Hi, a close family member of mine has been a resident at an assisted living facility for about 2 years. It's part of large national brand (Sunrise) that has many, many locations in the U.S. He is paying privately from savings for a one BR and their 2nd highest level of care (about $90,000 / year)

Honestly, about the only staff member who was happy and pleasant to deal with was the admissions director who sold us the room. Pretty much everyone else there has been difficult to deal with or visibly unhappy with their job. They have had a great deal of turnover - all major players - EDs, Nursing directors, etc have all been replaced multiple times.

Everyone I deal with there is unpleasant or hostile. They really seem to be always threatening to raise his care costs. The issue is my uncle is wheelchair bound and hard of hearing and a chronic complainer. He also is someone that uses his call button a lot - he needs assistance with most activities. When the staff doesn't respond quickly, he really gets upset. Honestly, he is difficult to please. However, whenever I talk to nursing or personal care directors, or the personal aids, they never seems to express concern about my uncle's well-being or whether he is happy. They more often just seem exhausted. My uncle also isn't particularly happy there, but he has never been happy wherever he's been. It's just difficult to move and visit a new facility now because of Covid.

So, he is what you would call a difficult patient/resident. Now, his opinion is that for what he pays, he should expect fast, prompt response times. They now want to raise his care cost by 1000/month because they say he is developing dementia and he requires too much care. But, they can't quantify when he crossed over this threshold. When I speak to him, he seems perfectly lucid and not much different than a few years ago.

My question is: Is this what you have to put up in general if you are a demanding/difficult resident? Would these issues come up pretty much anywhere he goes? At some point, do the higher quality assisted living homes just make a decision that a resident is too much work and just try to get rid of them (either by raising their costs/care levels or just evicting them?) My thoughts is that if a facility does not have a problem filling rooms, then maybe they are happy to get rid of more difficult patients? Has anyone experienced this?

There should be a line between thinking that a patient is really developing dementia and just saying that a patient is too demanding and unpleasant to deal with. The explanation they are giving me for the care increase seems to be neither one, but something in between.

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Your Uncle is not a good fit for this AL. ALs are just that, they assist. Staff should not be at his beck and call. He needs to realize he is not the only resident. Maybe he should take what he pays in care costs and hire an aide/s. Or find an AL better equip to handle him. You have ur hands full.
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So, I had my parents placed in Brookdale, which is a corporate owned Assisted Living residence back in 2014; at first, it wasn't owned by Brookdale and everything was fine. Then Brookdale took over and all hell broke loose. Everything went to hell in a hand basket FAST, and every month, the bill kept getting higher and higher while the service kept getting worse and worse. Not ONE bill was correct, either, and I had to spend hours on the phone with 'corporate billing' every month. I finally lost my cool and said ENOUGH. I found a great privately owned Assisted Living residence which was LESS expensive and the care was MUCH greater and I moved my folks right in. I can't tell you the difference between private and corporate; night and day. My dad passed in 2015 but my mother is still alive at 93.5 and living in the same ALF, but now in the Memory Care building. She too became too much of a care burden for the staff at the regular ALF and that, combined with dementia, created the need for the move to the MC section. She's not happy about it b/c in her mind, she doesn't have dementia. But she does. AND she's a gigantic handful that no ALF would think about taking on at this stage of the game.

I also worked as a receptionist for a corporate owned Memory Care ALF before the plague hit. Same exact thing: all they cared about was the bottom dollar. When the owner came in at the beginning of the covid19 outbreak and laughed it off as the 'flu' when another of his facilities had an OUTBREAK, there were a few people who quit on the SPOT as a result. I gave my notice at that point as well.

He's right about not wanting to go into the MC section yet.............most residents of the regular ALF section DO have memory issues; it's not until they get pretty bad and start wandering that they need to move to the MC section. He, like my mother, will be the most lucid of the bunch and that's not a great scenario for a guy who's already in a bad mood, you know? But, if/when he ALSO becomes too much for the regular ALF to handle PHYSICALLY, as my mother did, that in combo with the memory issues will create a scenario where he'll be forced to move to MC. Make sense? That's how most of these places operate.

The staff at your uncle's ALF have an obligation to treat him and his family members with respect and kindness. If they can't manage such a thing, then he needs to be placed elsewhere, in my opinion. NOBODY should be treated badly in an ALF, ever, no matter how difficult they are! Let's face it, ALL of these elders complain..........and they turn it into a competition! Who can be the most irritating! It goes with the territory and a decent staff knows how to handle these residents. My mother has a nurse on staff who knows exactly how to handle her OCD and chronic complaining. She insists on having things done for her immediately, and Nina sees to her every need, thank God. BUT, there are only 23 residents in her Memory Care. When my mother was living in the regular ALF, there were 100 residents and it was not uncommon to wait 20 minutes for a call to be answered. They all hate that, and complain bitterly, but it's the norm wherever you go, unless the staff isn't busy. So, expect complaining wherever your uncle goes, is my point.

Where I think you're a bit off base is when you say you want the facility to confront your uncle directly; they just don't do that. Rate increases and behavioral issues are normally discussed with the POA who in turn can choose to discuss it or not discuss it with the resident directly. That too is the standard across-the-board handling of all matters in residential care, at least in my experience.

I urge you to see about getting him into a different privately owned ALF; talk to the residents and see how they like living there, that's your best best. Make sure they have no virus outbreaks and are accepting new residents, and go from there. GOOD LUCK!!
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Based on your question and respond, I think that he would be better served with caregivers at home. The amount of money that he is paying would get him 3 shifts of caregivers that could provide the 1 on 1 care that he thinks he is paying for.

He is never going to get that at a facility unless he hires an aid.

These facilities are shameless at being greedy. That they have such huge turnover and unhappy employees tells me that it is a miserable business to work for. That alone is enough for me to take my business elsewhere.

You should ask him how he wants to handle the situation going forward.
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Hi. Thanks for the response. Your post was interesting. So, this place does have a memory care unit (secured unit on a higher floor.) The staff has told me that they don't think my LO needs that yet. The issue is that he has seen the patients from the memory care unit on occasion and that alone is upsetting to him. Seeing how much care and how diminished they mentally are I think scares him and it would be difficult to even begin to discuss moving into that type of facility with him.

I just think he is a ways off from memory care based on how normal the conversations we have are. He is showing early signs of some memory loss, but generally can be dealt with through reminding.

Getting an independent eval might be a good idea. The problem is they had a psych NP talk to him and recommend an anti-depressant. The issue is he used to be a pharmacist and really doesn't like taking any meds that he doesn't feel he really needs and he doesn't think his mood is bad. He thinks any anger episodes are justified by poor service.

So, he's not fully given up making important decisions in his life. He let us take care of his financial matters. But, he does make decisions like what meals to select and activities to do and he complains about medical issues and asks to be taken to doctors.

So, the AL doesn't quite know whether to treat him as someone who can make their own care decisions or not. For example, when they told me about the care increase coming, I told them to go into his room and tell him directly. I told the care coordinator to go in and tell him that they think his behavior and attitude is problematic and that they will have to charge him more for care. In my opinion, he is rational and should be able to understand this. Of course, she wouldn't do this, so I told him what she said over the phone. Then they called my back and got mad at me for upsetting him. To me, the only way he is going to modify his behavior is if he is told it will cost him more. This is his money and he should know how much is being spent.
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Especially with Assisted Living, what is charged is up to them; they will charge whatever the traffic can bear. What raises they give is also up to them. And when they decide they would as soon not have a particular senior is also up to them, as well as who they hire, how well they pay them, and what they expect of them as their employees.
What is up to the Senior and his family, his POA if he cannot make decisions (or guardian or conservator) is whether to stay or to go. What is, to their mind reasonable given their needs and how they are fulfilled.
It is also of importance to know how many choices there are of Senior Assisted Living places in your area.
My brother was in his last year plus in a Senior Assisted Living Facility in So. California. His costs were VERY reasonable compared to what they would have been in the Bay Area/San Francisco area I live in. The place he was at was, to my mind, stellar, but I will say that my brother was self-caring, neat as a pin, without needs for medications, on his feet, and exceptionally pleasant to all. His mentation was above the norm for the facility. I visited the facility, after helping choose it, a total of three times. This is what I LIKED about them.
First of all, I will start with the negative of people you love leaving. Several staff members moved on, but they moved to places, for the most part, within their own chain. As to what I liked, I don't know HOW they did it, whether pay or expectations, but without exception and no matter WHAT they had to do in terms of work the caregivers were kind and respectful of the elders. I saw situations they had to deal with that would have broken me, and in the end, when my brother had hospice and was dying he himself was a lot of care. The caregivers were wonderful. I think that it was "corporate" as my brother said. As in if you talked to someone in office it was much "all business" BUT, I would also say that they were very upfront. The initial paperwork was very specific about raises, when they would come, and what they would be (3% to 5% per year barring anything unusual; and covid-19 with cost of food going up, and ill workers is unusual. think of the cost in PPE alone). Then there were the care levels and they were well deliniated. And there were the discussions of what circumstances would require the much more expensive memory care and what care levels cost were. The food was good and they tried VERY hard with healthy snack and good food.
So I think every facility is unique. Every one is a business. And that is pretty much it. Try to do some tours in the area of facilities. Yes, they will ALL ask you what the assets are. Basically I got so sick of that question that I started to say "you are looking at a million dollars on the hoof" making it sound like the auctions I remember as a kid on the farm.
Good luck with all of this. It is an education.
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If you have a concern over “the line” why not consider bringing in an independent geriatric professional to formally assess his cognitive abilities? Is there a memory care unit associated with his AL? Might that be a more suitable setting. Or if not, could you ask if a trial of a small dose of anti-depressant or anti-anxiety medication might be warranted?

I would say that my LO was on the far side of “difficult” from the very beginning of AL, and memory care was definitely a better fit, but I also had an assessment done early on to see if a small dose of calming medication might help, and it did. In addition, I got a document that was helpful to me as POA moving forward.

I also think that the best of any residential centers are still suffering the damage caused by Covid19, so turnover is worse than ever. Caregivers are also frightened themselves, and coverage can sometimes be hard for facilities to find.

Since he’s “never been happy” (mine wasn’t either!) it might be more unsettling to him to try to move him right now.

The costs of my LO’s care have risen, but between the virus and the rest of the economy, it seems like an ongoing question mark for everybody.

He’s lucky to have you on his side.
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