Our mother is in AL care and she has no bowel control which requires full-time cleaning. Do we need to move her to a nursing home?

AL is not intended for elders who have no bowel control and need full time cleaning from aides, I'm sorry to say. Nor is it fair to expect your mother's bathroom to be immaculate under such conditions! The 'only b/c of' you mention is a pretty HUGE 'only', in reality! AL residents are expected to require a minimum of care and be pretty independent in general, otherwise, they are intended to move into either Memory Care or Skilled Nursing. ALs such as Morningstar DO have higher care levels than other ALFs, however, but charge SNF prices for those levels, which also include accommodations for mechanical diets and 2 person assists. My parents ALF had NO such levels, and would have expected them to leave if they had bowel incontinence which required f/t cleaning from the aides. When mom became wheelchair bound and her dementia got to the moderate stage, she was asked to leave regular AL and move into their Memory Care building, which I agreed to.

I think it's only a matter of time before your mother is asked to leave the AL and move into Skilled Nursing where her needs can be better served, as an elder with such issues only tends to develop MORE issues over time, never less. And if the staff isn't up to snuff now, they're not going to be up to snuff later as mom's needs increase. If there is a Morningstar ALF in your area, or another ALF that has higher care levels, you can look into that as well if you don't want to go the SNF route quite yet, which I understand fully. I was there with my dad, but he went onto hospice at the 11th hour and the AL kept him until he passed, as is the rule with most ALs when the extra help is on board with hospice. It relieves THEM of some of their duties when hospice is there to help out.

Good luck.

I want to address the cleaning up the bathroom thing.

My Mom was in an AL. I went to her room to get laundry. She was always in the Common area. They gave her a shower that morning. She had a small accident. A little in her shower chair and some on the shower stall floor. The soiled wash cloth was left in the sink. What if Mom had gone back and used the washcloth? I left Clorox wipes so easy enough to use the handheld shower head to wash everything down the drain and use the wipes to wipe everything down. The soiled washcloth, from what I was told, should have been thrown in their wash. I may not get it back but it would not be left in Moms dirty clothes. I cleaned it up. Asked my RN daughter if I should complain, she said yes, so I did the next time I was there.

There is no reason a bathroom should be left dirty. At Moms AL, soiled diapers and wipes (oh yeah, I left wipes too which could have been used) are put in a plastic bag and out outside the room door to be picked up regularly. It doesn't matter how many times they need to change Dad, the bathroom needs to be cleaned up.

I would talk to the RN. Ask her/him if she feels that Dad needs more care than her staff can provide. I always took my complaints to the RN. She is the CNAs boss. She should be told they are not cleaning up. You go to the director when the RN has not solved the problem.

When my Dad was in MC there was a list of types of required assistance "included" in base care and how much extra available assists would cost. For example when Dad returned from a hospital stay there was a requirement for two days of extra care and monitoring. If he needed more than 1 cleanup a day or full assistance when eating his meals, there was an additional cost. The MC used the extra money to hire more nurses or aids so when you're LO was fairly independent the cost was less and when they needed additional care it was available (there was a max cost). The MC Dad was in did not require transfer to a NH generally unless the person required some medical treatment that required more effort or monitoring than they could safely provide. For example, one man required dialysis and would pull the connections out (because of his dementia) had to move to the NH wing.

If the director has suggested a move, it's probably because the AL does not have the staff to meet your LO's needs. If the LO's general health still meets the AL's capabilities, then it may be possible to hire extra help (at extra expense) to stay in AL. But this may be a problem created by other related problems; maybe mobility problems are becoming bad enough the LO shouldn't be left alone as much as AL does?

It may differ where I live, but assisted living suits people who are fairly independent & can make do with *intermittent assistance*.

If someone requires hygiene assistance 1 x day eg shower assist, AL is a good fit.

If someone requires multi assistance at various/random times throughout the day, then this level may exceed what AL offers (places will vary). If BMs are frequent on a regular basis, the person requires frequent assistance - to maintain dignity & prevent skin breakdown.

Is this incontinence new? Temporary? Able to be treated/cured?

Or is this the new normal, part of overall progressing functional loss?