Can Assisted Living force my father to move to Memory Care?

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My father is in AL and originally went in for a 30 day respite stay, but we believe will need to stay due to vascular dementia and not being safe in his 2 story home. He is always calling his friends and neighbors to come get him and either take some things home or pick up a few things from the house. One friend did actually take him to his house once and tried to leave with him a second time (and was stopped). We have told this friend he cannot do that, no matter what my Dad says, and he has promised he won't. He now only visits my Dad for lunch or dinner at AL and then leaves. This friend came to visit my Dad on Sat and my Dad thought he was going to take him home to drop some clothes off. When the friend arrived and saw my Dad with clothes in hand, he immediately took my Dad to his room and hung his clothes back up. They never even came close to leaving the facility. The head nurse called my sister and said that since he continues to try and leave they will have to move him to memory care or we have to hire a 'sitter' all day. While we were trying to figure out what to do on a Saturday w/ short notice, they got him to go have lunch with someone he knows in memory care and then wouldn't let him out until we hired a company to come sit with him during the day. He was very confused and upset and even the nurse from the outside care group thought what they did was ridiculous. Can they "force" us to move him to memory care? We just talked with them a week ago about how he wasn't ready to fully accept he was not going home and we would work on distraction techniques when he was asking about taking clothes or getting clothes from his house. This just seemed a bit extreme to me and put my sister and I in a very bad position.

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They can't "force" you to put him anywhere, but they can evict him because he needs more help than they are able to handle. I know it seems to amount to the same thing, but you are free to place him somewhere else.
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Who was taking care of your father before? Is he competent to live alone? If not, then, I'd likely discuss it with the facility, his doctor and even an attorney about the options.

I don't know the laws in your state, but, when my LO started trying to actually leave the regular AL facility, it was described as wandering. She was actually going into the parking lot and asking strangers to get into their car. At this point, the facility had to assign her a person to watch her constantly around the clock, since she is at risk to leave and this is UNSAFE. She had significant dementia at this time. The facility could only assign her a one on one person for a short while, though, then it would be up to the family to hire one or she would have to leave. Her level of care was greater than what a regular AL could provide. Her doctor prescribed Secure Memory Care at that time.

I can see how a facility would be afraid of liability and the safety of the resident. If no one else will transport your dad, then what's to stop him from walking away, walking into traffic, getting lost, robbed or getting into the car with strangers. It's a liability and safety issue, imo.
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I have to believe that the NH was just trying to keep your dad safe. My mother’s facility handled this by having 2 meetings with me. The first time they caught her trying to get out of the building, they put an ankle monitor on her, which she sawed off with cuticle Scissors two days later. They fixed the strap and I took the scissors, but somehow she managed to cut the second one off too. This was in addition to wandering into other people’s rooms and stealing their possessions. They told me if she wanted to stay on the main floor, I’d have to get a sitter—at $50 an hour, self-pay. We moved her to the Memory Care unit. It was a very good choice for us.
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My sis works at an AL, and the premise is that people living there can manage on their own with minimal assistance - bath help, pill distribution, meals and housekeeping. More and more people are living there with various levels of dementia - some don't fully disclose when they enter and some are long term residents who are aging - and it is causing all kinds of stress for the staff. Sis is a receptionist and on evenings and weekends the only person working on the main floor at the entrance, it shouldn't be her job to chase residents out the door but she often has.
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You stated: "My father is in AL and originally went in for a 30 day respite stay, but we believe will need to stay due to vascular dementia and not being safe in his 2 story home."

Obviously your father cannot be left alone in his home - if he lived alone, this is not an option (which you are aware of.) Given that you believe he needs to stay at the AL because he is not safe in his home, why would you believe he is any safer in the AL? There are NO safeguards for AL residents as far as leaving the facility. If a staff member happened to see him, they *might* be able to stop him, however there is no guard against leaving the facility!

That his friends/neighbors are on board with not agreeing to take him out is also good.

However, it sounds like he is at that point where he might try to leave on his own, or enlist some unknown person to help him "escape" or go home. Although I would agree that "kidnapping" him might seem like they are going behind your back while you and your family were assessing, their reasoning may have been acceptable. You are not there to see what was going on, so it would be best to ask. If he was indeed making other attempts to leave, then I would lean towards supporting their decision, to keep him safe. If he were to leave and get lost or worse, they probably would have a liability issue. They have to protect themselves from situations like this. Even without consulting them about it, you stated that they said "since he continues to try and leave they will have to move him to memory care or we have to hire a 'sitter' all day." That sounds like perhaps what was happening. Again, if you are not there, how would you know how often he attempts this, alone or with someone besides his friends?

Can they force you to move him? Probably not, but as others have said they CAN request you make other arrangements, such as hiring a sitter or moving him to another facility. We were advised at one place we were checking out, and asked about this at another, that if the resident becomes an issue, they CAN give notice for you to find other arrangements. You would have signed paperwork with them - please review that paperwork and you will likely find something about this situation.

With dementia he most certainly could end up being confused and upset because the "new" place was unfamiliar (and he could not find the door to get out!)

You also said: "We just talked with them a week ago about how he wasn't ready to fully accept he was not going home and we would work on distraction techniques when he was asking about taking clothes or getting clothes from his house."

More than likely he will NEVER be ready to accept not going home. This should not be the deciding factor between AL and MC. Our mother, in MC, was in this mode for 9 months, but most recently "home" has moved back in time to a previous location (this does happen.) She will still periodically ask about getting a ride "home", which is now that previous home (sold 23 years ago) or even better, a ride to Nana's, which is a reference to her mother who has been gone almost 40 years! There is another woman there who would ask everyone who came to visit someone in the MC unit if they could give her a ride to her mom's for a visit. Highly unlikely her mom is still alive! Dementia IS a progressive disorder, and like with children/toddlers, you need to be aware of this and be one step ahead of them!!!

Additionally, distraction techniques only work while you are THERE. If you are not there all day, distractions will not work. Distractions only work "in the moment"; later, even minutes after you are gone, the thoughts to leave, go someplace, or whatever is bothering them, will return. Short term memory is the first to go, which is why distractions only work for a very short time and why repetitive statements, questions and thoughts keep coming back (including the need to go home.) Distractions and redirecting are used to get a person to refocus on something else and once that succeeds they will be okay, for a while. Every so often mom would get the staff to call me and then she would ask me for a ride home because she is at a hospital she used long ago for various medical issues, no where near where she really was, and say she is not sick or anything, just needs a ride home. When I give my excuse (too late, too busy right now, maybe tomorrow), they in the background assure her that she has a room for the night. That satisfies the urgent need, and then the idea is forgotten until the next time! If you are expecting the AL staff to do this distraction and redirecting, you do not really understand the difference between AL and MC. MC staff DO understand these issues and have experience with distracting and redirecting. AL staff are there to assist residents PHYSICALLY (MC residents sometimes need this help as well, but AL is only for physical assistance.) They may be aware of these techniques, however it is NOT a part of their general tasks.

When we were checking out places for our mother, my younger brother was adamant that she would prefer the AL rather than the MC. My argument was exactly what your dilemma is - there is NOTHING in place to prevent the resident from leaving. A secondary argument for me was that she did not NEED AL help - she is still doing basic things by herself, and needs no assistance yet with walking, bathing, dressing, etc. Although eventually she may need this help, MC provides that as well. AL, as others have stated, is for people who need assistance, such as meals, bathing, cleaning, etc, because they have difficulty with performing or are physically unable to perform these tasks. They are not "flight risks" at that point. Many have wheelchairs or walkers. His arguments were that she doesn't wander, and would not want to be in with a "bunch of old farts." Most AL residents are not "old farts", and not all in MC are either (there is one woman in her MC place who is in her 50's!) His argument that she doesn't wander doesn't hold water either - 1) because she was familiar with and self-isolating in her condo, 2) because she had not reached that point, though not all dementia patients would wander and 3) since she keeps harping on going "home", she most likely would have exited the facility (several times recently she has either stated that she wanted to walk to my place or got so agitated one evening that she put on her coat, took her purse and was adamant that she was going to walk to her mother's place!) During that initial visit with mom, the facility staff response was no, she would need the MC. He finally relented, but probably not wholeheartedly.

Given your dad's history of attempting to get others to take him home, and the possibility that he may have attempted to leave without their assistance, along with diagnosis of vascular dementia, I would highly recommend you consider allowing the move to MC. If he continues to make these attempts, moving to another AL is not the answer, and other ALs may reject him due to this issue. Even if they did allow him to move into another AL facility, the confusion and upset will likely happen again or continue, as it is not the place he was in and the surroundings are different (dining area, etc.) A move to another place will not stop his attempts to go home. Once his "familiar" items are in the new MC room, he may settle down. He may not settle down, but given that MC staff should know how to "handle" him versus the alternative of him getting lost or worse - do you want to take that chance?
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Same thing happened to my Mom. She was in AL for about 3 years with no significant problems of dementia. She needed help with pills and meals. Unfortunately her dementia progressed. First sign was wandering halls at night, followed by entering other resident’s rooms and finally wandering off the premises endangering herself. Our choice was to hire someone to watch Mom or move to Memory Care. We chose MC. First one okay but went downhill when director changed jobs. Moved her one year ago and we LOVE the new place. We are active with checking on her at different times of the day. We picked a place that has an Activity Director assigned to Memory Care and she keeps Mom socializing. And...if this MC unit changes to the negative we will move Mom elsewhere.
Sounds like it is time for you to move your father to a good Memory Care Unit - hard fact to swallow. But you will be happy knowing he is safe and being well cared for - good luck!
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The facility my mother is in told me if she was a flight risk she'd have to go to memory care. Since she is too lazy to leave her room, I don't think it's happening soon. I have seen some residents move to memory care here. Unlike the nab and grab you describe, it's a process. And it always involves the family. Now the facility has announced a new program for lower level dementia. Residents stay in their AL apartment and are enrolled in special programs with more prompts and activities designed for them. Of course problem behavior could mean a transfer. I hope this works for us.
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aelkins, we need to keep reminding ourselves this is our first rodeo. The senior facility has been on this rodeo hundreds, if not thousands, of times, thus they are familiar with what is best for the patient.

One thing to remember, you are not there 24 hours a day to see how Dad is reacting. After hours he could be sundowning and wandering the building, wanting to walk out the front door.

I remember when the Staff at my Dad's facility, where he was living in Independent Living, told me it was time for Dad to move into Memory Assisted Living, or to hire 24 hour caregivers to watch him. It took me totally by surprise even though Dad's private hired morning caregiver was telling me Dad's memory is slipping. The Staff said Dad was wandering, so that was major in my book.

I did a "therapeutic fib" with Dad regarding him leaving his really nice apartment to go into a studio apartment, told him it would be a lot cheaper.... when Dad heard "cheaper", he was ready to move to his "college dorm".

Now I could sleep nights now worrying about Dad walking out the front door :)
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The AL's job is FIRST to keep your dad safe, in this case, inside the unit. They have identified him as someone who is attempting to elope from the facility several time.

Ask for a care meeting immediately. You need to find out if they can keep your father safe at the level of care he is currently mandated to receive.

Some AL's do dementia better than others; it sounds as though this AL is not going to provide the right level of care for your dad.
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Thank you all for the responses and advice. I went to visit my Dad this past weekend and meet with the director and head nurse. Since my Dad only seems to pack up and try to leave with this one particular friend and I deleted his number out of my Dad's phone, they agreed to try and pull back the sitter and see how he does. We will meet again at Thanksgiving and make a final decision. I also met my Dad's OT who said she does not think my Dad needs to be in MC. So it is really just a safety/liability issue for the ALF, which I understand.

Like one person said above, this is my first rodeo so I am just trying to do the best I can and take it day by day.
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