How much do cognitive/behavioral issues limit the ability to get into nice ALFs?

ALFs have their own set of requirements for admittance, each one is different. You'd need to explain to the new ALF that your uncle displays behavioral issues and is going down the dementia highway, it seems, so you'll all be on the same page in terms of speaking and knowing the truth. Nobody wants surprises, they don't and you don't. I would not even consider an ALF for him that does not have a Memory Care annex so he can be segued into it if/when the time comes.

When your uncle is evaluated for a new facility, the admissions nurse will certainly review all of his records from the current ALF to see what's been going on. His issues will likely all be recorded in his chart anyway, so they'll know what they're taking on should they agree to accept him as a new resident.

That said, nobody likes a troublemaker. Depending on the level of trouble your uncle causes, an ALF may or may not decide to ask him to leave in addition to raising his care costs to the max. If he's cussing and upsetting other residents, you can understand why his presence may be an issue, or may become an issue a bit down the road. The ALFs goal is peace and harmony for ALL, as it should be.

If your uncle is unhappy where he's at, he may be in a lot better spirits in a new ALF. It's possible that some of his behavioral issues stem from being unhappy where he's at. But with COVID being a factor everywhere for the time being, I'm not sure where he CAN go where things would be much different in terms of more activities, etc. Hopefully, restrictions will ease up soon but I don't personally see that happening until/unless a vaccine is developed and the elders qualify for it (health-wise). Again, as far as waiting for a call light to be answered, it generally takes time whichever ALF he moves into.

Part of the problem for elders living in residential care is that they can be very demanding and set in their ways, expecting things done to their standards 100% of the time, which isn't realistic. No matter WHERE they go! So take that into consideration when making a decision about moving him: what's making him unhappy to begin with? And will a new place have the same problems he's trying to escape from in the old place?

Good luck!

Thanks for the input. I always wondered where the threshold is where they are happy to get rid of patient vs happy to keep them while charging them for a higher care level. If you think of it like a business, if you have someone who has been paying $90K/year, why would they want to make them leave? For them to willingly ask that person to leave, I figure that they would have to be doing something that either injured staff or other patients or made life so unpleasant for staff and other patients that other patients would want to leave themselves because of it.

This would be an excellent question to ask those LIVING IN the ALF. Because the bad behavior of a resident is a crucible for those members who live together peaceably. My bro and I used to tease that it was like the hippie communes of our youth, where you had to have these community meetings about the bad behavior of some members.
Yes, the behavior will be a very big problem. If not initially, then soon. Again. What if you were a quite normal person with a few memory issues, perhaps more physical needs of balance and etc. And now you have a member sitting yelling, screaming, taking the time of caregivers, and etc.
You are describing someone who, sadly, needs memory care. This is both less "nice" and more "expensive." An assisted living facility is not regulated like nursing homes. They choose their residents and are often quite up front about what they will NOT put up with. My brother's certainly was. They will cherry pick the best patients if/when they are able. They are dependent on good behavior to get meals, cleaning, laundry, various levels of care in bathing, changing, feeding done.
Your best bet is to be honest going in about behavior, and problems with behaviors as you understand them. But for myself, you clearly need a memory care situation. I am wishing you good luck.

From my personal experience, behavioral problems can cause difficult situations when moving from one facility to another.

You may also find that there are notes in his records that are not true in the least. These can cause problems as well and it is quite common that cruddy notes cause problems and there isn't a word of truth.

When you are interviewing new facilities be completely open and honest about his attitude. Tell them the truth up front and then you will be able to address any lies as they bring them up.

Yes, behavioral issues that cause more care will increase the bill. That is the nature of the industry. I recommend non profits for the best care.

Best of luck, you have your hands full.

I wish there were more non-profits in our area. I have another relative in a non-profit ALF and I think it is better run. What I notice most is that the people in the administrative positions seems to view their job more like a mission and seem more dedicated to the residents. At a for-profit, there seems to be some built in distrust. I just don't trust that the administration is really raising care levels because my relative needs more care or they are just instructed to do it from upper management because profits are lagging.

The problem in our area is that most of the non-profits have been around the longest and have the best reputations. Why is this a problem? Well, they cater mainly to more well off retirees and tend to be more expensive. Believe it or not, a lot of the lower cost AL's are for-profit. The problem is I really don't trust the quality of care that they deliver.

I really worry that our current for-profit ALF, will deliver clinical notes that make my uncle undesirable to other facilities and at the same time will keep raising his care levels. I really don't trust their accuracy. In other words, I worry they will trap him in an institution he is not happy with.

Helperson, that is why it is so important to tell any prospective new facility the whole truth, warts and all. Then you can say that there is no truth in any lies that surface. If you tell all the nitty gritty they are more likely to believe that you are telling them everything. Because why would you tell them....and withhold...? Understand?

I would definitely have a talk with your uncle and make sure that his expectations are realistic or you will be dealing with the same problems anywhere he lives. They will not be jumping to every request, he will not have one on one care, he will have to be patient and those sorts of reality need to be understood by him.

Maybe hiring someone to come in to the facility for one on one care, this would modify their charges because they are not having to provide any care. Just different ideas to consider.

I think that I would make it clear that he needs to play nice or you won't be playing. Because this could all just be manipulation to make you dance faster. He has been at this facility for a long while and yet he hasn't done anything to change that, now you are helping him and he can't stand it? Be careful that he isn't using you. It is more common than you can imagine. Seniors have a lifetime of experience to be crafty with.

Just be aware that the "nice" facilities are generally geared toward those who are physically and cognitively mostly independent. A person who needs someone to attend to all his physical needs as well as having a difficult personality may not benefit from the 5 star amenities if the staff has neither the time/numbers nor given his personality the incentive to provide much (if anything) beyond his most basic needs.

Yes, behaviors cause problems getting your LO into a nice place. It is hard to even get someone with behaviors into a not so nice facility. They just do not want it.

Same remains true with a Memory Care Unit. They will turn them away. I have been down this road a very LONG time ………….

That is interesting. I would have thought that a memory care unit would be more amenable to people with behavioral issues.