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A little while ago, my mother broke her hip. She and my father were living in Independent living in a large retirement community. When she left the rehab facility, and attempted to go back "home", the retirement community said that she couldn't go back. I asked the community what their options were and they said that my mother and father could move into an assisted living apartment together, but the only option they had was a room that cost well over $10K/month. We then decided to wait until something else opened up there, but in the meantime my mother might be allowed into their memory care unit. Then they said that she couldn't move in there because she was a "2 person assist" and they weren't able to accommodate that. I couldn't believe what was going on. This place advertised themselves as being able to house residents from independent to assisted to memory care, through anything they needed. I floated the idea of hiring outside nurses to care for my mother and for her to stay in independent living with my father. They proposed 24 hour care at $30/hour. And they said that we could do that until a more appropriate assisted living option opened up. Then they said that an option just happened to be opening up this week. Then they said they needed to have a meeting with the director of the community to see whether my mother could even live there at all. We then reached out to another property in the same corporation about whether my parents could live there and they said yes, but they needed to bring in outside nurses to help with my mother's care. The monthly grand total? $17K for the first month. Then possibly $9K/month after that, but that was contingent on how much care my mother needed. While we were listening to both of these communities, offering their services, they started talking to each other about the fact that they were both currently trying to sell their services to us. It was like they were competing with each other to get my parents, but in the end, they were not doing much else than trying to bill my mother and father tens of thousands of dollars a month for care. Meanwhile my mother is stuck in a rehab facility away from my father except when he visits her throughout the day.

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So my dad was 91 when he fell & broke his hip; he had pins & rods put in to repair his hip. There was no reason why he shouldn't be walking again, yet he was unable to. CT scans showed a brain tumor, but the doctors were unsure of it's age or what role if any, it played in his inability to walk during rehab. He failed to make the required 'progress' Medicare demands in rehab, so they released him and would not allow him to go back to live with mom in Independent Living; he needed AL at least. He was also Sundowning (acting confused/delirious and dementia-like) while in the hospital AND in rehab. The pain meds were causing some of it, the general anesthesia was to blame for some of it, and being 91 and out of his element was causing the rest of it. "Hospital delirium" is real; Google it and you may see your mother's symptoms in black & white. Mom was seeing MICE crawling on the floor when she was in rehab after being hospitalized, to show you how bad hospital delirium can get!

So dad went into an AL I found that was willing to take him as a 2 person assist and having a urinary catheter. They were unwilling to do anything BUT empty the urine bag though, so I was schlepping the man to the ER constantly with UTIs and issues with the catheter, it was a pretty bad scenario, in all honesty.

As it turned out, the brain tumor was responsible for dad's mobility issues after all. He lived for 10 months after the hip repair and then passed with hospice care in the ALF who agreed to keep him with hospice on board; so I was able to keep mom & dad together till the end. It was the brain tumor that ultimately took his life.

What other tests have been done on your mom to see why she can't walk? Dementia and/or hospital delirium should not cause her mobility issues; is she scared? What is she saying? Is she having pain anywhere else in her body that would justify a CT scan or MRI of that area? A geriatric psychiatrist is a good idea, but it's really all guess-work on their part. Nobody understands the human brain. All doctors understand is empirical evidence: can I see it on a CT scan or an MRI? No? Then it doesn't exist and I'll lump it into the 'dementia' category and then medicate it. My suggestion to you is to press for an organic reason mom can't walk, and have the docs explore that a bit more.

Best of luck with a tough situation. Hopefully, this is all temporary and mom can ultimately go back to her AL w/o being a 2 person assist once the docs figure out what's going on.
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Buried below, the OP says that mom is a 2 person assist for mental reasons.

Is she being seen by a geriatric psychiatrist to assess her cognitive skills and whether dementia is in play?

Something I learned from the "senior advisor" we worked with when looking for an AL for my mom--sometimes state laws come into play. In NYS, a 2 person assist mandates NH level care. In neighboring Connecticut, AL can handle a 2 person assist, which at the time saved us about 5k per month.
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2 months after a successful partial hip replacement, all else being equal, your mother should be back to full independence with mobility. What's been going on?
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Steertire22 Oct 2022
We don't know. Her condition is being evaluated daily.
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You will just need to shop around. I found a rare place for my mom that had 5 levels of care so that she could potentially be bumped up in care at a higher cost but she would still know the staff and a move would mean moving to another wing. I noticed a couple of husband and wife where the healthier one just had to go visit the other wing. The locked wings would be where the spouse could visit and staff would just open the door by keypad.
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Steertire22 Oct 2022
Yes, I've been shopping around quite a bit. The challenge is keeping them close to their doctors and me. I would easily bring my mother home, but my restroom can't accommodate a sit to stand device, and that is what she needs. It really is unfortunate. We considered a medical portable toilet, but we'd still need in home care gives working at least 12 hours/day, and we'd need two of them. So, long term care facility is the best option, with us visiting her daily.
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It's quite a shock to realize the cost of care. I suggest you look for an assisted living facility that is not corporate owned. But move her there when your mom is a one person assist. She probably needs more rehab. I know it's hard on your parents to be separated, but that might be what is needed for them to eventually be together. I was told that if my mom entered as a one person assist, if she then got worse while there, they would care for her that way, but she couldn't go in as a two person assist. There are agencies that will help you find a place, but the smaller facilities aren't on their lists, as the facilities pay those agencies to list them.
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Riverdale Oct 2022
I would have agreed with you regarding the corporate versus non corporate owned facilities if it were not for the fact that the care my mother was most recently receiving in a church backed facility grew to be very sub par not to mention that a variety of events occurred which caused her to become bedridden.

I recently moved her to a facility that is a for profit one with high standards. Everything about this facility is far more preferable. The staff are kind and polite from the moment we walk in. The room is kept much cleaner. My mother generally looks better. The cost is slightly higher but it is understandable when considering the overall state of all aspects of the facility. I never have to call someone to complain about anything. I realize this can be different in areas and states. It just has been my recent experience.

I worked on getting recommendations. I found that if a facility is really good that all those recommendations ring true.
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Yes, many here can sympathize. And if you cut the care costs you will not have enough care. My brother's assisted living was, three years ago, 4,500. I imagine were there two in his room it would nearly double. And the cost goes up exponentially when more care is needed. It's the fact of life. And you are finding that the cost is comparable in other facility. I think others here will assure you that these are the costs we are looking at. It is amazing, but I think were some facility able to undercut the others by operating with less, they would remain full up and have lower prices. It is hard, and without having saved a lifetime in a good job, most seniors cannot bear these costs for long. Sorry you are facing this down.
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Steertire22 Oct 2022
I think $9K/ month is fair. For what they need, it's understandable. And if their needs decrease, then they could possibly go back to independent living, if a miracle happens. 🙏🤞🤞
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Is she 2 person assist ? .. makes her not qualify for independent living.

find a place that meets her needs.. father moves with her… Google care advisors, and find an independent to meet with you , set up and tour with you, they know the area , cost , your needs, reputation, openings… they are paid by the placement place.. great invaluable service. I used a franchise called care patrol 3 times…
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Steertire22 Oct 2022
Yes, I've talked to a few people like that. Mainly I use Google and then call a place, then go tour it. I know what they need now. We are on some waiting lists. Meanwhile, Mom will stay in a long term care bed and keep doing rehab until something more appropriate opens up for the both of them.
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Steertire22, did the senior community state they were able to do a 2 person assist prior to your parents moving in, thus prior to your Mom breaking her hip? What does your parent's contract with the community state? Your area is high price when it comes to senior housing, as are other large metro areas.

Please note there is now a shortage of caregivers to help at these senior facilities, something that wasn't a problem a few years ago. Thus the sale pitch probably was true back then, but things have changed.

I have had experience having both very elderly parents being in rehab and also having rehab at home. It can be very difficult or it can work out smoothly.

Was there a problem with your Mom doing the exercises to help her gain more independence? Did her surgeon recommend more rehab time?
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Steertire22 Oct 2022
I didn't know about this 2 person assist classification when shopping around for a place. I don't know what the contract says. From what I've seen, the people in assisted living and even memory care are physically small people, E.I. easy to lift and move around. My parents like hot dogs and ice cream. I think I'm screwed. Lol.
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Why do you have to hire aides through them? Is that in the contract? $30 is a lot for an aide. You can private hire one for $15/20 an hr.

As Cover 999 says, its a business. Independent living is just that. You have to live independently. Assisted living is just that, they assist. They do not do skilled nursing or 2 person assists. You need more than they are capable of doing, you pay for it. Its been years but my Aunt and Uncle we paying 7k for a room together in an AL, so 10k maybe reasonable now for 2 people.

Are they ready to release Mom from Rehab? Because if they are, you don't have much time. Medicare determines the stay according to the progress she makes. As said, if she has had surgery, she should be up and around on her own. If they aren't doing surgery, then maybe Mom will need to be transferred to skilled nursing which in the long run will be cheaper than hiring aides. It does not need to be permanent just long enough for you to maybe find them another place to live.

These Communities you usually buy-in to. Meaning your parents put in a big chunk of money to live there. And probably paying rent on top of that. You need to read their contract carefully to find out what happens if they move out or even die. If there is longterm care there, should Mom use it and at what cost? I may have an elder lawyer look over it for any loop holes. I say this because a friend was handling her SILs estate. The SIL lived in one of these Communities. She had a severe stroke and was moved from her IL apt to LTC. My friend was sent a bill for the LTC. She informed the facility that 90% of her SILs buy-in was to go to pay for LTC when needed.

So sorry for what you are going through but sadly this is how these Communities work. You have to have money to live there.
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Steertire22 Oct 2022
I'm learning about how all these communities work. If I had it to do over again, I'd have picked a different place for them. But no one knows what the future holds. Her situation could be completely different in several more months. I definitely see a difference in both my parents now over 2 months since she broke her hip. Reality is firmly setting in. The places I've been looking at are really nice, but lacking staff. So one place suggested that I hire staff. But it's a ridiculous idea. If they don't have the staff, they can't do the job.
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I'm curious here. My grandmother suffered a broken hip that caused a fall and my mother had elective full hip replacement surgery at 68 and 64 respectively. Grandma had a longer hospital stay before the days of rehab hospitals (at leadt here) and Mom spent a week in rehab. Both were able to get out of bed and get to the toliet (at least an bedside commode) independently when they cane home about 2 weeks after surgery. Why is someone a 2 person assist after hip replacement (which I assume she got as treatment for the broken hip)?

On another note, a friend of the family had one senior who had a stroke and need NH while the other suffered from MCI and needed someone to provide a structure. Both were accommodated in a shared NH room. It worked well for them. They were together and the one with MCI was able to assist the post stroke LO with movement around the facility, especially to the garden area.
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Steertire22 Oct 2022
Mostly she's a 2 person assist for mental reasons. The anesthesia really did a number on her. Plus she has chronic UTIs. For which she's being treated. She's very strong so she's been fighting this and letting time go by.
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It's business.
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Steertire22 Oct 2022
Wow, is it ever! My Dad and I served in the USMC. My mother raised 2 veterans and married two veterans in her lifetime. They both worked into their late 70s and paid into the system their whole lives. I think this Healthcare system is disgusting. But don't get me started.
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Who has assessed your mother's care needs?
Was her hip repaired? When?
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Steertire22 Oct 2022
She's been assessed by several nurses that represent the senior community homes and the staff at a SNF and a rehab. Hip was replaced 2 months ago. Partial hip replacement.
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2 person assist generally means it's nursing home time. MC, AL, and (especially) IL aren't really qualified to do that. They aren't being greedy, they just can no longer meet her needs. Off to the nursing home she goes, unless she can regain her strength enough to not need a two-person assist.\
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Steertire22 Oct 2022
She's in a long term care bed now. I'm helping her do rehab. She quit doing the required rehab to allow her to get insurance coverage. She has bouts of dementia, so there's not much we can do but encourage her. So, she's a 2 person assist with memory problems, but she isn't difficult to deal with. All the caregivers love spending time with her. I think she's making very slow, but good progress. My next step is a Geriatric psychiatrist. But really, I think time will tell.
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Its not fraud or a scam to refuse your mother re-entry into IL when she's a 2 person assist! She may only qualify for Skilled Nursing at this point, because most Assisted Living facilities don't provide care for residents who require 2 caregivers to help them with transfers.

Unless your mother has moderate to advanced dementia going on, I would NOT even think about placing her in Memory Care because that's inappropriate from a lifestyle perspective. Memory Care does accept residents who require more care, BUT, they also need to have dementia as a diagnosis. Unless she'll only be living there on a VERY TEMPORARY BASIS, I'd nix that idea entirely as she'll be miserable otherwise.

The tough part is that you don't want to separate your parents. I was in that exact situation myself in 2014 when dad broke his hip and couldn't go back to IL with mom. I had to get them both into AL but dad was this-close to needing Skilled Nursing which meant they'd have been living separately! I had to find an AL that took more difficult residents who required more care, so I did.

You need to either work with this community to house both of your parents or find a new one that will accommodate your mother as a 2 person assist. If you have Morningstar AL in your area, I know they are very accommodating to elders with higher care needs. You'll pay for the services, but one way or another, you're in the same boat.

The other thing you can consider is leaving mom in rehab to regain her strength and recover to the point where she is no longer a 2 person assist. If the doctor orders it, Medicare will usually pay for up to 100 days of rehab if needed.

Some food for thought for you to consider. Best of luck.
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Steertire22 Oct 2022
Thank you lealonnie1, I think the reason I'm frustrated here and saying fraud and scam is because these communities have huge complexes that hire entertainment and whatnot, but the main thing the residents need is caregivers. These places rake in billions and don't hire enough staff. And I'm talking about a place that has all 3, Independent living, Assisted Living, and Memory Care. I was expecting my mother to go to assisted living with my father, as this community falsely claimed they could do for her. Now that the time has come, they won't live up to their sales pitch. I've tried to figure out what their problem is, and it boils down to money. They won't pay for what's needed for my mother. There's plenty of caregivers around, but this community won't pay for them and expect my parents to pay. So my mother has basically been kicked to the curb. So, yes, it's commonly fraud, not legally, but it's the kind of behavior, that if your friend or anyone you knew pulled on you, you'd say, "you're a liar". Because they are.
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