My mom’s independent living facility has determined she needs a higher level of care. She’s refusing to move to the AL building. Now what?

Most IL's do have strict guidelines about who can remain there and are very firm about sticking to them. She's being evicted but she has a place to go, there's not much here to discuss other than how to go about getting it done. I think the idea of the move is more frightening and overwhelming than the actual move will be, I'd just make arrangements to get it done and then keep her occupied elsewhere while you go about it. But ... wandering is a sign of dementia and I question whether an AL is an appropriate place for her, you wouldn't want to go through the trauma of a move only to have them tell you she needs more care than they can provide there. Have you investigated any other facilities, perhaps one with a memory care option?

If she doesn’t move willingly, she may likely be forced out through eviction. I’d hope it would not escalate to that. It certainly sounds like memory care is the most appropriate option given the behaviors you’re describing. If this were my mom, I’d sadly tell her whatever lie was necessary to get her moved. I’d not discuss it with her any longer at all. I’d have one family member take her out for lunch or a drive to see holiday lights or whatever, while the other family members and/or staff makes the move happen. When she gets back, she has a new home. Don’t expect it to go smoothly, though sometimes it does, but endless looping conversations about it don’t help anyone, just “this is your home, isn’t it lovely” and move to another topic. Sadly, your mom is at a point where she’s confused and may not be pleased no matter what. It’s about making the best of the rotten choices and keeping her safe. I wish you the best

At her age with the behaviors you describe she should be moved. She no longer exhibits behavior suitable for an IL situation. I think you would best be on board with planning that for her.

It often is hard for individuals to accept their limitations. I think you need to be frank and help her to realize that. You would all be better off if she is in an area of care better suited to her physical and mental state.

My mother is the same age but sadly bedridden. She is now in SN. It is sad but that is our reality. She too will not be able to afford it in a few years but for now she can. I don't know that she will be around in a few years.

Your mom needs memory care… when I moved my mom from AL, in another state, I didn’t realize that memory care was for her.. my mom was paranoid of people stealing, people of color.. hallucinations had started and after moving her got progressively worse. With your mom wondering a lock down memory care will satisfy those needs…

Find one that will eventually take Medicaid and not put her out on the street when money runs out. I used a care advisor franchise called Care Patrol. Find someone local who can meet with you and guide you .. ( best thing I ever did)

I totally know the situation that y’all are in…. Got my in her 90’s mom from her home of 50 yrs into IL of a tiered facility. By that I mean one that goes from IL (it’s own building w/individual apts) to AL in another building to a NH (& hospice sector) in yet another building. There was a huge common house with administration, central foodservice kitchen for the “3”, art n crafts, exercises, reading room, events and where IL went for their meals. IL cost very much affordable & the AL participated in Medicaid waiver, & the NH/SNF took LTC Medicaid. I was some kinda happy as I thought “1 & done”. Well hold my beer, cause that is far from what happened. This posting may be long…..

First couple of IL years were fine. Some initial problems in leaving her YARD & downsizing but once there and getting a buddy or two & figuring out the schedule (Steinmart & H‑E‑B every other Thursday!), it was all just fine. Then she started wandering hallways on her floor at night and issues with her not appropriately dealing with laundry room stuff (flooded out the washers more than once). The wandering poses safety & security issues for everyone. The laundry stuff too.

I live in a other state, but had gotten to know administration & staff over time as 2 Aunts & an Uncle at their sister tiered facility which shared some positions. Anyways I got a call to set up a in person meeting asap. On the plus side, mom was still 100% good on fire drills and on setting out every AM door hanger b4 the daily security guard check; she was still going to meals, activities, dressing appropriately. She was nicely social, they liked her. All this imo matters big time.

What I found out was IL can do an eviction. 30 Day Notice. As they are a resident in IL (& this hold true for AL as well), there is absolutely no requirement to find placement for them. Being IL & AL means in theory & by definition that they have the ability to do for themselves; so they can be sent to a shelter or leave with anyone who comes to pick them up. They are not in skilled nursing which has medical by a MD oversight and…. this is imo very important… as that medical oversight is being billed in some way to Medicare (Medicare not Medicaid) then Medicare requirements come into play. Medicare requires for a facility to provide for a continuity of care. So the NH has to find someplace to do a lateral transfer to. But IL & AL can kick them to the curb.

It’s terrible optics to do this, so IL & AL instead will find a reason to have EMS come to the residents apt or room and take them to the ER/ED. What often seems to be the reason is that they look to have had a transient ischemic attack aka a TIA as these are very subjective as to how they “present”. Then once at the hospital ER/ED and ready to leave. the IL or AL will not take them back. They will say “we cannot meet the level of care needed” and refuse return. Then your elder becomes a problem for the discharge planner at the hospital. The discharge planner will hound family to come and get their elder or will try to find a NH if they meet the requirements for a SNF. If neither seems to work out them, APS gets called in and APS contacts family & if family still isn’t trying to find a place for them or cannot then APS can ask for a ward of the State action to happen. They go under State system without family input. It’s a drastic step, you don’t want to go there if there are still options.

and discussing options is what imho you want to get with the IL asap to discuss.

To me, the first step is to do a reality check as to the w level of care your mom is really truly at and if there are add on services that will get her to be at a point that is ok for the IL. If your mom absolutely is not at all ok to be in IL, then that’s a whole other planning decision. Do that 1st.

For us, mom was still ok if she had her laundry done & changed her medication management. That’s what we did and it bought us time….

more in part 2.

Part 2.
It bought us time and that is what I’d try to negotiate for.
So where your mom is now wants her to move to AL. & Moms resisting. This AL is part of the same IL corp or ownership, right? They have an interest in keeping her $ stream. I was somewhat pressured by my moms tiered facility to just do private pay with them till a Medicaid bed opened; heard you really didn’t want your mom (we love her & your Aunties and Uncle chatter) to go to one of those (Medicaid) places.

Personally I would not move her to AL. I’d try to get her into a NH and a NH that has LTC Medicaid beds, unless your state LTC Medicaid clearly and easily pays for MC, or pays for AL via a Medicaid waiver. I’d go & do whatever to get her into a SNF. It sounds like $ is an issue for y’all, so ya got to factor in how to make Medicaid work to pay for her.

For my mom, I was under the impression - back when initially looking at places - that as there was participation in Medicaid by the AL, that would be what my mom segueway’d into. Easy peasy. The AL had Medicaid waiver beds. She would merrily go along from private pay IL then go private pay for AL till she ran out of $ and then easily into an AL Medicaid bed, then onto a NH or hospice bed and again with Medicaid. Flat not happening. # of AL Medicaid waiver beds were just a few and all were placeholder beds till a LTC Medicaid bed opened up in the NH building. As 1 NH bed opened moved whomever at top of placeholder list moved. Easily a dz plus ahead of mom. Could be a yr or more (and this is why you often hear that it takes 2 yrs of so private pay in AL before they can go onto Medicaid). This wasn’t going to work.

I had literally bought some time by hiring someone to do moms personal laundry and to do medication management at night (so she slept and wandering stopped). What we did was have mom go to see her gerontologist every 3-4 weeks to effectively build up her health chart to show she was “at need” for skilled nursing.

One big issue for those still living at home or in IL or AL is that they see their MD maybe once or twice a year. They do not have the fat health chart to show labs, testing, evaluations to show need. It took abt 5 months. Mom did the move to hyperspace going from IL to a NH and bypassing AL phase totally. That she was mid 90’s was a factor in all this. Had she been in her 80’s it wouldn’t have been possible, as likely be deemed too spry, too capable in her ADLs.

Holly - Your mom is in her 90’s, she’s not going to get better. Moving her to AL now is just a bandaid on the situation. Come another yr or two and you’ll face moving her again. Yeah, horrors! Try to work with her doctors to get her ok for a SNF and a SNF that takes LTC Medicaid. Should your State actually do LTC Medicaid for MC, then look at MC places.

Pls realize vast majority of NH residents enter via post hospitalization. Like they fall and break a hip, get hospitalized/ have surgery (MediCARE pays); then discharged for rehab (MediCARE pays) in a SNF / NH; rehab ends and it’s determined they cannot go home or to IL or AL and they go from rehab patient (MediCARE) to long term custodial care resident (private pay, LTC insurance or Medicaid). They have a huge fat health chart to show need for skilled. NH is happy as MediCARE days pays double or triple what Medicaid pays & they know what she will need for custodial care. An easy transition.

To me, you need do whatever to get her eligible for a LTC Medicaid bed. If that means getting her chart built up or getting her admitted to a hospital, then get on getting that done. If you find a place that will take her as Medicaid Pending and you kinda don’t like it, please realize that you can move mom to another NH once you clear Medicaid.

Best of luck this month!

Lie! Tell her the apt is being renovated, has pests, whatever she will accept. Once she is up to moving take her for a drive have her things moved... hire someone, then when you bring her home she just goes to her new apt. Probably won't even know the difference.

Don't waste any more of her money there. She needs memory care, not AL, and she obviously doesn't have the capability to make the decision to move.

That's where your POA kicks in, so take care of business and move her.

Your mother needs Memory Care Assisted Living and NOT in this facility, in my opinion, from someone who's had her folks in BOTH AL and Memory Care AL. In her condition, your mother needs a locked door Memory Care where she cannot roam around and leave the grounds at night. With hallucinations and paranoia going on, she needs a Neurologist or a Geriatric PCP who's FAMILIAR with dementia/Alzheimer's who can prescribe meds for her to keep her calm. This is a terrible situation for your mom and for you! Yes, the AL is within their rights to evict her, fyi. It's not safe for your mother to live in Independent Living anymore, that's for CERTAIN.

You, as POA, DO have the right to place her in Memory Care or Skilled Nursing against her will once she's diagnosed with dementia. All she needs is a mini cognitive exam (MoCA SLUMS or the like) and that's it. When my mother lived in AL and her dementia worsened, I moved her into MC and she was not at all pleased, but I had POA and it was for her safety I did it. Things turned out fine, too.

If this were me, I'd move her to Memory Care and private pay until her money runs out, THEN apply for Medicaid to fund her stay in a Skilled Nursing Facility. But, you can apply for Medicaid now and get her placed in a SNF if you want to, knowing that the accommodations will not be as they are in AL or MC, and she'll have a roommate with Medicaid. I fought it off for my mother, and kept her in MC until she passed, which was a few months BEFORE her $$$$ ran out and I would have had to apply for Medicaid on her behalf.

Wishing you the best of luck with a tough situation.