Problems with Continuting Care Retirement Communities

What to Do if Things Go Wrong in a Continuing-Care Retirement Community
Common problems when an older adult joins a continuing-care community

If you suspect or know of a problem with your friend or relative's care, the first thing you'll want to do is spend some extra time just listening to her and encouraging her to talk the problem through with you.

It also helps if you know in advance what to keep an eye out for. Here are some problems that may arise, and what you can do to help:

  • Trouble adjusting to new living arrangements. Early days in a new housing environment -- especially a communal one -- can be particularly hard, so even a small problem or irritation during the settling-in phase can feel overwhelming if she thinks she's going to have to live with the problem for the rest of her life.

What you can do: Hearing her out, encouraging her to try new things (like joining an on-site club or signing up for an activity), sharing a meal or two with her in the dining room, and helping her focus on the positives may make what seemed like a deal-breaker shrink in perspective as the plus side of continuing care, with its wide array of activities and options, comes into focus.

  • Not getting along with another resident. Conflicts can arise, from small misunderstandings to full-fledged flare-ups.

What you can do: Family, friends, and staff can support older adults in a new social setting by making sure they're comfortable with basic logistics and daily routines. New residents should understand procedures for reporting problems and feel comfortable sharing concerns.

For anything more than a simple slight, it's probably a good idea to involve staff to help check facts and determine the cause of the conflict. An experienced staff member should be familiar with all the different personalities and able to help sort out misunderstandings.

  • General boredom. A good continuing-care community will have a full calendar of activities to keep residents active and engaged -- but just because activities exist doesn't mean your friend or relative will take advantage of them. When you come to visit, take note of whether she's habitually in her own unit rather than in a communal area engaged with other residents. Does she complain of loneliness or say that there's "nothing to do"?

What you can do: Sometimes simple shyness keeps older adults from taking advantage of the very group activities that would lift not only boredom but the social isolation that can contribute to declining health in a continuing-care community setting. You can help by inviting yourself along to an initial meeting of a club or activity group to help break the ice. If her health permits, take advantage of visits to go on a simple outing to a nearby restaurant or movie, or to see old friends.

Serious problems to look out for in a continuing-care community

Most often, the problems that arise when an older adult joins a continuing-care community can be solved with a little brainstorming and plenty of love, support, visits, and interaction with staff members. But occasionally, issues verge into more serious territory.

  • Physical or verbal abuse from other residents. Moving from living alone or with a spouse to a group setting can be especially challenging if some of the residents are beginning to show signs of pre-dementia or other conditions that can cause aggression, at times even violence.

What you can do: You'll want to address the problem immediately with staff, and if it's not resolved quickly, don't hesitate to contact their supervisors.

Nan Hayes, president of RightSized Living, also suggests that if a new resident is the target of aggression from a more long-standing one, staff and family should also take time to evaluate the behavior of the target, who may unknowingly be contributing to the situation. For example, a new resident who's disoriented may wander into another resident's "space," which can create fear or anxiety and result in verbal abuse.

  • Problems with a staff member. It's hard to find oneself suddenly dependent on strangers, so it's not uncommon for older adults to complain about their new caregivers, especially initially. Whether or not these complaints are well founded, it's important to hear them out and try to help resolve them.

What you can do: After you've gotten your friend or relative's story, and if the allegation doesn't seem too serious, try gently bringing the subject up with the caregiver -- not necessarily to point a finger but to figure out whether, together, you can come up with a solution. You know the older adult best, so sometimes simply explaining a personality quirk or special need can help smooth a relationship.

Caregivers vary from one shift to another, so make sure you ask who is assigned to your friend or relative each time you visit or call, and get to know the various caregivers.

If speaking to the caregiver doesn't solve the problem, or if the accusations are serious, you may need to go up the chain of command, all the way to the facility administrator if necessary. Exactly whom this will involve depends on how the particular community is run and how its administration is structured, so it's a good idea to ask for a facility manual early on, before your friend or relative signs a contract and moves in.

  • Signs or complaints of poor care, neglect, or abuse. Because many older adults were raised "not to make a fuss" and may not speak up for themselves for fear of alienating their caregivers, it's important to ask questions that leave the door wide open for her to report serious problems. Along with asking "How are you?" from time to time you may want to gently ask a more directive question, such as, "Is everything OK? Are there any problems I can help out with?"

Trouble signs to watch out for include frequent bedsores, unexplained weight loss, or older adults who spend long periods unattended in their beds or in wheelchairs in hallways or common areas. These kind of problems are less likely when she first moves into a continuing-care community, but you may want to watch for them if she moves "up the care ladder" and finds herself in the skilled nursing unit, for example, where she will be more dependent on caregivers to fulfill basic functions.

What you can do: If you have reason to believe -- or she alleges -- that a particular caregiver is neglecting or abusing her, then ask that she be moved or assigned to a different caregiver while the concern is investigated.

If you try to contact an administrator and don't get a response right away, keep pushing. These may be busy administrators, but your loved one's health and happiness is at stake!

If at all possible, you'll also want to make frequent, unannounced visits to check on her well-being during a period when a serious concern has been raised. Or have a trusted friend do it if you're unable to go.

If, after going up the chain of command at the community, you still have serious concerns, you can contact your local or state long-term care ombudsperson and consider filing a complaint. Of course, if your concerns have reached this level, it may also be time to think about looking into a different continuing-care retirement community.

Nell Bernstein

Nell Bernstein's writings have appeared on Salon. See full bio