"Aging out" of assisted living?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Are there any laws regarding what services MUST be given to a resident of an assisted living facility? As they decline, can their needs become so great that they may be asked to move to a nursing home?

On the other hand, can someone already on hospice care move into an assisted living facility rather than a nursing home/skilled care facility if they have their own private hospice care team already in place?

Trying to think a few steps ahead. Thanks.

You can get kicked out of an assisted living facility and often you aren't given much time.

How about if we move a parent into assisted living already on hospice and with our own private hospice care team (that we pay for)?

Doubtful, assisted living centers are only allowed to accept certain types of residents and that doesn’t include people who need assistance with daily life skills. Since hospice nurses aren’t under their suoerviisio or employment, that doesn’t change what the calculus.

There are some really nice hospice centers. I’d look into those

This is what I'm tryin to find out. Is this covered by law or just the regulations of the facility? Parent DOES NOT want to go into a nursing home but will consider assisted living environment. We want to figure out timing on the move if any. So is there a law governing what kind of needs are too much for the facility to accept, or do we just find one willing to let them in? And when?

Assisted livings are less regulated than nursing homes; it’s really all about what’s in their contract. I work in a hospital and some assisted livings require a certain level of ability to manage daily activities before returning home, while others continue to care for dependent patients. It varies so much.

We have sent many hospice patients home to assisted living. You just have to check with the particular facility.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Are there any laws regarding what services MUST be given to a resident of an assisted living facility? As they decline, can their needs become so great that they may be asked to move to a nursing home?

On the other hand, can someone already on hospice care move into an assisted living facility rather than a nursing home/skilled care facility if they have their own private hospice care team already in place?

Trying to think a few steps ahead. Thanks.

You can get kicked out of an assisted living facility and often you aren't given much time.

How about if we move a parent into assisted living already on hospice and with our own private hospice care team (that we pay for)?

Doubtful, assisted living centers are only allowed to accept certain types of residents and that doesn’t include people who need assistance with daily life skills. Since hospice nurses aren’t under their suoerviisio or employment, that doesn’t change what the calculus.

There are some really nice hospice centers. I’d look into those

This is what I'm tryin to find out. Is this covered by law or just the regulations of the facility? Parent DOES NOT want to go into a nursing home but will consider assisted living environment. We want to figure out timing on the move if any. So is there a law governing what kind of needs are too much for the facility to accept, or do we just find one willing to let them in? And when?

There are licensing requirements, but there are facilities licensed for multiple care levels.

Though generally they are not housed in the same area. Independent, Assisted and Skilled (and Memory) are separate as each of those groups don't want to have to see all that the more advanced group is going through.

Depends on the facility. Larger places, certainly. My aunt and uncle were in a smaller place in West Virginia that did assisted living through hospice in the same location. My uncle lived with my aunt in the same unit until the end of his life. He passed away in a home-like environment surrounded by his family. It was really as good a set-up as they could have wanted.

Was this one of those independent homes that legally can have just a few people?

No. It was a full-fledged facility. I’m the one who did the research for the family. They told us they could handle assisted living through end of life, and that’s what they delivered.

So it was a continuing care facility.

So is "continuing care" a legit label for this, and is there a license for "continuing care"?

Yes, but most only accept patients who don’t need any care at all at time of admission. And wait lists can be very long, sometimes years for the more popular (nicer) facilities. We were quoted two years by one and four by another in the Baltimore area. Fortunately my parents have already been on the wait list at the place with the two year wait, so it will only be about a four month wait from when they were ready to move in.

This really depends on where you are. It can vary a lot.

I don’t think it varies alot in more populated areas of Maryland.

Maryland is a big state.

[Anonymous]

Anonymous wrote:My dad and mom were in a continuing care community in independent living. My dad had Parkinson’s and they stayed in independent living with private pay 24 hour care coming in to their apartment. It is a common set up. My dad could have moved to their skilled nursing facility but he wanted to be at home.

Remove the hospice option from your thinking for the time being - it is a kind of care, but can be provided anywhere. The important thing to figure out is what level of care your mom needs. And remember that at home with private pay home health aids is also an option if she has the money, or if assisted living believes she isn’t eligible due to her level of functioning.

I think it is easier to bring an outside nurse into independent living than assisted living. Again, just due to the way they are regulated.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Are there any laws regarding what services MUST be given to a resident of an assisted living facility? As they decline, can their needs become so great that they may be asked to move to a nursing home?

On the other hand, can someone already on hospice care move into an assisted living facility rather than a nursing home/skilled care facility if they have their own private hospice care team already in place?

Trying to think a few steps ahead. Thanks.

You can get kicked out of an assisted living facility and often you aren't given much time.

How about if we move a parent into assisted living already on hospice and with our own private hospice care team (that we pay for)?

Doubtful, assisted living centers are only allowed to accept certain types of residents and that doesn’t include people who need assistance with daily life skills. Since hospice nurses aren’t under their suoerviisio or employment, that doesn’t change what the calculus.

There are some really nice hospice centers. I’d look into those

This is what I'm tryin to find out. Is this covered by law or just the regulations of the facility? Parent DOES NOT want to go into a nursing home but will consider assisted living environment. We want to figure out timing on the move if any. So is there a law governing what kind of needs are too much for the facility to accept, or do we just find one willing to let them in? And when?

There are licensing requirements, but there are facilities licensed for multiple care levels.

Though generally they are not housed in the same area. Independent, Assisted and Skilled (and Memory) are separate as each of those groups don't want to have to see all that the more advanced group is going through.

Depends on the facility. Larger places, certainly. My aunt and uncle were in a smaller place in West Virginia that did assisted living through hospice in the same location. My uncle lived with my aunt in the same unit until the end of his life. He passed away in a home-like environment surrounded by his family. It was really as good a set-up as they could have wanted.

Was this one of those independent homes that legally can have just a few people?

No. It was a full-fledged facility. I’m the one who did the research for the family. They told us they could handle assisted living through end of life, and that’s what they delivered.

So it was a continuing care facility.

So is "continuing care" a legit label for this, and is there a license for "continuing care"?

Yes, but most only accept patients who don’t need any care at all at time of admission. And wait lists can be very long, sometimes years for the more popular (nicer) facilities. We were quoted two years by one and four by another in the Baltimore area. Fortunately my parents have already been on the wait list at the place with the two year wait, so it will only be about a four month wait from when they were ready to move in.

This really depends on where you are. It can vary a lot.

I don’t think it varies alot in more populated areas of Maryland.

Maryland is a big state.

I”m nit sure why you want to debate this, op is presumably in the DC suburbs. But sure, if not, might be different. It has been my experience that it is difficult to get into the more desirable communities without being put on a waiting list. YMMV. Op can call around.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Are there any laws regarding what services MUST be given to a resident of an assisted living facility? As they decline, can their needs become so great that they may be asked to move to a nursing home?

On the other hand, can someone already on hospice care move into an assisted living facility rather than a nursing home/skilled care facility if they have their own private hospice care team already in place?

Trying to think a few steps ahead. Thanks.

You can get kicked out of an assisted living facility and often you aren't given much time.

How about if we move a parent into assisted living already on hospice and with our own private hospice care team (that we pay for)?

Doubtful, assisted living centers are only allowed to accept certain types of residents and that doesn’t include people who need assistance with daily life skills. Since hospice nurses aren’t under their suoerviisio or employment, that doesn’t change what the calculus.

There are some really nice hospice centers. I’d look into those

This is what I'm tryin to find out. Is this covered by law or just the regulations of the facility? Parent DOES NOT want to go into a nursing home but will consider assisted living environment. We want to figure out timing on the move if any. So is there a law governing what kind of needs are too much for the facility to accept, or do we just find one willing to let them in? And when?

There are licensing requirements, but there are facilities licensed for multiple care levels.

Though generally they are not housed in the same area. Independent, Assisted and Skilled (and Memory) are separate as each of those groups don't want to have to see all that the more advanced group is going through.

Depends on the facility. Larger places, certainly. My aunt and uncle were in a smaller place in West Virginia that did assisted living through hospice in the same location. My uncle lived with my aunt in the same unit until the end of his life. He passed away in a home-like environment surrounded by his family. It was really as good a set-up as they could have wanted.

Was this one of those independent homes that legally can have just a few people?

No. It was a full-fledged facility. I’m the one who did the research for the family. They told us they could handle assisted living through end of life, and that’s what they delivered.

So it was a continuing care facility.

So is "continuing care" a legit label for this, and is there a license for "continuing care"?

Yes, but most only accept patients who don’t need any care at all at time of admission. And wait lists can be very long, sometimes years for the more popular (nicer) facilities. We were quoted two years by one and four by another in the Baltimore area. Fortunately my parents have already been on the wait list at the place with the two year wait, so it will only be about a four month wait from when they were ready to move in.

This really depends on where you are. It can vary a lot.

I don’t think it varies alot in more populated areas of Maryland.

Maryland is a big state.

It’s actually a small state.

[Anonymous]

Adding the independent Senior living communities/bring in your own nursing combo are less popular and therefore can usually get in quicker than continuing care facilities.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Op, how far away is your parent from needing hospice care? Is it a several years away or several weeks away situation? Continuing care facilities often only accept new patients who currently only need whatever is their lowest level of service. Also good facilities at any level often have waitlists.

If you want meaningful answers, you need to indicate the state and what your mom’s current needs are.

We don't know timing, that's the issue. Things could continue as they are for several years or decline rapidly (like our other parent). They can't live alone anymore, can't shower alone or cook safely, etc. They don't need to be in a nursing home but can't function if that makes sense. They can't safely get in and out of bed anymore but are lucid enough not to want to be in a nursing home.

Assisted living facilities will do an assessment at time of entry to determine if your mom qualifies to live there. I would add that you don't want your mom in an assisted living facility if her needs exceed what they can provide. They won't have one to one staffing (or even close) so I would worry if she truly can't get out of bed and be mobile without assistance-- that's when people are at a high risk of falls. Help with cooking, showering, or dressing is less serious.

It sounds like finances aren't an issue, but most of the options discussed in this thread, including assisted living, are not covered by Medicare. Generally hospice and a nursing home would be.

[Anonymous]

My mom's assisted living just charged more as needs increased - they did not kick people out for needing more care (maybe they would if people got violent or something but in that case I think they would try to manage that with drugs first). At the extreme you could have to pay for a 24/7 aide plus the assisted living costs. They also arranged hospice via JSSA at the assisted living facility. That worked pretty well.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My dad and mom were in a continuing care community in independent living. My dad had Parkinson’s and they stayed in independent living with private pay 24 hour care coming in to their apartment. It is a common set up. My dad could have moved to their skilled nursing facility but he wanted to be at home.

Remove the hospice option from your thinking for the time being - it is a kind of care, but can be provided anywhere. The important thing to figure out is what level of care your mom needs. And remember that at home with private pay home health aids is also an option if she has the money, or if assisted living believes she isn’t eligible due to her level of functioning.

I think it is easier to bring an outside nurse into independent living than assisted living. Again, just due to the way they are regulated.

At the facility my grandmother was in (IL, AL, Memory, SN) many of the people in IL had a caretaker that helped them, which frankly was a surprise. My grandmother never needed more care. But it wasn't safe for her to live alone.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Op, how far away is your parent from needing hospice care? Is it a several years away or several weeks away situation? Continuing care facilities often only accept new patients who currently only need whatever is their lowest level of service. Also good facilities at any level often have waitlists.

If you want meaningful answers, you need to indicate the state and what your mom’s current needs are.

We don't know timing, that's the issue. Things could continue as they are for several years or decline rapidly (like our other parent). They can't live alone anymore, can't shower alone or cook safely, etc. They don't need to be in a nursing home but can't function if that makes sense. They can't safely get in and out of bed anymore but are lucid enough not to want to be in a nursing home.

Assisted living facilities will do an assessment at time of entry to determine if your mom qualifies to live there. I would add that you don't want your mom in an assisted living facility if her needs exceed what they can provide. They won't have one to one staffing (or even close) so I would worry if she truly can't get out of bed and be mobile without assistance-- that's when people are at a high risk of falls. Help with cooking, showering, or dressing is less serious.

It sounds like finances aren't an issue, but most of the options discussed in this thread, including assisted living, are not covered by Medicare. Generally hospice and a nursing home would be.

Hospice is covered by Medicare, but nursing homes are not. A stay in a rehab facility is generally covered by Medicare for up to 90 days (in some places 110 days) but only if the patient is improving. If not, then the stay turns to private pay.

If the patient qualifies due to assets under X amount, then MediCAID will pay for nursing care.

[Anonymous]

Independent living and Assisted living will not take a person if they are a fall risk. One of the biggest federal/state assessments for elderly facilities is fall rate. They get dinged heavily for falls.

[Anonymous]

They have pretty stringent rules on what a resident needs to be able to do for themselves. And they kick you out quickly if you aren't following them.

For instance, my relative went to a nursing home but within 3 months she was kicked up to the pricier memory care floor as she had dementia.

With nearly every relative, we've done hospice care at home. It's only for a few weeks or months, but allows all relatives to come and see the person and for the person to die at home or in their kid's home. Hospice helped us so much too. They gave us hospital beds, meds, nurses. Hospice depends on the state though and it's different in each state. I feel like dying in a hospital is for those cases where someone passes quickly due to an issue (sudden heart attack, car accident).

[Anonymous]

Anonymous wrote:Independent living and Assisted living will not take a person if they are a fall risk. One of the biggest federal/state assessments for elderly facilities is fall rate. They get dinged heavily for falls.

Yes but they wouldn't allow for bed rails. My relative was used to a king sized bed, with a rail to push herself up on. She also had trouble getting out of bed and without a bed rail wouldn't wait for an aide. So lots of falls. I understand that they don't want people caged in, but if the elderly person wants a bed rail, one should be able to be provided.

[Anonymous]

agree the no bedrails rule is a problem. We ended up putting my mom's mattress on the floor to avoid falls but that is obviously not ideal

[Anonymous]

Anonymous wrote:

Anonymous wrote:Independent living and Assisted living will not take a person if they are a fall risk. One of the biggest federal/state assessments for elderly facilities is fall rate. They get dinged heavily for falls.

Yes but they wouldn't allow for bed rails. My relative was used to a king sized bed, with a rail to push herself up on. She also had trouble getting out of bed and without a bed rail wouldn't wait for an aide. So lots of falls. I understand that they don't want people caged in, but if the elderly person wants a bed rail, one should be able to be provided.

I think this is because bed rails are not a substitute for adequate supervision. AL probably doesn't allow their use because people who aren't mobile without help exceed the level of care they are allowed to provide.