Moving parents from AL to higher level care facility versus hiring someone to come in during the day. Advice? - AgingCare.com

Moving parents from AL to higher level care facility versus hiring someone to come in during the day. Advice?

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My parents have been in assisted living for 1 year. My dad is 90 and my mom is 87. Their health is deteriorating. My mom's vascular dementia is worse and she has fallen 4 times (that I know of) in 4 months. The facility is a large one and getting the proper follow-up with the staff is hit or miss. I am trying to decide if moving them to a smaller facility or one that has a memory care unit will be more helpful or more disruptive to them.
The other option is to hire an outside caregiver to come in during the day to help
them. It took a lot of persuasion to get them to this facility after they had lived with me for 3 years, so I know that another move will be difficult. They are used to this routine and the people there. They are not getting the care that they need and no amount of conversations with the staff and management has changed that. Has anyone been in this situation and did you make a move?

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Burnedout - "A place for mom" can help in your search when you are ready. I recently found an excellent adult residential home with great staff and on a much more personal level than the large corporate facilities. A rep will recommend facilities for you to tour. They were a huge blessing to me and I hope can help you also.
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Thanks so much for all of the advice. I haven't been able to check in on the site
regularly. My mom fell again and it has been a few days of craziness. A lot of great ideas. It is difficult to step back and look at the big picture when you are
in the middle of the drama. I like the two-step approach and I also agree that
after the move, my mom won't remember the first place. She doesn't remember
falling, hospital visits or the rehab stays. I talked to their doctor yesterday and he felt that a smaller facility with more care would be better. He can't do anything for them medically but feels that many of the issues are environmental.
Since I am the only child, it is a platoon of one. But I am there all the time, particularly since I am concerned about the level of care. I know that they have to stay together. They have been married for 70 years. I am planning on calling one of the caregivers that was absolutely wonderful when my parents were in my home. I am sure she is in great demand but - she has visited my parents regularly over the last year and has stayed in contact with us. Again, thanks for all of the advice. I don't feel so isolated.
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One more thought. You mentioned and expressed a lot of anxiety on your part, as a caring daughter, for forcing them to make an uncomfortable change. It is very hard to switch roles and become the parent to the parent. But think about what, as parents they needed to do for you when you were young and vulnerable to keep you safe. While you may have 'wanted to walk to the store alone' or some other thing that would have pleased you, they knew it was not in your best interest to do that. You were too young or too immature, etc. to handle it. Now your parents may want certain things and it is hard to say no, but remember your motivation is to help keep them safe. Follow your gut and don't beat up on yourself. If they are in a good place, the staff is used to dealing with this kind of emotion and issues with such upheaval. You will be visiting and reassuring them and it will all be ok, if a facility is what you determine is best.
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I agree with the comments that at the least, you should move them if your hunch and experience is that you are not getting the response you should nor are they getting the care they need. Try to find a place that has more actual employees than 'contractors'. My MIL's place was mostly non employees and that was a huge impact. It doesn't need to be fancy but the care needs to be wonderful. Someone coming to them might be the best, but only you and their doctors know if that is something manageable for them financially and realistically, depending on their conditions in the financial and physical regards. They are so far together and when one of them goes, it will be another hurdle for everyone involved. So much to think about. It is a fact that in any care facility, regular and non scheduled visits from caring family help keep the care factor and accountability factor higher. If it is too much for you to have them back in your home with a constant caregiver, I would make sure you and other family 'platoon' to check in on them and keep the caregiver staff on their toes. Also, look for a not for profit place. Best wishes.
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If your parents can afford it, hire someone. A momma hen with one little chick is much more responsive. In other words the AL facility has dozens of residents to look after and probably is under staffed (it's all about the bottom line for the owners or corporation). One person to look after two elderly people is probably overkill, but I have a full time person in my home to help with my mother. She is a God send. She looks after her like a momma hen with one little chick.
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Burnedout, I am going through the same thing now with my cousin. I really understand what you are going through. It can be frustrating.

My LO is in an ALF, but her needs at times are too great for them to handle, though they do have many dementia residents. After much research and a meeting with the ALF team, I have accepted that my cousin, who has significant dementia, is going to continue to go down hill with her mental and physical ailments. She falls a lot and she is growing uncooperative, refusing to eat, etc. I'm told these things will not get better, but worse until she is not able to talk or stand on her own.

I'm happy where she is, but know they cannot handle her needs down the road. I'm looking at two Memory Care facilities today. I hate to move her, but I'm told I need to get her in place soon. She needs time to adjust to a place. I was told by the director of the Memory Care facility that they will stay with others as long as they are able and when they are not able they go to a special section of the Memory Facility where they cared for when they can no longer eat, walk or move. They are trained to work with dementia patients and I think that is important.
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you have to look for a place first. the best time to go in see a place is in the morning. if it smell urine walk away. ask when was the last fall and bedsore they have had and ask for it in writing. look around for people being drugged. after you put them in the new home come at different times. check your loved one body at least twice a month you can even have an aide help you with this. you don't want to have to move them again. i am praying for you and yours
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I moved my mom, who has dementia, to AL in May, 2011 after she fell and broke her ankle. I had a short time to select a facility, and very little experience in evaluating facilities. After about 18 months, I felt that the staff was not making an effort to get mom out of her apartment and involved in activities, and I had some other concerns about her care. I found it difficult to communicate with the staff and administration. Also, this facility had considerable staff turn-over, and had three different directors of nursing during the 18 month period. I decided to look at other options. I called the Area Agency on Aging for their recommendations and started visiting places on the list.

I spent a month making phone calls and personal visits, and I talked to friends who had experience with placing aging parents. I selected a facility that is actually quite large, but has independent, assisted, advanced assisted and memory care living wings. Mom was more confused for about a week after her move, but the staff was extremely helpful. Now, 18 months after her move, she doesn't remember living in the first facility, and the staff in this facility has been great at keeping her busy and giving her good care. My only regret is that I didn't move her sooner.

Burnedout, I would suggest that you visit some facilities, particularly those that provide several levels of care, and visit with the staff about your parents' needs. Any facility that you consider will send an intake person to evaluate your parents' condition and decide if their facility can provide appropriate care. It sounds like their needs might be increasing, and it might be easier to move them sooner rather than later.
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My mother has been in the memory care unit of AL for a year and a half now. The AL facility also has a Resident Services Director who has been most helpful - more so than the Director. My mother has Alzheimer's, and it was the RSD who suggested hospice to us in October of last year. Mother had lost a large amount of weight in less than 6 months, along with deterioration in her mobility and her ability to speak. She fell and broke her hip the middle of August, with repair and 4 weeks of rehab afterward (another story). She had to be taken off hospice when she went into the hospital with the break and when rehab could no longer "keep up with her" I called them to see about moving her back to AL so that she could be back in familiar surroundings. Their requirement was that she had to be able to help with her transfers (wheelchair to bed or toilet, etc.). Hospice sent someone to rehab to reassess her, she met their qualifications (further deterioration than before break) and returned to AL. They send nurse to AL as needed (generally on a regular schedule (ex: once a week, once every other week, or more often if needed). She also has a personal aide who comes by to help with bathing and other functions as needed (for about an hour, 5 days a week). AL benefits from having hospice come into the facility to help residents, and the resident receives more personalized attention as needed. You didn't mention whether or not your father has dementia. I was told that the only way you can live in the memory care unit is for a doc to certify that you have some type of dementia - as my dad is 90 and doesn't have dementia and my mother is 86 and has Alzheimer's. I was trying to talk dad into moving into AL, thinking that he would want to live in the same apt as mom - but AL would not allow that (lots of additional reasons why not). All this to say, check and see if the facility has a Resident Resources Director - they may be able to help you/your parents. Best of luck, no decision is an easy one.
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I would recommend that she contact the ombudsman for her state if she feels that the facility is not being responsive. But only after you've found that a meeting with the Director of Nursing and the Administrator of the facility does not improve care. The problem may be, though, that these folks may be beyond what can be coped with in AL.
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