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When Assisted Living May Not Be Enough

Jane’s father Jerry decided, on his own, that it was time to move into an assisted living facility. Jerry’s arthritis had worsened to the point where he couldn’t dress himself, he struggled to get in and out of the shower, and he was lonely living by himself.

Jerry did very well at his new place. The social activities that the assisted living facility offered helped his mood, the staff was available to help him bathe and to monitor his medication, and he appreciated not having to cook any more.

However, over time Jerry showed signs of dementia. The assisted living facility he had moved to was simply not set up to meet his needs. Dementia patients can become disoriented, wander away into danger or exposure, or become agitated or aggressive. Dementia is a particularly difficult disease to care for, as the right balance must be struck between sufferers’ need for social contact and mobility on the one hand, and safety for themselves and others on the other hand.

There are facilities that provide “memory care” services, with locked doors to prevent wandering, but these are usually more expensive and Jerry’s wasn’t one of them. If the facility doesn’t have staff trained in how to “talk down” and reassure an agitated or aggressive resident, staff may over-rely on psychotropic medication. But over-medicated patients are exposed to increased risk for strokes, falls, and confusion. Staffing and training regulations vary widely across the states, and often the staff-resident ratios are left to the facilities to determine. For-profit facilities must balance staffing expenses with attention to their bottom line. The problem is particularly acute in rural areas, where there are fewer facilities available.

10 Important Questions to Ask Your Assisted Living Facility

It’s particularly important, then, that residents’ family-members keep tabs on the facility’s environment and treatment of residents. Here are questions to ask:

  • Is the facility clean, sanitary, and in good repair?
  • What is the ratio between staff and resident?
  • What training does the staff get?
  • What is the staff turn-over rate?
  • Are residents medically assessed at least once a year?
  • Are the hot-water temperature controls kept at a safe and effective level?
  • Are the following kept away from residents: alcohol, cigarettes, and toxic cleaning supplies and disinfectants?
  • Are medications kept in a safe, locked place that is not accessible to anybody other than employees responsible for the supervision of the medication?
  • Is safe storage provided for knives, matches, firearms, tools, and any other items that could constitute a danger?
  • Are there provisions in place to protect life and property against fire and panic?

With careful monitoring, assisted-living facilities may provide a safe environment – but monitoring can also flag when the environment is no longer safe enough.

We are here to help.

At McDonald Law Firm, we help families find, access and pay for long-term care. If we can help you or a loved one, please don’t hesitate to reach out to Andre O. McDonald, a knowledgeable Howard County and Montgomery County estate planning, special needs planning, Medicaid planning and veterans pension planning attorney at (443) 741-1088 to schedule a consultation.



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For help with estate planning, special needs planning or elder law throughout Howard, Montgomery, Prince George’s, Anne Arundel, and Baltimore County; and Baltimore City, contact McDonald Law Firm, LLC.

McDonald Law Firm, LLC

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Columbia, MD 21044-3563

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Bethesda, MD 20814

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Washington, DC 20037

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