Can he be forced out of assisted living?

10 answers | Last updated: Nov 05, 2016
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 Answers

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.


Community Answers

Frazzled46 answered...

Truthfully for his own safety if he is wandering around at odd hours looking for things he doesn't have then he really doesn't belong in assisted living any longer. He needs to be in a more secure environment. Sounds like the assisted living place has decided that they can no longer assure his safety and that is good that they are being honest. I know it is hard to come to terms with but it may be in his best interest to have him in a nursing home. Don't wait for a crisis to happen.   Talk to his doctors and see what they think.  Good Luck!


Bobbi 1212 answered...

Your brother is now at a stage in the disease where he needs to be in the memory care section of an assisted living facility. Memory care units are locked facilities. My mom is in a Sunrise Assisited Living facility - memory care section, which is wonderful - the care takers are straight from heaven. My mom has a fun life there while receiving the care and safety she requires. Both my mon and my partner have alzheimer's so I'm very familiar with the disease. My partner has also early onset alzheimers. He's on aricept and doing very wellfor now.


Lindasd answered...

I was told by the Florida state Child and Family Welfare that my father could indeed be refused treatment or forced to move if the facility did not feel it could meet his medical and safety needs. When I tried to get him into an assisted living, I was turned down at every local facility.

Then when he was admitted to a nursing home after a hospital stay, the facility he was placed in told me they could not care for him due to the issues with Alzheimer's and would either start charging me some ridiculous fee or force him out unless I came and moved him. They said they did not have the means to control him.

I moved him to another facility that had an Alzheimer's unit but the first night there was some issue with another patient. The facility didn't call me but they actually Baker Acted him out to a holding facility who called me after 4 hours of holding him. I could not get the facility to tell me what happened. He was of course upset and confused really bad. At least the holding facility was kind and helpful.

When I tried to find another local facility that has Alzheimer's unit I was told he did not meet their criteria and was refused admittance. I eventually had to get him into a nursing home 2 hours from where we live that said they would take him.

In the end the nursing home he was in was very good but it made me realize that all this is a business. Some facilities don't have the staff or ability to care for specific Alzheimer's patients, especially assisted living facilities and have the right to refuse or move the patient when their condition changes.

Maybe this is a state thing since the expert answer is different than what I was told? Find a facility that cares, not one that is causing you and your brother problems. You both will be happier and you will not worry about his care. Good Luck and hope you find help.


A fellow caregiver answered...

My friend's father had a similar situation. He liked where he was staying and did not want to move but there was a concern over his safety and potential for wandering. So my friend purchased a GPS tracking device from www.i-tag.biz and is very happy with it because his dad can stay at the facility and they feel better knowing that he can be found quickly if he wanders. In fact, the facility is now looking into offering the device to other residents.


Pam l answered...

We are having the same problem with my Dad. He is in Assisted Living but will be moving to a memory care unit of a nursing home as soon as there is an opening. He is physically pretty good, continent, able to get in and out of bed, chairs, feed himself, but the memory problems, wandering (trying to get out of the building) and aggression that sometimes occurs has made it impossible for him to stay there now. I live across the country from him so my sister who lives about an hour away has been touring memory care units attached to nursing homes and has found one she really likes. He would still have a private room , which is good because he could not handle a roommate, but being attached to the nursing home he would be able to get additional meds when he needs them which cannot happen at the strictly Assisted Living place he's at now. he has gone to the ER several times when his aggression or agitation got too bad, which is very stressful on him. Now we just have to wait until there is an opening. The place he is now has given him a deadline, but they know they can't actually kick him out until he is placed somewhere. Hopefully it will be soon.


Journey002 answered...

Anonymous, as someone who has cared for an elderly person with Alzheimer's and has gone through this exact same thing, I wanted to respond to you. The first time my mother-in-law opened my front door at 3 o'clock in the morning, I, too, tried talking with her and tried to reason with her why it was not safe for her to do that. She had been told by some mysterious visitor (that kept showing up in her bedroom on numerous occasions...thank God for our alarm system!!)that my mother-in-law needed to get up because company was coming over to see her. I explained that no one was coming to our house at that time of the morning and that if this woman kept telling her that, then, she needed to tell her she had to wait until we had gotten up before she could visit. (Much easier to work with my mother-in-law on that level than to get into the whole there was no woman in her room thing...that would have just added to her confusion and that didn't serve a purpose.) I also explained how there could have been someone outside that could have harmed her and harmed the rest of us in the house. Absolutely told her that she was not to open that door unless one of us was up and with her. She completely understood and swore that it would never happen again. She felt very bad about all of it. I thought the problem was fixed. Two weeks later, yep...it happened again. This time it was 4 in the morning and I ran out of my bedroom and looked at the front door (my alarm system tells me exactly where there has been a breech of the alarm) and there she was. The alarm was blaring, she is leaning out the door, oblivious to the alarm blaring, and just saying "Hello? Are you out there? I'm here!", over and over. So, I repeated my conversation with her and again, she felt bad that this had happened but was sure she was told by this mysterious woman that she was getting visitors at 4 a.m. My mother-in-law had even gotten up and showered (another thing she wasn't to do by herself because of her falling issues). I ended up buying a monitor system that would let me know if she was up and moving around so that I could prevent her from possibly getting hurt. My point in this is that even though your sister talked with your brother about going outside in the middle of the night, he will not remember it the next time he wants to go looking for his car. Someone with dementia/Alzheimer's cannot process things the way they used to and their actions show that. They will do unreasonable things because, in their mind, its okay to do it. They lose the ability to be able to tell right from wrong, the ability of using common sense on issues where they feel they have to do something right then, no matter if it makes sense to anyone else. They will promise you that it won't happen again and yet, it will. They become childlike where you have to tell them something over and over and hope that they will get it, yet, they usually will not. Its hard on the family to watch them revert to this stage in life, yet, with the disease, it is inevitable that this will happen in some form or another. If the assisted living facility is not able to accommodate someone with your brother's needs and they have asked you to move him somewhere else, I would certainly follow their advice. They are not only trying to protect themselves but, they are trying to protect your brother and the other residents, as well. Please view it that light and not be so angry with them. Do what is right for your brother and move him somewhere that he will not be able to get outside of at night and possible harm come to him, for his own safety and protection. I so understand what you are going through and I am sorry that this is happening in your life and to your brother, but, reality is saying this is getting worse and your family has to deal with it...now! I will be praying for all of you as you go through this difficult journey in your life.


Lindasd answered...

I also wanted to add that a gps unit might help find the person after they wander but without an alarm system telling the facility that someone has left the premises, they could wander for hours before their absence is noticed. Some gps services have alerts once someone has wandered beyond a set zone but that means someone has to monitor it to know. If the facility is not doing that, the gps unit will do little to keep the person safe. I too have bought a simple door-open alarm for the doors my mother could and does go out. If someone is wandering, they really need to be monitored especially if they are in a facility. If the facility does not offer a full range of services to deal with an Alzheimer's patient, they need to be moved to one that does. This depends on the issues with the patient which can change, and do change. It only takes a few minutes for someone to wander into danger once outside the facility. Journey002 said it all very well. My father was "exit seeking" and had to be in a until that was locked so he could not get out. And he had an ankle device that set off a facility alarm if he did get past the unit door. Usually assisted living facilities do not do this. If the person is wandering it is not unusual they are in need of full time nursing care, where they cannot do things for themselves (give medication, dress, bath) and most assisted living facilities won't take someone that needs that kind of care. Call you local Alzheimer's organization for help, or senior center.


Pam l answered...

At the Assisted Living place my dad is at, they have an alarmed door that will open after someone pushes on it for over 15 seconds. They have to for the Fire Code. once outside they have to be talked back inside , they cannot force them to come back physically. So, he ended up in the ER for Meds after and ambulance ride to and from. The next time he did the same thing because he of course cannot remember any previous incidents. This time he told people that Bill was coming to get him. There is no retention so telling someone over and over and reasoning with them as to why they shouldn't go outside is pointless. They cannot help it. So, alarms and gps can help but at some point there has to be a way to keep them safe. For my Dad it means moving to a Memory Care unit. There the only door they can go out, for fire safety, takes them into a fenced courtyard, not a sidewalk next to a street. It meets the fire code and keeps him out of harms way and needless trips to the ER if he won't comply with coming in right away. If he refuses this place is attached to a nursing home and there is a Dr on duty , unlike the Assisted Living place, which is why he has had so many trips to the ER. Tricky to find what's right for your parents. My Dad refused to live with any of us, got aggressive, threatening damage to property if we didn't take him home,saying we were kidnapping him etc., so this is what it needs to be for him.


Texas bluebonnet answered...

I'm in the exact same situation with my mother. She keeps leaving her room at the Assisted Living Facility to "catch a taxi" because she is going to the bank to pull out all of her money. She thinks my sister is stealing from her. The staff found her this morning down the road by a very busy intersection. So, after being here for only one month, we are moving her again - this time to a facility with locked doors. She is going to be furious when she realizes what we've done, but it's better than her getting hit by a car or kidnapped. This is a cruel disease and it's hard to know what to do sometimes. I believe we have to consider our parent's safety first and foremost, however.