Elder Care - Ask Dotti

  • Written by Dotti Snow, RN, Director, Aging Safely Inc.
Recently I was interviewed for an investigative series in The Seattle Times, named SENIORS FOR SALE. The complete series with videos is available in the archives at The series was aimed at exposing inadequate oversight of adult family homes (AFHs) by the Department of Social and Health Services of the state of Washington. I believe the series did expose serious problems that exist within DSHS, and no one denies that there are problems in the AFH world. However I do not believe this series painted an accurate picture of the adult family home industry.

I believe that all the stories portrayed in the series were true, but equal time should have been devoted to how the AFH Industry has hundreds and hundreds of homes that have honest, hardworking, loving and skilled providers and caregivers who care for our frail elders.

The visit to the AFH of Dee Burris, RN in Newcastle was my suggestion and I believe it is a great example of an AFH run by an RN who can think outside the box and above all deliver safe, professional care at a reasonable price. She has never asked a client to leave because of financial reasons and she is not alone in the AFH world.

When an AFH is good, it frequently is giving spectacular care to its residents. I believe the AFH industry is the future of long- term care.

Because of this series, I have had many calls from concerned families who have a parent in a particular AFH and want to know if the parent is safe. I would like to talk about that.

First, there is nothing that will do more to make sure your mom or dad is getting quality care than your involvement. You need to visit and observe, talk to them, look at their skin. Are they dressed well, and are they odor free? If mom or dad has been in an AFH for years and you are thinking everything is OK — it probably is! But if the caregivers are changing, your parent seems unhappy or you start seeing bruises, loss of weight, perhaps dirty clothes then it is very appropriate to start asking questions. Be proactive in physical inspections of your mom or dad’s skin. Are they getting their teeth cleaned? Like any medical facility things change for better or worse. What do you do if you are not sure?

Moving is very traumatic to our elders, and folks with dementia are affected even more. It is called transfer trauma. Unless physical and/or emotional abuse or neglect exists, I much prefer to see if education, counseling and support in the current AFH will work. Sometimes caregivers are just plain tired and are struggling to meet patients’ needs. This is not isolated to AFHs, but commonly occurs in nursing homes and assisted living facilities as well. However, no frail, vulnerable elder should be getting less than competent, nurturing care. It is our responsibility to see to it. If there is abuse or neglect in any AFH or assisted living facility, the number to call in this state is 1-800-562-6078. An immediate inspection of the facility and complaint will occur. If you want a professional assessment of your parent in the current facility, a geriatric case manager or RN placement specialist would be an excellent choice to call for help.

If you are just entering this arena because of a failing parent, I strongly suggest that you work with a professional. Again, a geriatric case manager or RN placement specialist is the best choice. For me, it is never too early for a family to call.

I frequently have spoken with family members for one or more years before the timing is correct for the placement. The family needs to be prepared to provide appropriate medical records and to allow the professional to spend time with their parent. That professional should recommend "The least restrictive environment that meets the needs of the patient."

Families tend to wait too long and then find out their parents needs have drastically changed when there is a major event. Again, involvement in your parents’ lives, talking to them about their changing needs, fostering good communication back and forth will avoid many disasters. It really can work-and what’s more it is an incredibly good lesson for the grandchildren who some day will be helping you.


Dotti Snow is a registered nurse who uses her professional nursing skills and knowledge of the adult family home industry to safely place frail elders needing extra help into adult family homes. She lives and works in Woodinville and has been doing this for approximately the last decade.

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