Assisted living - a caveat

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Tom

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We played/sang at several assisted living facilities in the East Bay, and I got to know the Activities Directors quite well. One day I turned up at my primary care physician's office building, and noticed a lady alighting a shuttle bus from a nearby assisted living facility. When I came out of the men's room, the lady was wandering around the lobby, apparently lost. It didn't take long to get her to her Doc's office.

Next time I was at that assisted living facility, I replayed this experience and asked "don't your bus drivers ensure that residents arrive at their destination?" The response was a stern "this is ASSISTED living; If we see someone who's a little confused, they're out of here".
 

Isaac-1

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Sounds like typical care standards these days, does not matter if the person has 99 good days in a row, 1 bad day where they are confused possibly due to low blood sugar, etc. and they are someone else's problem.
 

Oldgator73

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I was an activities director at an assisted living facility for about a year. The residents ran the gamut from full on dementia to completely self sufficient. There was no division in the facility for the dementia residents. Some residents had vehicles and drove to their appointments and did their own errands. Others without private transportation relied on us to transport by bus. For those with all their facilities about them we dropped them off at appointments and picked them up when called. For those the dementia residents we accompanied them into their appointment and did not leave until someone took possession of them. If it was a shopping trip a staff member stayed with the demenTia resident while they shopped. During the summer Dover used sponsor a concert on the green. On time my wife volunteered to help me with the residents wishing to attend. This particular evening several dementia residents wanted to attend. I dropped the residents off with my in tow. I told her to make sure resident X, y and z did not wander off. After I got the van parked and met up with my wife she had a look of exasperation on her face. She informed me keeping the dementia residents in place was like herding cats. 😎
 

SpencerPJ

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Ironically, with my dad it was the opposite experience. The assisted living place went above and beyond to keep him there, maybe it was because most of their clients were getting government funding and I was writing monthly checks for dad. I think different places have different ideals. The employees occasionally grumbled, but the director always assured me he was fine there.
 

UTTransplant

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I live in a small city with a huge number of accommodations for a variety of elderly issues. It is due to the Lutheran Church establishing an “old folks home” here well over 100 years ago. The place grew into a large array of communities, each with a specified demographic. There are home health concierges, senior living “villas” (mostly twin homes with exterior maintenance covered), assisted living apartments that provide housekeeping and some meals, memory care for dementia patients, rehabs, and full nursing care. The idea is you move from segment to segment as needed. I know a number of people in the villas and assisted living places, and a few in the memory care apartments where one member of a couple has dementia and the other does not. I don’t know how well the transitions are managed, but people seem pretty pleased with their current accommodations. Then again, the ones I know are not on Medicaid.
 
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Tom

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The idea is you move from segment to segment as needed. I know a number of people in the villas and assisted living places, and a few in the memory care apartments where one member of a couple has dementia and the other does not.
One of the local facilities has something similar, although I didn't previously fully appreciate why they had a "dementia segment". Your message explains it.

I must admit that I was taken aback when I received the "they're out of here" reply from the first facility.
 

Larry N.

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The response was a stern "this is ASSISTED living; If we see someone who's a little confused, they're out of here".
My dad had multi-infarct dementia and ran into exactly that with the first place he went, one that he and mom had picked before they knew she was terminal. It was a really nice place, but after a few months they said he was beyond their capabilities. But they really were not set up to handle dementia, and after almost four years of him being in various places, seeing the various facilities, I understand. Beyond a certain point in the progression of dementia they just about need locked doors or a very large staff, since dementia patients will wander around a lot, even somewhat in the earlier stages.

In those earlier stages, but after he had to leave that first facility, I traveled with him to visit his sister (who also had dementia) in Oregon. It was an interesting but awkward and sad trip. He looked and acted almost normally at that stage, but I had to keep a very close eye on him all the time, even at night. Such things as, "That little old man is following me" whenever he'd see his reflection in a window or mirror, for example. And after discussing reflections with him once, he "seemed" to understand during the discussion but couldn't apply it to what he was seeing, probably at least partly because he "knew" that HE didn't look like that.

I could relate a lot more, but it wasn't pleasant, and the facility really DOES need to be set up to handle dementia specifically.
 

Kirk

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Next time I was at that assisted living facility, I replayed this experience and asked "don't your bus drivers ensure that residents arrive at their destination?"
There have been a lot of ugly stories on the news of bad things in eldercare facilities but little reporting of the good things or good locations. Both exist and at least some of the stories we hear are true, good or bad. My mother lived her final years in a full-care facility and they were wonderful with staff who seemed to be angelic.

That story strikes a cord with me because we presently live in what can be termed an "age in place" facility, which has 3 levels of independent living, assisted living, memory care, full care, adult day care, hospice, and in-home assistance, all in different facilities on a single campus. We have several residents who live in independent facilities while a spouse is in memory of full care. I am both a resident and a part-time driver for the facility. More than half of those in independent living do have cars and drive but not all. Drivers are available for medical appointments and other similar things and we also run a bus to Walmart and grocery stores weekly and to many other places either monthly or as needed. Drivers here do assist residents within reason but there are situations that can limit that. If the resident is living in independent living it is expected that they can do most things for themselves and while we try to help, there are times that it simply isn't possible. Medical appointments can be problematic since parking is often very limited or far away in many of the medial complexes which means that we simply can't do a lot more than drop the resident and pick them up.

Residents in assisted living do get significantly more help than those in independent living but even then if a driver is sent to pick up a resident and they are alone, we simply can't be in 2 places at once and the parking issue can still be problematic. On shopping trips, our assisted residents always have either staff or volunteers who do with them, a person for every 2 residents. The fact is that in all senior care situations, the staff are very limited in what they can do or require due to legislation on citizen rights and we are very dependent on the family of our residents to step in when a resident has dementia or such and needs help, but all too often that doesn't happen and we are left to manage as best we can. In our community we recruit volunteers from our independent living residents to ride along and assist those residents as much as possible, but if that resident resists there is nothing that we have the authority or ability to do.
The response was a stern "this is ASSISTED living; If we see someone who's a little confused, they're out of here".
I don't understand that statement at all. If the resident is in independent living that might be true in some facilities, but I have never heard of any with that sort of attitude for assistant living. That sounds like one of those homes in the news stories.
 

Tom

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I don't understand that statement at all. If the resident is in independent living that might be true in some facilities, but I have never heard of any with that sort of attitude for assistant living. That sounds like one of those homes in the news stories.
I'd visited and performed at this facility multiple times before that incident, and was impressed with the facility and the staff I dealt with. My wife accompanied me one time and wandered around a little; She later said "this is a nice facility".

Hopefully, new residents understand the limitations when they sign up.
 

Tom

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One time I had an orthopedic appointment across the street from a different facility that had the different 'segments' mentioned above. I observed a guy in an electric chair exit their parking lot, cross a busy intersection, and disappear into the distance. I went into their lobby and asked a staff member if they'd lost a resident. They asked if the guy was in an electric chair with a flagpole attached. When I said yes, they explained "that's just Fred ... he wanders all over the local neighborhood, but always comes back".
 

Bobtop46

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My DW and I are in the midst of this. The underlying problem to the whole sector is shortage of caregivers. The national standard is 1:7 ratio of caregivers to residents. All facilities are dealing with shortages. This is the only question that matters when viewing a facility with the possibility of making a family member a resident. We are experiencing 1:12 during the day and generally 1:24 at night. Normally 2 or 3 caregivers during the day and 1 at night. The facility pays well is very nice, but can't find caregivers.
 

Kirk

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Hopefully, new residents understand the limitations when they sign up.
There is more to this than you seem to grasp. Many of the residents of such facilities are "put there" by their children or some other family member and too often are not even part of the decision about where. And it is also quite common for the kids to put a parent into independent living when they need assisted or into assisted when they need full care but they just don't want to spend that much money because it cuts into their inheritance. I see that a lot and frequently they rarely or never visit the old folks. In the community where we live, I suspect that close to half of the residents had kids pushing them to move here and probably 20% of them feel that they had little or no voice in the decision. In our area of 86 apartments in units of 4, each around a courtyard, there are at least 3 residents who have early stage dementia and live alone. Because we are independent living we do have very easy access to come and go as we wish and although staff know about the 3 problem residents, there isn't much they can do about it. Legally, once a resident is moved in about all that staff can do is to ask the responsible person or the emergency contact to check on them but if nothing changes they have to choose between trying to care for the resident as best they can or they could terminate the rental with proper notice. Our management is very hesitant to put a resident out, especially when the problem is an obvious lack of concern or care by other family members. The result is that staff does the best that they can and they also ask neighbors of the dementia patients to help watch out for them. Even in assisted living the staff have very limited authority to take action if the patient doesn't take advice or direction willingly. The majority of the fault for such cases belongs to the other family members who don't want to be bothered and so dump the person with dementia and as the dementia progresses, typically the family comes less and less and often refuses to spend what is necessary to move the patient into an area with higher levels of care.
I observed a guy in an electric chair exit their parking lot, cross a busy intersection, and disappear into the distance.
You might have seen my neighbor! We have a resident here who uses a power chair for longer distances but who is only 63 and mentally quite fit but he sometimes travels as much as a mile to the shopping area just down the road if weather is nice. He does so not because he has to but because he wants to. He has done that enough that our local police patrols know him and kind of watch out for him. Mentally, he is just as competent as you but he just likes to do things for himself.
The national standard is 1:7 ratio of caregivers to residents. All facilities are dealing with shortages. This is the only question that matters when viewing a facility with the possibility of making a family member a resident. We are experiencing 1:12 during the day and generally 1:24 at night. Normally 2 or 3 caregivers during the day and 1 at night. The facility pays well is very nice, but can't find caregivers.
You must be looking at either assisted living or full care? Independent living is really little different from living in any other neighborhood or apartment complex. The main difference between where we live today and a typical neighborhood is that Staff check on anyone that they haven't seen in a week or so and more often in bad weather. Back in 2021 when TX had the Feb. power outages they were checking on all residents daily and anyone who was using oxygen more often. In addition there is a recreation center for each area of the community with an activities director who organizes frequent social events and activities, as well as trips to things like the state fair, the symphony, or even special shopping trips and occasionally an overnight trip, usually using the community busses. There is also a dining room that is available to those not wishing to cook and others of us can use it for a meal out occasionally if we wish. Assisted living provides far more care and all meals and full care does pretty much everything for the resident. There is a very wide range in what different senior facilities provide or have available.
My DW and I are in the midst of this.
So are you looking for yourself, or for a parent or loved one?
 

Tom

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There is more to this than you seem to grasp.
Maybe, but I understand the issue of folks dumping relatives in such places and trying to save their inheritance. I was trying to avoid saying that, but you made it quite clear.
 

Kirk

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but you made it quite clear.
I suspected that may have been the case and it was my intent to be clear. But it is also important to realize that not all residents of a senior community are senile or in need of help. The majority of our neighbors are just folks like us who are getting to the point that help could be needed and so choose to live where it is readily available if the need should arise. There are several who have developed vision issues so no longer drive but are mentally and physically as able as most of us. In my case, my wife has ongoing medical issues and some of them are degenerative, so we chose to move here where there is help if we should need it, rather than expecting our children to provide that help. We have a neighbor who is 95 years old and is still a formidable trivia competitor and a gentleman who just had his 100th birthday who is a volunteer tutor for the elementary school near us. There are more than 30 residents who help at that school with reading programs, volunteer teacher's aids, or in various other instruction capacities. We have many residents who play golf on the course next door on a regular basis and the community gym is busy most of the day.
 
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Lou Schneider

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We're going through this with my Mom. She's been living with my sister and her extended family but they're unable to find caregivers who are willing to travel the hour each way from the nearby big city to her rural house to provide the increased care Mom needs as her Alzheimer's progresses. So we're reluctantly moving her into an assisted living facility that can provide the needed care.
 

Kirk

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My sister is unable to find caregivers who are willing to travel the hour from the nearby big city to her rural house to give her the needed assistance as Mom's Alzheimer's progresses so we're reluctantly moving her into an assisted living facility that can provide the needed round the clock care.
I traveled that road with my mother. She didn't want to leave her home but was sometimes forgetting that dad had passed and would call 911 because she was unable to find him or get lost when returning from the grocery store. She lived with my sister for a short time but that is not usually a good answer either. When we found a good care facility for her, once she adjusted to the new lifestyle she as happy and content until near the end. She lived there for 5 1/2 years. Keep in mind that not all dementia victims have Alzheimer's.
 

Oldgator73

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I just sent for information from Bob Hope Village, an independent living facility in Shalimar, FL for spouses of retired Air Force enlisted members. Couples can also live there. Apartments rent from $1100-2500 month. There is a $4000 entry fee that goes towards amenities. If you don’t drive there is a bus to take you to appointments and shopping. They will also pick up prescriptions for residents. There are other levels including assisted living and full care that you can move to if the need arises.
 

Larry N.

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I observed a guy in an electric chair exit their parking lot, cross a busy intersection, and disappear into the distance. I went into their lobby and asked a staff member if they'd lost a resident. They asked if the guy was in an electric chair with a flagpole attached. When I said yes, they explained "that's just Fred ... he wanders all over the local neighborhood, but always comes back".
I can understand that- if I were in such a facility and had such a chair but no car I'd probably be that way, just due to boredom and wanting something to do. So many of the activities provided in the facilities I've seen aren't to my taste (games, arts, crafts, etc.).

Keep in mind that not all dementia victims have Alzheimer's.

Yup - my dad had multi-infarct dementia, basically a series of mini-strokes over a long period, each one causing a slight mental degradation, but the symptoms and behavior are similar in most respects. Dad's mother and sister also had this. From the NIH (nih.gov):
Multi-infarct dementia (MID) is a common cause of memory loss in the elderly. MID is caused by multiple strokes (disruption of blood flow to the brain). Disruption of blood flow leads to damaged brain tissue. Some of these strokes may occur without noticeable clinical symptoms.
 

Oldgator73

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So many of the activities provided in the facilities I've seen aren't to my taste (games, arts, crafts, etc.).
When I was an Activities Director at an assisted living the residents wanted a lot of activities scheduled. Problem was they didn’t want to actually do the activities, they wanted someone else to do them and they just wanted to watch. The owners of the facility came down from NY and looked at my activities board. Told to double the number of activities. I said I didn’t have the staff or funds to do that. They said we didn’t actually have to do the activities, just put them on the board. Said it looked good when folks toured the facility.
 

UTTransplant

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Among the many people I know who live in independent or assisted living communities, the vast majority just need some basic help. In the independent senior living, that generally means outdoor maintenance and some housekeeping. Heck, we hire those done in our house! But some people had lovely, multi-floor large older homes on large lots that just become overwhelming. The assisted living people generally have some medical issue, but it isn’t a mental health one. Three men I know moved in because their wives died and they didn’t know how to cook, do laundry, or clean. Their mamas and wives totally failed them. One man has always been single, but he lost a leg to diabetes and isn’t very mobile. One woman I know who has always been single moved in at 60 because she hated housework and cooking, and she wanted more time to run her business! At 70+ she still has the business and is still in assisted living. It is awfully nice that such a variety of living arrangements exist.
 
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