The staff at assisted living and skilled nursing facilities is prepared to watch out for your parents' well-being, especially as Alzheimer's or dementia progresses.

You should expect them to track your parent's condition in a variety of ways, from conducting major assessments annually or semi-annually to being on alert daily for signs of a decline in your parent's behavior.

But what you are seeing and hearing in visits and phone conversations with your parents also can be advancement into a worsening stage of dementia. Don't hesitate to ask questions about your parent or to discuss any changes you see or hear in their behavior, small or large, senior living facility administrators say. Staff at senior living communities should be willing to discuss any questions or concerns you have.

"I always think it is so important. The phone calls that we get from the daughters and sons that are not here, they say that they are hearing things over the telephone that perhaps don't sound too good," says Shona Alexander, a nurse practitioner and director of clinical and home care services at Park Springs, a senior living community in Stone Mountain, Ga., with assisted living, skilled nursing and memory care units. "They feel so helpless that they can't be there to help their parents."

Regular assessments are critical

When someone moves into an assisted living or skilled nursing facility, an individualized service plan is created to outline the resident's current needs and the services the facility will provide.

Service plans are required to be updated a certain number of times as a year, depending on the state, and after a "change in condition," such as a hospital visit. Ask the facility how often they are required to update their service plans, or check with your state, through agencies such as departments of community health or health care services.

If you can make it, attend a meeting to discuss the service plan updates. If you live out of state, you should expect someone with the facility to call you about changes before providing a copy of the service plan to you.

Some family members also set up more routine visits or phone calls to discuss their parents' condition throughout the year and to be prepared for future changes, such as moving to a memory care unit or into skilled nursing for more round-the-clock care.

"I've had those hard conversations many times where I say, ‘it's not happening now, but I wouldn't be doing you a favor if I didn't explain to you that memory care is in the near future for your mom,' " says Casey Litton, executive director of Wyoming Springs Assisted Living and Memory Care in Round Rock, Texas.

Picking up the phone

When staff at a facility notices a major change in a resident, they should call the family, Litton says.

She recalls one situation where the staff noticed a female resident wasn't eating as much and not bathing routinely. They conducted a new assessment of her condition.

When changes in a resident's habits or personality becomes apparent, it is important to do a full head-to-toe assessment of the resident to ensure that theire needs are still being met, and to assess if additional care is needed, Litton says. She stresses that a senior community should conduct these routinely and when a change in condition is noticed, or when residents get sick.

Watching out for your parent

At the same time, the daughter, who did not live nearby, had noticed her mother was not calling her as often at night. She assumed her mother was becoming more socially engaged and not as dependent on those conversations. Unfortunately, that was not the case.

They called the daughter to let her know her mom's condition was worsening and that they needed to add some more services, such as helping her bathe and coming to get her for meals, instead of letting her arrive on her own.

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Sometimes daughters or sons will call the facility, simply saying something seems different - even if they don't have an exact example. Or maybe they see a specific change, such as weight loss or are calling because they are concerned about how their parents are handling their finances, if they still have their checkbook.

If you call, ask to talk to someone such as the head nurse on staff, who should respond immediately, Litton says.

If the nursing staff notices a change in an assisted living resident's behavior, or family members express concern, the staff will evaluate them, which may require lab tests, Alexander says.

Depending on how significant the changes, the resident could see their physician for more tests, or may need to meet with a dietician or another specialist. Ask the facility how often it will follow up to monitor the parent, if they are in assisted living where they have more independence. The facility might assess them in a month or two months.

The results could be monitoring the parent more often or adding a medication, Alexander says. Or it may be severe enough to warrant a move from assisted living, which offers more independence, into memory care or skilled nursing.

"We're not perfect in our industry. Because we see mom every single day, there are times that we don't see the change like a family member that comes monthly might see a change," Litton says. "It has to be a team approach."