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My father is currently in AL which I think is a good fit for now. However, I am seeing progression of dementia and we are also having issues with personal hygiene. The facility is aware, but he refuses increased assistance. My question is, will the AL facility prompt me when it is time to make a change? They offer all levels of care, but he would need to move to a different building. What is your experience?

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The earlier in a transition the better so it is easier for the adjustment.
You could set up a meeting and discuss options. One might be that despite what he wants a staff person should come every other morning and help him with a shower and clean clothes. (or maybe start with every third day to ease into this and make it less intrusive for him)
At this point you do not want to move him to a new building, wait until restrictions are eased and you would be able to visit and he would be in a better position to be in a "new germ pool" sort of like when the school year starts every kid comes home with a cold, you do not want him picking up anything if he were to move now. And a move will probably lead to a decline anyway. ( it will happen no matter when he is moved to Memory Care it is expected)
You need to advocate for your dad, they will not suggest a move probably unless it becomes a safety matter either for him or the staff.
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Reply to Grandma1954
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IMHO, you should be the one to speak up about your father's facility needs.
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Reply to Llamalover47
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They like to keep paying customers as long as they can, but there comes a point where the staff starts to object to some things. In my dad's case, he started urinating on his bed, and at that time the Al facility started talking to us about that not being acceptable. Then, the final blow came when my dad took a spill from his wheelchair at a restaurant and broke the shoulder on his usable side. At that point he had to go to a nursing facility, and he died less than a week later. I think he just gave up. I have a great deal of guilt over everything that happened, particularly not visiting him more often when he was at the AL facility.
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Reply to OkieGranny
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swilson1 Mar 12, 2020
Thank you for you insight. I am so sorry for your circumstances. Be kind to yourself.
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They will let you know, no worries there. My mother went from AL to a SNF. The nurse at the AL started sending her to the ER for every little thing. It got ridiculous. At $300 an ambulance ride. It was very passive aggressive and I did not appreciate it.

With the prices being less at the AL, just follow their lead and move him when they suggest it. You can always talk to the administrator about it. The administrator at my Mom's AL was great, and she knew the time was coming and she understood my frustrations with the nurses and their games. But because it was "subtle" it was hard for her to take any disciplinary action.
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Reply to LadyCarolyn
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Talk with the administration and their guidelines. Also clue them in to what you are seeing.
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Reply to Taarna
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swilson1 Mar 12, 2020
I’ve done this, but they seem reluctant to help push my agenda, on hygiene for example. I truly think it’s because they have seen much worse and aren’t s alarmed as I am.
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I think it depends on the facility and the situation. It would be good to have a discussion with the facility. Each time my parents approached needing the next level of care, I asked the facility to help me know because they had knowledge than me. Each time, they said they would not force a move (it is a full-spectrum graduated care facility) unless there was a safety issue. They assured me that otherwise it would be a family decision. And every time I asked if it was time they let me know they could continue to care for my parents where they were. But they also outlined what benefits there would be to moving so we could make an informed decision. There was one exception: when my parents were in AL and dad had three serious falls in three days. He had to be moved to skilled. He had been helping care for mom (in his own limited way). The decision to move mom to MC within a week went just like all the other decisions. It is good you are thinking ahead. And your dad is lucky to have you. Sending you good thoughts for wisdom and peace for the journey ahead.
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Reply to MelissaPA2AZ
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Be aware the fee goes way up from AL to MC. I wasn’t expecting a $3k jump.
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Reply to ElleK
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My mother was moved by the AL facility staff. They came to her rehab center and evaluated her after she had broken her hip. She was not in good shape at that time. They told me she would need to go to MC if she were to return. My mom has improved physically and is doing well, but continues to pack up everything every night. The rehab center said they also evaluated her and didn't feel she belonged in MC. I have to go along with the AL center's decision even though I feel she is doing much better. So my experience is that they will let you know what you need to do and when.
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AvaC42 Mar 10, 2020
I had the exact same experience with my Mom's AL after a fall. They came to the rehab facility and said they didn't have the ability to give her the assistance she would need (physically) after being discharged. So she went to Memory Care. She also had a fall there but they were willing to have her come back after rehab as they could do a two person assist if she needed it. We decided to have her stay in the SNF but it was our decision not the facility's. Also - are you sure your Mom and mine aren't the same person?? She would pack her things up every night too!
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The ALF will let you know when your dad's care gets to be too much for them to handle. Then you can move him, whether he wants to move or not, into the MC section of the ALF or to a SNF, if necessary. Unfortunately, the elders do not get to make their own decisions in these matters anymore. The ALs just want people who require a minimum of assistance and who have a minimum of dementia at play, and who agree to shower regularly, and who don't make a commotion in the dining room or other public areas. Once they start becoming too much to handle, the ALF will be right on top of it and calling YOU on the phone.

I faced that same situation with my mother last May after a hospitalization & rehab for pneumonia. Her dementia declined AND she became wheelchair bound. She was refused entry back into her ALF apartment but accepted into their Memory Care building, which she hates. A SNF is her next stop.

Best of luck!
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Reply to lealonnie1
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My mom was in AL for almost one year. Didn’t need any help and then she started needing two aides to get her off the toilet. They sent her to the 2nd floor SNF for PT. She always hated PT. They told her if she wanted to go back to her AL apartment she had to get stronger. My mom said she was “over” the apartment and thought she needed to stay where she was. So they moved her to the 3rd floor SNF where all the activities and hair dresser was. She was involved in all activities and got her hair done, always busy. She adjusted very well.
I often thought if that was the plan of the staff, to let the decision be made by my mom.
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Reply to LisaNJ
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When my mother was moved from the skilled nursing floor to Memory Care, the decision was made by me as her POA and after a Care Conference meeting regarding her needs with me and all medical staff who had anything to do with her present. The transfer was effected by the staff without me present. Everything worked out fine.
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