ALF says they can't provide care needed, but her needs haven't changed in the last 3 months. Can they just say that and discharge?

This post is from Sept 2023. OP has not been back since then.

It's very possible her needs have changed. Perhaps she is calling for help more or simply calling to ask for help, but really wants some company to visit. Have you asked them to show you records of 'what' in the way of needs have increased?? Calling for staff, wanting to transfer bed to chair to bed to bathroom more than she used to? AL is for folks that can do quite a bit for themselves. Some facilities just up the level of care cost as needs increased. Some probably don't have staffing or the next level of care. I would go with staffing, because if they could provide next level of AL care why wouldn't they just up the monthly fee instead of losing a self pay patient?

If mom is on Medicare/ Medicaid enroll her in one of their Wavier programs. Those programs are great and they help seniors stay in their homes verses going to a SNF. They will evaluate her and pay for homecare aides or a family member to provide care at her home.

RitainNC: Yes, the AL can refuse residence based on the amount of care that the individual requires.

Yes, the ALF can choose to accept or reject someone based on the level of care needed. ALF's are not automatically LTC care facilites. Unless your mother is in a CCRC faciity which will move (and charge her) as her needs change, she will probably need to find another facility. Having gotten in in June does not guaqrantee that the current AL facility will continue to meet her needs. A new administrator can probably revise resident eligibility.

Unfortunately, the facility is privately held and they may refuse service to anyone.
A Skilled Nursing Facility may be paid under Medicare or Medicaid with a doctors order for up to 100 days, otherwise it will be private pay unless they qualify for Medicaid in your state. M.

My wife was in a memory care facility. She developed a UTI and lashed out at another one of the residents in fear. They called 911, took her to an emergency room where they strapped her down because she kept pulling out the antibiotic IV. The memory care facility called me to say she was evicted, the hospital called me to say they were sending her to a psych ward. The psych ward would only let me visit her for 30 minutes a day. Her arms were terribly bruised from the straps. They eventually released her to me where I will keep her safe at home with me and away from them. So, yes, they can and will evict. Had I known any of this in advance, I would never have placed her in memory care. I would have spent the money on home care where I would be the supervisor.

Ritain,

Would sure love to know what occurred when you spoke with the facility, and what they had to say about their reasoning for their decision. Also what you plan moving forward. It so helps to know if you have a response to our suggestions.

This happened with my Mom. And, yes they can evict your Mom.

Regardless of what we think, numerous things can cause this situation:

-your Mom truly needs care they can not provide, but also
-there is a change in management with new priorities
-the facility wants the bed
-staffing has changed, etc.

Your state should have an Ombudsman program, to help you maneuver this situation. They can tell you the laws too. You can challenge this, and they will take up your Mom's case in court.

In the meantime, call for hospice to come in. Hospice came in to provide extra care for my Mom during this transition. AL wasn't happy about this, but you have to just think of your Mom's care right now.

The AL also worked with my sister, and my Mom actually ended up staying way beyond the 30 days due to personnel, dating and delivery errors of the AL.

I don't want to get ahead of myself here for you and your situation, because there is a lot to digest now for you. But my story is taht my Mom came to live with me (I had done CNA work previously, and was between jobs), but I'm was very sorry that my Mom wasn't here sooner. IF you go this route, make sure her hospice is set up before moving her, and AL gives you a Care plan. AND, any move like this is traumatic. My Mom had dementia, and was in a dementia unit, but actually was very happy to be here and leave AL behind.

In the mean time, you can show "good faith" by talking to some NH, I also contacted Elder Services in my state, and they were super. As well as my local Senior center.

I know this is a lot. I'm so sorry that you and your Mom are in this situation. It was certainly not what were were expecting, and just felt so wrong. A real betrayal.

Feel free to PM me. I could write a book on this, but must be off to work.

<3 to each of you!

I would not feel comfortable insisting that my mom stay in a place that has told us that she needs more care than they can give her. They may not have the staff or they may have underestimated your moms care. Either way, it sounds like this place is no longer a good fit for your mom.

Moving her is a big deal and I get your resistance to do it, but things change on a dime with the elderly. It is a constant mode of evaluate and adjust.

I wish you luck in finding a new place that fits all of your moms needs. We have had to downsize my moms things several times. First when I sold her home and moved her into assisted living and then again when we moved her into memory care and then again when we moved from private pay memory care to medicaid accepting memory care. Their world keeps getting smaller and smaller and their need for assistance and care keeps getting bigger and bigger.

Have her PCP or other qualified medical professional provide you with a " level of care needs assessment" for her. This will tell you what level of care she needs or is able to live in. All facilities , Independent Living, ALF, Skilled Care and, Memory Care, have specific guidelines that residents must meet . This is for the resident safety and care expectation and accountability as well as the facility safety of employees, and accountability.

State law governs. The contract is pertinent to the extent it does not violate the state law. The law requires that the discharge notification include a request for a hearing option. You need to get the ball rolling on that IF you want to appeal their decision.

NC pertinent law:
https://info.ncdhhs.gov/dhsr/acls/rules.html

Section on discharges and appeals of discharges:
https://www.ncleg.net/EnactedLegislation/Statutes/HTML/BySection/Chapter_131D/GS_131D-4.8.html

p.s. I am not an attorney, but a nursing home attempted two legally baseless discharges on my mother. They lost both times. If you go this route, you can private message me for input.

My Mother was going to be taken off Hospice .
I was so worried....
I called The Quality Improvement Program and appealed it and the next morning ,I got a phone call that we'd won the appeal.
Maybe they could help you too.

My father was evaluated by the head nurse at the AL my folks wanted to live in before he'd be accepted. He had to prove he could transfer with a minimum of assistance before he'd be cleared to live there.

If an AL feels a resident is a 2 person assist or a huge fall risk, they are not approved to live there or asked to leave as a resident. This is for the safety of the resident and to insure they won't be sitting there for an hour waiting for transfer assistance to the toilet if the facility is understaffed.

Everyone seems to see nefarious reasons behind the rules an AL creates, yet by asking a resident to go into a higher level of care, they're losing a huge check each month. Its mind boggling how much an elder can decline, mobilty wise, in a 3 month period.

Get mom into a situation where she can be properly cared for, that's my suggestion. Good luck.

ALF are private businesses that often do not accept state and federal funds; therefore they are not governed in most states by the same rules that a nursing home is. Their contract on admission (you will have one if you are POA, or your elder has one) will enumerate the circumstances that allow them to request a move from a resident.

In my brother's ALF the line they walked was fine indeed. Many residents, including my brother, were overall mentally and physically fit. There were certain some residents in W/C. And there were the usual levels of care from I to IV. There were some folks with early dementia (my brother had a dx. of probable early Lewy's Dementia), but when anything progressed to needing more care, or as disruptive to the community cottage in general, moves to more comprehensive and better staffed care was required. They tried very hard for families who could not afford moves to MC, but when residents complained overmuch of the needs and requirements of a single resident, or the workers said that they were not well staffed enough to meet that resident's needs, a move was required.

Basically the answer is that they like CAN ask for this move. Your best hope is to TRY to find out EXACTLY what the problem is, and see if it can be remedied in some way. If not, I am afraid there isn't a lot of choice. I am sorry and surely do wish you good luck.

My Moms AL allowed people with Dementia. Actually one man they had there may have been better off in a SNF. I would have never lived there. It was not what an AL should be. Which is they just assist. The resident should be able to do alot for themselves. Those with Dementia passed a certain stage should be in MC. A person who is a 2 person assist needs to be in LTC. It was found in the 3 months Mom was there, that she needs more care then they have the ability to give or want to give.

The rent may stay the same for a year but its usually 30 day notice when it comes to Mom leaving on her own or the AL is saying we cannot care for her.

My LO was in a truly lovely continuing care placement, briefly in AL, then in MC, then 2 COVID infections.

There were levels of care within MC, and by the time we were able to visit her on a regular basis, her needs had become both difficult for her AND her very caring staff.

Through the kindness and concern of the MC staff, she continued to live there until it became obvious to all of us that her presence WAS distressing to other MC residents who had fared through the disease better than she had, and she was moved to the next door SNF, where she lived for a year in hospice care.

What grieved me was that she’d failed as much as she had, and that year was certainly the most difficult, but the decision to move her was clearly the correct one.

If it is not safe for the staff or your loved one they can ask you to find another place that will meet her needs.
You may not see all that happens early in the morning or in the evening so it may appear to you that her needs have not changed when in fact they have.
It may even be a matter of time. If she required 1 person to assist her to get up and that took 5 minutes but now it takes 1 person 15 minutes so they get another person to assist that takes staff away from others that need help.
Depending on where you live ALF can not use equipment to make the process faster and easier so helping a person can be m ore of a safety risk for both the resident and the staff.
SNF can use equipment to make transfers safer, easier on the resident as well as safer for both staff and resident.

I would suggest that you look at the contract it may spell out what can and can not be done. It is very possible that your LO should have been in SNF from the get go.

Yes, in my state if the resident can not help by standing and pivoting to transfer with having just a bit of assistance by one aide they can not stay . The minute they need to be lifted or have more than one person help them in anyway they go to SNF , or the family has to hire an aide to come in . AL’s are not staffed with enough help to handle residents who need a lot of assistance .

Yes they can as AL is not place for people for people who are no longer self-sufficient.

We had to move our stepmother from AL to MC as she had mentally become beyond the point of staying there.

Independent Living and Assisted Living both want to be attractive places to live for people who want companionship, plus a little support and assistance. In AL, if most residents are virtually semi-invalids, it’s not an attractive place to move into. The activities won’t be great, not much companionship, getting together isn't a lot of fun. Very expensive without getting the life-style you wanted.

If the new ED has come into a place which isn’t very attractive for new residents, perhaps she really is ‘clearing out all of the seniors with higher levels of care’. It’s a sensible business decision, and AL is a business. Unfortunate, but true.

Yes, as long as they follow state laws.