Assisted Living that isn’t CCRC- how does it work?

[Anonymous]

Where my mom lives, CCRCs are quite unusual. The area is full of existing and under construction Assisted Living places, some with memory care.

My maternal grandmother was at a straight up assisted living/memory care place and it was just right for her. She died of heart failure in her sleep.

My paternal grandfather was at a CCRC and spent his last year there in the nursing wing in a hospital bed, essentially in a coma.

For someone who ends up like my grandfather at the end but is at an Assisted Living facility, what happens? Do you transfer them to a SNF or nursing home at the very end and hope you can afford it or do a Medicare spendown? I like the local Assisted Living options for my mom but they are really fuzzy about what happens when care needs exceed what they offer, while simultaneously claiming they’re better because it’s “all in one place.” Help me figure out how it would really work if my mom was in a place that only offered Assisted Living.

[Anonymous]

My experience has been that for assisted living you can generally ramp up the level of care if the need isn’t dementia or cognitive based. Someone in a wheelchair can get assistance transferring or showering or getting dressed in assisted living. But once they start being able to understand things or being confused they’ll move to memory care.

If your loved one needs medical attention then I believe the path is to a nursing home. They seem somewhat hidden in todays world though. I am never clear on whether a facility is assisted living or nursing home.

[Anonymous]

My mom is in a facility that has independent assisted and memory care. No difference between the first two except that you pay each increased level of care. Memory care is separate (locked) wing. People do have hospice come in when needed and people have died there. But there is not a high level of medical equipment or care. They can bathe, bedpan, medicate, do blood work work. people have visiting medical care, others hire additional care (already a fortune) to ensure their loved ones are being taken care of. some people who have had a fall go to a nearby place that has a nursing care wing paid for bu insurance for rehab but it’s short term. Not sure about long term nursing care.

If my mom gets to that point I’ll probably have to move her closer to me and cheaper and then hire my own additional health care. There are a few facilities near me with nursing units, some with Medicaid programs, but they look grim.

[Anonymous]

My dad’s assisted living pledges care through end of life, with the exception of intubated status. In reality, I cant imagine that they would be able to care for someone who is bed bound - realistically they would have to be moved to a snf unless they were under hospice care.

[Anonymous]

My dad’s assisted living pledges care through end of life, with the exception of intubated status.

I like the clarity of that. np here. I wonder how it is worded in the document, whether it can be changed with new ownership. I'm just speculating. Clarity is what's needed in this process and it's exactly what doesn't exist. What I've seen is sometimes the facility has to stall moving residents between living options because available space, and sometimes the facility needs more residents and will take anyone into any level of care if they show up and have the money.

[Anonymous]

Anonymous wrote:

My dad’s assisted living pledges care through end of life, with the exception of intubated status.

I like the clarity of that. np here. I wonder how it is worded in the document, whether it can be changed with new ownership. I'm just speculating. Clarity is what's needed in this process and it's exactly what doesn't exist. What I've seen is sometimes the facility has to stall moving residents between living options because available space, and sometimes the facility needs more residents and will take anyone into any level of care if they show up and have the money.

This is so true! Both for assisted living and now memory care no one is able to give me an answer as to what each level of care is and what you get by paying more. They just say “she’s level 3” or whatever. I think they pull the levels out of the air depending on whatever they think you’ll pay. It’s so frustrating. Only one memory care place I toured was all-inclusive but they didn’t have overnight checks and relied on a motion detector in the room. I wasn’t comfortable with that.

[Anonymous]

It’s all about what’s in the contract. But basically, some assisted livings continue to care for patients who decline and require total care, while others may refuse to re-admit someone discharging from the hospital without them going to rehab first (and those people might transition to nursing home care from there). Every facility is different, but the patients with behavioral challenges, wandering, and very complex nursing needs are not always accommodated. I would be very explicit and direct in your questions with the admissions manager.

[Anonymous]

they didn’t have overnight checks and relied on a motion detector in the room. I wasn’t comfortable with that.

You might get comfortable, enough, with that. I had a an elder in dementia care. A door opening (to check on him), that could have startled him. If it wakes them up they are disoriented and scared. Let them sleep. I could see a motion detector being ok, and that may have been what my Dad had.