Can you hire outsiders to come in and care for parents at assisted living?

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Kablooie Asked October 2022

Can you hire outsiders to come in and care for parents at assisted living?

It has become very clear that my dad's needs are bottomless and far beyond my capacity. I have serious worries about my sanity and mental health from this situation. His assisted living place is happy to take his money but does nothing to engage him. They'll give him meds 3 times a-day and he gets housekeeping once a week. But when I walk in there's always diarrhea on the floor or in the shower, and open food containers all over the counters. His fingernails are super long and nobody cuts them except for me. I'm tired of worrying about him and wondering why I thought assisted living would make things easier when it's made it hellish. He gets sick because he eats spoiled food. He was isolated in the hospital and his apartment for 10 days due to covid and his mental health really suffered. Since he's already got parkinson's that's a huge challenge, and he's got metastasized prostate cancer, is 94, can't hear anymore and his vision is bad. The ALF doesn’t seem to have the staff to help with other things that he needs, or to even notice that he might need more. It's always something: the main nurse is on vacation or the building superintendent is on vacation and can't fix the broken whatever....How can I get someone else in there to help? Would it be a social worker, engagement specialist, another house cleaner,... and would his private insurance pay for it. I am fed up with his ALF. His air conditioning has been broken for nearly 3 months, the whole time hes lived there, and it's always almost 80ﾟIn his apartment. They are trying to fix it but having a hard time getting a replacement that fits. I passed the end of my rope a long time ago, I can't even begin to type all the other crises that have been going on in the family. But suffice it to say those family members are not able to really help with this problem. They do what they can around their own crises. Sorry for typos this is a bad keyboard.

Assisted Living Burnout Family Caregiver Home Care

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score 0 · Answer 1

I would suggest that you look around for a better assisted living facility and move your father as soon as possible. Another thing I would suggest is that you contact the department of health and file a complaint. In Colorado the department of health regulates senior, living facilities. Also, in Colorado it is a law that, adequate living conditions must be met for anyone. In Colorado at an assisted-living facility, it is allowed to hire out another caregiver for your loved one. As a matter of fact, in Colorado, the facility will suggest that if you would prefer that type of care, Sometimes skilled nursing facilities are way too expensive and that is a better option. Please move your father out of this facility immediately. And start making calls to the attorney general’s office as well because they also monitor senior facilities at least in Colorado anyway. Every state I imagine is different. Once reported to the proper institution, I bet the facility will be closed down, and everyone will have to move. These conditions are not allowed ever.

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score 0 · Answer 2

I would definitely look for another place that provides more care. He may need to be in SNF or MC where he would have more help.

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score 0 · Answer 3

No, you cannot hire outsiders to come into an assisted living facility. They have various levels of care that you have to pay them for. It does sound like he needs a skilled nursing facility now.

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score 1 · Answer 4

Seems your parent needs a skilled nursing facility and not an ALF. Check with his insurance about coverage.

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score 2 · Answer 5

Yes, in most ALF , " other" paid help is usually allowed. As with any " help" you and the ALF will want to know they have appropriate skills to care for his needs. It honestly sounds like you are dealing with at least three major needs:
1. Patient needs to be formally reassessed for present decline and potential higher skilled care needs than ALF provides. It sounds like he may well have declined beyond ALF .

2. The ALF administration and corporate ,if needed , should be contacted re what you are experiencing from the ALF conditions. Attend patient care planning meetings, you should be notified about these. Schedule a 1:1 meeting ASAP with administration/ supervisors.

3. Your own self care needs ....
" Caregiver exhaustion" is a real diagnosis.....
See your physician, exercise ( simple outdoor walks etc), stay hydrated with water, eat well, get support from your local clergy and, or other caregiver support systems in your community, monitor your rest and, follow up on getting help needed for your father...

You might could also have him assessed for hospice appropriateness..... this will add several other skill sets seeing him each week and support for you ,. if he is indeed deemed hospice appropriate.
Peace....
Best regards,

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score 1 · Answer 6

Yes you can hire outside care to come and care for your loved one. I care for both of my parents. Mom has dementia and Dad is 97 yo.
After years of caring for them at home they moved to memory care. Dad is still “ with it” but wanted to be with Mom. The place they live is absolutely lovely but my folks also have endless needs as you say.
I was blessed to find two woman that alternate to go in and take care of their needs. They take care of all those extra needs plus companionship for Dad.
I live out of state so that saves me so much worry.
I agree with the other posters on changing facilities but once you do, get outside help.

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score 2 · Answer 7

You didn't mention whether your father is on Medicaid. If so, while he still needs to be moved to a higher level care facility (like a nursing home), don't expect that the care will be much better. My brother is in a nursing home paid by Medicaid and the food is horrific, cleanliness is bad, and the staff are lazy/unqualified, and the nursing staff is overworked.

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score 1 · Answer 8

Kablooie: Due to your father's MANY health issues, he requires placement in a higher level of managed care, quite possibly Memory Care, especially since he has metastasized prostate cancer. A patient in an Assisted Living facility is routinely independent and this is definitely not your father. Diarrhea on floors and shower stall and consuming rotten food is very telling that he is in the wrong facility.

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score 1 · Answer 9

Ask his doctor about approximate months left to live and hospice care.

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score 4 · Answer 10

"metastasized prostate cancer" ????????????????????

I believe he would qualify for a nursing facility with Hospice. Please call Adult Protective Services to get a more suitable placement and please ask the Health Dept. to visit the facility for hazmat issues.

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score 2 · Answer 11

Assisted Living is not Care Taking. You need to hire care taking help on your your own. Your father may also need to be moved to a higher level of care.

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score 2 · Answer 12

Yes, and if you can afford it, do it. We bring in private duty from 6:00 a.m. to 9:00 p.m. It's very helpful to have if you can afford it. In addition to having a caregiver on hand, I find it essential to have someone who monitors my mom's toiletries, incontinence supplies, and snacks. I have also asked the two most trusted aids to manage the laundry. The ALF was constantly commingling clothing and bedding. Just have a conversation with the facility ahead of time to make sure they don't have any requirements on their end. Also, have a conversation about your dad's fees. We have an agreement in writing that we will pay only the base fee. Works well for us for now.

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score 3 · Answer 13

My dad was in AL in 2019. We had to bring in extra care 3 days a week. Out-of-pocket. It became very expensive and it still really wasn't enough. He ended up in MC which is actually less money for a much higher level of care. He is doing so well now with more attention. All services are brought to him. I think it's time for a move. AL is not meant for what you are trying to use it for. Also look at private care homes.

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score 4 · Answer 14

Good Morning,

As I said in a previous post--I repeat, Assisted Living is real estate.

Everything is a la carte, out-of-pocket. You basically get a room, studio
type apartment, fancy le foyer, good meals, usually after the 3rd day the
senior wants oatmeal and maybe a grilled cheese.

They are not government regulated and you have to check the ratio of RN
to how many elderly residences live at the facility. For example, if there are 65
seniors up there in age, what are the chances that a few with take sick at the same time and the the RN's assistance? It's pretty high.

The brochures always look lovely and yes we will treat your loved one like family--until their $$$ goes.

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score 0 · Answer 15

Assisted Living always has private caregivers visiting and assisting patients. My question is has your ALF called you and brought to your attention the extra help your parent needs? I understand they can't administer services they don't have like a licensed nail tech on staff. I understand that they can't perform cleaning that they are not being paid for. If they are hiding from your inquiries and making excuses that post pandemic care is what you get, then remove your LO from the poor facility. Get him the skilled care he needs. Maybe others in the ALF are being treated as poorly and their families would combine with you to make lasting change?

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score 4 · Answer 16

Typos are fine; care facility for you dad isn't so fine.
(What I did / do).
Be sure to have in writing what the AL facility offers and is required to do.
Speak to facility administrator (as needed, personally, I would also notify by email some / all of the board of directors). Hold them all accountable.
* Ask administrator what procedures are for you to hire personal care / giver. Be SURE that facility isn't slacking off (more) due to another outside agency being paid to do the work this facility is supposed to do.
* Get everything in writing.

* document everthing: take photos, keep a journal of your visits and observations.
* contact your local Ombudsman - work with him/her, i.e., send your photos and notes for their records.
* Find out who is the reporting agency (and person) for the licensing board of these facilities.
* Hold facility administrator(s) / management accountable. Call and send them emails - regularly noting your concerns.
* Consider if another facility is possible (financially and otherwise). Do research to see if it is actually better.
* Have friends / others visit your dad to check and see what's going on - report back to you for your records.
FYI: I've been doing this for 8 months now ... for my friend in a nursing home. Most in a nursing home cannot / do not speak up for themselves. It is up to us to report and hold facility management accountable.
Gena Galenski
Touch Matters

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score 5 · Answer 17

I pay someone to spend time with my mother in her nursing home twice per week. They've developed a good rapport over the past year. She is also authorized to speak with the staff about her medical condition. When I am not around, she is my eyes and ears and will advocate for my mother. It's worth the extra expense for this service.

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score 1 · Answer 18

Yes we did for a aunt who fell

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score 4 · Answer 19

Sounds like a move to a nursing home may be a better option as it sounds like his needs far outweigh what an AL can do. You could pay for a private aid to help but that cost adds up, so it depends on finances. With a NH either you private pay for a while if he has the funds,, or apply for Medicaid. My dad is 90 with Parkinson's and a host of other issues, and any health crisis, like a UTI or surgery or anything can make the Parkinson's progress rapidly. That's what's happened to us, and at 94 unfortunately your dad is not going to improve in that sense. Sounds like this AL is also lacking in cleaning and sanitizing. You'll still need to be his advocate at a NH but he'll have more care, more consistently.

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score 0 · Answer 20

Sounds like a moving van is in the future, perhaps call "A Place for Mom" and the Care Advisor here (on the right). Hope you report the facility to the Health Dept or licensing office.

from the Internet:
How do I report an assisted living facility:

Who do I contact? Some facilities, such as nursing homes and assisted living facilities, are regulated by the Department of Social and Health Services (DSHS). You can file a complaint with DSHS by calling 800-562-6078.

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score 0 · Answer 21

Sounds like your Dad needs Memory Care, not AL.

At my mother’s MC, I have signed her up for manicures, via their on-site salon. That happens once a month. Same with haircuts, every six weeks. Mom pays for those.

The podiatrist comes once every six weeks. That is paid for by Medicare.

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score 0 · Answer 22

Your father needs more support than any AL can provide. They should be cleaning better and maintaining the A/C but he still needs more support than they can provide.

My mother was in a similar situation, and I had to move her to a nursing home. Of course, she didn't want to go but went for respite care and stayed. She is by far better cared for as they can deal with her higher level of care needs. She knows everyone who cares for her, gets more interaction and is healthier than ever.

If you don't want to move him, hire someone but his needs would better met elsewhere.

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score 3 · Answer 23

Most ALF state that the residents must not be incontinent or be able to clean themselves and change their own depends. Occasional accidents are allowed and should be cleaned up by the aides, but continued issues around toileting makes it seem he should be in memory care or nursing home. Simply leaving food with an elder without company or help is cruel. This AL should be telling you he needs more care and helping you find a place, or at least letting you know who to contact. They should also have a manicurist and podiatrist come for nails. They aren't doing their job. Are you speaking to them about these issues?

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score 2 · Answer 24

Thanks all for your input. There is disagreement in the family about moving him so soon after he just moved in in August. There's also the fact that nobody has bandwidth to initiate such a project, especially me. There's also the fact that he would reject this whole idea that he needs any more help, or would want to move. He's very stubborn and thick headed and doesn't think there are any problems. The problem is that if I visit him I get so depressed I get nearly suicidal. I think we're going to have to get a companion caregiver in there twice a week to give him some engagement and interaction, even though insurance doesn't cover it. I just have nothing left to give.

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A companion a few times a week sounds good. Worth a try!

Hopefully this will enable your stress to come down. Fill your new time with something you like to do or something new. A peaceful walk, YouTube yoga, dance on your own at home.

Add in some self-care 🤗

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score 2 · Answer 25

Dad needs either a Skilled Nursing Facility or a Memory Care ALF which is not 'just a step up from AL' at all, but provides A TON more assistance than AL which has about a 20:1 ratio of caregivers to resident; any decent MC has about a 6:1 ratio of CG to resident. MC helps with feeding, toileting on a 2 hr schedule, just a million things that AL has nothing to do with at all. AL is for a pretty independent senior who doesn't need much help with anything except a shower 2x a week, honestly. Anything more than that and you need MC (if cognitive impairment is involved) or Skilled Nursing. #Truth. I saw a huge difference in care when I segued mom from regular AL into MC. She had more issues than Newsweek and they were ALL well handled in MC. All but nail trimming, which you would not want any CG doing for your dad ANYWAY. Call in a podiatrist the AL should have on hand (monthly, normally) and ask him or her to cut his nails. Medicare pays for it once every few months, I believe.

I've yet to hear of an AL that won't allow an outside caregiver to be hired at YOUR expense, but that won't solve the issues this AL is having, like the AC not being replaced, etc. You'll be spending a lot of $$$ and still have the same issues to deal with, it seems to me. Your dad needs a different level of care at a different facility, instead of a private CG in a place that's very poorly run, imo.

I hope you can find a better fit for your dad, placement wise. Wishing you the best of luck with all you have to deal with.

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score 3 · Answer 26

First, its the AL in some respects. If they could not fix the airconditioner, they were obligated to put one in there that works. The aides should have cleaned up the bathroom and the open containers. I would not go thru the expense of hiring someone either. I do think your Dad is beyond an AL and MC which is just a step up from an AL. I think you need to find him a nice LTC facility because his Parkinsons will only worsen.

Its illegal for aides and nurses to cut fingernails or toenails. Medicare pays for a Podiatrist to cut toenails every 10 wks. My Moms doctor went to her AL to do hers. LTC facilities have a Podiatrist come in. So when it comes to fingernails, you may always have to do them.

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Perhaps states have differeing regulations.
Nursing Home nurse cut fingernails for my friend. She didn't clean them though. Check out requirements for the state you are needing the service.

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score 0 · Answer 27

Have you considered moving him to a group home? My dad had dementia and needed assistance with walking because he was falling and I placed him in a group home where they had live in aides and housed six elderly residents. He had constant supervision and his meals were provided to him. They assisted him with bathing, toileting and anything else he needed assistance with and they gave him his medication. The group home even had a doctor that came to the house every couple of weeks to manage their medical care and prescribe necessary medications. It was a very home like environment.

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score 0 · Answer 28

Kablooie, to bring in an outside caregiver you would need to check the senior facility to see if that is allowed.

My Dad was able to bring his home caregiver with him when he moved to senior living, but first she needed to be vetted by the facility, even though her employer was a caregiving agency. The facility also needed proof she has had her flu shot and now a days, probably would also require covid shots/boosters.

As for the broken air conditioner, that is uncalled for. Your Dad is paying rent to the landlord [the senior facility] and such items should be repaired in a reasonable time frame. Three months is not reasonable, neither would one month or two weeks. If parts are hard to get, that tells me the HVAC units in that facility have run their course, and new units need to be installed.

All in all, as others on the forum had mentioned, sounds like it is time for your Dad to find a place in a Nursing Home, as he now needs a larger village to take care of him.

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score 0 · Answer 29

I read your earlier posts, when your father lived far away from you. So he moved to an AL near you? When?

His needs have changed -- he needs more help during the day. In your earlier posts you also noted that he is well off financially. Can he hire add'l caregivers if he insists that he won't go to a higher level of care?

Are you his POA/HCPOA? Is he still considered legally able to make his own decisions?

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Can you tell me how do you see a person's previous posts??

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score 1 · Answer 30

I've seen privately funded aides in AL. To provide extra support eg a weekly 'friend' to go walk around the garden, or for other planned or meaningful activities 1:1. Mostly for short 1-2 hour visits.

But if all day/most day support is required for meds, meals, mobilising I'd have to agree with the comments already. Dad's needs outstrip what this AL can provide.

The main concerns are open/old/spoiled food? Sounds like the containers are too hard for him to manage.

This could be trouble with lids, trouble with eyesight seeing use by date, or planning processing problems.

He may now need full meal service. An OT could advise you. But with cancer too, you may be looking at comfort care quicker that you planned.

Moving him as he gets frailer may be needed.. or maybe it would benefit him to stay put but add extra services. Having a good chat about what's important to him may help you choose the way.

You are a wonderful advocate & Dad is lucky to have you.

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Can you hire outsiders to come in and care for parents at assisted living?

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