When do you move a parent from assisted living to a nursing home?

Move her into NH before they evict her for not being able to meet her needs …Hugs 🤗

Ugh - it is so hard trying to make all the best decisions. During this journey of managing my mother’s care I have found there is no perfect answer. And I always doubt myself at first. But I can share my experience. First, I have been in health care and know that they are some AL facilities that will try to hang on to their good paying clients. And there are some that will keep in good communication with families about when it’s time to transition. I moved my mother into an AL almost two years ago and she was still appropriate for AL level of care with some basic “step-up” care. But after about five months I got a phone call informing me that she needed much more care and they were increasing her to another level of step up care. When I asked about nursing home care they said she was still appropriate for AL. Visiting was not allowed during COVID so it was hard to assess. I could read the notes written by the visiting NP so I could see that my mother was barely oriented to herself, had toe and leg wounds, etc. When I called to speak to the DON at the facility I didn’t get calls back. Also I couldn’t get the visiting NP to call me back to discuss her care needs. I had hospice in at one point. And I will say that sometimes outside agencies are more concerned with making the facility happy to keep referrals coming. I don’t say this lightly at all. I would say that in my mother’s case the line was being pushed and no one wanted to be the one to say that she needed LTC. I was also worried about Covid and the AL had managed the pandemic well. And maybe the AL was overwhelmed with losing staff due to the pandemic and angry family members. I kept cutting the AL a break. But my gut was telling me something needed to change.

The cost of the AL had become equal to that of a LTC facility and there is no Medicaid Waiver for AL where I live that would help my mother. And she was going to run out of funds sooner and after she could no longer pay, she would have to move from AL. After speaking with a social worker I made the decision to move my mother to LTC while she could still pay privately for at least six months. This is desirable in my state according to the social worker. It was the best decision I made. She is getting better and more appropriate care. They made changes for her safety. Her interaction and strength has improved. She was discharged from hospice. The LTC facility has more trained staff on hand 24/7 and is equipped to provide a wider range of care on site.

While I hoped for my mother to pass away in her nicely decorated AL room with a view of the mountains, it wasn’t in the cards. She is better off in LTC and has more eyes on her to insure her safety and well being. And she will be able to transition to Medicaid once her funds run out.

I can only say press the staff for answers and follow your gut instinct. While I had a negative experience with the AL, that is not always the case. There are some great facilities out there. Good luck!

In the Assisted Living facility are they safe?
Can they leave? Is the wing locked down? If it got into her head to take a walk would she be able to leave through ANY door?
Would she be able to leave with anyone that you do not know? Or someone that does not have the legal right to take her off grounds?
If ANY of the answers to these are YES then she should be in Memory Care not necessarily a "Nursing Home" or Skilled Nursing Facility. That would be reserved for a time when the Memory Care is not able to care for her safely. Some can not or will not use equipment where a SNF can and does use equipment to safely transfer or care for residents.

When my dad was in AL, we hired extra caregivers 3 days a week and I went on Saturday because his care went beyond what AL could provide but he could still get around with his walker, to the dining room, and enjoyed the companionship and activities. Fast forward to Covid, no more visitors, caregivers, or me, and things started to tank fast. AL was a bit in my face because even with buy-up, they could not provide enough care without me paying for extra caregivers which I couldn't do because of covid. Home health had him moved to skilled nursing and after a number of months he moved to MC where he is doing well. I think the whole thing really depends on the facility and what their 'buy-up' plan is capable of managing.

I think it depends on the facility but they are also the best ones to ask I would think. It’s my understanding that at least the good IL (Independent Living) and AL (Assisted Living) facilities will tell you where that line is and warn you when they see it coming. If this is a new situation they should evaluate the patient and probably are unlikely to take them if they feel the need for more care than really available will require another transition soon.

likewinered, it depends on the senior facility. Some will continue to take care of a resident who has been there for awhile instead of having that person move out to a nursing home. It all depends on the medical issues.

For my Mom, she went from home to the hospital to rehab to a Nursing Home because she needed a lot of care. More then what an Assisted Living or Memory Care could do.

Dad, on the other hand, went from home to a senior facility Independent Living, then later to their Memory Care. When he became quite sick, the facility was still able to work with him.

This can vary from State to State, from facility to facility.

My mom's nursing home offered patient lifts to get in and out of bed as well as lift assisted bathing in a spa tub.
They helped residents who could not ambulate independently get to the dining room and to activities.
The kitchen offered modified diets for those with chewing and swallowing difficulties (dysphagia) and aides prompted people to eat and helped feed those who couldn't do it themselves.
No resident was "bed bound", everyone was up and dressed daily unless they were acutely ill.
There were 3 facility doctors and a nurse practitioner, RNs and RPNs as well as as higher number of PSWs than were available on the AL/retirement home side of the building.
Residents were toileted regularly and incontinence was dealt with routinely throughout the day and night.
Those who were frail were repositioned on a schedule. PT and range of motion PT was also routinely given.