The staff is now not capable of keeping up with the needs of the residents. We pay extra for daily showers and med assistance for both of them and it’s a daily battle to make sure these are done. We are considering moving them to another facility (which we have checked out) and has a top notch rating. Will it confuse them too much to move them again?? My Dad has on set dementia (some days good some days not) Mom is not far behind. Our concern is for their safety and well being. I just worry about them handling it.

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Such a hard decision and an all too often situation. We have had to move my parents 3 times in the last 4 years. Two IL facilities and then to AL in the second facility 3 months later. My mom with dementia had adjustment issues for several months, but then settled in.
Problem is all the facilities seem to have staffing issues at one time or another and the food gets boring and tasteless after a while.
On a practical note, why daily showers? Most elderly people are good with 2 or 3 times a week at most with daily washing of critical areas. Skin gets dry and they get exhausted from showers. You might re think that...and you might consider an outside agency coming for some responsibilities.
Helpful Answer (8)
Reply to Judysai422

It will confuse them initially but please do move them as soon as possible. They will adjust.

Your parents need to receive proper care and you do not need the stress of having to do battle with what sounds like a sub-standard AL.

Yes staff turnover is a given but that is no excuse for neglecting vulnerable residents. I would also be leaned more towards communities with fixed monthly fees for all services. My M-I-L has been in a small (32 beds) AL for 2 1/2 years now. We've only had one issue with staff in all that time and it was relatively minor.
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Reply to Sanibel01

A move is "easier" if things are set up as much as possible in advance.
If you can gradually take clothes "to be cleaned" or changing winter to spring clothes. Take some of the nick-knacks to be cleaned or repaired..
The day of the move have an outing scheduled and have someone come in move all the rest of the items to the new home. Have the new room set like the old one as much as possible. When you return from the outing to the new location when they see their belongings it should be more comforting.
If you can before the move if you take them on a "visit" to the new location so they can get a feel of the place, arrange a lunch or dinner there so they know the dining room, some of the staff and sort know their way around. When they move in some of what they see would be familiar to them.
It will be a bit of an adjustment and don't be discouraged if they decline a bit, or tell you they don't like it there, they "want to go home". Just tell them they are safe, they are home.
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Reply to Grandma1954

Where we live the various facilities tend to by cyclical in being the “good” and “bad” ones. Among the nursing homes the good therapists will all suddenly move to a different place. Or there will be a corporate buyout of a place and new owners will either make it far better or far worse. My dad is still in his home but he has a network of fellow elderly he knows and they all keep up with the scoop on what places are the ones to go to or avoid. When an assisted living starts wanting you to pay extra for what should be normally provided and then not providing it, I don’t think it’s a bad idea to have your radar up and be thinking about moving.
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Reply to Daughterof1930

Thank you for you advice. My dad says he just feels better after his showers. Has more energy. Helps with the stiffness in his back. Will definitely talk to him and see how he feels about cutting back a little.
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Reply to Bobandflo

They will adjust. Get them the best care they can afford. You will be more at ease. I moved my mom. It was far less of an issue from what I imagined it would be.
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Reply to jjmummert

I’d suggest you have an outside needs assessment done on your folks. Contact your AoA - Area on Aging to see who does these OR have a frank conversation with the SW or admission where they currently live as to who does independent assessments.

It may be - and this will be hard to deal with - that 1 parent is ADL ok for AL while the other is more frail and truly needs skilled level of nursing care in either a NH or MC with a better than average MC staff.
If $ is no object, a NH will take both in and they share a room with each at private pay rates even tho’ 1 may not actually need skilled. But if Medicaid is involved in covering cost, the needs assessment will be the determining factor as to if 1 goes NH and the other stays AL. As far as I’m aware there is not “but their married” exception to have them stay together to the being “at need for skilled care” rule for Medicaid eligibility.

I will echo Daughterof1930 experience as to the cycling in & out of better staff at facilities. New place opens & offers more $ per hour and staff moves. My mom’s first NH when she finally moved in was quite different than what I toured 2 months earlier. Ownership was same & based in another TX city, but administrator left and within mom’s stay there it was 3 different ones, plus SW & admissions gal left. Last straw was the MD / medical director told me he was not going to renew his contract for the incoming year. The DON had obvious staffing favoritism as well as for steering hospice placement. Between that and the pharmacy supplier having similar corporate adresses and agents names to facility ownership, I filed a Stark Law complaint on NH 1 after I moved my mom to NH#2. Mom’s Medicaid took almost 6 mos to clear and then like 2 months to straighten out billing issues. I moved her to another & eons better NH with an open Medicaid bed at month 9.

Moving can be done but will be a bit of a ballet to do. I was lucky as the new #2 NH sent out their 2 person assessment team to visit my mom and steered me thru how it was best handled and timed. She was on Medicaid, and Medicaid allows for lateral transfers without penalty. I gave 2 weeks notice but technically did not have to as Medicaid pays on real time daily census to the NH.

My understanding is if they are in AL, the AL facility does not have to provide oversight for their move to another AL or to a NH. If they are in AL, they are consider to be fully capable by & large and in theory just needing some assistance. Often the issue is that AL and family downplay or ignore that their elder has crossed their ADL ability till it’s beyond the pale. This is why an independent needs assessment is important. AL by & large is private pay and you cannot overlook the
profit motive of the AL; they know how your folks roll so will overlook issues till it gets just too, too problematic. Then it’s “we love them but they need a higher level of care” storyline from the AL.

It’s only if they are in a SNF aka a NH, that Medicare and Medicaid will require a facility to ensure a continuity of care by the move. AL does not have that requirement as it’s just assisted living.

Separating couples can be very hard & filled with angst. My aunt was totally NH but uncle was AL; they fortunately had $ to private pay for both to be together in a NH. She predeceased him and he stayed on in the same room at the NH. Only cause they had the $ to private pay.

If medicaid will be filed, see if there is a tiered facility - the type that goes from IL to AL to NH & likely has a hospice wing or MC - that they each can go into at the appropriate level of care and accepts Medicaid for NH. At least this way they can visit regularly. Plus easier for family to visit. Good luck.
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Reply to igloo572

It can be pretty disruptive to make another move if they are fairly well adjusted to their current situation, so first try to determine if it's a systemic problem or a shorter term 'bump'. Sometimes, ALs have a period of unusually high staff turnover and on-boarding new staff can create short term issues with care delivery. Be up front with the executive director and nursing director. Tell them about your concerns and say that you'd rather not move your parents if it's a situation that is improving, but that you want to hear their assessment of how the situation will be improved.
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Reply to IsntEasy

Everyone has long answers for you. Mine is short and from the heart.

If they can’t handle giving showers to your parents everyday. Then they are certainly not handling medical necessities correctly. GET THEM OUT.

I have been down this road, if you even thought it, then it needs to be done. Trust your instincts.
Helpful Answer (3)
Reply to anonymous885003

My dad has moved a total of 4 times over 8 years.
As his needs change, I *have to* know that he's safe.
And I will not allow facilities to rip us off, spending the kind of money we do on care. It should be a 5-star experience! It's simply unacceptable.

I make complaints to the higher management, to the state...
I'm an elder advocate!!

I have really tried to work with the facilities, yet when I have to hire my own caregivers to make sure he's good, then it becomes impossible and unsustainable. Then I have no choice. I do what I have to do.

I know it's challenging and difficult...

All the best to you and your parents!
Helpful Answer (2)
Reply to Savitaa
NeedHelpWithMom Feb 26, 2019

I applaud you for not settling for less than is deserved. Why can’t issues be settled? Do you prefer individually owned or corporate owned? There are no non profits in my area.
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