By Steve Moran
I have written half a dozen or so articles about my senior living consumer journey managing the care for my stepfather, Gary. That journey is now over. We have moved him from the community back into our home.
What is most shocking, most frustrating, is that our experience at his community was not awful. It was like staying in a two-star roadside hotel where you get a more or less clean room, a bed to sleep in, a shower, a tiny bar of soap, and maybe a bagged bagel for breakfast.
Fine for an overnight stay but terrible if that were the rest of your life. Fine for a budget price, but we were paying for more than that.
Dear executive director,
Just to make sure we are on the same page …
Gary will be leaving the community on Saturday, December 21, 2024, shortly after noon. We will need his medications ready to go at that time.
We will have his personal things, clothing, computer, papers, and documents out that same day.
As I understand it we are “stuck” paying rent through the 30th, so sometime in the following few days a friend will come and remove all of his furniture and return the keys to the front desk.
A couple of notes …
- I remain profoundly grateful that you were able to take Gary on short notice coming out of the hospital.
- I found a number of your memory care team members to be amazing.
- The contract provision that you can only give notice on the first day of the month, may be legal but it is grossly unfair and unreasonable. The idea that I could miss by one day and be stuck paying an additional 30 days’ rent is very simply morally wrong.
Note: This community has a provision that residents can only give a 30-day notice to move on the first day of the month — so that if you give notice on the second day of the month they can force you to pay two additional months.
It appears to be legal in California, but it is not moral.
- This move-out did not have to happen:
- The very worst part of his AL experience was discovering that after two weeks he had not taken a single shower. While he has a right to refuse, your team has a legal and moral obligation to put some real effort into getting him to shower, and at the very least, notify me of the problem. It took him calling me telling me he had pain in the groin area to dig deep enough to figure this out. I have had several people suggest I report this to licensing, and while I am not planning on doing that, it is clearly a violation of your legal obligation to keep him safe. I think at a very fundamental level, part of what AL should be doing is lifting a big portion of the caregiving burden from families. Some of that burden is physical, and as significant is the need to manage and worry about his well-being. I actually find myself worrying more with him being in your community than I did before, because as near as I can tell, no one is really paying attention to either his physical or mental well-being.
- There was never any serious effort made to integrate him into the community. He was offered activities and said no. He could have been encouraged to participate — taken by the hand or something. I feel like there was no serious effort to make this happen.
- I ate a bunch of meals in the dining room, and honestly, each one was mildly depressing in its own way. Your servers are mostly going through the motions. I see many people eating alone and very little in the way of conversation and socialization. It could and should be so much better. I have the sense they are understaffed, but it may be that they simply don’t like their jobs and don’t see the need to do more than take orders, serve food, and clean the tables.
- It is really distressing that no one apparently cares about visitors signing in at the front kiosk. It would be so easy for a stranger to walk in, turn door handles, and do terrible things to your residents.
- Gary would frequently ask me what staying there cost and I would tell him. He would be shocked. And when I would think about how much service he actually received it would bother me too. Meds and meals were about it.
- The last thing is that no one seemed to care about me, the family caregiver. No one came and said, “How are things going?” “What could we do to make it better?”
I suppose that I am more critical than many consumers because I have been in hundreds of senior living communities, big and small, high-end, middle market and low-end. I know it can be so much better. I know senior living can make a huge difference in people’s lives. It can create great life experiences and vastly improve the lives of family caregivers. None of that happened at your community.
SM
Ultimately, if Gary continues to deteriorate in a steady progression, he will likely need assisted living, and I have some good ideas where he will land. A number of years ago my mom, Gary’s wife, needed assisted living for the last eight months of her life. It was an amazing experience. I am not the family member from hell, though I suspect the community leadership would describe me that way.
We can and must do better.
Do you think having someone in a good CCRC solves this problem? Or you still see potential issues. Of course “good” is a hopeful term.
This is a good question and I think it could go either way, because I think it is mostly a leadership problem. I do think there are AL’s that do a great job, where this would not have happened, where they would have seen me as a partner in creating a great life for Gary.
The problem with CCRCs is you have to plan ahead – it’s a lifestyle decision, not a care decision. Most CCRCs require that to move in you must be fully independent with a reasonable expectation that you’ll remain in the Independent Living section for a period of time. If a person already needs care, it’s usually too late to choose a CCRC.
As a Director of Client Services for a Home Health Company, a RN with years of experience working in AL and SNF I now believe that having in home care is really the best for individuals who need care. It prevents confusion, stress and many preventable problems. Until it is covered by insurance unfortunately it is not affordable for many. Home Care gives individuals security, safety and autonomy to age gracefully.
Yes in home care needs to be able to get some financial support!! Thanks for mentioning this in your comment.
I had a similar experience to this. I ended up taking my Mom back home. Yes, home care is so much better because you can supervise and change care if needed. Thank you for articulating this journey so well. I’m glad that you were able to witness some amazing experiences, I tried and they were just worse and worse. Yes, we have to do better…
I am so sorry to hear this. One of the things that makes this so difficult is that consumers don’t have a really good way to assess the quality of a community or company. The place where Gary was has a google review score of 4.7 with around 50 reviews. it is way over stated, because they work at getting good reviews.
Yes! You’re right, they have people work on that, so it is misleading or overstated.
As someone who has worked in Assisted Living for years this saddens me to hear. I have been in hundreds of communities and know they all vary in services, care, cost, etc. However, the one thing I believe all Assisted Livings need to remember is that they offer a service and customer experience and satisfaction is vital. The building may not be the newest or have the most amenities but what people remember is the care that was received.
This is exactly right. I have been in amazing communities where the building was 30+ years old and new ones where they simply felt new and impersonal.
I’m sorry this happened to Gary. I live in SE Florida, and in our state at large, I know 5 years ago, 75% of licensed beds were in smaller communities, aka “board & care” or Residential ALFs, with 15 beds and under.
I’ve seen a great post on this very blog, where a retired doctor & resident posted photos of his Home and the Facility he now lived in. The latter looked like a castle, as a few remarked… But the first is very similar to our small ALF home.
That’s why it works. Once people lose abilities, the human connection, encouragement as you said, to participate is so vital!
It also comes down to something every parent knows. Youngsters and those young-again, need routine more than any other thing, to feel safe and they need others. People almost always decline at first – Why did they put me here, I’m not like these old people! Hydration is hugely important and if nobody’s seeing he’s not showering, how can we know he’s hydrated?
I love our small home, and I wish there was more visibility for this model. I say this to an audience of largely, corporate senior living specialists. I’m just hoping there remains a spot for the most loving (professional) care model yet.
Yes, I know family loves them – but I also know family needs to lay that burden down in favor of their own health and well-being. The search for a large facility can be daunting, but the small ones are so often owned & operated from the heart. We don’t have shareholders to placate, and our staff also become like family. Their job is so rewarding, being when the same people for years, knowing their names and stories, “how’s your daughter’s hubbie?” and all that. One reassures another that, “We’ll go out again later – we have to come in and go to the bathroom, ” They look at that one as a “little brother or sister” and even if they announce “I went to the bathroom, and I washed my hands”, it’s taken with a good-natured smile, and the person is congratulated. “I knew you could do it!”
It really is quite like a family and it’s why many of us keep going, when we’d rather retire. Where would 4 to 6 people go to remain a family, together, with individual care and attention?
Happy New Year all from Angel House
I think you are being far too generous by not reporting the lack of a shower. As you said, the very least is you should have been notified. If it was in his care plan refusal of care is required to be documented and reported in California. What will happen to other residents that move in w nobody to advocate & follow up? As professionals in Senior Living we are only the “family member from hell” to communities that miss the mark. Please report them for the sake of other new residents.
You make a good point here. Even if he refused and they documented it. As the POA they should have notified me because it was clearly putting his health in jeopardy.