"Aging out" of assisted living?

[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.

Medicare does not pay for a nursing home, just hospice. Long term care Medicaid pays for nursing home. Some states pay for assisted living, most don’t.

[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.

They are not allowed to use restraints and it’s considered one. Using homes lower beds close to the ground.

[Anonymous]

Anonymous wrote:

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.

Medicare does not pay for a nursing home, just hospice. Long term care Medicaid pays for nursing home. Some states pay for assisted living, most don’t.

Maryland does not.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Medicare does not pay for a nursing home, just hospice. Long term care Medicaid pays for nursing home. Some states pay for assisted living, most don’t.

Maryland does not.

There is actually a small program that can but the waitlist is crazy long. My relative was on the list for years and never got it. Not sure if it is an actual program.

The Maryland Home and Community-Based Options Waiver (CO Waiver) helps seniors and disabled adults pay for assisted living or in-home care, allowing them to avoid nursing home placement. It covers services for eligible Maryland residents, usually requiring income below $2,829 per month (300% of SSI) and assets under $2,000. Applications are handled through Maryland Access Point.
The Maryland People's Law Library
The Maryland People's Law Library
+4
Key Details of the Maryland Assisted Living Waiver:
Eligibility: Must be 18+, a Maryland resident, meet financial guidelines, and require a nursing facility level of care.
Benefits: Covers assisted living costs, case management, personal care, medical daycare, and home-delivered meals.
Waitlist: There is often a waiting list for the CO Waiver; registration for the list is required to start the process.
Application Process: To apply, contact Maryland Access Point (MAP) at 1-844-MAP-LINK (1-844-627-5465) or visit marylandaccesspoint.211md.org.
Maryland Inclusive Housing (MIH)
Maryland Inclusive Housing (MIH)
+4
The program enables individuals to reside in approved assisted living residences that accept Medicaid payment rates.

[Anonymous]

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?

I only know Maryland law but the answer is yes. Assisted living facilities aren’t allowed to accept patients who need skilled nursing. That’s the trade off for being less regulated than nursing homes. Your mom doesn’t have to move to a nursing home, there are hospice centers than offer services on site, I think you will find some, of them to be “nicer” than nursing homes.

But note that most nursing home residents don't need skilled nursing care. Think of skilled care as that provided by a registered nurse or a physical therapist--complex wound care, IV medications, respiratory treatments, physical therapy. Most people in nursing homes need help with activities of daily living (ADLs), like dressing, bathing, toileting, etc. These aren't skilled services.

OP, the answer is that it depends on the assisted living facility. Some won't provide ADL assistance, some won't accept anyone who needs that level of care but will provide it if a resident develops the need for it. By the time my MIL died, she was completely bedbound and could do almost nothing on her own. Her assisted living facility took care of her in her regular room until the end. However, it was very expensive.

[Anonymous]

[mastodon]

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?

I only know Maryland law but the answer is yes. Assisted living facilities aren’t allowed to accept patients who need skilled nursing. That’s the trade off for being less regulated than nursing homes. Your mom doesn’t have to move to a nursing home, there are hospice centers than offer services on site, I think you will find some, of them to be “nicer” than nursing homes.

But note that most nursing home residents don't need skilled nursing care. Think of skilled care as that provided by a registered nurse or a physical therapist--complex wound care, IV medications, respiratory treatments, physical therapy. Most people in nursing homes need help with activities of daily living (ADLs), like dressing, bathing, toileting, etc. These aren't skilled services.

OP, the answer is that it depends on the assisted living facility. Some won't provide ADL assistance, some won't accept anyone who needs that level of care but will provide it if a resident develops the need for it. By the time my MIL died, she was completely bedbound and could do almost nothing on her own. Her assisted living facility took care of her in her regular room until the end. However, it was very expensive.

This is not correct. If a patient needs help with more than few ADLs, they may be determined to need a nursing home rather than assisted living. This has to do with differences in staffing ratios.

[Anonymous]

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

You don't know what you're talking about. Many assisted living centers evaluate how many "activities of daily living" (ADLs) their residents require assistance with, and you pay more depending on the number of ADLs. You are describing independent living facilities.

[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

You don't know what you're talking about. Many assisted living centers evaluate how many "activities of daily living" (ADLs) their residents require assistance with, and you pay more depending on the number of ADLs. You are describing independent living facilities.

it’s the reverse. Assisted living centers need to evaluate their patients before entry and every 30 days. If a patient needs more care that the assisted living center can provide, the patient needs to be transferred to a nursing home or hospital, whichever is appropriate. Level 3 assisted living in Maryland can do a lot but not all assisted living centers have that license.

[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: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.

I searched for "levels of care" for assisted living in Maryland and there seems to be a wide range of acceptable resident needs to be admitted to assisted living. It seems like assisted living is just like a nursing home for seniors who don't need medical care. It seems that accepting residents with memory issues, who are wheelchair bound, can't toilet or bathe themselves and need constant supervision is perfectly acceptable for a level 2 or 3 assisted living facility in Maryland. What am I missing?

[Anonymous]

Anonymous wrote: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).

Where can you find these rules? Are they dependent on the facility or state-wide regulations?

[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: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.

I searched for "levels of care" for assisted living in Maryland and there seems to be a wide range of acceptable resident needs to be admitted to assisted living. It seems like assisted living is just like a nursing home for seniors who don't need medical care. It seems that accepting residents with memory issues, who are wheelchair bound, can't toilet or bathe themselves and need constant supervision is perfectly acceptable for a level 2 or 3 assisted living facility in Maryland. What am I missing?

Other than dementia, or serious illness, mobility is usually the factor that leads to nursing home over assisted living. If a resident keeps suffering falls or has no independent mobility (if can transition to wheelchair or Walker with limited assist, probably can stay in AL).