What are some care warning signs that I might want to watch for with assisted living facilities?

Pam, AL's where I am in Minnesota handle incontinence issues and wheel people to the dining room.

It's not the same everywhere.

First, please realize that the ALF needs written orders. If mom needs help with stockings, get a written order. If Dad needs help bathing, get a written order. From an MD, not from family.
Now if mom or dad are getting nasty with aides or other residents, they have to leave. If they wander off and will not accept a redirection, they have to leave. If they poop their pants or they can't get to the dining hall, they probably need full on nursing home. Assisted Living is not for everyone.
On the other hand, the Head Nurse should never be rude to you. If you are the POA, go see the Director. If you are not the POA, then channel your concerns through the person in your family who is.

The PA can write orders.

With the drinking, I would find out if its a glass here and there or several of glasses a day. You will be able to know when you visit.

I'm guessing if they're doing this to you, they're doing it to others. Chat with some of the other families there and just see how things are going with them. Maybe stop by a local church and see if they have any thoughts on the place your parents are at. They are in the communities a lot to see members, and often see things "behind the scenes".

Why not move them closer to you? This long distamce caregivingmust be h*ll.

Like Sunnygirl, I moved my mother to a different ALF after I became concerned that the first one was not meeting her needs. I made two attempts to communicate with staff, and after seeing no improvement, I started looking for a new facility. I felt like I knew more about what to look for the second time, and although the move was somewhat disorienting to my mother for a couple of weeks, I wish I had moved her sooner. Maybe you could spend some time during your visit looking at other facilities, or, as Kathy suggested, look into moving them closer to you. ALFs vary greatly in services, quality and price, and it sounds like this one is causing you a lot of stress.

Sometimes the resident's level of care is more than what the facility is able to handle. Of course, if the ALF is not being honest about this, it could indicate a problem.

I encountered something similar with my loved one. The ALF seemed to call me multiple times per day over trivial matters like a lost comb, but they clammed up over major things like falls. I had to move my loved one and it was a good move. The new place handles the matters appropriately.

I would ask the ALF to provide me in writing what issues they have, giving times, dates, etc. When I asked for that from the initial ALF, they didn't have anything. When I talked to specific people, I found out that they were not working full time and the staff was not on the same page. We had a meeting with the director and major staff dept heads to discuss her case. It did help, but we still ended up leaving that facility. Some places are not a good fit.

Thank you for your reply (PamStegman Give a Hug). I do have a POA and have talked with the Director in the past about the behavior of the head nurse.

The ALF has a PA that comes in once a week, is this professional capable of providing a written order to help my parents? I'm concerned that the ALF is trying to move my parents into their nursing facility yet they're both mentally OK (at least 90%), but getting them to wear their hearing aids is a challenge.

My dad's a proud older fellow and is 94. He was always dapper and now is a lot less concerned about his physical (dress) appearance.

I'm going to visit them Sunday - Tuesday (I'm in CT and they're in FL) just to get my hands around the current situation. The nurse is also complaining that my dad and mom are drinking - which was NEVER an issue with them before. Is this common?

Windytown, Thank you for your note too. My heart aches with how this ALF treats so many of their residents. As the older of two daughters, managing most of this care management long distance, my observation is that the AL is more concerned about the profitability of the business, and less about the people living in their facility.

What sort of inspection schedule applies to your parents' ALF? Do you have any information about the local regulatory authorities? I agree that it would be worth investigating to see if there have been other complaints or reports of concern.

Do bear in mind, though, that people's care needs inevitably increase. It could be that the ALF is routinely having to do more than is strictly within their contractual terms - and they can get quite shirty about that sort of thing.

Thank you everyone!
I'm heading down to see mom and dad tomorrow morning. All your posts are of great help. Will have more info when I return.

My best wishes to everyone for a happy holiday and love to all your parents in the New Year too. Nancy