Can he be forced out of assisted living?

A fellow caregiver asked...

My brother is 60 years old and has early-onset dementia/Alzheimer's. This past week, the security guard at assisted living facility where he is living found him outside in the parking lot at 3:00 a.m. He said he was looking for his car and had to meet someone. He hasn't been allowed to drive and doesn't have a car there. Not driving has been extremely difficult for him. He has also had a few instances recently with urinary incontinence--although they have been sporadic--like 4 in the past 4 months. He has a key to the front door and to his room, and has been allowed to come and go as he wants as long as someone is informed. He doesn't talk much, and it's unlikely the overnight attendant was at her desk near his room at the time. Now the new director wants him moved into the nursing home right away. I can understand them fearing a lawsuit should he possibly wander away and get lost or hurt, but what are his/our rights in this situation? I think that one instance of being out late is not yet reason enough to believe he'd do it again. My sister talked to him about this situation after the fact.

Expert Answer

Maria Basso Lipani writes a popular website on geriatric care topics, where she puts her expertise as a Licensed Clinical Social Worker to good use answering care planning questions. Maria is a graduate of Columbia University School of Social Work and is licensed in California and New York.

A nursing home is not the appropriate setting for a relatively young person who is physically active and still able to care for himself in many ways. I think you are 100% right to question the facility’s rationale and you should know that the facility cannot force this transition.  Your brother’s power of attorney would have the authority to make alternate arrangements if this particular assisted living facility will not accept him back. 

That said, I would strongly suggest that another assisted living facility, one with a special unit for the memory impaired, be considered.  The wandering is a definitive sign that your brother now requires greater supervision and no amount of talking to him about his wandering will be effective at curtailing it.  

With regard to the urinary incontinence, it is not uncommon for people with dementia to have difficulty interpreting what the urge to urinate means. Reminders to use the restroom at regular intervals can go a long way toward reducing accidents.  Trained staff on a unit for the memory impaired would provide such reminders.