Posted July 8, 2009

We are often asked who is perfect for assisted living, but rarely asked how cannot move into assisted living.   While it does seem like some assisted living facilities are willing to cross the line and care for people whom another facility down the street won’t, there are some general guidelines.

* If the resident is a danger to themselves or others.  This could mean that they are violent.  Hopefully this could be controlled with medication but if a resident is threatening to kill themselves or is harming staff or other resident they are not appropriate.  If this sort of behavior starts after someone makes the move, the resident is usually transferred to a geriatric psych unit in a near by hospital for observation and review of medications.

* If a potential resident needs “total assistance” with 2 or more activities of daily living.  If staff or a caregiver needs to perform the entire activity without your participation.  Sometimes, if the family hires a full time caregiver to live in the assisted living home with the resident, it may work.  However if two people are required to help then they need a higher level of care.  A common example is a person who needs help transferring.  If they can get from their wheel chair to their bed with some assistance, meaning they can pivot or support themselves while another person helps, that is OK.  If they are unable to move at all, then the caregivers are performing total assistance.  Eating is another example.  Its OK if someone needs assistance getting the food to their mouth, or need the food pre-cut or pureed.  But if they need help actually eating once it gets to their mouth, then they need skilled care.

* If the resident needs more than minimal assistance in an emergency – if you cannot get to a safe area.  Being able to respond with our without assistance may be OK.  If the resident cannot respond at all, it is not appropriate.

*I find that some assisted living buildings will not residents who cannot self-propel themselves in their wheelchair to live there.  And others provide escorts.  Depends on the facility and their staffing and what they are willing to do.

* If the following treatments cannot be self-administered or administered by a qualified licensed health care professional (not a care manager or caregiver but a RN, LPN, or physician assistant.  IV therapy; IV feeding; gastronomy feedings (g-tube); insertion, sterile irrigation and replacement of catheter; sterile wound care; sliding scale insulin administration; and routine insulin injections for diabetics.  If you need treatment of stage 3 or 4 decubitus ulcers or exfoliaitive dermatitis you would also not qualify.

If any of these apply to you, you need to bring them up with the facility as soon as possible, preferably before you set up a tour.  Some may immediately tell you they cannot care for the senior.  Some may ask you to come in a tour and then they may send their nurse out to do an assessment to see for themselves the type of care needed and go from there.  And some may decide to let you stay in a facility you have already moved to if these things start to happen if you become terminally ill and you qualify for hospice care.

It does surprise me how often families do not give all this information when conducting their search and then end up making a bad decision and having to repeat the process.

These are just some considerations.  I would love to hear from any facilities out there as to what they can and cannot do!

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