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How can I approach assisted living about an issue my dad is having. According to the physical therapist, his last two meals were untouched and he is getting noticably weaker. He says the food doesn't taste good but actually it makes my mouth water so I know it's fine! He didn't even like his favorite dish last night at my house so it's something else causing him to not want to eat.


Anyway, it's ASSISTED living. I'm sure they don't track food consumption, right? If I do say something, what can they even do? If I don't say anything I doubt they'll know.


He had an episode I caught on camera which he doesn't know I know about. I'm sure he's very embarrassed but he didn't make it to the bathroom and had a big mess on his hands with poop everywhere. They helped him and it all got straightened out... but I'm wondering if he is withholding food for fear that might happen again?


I have been nothing but a pain in the butt for the past two weeks with assisted living managers about his continued decline. He hasn't lost any weight (yet) so I don't want to appear to be a "Chicken Little" always calling them.


But don't you think they would notice this not eating themselves?

Marydys, my understanding is that there are basically 2 versions of ALs in terms of extra services. Some ALs do not charge differently for different levels of care. The argument here is that you'd prefer to know what the cost is. (Of course, I think it might go up more when it's time to renew the lease!) In this version, you can't pay more to get more services, which it sounds like is the case for your father's AL. Other Als have some sort of point system, where you pay differently according to your level of care, and as the level changes, what you pay monthly changes. For example, if you didn't need help with showering when you moved in, but later did, you would pay more (not the day you first asked for help, but if it became the norm, then your rent would increase). That might be a better model for your father.

Did the AL not discuss with you or with you and your father before he moved there what levels of services they provided, and whether their AL was likely to be a good fit? Obviously, they want to recruit residents, but not to recruit residents who end up leaving in a few months!
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Start asking them to weight him every morning and keep a record that you can check. Then, you'll know if he is losing weight.

As for meals, some seniors won't eat more than a few mouthfuls at one time. Try giving him snacks of supplemental drinks and bars to have near him at all times. Sometimes the snacks are a way around this problem.

If he is still not eating, consider talking with his doctor about the experience you witnessed and his lack of eating. The doctor will check to make sure there isn't a physical problem. If everything checks out fine, then a referral to a geriatric psychiatrist may be needed.
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AL, MC, SNF, If food is placed and the resident does not eat, plus it is not an issue with swallowing, then the resident can refuse. It may mean that his body and digestive system is shutting down. Of course he is getting weaker. He may be able to get by with supplimental drinks. I recommend that he sees his doctor for recommendations for which types. Someone will have to bring the drinks in for him since ALs do not provide these. They can be ordered to be delivered. But once he tires of the same ones, he may begin to refuse again.
My story...my 98 year old mom started to have a decreased appetite a year ago. Her doctor did order the drinks which she took about 75% of a bottle each day. She is down 25 lb, her muscles are wasting and she started falling last week with an injury that put her in the hospital. With this visit, palliative care contacted me. I heard them out and I know that my mom senses she is getting weaker. That does not mean that she is ready to increase calories. The hospice decision is made. Staff will continue to offer but will not force. She is on comfort care now.
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Not to be rude--but at 93, what are you expecting him to be?

He is in a NH facility b/c he can no longer care for himself alone, right? I think that perhaps you thought this place was going to restore him to his 40 years ago stage, and that doesn't happen.

IMHO--placing someone in a NH usually results in a downward spiral, to a degree, as they acclimate (or not) to the new living situation.

He probably does need a checkup and baseline workup. He may simply be growing older (well, of course he is) and you don't see him everyday as perhaps you did before, so the deterioration is more apparent.

When mother had to put Gma into a NH, it was shocking how quickly she went from 'needing a little help' to dying. Actually, she'd be living at mom's for a week and it wasn't working, so mom put her in the NH that grandma chose. She went downhill so fast--and at age 95, that was fine. Gma wouldn't eat and barely drank. It's been almost 28 years and mother STILL feels horrific guilt about it, even tho gma was where she chose to be.
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caroli1 Mar 29, 2021
I believe he's in assisted living, not a nursing home. The description of her father does seem to indicate a large number of health problems, in addition to is being 93.
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Hmm, he's on a slightly different med than before for his bp, but it's the same general kind...a steroid...but that could be it. The side effect for that drug is USUALLY weight gain, not loss of appetite. The doc is going to see him tomorrow. He's fallen 4 times, sprained his ankle pretty badly then seemed to get better and now this diarhrea thing that NO ONE reported to me (I just caught him getting help cleaning up on the camera). And now this really strange weakness that is way different than he was just 3 days before. All since move in day of March 5 (today is the 22) so 17 days? Anyway, I think I've said all that already. But knowing that the nurse is "measuring up" all these events is good to know. He's has only mild dementia but is nearly deaf... and I can see his dementia get worse when he isn't feeling well or is tired. but I guess the next thing is memory care for him. I really hated to have him around people he couldn't socialize with because he loves to be social... but if assisted living is for people who can take care of themselves, that's not him.
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MJ1929 Mar 28, 2021
Memory care isn't full of people who can't socialize -- quite the opposite.

A good memory care will have those who are still high-functioning doing things together and the lower-functioning ones doing their activities with caregivers.

My mother's memory care has more people who are still pretty with it than those who aren't. Before Covid, I regularly talked books with one resident who's a retired neuroscientist and visited with another who was a retired city manager. Another one was an RN who knew exactly what memory care is and was mighty bent about being put there, but she was part of the girl's clique within a week. They even havea guy in there who's only 49 and has two elementary-age kids. Nice guy and I have no idea why he's there, but he either has early-onset Alzheimer's or had a head injury. Either way, he assists the caregivers with getting out the silverware for meals and watches a lot of sports with the neuroscientist.

It's harder on someone to be in an AL with people who avoid you than it is to be in a memory care where there are folks who are more like you. Don't worry about the socializing, because that's what memory cares emphasize.
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Well, there really IS an adjustment period when an elder of 93 goes into Assisted Living. There's no escaping it, either. He may feel disoriented and out of sorts. He's eating new food, too, which could be disagreeing with his stomach & giving him some diarrhea. It's not an ALFs job to monitor what a resident eats or doesn't eat; that's more of a Skilled Nursing or Memory Care's job, in reality. Assisted Living is intended for fairly independent elders who require minimal care in general.

If your dad is not losing weight, he's not in immediate danger from lack of calories.

Let the doctor come in and give you an evaluation. The nurse on staff at the ALF should call you if something is awry, or if she feels your dad is ill or needs to go to the ER.

Every time there's an 'incident', such as your dad having a diarrhea blow out and the staff needing to clean it up, it's written down in a book for the next shift to see and so it's charted for reference purposes. The nurse will look at that book to see if she thinks a pattern is developing; if he needs urgent care, etc.

Not eating much, in and of itself, is not really cause for a huge amount of concern, especially when there's no accompanying weight loss. That's not to say there cannot be a medical issue going on; there certainly CAN be, especially at 93. Things can change on a dime at that age. So it's important his doctor comes in to see him and do an evaluation asap.

That said, is your dad taking any new meds, especially pain killers? When my father was taking Tramadol for pain after hip surgery, everything he ate tasted foul. It turned out to be the MEDS causing the foul taste in his mouth, we came to learn. If there are any new meds in his life, that would be the first culprit to be suspicious of.

Good luck!
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I would get his doctor (one who knows him, yes?) on this right away.

Did these episodes of weakness and not eating start AFTER the falls? How closely was he examined after the falls?

This doesn't sound like an adjustment problem; it sounds like a medical issue.

My mother was briefly in a nice AL. It was completely the wrong level of care for her; she was having a medical issue (episodes of VERY high blood pressure--in the 200s) and it was badly mishandled, in part because they didn't know my mother and WE didnt realize the level of her cognitive loss. (Ex., she took her bp, saw the number and went to the nurse and said "I think my bp machine is broken". Nurse labelled her a chronic complainer(!) Dr. who called in several times a week was unavailable that week, so it wasn't until my SIL found mom unresponsive in her room that she got care (as in ER).

Get dad the medical attention he needs and make yourself as big an annoyance as you need to until he gets seen.

Then re-evaluate if he's in the right place. We moved my mom to an Independent Living facility with better on-site medical care and she was much off.
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marydys Mar 22, 2021
I'm confused... she was in assisted living but she went to Independent living and got better medical care? Yes, I'm thinking he is at the wrong kind of facility. I didn't want him to face memory care if he COULD enjoy and do OK in assisted living and he really wanted "an apartment", not just a room. But this isn't working. He has such slight memory loss but between that and him being basically deaf and now needing more care for this weakness issue....
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Mary, if he's being offered his favourite foods and says that they don't taste good, and this is new, there is something wrong. Could be a dental problem, could be thrush, could be reflux, could be a stomach upset (which would also explain the other end) - but anyway, *something.* It wants checking out.

I don't work in a facility - I belong to a community-based team providing short-term services aimed at helping people live safely and sustainably at home. Quite often they've been discharged from hospital, sometimes they have longstanding mental health issues; but in any case if there's any question that poor nutrition is a factor or a concern that's something we monitor.

Has your father only been in this ALF for two weeks, then?
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marydys Mar 22, 2021
Yes, only a couple of weeks now +2 or 3 days. I am having his doctor see him tomorrow. He has changed so much in only a few days! I am agreeing with you on the diarhrea thing and the doctor says the same, it's probably related to why he's not eating much... but he isn't complaining of any stomach issues AT ALL. Thanks for your help... I'm sure the doctor will want to know more about how his meals are tracked. He works at this facility a lot and knows the care team so I think he can make things better. I hope so anyway.
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Is it possible he has lost sense of taste and smell? If so, I would maybe consider Covid. Some people I know who have had it say everything tastes bad or has no taste.
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marydys Mar 22, 2021
No, that's a good thought though. He's had the vaccine and completed it in January. He has no other symptoms except weakness.
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You've noticed loss of appetite, change in taste, and at least one episode of violent diarrhoea. So, when you say you've been a pain in the buttercup with the ALF managers for the last two weeks - what have they had to say for themselves? What are they monitoring and what medical advice are they getting for him?

I doubt if your father is starving himself for fear of another explosion - I'd be more worried about the nasty taste he's experiencing, and what's causing that. Meanwhile, though, I know that we use two different charts for clients we have concerns about, one for Fluids and one for Nutrition - everything the person is given to eat or drink is documented, along with whether or not it was consumed and how much. It isn't difficult to do, and I'd expect the facility to use something similar when necessary. Have you asked?
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marydys Mar 22, 2021
He didn't say anything tasted nasty, just that it didn't taste good. I've had their meals, this place is known for their meals... they make my mouth water. And he didn't eat his favorite dinner which we made for him last night. I'm glad to know that you use a chart and are keeping track of this at YOUR assisted living. I have not asked as I seriously have been a royal pain to management this whole time (he moved in only about 18 days ago). I have called his primary to give him a heads up. He's familiar with the facility and does house calls there. He's just continued to decline every day since we placed him and I'm very concerned.
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He hasn't lost weight? Really? But yet you are this worried? I am not certain I understand. I will tell you that the elderly need VERY LITTLE food to sustain life, and that appetite decreasing is often a part of aging. Until I saw something to be concerned about I think I would not worry over much. I imagine your Dad does have a medical doctor. If you are truly concerned after a month's time (in which you should know if there is weight loss) you might consider a visit to his GP for a checkup.
As far as being a "chicken little", if your Dad is new to ALF then they may expect to hear from you more. But if you recognize that you are being too bothersome then it is a good time to take some control over yourself. They do have care levels that can be bumped up. If you want his meals monitored that can likely be done for a fee.
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marydys Mar 22, 2021
He's just declined a LOT since moving in about 18 days ago. He is weaker than I've ever seen him even weaker than after heart surgery 2 years ago. He fell 4 times in the first week. He went to the doc on Thursday. His BP is OK. His weight is the same (157) . It's now Monday and now he's so much weaker than even Thursday.... and just sleeping all the time. He never did that before either. All I can think of is he's not eating and the physical therapist said there were two trays of food untouched. She said he's not acting like his normal self either (he's a joker). And he didn't eat his favorite meal at my house last night. He's always had a good appetite so this is new, as is the weakness. I have called the doctor and hope to hear what he recommends soon. Maybe he is depressed or something. My issue is how to talk to the assisted living people who really are quite fed up with me. I'm not imagining it. They recognize my voice on the phone! They don't realize that this is not dad's norm and so they think I'm alarmed over nothing. "There is always an adjustment period" etc. And NO, they won't let me up his care level to get more help. I actually TRIED to pay more to get him more help, such as getting him to activities and they said no, they don't do that!! (I guess that's better than charging him for services they don't deliver). I've had to hire part time care givers on top of their care levels to make sure he's getting to at least some of the activities he's paying for. I'm very worried about him and so is my husband. Even at 93, a man shouldn't go from walking 1/4 mile a day and eating as much as I do ...to hardly being able to walk and barely touching his food. I'm trying to give this place a good month for adjustment before deciding its the wrong fit and dad needs memory care. But in the meantime I'm worried he'll decline so much while I'm waiting for him to adjust. Man, I knew this would be hard on him, but it is also way hard on me!
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