My parents are in AL for a year now. We have found the services have been going downhill. The staff turnover is constant. Do we move them?

Hi my husband has been stuck in assisted living since his work injury in 2014
We have lived in one for over 2 1/2 years and are now being evicted after being here because we are In our 40s
Because a new director came on and changed a bunch of rules
My husband is allowed to stay as long as I his wife of almost 25 years never comes to his facility
I was told today to leave the premises I told her to call the cops the proplem with these facilities is that the tenants lose all their rights once they move in
But some times the only way you can move forward is to use their services
I would definitely move them if the facility is actually better
But you don't know how long they will be better
From my experience they seem amazing viewing them but once your in it really sucks
Best advice talk to the residents about what they don't like about their facilities before making a move

My advice would be to get them out of there at once. You will be bringing their furniture and belongings and have people on hand the day of the move so it can all be accomplished quickly. Take them out to lunch or do something with them the day of the move. Don't say anything and just bring them to the new place If they have dementia, tell them the place burned down and that is why they are in the new place. Visit them for the next few days to keep their minds occupied and they should adjust quickly. I don't think that old place is safe or right for them.

If you're strongly considering moving them, do it NOW.

Everyone has long answers for you. Mine is short and from the heart.

If they can’t handle giving showers to your parents everyday. Then they are certainly not handling medical necessities correctly. GET THEM OUT.

I have been down this road, if you even thought it, then it needs to be done. Trust your instincts.

"The staff is now not capable of keeping up with the needs of the residents. We pay extra for daily showers and med assistance for both of them and it’s a daily battle to make sure these are done."

Someone suggested cutting the requests down, but 1) dad likes his daily shower and 2) what's to keep them from skipping those too? If you are PAYING for this service and it is NOT being provided, then they should not be charging you for any missed days!!!

"We are considering moving them to another facility (which we have checked out) and has a top notch rating."

Where was the rating from? Those online are not really trustworthy. If it is from people who live there that you know, then most certainly that is the best rating method. I think there is some kind of Medicare or Medicaid rating system, but the ratings are suspect.

"Will it confuse them too much to move them again??"

Assumption is "again" means from their home to AL. It could, but if there is any way to set up everything in their room(s) the same, that will help. However facilities are not laid out in some preset fashion, so they will have to learn where everything else is, which can be confusing for a while at least, possibly longer depending on how far the dementia has gone.

Since you mention Dad is already heading down the dementia path and that mom might not be far behind, it might make sense to consider a MC place NOW. I only suggest this IF you decide you want to move them out of this place they are in. Doing that move to MC now would negate the need which will come soon enough, and every move can be even harder on someone with more advanced dementia. The other bonus is they would not need to learn as much, because in general the MC unit is self-contained: private rooms with baths, communal areas, including dining space.

Our mother is in a non-profit place, and yes there are staff changes (I do not fault them, they are the ones who provide the most care, yet are likely the lowest paid!!!) Her monthly fee includes up to one hour of personal care (such as showering!) The fee is higher than AL, but that is because MC residents generally require more care (mom is mostly self-caring, but needed a safe place.) AL is more ala carte - you pay extra for what you need or want. We're into year three now and we have only had some one time/month extra cleaning of the carpet (hopefully the disposables we replaced her undies with stops that! She isn't incontinent, yet, just sometimes cannot get undressed fast enough!), but NO extra charges yet for help over 1 hour. Medication dispensing, up to quite a few times/day is also included. If you could find an MC place like this, it'll be a little more expensive, but the medications and showering would not be extra!

You will have to shop around and ask about costs, what is covered, how much any extra service(s) cost, etc. While asking, you could inquire about staff turnover, but if at all possible, wander about and talk to any residents who are willing to chat! You'll get the best feedback from someone living there. Check out the MC area, different times of the day if you can. Mom's place has a variety of needs among the residents, some seem quite normal, others wheelchair bound, non-verbal, etc. Most are like mom, need walkers, maybe help showering, self feeding (and choosing!) - medication is always dispensed, no self-medicating in MC!!

I would be careful about hiring outsiders to provide the showering/medications - another thread here was about someone being told only those approved by the facility would be allowed going forward. You might not be able to hire outsiders!

Boy this is a tough one. A year is a good amount of time and I imagine they are well settled in but to me part of the decision depends on what that looks like. Are they involved in the social life there at the facility, have they made friends together or separately or do they pretty much stick to themselves and each other for company and day to day stuff? It doesn't sound like the staff is bad or there have been any real problems but good for you to be keeping an eye on things and trying to plan ahead before there are. Have either of your parents bonded with staff at all? I ask because while the turn over isn't great, unless of course it for cause and they are just fixing issues you haven't experienced and is probably hard on the patients just like any change, if your parents have formed bonds with even some of the staff who are still there that might make a move harder just as leaving friends might. However if your parents haven't really formed any bonds with peers or staff while transition is always difficult, at least these aren't factors in the decision. Then the questions are really which facility is going to be best in the long run. I would do some research if it's possible about the ups and downs of reputation, as someone mentioned things are often cyclical and what's more important is how they learn from and handle personnel issues, everyone has them at some point. Fee's are another consideration of course, it does seem odd to me that you have to pay extra for bathing and medication in AL, seems like those are some of the bare basics that make the "Assisted" a need over IL. But I also know places are all different. You will always need to keep up on things, make sure needs are being met they way they should be but it would really bother me that things I am paying extra for aren't getting done without my oversight, I would have a discussion with the person in charge about that. But if in general you and your parents have been happy with the place they are in I wouldn't be quick to leave I might spend a bit more time trying to get explanations (hopefully satisfactory) and giving them time to correct things. However if you and or they really aren't happy with the majority of things I would spend more of my time really researching, visiting the other place and talking to both residents and staff then do the same with any other options and make your decision about whether or not a move is worth it. People's views vary and there may be as many people saying good things about the place they are in as this new place, you never know when they got that view (maybe their impression is based on 5 years ago) so making your own assessment is important. If it makes sense for one or both of your parents to go look with you, great do that too. I recognize that can cause more problems than help with some LO so just a thought, you know yours best.

The long and short of it I guess is even in the best of circumstances moves, changes are tough so weigh all the factors that apply here and I think the answer will be apparent to you, you obviously care about your parents and are vigilant about being aware and trying to plan ahead and gather info so I think whatever you decide now and in the future will be the best decision for them.

It can be pretty disruptive to make another move if they are fairly well adjusted to their current situation, so first try to determine if it's a systemic problem or a shorter term 'bump'. Sometimes, ALs have a period of unusually high staff turnover and on-boarding new staff can create short term issues with care delivery. Be up front with the executive director and nursing director. Tell them about your concerns and say that you'd rather not move your parents if it's a situation that is improving, but that you want to hear their assessment of how the situation will be improved.

I’d suggest you have an outside needs assessment done on your folks. Contact your AoA - Area on Aging to see who does these OR have a frank conversation with the SW or admission where they currently live as to who does independent assessments.

It may be - and this will be hard to deal with - that 1 parent is ADL ok for AL while the other is more frail and truly needs skilled level of nursing care in either a NH or MC with a better than average MC staff.
If $ is no object, a NH will take both in and they share a room with each at private pay rates even tho’ 1 may not actually need skilled. But if Medicaid is involved in covering cost, the needs assessment will be the determining factor as to if 1 goes NH and the other stays AL. As far as I’m aware there is not “but their married” exception to have them stay together to the being “at need for skilled care” rule for Medicaid eligibility.

I will echo Daughterof1930 experience as to the cycling in & out of better staff at facilities. New place opens & offers more $ per hour and staff moves. My mom’s first NH when she finally moved in was quite different than what I toured 2 months earlier. Ownership was same & based in another TX city, but administrator left and within mom’s stay there it was 3 different ones, plus SW & admissions gal left. Last straw was the MD / medical director told me he was not going to renew his contract for the incoming year. The DON had obvious staffing favoritism as well as for steering hospice placement. Between that and the pharmacy supplier having similar corporate adresses and agents names to facility ownership, I filed a Stark Law complaint on NH 1 after I moved my mom to NH#2. Mom’s Medicaid took almost 6 mos to clear and then like 2 months to straighten out billing issues. I moved her to another & eons better NH with an open Medicaid bed at month 9.

Moving can be done but will be a bit of a ballet to do. I was lucky as the new #2 NH sent out their 2 person assessment team to visit my mom and steered me thru how it was best handled and timed. She was on Medicaid, and Medicaid allows for lateral transfers without penalty. I gave 2 weeks notice but technically did not have to as Medicaid pays on real time daily census to the NH.

My understanding is if they are in AL, the AL facility does not have to provide oversight for their move to another AL or to a NH. If they are in AL, they are consider to be fully capable by & large and in theory just needing some assistance. Often the issue is that AL and family downplay or ignore that their elder has crossed their ADL ability till it’s beyond the pale. This is why an independent needs assessment is important. AL by & large is private pay and you cannot overlook the
profit motive of the AL; they know how your folks roll so will overlook issues till it gets just too, too problematic. Then it’s “we love them but they need a higher level of care” storyline from the AL.

It’s only if they are in a SNF aka a NH, that Medicare and Medicaid will require a facility to ensure a continuity of care by the move. AL does not have that requirement as it’s just assisted living.

Separating couples can be very hard & filled with angst. My aunt was totally NH but uncle was AL; they fortunately had $ to private pay for both to be together in a NH. She predeceased him and he stayed on in the same room at the NH. Only cause they had the $ to private pay.

If medicaid will be filed, see if there is a tiered facility - the type that goes from IL to AL to NH & likely has a hospice wing or MC - that they each can go into at the appropriate level of care and accepts Medicaid for NH. At least this way they can visit regularly. Plus easier for family to visit. Good luck.

My mom was in the same facility for 8 years but the rate kept going up and was no longer affordable. I toured another nice place in her area and she agreed to move initially and then for a month between the decision and the actual move she called me everyday and asked if she could figure out a way to stay, by taking on a roommate, etc etc. The thing is, she had thought she would be in the same place until death and since she worried about what would happened to her furniture and clothes after her passing, she now worried about what would happen to her things when she moved. I could not convince her that she would be taking things with her and the day we arrived to move her I found out she had given away almost all of her clothes and furniture. So no matter what you do, there will be surprises along the way. My mom is doing fine now at the new place although she has not made many friends because she can't remember people's names and after 6 months still feels a little like an outsider.

My dad has moved a total of 4 times over 8 years.
As his needs change, I *have to* know that he's safe.
And I will not allow facilities to rip us off, spending the kind of money we do on care. It should be a 5-star experience! It's simply unacceptable.

I make complaints to the higher management, to the state...
I'm an elder advocate!!

I have really tried to work with the facilities, yet when I have to hire my own caregivers to make sure he's good, then it becomes impossible and unsustainable. Then I have no choice. I do what I have to do.

I know it's challenging and difficult...

All the best to you and your parents!

A move is "easier" if things are set up as much as possible in advance.
If you can gradually take clothes "to be cleaned" or changing winter to spring clothes. Take some of the nick-knacks to be cleaned or repaired..
The day of the move have an outing scheduled and have someone come in move all the rest of the items to the new home. Have the new room set like the old one as much as possible. When you return from the outing to the new location when they see their belongings it should be more comforting.
If you can before the move if you take them on a "visit" to the new location so they can get a feel of the place, arrange a lunch or dinner there so they know the dining room, some of the staff and sort know their way around. When they move in some of what they see would be familiar to them.
It will be a bit of an adjustment and don't be discouraged if they decline a bit, or tell you they don't like it there, they "want to go home". Just tell them they are safe, they are home.

They will adjust. Get them the best care they can afford. You will be more at ease. I moved my mom. It was far less of an issue from what I imagined it would be.

It will confuse them initially but please do move them as soon as possible. They will adjust.

Your parents need to receive proper care and you do not need the stress of having to do battle with what sounds like a sub-standard AL.

Yes staff turnover is a given but that is no excuse for neglecting vulnerable residents. I would also be leaned more towards communities with fixed monthly fees for all services. My M-I-L has been in a small (32 beds) AL for 2 1/2 years now. We've only had one issue with staff in all that time and it was relatively minor.

Where we live the various facilities tend to by cyclical in being the “good” and “bad” ones. Among the nursing homes the good therapists will all suddenly move to a different place. Or there will be a corporate buyout of a place and new owners will either make it far better or far worse. My dad is still in his home but he has a network of fellow elderly he knows and they all keep up with the scoop on what places are the ones to go to or avoid. When an assisted living starts wanting you to pay extra for what should be normally provided and then not providing it, I don’t think it’s a bad idea to have your radar up and be thinking about moving.

Thank you for you advice. My dad says he just feels better after his showers. Has more energy. Helps with the stiffness in his back. Will definitely talk to him and see how he feels about cutting back a little.

Such a hard decision and an all too often situation. We have had to move my parents 3 times in the last 4 years. Two IL facilities and then to AL in the second facility 3 months later. My mom with dementia had adjustment issues for several months, but then settled in.
Problem is all the facilities seem to have staffing issues at one time or another and the food gets boring and tasteless after a while.
On a practical note, why daily showers? Most elderly people are good with 2 or 3 times a week at most with daily washing of critical areas. Skin gets dry and they get exhausted from showers. You might re think that...and you might consider an outside agency coming for some responsibilities.