Are elderly entitled to live in the "least restrictive environment"?

My Aunt E was 65 when she earned her LPN degree, and continued working in the local care center for another 10 years or so. In her 80s she walked the two blocks from her home to the center and signed herself in "for the winter." She made her own bed, bathed herself, was ambulatory- no walker or cane, fed herself, had no bowel or bladder problems. But she was becoming frail, had had some medical issues, and wanted the security of getting care. She did not have cognitive problems. Come Spring, she decided she wasn't strong enough to garden anyway, so she wasn't so eager to leave. (And she liked the food!) She eventually needed a wheelchair. She was frail and weak but alert and in her right mind when we celebrated her 100th birthday.

I think the real question is whether Dad is getting the care he needs, and whether he is content where he is. Does he have a nice room, decorated with his things? Are there activities he enjoys? Does he like to read, watch television, do jigsaws, have coffee with some of the other residents? What would he enjoy more about assisted living? What restrictions does he have to live with now that you feel are inappropriate? Do you or other family members take him on outings occasionally?

Do you attend his care conferences? What reasons do the staff give for his placement in skilled nursing? Have you talked to his doctor? (Dad can sign a waiver so that the doctor can talk to you.)

Assisted living is generally less expensive than skilled nursing care, so I'm not clear what the financial implications are.

I congratulate you on being concerned that Dad has the best possible quality of life. I hope you investigate enough to make an informed decision.

Do l detect they note of challenging hostility to "ps's" response? I don't think you cared for her answer because it doesn't go along with what you're thinking. My answer would have been likewise along ps's lines, with the caveat that there is a world of differences in the land of assisted living. Some will "assist" barely at all, some will assist at a very full level included in the "price of admission" and still others will assist on a "fee for service" basis that may nickel and dime you to death.

Many of us on this forum have cared for more than one person with dementia or other debilitating elder diseases (sometimes even some who are not true elders). I have been responsible for the care of people at home as well as the care of people who had to be institutionalized. We don't have to have worked at a nursing home (???) to know intimately how they function. No, we do not need to have been an employee anywhere to understand the needs of a person with any type of memory loss.

I don't want to try to put words in ps's mouth, but I think she was trying to address the fact that a person who is located in a skilled nursing facility has to be proven by the doctors certification and the nursing home's on going evaluation, that the patient is medically qualified to remain there. That would be an awfully large group of people perpetrating a fraud to say that your father is qualified to continue their if he weren't. If you are in a POA position (because of privacy and HIPAA laws, you need to be), and you are in doubt, you can always ask for a meeting to clarify the situation and receives and in depth explanation.

But consider your actions carefully. The other side of the coin I believe ms' ps is trying to address is that since your father has impairment, even if it is mild at this stage, it is not ever going to get any better. You also have no way of knowing how quickly it is going to degenerate. And we're talking physical as well as mental. Moving these folks back and forth to different locations, having them exist in an environment of perceived tension, etc. can actually add to their deterioration.

My aunt had all of the qualities you described in your dad and yet I HAD to locate her in a full skilled memory care unit. Why? Because her short term memory was so faulty, she couldn't remember what she ate, whether she ate, or what was really wrong with her. At home, she had a severe UTI but believed it was an ulcer and took 1/2 of a small box of baking soda (that l was unaware she had secreted away for just such an occasion), over a 12 hour period, and threw her electrolytes so far off that it nearly stopped her heart. Even tho they may seem physically fit, they are coming to incorrect mental conclusions that can do them great harm.

Even when you think they're okay in a partially unsupervised environment, they're not always. An unthinking visitor left a bottle of heavily perfumed Avon mens body lotion in a man's closet across the hall, instead of leaving it with the staff, as was the requirement for all the memory care area. What was my aunt doing in his closet? She didn't belong there but she found the bottle and thought it was hers and that it was her facial moisturizer. Do I need to describe her allergic reaction, our (yes, l was with her) 14 hours in the emergency room with benadryl and steroid injections, etc, or her intense itching that went on for another week where they were unable to give her anti itch medication because it made her dizzy? And the secondary infection she got for which she had to take antibiotics because she couldn't remember not to scratch.

We all know how hard it is to see our loved ones in an environment we wouldn't like to be in ourselves. But, ladydi, consider your concerns carefully and try really hard not to make emotional decisions about your dads placement. Most folks are worried when they have them in lesser care about how their loved one is going to react when they're moved to more restrictive care, which is unfortunately but eventually inevitable.

Thanks so much Pink, that is exactly what I am looking at and his granddaughter works at just such a facility. Thanks

Maybe you can find an assisted living facility that will transition him to a memory care facility if he gets to the point where his memory fails more. That is one of the issues about an assisted living facility, if he begins to exit seek or begins to forget things due to dementia they will ask you to remove him and put him into a memory care facility. If you find one that has assisted living and memory care then he won't ever have to leave the one facility and it will make him a little more comfortable and mobile while he still can be. That way he has the benefits of an assisted living facility where he can go on outings, etc.

Thanks for your response. No he did not"just walk into a nursing home." I should have said that the reason he went was due to a case of pneumonia which he quickly recovered from. That was a year ago. I don't see how a mild cognitive impairment requires 24/7 care. Do you work at a nursing home????

You can't just walk into a nursing home, it would have to be approved by an MD and the insurance carrier. It's not fraud, and the fact that he is functioning well indicates his placement is appropriate. The cognitive impairment will continue to accelerate and moving him can actually make it worse. Try to accept what is working well, and restrain your instinct to take over every aspect of care.