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Hi. I've been posting over the past few weeks about my LO upset with their current ALF. The most recent source of upset was an unexpected care level increase that he didn't feel was warranted.


This has led us to look for a new ALF for him. It just so happens that we discovered that quite close to us a brand new beautiful ALF is be constructed ready to open in a few months. It really does seem a better situation. It's closer to us, rooms and facilities look beautiful. It has far more amenities - movie theater, pool, spa, a gorgeous dining room on the upper floors. It is also right across the street from a new medical office building where many of his doctors will have offices. It will make doctors visits so much easier for him.


The best part is that the costs are better. He would get a nicer room, and similar level of care for $2000 less per month than his current ALF. Costs are also more predictable. They have just 4 levels of care and even if he needed the highest level of care (that would be a hoyer lift patient), the cost would still be less than his current ALF. They also have a memory care floor if that were ever needed. Even the MC would cost less than his current ALF.


We were so impressed by what we saw, we put a refundable deposit down and picked a room we think my LO would like. The incentives to fill new rooms were great, too. $10,000 off your first 4 month's rent and a generous gift card for making a deposit.


I do have some concerns. One is that this is a new company without a track record I can check. The other is that it is for-profit. My LO is currently at a for-profit, and we've been not happy with a lot of things that went on there.


However, my biggest concern is if my LO will even like or tolerate moving to a new ALF. For someone almost 90, I'm worried they won't be able to tolerate a big change in the way they live. This would be different. In his current ALF, he lives on the first floor and everything he needs is there: dining room, activities, etc. The new place is a high rise and he would need to use the elevator to get around. He is wheelchair bound, so there is some concern there.


Has anyone gone through this experience, where you pick out an ALF you think will work out great for a LO and then as soon as they move in, you find it just won't work for them? The problem here is the $5K non-refundable community fee if they just can't tolerate it and say they want to move out. It seems like a risk. I hope that at some point Covid restrictions get relaxed and allow us to get him there and try it out and inspect the facility and see how he feels about it. He was lukewarm when I described it to him on the phone, but he also does not like his current ALF. A difficult decision all round.

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One thing I would seriously weigh is if his current AL has a continuum of care, i.e. does it also have LTC, MC and hospice in one campus? Anyplace he moves to should have this, especially at his age. It should also accept Medicaid. Don't go anywhere that doesn't accept Medicaid unless your LO is very well off. I can't really speak to the for-profit aspect of your question, my MIL has been in 2 non-profit, faith-base facilities and we were very happy with both.
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Helperson132 Aug 2020
So, his current ALF can handle a fairly high level of care and also has a MC unit. The new ALF I am considering also can handle a fairly highly level of care and has a MC unit. Neither of these has a nursing unit though. So, in both cases, if the care needs get to the level requiring nursing home, he would have to leave in both cases. I guess my point is that the continuum of care situation is the same in both facilities.

So, with regard to Medicaid, that is highly dependent on the state that you live in. We live in PA and in PA Medicaid never pays for AL. It only pays for long term stays in nursing homes. So, here is the problem. There are a number of communities that have the full continuum of care - AL, MC and nursing home. But most of those are pretty expensive and are private pay only - meaning they don't accept Medicaid ever for their nursing beds.

Now, most of the standalone nursing homes in the area do accept Medicaid. So, we are sort of in a difficult spot. We have to prepare our own transition plan to go from AL to nursing care when he runs out of money and needs Medicaid. It's a difficult situation. See, most of my LO money was put into Medicaid complaint trusts over 5 years ago so he could qualify for a Medicaid bed at a nursing home. The problem is that he's running low on his personal funds and doesn't need nursing care yet. So, we are sort of in a difficult situation. We can tap money in the trust for AL care, but then we are sort of defeating the purpose of the trust.
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Helpperson, just a quick response as I have to leave shortly, but I wanted to make you aware of one way to potentially check out this new company.    Check your state's website to determing  the department which manages corporate records.   It would be the source of filing of assumed name dox, LLCs, corporations and/or any other commercial entity must file (a) articles of incorporation (b) designate registered agent (c) names of officers, etc.

It can be a treasure house for corporate information, but also depends on the state.  I used to be able to get a lot of info from the state of Michigan, but the Internet has introduced an opportunity to charge for all this information, so it costs to get data.

You can then check out the offices of the company individually, but w/I limits.  With the extensive data collection online, you might find out what these people did before opening this facility.   If you can't get any information on anyone, try to back trace by using Google to see if you can locate the addresses they use.

I did this when I needed contractors, and found that one who claimed to be a reliable contractor had an "office" in a large vacant lot!  Another had a real dump, surrounded by grass growing at least knee high, junk in the yard, ratty looking office.   Obviously, neither of those passed the initial selection process. 

The goal is to get as much background information as you can on the principals, so you can get an idea what they've done before, whether they're legit (or working out of their garage), etc. 

I haven't done this in awhile but you can also check with the state department which requires filing of UCC-1s, a security document for the equipment, etc. which typically is collateral for a loan.    You might at least be able to get an idea how extensively indebted the company is, and with which lender.  If it's the corner Joe Blow (no offense to Joe's), and not a major bank or recognized lender, time to start becoming nervous.

You also can ask the principals what their experiences and backgrounds are.  For an unknown entity, I think they should be willing to provide that information.

I honestly don't know what general amounts are for non-refundable community fees.  There was a post with a similar question in the last several months, if I remember correctly, and will search for it later.

You could contact similar organizations in your area to get an idea what they fees are.  $5k seems inordinately high to me.   And if the staff, support and service are bad, it's a method of scalping the residents and/or their families.

Turnover of staff and residents is another issue to explore.

The goal is to get as much information on the incorporators, their track record, if any, possible.

Hope this helps.
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Another thought-- presumably the staff would have made arrangements for DON, other admins, and medical people in the event of an emergency.   Try to find out if this has been done, and who the medical people are.   If they're staffers, or even if they're on call, you can check out their reputations and get an idea who they are.

I confess though that I'm not that familiar with this level of care and don't know as well as others here what level of medical support might be available, but it's a good topic for inquiry.

I guess one of the issues that would bother me is the experience brought to this new facility, which apparently has no reputation...yet.
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Is this company brand new, or new only to your area? It is the for profit/lower cost that worries me if this is in the same area. The four levels of care is what my bro had; and the well laid out costs per level as well, which is as it should be. Most Assisted Living is for profit in all truth. It is not regulated in ways nursing homes are; most are "When your money is gone, you are as well".
The worry I have with lower cost/new company, AND for profit is where will they cut so as to make this profitable? Sometimes in whom they hire. Or in how many they hire; because their highest cost is in their employees. It was the people hired, both the numbers and their excellence that made my Bro's ALF so good for him. The people were dedicated; a real vocation for them.
You mentioned also that this is more like an apartment building. Where my brother lived there were two main facilities, one like what you describe, the other cottages, on one level, rooms arranged around a communal dining area on one end, living room with TV on the other, and with beautiful grounds where many of the residents spent most of their time just outside the doors, just outside their windows. He spoke with a lot of people in each facility before making his choice. While the facility that was more like an apartment building type had great food and cafeteria, really kind of world class and one man said he and his partner felt like they were on a cruise every day, the checking on them was much less, there was less communal activity, and they said they wouldn't want to be there alone.
As to new management? My brother's ALF had been taken over by a new group. They were absolutely great. But there were few ways to predict that would be the case. In any place it is so much about management.
Wishing you good luck, remembering there is nothing perfect.
I do believe, in so far as you are able, be certain that the elder, after all the one moving, is on board for this move. You do have to manage finances for life care, I understand.
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Helperson132 Aug 2020
Well, this company has been operating assisted living facilities in other parts of our state for a little over a year. They are new to my area though. The fact that it is cheaper, doesn't concern me that much - because it is understandable from a real estate perspective. My LO's current ALF is in a very dense, high cost of living area. Real estate is just quite expensive there. The new ALF is opening in a brand new development on open land in a lower cost area. It is just a cheaper area to own real estate in. Now, I think the question I really need to get answered is what is the patient to assistant ratio. I have to see if they have set guidelines for how many care staff they will hire per patient and compare that with my LO's current facility. My LO already does not think his current ALF responds fast enough. If that were to get worse in a new facility, they would go nuts. I wish their were more non-profit ALF's in our area. There actually are some very nice non-profit ALF's in the area - in fact some of the one's with the best reputation. The problem is that almost all of them are in highly desirable continuing care communities. They all have high community fees and long waiting lists. Those just aren't an option for us anymore.
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Check out what precautions the new place will be using for prevention of Covid-19 with staff and distance etc. Check if they have other facilities already up and running in other locations and if so check Medicare and Medicaid complaints etc. is a good indication on what to expect at any facility you check out.
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I have been struggling with this question myself..With Covid restrictions I would not change facilities unless I suspected abuse. 27 years of experience as a clinical staff member of LTC facilities tells me you need to see a track record or know someone who lives there before you blindly trust a new facility. I would not do a move during covid lockdown.
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Check out some of their other facilities with their local BBB and any accrediting organization for their current "grades." If those other facilities are well-managed, you cold expect similar results with this new one.
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The old adage if it sounds to good to be true....
How fast will they increase the rates across the board? You may end up spending just what you are spending now if not more as his level of care increases.
You do not mention what problems this person has other than he is in a wheelchair. If there is dementia involved finding his way around a high rise might be difficult, and may be anyway for someone used to living where everything is contained on one floor. Would he have help to be escorted to the dining room? to the theater? other activities? Or would he be left to navigate on his own?
You can check the Medicare website and search other communities that this company runs, owns or is otherwise involved in. The BBB might also be a good resource as well. The State Ombudsman or State Health Department might also offer insight. While they may not be able to tell you if a place is good or not they might be able to tell you if there are any past complaints and if the company resolves issues
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Frances73 Sep 2020
Medicare only rates Nursing Homes, not Assisted Living. I am currently searching for an AL with Memory Care for my mom and am finding it hard to find ratings.
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Helperson, I moved my dad into a new facility, he was the 2nd resident. It was great, at first. They spoiled him. Then they started filling up and did not know how to expand their staff to meet the new needs of their residents, so the less needy received less care than they were paying for. My dad went from being spoiled to being ignored (aka neglected), it was a nightmare for everyone involved. The place was eventually shut down because of many issues that the owners had. They believed that they knew it all and refused to listen to anyone trying to help them. It was a small place, which it sounds like you are looking at a larger facility and you will have different bumps to get over. Know going in that there will be bumps, any new business, even just a new location for an old business will have issues getting things figured out. Can your uncle deal with issues and communicate with the powers that be reasonably when something comes up? If he tends to go straight to anger he will not be happy with his care and they will label him as a problem child.

So ask lots of questions, preferably in writing and make them respond in writing.

If your uncle doesn't sound very interested, please listen to that. He will find a reason to be unhappy with the place if he isn't excited about moving into it to begin with.

I can't help but feel like he is just complaining about his current situation and having you do these exercises as something to entertain him. He needs to participate in the move, he is able to make calls and get information, make him do this to see if he is really interested in moving. Otherwise you are just wasting your time and he will find a reason to say no to all of your choices.

He is blessed to have you, you just be sure that you take care of you during this difficult time.
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i think I learned a big lesson when my mom was placed in in-patient rehab after a hospital stay. The facility was beautiful- marble floors, crystal chandeliers, private rooms, movie theater, even a pub. It was a for-profit facility. When COVID hit, they began moving residents around so they could isolate COVID-positive patients. Then the moved in COVID-positive patients from one of their other facilities. My mom caught the virus and died. I will never again judge a facility by its looks. For-profit means just that. It is all about the profit.
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Please stop using using a few letters instead of the actual word spelled out.
It is difficult to follow what a person is trying to say. Examples. LTC, LO ALF, MC.
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katskorner Sep 2020
Search under abbreviations. They have a whole list. I was going to print it out when I first got on here. I still have to look occasionally. It can be confusing.
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I'm confused:  You wrote:

" One is that this is a new company without a track record I can check. "

And later wrote "this company has been operating assisted living facilities in other parts of our state for a little over a year. They are new to my area though."

So the company isn't new to the state, but just to your area.    So it would have a track record in the state.   

You do have more options to check it out.
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AlvaDeer Sep 2020
I missed what you caught. My brother's ALF had been recently bought, and had others across our State. My understanding is that they are ALL good. I surely do know his was.
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Imho, a few considerations - how fast would they increase fees across the board? and would your LO be able to tolerate the move if you go ahead? Prayers sent.
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Having a lovely place with many amenities and a closer location as well as reduced cost are certainly considerations, but as you noted, I would be more inclined to be concerned about how a move might affect your LO. Also, would he even have any interest or ability to participate in most of these amenities?

I may have missed it as I originally read through a few days ago. Does your LO have dementia, early or not? What are his concerns about the change in level of care? Do you know or can you discuss with the facility as to why the changes were warranted and what it involves? He may actually need the increased care level. It is likely that his place, like most others, are off limits to us, so it is hard to determine if the changes are necessary or not.

If he does have some level of dementia, I would hesitate in making a move. Moves are generally very disrupting to those with dementia and can lead to confusion and sometimes a set back in the level of memory loss.

If discussion with the facility about the changes instituted seem reasonable AND he has dementia, try to assuage him by passing it off as something they have to do for everyone, blame his doctor, blame the virus, whatever works. If they don't seem reasonable and/or he doesn't have dementia, see what you can do to help the facility and your LO find a good compromise. If the changes are actually necessary, how would that impact the cost of this new place? If the increase care his current facility has instituted isn't covered in the base cost or the new facility, it could end up being the same if they determine he needs this level of care. That 5k would include assessment as to what his needs are - rather expensive way to find out, so asking the facility he is in now might be better and won't cost anything.

When signing my mother up for a facility, I was a bit taken back by the fee (used for assessment mainly - not that we needed any! I knew what her issues were and what care she needed.) What gets me more is the huge amount that the continuing care communities charge, just to get in the door! Mom used to check out places, generally going for the tour and free meal. Most of the places in her area had this charge. One of the ones in my area did as well, so I crossed them off the list immediately!
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Re-reading your original post, I do see that the highest care level cost in the newer place would be less and you mention a MC wing, which would also be less expensive than his current facility. So cost wise, at least for a while, it would be a plus in the weighing of making a change.

I would still have a discussion with his current facility about why they feel his care needs have changed. It is possible he needs the care, but it also may be overkill.

I do know that where my mother is this increase in care will be an expensive bear! Included in the cost of MC is 1 hr of personal care. If she were to need more time, they charge in increments of 1 hr, whether she needs 10 min or 60! I would much prefer that they charge in increments, because most likely those increases are NOT going to be a 60 min jump! I would be satisfied with increments of 15 min, adding more as needed.

So, the issues really come down to how would HE react to a move? How would he feel about having to navigate to get to where he needs to be? If he doesn't have dementia, this should be HIS decision. You can provide as much information as you can to him, even if it has to be mailed, so that he can be informed and have input.

Since it is new, would it be possible to have a tour before they allow residents to move in? Clearly after people move in, it would be restricted. Mom's place was originally very old buildings and they made the decision to tear it down and rebuild rather than refurbish. The deposit was refundable, so I paid that ASAP (the other places were not really what I would prefer, location and cost for one, most of the setup for the other.) They had an open house that we attended (mainly we got to see the main AL dining area and some of the IL and AL rooms.) They opened in stages, first IL, then AL. MC was delayed a bit as they wanted a min number of residents first. Due to issues beyond their control, and even with a few days medical delay for mom's move, she was the only resident for about a week. One aide would stay with her and include her in AL activities. So we had to make most of the decision without seeing it first hand, and certainly before any reviews could be done!

Also, does he have a lot of friends in his current facility? Favorite staff members? Is he gregarious and could make new friends in a new place or would he be lost?

Would he have any interest in the amenities they offer? I'd place less weight on this - a plus if he's interested, otherwise it would be a lateral move, as if these didn't exist.

Moving is already on the list of high stress inducing activities, but at his age it might be even more demanding. Getting his input would help you make the decision.

https://www.lifestorage.com/blog/moving/moving-stress-and-anxiety/

From the link above:
"Moving a Senior
For seniors, the moving process can be very different than it is at other stages of our lives. Many seniors are moving into assisted living facilities or nursing homes, which are probably going to be much different than their current housing. When helping a senior move, it’s important to understand what their needs are and how their new space will compare to their old one."
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Helperson132 Sep 2020
Thank you for posting your experiences, they were quite helpful. I agree with all your concerns. My mother and I have been going back and forth wondering if moving my uncle is a good idea. So, he doesn't have dementia, but I am definitely noticing some short term memory loss. He also has very bad hearing and I think this causes a lot of issues for him.

So, he's not particularly happy in his current ALF. Even before Covid, he never really got friendly with other's there. This particular ALF has a sicker and older and lower mental acuity population and he is honestly probably sharper mentally than most of the other patients. The other issue is that men in their late 80s are outnumbered heavily by women in ALFs, so he really couldn't find anyone in his pier group to talk to.

There are other issues, too. He's not fond of the caregivers and not fond of the food. We all believe that it is overpriced for what you get. Regarding the most recent care level increase - I tried to fight it hard. Basically, they said that he had mentally slipped and was requiring more care. It all seemed very slippery to me. They couldn't name any particular things they had to do for him now that they weren't earlier. I obviously haven't been able to get in and really see what is happening with. I just think it seems slippery. The facility is part of the Sunrise family and they seem to have reputation for tacking on costs.

In terms of the new facility, it really is quite nice, but I'm not sure he will be able to use the amenities. I put a fully refundable $1000 deposit on a really nice room. The room is specially designed for wheelchair use, which is a big plus. The problem is that he will be on the 6th floor and dining room is on the 10th floor. His room is right next to the elevator, which is good. But, it is so different from his current facility where everything is on the first floor. I'm worried he won't adjust having to us an elevator daily and might just get overwhelmed by that.

Honestly, if I had to pick the perfect situation for him, it would be in a nice 2 bedroom independent living community where we would hire a full-time live-in caregiver to take care of him. He gets very impatient using the call bell, so having someone hired just to take care of him would solve that problem. I also think he would do better dealing with the same person all the time. However, that is outrageously expensive, and really out of our price-range.

I have also been doing more searching and discovered some other newer facilities that might work better. One I just discovered today is multi-story, but every floor has their own dining room. That actually sounds a bit better to me.
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