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I am trying to decide if it is time to move my mother into Assisted Living.


Currently, my mom is living in independent living, where they offer 3 meals a day, transportation and some activities, but no medical. If a resident needs a home health aide, they can contract with the company that is management-sanctioned (they have an office in the building).


I'm hearing conflicting reports about her capabilities, also muddied by my own observations.


I've asked my mom's doctor what she thinks, and she says mom is fine where she's at, but needs a little help with medications and housekeeping. (That sounds like entry level assisted living to me.)


The management where she lives treats her as completely incapable and my mother constantly asks me to call them for her requests because they won't listen to her. They have all but forced her to give up her cat due to her not managing the litter box. She is very upset to lose her friend. (On this I agree with the management and wish I could thank them, at least for the cat's sake.) The management is supposed to provide light housekeeping, clean towels and linens. Due to COVID they are not housekeeping at all. They drop off sheets and towels every week,and then they are appalled at her lack of housekeeping (she has never been one of those spotless types) and said pre-COVID that they can't clean because she has too much stuff. So, she has her own vacuum cleaner and mops the tile areas, cleans the bathroom as best as she can. They charge to bring meals up when residents are sick, after the first three meals. This place is way too expensive to have to pay for someone to walk up one flight of stairs and hang a bag on a doorknob. I wish they would credit us for the unperformed housekeeping, and all the breakfasts she has never eaten.


In their defense, having lived with her all my life, I confirm that she can be challenging. What annoys me is their supposedly hands-off-independent-living-we-don't-mess-with-anything approach while still managing to meddle in an epically unprofessional scale.


Okay. Rant over. Point is that although they haven't said anything, it's obvious that they think she is overly needy in terms of their offerings.


My own observations... I think she could use a more structured environment where there are people looking in on her daily and helping out where needed. (housekeeping and the like). She is a social person, so I would like her to be able to make friends and to live somewhere where the staff is supportive and treats her with respect. You know, like an adult with a mind of her own.


A couple other things:


-My mother has asked for the home health aides to set up her pills every week. (leading me to believe that she is unsure in this area).
-She is incontinent. (I point this out from a housekeeping standpoint.)
-She does have some trouble with short term memory and I expect that will only get worse over time.
-My mother is really good at pulling the wool over strangers' eyes when it comes to her capabilities. Hence why I think the doc thinks she's good.


I have broached the topic with her, more as a threat than a reality, but I plan to bring it up again in the near future. Currently I am running the numbers, and doing the research to find places that will eventually take Medicaid.


Anyway. Do I go with my gut on this?


Thanks!

Find Care & Housing
Let your mom live in peace and stop being so critical.

Dones that hurt to have her pills set up for her and that was smart of her to ask.

If you're worried, Set up a Camera in her place where you can check on her anytime.

You may think about this...Do you want to move your mom for your well being or hers?
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Reply to bevthegreat
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If she has short term memory issues medication management can be critical.
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Reply to Gigi4home
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Imho, your mother may require a higher level of care going forward. Prayers sent.
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Reply to Llamalover47
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As noted in replies to others, you could try a declutter and good cleaning, then hire aides a few days/week for an hr or 2 to check on her, use a timed/locked medication dispenser that they can check and indicate any missed (aides can't dispense meds), minor cleaning as needed and see how it goes. Being unable to provide care for one cat sounds like your mother is beyond what her doc thinks she is capable of!

In looking for AL with Medicaid (those could be hard to find), also make sure they have a MC section, as she may need that in the future. Best to keep her in one facility if you can.

NOTE: AL itself is not deductible, but any medical necessities paid for are. I would think if they determine a nurse has to dispense meds, you will pay for this service and therefore should be able to deduct it. Mom's MC is considered fully a medical necessity (as are most of the supplies and medications I have to supply), so she currently is a no tax status, aka income does not exceed expenses. More recently there has been some state tax, but only on the taxable portion of the trust distributions. Be sure to ask about what deductions (EC atty or tax person) might apply while she is self-paying and how to break them out of the bills you will get (lump charge for certain levels rather than getting a break out of all charges? Mom went from her own condo to MC, so we skipped the AL.)
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Reply to disgustedtoo
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CMS and Medicaid look at the 7 ADLs (activities of daily living) and the IADLs (instrumental activities of daily living) to determine what level of care a person requires. You can Google these terms to find out the details of each. States usually regulate what level of care is provided by assisted living facilities. If you don't feel her doctor is adequately assessing her capabilities, get a second opinion.

Sounds like she is unable to do a number of ADLs which would indicate she should be in assisted living. If you or your mother are  private pay, you should be able to contact the different assisted living facilities in the area and find out exactly what their services include. Some offer medication management; some do not, etc. Rarely, do they have a physician on site so you will still need to take her (or have her transported to) her different doctors.  Regulation of assisted living facilities is fairly loose. Only nursing homes/long term custodial care is highly regulated by federal and state authorities. One also has the support of a federal ombudsman's office (at least in California). It definitely sounds like your mom is ready for assisted living. Your research will pay off. Good luck!
https://www.aplaceformom.com/caregiver-resources/articles/assisted-living-facts
https://www.after55.com/blog/senior-housing-regulations/
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Reply to CarolPeaches
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Something else to consider: assisted living costs more than independent living. Check with the home health care agency about costs for "upping" the types of help mom receives: medication reminders (they can not give meds), daily housekeeping, and help with ADLs (activities of daily living: bathing, toileting, walking...). Mom may need 4 hours of care daily. Is her residence giving discounts since they no longer provide housekeeping? Are they still charging for food delivery since most residents should not be eating in the dining hall?

If 4 hours of increased home health care is within budget, this is probably her best option for now - less people in and out of her place, less exposure to others, and more independence in her own room/suite. Try it for 2 months and see how mom does.
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Reply to Taarna
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disgustedtoo Oct 4, 2020
Medication - I suggested setting up a locked/timed dispenser, with someone who can check that she's taken the medicine. We did this with mom, for the time we could still get 1hr visits from aides. As you note, THEY can't dispense it, but they can check to see it is taken and point it out if it hasn't been taken.

I would also think they wouldn't need 4 hours/day yet. Certainly try to clean out the place to get rid of unnecessary stuff, making it simpler to keep clean. A 1-2 hr visit, even a couple days/week should suffice initially. How dirty can the place get in one day? While there was a lot of more intensive cleaning I had to do once we moved mom, it was areas that wouldn't get cleaned daily or even weekly. Wiped down maybe, but not intensive daily cleaning.

The aides (at least some of them) would sweep the kitchen floor and maybe give the bathroom a quick check/clean - I only was concerned with getting eyes on mom every day and checking that she took her meds. Any cleaning done was a "bonus." OP could maybe devote some time when clearing out clutter to get the place cleaned, and then 1hr or so every few days should suffice, for now.
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Incontinent and unable to handle meds screams a need for AL to me.
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Reply to ZippyZee
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Somewhat, her life changed because of covid. You pay for housekeeping as part of the independent living and she no longer gets that service. Wondering if they have deducted that service from her rent? They should. She should be getting the same level of care that she got before with precautions added - masking, gloves, hand sanitizers, more cleaning.

That cat is more important to her than to anyone else. Isn't there anyone who could go in daily and clean out the box for her? Pay someone to do it. If she wasn't a great housekeeper in earlier days, she certainly can't do it now. I would talk to the facility and find out what they plan to deduct from rent to offset services they are no longer providing and use the money to hire a private pay person to do it. Can you or other family member go in and tidy up to make it a little easier to keep it clean? She's probably been sitting in there, alone, and just lets things go more so than she would have when there was a little activity. Anyone can get in to a rut of no motivation.

Actually, you have a contract with this company. They have to honor their end of it, covid or not, or reduce the rent comparable to services she no longer gets. Seems to me they are taking advantage of the situation. Call your ombudsman's office or aging council in your area and find out about the services that have ended.
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Reply to my2cents
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HI.
Well I think I don't agree with everyone.
I think she needs a different place to live with more structure. And during covid, seems alot of things are in turmoil... at least wait for it to be over!
Her apartment sb clean. Her pills sb done. Her meals sb eaten in designated area. Not delivered if she's capable, she needs to follow rules.
Read her contract.
Goodluck with medi medi. By the time you finish that, she may be ready for a change.
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Reply to Clou1313
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You could have been describing my mother, except she has a chihuahua which between me and some gracious aides is still allowed to live with her. As she already qualifies for Medicaid, we have an aide coming every morning and some evenings. If not for that, she would have already moved to AL. We are trying to keep IL for the sake of keeping her dog.
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Reply to MaryNTN
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Sounds like she would do better in Assisted Living but the question I have for you is..
Will she be in the same facility managed by the same people or will you move her to another facility that might have better management? (If the AL portion of the current facility is not staffed and managed by the same people then this question is moot)
If you plan on moving her to another facility make sure it will accept Medicaid. Often they will allow a resident that has been private pay for a number of years to remain on Medicaid. But there are some that will not accept Medicaid at all and you would hate to have to transfer her. Also the facility should have Memory Care as well.
As to the question when should she move..
When it is unsafe for her to remain where she is. If medication is a problem either not taking it, the wrong dose that is not safe. Not getting her apartment cleaned, particularly if she is incontinent (question also is does she need help bathing?) So it sounds like she is ready for the move to AL.
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Reply to Grandma1954
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my2cents Oct 4, 2020
Great question Grandma1954 - would she be moved to another area under the same management. If this company/facility has the ability to give more care, housecleaning, meals in the AL area - they can also figure out how to honor the contract of services in the Independent area. Sounds to me like they found a way to save tons of money. All too common for people who make an exceptionally good living off our nation's elderly and most vulnerable population.
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I
I am dealing with a lot of the same things-my Mom is 91 and lives in an independent senior building. She recently broke her hip and is in rehab but will come home to her apartment with 24 hour care. At this point I would say that your Mom needs more care, either in her own place with a team that comes in and helps her, or assisted-living. Yes go with your gut.
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Reply to Peteysmom
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It’s sounds like it’s assisted living time. The assisted living will also send someone out to evaluate her (usually) to make sure she’s appropriate. With proper medication management you may see some improvement, but a decline will likely continue. When you talk to the assisted living factor in additional fees for medication management, bathing and dressing. For instance there is a basic fee for my mother’s AL that includes laundry, cleaning, paper goods, meals, activities, transportation to stores. We pay extra for medication management (nurse administers all medications), bathing, dressing, etc. Her fee structure just went up because she is declining. I didn’t worry about Medicaid for AL because her next step will need to be LTC if she continues her decline and outlives her resources. Go with your gut. Things are not going to improve. And I found in my research that the AL was cheaper than hiring in outside help at her independent living apartment. The AL that my mother is at also has a visiting doctor, mail order Rx service, and mail order incontinence products that they manage and tack on to the bill. I found this very helpful in that I have basically two main bills, the AL and the pharmacy that lists all costs for her care. This makes it very easy to track ALL her expenses for Medicaid in the future. Good luck - this isn’t easy. I can only say that when I second guessed myself I was wrong!!!
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Reply to Mepowers
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My father lived in a complex that offered a variable range of senior living arrangements. The building has apartments that are independent and some that are assisted. Dad started in IL and eventually moved to an AL apt. The move was easy since same building. Toward the end he moved to the memory care wing, also in the same building. Note that the name is misleading. They do offer memory care but he didn't need that. The wing offers the highest level of care; what one needs toward the end.

Since they have staff for assisted they offer assistance to folks in IL a la cart.

I don't tell you this since I expect that your mother lives in a facility with this variable care options. And not saying you must find such a facility. What I want to say is that a facility is designed to offer certain services. And if you need other services, the staff are in a difficult position. They may want to help you but really can't since they are not setup for that service. Maybe they want to help your mother keep her apartment clean but for IL that is not a typical service. They may not have staff trained and dedicated for that.

A cynical viewpoint that I had sometimes was that the facility wanted to move my dad to higher level care so that they could charge more. But eventually I realized that their systems work certain ways. When dad needed more care the staff gave him more care but it disrupted the care of others. They needed to move him so that the staff was not overworked and the other residents got what they need.
...
Lastly, at the end of the day all decisions are gut decisions. Listen to yourself.
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Reply to chillinwithscb
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Move in with her for a couple of days even if you have to sleep on the sofa. Then you will know for sure. Tell her work is being done on your house and you need a place to sleep for a couple of nights.
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Reply to careinhome
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chillinwithscb Oct 4, 2020
I don't see any reason to lie. But staying with her nonstop for a couple days is a good plan. I did that with my father when the senior center staff told me me he was declining. I had stayed away due to covid and thought he was still ok. But after 3 days and nights in his apartment I knew exactly how he was. I knew better than his doctors or the senior center staff; better than my dad knew himself. It was time for me to care for him: to make choices he no longer could make for himself.

I hope you find that your mother is still able to care for herself. But be prepared to step in.
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She would be perfect for an assisted living situation. My dad is in assisted living - 1 bedroom apartment including full kitchen. He gets 3 meals a day, weekly housekeeping (cleaning/linens), personal laundry, activities, a call button to wear so that any where on-site they can locate him if he pushes it, etc. A nurse is available 24 hours a day. In addition, he also has medication management, his doctor makes on-site visits, someone checks on him a couple of times a day. He is completely independent with personal care but should he need more assistance, either with ADLs, or housekeeping, etc I can just bump up his level of care. Should he need more full-time assistance I can bring in home health aids that I contract for separately. Sounds like your mom needs at least medication management (in my dad's place that's level one care) and maybe an additional level for help and additional cleaning/laundry due to her incontinence.
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Reply to jkm999
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You say, "I've asked my mom's doctor what she thinks, and she says mom is fine where she's at, but needs a little help with medications and housekeeping." That is a conflicting statement! She's not 'fine where she is' if she needs help with meds and housekeeping, neither of which is offered where she's at.

It's time for Assisted Living. A person does not need to be totally incapacitated to require Assisted Living. Being incontinent, having a poor memory and the inability to administer her own medications is MORE than enough to qualify her!

Good luck!
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Reply to lealonnie1
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I just this week moved my 91 year old father into AL after 51 years in his house. He sounds very much like your mother but he has bad mobility issues too. The complex also has independent living (his lady friend of 15 years lives in IL) so he will have company, but he is getting cared for. They will take care of his meds, make is bed and tidy up every day with full housekeeping once a week. He gets 3 meals a day and snacks, but does have a kitchen so he can have food at other times. I am adjusting too because it's a change for both of us. But, I can worry less about him (he has fallen or gotten "stuck" and can't move well 3 times in the 2 weeks). I worried so much about the days he was alone in his house that it was depressing me. It sounds like it's something she needs, but it will also be for you. This way you know she's better cared for and you can worry less. I'm still working on not worrying (my daughter says I'm just a chronic worrier) but I know it's the best thing for everyone. I would say "Do it."
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Reply to Sharon40az
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Time for AL, and if you can get her to do it, you're very blessed; mine's still holding on to the doorframe of her apt..... while she falls apart.
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Reply to mally1
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Assisted living would meet your mom’s current needs. They will administer a needs assessment test to determine her level of care.
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Reply to NeedHelpWithMom
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I think you already know the answer.
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Reply to LoopyLoo
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It sounds REALLY clear to me that your Mom needs a higher level of care. Actually she should almost certainly be given her meds now, which puts her a bump up from the first care level in my experience. Each place is different, but in my brother's place the medications nurse need bumps you to level 2. I believe your Mom needs to be in assisted living. Another poster today makes it clear that brief visits to doctors people often confabulate so well that the doctor cannot imagine what is really going on. Your post makes crystal clear what is going on and I can't really imagine not moving up to Assisted Living now, from my own read of it. Wishing you good luck.
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Reply to AlvaDeer
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Independent living is just that. You need no help.

I agree, time for AL. If she could not care for her cat, then she no longer can fully care for herself.
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Reply to JoAnn29
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