Moving TO or FROM an Assisted Living Facility

Moving into an assisted living facility (ALF) is a milestone for our Elders.  In many ways it signals the beginning of the end for them.    To get started you have to understand your Elder's needs and personality then begin searching for some place where they'll fit in easily and feel at home.  These  lists should give you a good place to start.  These are a work in progress, as I hear more great ideas, I will up date these lists.   If you have anything to add, please just send an email!

Initial Questions for You (Get your Elder on paper)
  • Why move your parent? Is it for his/her healthy and safety? Your convenience? 
  • Does your elder/parent want to move?  What are their reasons? This is important because you have to help find a living situation that meets their needs, desires and preferences.  If not, s/he will be unhappy and adjusting will take longer. 
  • What are their objections to moving?   This is important because you can work to eliminate these objections and find a living situation that helps ease them too.
  • Do you want your parent/elder to live close to you? How often can you visit?  If you have a sibling that is willing to visit more often, it might be wiser to move your elder/parent closer to them.   Don't be selfish, it's not about YOU, it's about what's best for your elder/parent.
  • Does s/he has residency in YOUR state? If not, s/he might need to establish residency before qualifying for any state assistance or medicaide. 
  • Who has Power of Attorney (PoA)? Is it durable? Durable grants all kinds of power for any and all decisions  so should be considered carefully.
  • Does the Elder/parent have a living will, PoA for Healthcare? A will? 
  • Can the Elder still drive? Should s/he still be driving?  
  • What is your elders monthly income?  
  • Does s/he have supplemental insurance?  Do they have a separate long-term care plan? Does their health plan have a long-term care benefit? If yes, what does it cover? What are the time and dollar limits?  Under what scenario will it pay?  Often health providers will pay for a short term stay in a nursing home as an elder recouperates from surgery or something.  Once it's deemed that the elder should stay, they will not pay. 
  • What cash assets are available to pay for ALF rent.  Note: The last credible information I saw on average rent at an ALF was $3000 a month for assisted living and $5000 a month for nursing home care - it all depends on need and level of care.
Questions for the ALF - match up with your Elder's needs and personality
  •  What is the "business model" of the ALF?  Do they have a one-fee fits all system or do they charge a basic rent and add more for each service?
  • What is their policy for rent increases? When might these occur?  When might your elder/parent be reassessed for additional needs and thus fees if applicable?
  • Can you set up direct deposit for rent payments?
  • What are the fees if rent payments are late?  
  • Can the elder "age in place"? Can they move into assisted living and then to rehab or skilled nursing care as their physical needs grow?
  • Does the facility accept medicaide in case your elder/parent's funds run out? Note that most ALF's require a resident to share a room once they need medicaide. 
  • What are their procedures to notify family of doctor appointments? of emergencies? 
  • How do they communicate changes in status or concerns about residents to doctors? to families?
  • How do they monitor and purchase prescriptions?  Who pays for prescriptions?
  • Do they have a van to transport residents to/from appointments?  
  • Is there a nurse on staff and on call at all times? 
  • Who dispenses meds? Nurses or specially trained aides?
  • How are prescriptions handled? Many ALF's use mail order pharmacies and require that all pills - even over-the-counter vitamins are bubble packed by a pharmacist. 
  • Who checks the residents vitals?
  • If your elder/parent has special needs (epilepsy, diabetes, parkinsons) - what is the facilities' experience with other residents with the same condition?
  • Can the facility to physical therapy at their location?
  • What activities are available for your elder/parent?  Consider your elder/s preferences, can s/he find them at this facility?
  • Does the facility do laundry? 
  • Does the facility provide bedding, sheets, towels, toiletries like shampoo, lotion, toothpaste?
  • What about personal care items like bandages, adult diapers and the like? who pays for these?
  • When are meals? What about snacks, coffee, juice, etc?
  • Can they prepare special meals like kosher or diabetic menus?
  • Can you bring food in for birthdays and the like?
  • Are dining places assigned seating or open seating? 
  • Can the resident cook or eat in their rooms?
  • Can they have microwave ovens? 
  • Is housekeeping included? If yes, exactly WHAT is done and WHEN.  
  • What about their own phone, mail, subscriptions or TV? Often cable TV is included in the monthly rent. 
  • What are the "common" areas like, will your elder feel comfortable socializing there?
  • What entertainment is available? What about organized outings? Can family attend these outings?
  • How does the ALF communicate with residents physician?
  • How does the ALF handle falls? other emergencies?
  • Are pets allowed?
  • What are the criteria for residents deemed "too needy"?  When are residents referred to a nursing home?
  • What is the aid-to-resident ratio during the day? during the evening? on weekends?
  • What are the financial requirements to move in? deposits? move-in or assessment fees?
  • What does the resident need for their living space? Bed? TV, Fridge? other appliances?
  • What are check in procedures?  Does the resident need a physical before moving in?  Does a staff nurse need to do an assessment BEFORE moving in?
  • Understand all the rules of the ALF - they will give you a packet, read it thoroughly.  For example: my Mom's ALF allows ONLY plastic Christmas tree ornaments and all lights must be on a surge protector.  Each may have rules depending on fire codes within their state and county.  
  • Understand what's necessary to move out and notification periods.  (My mom's  ALF wanted 15 days yet she was moved out in a hurry on the 28th day of the month. We'd already paid the next months rent and only got a partial refund.)
  • If your elder/parent is wheelchair bound or movement is difficult, can they easily navigate the halls, use the elevator and find their way around in general?
  • Look at their room or apartment, are the doors heavy? easy to open? can they control the heat or cooling easily?  
NOTE:  Before moving your elder/parent into any facility understand who does what.  Understand who you should contact for any of the following:
  • doctor appointments, scheduling and orders for treatment, etc
  • transportation to/ from appointments
  • dining issues - bad food, bad tablemates
  • maintenance in your elders room or around the facility (cleaning and repairing are generally done by different people)
  • laundry - clothes and bedding
  • rent, extra fees, billing, late payments, refunds
  • emergencies at the ALF - what should you do if you're there and the fire alarm goes off? what if your elder/parent has an emergency?

Moving into the ALF
Before moving in: 
  • BUY A LABEL MAKER AND PERMANENT MARKERS - put your elder or parent's name on EVERYTHING  - clothes, appliances, underwear....label, label, label 
  • What does your elder/parent WANT to take? a recliner, coffee table, pictures, craft stuff?
  • What practical things will your elder/parent NEED?
  • What sentimental things does your elder/parent want?
  • Will their bed fit into the room? Do they need a smaller bed (generally full or twin size)
  • Does a new bed mean new bedding. 
  • Will they take other furniture - table, chairs, sofa??
  • Do they need towels for the bath, dishes, wash clothes?  A shower curtain?
  • Do they have physical aides at home that need to be transferred too? Shower chairs, bed side commodes? toilet risers?  Often the toilets at ALF are raised so the staff will assess the need for a riser. 
  • Will you outfit a small kitchenette for them? How many of each will they need: plates, bowls, utensils, cups. 
  • Will you get new appliances that are smaller and easier to use - coffee maker, microwave, TV, alarm, etc. 
  • What subscriptions should be transferred? newspaper, magazines.
  • Can they move their old home telephone number to the new residence? This is often important to help keep the elder connected to friends. 
  • What bills does s/he receive now and what will be cancelled once they move? When should these be cancelled?  
  • Is the elder leaving a house that they own?  What will happen to it? Who will pay bills for water, garbage, heat, taxes, insurance etc??  This is often a huge concern for families and the individual.   The house represents their home, family and independence.  See blog posts for various issues related to this.   From a practical standpoint, consider keeping it safe, clean and well kept in case your elder wishes to return or if it must be sold some day. 
  • Make a list of EVERY single thing you take to the ALF and it's general condition.  copy this list and keep one for your records and provide one to the ALF.  This will be used at move out to eliminate questions about ownership of furniture, etc.

Moving out of the ALF
Moving out of the ALF really depends on WHY the move is necessary.   Most often it's necessary because someone requires more care and they move to a nursing home so that's the focus of this list - to downsize and help your elder adjust to different surroundings.
  • How much notice to move out does the ALF require?
  • Must notice be in writing or is a verbal message acceptable?
  • What is the final balance due to the ALF?
  • Is there a refund coming to your elder?  How long will that take to receive?  To whom will it be made?
  • What sort of cleaning is expected upon move out?
  • Was there a telephone, internet or cable/satellite TV connection that must be turned off?
  • Did your elder receive Medicaid assistance to supplement rent at the ALF?  Notify them IMMEDIATELY of any changes in living situations.   
  • Notify the NEW  facility of your elders financial status and if s/he receives Medicaide.  Often they will help you transfer information and deal with state and federal entities. 
  • Use the list created at move in to take inventory of all the things that must be moved out. This is especially important for items like walkers, canes, bathing aides.  Pay special attention to things paid for by medicare that BELONG to your elder NOT the ALF.  
  • Was anything at the ALF rented by Medicare for your elder?   Does it need to be returned?  If it's not returned on time Medicare may refuse to pay so who can/will pay the bill if it's late.
    NOTE:  Wheelchairs are the most common item rented by Medicare, after 18 months these become the property of the patient but before 18 months, they must go back.
  •  What will your elder need in their "new" location?  Can they use an existing item from the ALF or must items be purchased?
  •  Complete a "change of address" with the postal service; forward mail from the ALF to the new location or to a responsible party.
Where do i start to move mom to assisted living?  Where do i start to move dad to assisted living?  Where do i start to move mom dad to assisted living? What do i need to know to move mom dad to assisted living?  How do i know it's time to move mom dad to assisted living?