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Brookdale Santa Fe was nice and pretty, and the rooms were really nice. They had exercise classes, movies, gym, a salon, and activities.
My dad moved to Brookdale of SF in July, 2015. He is coming up on a year. Frankly, for the cost, he has been very dissatisfied. The food is subpar, verging on unhealthy, the cleaning crew is overworked and understaffed, and the facility in general is in need of upgrades. The rooms are decent, but in my father's, the cooling system was underpowered for the space. Maybe it's the classic case of big business being aloof to the needs and wants of their clients because, after all, they aren't exactly going to revolt and move out. How can they? Most are physically unable. But my father will. It won't be easy, but he will move to a better place. One plus: the staff was/is generally client centered, but the administration I'm sure feels the budgetary pressures of the out of state bosses and cuts corners where they can. Assisted living has become big business.
Ponce de Leon/Brookdale Senior Living Review My father spent the last seven months of his life in Ponce De Leon Senior Living Community, from January through July of 2015. (I’ll call it simply Ponce, but even at that time it was transitioning to the name of its corporate owner, Brookdale). While the memory is still fresh I want to share some experiences with others considering taking up residence there or helping a loved one to do so. First, the positives. Ponce is a lovely place physically. My father had a room right on the courtyard at the center of the building, and its beautiful landscaping (mature trees, flowers, and a recirculating stream that feeds a pond) made for a peaceful environment that never felt sterile or institutional. We put several bird feeders outside his windows, and I know that the colors and birdsong brought my dad comfort and delight. When we would open the window by his bed at night, the sound of the running stream made me feel like we were camping somewhere in the Pecos wilderness. The food is another aspect of Ponce that impressed me. The dining room provides quality meals, an elegant atmosphere, and decent service. For much of his stay my father had to take his meals in his room, and it was never a problem to have them delivered by the staff. His illness made my father a little finicky regarding food, and I was pleased to see how willing the staff was to try different options for something that he would find palatable. When I would spend entire days at Ponce with my dad, I ate a fair number of their meals myself and always felt that the quality was pretty high, at least when judged against other institutional food. My family and I had many frustrations with aspects of Ponce de Leon, however, mostly regarding the management of the staff. The bulk of the care is provided not by nurses, but by a staff of certified nurses aides (CNAs). Although they were generally kind and caring, it was evident from the start that they were not always well trained or able to provide the care my father needed. We understood from the start that my father’s needs would grow with time as his illness progressed, and were willing to up the contractual level of care (and monthly cost) in accordance. No matter how high we took the level of care we were paying for, however, simple daily care tasks such as connecting an oxygen mask at night or refilling the water reservoir of a sleep apnea machine were often ignored or forgotten. To address this problem, one of my sisters created a daily checklist of procedures with places for the aides to initial when they performed needed duties. Often when we would check the notebook containing these sheets, we would find that procedures had been skipped. We’d then check with the head nurse, who would promise to look into it, but the same thing would happen the very next day. I eventually took the book of checklists to Karen, the Executive Director and politely explained my frustration. She said she would look into the problem and find a solution; several days later, the checklist book was removed from my father’s room; Karen’s solution to aides not doing their job was remove the evidence. “We’re no longer going to use that system,” we were told, in regard to the checklists. No alternative system of accountability was offered, so it really seemed to us that Karen’s way of dealing with the problem was to hide it rather than actually fix it. Early on in the seven months my father was at Ponce, when we still had some faith in the competency of the staff, we decided that what my father needed was the one-on-one attention of what is called “private duty” care - caregivers who are working just for you and your loved one. You pay for this separately from the basic “levels of care” structure, and it’s extremely expensive. But of course you want your loved one to be cared for, so you do it. Unfortunately we made what turned out to be a colossal mistake: we signed on with the Ponce administration to provide this care with their own staff members. It seemed to make sense at the time; the in-house aides already knew him and his needs; they were already in the building, familiar with its resources and rhythms. If they had no other duties but to attend to my father’s needs, surely they could manage to do their jobs. What could go wrong? Many, many things. Scheduling was a constant problem; even though the CNAs were already employees of Ponce, finding ones who could work the hours we needed was an ongoing problem. A CNA would be scheduled for a shift and simply wouldn’t show up - leaving us scrambling to make sure Dad was cared for. The above-mentioned problems with forgotten or ignored tasks continued with no improvement. Even though the aides were “on the clock” exclusively for my father, they came and went sporadically; they would disappear for a while and then would stop by and say “Hi, just checking in!” as though they had other things they needed to do. Which essentially, they did; because they were employees of Ponce, the other staff felt free to call upon them to help out elsewhere, even though this amounted to “double dipping.” Or maybe they just taking breaks with their co-worker friends. Getting them to actually devote their undivided attention to my father’s care was an ongoing struggle that we eventually realized we could not win. We finally switched to an outside staffing agency, Elite Home Health Care (while still keeping him a resident of Ponce), and the difference was stark. The young women from Elite were true professionals who, from the moment they set foot in my father’s apartment, were completely devoted to his care. If they weren’t actively feeding him, cleaning him, giving him medication, helping him to the bathroom, recording notes, etc, they would find some task to take on, such as straightening out his closet or doing laundry. It was only when I saw them performing their duties with such professionalism and competence that I realized, by comparison, how unprofessional and incompetent the Ponce CNAs had been (even when paid for private duty care). I want to be clear that I never felt the Ponce CNAs were in any way malicious, unkind, or even indifferent to my father and his needs. They were sweet, decent people who were poorly trained, poorly managed, and often not held accountable for the tasks they were being asked to perform. All in all, my father had what I believe to be a good death. If I could change one thing about my father’s experience at Ponce, however, it would be to minimize his dependency on the in-building staff by opting for the lowest level of care and instead make use of the private duty care provided by an agency such as Elite. The in-house Ponce staff was fine as long as my father was basically able to care for himself, but once his needs grew, they were simply not up to the task. An alternative approach would be to avoid assisted living altogether, sign up for independant living, and then hire full time staff from Elite or another home health care agency to meet your daily needs. This way, you would have full time assistance while avoiding the additional cost of assisted living. Your needs - and pocketbook - would be far better served this way. -Michael Armbruster
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