Can an assisted living facility "force" a resident to use their personal care services instead of bringing in a private caregiver?



Recently we added "personal care" services for my mom at her assisted living facility. Although, now it seems best for her needs that we bring in private personal care and have someone come in for a few hours a day at different times of the day.

It appears the AL staff is extremely reluctant to now end the current care plan and is almost "forcing" us to keep it with them vs. letting us hire a private person to give her the 1:1 attention she needs. Can they do this? Can they "force" a Resident to receive this care from them? This doesn't seem right, much less legal, etc. And as everyone knows, it AL add-on services are extremely expensive, not very cost-effective and very little value added.

As with all AL facilities, this place is understaffed and they can't "deliver" on what they've promised and what we've agreed to. It just isn't working and we don't see it improving. A few staff members are having to "serve" about 40 AL residents. Mom really needs, and would prefer, a private person to give her 1:1 attention versus having the AL staff "dash in/out" and rush because they have other residents to attend to.

Please let us know your thoughts. Thanks!



The only thing I can think of that would give the AL pause is that outside caregivers may not be covered under their insurance. If the caregiver should be come injured while caring for Mom, he/she could sue the facility and they don’t want that. They’re just doing CYA.

When my mom went to the SNF, they told me she needed a sitter. I’m still not sure she did (at $25 p.h. self pay) but anyway, we had to use an agency recommended by the facility. They probably had a “business deal” with the recommended agency, but it was approved by the facility so all was well. Because of possible lawsuits, every caregiver including Hospice, who enters the premises must be sanctioned by the facility. They have to sign in and out.

You may want to check with the facility and see if there are any healthcare agencies they work with.
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Reply to Ahmijoy

We have used private caregivers for my mom since she moved into AL The facility where she was living was very understaffed and we had my mom on the highest level of care and the private caregivers were there as companions and provided my mom with one on one time which mom likes. The caregivers were advocates for my mom and would make sure the facility was providing the care that we were paying for, so this meant constantly buzzing for help to get them to change her depends, shower her and provide assistance with the ADLs we were paying for. When the problem of understaffing continued I went to top management of the company which owns the facility and cited specific instances of lack of care for my mom. I kept being told things would improve but they did not. I ended up moving mom into another facility which provides the care she needs so I now do not need to use private caregivers unless I want them to take her on an outing. So for me the private caregivers were my eyes and ears to advocate for my mom as many seniors can t do this. I would recommend sitting down with management and going over the care plan you are paying for and get specifics on time of day they are to perform each task and hold them to it. I did not get approval to bring in private caregivers as I hired them myself and did not use an agency. And they were not providing hands on care. The facility does not need to know if this person visiting mom is a friend or hired help, especially if you do not have them doing hands on care. I have not heard of a facility restricting friends from visiting. Good luck.
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Reply to Marysd

Didn't see anyone else mention this so I'll add my thoughts and that is to check your contract with the assisted living facility. It may include a provision about personal care services.
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Reply to annandpaul1629

rddagg, I can understand your concern about your Mom needing 1:1 personal care.

Now, where your Mom lives, if this is a nationwide corporation facility, there could be rules that no outside help from private Agencies are allowed to come in to help. It could be that the facility hires from an Agency that is on contract with them. It is possible if there is a contract for your Mom's caregiver, it is for a certain amount of time.

When my Dad wanted to move into Independent Living, he wanted to know if his private caregiver could come along. The cargiver was from an Agency that was licensed, bonded, insured, and that had workman's comp. The facility still needed to vet the person to make sure the caregiver was up to date on her flu shot and TB test.

The facility gave the ok to have the caregiver who was there just mornings, it gave my Dad a good routine. The facility said that if the residents sees a new person out in the hallways, the residents get concerned. Since the caregiver wore a standard uniform, beige pants and a polo-shirt with the company name on the front, it made the residents more comfortable. Dad's caregiver was very friendly, and eventually everyone knew her, including all the staff. So this worked out well.
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Reply to freqflyer

When my mother went into a nursing home, we inquired about having a physical therapist come in. They told us we couldn't because of liability issues, in case she got hurt. Since my mother wasn't cooperating with in house PT, anyway, we didn't pursue. We we do have is a "sitter" coming in 3 days a week, because we live 800 miles away. Not only does this give mother visitor to help keep her alert, it provides us with eyes and ears on the ground there. No question in our mind that she gets better care because of the "sitter" who will complain to management if necessary.
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Reply to rusbar

I would request a meeting with the highest level at the facility that seems appropriate, you have a right to ask and to arrange what you know your mom needs!
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Reply to Zdarov

Is there an option to move your mother into Independent Living? My friend had her dad in IL with private caregivers right up until he needed NH care. When he was failing, she interviewed the AL and they told her not to move him- that they couldn't replicate what she already had set up for him in his IL situation.

I think in addition to the insurance/liability considerations , there is a problem with one resident in AL getting individual care. It causes resentment among the other residents and their families. They don't understand (or don't care?) that the family is paying for the care. It looks to them as though one resident is being given more attention. Sometimes AL can be a little like high school so you don't want to antagonize the other residents, for your mother's sake.

We hired a private duty nurse for my mother as she recuperated in the hospital from a major surgery. Her roommate, her roommate's family and the other people on the floor were ready to get out their pitchforks and go after the nurse because they didn't understand why she wasn't attending to them, too. ("Here comes the Princess on her walk" was one snide remark I overheard. )
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Reply to Marcia7321

Do not let potential hatefulness keep you from getting the appropriate care for your mom, people do not need a good excuse to complain so let them do it, they are not the ones that love your mom and have her best interests at heart.

The AL facility that my dad was at, had a problem with it because they didn't want a regular person, who is a mandatory reporter, to see the lack of care provided.

Are you hiring from an agency? If you are, they have insurance, so that is a mute point. If not, you are not obligated to tell them this is a paid provider, get a contract and pay them enough that they can get insurance, make that part of the contract, this will weed out anyone looking to take a fall and get a big pay-off from insurance. Then have this long lost loved one start helping mom.

If you feel that you are paying for services, not provided, talk to the upper management. Tell them you would like to change the contract and if they get ugly, explain you are tired of paying for services not received. You don't want to make a big fuss, you just want what's best for mom, hopefully, it doesn't involve a move that would allow you to do just that. These added services are big money for AL, of course they are going to buck and snort. Oh well, moms care first. What they are really hoping is that you will continue to pay them for added services and bring someone else in to do the actual work.

I hope you can implement the care you and mom desire for her asap.
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Reply to Isthisrealyreal

My first thought was the same as annaandpaul1629, read your contract and see if it has anything about this. If not or if it doesn't indicate that you have signed away rights to hire someone privately (something I wouldn't have thought to check when setting my parent up in AL and seems like a reasonable right to do) I would start giving some firm, clear but polite push back to the people in charge about how you aren't being publicly vocal about the lack of service you are getting from them at a very high cost (breech of contract perhaps?) or even complaining about it, yet but that can certainly change if they don't start working with you or at least step out of your way. Your LO is your first and primary concern and this is what you feel they need.
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Reply to Lymie61

I hired a personal caregiver several months ago, when my Mom's needs were more than the AL staff could really handle. It's one of the best things I've done! In my case, all parties cooperate well. I believe the AL staff appreciate the extra help, and my Mom certainly likes and needs the personal attention. I think a sit-down with the AL management is a good place to start. Explain what you hope to accomplish, and how it can take some of the pressure off of them. Let them explain what they view as problems. It should be possible to come up with a reasonable solution. If not, consider some other AL facility.
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Reply to billmarting

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