Five Lessons I Learned After Dad Moved to an ALF

April 9, 2018

When Dad decided to move to an ALF, I was so relieved. We’d been worried about how he was managing at home. After he moved, I learned several valuable lessons. Hopefully, these will help other families when a parent is planning to move to an ALF.

The stress doesn’t end when a parent moves to an ALF

I quickly discovered that my relief was overly optimistic. We’d been so happy Dad agreed to the move, I thought our worries would be over. However, in the first week I spent more time dealing with caregiving tasks than when he lived at home. And, for several weeks the phone calls from Dad and the facility staff seemed constant.

My takeaways:

We would have benefited from an advocate…to check in on Dad and as a sounding board for me. Shortly thereafter, we did hire a care manager. This was especially useful as I began to think maybe we should just move Dad home. Or, I wondered if this was the wrong ALF for him. He always had complaints. The care manager helped him adjust and addressed the concerns. More importantly, she gave me an independent assessment that helped me conclude it was not best to move Dad now. I think many caregivers find themselves in this predicament and “give in”. It can be hard to separate the emotions of dealing with change versus true problems. Moving Dad home or elsewhere before an adjustment period wouldn’t have allowed for a fair evaluation.

Our family was sure an ALF was THE answer to Dad’s care needs. And, while it worked out in the long run, I now realize it’s not the only solution. I wish I had pushed harder for Dad to try a home caregiver first because I don’t think he was quite ready for the ALF.

The transition period is vital and challenging

To add on to #1, I was caught off guard by how difficult the initial transition was. Dad was so angry, even though he’d willingly made this decision. I’d helped with the basic logistics of finding the place, arranging movers, etc. But, I would put much more effort into a full transition plan if I had to do it over.

First, the day of the actual move was highly stressful. I should have had professionals to coordinate things so Dad and I didn’t have to be so involved. I also didn’t think about things like the timing of our arrival. It happened to coincide with the end of lunchtime. All the staff members were tied up and Dad ended up missing lunch. They eventually brought a tray of food to his room, but this gave him a bad impression right away. Looking back, I’d probably take him out to his favorite restaurant to make the day more enjoyable, and arrive after lunch. He also moved in on a Friday (so I could minimize time off work) which was bad timing. Staff was light on the weekend, and activities were few and far between.

A friend of mine told me some tidbits about how they handled their move. Their hired caregiver (who’d been working with Dad at home) came along that day. She took their Dad out to a meal and to pick up a few things on the way. The family went ahead and set up things in the apartment. They (and their care manager) talked to the staff and made introductions. The care manager showed Dad around and the caregiver attended an afternoon activity with him. They had the caregiver spend a few hours there daily for the first couple weeks, including taking Dad on outings. She also told me about a lot of great resources to help with the move. I wish I’d heard her story first.

The first few weeks were especially tough. I ended up leaning on the care manager a lot, just to confirm I wasn’t doing anything wrong. And, she could report in on how Dad was doing, which made me feel better. At first, everything he was telling me was negative. She’d share the activities he’d participated in and some of the good news. It took him a little longer to admit some of the things he was enjoying.

Understand the fine print

For example, we knew the facility provided transportation. They had group outings, but also provided rides to the doctor. The “fine print” we realized later was that a couple of Dad’s doctors were too far. And, the appointments had to be made within a specific window. Sometimes Dad would have to arrive very early or wait to be picked up so they could juggle appointments for various residents.

Dad also didn’t like some of the meal times. He hated going down to the dining room for breakfast. The facility could only bring the meal to him for a limited number of days if he was ill. Dad was furious about this and refused to go to breakfast. But, he couldn’t wait until lunch to eat due to his medicines. We were eventually able to work something out for an extra fee.

It’s essential to understand “level of care” and the limitations of what your ALF can provide

There are different types of facilities. For example, in Florida an ALF can have a standard license to provide routine personal care, or a specialty license. The specialty licenses permit them to provide additional specific services, to help residents “age in place”. In addition to licensing, facilities may put their own limitations on services. They may decide they cannot meet the needs of a particular resident and evict him/her.

The best way to ensure a facility can meet your parent’s needs now and in the immediate future is to get an independent assessment. You should be very clear and truthful with the ALF. Don’t try to hide your parent’s needs or potential problems. It will only be a nightmare for you later. However, you may not fully understand your parent’s needs if you haven’t been providing full-time care for them. And, a facility assessment may not uncover a mismatch. The ALF may be motivated to get you to move in, but you want to be absolutely sure it’s the right fit.

On the flip side, an ALF might be too much or the wrong environment for your parent at the time. My Dad, for example, probably would have been better off a bit longer at home or in independent living with some help. He was much younger and more active than most of the other residents. On the other hand, my friend moved her Mom to an independent retirement community not realizing she wouldn’t have the help needed. An independent evaluation can save you a costly mistake (literally and emotionally).

There are certain realities to “group care”

An ALF does not provide one-on-one care. ALFs in Florida have staffing requirements, calculated by daily care hours. They will typically assist with some personal care but do not have the staff to spend much time with each resident. Just to provide an idea, in Florida, facilities must have one awake staff member per every 17 residents. It is important to find out just how many staff are on site at different times and what the day-to-day care is like.

Very few staff will typically be available on weekends and nights. It is highly likely that if a problem occurs during these times, your loved one will be sent out to the hospital. I wish I’d asked more questions so I’d known what to expect.

Though Dad’s facility exceeded minimum state standards, I soon learned we needed someone there regularly. I don’t live nearby, but thought he’d be okay with a neighbor going by. However, little things would slip through the cracks. I couldn’t expect the neighbor to be his advocate, read his chart and ask questions. Without regular family visits, I realized Dad was likely to get less attention.

We set up regular care manager visits. She reviews the chart, talks to staff and sees Dad. She often notes changes and keeps little things from turning into crises. We also have her on call for emergencies. I can’t imagine Dad waiting in the ER by himself.

It’s important to be realistic about care and logistics in a group setting. Understand what to expect and how to address problems. Make sure someone’s visiting regularly.