Assisted living doesn't do what they said they would. Is there a solution?
So this will come as no surprise to any of you, not even me, but is this just another example of something that has no solution?
When signing mom up for AL, we were shown a monthly calendar of activities, told she would shower twice a day, etc. Of course COVID is a convenient excuse why there have been no activities since she moved in (Jan of this year) and probably never will be activities again. She has not showered since moving in, except when she was in the nursing home for a month-long stay. She "washes up" in the sink , but won't get in the shower. They don't make her, which I sort of understand, because it would be a battle and they can't manhandle her. Lately I've been taking wipes over there and encouraging her to clean herself with them. She doesn't smell and her clothes are always clean (until yesterday when I went and she had the same outfit on that she was wearing Friday and I think she's had it on for the last four days).
Anyway, the only way she gets her hair washed is if I tell them my sister is coming to cut it and then they will take her in the salon and wash it. WTH? I thought it was assisted living?
They have a hairdresser that comes every other week and charges $22 for a shampoo and style. So I have started paying for that since I know it makes her feel better and I can't take her anywhere with greasy hair. So on top of the place receiving nearly $6k per month, I have to pay for her medicine (through their pharmacy), Ensure, Depends and hair washing. It's a real racket.
But that isn't even my biggest complaint. All she does is lay in bed all day and barely gets up for meals. Because there is nothing to do! No reason to get out of bed. The only thing happening there is 3 meals a day and a snack or two. She is not eating all her meals anymore. We are all trying to visit and call more, but she won't answer her cell half the time (why is getting a "home phone" so much drama?). I went over yesterday and found Little League on TV for her, because thank God that is one thing she is interested in and at least she can sit up in her chair and watch it. But really! Is COVID going to be the reason the place is understaffed and not having activities forever? Is this the new normal? I assume all of them are the same and Mom is already in the nicest one we can afford.
I am tempted to put her back on Hospice because at least then she would have more visitors - the nurse, the chaplain, etc.
I just think there are things they could do there w/o having outside people come in. I'm just aggravated, y'all, and I am venting.
It's like they have us over a barrel, they know we can't afford to pay someone at home all day and night (still no activities but more than where she is now) plus the whole caregiver scheduling thing, and they know all the places are the same, so they can do whatever they want. It's just very sad. Her doctor mentioned putting her on an antidepressant, and I told him she is depressed because there is nothing to do! If you can change your situation, that should be the first choice before taking a drug, but I guess in her case, we can't change her situation.
And worst of all, none of this is going to change before I am 87! What in the world am I going to do with myself then?
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She was assessed by the nurse supervisor before being admitted to ensure she was able to live with minimal assistance. Because she was a fall risk one of the aids would sit in her room while she showered but didn’t help. Side note: some facilities like to assist in showering and dressing to watch for signs of injury or skin problems. The staff ratio was 2 daytime aids and 2 nurses for 48 residents, 1 aid at night with a nurse on-call.
Mom was able to dress herself, made her bed everyday, keep her room tidy, and using her walker get around the facility and out to the transport without help. Having them administer her meds was a huge help because she kept forgetting which ones to take when. She wasn’t a fussy eater and enjoyed the soups. The facility provided space for a stylist to work one day a week to cut and style hair for a low fee.
Just remember that AL isn’t a 4-star hotel, they provide supervision not personal care. Even hotels are starting to reduce rates and have a menu of added, for a fee, services so customers aren’t being charged for amenities they don’t use.
Yes, Covid put a halt to all activities but that happened everywhere. Good places were creative in getting around the isolation. Mom's AL had a fantastic, committed activities director. You might want to move her to a different facility.
At my moms last care plan, the nurse stated that she is a 2 person assist and needs to move to a nursing home. Yet I am able to toilet her myself, shower her and get her in and out of a car to go to doctor. I have 3 physical therapists who evaluated her and agree with me that she does not need to go to a nursing home. She is able to wheel herself to & from the dining room, stand with help, and follow directions.
I have appealed her discharge and have a hearing with the State this week. I feel these assisted living facilities are happy to take your $ but not willing to provide the care you pay for.
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We moved her home after a year of this and trying two different assisted living facilities. We had to completely redo her bathroom and we now have caregivers come in. Very expensive but at least she is safe and happier.
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K. Allen
You should be able to bring her food or have it delivered as a treat.
Ala carte charges for extra services are the norm.
1. AL's, slightly understaffed in the best of conditions, are more understaffed now than ever. People would rather work for $15/hr at fast food chains, with flexible hours and free lunches or better yet at Amazon for $18 to $20/hr than in the senior living for $13/hr (kitchen aides start at a whopping 11.50/ in high priced). You better believe AL's, NHs and some hospitals are understaffed in the lower levels. Staff cannot force anyone to participate in showers or activities. Resident's rights and all that!
2. Depending on the situation in the individual facility, activities may be curtailed and dining rooms closed to protect the health of the residents. We have one 4 star facility in NJ that had opened it's dining rooms and started activities in June but closed them this weekend when 10 residents begin coughing and running temps. Everyone (staff and residents) has to be tested again but they are waiting for results before going back to "normal" dining and activities. Bummer for all concerned.
3. ALs are just that. They provide an "assist" to a resident, not full care; in some instances they are almost more geared for the independent living folks who just want a 5 star meal every evening. Hair cuts and styling are extra even in NH's. Housekeeping is usually 1 or 2x per week. I would look to see what level of care you at which you have your Mom. Some facilities include 1 med in the basic entry fee but many do not. Depending on the number of medications, your Mom may need a higher level of care (definitely has a higher cost associated with it).
All that having said I think you should know that the standard marketing tour of an AL is geared for the person (their family) who is ready and willing to move into an AL (you'd be surprised how many people who look forward to it. They are tired of mowing the lawn, getting service people in to check the water heater, cooking dinner for one or two.) The AL allows them to grocery shop more lightly as there is one full and sometimes outstanding meal (usually dinner or lunch) provided. Activities that they like and are interested in are on site. Meals and activities are provided and announced and it is basically on the residents to participate unless they have one of the advertised level of care (here go the rates on the upward spiral again!) in which case they MAY get more of a push toward participation.
You can call the Ombudsman office and your state DoH and report your issues; they may not find neglect or abuse but they will respond to you with their findings. You may need to search for another AL that more closely meets Mom's needs or she might be at the level of MC now; if you can come to an understanding with the current administration and they have good MC service on site you might move Mom there (with a new agreement in place for those services). In any event I urge you to closely ready the agreement you sign (never mind what you were told, it's the written stuff that holds up in hearings and in court rooms), I have even advised my clients who are considering CCRC to have that agreement read by their attorney. That big entry fee is just like buying a house.
Based on her current activities and care she is receiving, other than being bored out of her mind, she is managing with a very solitary life. What if you found some in-home health at about $20 to 25 per hour to provide assistance to her in your home. Clearly she doesn't need 24/7 eyes on her every move - she's not getting that now. Maybe hire two different people - AM person to do bathing 2-3 times a week, get breakfast, meds and pick up around her bedroom. Start with 2-3 hrs for that shift. Afternoon or evening - another 2-3 hrs to prepare a meal, a load of laundry a couple times a week, etc. You may have enough leftovers from your own meals to have a lunch in the frig to heat up for her in the middle day.
I think her money would be better spent to get actual hands on care for her - and perhaps less than she's spending now. In your mind, you might be thinking that $6K a month is getting her 24/7 care and that's why you can't afford it at home. But, that is simply not the truth. She's not getting anywhere to close to that kind of care. That's why it's called 'assisted'. NH is for people who need 24/7, and you'll even find similar issues there. If her care actually reaches a 24/7 need, then a NH might be the better option at that time. Just doesn't appear that assisted living, where she is, is worth what she's spending.
You might also look for another facility. This one is just one of those who is willing to take the money, but lower the level of service by using covid as an excuse. Many facilities did as little as possible before covid was even an issue, but now they seem to blame staffing and lack of care on something that everyone sees on the news every day. Not saying covid is not real - it is - however there is no reason the can't have some sort of activity.
The final straw for me was when we were picking up mom to come home. There was a little old man outside with flowers in a little vase for his wife. He was asking when they would be able to leave their rooms because his wife was going crazy. She was the type to go all over the NH - dining room, activities, visiting her friends in their rooms, etc. and now she was just laying in her bed all day and he could tell she was getting very depressed.
Though mom was home already, I contacted the corporation that owned the nursing home and the ombudsman telling them about them lying about their positive staff cases and my thought that they were just using it as an excuse to keep the residents confined to their rooms. I don't know if it did any good, but I noticed that their webpage now has an daily updated list of Covid cases, so that argument can't be used by them anymore.
The reality is that practically all of these facilities are understaffed and only a few of them offer comprehensive staff training in everything from bathing to dementia communication.
So, what to do? First some practical things you can do right away: Buy her incontinence products yourself. Likewise her medications. Next: volunteer to help out with activities or if you're not available during the day, visit at dinner time in the dining room with your mom and her table mates. You can help them engage in conversations. You can offer to lead a weekly sing-along or an after-dinner chat group. - These are very simple things that will help your mom and also take the load off the over-burdened staff.
And get to know the Ombudman volunteer.
Don’t forget to acknowledge the staff. They are your “team-mates” - Share with them tips on how to help your mom, your concerns, and your pleasures. An occasional “thank you” note, box of chocolates or cookies, and bouquet of flowers will go a long, long way.
PS. In thirty years, I’ve never heard of more than three showers a week, unless the resident has an accident.
About a year ago, we bought mom an IPad and had it mounted on her wall next to her bed. The iPad can be set to automatically accept FaceTime calls; she needs to do nothing. The FaceTime simply pops on when any of us call.
The iPad has been a Godsend! We can check in on her anytime and we family members have a schedule to support the staff in getting her to meals or activities that she likes.
Of course the place must have wifi. We got the iPad for about $250 and a wall bracket with a lock was about 30. The maintenance man attached it to the wall. It was a great investment.
The thing about assisted living is that they tread the line between being available to help your mother and forcing her to do things against her will. The family usually has one standard (expectation) and your mother doesn't want to be bothered. I loved that they respected my father's wishes enough to ask him first (in memory care even), but you do have to communicate YOUR expectations and if you can put a written care plan in place, you and the assisted living staff have something to refer to. Explain to your mother that this is a service you are paying for so she needs to go along with it.
I have a friend who has just grudgingly entered assisted living. There is an adjustment period. Her daughter is knocking herself out to address each problem as it occurs and I am reminding my friend that she is lucky to have such an advocate but she also needs to put forth the effort to make it work. There is no question that she is better off having someone help her with meals and medicine than she was living alone as a diabetic. She has a network of friends who drive her to appointments and she has taken us out to dinner. They let her keep her dog and we are finding ways to incorporate her favorite activities. That may mean that she uses their bus to go to the movies or grocery or initiates an invitation to one of us.
Assisted living, long-term care, memory care, group homes - all these places were short staffed before Covid. Until they are paid better, with the booming labor market, this will continue to be a temporary job. You can help retain good people by helping them help your loved one. Consider yourself one of the workers.
Showering twice a day seems a bit much. I would think twice a week would be adequate. Ask her doctor what she needs.
To cut costs and appropriate most of the thousands you pay per month toward office big shots they cut corners on floor staff- even in memory care there’s a range of 1 staff person per 10-16 residents. The assisted part? Is that a joke- paying thousands a month you’ll need to pay extra for your loved one to have assistance dressing or in the shower etc. The food is cheap cafeteria food not fresh nutritional food — this is generally speaking. There may be the occasional assisted living that lives up to its name but most are predatory and greedy focused on making profits. If you ever call or go tour one they will keep calling or emailing you like car sales or realtors!!
Try it!