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He has been evaluated by staff who say he is ok for AL. He is currently at a rehab/skilled nursing facility. I don’t know —but hope— he will improve over time after he's discharged. But he has declined rapidly over the last 6 months. I worry that he might need a dedicated caregiver to address incontinence and everything else —including simple things like getting himself a drink. Or is AL better for addressing changing needs? Thank you.

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One thing that I have noticed, AL means something different from facility to facility.

You have to listen to the facility to understand what it looks like for them.

When my dad was in rehab he met a lady that was paralyzed from the neck down and she was in the assisted living area at the continuing care facility. She needed help with everything and it wasn't a problem in the least.
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Liebejud Dec 2020
Wow thank you.
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Assisted Living is NOT '24 hour care' by any means; that is Skilled Nursing. While AL is definitely staffed 24/7, their purpose is not to provide '24/7 care' to their residents. Assisted Living provides some care, including incontinence care at additional costs, which varies by facility. In general, an AL wants the resident to be fairly functional; they do NOT want a bedridden person, or a person who needs 'too much' care. If your dad cannot get himself a drink of water, that CAN be a definite problem. The ratio of caregivers to residents in AL is approx. 20:1, meaning, the caregivers are not available for every little thing all the time.

I'll give you an example: my mother lived in the same AL for 4 years; declining the whole time. She fell 40x but still used a walker. When her vertigo got very bad, she sometimes required TWO people to assist her; a big no-no in AL's in general. A resident must be a 1 person assist or he doesn't quality for most ALs. She was becoming too big a burden for AL; then she got pneumonia, was hospitalized for it and went to rehab for 3 weeks. The AL would NOT accept her back because she had gone into a wheelchair by then, combined with moderate dementia AND her other mobility issues, she was no longer a candidate. So we moved her to the Memory Care bldg which has a caregiver to resident ratio of 5:1.

ALs are very eager to accept new residents, this is true. Make SURE the place you're looking at isn't going to ask your dad to LEAVE a few months after he gets there b/c he's 'too much to handle'. Find out what their cost tiers are, what level your dad will be at upon entry, and how many tiers he can CLIMB before he needs to leave for a higher level of care ie: Skilled Nursing. In other words, how much worse can he get before he has to move? See where I'm going with this? Can he get up and down alone? Does he require MORE than 1 person to help him? SOME ALs DO allow a resident to be a 2 person assist, Morningstar is one of them. They will accept a resident at a very high level of care and charge them SNF prices for the privilege. But they're still in AL, so some people are happy with that.

All ALs are different, so make SURE the one you're thinking about is above board with you and that you read their contract very carefully. See under what conditions your dad would have to leave. Because the real goal is to have as FEW moves as possible for the elderly

Good luck!
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Liebejud Dec 2020
Thank you. I very much get your point. I fear my dad is on the cusp of needing too much assistance for AL, although he does not have issues that would warrant skilled nursing or memory care. This is why I think 24/7 home care may ultimately be the better option. The AL we’ve selected has a respite care option which will allow my dad to stay for a month to see if he likes it and if it is a good fit. He’s already in the facility, because he was discharged to its rehab after being in the hospital for pneumonia. So it will hopefully not be as drastic a
move as if he were to move out of the house. Thank you very much.
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Assisted Living accepts Resident that are incontinent. May have a charge Association with incontinence. Assisted Living is 24 hr care and so someone is always in house and available
The Caring Nurse
Fatima
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Liebejud Dec 2020
Thank you very much
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Speak with the AL about his costs. The cost of levels of care I-VI change markedly, often by 1,000s of dollars per month. Most assisted livings do not have aids who free to change patients with great frequency. Do know the full costs before considering this. I do know that those needing such a lot of care in my brother's assisted living were often resented by other elders as they took up the larger bulk of time by assistants there to serve all residents. Often these seniors were quickly moved to "memory care" where cost again escalated a lot. I can't know what you will find to be the case, and facilities differ remarkably. Just be certain you are fully honest in your Dad's condition and needs and the monthly costs involved. I wish you the very best in finding the right placement. As observed below, this is worth a try, to be sure, as long as everyone enters informed, and it is understood it may not be appropriate placement; only time would tell. Sure wish you good luck.
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Liebejud Dec 2020
Thank you very much.
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If the AL has assessed him and says that he qualifies for their level of care then by all means give it a shot.

My personal experience with AL has shown that they deal with the incontinence in a timely manner. Otherwise you would not be able to breathe in the building.

If he is able to call for help and tell them what his needs are that is so helpful to ensure that he is getting good care. As big as a messed adult incontinence brief feels to us, it is just a matter of course for facility staff. God bless them all for their willingness to take care of these issues.

I think that your idea of a month respite is a great way to find the perfect fit. If the 1st facility doesn't work, please don't give up. Take what you learned and ask better questions and research at the next place. You will be shocked how much you don't know and what you will learn to find his forever home.

Best of luck finding it quickly.
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Liebejud Dec 2020
Thank you so much. I appreciate that I am worrying about the unknown (like father, like daughter) and that I should be able to rely upon staff’s assessment. We have the added advantage of his rehab being in the same facility as AL, so both staffs can communicate directly about his progress and needs. Worst case, I suppose, is he doesn’t like it and he goes him to a full time aide. Thank goodness he was conservative with his money. We were never rich but he can now afford these options. Grateful for that. Thank you again!
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What does your father want to do? It is really important to involve him in the planning.

Incontinence scares many people and their families away from living at home, but it is very manageable and it certainly doesn't have to be a deal-breaker. How able is your father generally? What took him into the rehab SNF in the first place? How much longer does he have in rehab, and what do they say about how much more progress they expect him to make with them?
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Liebejud Dec 2020
Hi and thank you. My father has said he would like to move to assisted living. He had an aide in the home 3-4 hours/day, which was helpful but eventually not enough. He recently went to the hospital with pneumonia (he has congestive heart failure) and was discharged to rehab, where he is now. Although he has said he wanted to go to AL (and initiated the discussion), he is now panicking, I think, because of his fear of embarrassment due to incontinence and a general fear he will not be able to adapt/follow the rules. He is very smart but also horribly insecure. This has caused me to worry that perhaps serious incontinence will be an impediment to his being able to enjoy living there. I also fear that staff may not be able to respond to him as quickly as a personal home aide. On the other hand, the availability of doctors, nurses and multiple aides offers other advantages he would not receive at home with just one person. I think I’m panicking, too, because he is a wreck and incontinence is unknown and scary, honestly. I’m going to propose a month “respite” at AL so he doesn’t feel pressured into having to make a permanent change quickly. Your thoughts?
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