Is there something between assisted living and nursing care?

Yes. Care givers.

Get his hearing and vision evaluated and treated pronto. Hearing aids help stimulate the nerves so he can continue hearing. If that is a lost hope, then ask his doctor about therapy to learn other ways to communicate before his vision goes. He might need a home health care aid/companion for a couple hours each day to help him with his needs.

Perhaps a private nurse?
What exactly do you feel he needs that are 'in-between' these two areas of care?

jujubee2222: Perhaps you can contact the Commissioner of the Blind in your state. My late mother, a legally blind woman WITH LOW VISION was able to garner much assistance from the COB, allowing her to live by herself in her own home with her adult children residing many states away and/or on the opposite side of the country. This may help your father to remain IN the assisted living.

I live in an AL place. Some people hire private people to handle the medical issues. Our place can arrange for medication, not lifting etc, matters for more money, and different staff utilized. Certainly, would be less expensive than a SNF. You might also consider a group home. I am not sure they would be equipped for this but you could look into it. Also, many AL's meet different state requirements as to what services they can or cannot provide. You might check with your state's aging department or call several different places and describe in detail the services you need.

What does his ophthalmologist have to say about his vision? Has he been fitted for hearing aids? How about making an appointment with a Geriatric Psychiatrist to evaluate for placement?

Hello,

When my dad moved into assisted-living, they suggested if he needed more care than assisted-living, was able to provide, then we needed to hire home care services to come to him.

I am in agreement with some of the other responses in that you can have his hearing and vision checked and possibly improved. The assisted living facility will be able to take him to the appointment and then you can meet him at the appointment with a wheelchair to take him to the appointment.

Memory care is between the two. Even though he may not have memory problems you might look into a facility that provides a “continuum of care.” These usually provide assisted living, memory care, and skilled nursing all on one campus and your dad can be placed based on their evaluation and move from one unit to another as his needs change. In home care is also always an option if his finances allow for that. Others mentioned board and care which is an option, too.

I think a critical first step is getting his eyes checked. Could be treatable, like macular degeneration which can come on suddenly as it did with my mom.

Next step—hearing eval thru a doctor’s office and their audiologist. (Our experience this was far superior to what we had with Miracle Ear.)

Lastly, facilities differ. My mom’s ALF—which was kicking her out bc she needed too much care—suggested a smaller facility. Mom moved there last week after 6 months with me, (some of that in rehab after broken femur.) They do a lot more than the other place.
So ask his facility where they might recommend. Then start visiting places knowing Dad will likely only decline. Will they be able to care for A, B, C?

Best wishes,

As someone who has worked in the industry and cared for parents in home, I can tell you that AL residences have different levels of care. Some of it is determined by state licensing laws and some of it is determined by the kind of services the AL wants to provide. It looks like your father is in a residence that does not provide transfers. There are many ALs that do provide transfers, are able to communicate with hearing and blindness issues, etc. Contact your local Area Agency on Aging. They should be able to provide you with a list of residences that will be able to meet your needs. They will also be able to counsel you on the questions to ask and the answers that meet your father's particular needs.

That your father is declining so quickly is of concern. Have his physician check him out. The residence you moved him into may not be the right environment for him. There are lot of residential care options, so check out both small and large places.

Why do you think he is " not a candidate for " nursing home" otherwise known as " skilled care"?
While it may be difficult to accept this level of care need , you mention several things that point to this potential next step for his safety:
You speak about " lifting", " medication assist", " vision changes" and your personal observation of his " decline".
You can have him professionally assessed for his appropriate " level of care" needs by his PCP( Primary care physician) or other qualified professionals ( perhaps where he is now). Speak with the facility administration or his PCP.

In the meantime, a stop gap measure that some people use is hiring 1:1 daily assist for him in his current residence. The facility can most likely give you more information on any requirements/ permissions etc the facility may have regarding outside professional help coming in 1:1 for ALF residents.

You mentioned your dad has gone downhill in a short time since moving there, unfortunately there is a connection between the two. Is there any possible means to bring him to live with a family member who could be w him a good amount of time and then hire someone to fill in to help other times? a cna could teach the relative how to lift him

You in-between may be to hire some companion care....someone to help him read the paper or to assist him in planned activities. The AL staff should be able to help with dressing and bathing. The companion could be there either in the morning or afternoon and should cost less than full nursing care.

I worked in residential care in several group homes in Illinois. Our people had the range of disabilities from Aspergers and Down syndrome to blindness, deafness, severe mental and psych disabilities, to CF requiring pureed food and constant supervision. We used bed lifts, gave meds, transported to medical appointments, we had bedridden and wheelchair-bound as well as mobile residents. These were licensed by the State and we were required to undergo extensive training, i.e. for giving medications, conflict management, wheelchair transport... and lots more. We took our people who were able on outings to restaurants, the theater, parks, and the like. I'd look into what these are called in your state and get your loved one placed on the waiting list after visiting the homes and deciding which ones you like best. ~ Erin

You may read on the Agingcare website for information. Just click on the three lines on the top left corner. Chat service is available for your father's delimma situation.

In between is hard.

My LO requires what is called 'intermittent' assistance too. Not 24/7 support but on/off support required throughout the day.

Many places here are set up for 'low' care or 'high' care. I suppose similar to your assisted living to nursing care.

Maybe a hired aide could be brought in morning & night for 1-2 hours? For personal care (bathing/dressing assist) & again in evening. This would get pricey real fast. (The only reason my LO can do this is because it is Govt funded).

As your Dad is mobile, he could still move about his area during the day independantly but would have support for higher falls risk ADLs. Maybe even a shower aide 2x week if that's all he needed.

An OT could review his room & day rooms. Make them more suitable for his vision impairment. Does the AL have an OT on staff? Could you bring one in?

If Dad does does develop mobility issues that require staff for hands-on transfer assist then he will need more than this. I can see why you want to plan for this. Hey at 89 it's more than a vague 'if'.. I'm a planner too. But it is near impossible to plan for every eventuality.

I've made peace with the *now*. Making the now as safe as it can be with OT reviews, tips & equipment. The *future* will be worked out the same way. Talking to professionals for advice. Looking at the options. Choosing what is available at the time.

It can sometimes be a long life, followed by a short illness like many I've known. Or a time in assisted living, followed by a very short time in nursing care right near the end.

Is that the worry? You & Dad don't want him to be placed in that environment? If so, keep adding what you can to his current set up to make it work *as long as possible*.

You don't say where you live in your profile; if you have Morningstar Assisted Living facilities in your city, they DO provide lots more care than standard ALs in that they structure a care plan for the resident's individual needs. Many of them handle residents who are 2 person assists as well as those who require special diets, included pureed foods (which is outside of the norm for traditional ALs). They WILL charge you a lot for the upgraded care plan, but it WILL keep dad out of a SNF for much longer.

You can also ask A Place for Mom here about which facilities could possibly accommodate dad, or, you can hire a Senior Move Manager; here is a link to a good article on the subject:

https://www.daughterhood.org/a-daughters-guide-to-hiring-the-right-aging-care-professional/

Wishing you the best of luck finding the right type of managed care situation for dad.

Look into care homes. They are very different, smaller, better staff-resident ratio and cheaper than a nursing home. Their requirements for residency will vary though so will take some shopping.