A few years
ago, we wrote another article about how to open an assisted
living facility. It's become quite a popular article, and we're
pleased that so many people have taken the time to comment.
Many of these comments are from people who are thinking about
opening their own facility, or residential care home, and they
are just beginning the information collecting phase of their
As I read these comments,
at times I can't help but to think that some of these folks
are a little ignorant, or perhaps diluted about the more difficult
aspects of running a facility. Several people have commented
that they have a deep desire to "help the elderly"
and to create a happy and healthy home for seniors...in so many
words. We think this is a great attitude, but there is certainly
a level of reality that you need to wrap your head around if
you are planning on operating an assisted living home - especially
if you plan on accepting residents who have Alzheimer's, dementia,
or any other mental illness.
I also receive e-mails
every day from families asking for our help in finding an assisted
living situation for their loved ones - usually mom or dad -
and often times, these e-mails are very desperate sounding -
like they have exhausted all of their resources - since mom
or dad has issues that are difficult to deal with - and make
it difficult to place him or her.
One such e-mail
went like this:
is almost 90, and he has suffered mini-strokes and has severe
dementia. He tends to become aggressive and unruly and yes...he
is a difficult person to be around. It seems to be getting worse.
He spent time at another facility, where they involuntarily
discharged him without much notice. We desperately need to find
a suitable assisted living facility, but one that can handle
such a person with advanced dementia - and one that won't discharge
him after he has moved in. Can you help?"
this always make me think of several things.
you are planning on starting an assisted living facility, you
need to be prepared for residents like this - difficult, unreasonable,
and sometimes physically aggressive residents. These type of
residents can require enormous resources - in terms of attention,
safety monitoring, and patience. Also, a resident may move in
and be relatively easy to deal with, and then deteriorate over
time as their condition worsens.
As a family, if you are trying to place a loved one that has
dementia or Alzheimer's, you need to prepare yourselves for
the possibility of discharge...perhaps involuntary, if mom or
dad becomes too difficult do care for.
Do most facilities have a policy regarding involuntary discharge,
and if so, is it in writing, and a part of the resident agreement/contract?
How much notice is a facility required to give - either according
to their contract, or if there are any applicable state or local
laws that may apply? We recommend checking with the local area
agency on aging, or health services department wherever the
facility in question is located.
Is the facility required to list reasons for the discharge,
or is it at will?
The whole subject of
involuntary discharge can be looked upon from several points
of view - mainly, from the family point of view, and the facility
point of view.
Taking the facility's
side - we understand and support the fact that if a resident
becomes aggressive to the point of being dangerous to him or
herself, and the other residents of the facility - and if the
facility has exhausted all means to care for the resident in
a safe and dignified manner - then discharge may be the necessary
From the family point
of view, we also think that there needs to be a very specific
policy in writing that the facility presents to the family upon
move-in stating in very specific terms what their discharge
policy is, how much notice will be given, how much financial
liability will result (deposits, rent, etc), and what, if any
reasons will be provided.
We also think it is
appropriate for a family to ask how many discharges the facility
has had in the past, or how many it averages per year (for larger
Lastly, will the resident
have any rights to appeal the discharge? Ask the facility.
There are, of course,
many reasons that a facility may elect to discharge a resident,
and so far we have only covered mental health issues as reasons.
Naturally, there are a number of other reasons that a facility
may elect to discharge a resident, such as running out of funds/not
paying rent, violating rules, such as smoking in non-smoking
areas with repeated warnings (which can be serious if it is
done around residents with respiratory issues), wandering, etc.
The best course of action
from any point of view is to ask the right questions, and to
get it in writing.
We found a decent example
of an explanation of involuntary discharge on the Administrative
Rules .pdf on the Department of Public Health & Human Services
for Montana site here.
Most assisted living
facilities **should** have something similar on file, or as
a part of any resident or lease agreement. If they do not, ask
if they would sign one that you provide. If they refuse, then
perhaps the facility is not the best fit for mom or dad.
- Assisted Living