Assisted living is not doing there part. Am I expecting too much?

Old post from April

Since your mom needs more help and they can not provide it, I think it's time for a higher level of care. Either memory care or long term care. If she wanders, it'll need to be memory care.

My mom's needs have become too great for AL and she is moving to LTC.

I understand that people believe workers in care facilities should be better paid, but you have to look at the economics of it. If salaries were increased, then so would the cost of care. You are asking companies to pay top dollar for what is essentially unskilled labor. Yes, it's important work, but it does not require a lot of education or experience. If facilities were to demand more education and/or experience, once again, this would raise costs. It is also a difficult and demanding job so that many people prefer not to do this work.

Remember that whenever government comes in to "help", it always makes things worse. For example, they are about to decree that nursing homes must have more staff per patient. Great idea, right? However, many smaller facilities cannot afford to do this, so they will be forced out of business, leaving fewer options for patients.

We are an aging society, and that is going to cause more problems in the future, so I don't know what the answer is. However, you have to look at the business from a profit/loss perspective, because everyone loses if they become financially insolvent.

Many AL facilities have severe short staffing issues.

Do have a discussion with the management of the AL. if residents are "refusing" help from the caregivers, its easy for the caretakers to just write it down as that.
perhaps she actually needs what they would consider Memory Care level of help. Does the same facility have memory care? if so, perhaps request a transfer there (of course it will come at higher cost)

Abell01: Perhaps your mother requires a higher level of care such as memory care. Assisted living is just that; they are 'assisting' your mother with some of the daily tasks, e.g. mom handles the rest.

My husband cannot stand or walk and is incontinent of both bladder and stool. We pay $9600 for his room and board at the nursing home. Any diapers, or other items, like Kleenex and depends, paper towels, soap, medicine, —-all extra $$$! So $10,000 / month care is costing us. I had to sell the house to pay it so far 75,000 for 8 months so far. I am living with neighbors and pay them $525 rent, utilities, and internet. The nursing home is about an hour away, so I visit when I can. Am going through boxes and trying to downsize. Very frustrating and having some difficulties trying to adjust, and trying to keep bills paid.
Am sooooo thankful for everyone’s help and the Lord leading me. Am open for suggestions.

We encountered many of the same issues in AL..Finally my mom got out of the AL side of the building 5 times. She was found outdoors! Her dementia has increased badly. She requires more direct care. They suggested memory care.. 8 days into MC Mom appears to be getting better care. NOT PERFECT but better overall. We have a Monday am meeting weekly to discuss issues. We visit the building 5-6 days a week. Even if only for an hour. Staff needs to see family {I retired from 27 years as a nutrition counselor in dementia buildings}, family needs to report concerns and build relationships with the caregivers. Stop by at meal time or planned activities. I tell staff do not ask Mom…just say “it is time for your shower or everyone’s going to the activity..lets go!”. I pass out Lewy Body Association information to educate them…..Year 5. Managing managed care is my part time job…sad but true..we paid $4900 and now MC is $5900 a month. Our facility is a top rated one in our city. Others are worse. Good Luck..

gettyupgo, Yes, you hit the nail right on the head! This has been my actual observation especially about the pay, the treatment of workers and the "greed" rather than a conscience about the profit and the greater good of caring for our elderly. And lastly, yes the Church related facilities have a better approach.

I moved along with my mother from one end of the country to the other. My mother is 86-years-old with Dementia. I work remotely. Believe it or not, we both live in an Independent Living and I bring in services.

I have said this before and I will say it again. Assisted Living is Real Estate...there is no assistance. Basically, you are given a room, usually a studio or efficiency and everything is a la carte.

Every finance guru nowadays will tell you, don't play the stock market, invest in an Assisted Living. The return can be as much as 30-40%.

Before I moved I was well aware of the level of care that is usually promised in the brochures--"we're like family". This is only in the movies, not in real life.

Why am I here? The blood thinner, Eliquis. There is no way 1 or 2 CNA's can accommodate the dispensing of medications for a floor. Besides, $500-$600 per month for medications is too much for our budget.

The staff is overworked, short-staffed and underpaid, usually women of color or from other countries who barely speak English. When they return home at night, they take care of their own mother who usually resides with them. These women have to walk dogs, clean up dog poop, be called girl by the residents and don't realize the power they have because if they did they would unite and unionized. We need them. The waitresses at a well known breakfast chain who never organized were still working for $2 per hour plus tips only until a years ago. They never organized.

The pay for the employees who do the dirty work is miniscule. The Executive Directors' come and go. They take the brunt from residents, residents families, the employees and have to make their budget work. The owners usually never step foot in the place because they are vacationing on Nantucket Island.

When people call and rant, my father hasn't had a bath in 2-3 weeks, etc. they (the staff) know a family member is not going to show up and bathe them themself. So, it goes back and forth, I'm paying for this. In the mean time, the loved one's needs are not being met.

The Sunday night phone call is not enough. Someone needs to oversee everything--has your loved one eaten, do they have clean clothes on every day and clean underwear. Is the air conditioning unit working properly? Are the medications being taken with food at the right time.

I have witnessed female residents with facial hair, one lady wears the same dress everyday unless she bought more than one. Most are on walkers and the buffets are too much work for them, they struggle.

I think your loved one needs to be moved with a higher level of care. The elderly need to be protected. Their hygiene is important. I oversee everything. I have been billed for services that were not provided and have come at a time that was convenient for them and not when we requested them. Check your bill and don't give them access to a checking account or credit card until you read everything.

I have heard stories where the elderly have stayed in a facility for too long and bedsores were overlooked because they liked their lunch friends and bingo. I have heard other stories that the proper nutrition was not being provided nor sheets cleaned on a weekly basis or as soiled, nor their apartment cleaned and disinfected properly.

There's really not a lot of guidelines for these facilities. The chances of more than one call button going off at the same time are high. There is usually only one LPN or 1 CNA on duty at night. A lot can go wrong at the same time and not enough manpower.

I think a change needs to be made. I know it's hard but I want to be forthright.

My mom started declining showers because her favorite aid isn't there to do it. We have to tell the new aides to say, "It's shower time". Not, "Do you want to take a shower?"

I've only read about half of them and lived it for a year and half. The writing is on the wall for you here. I've lived in 3. The care will depend on the nurses, housekeeping dietitian and nurses aides on the shift you will fine there are good ones but in my experience in Ohio most are there for the paycheck and social life not their patients. Listen to the NNU "patients over profits." Many are equivalent to low lifes bottom feeders and the middle mgt, exec's n owners don't care. I live in one that did chapter 11 owning one in Cincinnati, Dayton, Florida n Tenn. Until the common people raise up and reform this industry it will continue being a domestic terrorist and killing fields even local coroner's are non-responsive like the nurses, aides and Ohio Dept. Of Healths, et al. Only surpassed by the recent pandemics. It's an under toe of suffering a cancer/virus eating away at the USA.

The staff in most AL will ASSIST but they usually will not cue people to do tasks. If someone needs help with toileting they will not come in every 2 hours and take a person to the bathroom. The person has to notify staff that they need help.

It does sound like your mom needs more help than AL can provide.
It may have been different when she first moved in. With any move a person with dementia will probably decline and this may have happened.
I think it is time that she be transitioned to MC.

No it’s a typical problem find a different place for her

I don’t think AL is sufficient for your Mom. Start researching MC facilities asap.

No, I see the same with an elderly dear friend. This is abuse as defined by the assisted living requirements. They are keeping my friend bedridden and treated like a child because they wouldn't get him in his lift chair or wheel chair, confined to bed, in Depends, sponge baths with wipes because it is easier to do nothing and say they did. If you go at night it is much worse. They lie and lie and say they will do something but never do. Are you by chance in Nashville? That is where m this assisted living is located.

The reality is that these places do not have a good enough care to resident ratio to ever provide help in a timely manner for everyone in AL or MC. If you have 1 CNA to 10 people, logistically it's impossible. This is why I'm trying to find a place that will allow my folks to live together and we bring in our own full time care. It's the sad reality no one wants to accept, as I see it.

My dad was one of the people who always turned down the suggestions that he do anything. If the caregiver then pushed a bit harder to get him to shower, eat, etc. he would just start yelling at them. Luckily my dad was not usually in need of any immediate help like getting to the bathroom but it still meant that he didn't get dressed and sat around in his bathrobe or he just stayed in bed all day. There was finally one aide that he seemed to like and he would behave much better for her and she was good with him and creating reasons to get him to do what he needed to do. I finally just had to pay for her private assistance to come in and be with him for 4-5 hours each day. This was an expense over and above the assisted living and level of care fees he was paying but it was absolutely worth it. When she went on maternity leave he reverted back to yelling at everyone who came to help. I was really glad when she returned to work as she seemed to have the magic touch. Luckily it was an expense we could afford. I'd find out if any of the aides at the assisted living have a better track record with your dad and then see if that person can be "assigned" to stop by to help with him.

You definitely need to move mom to another facility. I’m in a similar situation with my mother and the level of care the AL can actually provide. In addition to staffing difficulties there are also state and federal laws that determine the level of care AL and MC facilities can provide. Mom’s place has been wonderful but her health has declined and her dementia progressed to a level not manageable in AL. While they do have memory care, even that will only work for a while so I’m looking at skilled nursing facilities. Take some time to look at the bigger picture so you don’t end up moving her twice. Best of luck to you.

Assisted living in original concept and design was meant for people who wanted a social life and didn't want to cook dinner or deal with fixing the roof. The "assist" was to remind residents that breakfast was ready. As people have aged, the Assisted Living facilities are for the most part selling people services they can't provide. Based on what you've written, your Mom is above the AL level of care and should be in MC.
Now about the staffing issues. I'm a Certified Assisted Living Administrator, a former long term care Admissions Director, a Board Trustee of a HUD 62+ building and the Vice Chair of our township's Commission on Aging so trust me... I keep my fingers on the pulse of senior living! You are, unfortunately, going to find short and disinterested staff in most places because the bulk of the $8000/mo that you are shelling out is going to the owners, not to the people (LPNs, CNAs, cooks, kitchen and laundry staff) who do the grunt work. Even in states where the min. stage is $15/hr with taxes, a single person is taking home approx. $13.83/ hr which translates to 13.83*40 or 555/mo which comes up to about $30k per year. CNAs have families too and there are not a lot of places that you can rent to live and buy food and clothes for your family on 30K per year. We won't even get into the fact that since we don't really have a national transportation system, you need a car and all that entails just to get to work. Because a lot of people burn out (especially if they care about residents) facilities are having a hard time getting anyone to work so they are going to agencies for staff. Some agency people are great but they are getting even less pay per hour because the middleman, the agency, is taking the bulk of that money. The ones that are not great are so far in the garbage pail, you can't see them. Just got through writing a letter to the Ombudsman about an agency CNA who had to change a resident twice within a few hours and cursed her. Luckily, a caring fellow co worker walking past the room heard her, intervened and reported him. I followed up with a note to the Ombudsman. I'm not saying that more money would guarantee better workers (Lord knows, we have all seen idiots who happen to be CEOs with degrees from great universities) but it would help. I know facility in NJ that pays it entire staff a decent wage and they have people who have been on staff for years. That facility is also a religious one that accepts people of all religions. I have found over 20 years that the religious based facilities, while not a pretty as the for profit one, tend to offer a slightly better level of care.
It's unfortunate, but until we can somehow get the entitled owners to realize that instead of making 18% profit, they can make 15% and send the 3% to their staff, we are going to continue to see shortages and poorly trained staff regardless of what outrageous sums we pay. It's really sad.

If you continue to get no response from the Director, it may be time to find a different facility for Mom but it is likely she will need MC.

Wishing you luck and peace.

In every setting for assisted living, skilled nursing and memory care - the client has the right to refuse care. If your mother is saying she doesn't want ______ (fill in the blank), then it is properly charted as a refusal. I know you have expectations, but you need to find ways to work with your mom's level of understanding and cooperation.

I think the problem is you are looking at a much more skilled level of care than your mother would be getting in assisted living. AL is more for seniors who have some basic mobility and only need basic reminders or help like transport, light housecleaning/cooking. AL means a senior can still do most daily living activities with limited help and most people with dementia cannot be in AL because they need to be supervised. Your mother sounds like she's getting into the later stages where hygiene is neglected because they just do not remember to do anything (they can't even remember basic things like drinking water or eating). It is possible she might not even realize she needs to go to the bathroom and that she wouldn't be able to ask for help. She will most likely need memory care. Yes, change will be hard, but it is better than her staying somewhere that isn't suited to her needs and she would be confused where she is now.

We had the same issues with my mom in an AL. As a couple of other people have said, it is the “ask” that is the problem. The structure in MC is provided by “tell.” Not having options, not having decisions to make—because they can no longer make decisions, or the decisions they do make are formed without logic. I don’t know where you live, but it sounds like you might be able to find a memory care for a similar price.

However… We are finding in my area and the town where my mother was that the staff in care facilities is getting pretty bad. Facilities are not able to get and retain good people here. It is a revolving door. Some say the residents’ problems are too difficult, and workers are not interested in dealing with toileting and contentious clientele anymore than we are at home. But I am hearing similar stories even from people who have loved ones in the most expensive facilities. The care is shoddy and inconsistent, and they are paying a lot of money for that.

With dementia at play, mom needs Memory Care Assisted Living either at this facility or elsewhere.

Assisted Living is just that - assisted. The resident needs to be able to take care of themselves with help, specifically with meals and housekeeping and medications. It sounds to me like your mom is getting typical AL, but perhaps "they" oversold what you would get in the AL unit vs the MC unit.

My mom with Alzheimers was in AL for about 18 months and did fine with the light touch offered in the least restrictive environment. As her ALZ progressed, she became less able to function on her own (changing clothes, going to the bathroom in time, etc), so that her level of care became greater than AL could manage. The director was kind enough to suggest I start looking into Memory Care and made some suggestions. Once Mom started eloping, the director gave me 30 days. Three days later, she slugged the nurse that tried to tell her she had to do something and we were asked to leave immediately.

Once Mom settled into Memory Care (she was livid about the change and about the locked door during the first week or two), she did much, much better. I realized she NEEDED the extra structure offered by MC. The staff doesn't invite her to dinner but tells her it's dinner time and waits for her to come along with them. They don't give her her meds to take, but give them to her and watches her take them. They come through and insist she get up and go to the bathroom periodically if her Depends is dry or help her change if it isn't.

AL and MC staff have pretty different mindsets. AL is based on giving the resident as much freedom and autonomy as possible while maintaining their basic needs. MC recognizes that the resident can't manage that much freedom any longer and imposed more structure in a more authoritative manner. AL staff doesn't have as much training as MC staff in dealing with dementia and don't understand at well how to navigate around the dementia to get the desired outcome for the best interest of the resident.

It really sounds to me like your mom would benefit from moving onto the MC wing. Making change only gets harder the further into her dementia you get.

Unfortunately, if a resident refuses to go to the restroom, brush their teeth, care givers at the facility cannot make them. But, you should talk to the on site social worker and head nurse asap. The staff may not be doing their job. And in assisted living there are less CNA's per resident. She may need to move to Memory Care. Although, they may just put her in Depends and not bring her to the bathroom as much. It's very frustrating. Lucky your mom has you to help. I have no kids and am afraid of what will happen when I'm older. If talking with the site staff doesn't work, then contact the Ombudsman for the facility. The facility should have postings about them, if not, ask them for it.

You may be concerned over a transition, but I’d consider how much more comfortable your mom would be with specialized care that Memory Care can provide. After multiple problems, similar to what you describe, I placed my LO in MC and it was an immediate improvement. My LO seemed to relax, since she sensed these people were able to really care for her. They took charge and were trained on how to manage her care. They never had a problem with her refusing a shower. She got 3 a week without issue. She resisted showers at the AL. You might check the AL’s policy on incontinence. Many don’t provide changing of a resident who is double incontinent. With dementia, that is likely to develop.

Good luck with everything.

Mom needs to be moved from this facility . If you move her , I would just have her go to memory care to avoid the same problem . Better off in memory care where the staff to patient ratio is better . Assisted living is not staffed to take 20 minutes just to talk someone into using the bathroom .

I agree, this is poor care. The problem is the ask if a resident wants to go to the bathroom, get a bath, or get dressed. And what does the resident say...no. By law u cannot force them. I told an aide don't ask Mom just do it "Peg time to go to the bathroom" or shower or dress or down to to dinner. When said like this my Mom never said no. I never asked when she lived with me it was "time to shower" and she went. Yes, they should try another tactic. For my daughter, RN, she says u have to make them think it was their idea. "Mary, would you not feel so much better getva warm shower and putting on clean fresh clothes" usually the answer was yes.

At it's core assisted living is about providing meals and housekeeping plus limited help with bathing, dressing and medication management, I'm always leery of any AL facility that pretends they do more than that.

This is poor care.
You will have to find another facility.
You have discussed everything with those in charge here and they do not care. I can't see any option but to find another facility. I know this adds tremendously to your burden, but this isn't acceptable care, even if short staffed, and what's worse is the unwillingness to take any responsibility.