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Hi all - My mother is 86, has been in assisted living for a year+ now, and has increasingly been losing mobility. Her knees are bad and she's fallen several times there. She's been in rehab once and is going back today, but I know this will be a temporary fix at best, if at all. I am worried the assisted living facility will eventually say they can't care for her any longer and I'll need to move her to a nursing home. She's pretty sharp still mentally so this will be devastating for her. I'm unclear on what the defined levels of care are there - her agreement does not define them. I know she's currently rated at a level 3 out of 4.


I'd appreciate any advice from those of you who have been down this same path.

When my mom was in her mid 80's and having knee pain that was affecting her mobility and independence, I took her to an orthopedist. She has no cartilage in one knee. He gave her a gel injection (twice) and she's not had pain in that knee since (she's now 91). If your mom has the insurance, please don't give up on helping her find solutions (short of surgery). The orthopedist will also recommend PT, and it will probably help if she actually does it but she has to solve the pain problem first.
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Reply to Geaton777
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My mom’s doctor ordered home health with physical and occupational therapy after falls. It does help strengthen core muscles.

I’m so sorry that she has fallen so often. It’s so hard to see a person suffer.

Best wishes to you and your mom.
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Reply to NeedHelpWithMom
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Each AL has their own criteria for how much they're willing to tolerate from a resident, in terms of care needs. My mother has lived in AL since 2014 and started out pretty good; totally mobile, lucid, etc. She's gone downhill ever since, and has fallen over 50x since. I know the AL was wanting to boot her out for about a year before she got sick with pneumonia and went to rehab. She'd been having chronic vertigo beforehand and sometimes required TWO people to assist her, which is a big no-no for most Assisted Living's. Anyway, after her stint in rehab, she became wheelchair bound 24/7 and when the AL nurse came to do the evaluation to determine if they'd take her back in AL, they said No. This was their chance to get rid of her b/c she had been a big burden to them for a long time prior. Now, in a wheelchair and with moderate dementia, she was going to be WAY too much for them to handle with an approximate ratio of 20:1 resident to caregiver ratio.

They said they'd take her in their Memory Care building due to her compromised mental condition AND her compromised mobility. I had a choice of either agreeing to that arrangement or leaving her at the SNF she'd been at for rehab.

OR..........finding a different ALF that would accept her as is, like Morning Star which is a franchise. They are noted for taking 'more difficult' residents who really belong in a SNF but want to stay in an ALF. Of course, they will charge SNF prices at their 'gold care plan' or some such thing, which is astronomical. But..........Morning Star would have taken her. If you have a Morning Star in your area, check them out.

In the meanwhile, talk to the ED and the nurse in charge of your mom's ALF. Ask them what their criteria is for keeping your mom vs. asking her to leave. Tell them you do NOT want ANY surprises nor to be blindsided one day. You want to know so you can have your ducks lined up to get her placed elsewhere if they're thinking of asking her to leave. This has been one of my BIGGEST worries since placing my folks in AL in 2014. When my father became too much to handle, I KNEW they were going to kick him out and they wanted to..........but then he got a hospice evaluation and was accepted, so they agreed to keep him. That's something to know, too.........to keep in mind for future reference. Generally, if an elder is accepted in hospice care, the ALF will NOT kick them out but will allow them to stay until they pass away. Which was a godsend for me b/c my mother and he had been married for 68 years and I did not want to separate them at the 11th hour.

So.........if you don't have a Morning Star ALF nearby, and the current ALF wants to ask your mom to leave, call an agency that specializes in placements for elders. Tell them the situation and that you're looking for another ALF that will take your mom WITH her current conditions as follows; ABCDEF........etc. Let THEM do the homework and find her another ALF. That's your best bet. Or you can even ask an advisor here on the AgingCare website.......I'm not sure exactly what they handle, but I DO know they have a list of ALFs and places they deal with.

*I've had Physical & Occupational Therapy ordered for my mother at least 15x over the past few years, including a daily stint of it in Rehab. It did her little to no good; for some people it works wonders, but for others, they're too far gone with their mobility issues to get any real benefit from PT. Not to mention, she hated it and the level of complaining she did about getting it every day, and the incredible excuses she'd invent as to why she 'couldn't' do PT that day made the whole endeavor a giant waste of time & $$$.

GOOD LUCK!
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Reply to lealonnie1
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I believe it's not dependent on the state in which someone is living. Normally, ALs are not state-regulated, unlike NHs, I think you could check with her AL without bringing up your specific concerns at this time. Could you just ask them what are the minimum ADLs for each level of care?
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Reply to caroli1
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Is there any way she can get some PT?    Even if not, I'd consider something she can do on her own.   I've recommended and feel that this is a great device, and can be used without a therapist.    It's a foot/arm cycle, and helps build strength in both arms as well as legs.

https://www.allegromedical.com/exercise-fitness-c523/drive-pedal-exerciser-stationary-bike-p189381.html?CS_003=9164468&CS_010=8ab281020bb66dff010bb678d8560eb4&msclkid=31d4c6bb8b7b1c8c96fa99319af67e7e&utm_source=bing&utm_medium=cpc&utm_campaign=(ROI)%20Shopping-%20Top%20Sellers&utm_term=4580359291835476&utm_content=Top%20Sellers&adlclid=ADL-01181bd3-38c7-4b2b-b7bd-4e1af7cb51ff#1133-19F004D

Another version, about 3x as expensive:
http://www.binsons.com/ADEXPEDVRES.html

You can purchase these at DME suppliers, or through some of the plentiful multipurpose catalogues

Are you attending PT with her?  It's not a bad idea; you can get a list of the exercises assigned to her and do them with her when you visit, then have a celebration afterward so she looks forward to working out.    You can also play her favorite CDs, or other  music, to make the workout seem more enjoyable.
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Reply to GardenArtist
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If your mom needs a wheelchair to be safe, ask if they can focus on transfers so that she can still get in and out of bed, on and off the potty and other chairs to retain some independence.

Such a tough time when they start failing, it can happen so quickly at her age. Be prepared for anything at this point.
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Reply to Isthisrealyreal
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Many of the elders at my bro's assisted living were in w/c. I don't see that as preventing her staying there. I would discuss with her ALF if that would mean anything to her care or care level. I can't know how many assisted livings are available to you, but as I said, many residents in my brother's So Cal ALF were in wheelchairs. They even had dogs. Talk to the facility about your fears that Mom may soon need a w/c.
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Reply to AlvaDeer
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Maybe time for a wheelchair. You may want to talk to the therapist at rehab and see what she/he says.
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Reply to JoAnn29
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I suppose it depends by state. I recall that when my LO was in a regular AL, they said there were certain requirements regarding how much they could do for a resident. I recall that at that time in my state, the resident could not be double incontinent and couldn't be in need of more than reminders for things like meals, although, they did help escort some in wheelchairs to the dining room. I think they had a rule about needing no more than one person to assist in transfer in and out of wheelchair. Do you know if they are working on that in rehab? I hope you'll get some more responses from someone who has dealt with this. I personally know several people who were in nursing homes due to inability to ambulate.
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Reply to Sunnygirl1
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BilliesDaughter Oct 16, 2020
We're in Ohio. Hopefully rehab will help, but I fear it's a band aid on a long-term problem. Thanks for your advice.
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