear, your marriage takes a toll, you’re disappointed in your siblings, and your kids are on their own. Not only is your health failing, you are isolated from the outside world in a thankless and often abusive role.
It Takes a Team
The reality is, the care your loved one requires takes more than four full time jobs. This isn’t counting maintenance of the house, shopping, and all the other things that need to be done. It takes a team.
Options for Care
In Home
You need help and you may start looking within your network and at resources available to keep your loved one in his or her home or in your own home. Perhaps you can divide days with a sibling and/or hire in-home caregivers. You or your caregivers may even be able to get paid if your loved one qualifies for IHSS.
If they don’t qualify for IHSS, in-home care can quickly become cost prohibitive. Agencies charge about $40 per hour in the Carmichael area. This is nearly $30,000 per month for 24-hour care. Even if you pick up half the hours – two full-time jobs – it’s still $15,000 per month.
Rather than go through an agency, you may look to pay caregivers under the table at half the cost of the agencies. While this can save some money, it will still be more expensive than moving your loved into a facility. And, because it is now illegal to hire caregivers as independent contractors in California, you run the risk of a major workers compensation or overtime claim.
Even though you may want to keep your loved one at home, moving him or her into assisted living may be necessary.
Residential Care Facility for the Elderly (RCFE)
Residential Care Facilities for the Elderly (RCFEs), otherwise known as assisted living facilities, provide a supportive environment for seniors who need assistance with daily activities. Assisted living facilities provide a range of services, including help with daily tasks like eating, dressing, bathing, walking, and using the toilet safely. They also provide meals and medication management. Assisted living facilities are licensed and governed by the State of California to provide care to seniors. They may or may not have waivers allowing them to provide care to those with dementia or on hospice. They may be the best place on earth for your loved one. They may be abusive.
You’ve probably seen viral videos of elder abuse or heard horror stories of abuse happening in a facility. Many people say they would never move their loved one into a facility for this reason. But not all facilities are created equally. There are over 76 RCFEs in Carmichael to choose from. Many of these are independently run small businesses and many pride themselves in providing excellent care.
The first decision you will make is whether to move your parent into a large facility, typically called Assisted Living, or small facility, typically called Board and Care.
Large Facility – Assisted Living
Larger RCFEs in Carmichael, CA provide a number of benefits. They are required to staff an activities director. They have dedicated kitchen staff and likely provide meal choices. They have awake staff at night. However, the staffing ratio and staff turnover on the care side, may cause you to look elsewhere.
By the time your loved one needs 24/7 supervision and/or transferring assistance, they may not be able to (or desire to) participate in the planned activities. Meal choices don’t do any good if your loved one isn’t getting to the dining room. But oftentimes, it’s the nighttime calls for assistance, that may go unanswered for hours, that cause large facility residents to begin looking for other options.
Another reason you may begin to look at smaller assisted living facilities is cost. Larger facilities are often ill-equipped to provide the level of supervision and care that your loved one needs. Often the sticker shock associated with increasing level of care outweighs the benefit of having your loved one stay where he or she is. Typically there are fewer surprise rate increases in a board and care and the staffing ratio is much better.
Small Facility – Board and Care
As the search for a small assisted living facility begins, the choices become overwhelming. Nearly each home is run independently as a stand alone business. Nearly each home has a different price range. And price alone doesn’t tell you whether you’re getting a good value for your money or getting ripped off. There are two basic models for board and care assisted living facilities: professional and Mom and Pop Shop.
Professional Model
The typical professional model board and care in Carmichael features 24/7 awake staff and no live-in caregivers. They have at least four caregivers on staff plus an Administrator. They may also have a management team consisting of house manager, human resources staff, and operations manager. Considering most residential board and cares are licensed for only six residents, there may be more staff on the payroll of the home than residents living there. This level of staffing is a good indication that the home is following licensing regulations and that the home can deliver the level of care promised.
Mom & Pop Shop Model
The typical mom and pop shop board and care in Carmichael is owned and operated by someone who does it all. She works around the clock, 24/7, providing for the needs of the residents under her care with no vacation or sick days. Ever. If someone needs assistance during the night, she gets up to help which means she rarely gets 6 hours of uninterrupted sleep. She’s doing five jobs and she gets to know her residents really, really well.
At some point, the owner burns out and gets tired of doing it all. She is replaced by live-in caregivers, often working 24 hour shifts, and often getting paid under the table.
Needless to say, in this style of board and care, the immediate needs of the residents are prioritized over licensing requirements and paperwork. And because payroll expenses are minimal to non-existent, it can be considerably less expensive. The home may also lack the systems necessary to deliver the level of care promised.
What to Look For
So how can you tell if the assisted living facilities in Carmichael that you tour are running good businesses? First, look at staffing.
Staffing Considerations
Ask how many full-time caregivers are on the payroll. While it is common for caregivers to work 60 hours per week, if there are fewer than four caregivers on the schedule, the caregivers are working overtime and the business may be understaffed. You can also ask to speak to the caregivers. Communication difficulties due to language barriers, may be a red flag. Labor trafficking is a continual issue within the industry.
If there is one or no caregivers in addition to the owner, ask who watches the residents if she has to go to the store. Who does the grocery shopping? If the residents are ever left unattended, it’s a huge red flag.
If a home says that they have awake staff, ask them who responds if a resident needs help at night. If they say that they do, ask them how they know someone needs help. Many times homes that say they have awake staff don’t have someone awake all night. Rather the night person is supposed to wake up and respond in the case of emergency. If this is the case, it is highly unlikely that their bed bound residents are being repositioned and changed every 2 hours throughout the night.
Ask the home what happens if the primary caregiver gets sick. Do they have on-call staff who are trained and ready to take over for the incapacitated caregiver?
If the answers to any of these questions is less than desirable, the home is probably out of compliance as well.
Compliance Considerations
Second, ask about insurance. Many board and care facilities are paying their workers under the table and are not paying workers compensation. They have also let their liability insurance lapse. You can also ask about the Medication Administration Records (MARs) and Activities of Daily Living (ADL) records. If they do not know what these are or tell you why these are unnecessary, the home is likely out of compliance in other areas as well.
There’s a good chance that you will hear the following code phrases during this process.
Code Phrases
Third, the following code phrases are red flags:
- All I care about is my residents.
- As long as my residents are safe, I’m good.
- As long as my residents are happy, I’m happy.
If you hear one of these phrases, you can be fairly certain that the business is out of compliance and letting a number of the regulations set forth in Title 22 and the Health and Safety code slide. This doesn’t necessarily mean they are providing poor care. However, it is a good litmus test in evaluating value.
Don’t Overpay for Care in Carmichael, CA
With a wide range of prices for board and care and over a hundred assisted living facilities in Carmichael to choose from, it can be difficult to ascertain which businesses are overcharging and which are providing good value. It is unlikely that any board and care with legal 24-hour awake staff can charge less than $6,000 per month. Board and cares charging as much as $7,500 per month may not be profitable. Conversely, board and cares without legal 24-hour awake staff may be very profitable charging $4,000 per month.
Even on the high end, board and care homes often provide considerable savings in comparison to large facilities. The same level of care that costs $8,500 to $18,000 per month at a large facility may cost $6,000 to $8,000 per month at a small board and care.
Special Considerations
Other critical considerations when it comes to choosing a home have to do with whether or not your loved one is dependent on life saving medical equipment. In January 2023, parts of Carmichael lost power for over a week. SMUD does not give special consideration to residential care homes – care homes dependent on the grid were unable to keep their residents on oxygen concentrators or operate electric hospital beds.
For this reason, if your loved one depends on electric medical equipment, or may become dependent in the future, backup power is essential. Ask the home what the plan is in case of a power outage.
| Plan | Questions | |
| Concern | Rent or buy a generator: Home will be competing with everyone else to acquire a generator | Who will transport, install, and switch the home over to generator power? |
| Probably OK | Generator on site: must be set up and filled with fuelGenerator on site: incapable of powering entire house | Who will set up generator? Where is generator fuel stored? How will energy use be prioritized? |
| Ideal | Tri-Fuel Generator permanently installed and fueled by grid and capable of powering entire house | Which staff are trained on generator usage and switching from grid to generator power? |
The needs of our elderly loved ones are comprehensive and can seem overwhelming. A good home will be a partner, stepping in to shoulder the bulk of the day-to-day needs and care so that you can have peace of mind and focus on relationship rather than responsibilities.
The Hollister Care Home Solution
Assisted Living in Carmichael, CA
Hollister Care Home provides 24/7 care and supervision with luxury accommodations. Seamless systems allow staff to deliver upwards of 16 services throughout the day and night so that you can rest assured that your loved one is safe, comfortable, and cared for at all times.
24/7 Care & Supervision
Our incredible team of caring, capable, and competent caregivers have a combined 43+ years of experience. And they provide more than just physical assistance. They also provide emotional and spiritual support to better serve our residents and their families.
In addition to the awake staff on duty, the Administrator and her family along with an additional caregiver live on site providing an extra layer of oversight and increased ability to respond in an emergency.
Luxury Accommodations
Nestled behind a wrought iron gate in a quiet Carmichael neighborhood, the home is easy to miss. It doesn’t look that big. It’s relatively unassuming from the front. But in the words of one of our service providers, “there’s just something about it. You feel relaxed the moment you step inside.”
Filled with antiques and original art, there is something beautiful around every corner. Six private resident rooms open directly onto the landscaped grounds. Each room has floor to ceiling storage, a smart tv, and bedridden clearance. Which means that residents who become bedridden do not need to go on hospice in order to stay here.
Seamless Systems
Behind each of the 16+ services we provide day in and out there are systems in place to support staff and ensure seamless delivery.
Interested in Learning More?
Call today for a free consultation or to schedule a tour.
