Be very careful when you help your parents move to an assisted living facility because they may be kicked out just when they settled in and think of the place as “home.”
Why? Assisted care is just that—“assisting” a person who isn’t doing well at home and needs help with what are referred to as “activities of daily living” or ADLs. These include bathing, toileting, dressing and transferring (from bed to walker or wheel chair, etc) and help taking medications. Think of ADLs as the “personal” chores of day-to-day life. The assisted care staff is more “custodial” versus the “skilled” care of a nursing home. However, an RN is often on staff of the assisted care facility and able to administer some procedures such as insulin injections multiple times each day if needed. The decision about what is offered can vary from facility to facility and the monthly fee usually increases with escalating care needs.
When searching for the right facility for clients, most have said they will even keep the elder if they should suffer Alzheimer’s or other types of dementia. As long as the client isn’t on an IV or some type of advanced procedure, they would be able to live out their life within the assisted care facility. This is important to older adults and their adult children because transitions are extremely difficult for elders. I’ve known of cases where within a few days or weeks of such a move, the very healthy elder died. The move was simply too much to absorb in a life already filled with losses.
Since few older adults will require skilled care provided in a nursing home, the assisted care facility should ideally be their last move. If they suffer a fall or pneumonia or other disease or injury require skilled care, they may be required to move to a nursing home for a brief stay to recover but then they should be able to return to their assisted care facility.
However in a two situations we recently experienced with elders we knew, the elder was asked to leave the assisted care facility. In these cases, it was determined by the assisted care facility administrators that client’s level of care had escalated and now required skilled nursing care that could only be provided in a nursing home.
On the outset, while sad that the elder must move again, it seems reasonable if the care required had truly gone beyond what was normally provided in assisted care.
However, in each of these cases, the children of the elder and the elders themselves stated that while they needed more support dressing or transferring, etc, they weren’t on IVs, in a coma or requiring advanced medical procedures or experienced nursing beyond medication management.
What these cases had in common was that each of the elders had outlived their personal financial resources and had transitioned to Medicaid support which pays less than the rates typically charged by facilities. In both cases, these facilities said they would keep clients who began as private pay and moved to Medicaid so they couldn’t ask the clients to leave based on the change in finances. However, they could make them leave if they could prove the elder required skilled care. I found it interesting that in two cases mentioned, the assisted care facility had been taken over by a large chain. One can’t help but wonder if the new owners wanted only private pay clients in order to maximize their income potential.
In both circumstances, the elders and/or their adult children filed a grievance and both won their cases allowing the older adult to remain in the assisted care facility.
If you think it’s possible that your parent could outlive her resources when moving to assisted care, be sure you understand the facility’s policies about Medicaid. Additionally, if your parent is asked to move, you can and should appeal. As part of this process, get an ombudsman involved. If you are in Oregon, go to: http://www.oregon.gov/LTCO/Pages/index.aspx. If you are in any other state, Google “long term care ombudsman in XXX [your state]” or call the local Area Agency on Aging (AAA).
Finally, when considering the possibility of moving your parent to a facility, call a geriatric care manager (GCM). We are experienced in listening to yours and your parents concerns and needs and advising about programs and support available that may allow them to stay at home. When moving is necessary for safety, we will help select the right facility that will support safety while also encouraging maximum, capable independence.