Question about assisted living facilities

Iris L.

I am asking about my 89 yo neighbor.  She has had a couple of bad falls and wants to enter an assisted living facility.  She is ambulatory but is afraid to walk without someone right by her for her to lean on.  She refuses to use a walker.  She has no dementia.  Would an AL facility escort her personally to meals and wherever she has to go on the grounds?  She has no family, only one friend who visits once a week or so and me.

Iris

Quilting brings calm

I do not think they would accommodate her refusal to use a walker.  It’s not that they would deny someone in a wheelchair. They can assist with dressing etc, They just aren’t going to supply her with her own personal companion and caregiver.  Refusing to use a walker makes her a fall risk.

harshedbuzz

Iris-

Where I live (PA),  a hospitality model AL would not offer her a 1:1 attendant for meals and to squire her around as she desired.

She might approach that level of care in Personal Care which is very similar to MC excepting that it is not a secure unit and the residents tend to have more physical rather than cognitive challenges. Many of the corporate MCFs near me have PC and MC in different wings of the same building. A few are smaller areas in CCRCs. Some of the corporate PC places I toured had were more like a studio apartment, in the CCRCs they tended to be more like the AL apartments with a kitchen and living room.

That said, there may be an expectation that she use a walker for liability reasons and would be prompted ("nagged") around this daily which would not make her happy. And while I imagine she could arrange to be escorted to meals, group activities and planned outings, she might need to hire an attendant if she wants to come and go more independently.

HB

Cynbar

Assisted living facilities vary widely, both in price and services they provide. Several around me have a certain amount of caregiver time included in the rate, such as an hour a day ---- if more is needed, there are extra charges and I hear anecdotally they add up fast. I think many would get your friend to meals but probably in a wheelchair, they don't have the time (especially at mealtime) for a slow and leisurely walk. But there doesn't seem to be any universal standard that you can refer to. The only way to tell is to talk with each individual facility. And it's a good idea to talk with your friend about an honest appraisal of her needs/expectations before contacting the facilities ---- we see too many posts here about people who underestimate the help they need and end up with a bad fit.

MN Chickadee

She *may* find a place who can accommodate this but it could not be assumed, she would have to call individual places to find one that will. A typical AL is usually more hands off than this, but it is such a generic umbrella term. There is a lot of variety of what an "AL" actually offers. Where I am I can think of a couple places that have a bit higher acuity and would probably be able to do this, but just a couple out of dozens or hundreds. I don't know the legality around the walker. They may require her to use one if she is a fall risk and is cognitively able to use one. A physical therapy consult may help her find ways to get stronger and improve balance, or perhaps help her see the need for a walker.

dayn2nite2

She needs to use a walker.  The staff cannot have someone being paid whose only duty is to escort her at her whim.

If she wishes to hire someone to do that, great.  Otherwise she needs to ambulate or propel herself in a wheelchair.

Stuck in the middle

Has she tried a quad cane?  Those are helpful for people with balance problems who are otherwise ambulatory.

Iris L.

Thank you all for responding.

Quilting brings calm, my neighbor needs no help with dressing. She eats on her own, pays her own bills and showers.  She won't take a bath because she cannot lift herself out of the tub due to lack of strength.  I had suggested in the past that she use a shower chair, because she can just as easily fall in the shower.  She was not interested.

Harshedbuzz, I wasn't aware of the Personal Care option and I will certainly mention it to her to inquire about.  I have been prompting her about using a walker for months.  She fell last September on Labor Day, eleven months ago, while walking her dog.  She blamed the fall on the dog pulling the leash, yet she stopped walking unattended from that day.  I had suggested that she get physical therapy and exercise at home, also walk to the mailbox and around our complex daily, in order to keep her legs in tone.  But she has refused all my input.  I had suggested that she hire someone to attend her a few hours a day in her home, but due to Covid, she did not want a stranger in her home.  Even without Covid, she does not want a stranger in her home.  Since last September, she has been housebound except for  few medical appointments and a weekly outing with her friend.

Cynbar, her friend wants her to live closer to her, so I believe she already has a facility in mind.  But it's still a good idea to ask around at several facilities.  The reason I posted this question is is see what might be available.  I did not think an AL facility would provide a personal escort, because the requirement for entry is a certain level if independence.  Her expectations are of a personal attendant for her mobility.  I will talk with her more about her expectations.

MN Chickadee, my neighbor has refused PT on my recommendation.  Perhaps if a facility required it, she would comply.  Don't facilities require a doctor's note?

Dayn2nite2, I will put it to her straight like this.  This is how it is.

Stuck in the middle, I had not thought of a quad cane.  But it seems that her legs just give way.  She said she did not feel dizzy or lightheaded.  And she cannot pick herself back up due to lack of strength in her legs and arms.  I don't think a quad cane could help in this case.  But really a physical therapist would be the best one to make recommendations.

I did tell her to carry her cell phone in her pocket at all times.  She doesn't like to carry it nor wear her Medic Alert necklace.  When she fell the other day outside her front door, she had to crawl back inside in order to get to her landline to call a male neighbor to stand her up.  In our section, there are many of us at home during the day, but it is so quiet here no one knows what's going on unless someone telephones.

It's great to have so much experience.  Thanks again!

Emily 123

Correct, Iris, she would need her doctor to order PT, for fall prevention and strengthening. If she were switching over to using the facility's provider, and the facility was aware of her propensity for falls, they would probably be very much in favor of her having some, but of course it's up to her.  It would be covered by Medicare.

Jo C.

Hello Iris; as you know, I live not far from you.   I have recently helped a person find placement for his mother which was not successful as she just was not strong enough to live independently and get to the activities, dining room, etc.  They ended up hiring someone in the home despite the mother's protestations and fortunately, she eventually adjusted.

 ALFs are just that;  "assisted living."  They are not highly staffed.  They have a basic rate and also have a ladder of increased rates for increased care assistance - this is NOT walking with her to everything and definitely not being with her while she walks in  her apartment.  Increased rates often encompass a fee for assisting bathing; a fee for assisting with meds; a fee for assistance with dressing, etc.  Staffing in an ALF is fairly low; not at all like Memory Care or NHs.

 She should be very aware that the Marketing Person who usually does the admission interview, etc. as well as the Administrator, MUST fill their beds; it is demanded by the owner corporation.  Unfortunately as I have learned through professsional and personal experience,  promises are often glowingly made that cannot be kept; and sadly, within a few months the resident who was not a good fit in the first place is asked to leave as they cannot meet the care or safety needs.

Frankly, your neighbor may not have been diagnosed with dementia; but it does sound as though her logic, reasoning and judgment are compromised.   Even in a MC Unit, they would probably have her wheelchaired a lot of the time due to her lack of balance and history of falls and needing someone with her to lean on.   I am so sorry for her; that is a difficult place to find oneself.

ALFs have those long halls and are usually multi-storied necessitating using an elevator.

Having someone with her during at least the day would be wonderful, but most people cannot afford an ALF and a private aide.  So hope a good answer is found for her.

 J.

Quilting brings calm

Jo C  - I agree with most of what you says about Assisted living with one exception. 

My parents are in an all one price one. Medication management etc is  provided ias part of the normal price if desired.  There are no additional fees. Now,  if cste exceeded their list of provided care, then we would have to hire an aid.  Then it would become a calculation as to whether staying there or moving to a MC or skilled nursing would be cheaper 

towhee

Iris, does anyone go to the doctor with her? Someone who can actually talk to the doctor? Often older people will not be truthful about falls with their doctor. If her doctor knew he could order PT and also see if something could be causing her to feel weak?

I agree that AL MC can be completely different in what they do. I have seen an age in place AL that was practically a nursing home and would do a great deal to prevent falls, and an MC that basically said if you need special treatment you need to be in a nursing home. That said, if you fall too often anywhere (and the definition of too often differs by place) it looks bad on their record and you will probably be asked to go to a higher level of care. 

Right now she is probably getting around her home by hanging on to furniture and cabinets. In a lot of ALs they have a railing down the hallways that she could use. Actual physical support without holding on to the rail I think might be frowned upon as she could take an aide down with her. She might be able to get escort back and forth to meals and possibly to activities, they certainly will push a wheelchair, but they are not going to come at her beck and call. She will likely be pressured to use a wheelchair. 

She needs a small facility, or one with small separate households.

Iris L.

Well, there's been a new development.  My neighbor was under the impression that she would be cooking her own meals in AL.  I told her no, the whole point of AL is that the resident does not cook or do housework, but eats in a common dining room.  She does not like that.  I forgot to mention, she does have a lady do her grocery shopping and clean once a week.  My neighbor does her own laundry.  Now she wants to stick it out in her home.

I got her to turn on her cell phone and put my number in.  I told her to eep it in her pocket and to charge it every night.  She said she only uses it for emergencies.  I told her she has to do it because she never can predict when she will fall and she wouldn't be able to call for help without her cell phone.  One victory.

Emily, it's not that she can't get physical therapy, she doesn't want physical therapy.  Her husband had home PT and she helped him; I told her at least do the same exercises.

Jo, I have known my neighbor and her husband for over thirty five years.  We were pet-sitting buddies, also drove each other for medical appointments when we were not allowed to drive.  He passed away last year from Parkinson's and dementia. During his illness I told her what I knew about Parkinson's and dementia.  I have gone with both of them to their medical appointments, inside with the doctors not just driving.    Many times she had told me that I gave her better advice than her own doctors.  She belongs to the big HMO here which I'm sure you know.

Yes, her logic and reasoning and judgement do sound compromised.  I have often wondered why she thinks the way she does.  Both of them were stubborn and single-minded.  It probably helped them to leave a communist country and immigrate here in their late middle ages.  But I am sure she does not have dementia.

I think some of the issue might be from long-time isolation and not being around younger people.  I see some couples on the Spouse/Partner board who spend all of their time with each other, alone.  When her husband died last year, she fully expected that she would join him soon.  But she is still here.  

She is very solitary, almost like a hermit.  I tried to interest her in going yo the senior center when it opens up.  Not interested.  I tried to get her on the internet, she said she used computers at work and she never wants to see a computer again!  I did get her a volunteer to come from Heart of Ida for a few weeks last year.  

Towhee, her friend accompanies her to medical appointments now.  But she said, what could a doctor do?  I told her, review her medications for those that might make her vulnerable to falling, and refer her to physical therapy.  She just doesn't want to go. I don't know if she is leaning on the furniture.  I'll ask her, I didn't think of that.

What I have learned  from the members here is that often one has to wait for a crisis to occur.  I know a crisis will come.  But I am not a relative but a neighbor.  I will keep talking with her.  I can give her information and encourage her in certain things like keeping her cell phone with her.  But I can't force her.  I don't even know if someone has POA.  But I will talk with her about preparing for a crisis.  

Years ago, my elderly aunt fell in her apartment and was not discovered for a few days.  She was admitted to the hospital and was about to be transferred to a rehab facility when she had a seizure and died.  She always said she did not want to go to a "home."  So I am familiar with what could happen. 

Iris

harshedbuzz

Iris-

That is difficult indeed.

My mom is a bit like your neighbor. She lives alone with her crazy Maine Coon cat and doesn't like being told to do things safely. Her balance is terrible because she has significant scoliosis after a neighbor's dog attacked her and fractured a couple vertebrae. Dementia has not been kind to her; the dog, a Cocker Spaniel of all things, jumped her when she went to tell a neighbor his wife with EO had eloped and was headed down the 16th fairway clutching her knitting bag.

She did do a special PT program for people who are fall risks. It not only worked on strengthening her legs and stamina, but also on how to fall as safely as possible. But the pendant, UGH. She did buy one, but like your neighbor, mom's pretty vain. In the 3 years she's had it, I have never seen her wear it. When I call her on it, she complains that it's ugly and ruins the neckline of her clothes. This week, she's buying me a new Apple Watch for my birthday. What she doesn't know is that she's buying herself one too. She is fascinated by the watch and would see it as being the cool little old lady. The fall detection feature is pretty sweet.

HB

Jo C.

It is too bad there is not a smart and good adult child to assist and soothe the roiling waters.

If she had a "companion," rather than an aide, that may be more palatable for her if she thought of such a person as a friend.

My mother, in earlier years, adamantly refused any aide care assistance. She literally fired two of them at the door before they could even get inside the house.

So . . . . unbeknownst to her, I hired a lovely woman from church who was experienced in companion care of the elderly.

I had her over for coffee and cake with Mother and me, and introduced her as, "a friend of mine."  Lady interacted just lovely with mother.  Did a second time visit with mother participating - at one point I excused myself to attend to something; mother and the lady companion stayed at the table talking; the lady was marvelous at how she engaged my Mom.

Couple of days later, the nice lady called and asked to speak to Mom.  She told my mother how much she enjoyed visiting with her.  Then she asked if she could drop by for a short visit the next day. Mom consented.

I made myself scarce for that visit, Mom and she hit it off beautifully.  Done deal. After that, it was all good; to the beauty shop, looking at TV programs together, doing small crafts, assisting Mom in whatever, looking at magazines and talking.  Once they went to lunch together with me secretly footing the bill.  Fiblets yes; but it worked great.  Never, ever told Mom I paid that woman. 

If there was a way your neighbor would be willing to hire a companion to be with her, that may be more palatable and certainly a lot less expensive.

Unfortunately the lovely lady we had has moved out of state, so she is no longer available.

In any case, so hope an answer is soon found.  I think a companion would be just the ticket.

You are a good friend and good neighbor; she is very fortunate to have your caring,

J.

Iris L.

I learned some more today.  My neighbor does not have to lean on the furniture inside the house, she walks unaided.  She has had only two falls, the one last September and the one last Saturday.  But she is fearful of walking unassisted by a person.

I also learned that her husband's 95 year old cousin is her POA.  She said she signed the legal papers.  The cousin never leaves her house, so I don't know what she could be able to do in an emergency.  But the cousin does have children and grandchildren, so perhaps they could help out.

Harshedbuzz, I had spent a long time explaining that she needs to wear her cell phone in her pocket because if she were to fall again, she would not be able to reach the landline.  Today the cell phone is still on the charger in the bedroom.  It won't be of help to her there.

I don't know if her Medic Alert necklace has a fall alert.  Nevertheless, it won't help if she doesn't wear it.  Unlike your mom, my neighbor is not fascinated with wearable technology.

Jo, I already proposed a companion to her last September when she fell and stopped walking her dog four times a day.  In fact, it is my friend who used to do housecleaning, who I trust 100%.  My friend already had experience in caring for her neighbor with terminal lung cancer.  She even traveled with him back east so he could see his family one last time.  She also has a SIL in a facility and knows how to care for older adults who are slowing down and somewhat crotchety.  She is super hygienic and knows all about dogs.  My friend and my neighbor's husband knew each other, so it's not as if they would have been complete strangers.  She refused.

I am nice, but I am not that nice.  I feel like I was roped into this role.  Last year, when her husband was ill and failing I stepped up to do what I could for them because he and I had a history.  Actually, I did not know her that well.  But with his illness and then with Covid changes, we got closer.  We were reminded to check on our older neighbors.  I even got one of my cousins to sew a face mask for her.  I am neighborly.  For the first few weeks after he died I kept in close contact because she was so distraught, having been married for over sixty years.  But as the mourning period passed, I wanted to cut back on calling.  But if I didn't call her at least every day, she would call my next door neighbor and ask her to check on me.  I tried to tell her I was okay, but that I could not call every day.  But she seemed so forlorn that I resumed daily calling.  

She does not have dementia.  She told me details of their lives over there in the communist country, how they decided to emigrate, and how they assimilated once they got here.  She did not speak English but took a training program for immigrants and was offered a job right away,.  Her husband was a celebrity over there.  We had some good conversations.  She could still have good conversations and enjoy her life, if she were not overwhelmed.  She gets her own meals and does her own laundry.   It's too much for her.  But she insists on still doing those tasks herself.  It's like she doesn't accept being older.

For a while I tried to just listen and not make suggestions.  But that is not my nature.  I have to speak up when I believe it's called for.  But she does not want to listen!  She wants to complain about how bad she feels, but she does nothing to make things easier on herself.  I know, the solution would be for me to lessen the phone calls.  I am going to work on that, especially now that I know she has a POA.  Covid will be lessening eventually and I am looking forward to getting back into outside activities.  So I won't be around here all day all the time.

The ironic thing is, even though I call only once a day, I spend a lot of valuable time thinking about her and her issues.  I am not a caregiver but I am spending caregiver time.  This is not good.

Iris

jfkoc

Iris....your situation sounds a lot like the relationship I have with my sister. I try but make no headway with anything.