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Hello! My Father has been diagnosed with kidney failure, heart failure, and renal sarcoidosis, which causes extreme calcium levels (delusion, confusion, weakness and more), his heart is working at 30% and kidney levels are around 4.5 typically. He got discharged from the hospital and they ordered in home physical therapy because they believe he's not weak enough to be in rehab so I'm doing 7 day, 24 hour supervision with him. He doesn't understand how to take his medications and when I quiz him on how much meds he's suppose to take, he never knows, so I don't want him doing his medication on his own. He has random good days and bad days but overall he's able to go about his daily tasks (bathroom, changing, eating, very mild cooking). In 4 months he's been in the hospital 2x, very unwell and was admitted for 2.5 weeks both times, so I worry that we will move him into independent living and something will happen again in the next few months after we sign a lease on an independent living community, then will have to end it just to get assisted living anyways.
I know he's capable of living on his own most days and its about 3-4x cheaper than independent living, It's just his medication and weak days that I'm worried about. Is it worth it to move into Assisted living when its not deemed as "needed"? He also wants to move an hour away from me because he likes the area, which isn't smart if he moves into Independent Living.

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Please opt for AL. I just moved out of a senior independent living community (I’m still a young 71 year old and just couldn’t adjust). What I observed: one neighbor who attempted suicide because it’s easy to get depressed and no one checks on you, another neighbor who was confused and simply not able to function (kept her apartment door wide open, trash everywhere), another neighbor with increasing dementia who set the microwave for 45 minutes instead of seconds to do oatmeal. .setting off smoke alarm when it burned, another neighbor with cancer who was constantly falling and no one could hear her cries for help.

Your dad needs assisted living. Seniors who need support shouldn’t be in an independent living community unless a caregiver is employed to be there with them.

Hope this helps.
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Reply to jakefix
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This reminds me of my mother's doctor who keeps insisting she's not 'ready' for a hospice evaluation yet. She's 93.5 and has more issues than Newsweek, in addition to chronic pain & dementia. They said the same thing about my father......by the time he was deemed 'ready' for hospice, he lived for exactly 19 days.

Your father is ready NOW for Assisted Living. If you don't think so, try letting him live alone and then getting calls 24/7 about what he needs, what medications he should be taking, how he needs to go the ER, and about 99,000 other issues that will crop up.

It's only common sense that your dad needs help available to him 24/7, even if he's not using it 24/7. The one thing neither of you wants is to have him NEED help and not have it available.

Good luck!
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Reply to lealonnie1
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Independent Living communities don't usually offer meals or medical staff as AL & LTC facilities offer. They may have bathrooms with walk-in showers and bars , activities but that's about it.
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Reply to peace416
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Imho, you shouldn't give an elder a quiz on their medication. Chances are the LO may fail the quiz.
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Reply to Llamalover47
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The best thing about AL for my Mom was having them supervise her medications and get her to take them as ordered. The other was regular, healthy meals. The cook made great soups which Mom loved. She was capable of her personal care and only needed someone to sit outside the bathroom when she showered just in case. The social aspect was good for her too, she had never been very outgoing but enjoyed Bingo and other games. I will never regret her moving into AL.
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Reply to Frances73
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You don't help a person to take his medication correctly by quizzing him on what he's supposed to take when. You just make him feel confused, inadequate, and miserable. Many people find it difficult to keep their prescriptions organised, and by the time their health is in your father's kind of state it isn't surprising. These px's can run to two or three densely-typed pages.

There are various solutions. Pharmacies will make up his px into blister packs, labelled Morning, Lunch, Afternoon, Bed for example. There are all kinds of dosette boxes and pill minders, with or without timers and alarms. You could also pay separately (I expect) for visiting aides specifically to prompt and support medications management - certainly that's a task that our service undertakes, I imagine it would also be available to residents of his ILF.

Personally, I would like to make it The Law that pharmacies must make up prescription labels in size 18 font or above, with the dose, time and name of the medication *clearly* marked. Never mind our older and more disabled clients - I've seen px's that my senior colleagues have confused purely because the standard of labelling is so poor and so hard to follow. Brand names are a culprit, too: if one box is labelled Renaleze* (with the ingredients in small print) and the other is labelled furosemide (with the manufacturer's name on the other side), it isn't obvious at a glance that these are one and the same drug.
* not a real name!!!

Plus, if a nurse asks an elderly gentleman "are you taking apixaban?" how is he to know that yes he is, because he's taking Eliquis?

Call them the same thing!
Standardise the doses!
And make the bloomin' things the same colour! (tussle over fluoxetine with a client who refused to believe that the green and purple capsule was the very same Prozac as the blue and orange capsule she was used to...)

Personally, I like a chart. A good, clear chart, that the person is able to follow. I am also in favour of stout plastic boxes with lids for storage (as opposed to grocery bags, table tops, random cupboards, or a south-facing window sill over a radiator in once spectacular case), and Ziploc bags for spares, to be kept well away from meds in current use.

It is all in the method. For example, mornings:
x) Fetch a glass of water.
a) Refer to your chart to see which boxes you need for your a.m. meds
b) Gather your a.m. boxes, and place them to your left.
c) Take a small, coloured plate against which you can clearly see each tablet - mid or dark blue is a good choice.
d) Taking up each box singly, remove the correct number of tablets onto the plate, replace the unused tablets and close the box.
e) Place the box to your right.
f) Take the medication.
g) Tick the medication off on your chart.
Repeat d) - g) until all medications are taken.
h) Replace all the boxes in the storage box.

What I have against blister packs - among other hitches - is that their compartments are quite deep, and getting tablets out of them is quite fiddly, and People (especially but not exclusively gentlemen) tend impatiently to tip the box over onto their palms, then clap their palms to their mouths. With the result that you have tablets all over the shop - down the shirt front, between the cushions, up the nose - and Not A Clue which is which or where it's gone. You're looking at a good thirty minutes playing hunt-the-pill and then match-the-pill to the description on the blister pack's front cover; and even then you can't be 100% sure what's gone down. Hate hate hate...

Is medication far and away the biggest worry? Does the ILF he's interested in offer supplementary services?
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Reply to Countrymouse
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I'' jump on the bandwagon with the others.  I agree that it probably would be better to place him in AL now and avoid another move when IL doesn't work out.  I also agree that getting him closer to you as his caregiver would be high on my list of wants as you look at placement.  When I needed to move my mother to a SNF I made the choice to keep her closer to her sister who had helped care for her the last two years and take the hit myself of the two hour drive to see her.  Yes it limited my visits but my Aunt went daily and spent the day with her. 

Yes this may mean moving him away from his doctors but making a longer trip for his medical appointment wont be a often as you running to him each day to make sure he is taking his meds correctly.  Have you looked into a Medication Dispensing Machine that you can fill and it will dispense his medications on schedule or how about Medication on Time where the pharmacy prepackages his medications and they are labeled for when to be taken. 

Would meals be available? Even if you only have him go for the midday meal, which is usually the mail meal of the day, you would know he was getting a good meal.  We have friends that did that, they only ever had cereal for breakfast so that was easy in their AL apartment and then they made a sandwich for their evening meal.
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Reply to EllensOnly
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I think that you see what is coming, know it is close, and are thinking ahead. Covid-19 times is not a time to make a move. I would not opt for independent when you do. My brother felt he could have done independent living, as well, but opted for Assisted as it was more available, and soon enough it was what he really needed as well. I think moves are very disruptive and adapting to the moves is difficult. I think this is the time to discuss what care he will accept in future, to get POA in place that will not change when he cannot make decisions, so you can keep operating for him. Support him in home while you can as any way you look at it, even with some 30/hour care from Visiitng Angels or others like that, it would cost less to stay in home. If he already cannot take his medication you do know what's coming. Decide at what point palliative and hospice are appropriate, as that will give him a lot of extra support as well. Wishing you good luck.
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Reply to AlvaDeer
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Move him to a place where he can transition from AL to memory care as he declines further. It does not matter if he “likes the area” that is an hour away. He won’t be seeing much of it. Make him move to a place as close as you can to where you live. Don’t listen to the doctor either. His issues are why people go into AL: can’t keep meds straight, need supervision and meals. The doctor has no idea. Make sure you have the POA for healthcare and finances in place.
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Reply to dogparkmomma
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I would make it very clear to him that he can live where he wants, but you will not be making a 2 hour round trip on a regular basis.

Then he will know that he will be pretty much flying solo because he chooses to live an hour away.

I would also do the research on facilities that are closer and give him options. But don't cave in for his desire to live an hour away from you. Tell him the consequences and stick to them. Time, wear and tear on your vehicle and fuel costs are all legitimate reasons for only visiting once or twice a month, is he really wanting this kind of distance?

From what you describe, he really needs AL, the meds alone are reason enough for that level of care. But do your research on what the facility really provides and all associated costs for services. They are not all created equal and they will misrepresent their services until the dotted line has been signed.
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Reply to Isthisrealyreal
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Mysteryshopper Jul 1, 2020
True regarding actual services provided - sometimes it's not as originally presented. Many times dietary concerns in particular are dismissed as "preferences" rather than an actual medical issue. Even when brought up in advance, salesperson will say that it's no problem to accommodate such-and-such condition, when he/she does not really know and probably won't bother to find out. Dear family friend had this happen and ended up could not eat much of what was served in the dining room. Kitchen even scraped the gravy/sauce off of something and returned the same plate to her after she told them she could not eat the sauce. Too much trouble to not put it on in the first place? And this was at a "nice" place. Just be sure you go as high up the chain of authority as you feel you need to do in order to make sure you get what you think you're getting for the money.
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I would vote for AL.  He is only going to get worse, and moves, even if adjacent building are not good for the elderly.
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Reply to FloridaDD
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The fact that he does not understand how to take his medications is enough to think that AL would be a better place.
If anything were to happen to him in IL the staff is not permitted to help him. If he fell, he would remain where he is until paramedics arrive. And no doubt it would be a trip to the hospital.
Does the facility that he/you are looking at run the full range from Independent Living to Assisted to Memory Care? If so IF he entered as Independent Living and in 2 months needed more care would it be easy to transition to AL? If so that might be the way to go but if he would have to move to another room, another part of the building I would think to reduce confusion AL would be the place to start.
SOME Assisted Living facilities will charge based on how much assistance is needed. So if ti is just medication it would be less expensive than if they had to help with showering, dressing, toileting. Each of those would add to the cost. Nice thing is if you do not need a lot of help the cost is less but then it is like nickel and diming you for every little thing. While a place that has just 1 fee for AL might sound like it is more expensive at least you know the cost will not go up each time a task has to be added.

If you're keeping a tally of votes...I am voting for Assisted Living.
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Reply to Grandma1954
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You need the level he needs on his worst days. Because those are the days that will be more frequent as time goes by. Also just because they are in IL or AL, doesn't mean you are hands off or uninvolved regularly, especially if you are POA. You will get called if there is a fall, or other issues, or if he needs you at doctor visit. Most places provide transportation but can he comprehend doctor alone. Close by us better for you
My mom's place had both Independent Living and Assisted living apartments. Independent had a full kitchen and balconies., a little bigger. Assisted had kitchenette,, no stove just microwave, both studio and 1 bedrooms. All dining and activity are mixed. Check the pricing. You could add services like med management, to Independent Living, but lowest level Assisted Living is close in price to Independent Living with all the add ins, and if you end up needing an aide to stay in Independent Living that's costly also.
Most places require an assessment before move in, your Dad might not qualify for IL at this point anyway.
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Reply to Gracie61
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My 92-year-old grandmother intended to move into Independent Living because she was in reasonably good health and lived alone successfully. The problem was that she had "company" in the form of her nieces or me every day for two years.

It didn't matter whether she called us company or caregivers (which is what we really were), she wasn't living independently, and that's your dad. With you supervising him 24/7, he's most certainly not independent.

As another poster mentioned, he's not going to get better, so set him up in AL so he won't have to move multiple times as he declines.
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Reply to MJ1929
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I think you are wise to realize he truly needs assisted living. As he ages his needs will increase and he won't have to adjust to moving from one level to another. My father only needed medication management and greater supervision due to multiple falls and needing Home Health to do various lab tests etc., so we moved him from IL to AL.
Your dad's doctor is not the determiner of what is best. With all the health issues your dad has moving him to AL truly is the best option. Look for one that has a good atmosphere, lots of activities. Interview the director of AL and have lunch there to check out how the meals are.
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Reply to Harpcat
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Wellll....

He's not going to get 'better'. The best you can hope for with myriad health issues is that he is living in a place that cares for him appropriately.

IF you move him to IL, likely he will not be there long. A fall, simply decline in overall health, and he'll have moved into the need for AL. He really isn't 'independent' at all. If you have concerns about him keeping his meds straight and he's been in the hospital twice in the last 4 months, for fairly long stays--IMHO, he's about ready for AL. If he has 3/7 days where he's fairly 'ok'--that's not indicative of him being able to live w/o 24/7 care on site.

Yes, it costs more. But if you move him to AL and stick with it, you won't have to move him again. There are upfront costs associated with AL and IL, both. You might lose the 'down payment' of the IL if you need to move him within, say 6 months. I don't know.

Doctors are just looking at the immediate 'fix'. They see a pt for 20 minutes and make a recommendation--but it's just that--their opinion. YOU are much closer to the situation and have a clearer head about this.

If he is living an hour away from you, that makes your involvement in his care almost a moot point. 2 hrs driving --how many days a week? You'll burn out quickly.

This is not an easy decision, but I wish you the wisdom of knowing what to do for your dad--what is 'best' may not be what he 'wants'.
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Reply to Midkid58
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