How much care should I expect in an ALF?

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How much care should I expect in an ALF?

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I recently placed my mom in an ALF but have found in week 2 her care is not what I expected or was promised. I know it takes some time for the staff to get comfortable with her needs. Are my expectations to high this early in the process? I am certainly vocalizing my displeasure. Can someone give me pointers on how you handled this situation? I do not want to alienate the staff but want to protect my mom.

Assisted Living Care Decisions

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Beginning in the first few weeks to "vocalize displeasure" will not be a good start.
You do not say what you find lacking.
Did you do a careplan meeting yet? Have you asked to be part of her careplan? Were the "levels of care" usually one through four, explained fully to you?
An ALF is just that. It is for seniors who are competent, who are for the most part participating in their own care. They may need checking, medication delivery, assist with showers and laundry, housekeeping, meals, and etc. Some one higher levels of care may need assist with dressing, with incontinence if it is a problem.
So this is a learning process for both the facility, which is getting to know your Mom and her needs, and for you, getting to know what to expect, and whether or not this is a good fit. Some facilities such as Board and Care, with fewer residents and a more home like atmosphere work for some people, while for others, memory care may be needed if there are a lot of needs.
What exactly were you led to believe would be done that is currently not being done? Where was your Mom living prior to moving into ALF. What expectations does she have/you have that are not being met?
This is time not for vocalizing displeasure, but for making it clear that you had different expectations, for meeting with administration and discussing this.
My best to you. This is all adapting and learning hopefully, and adjustment. I wish you the best.

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Thank you. I did approach the conversation about expectations. It was productive. She lived with me for 5 years before the transition. It had gotten to the point that I would have had to quick work because she became too much of a fall risk to be alone. I wrote a narrative about my mom including her history, physical challenges and mental challenges prior to the move. We have had to adjust meals and if I can have confidence they are checking on her periodically, then I think this will work.

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When my Mom had moderate dementia, she qualified for Memory Care, not Assisted Living.

Did this AL give you assurances that AL was the correct placement for your Mom?

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We started in memory care but the facility, and I, thought that she was much stronger than the other residents. They felt like she was not placed in the right facility. She has adjusted in the ALF. We did do a Care plan. The facility assured me that the regular checks etc were consistent between the memory care and ALF. Mom lived with me, in my home for 5 years prior to this recent move. Her needs became too much without me resigning from my job and staying home. It was time for the change.

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Thank you for your responses. My mom is in moderate dimension but is physically pretty good. Lealonnie1, you were absolutely accurate with the expectations you listed. She cannot turn on a tv, lights etc but can put herself to bed and use the bathroom on her own. She wears a pendant but if she were to fall, she does not understand to push the button. She is a fall risk. I visited in the late afternoon and it looked as though no one had been in the room. The lights were off, tv off, blinds pulled, etc. I requested that they look in on her every couple of hours because if she does fall, they would not know without checking on her. I did speak to the administrator and believe we made progress this week. I know they are checking on other residents very often because they have a higher need. Does that make sense to you?

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Yes. At mom's ALF, they had a '2 hour check' service that could be put in force. There was an upcharge for that service, or points had to be used for it. My mother was a HUGE fall risk! She fell NINETY FIVE times during the time she lived in AL and then MC!! So when the falls started, I put the '2 hour check' service in force. A CG did come by to poke their head into mom's apartment every 2 hours, like clockwork, and sometimes they'd find her on the FLOOR, sure enough.
It seems to me, based on what you wrote, that your mom needs Memory Care. In my mom's MC, there were fewer residents and more caregivers, meaning MORE attention was given to each resident. Someone was CONSTANTLY looking in on mom; plus, she was brought out into the activity room each morning, then toileted every 2 hours regularly, so she was looked after ALL DAY LONG, and then at night too., It wasn't an 'extra service' to be looked in on every 2 hours, it was automatic in Memory Care. If your mom doesn't know to push the pendant, she's in need of more care than a regular ALF would give, imo.

FWIW, my mother was 'stronger' and 'more cognizant' than the majority of the others in MC too, BUT, she needed MORE CARE than the residents in AL. So there's the Catch-22 for women like this. Mom BELONGED in Memory Care for the extra care that was required, and she eventually needed it for the cognizance issues TOO. So in reality, maybe she could have stayed in AL for another year (she was in MC for just under 3 years in total before she died), but her mobility problems forced the move a bit TOO early. All in all, I'm glad I did it that way and moved her to MC a 'bit too early' b/c she needed the extra care & attention that she was given. The CGs loved her to death, honestly, and the parade thru her room the final week of her life was a testament to me having done the right thing for her.

I know the position you're in; between a rock & a hard place. There's no 'right or wrong' answer except to say, go with your gut. If you feel mom needs more 1:1 care, MC is the answer. She'll make friends with a few ladies over there and she'll adjust. If you think she's better off on the AL side, the care WILL suffer some b/c the ratio of caregivers to residents is just not there.

BEST OF LUCK to you.

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Both homes that we placed our mother & step mother in were very clear, stay away for a few weeks let the resident acclimate themselves to their new home. Now is not the time to be a helicopter child.

Not enough information, however, if these things are being told to you by your mother rather than you seeing yourself, I would be very hesitant to jump on the band wagon. They all complain about the same things, trying to manipulate a LO to take them back home, it is a very common practice and they will pull out all stops to get what they want.

Hope this all works out for you!

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Yes, my mom would complain, my answer… mom there is no place else.. you will have to get along..

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Difficult to know how to respond without more information, but PLEASE make sure that you are directing your concerns to supervisory staff, not individual providers.

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I agree that more info would be helpful. It could people give you feedback as to if your expectations are too high or if they're not doing as good a job as they should be. I know many facilities are short staffed and unfortunately have trouble providing the care they should be giving.

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What are your expectations? What is the staff not doing that they promised you would be done? Assisted Living is for residents who require a lot less personal care than Skilled Nursing would provide. Dressing/undressing, help with showers, medication administration and escorting to the dining room are all services provided by ALs. Caregivers also help residents get in and out of bed, if only one caregiver is needed, normally. Also help with incontinence care and brief changes is in the scope of AL care. That's just a guideline. If a resident needed to be fed their meals, most ALs would not provide that service, same with other strenuous services that would require 2 caregivers to perform at once.

You can always speak with the Executive Director of the ALF about your concerns....thats what I did when I had an issue.

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Thank you. We have made some progress this week and your guidance is so helpful. She can feed herself but I am find they do not always make sure she eats. Her food has to be soft due to chewing issues. Even though we covered that in the care plan, the staff still brings things she cannot chew. She has lost about 5 pounds in the four weeks she has been there so I am trying to respectfully request that they adjust….soft food that they make sure she eats. I am concerned that she is hungry. It seems the careful care plan did not reach the kind people that are doing the day to day jobs themselves.

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How much care should I expect in an ALF?

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