By Steve Moran

As a senior living (assisted living) consumer, I have come face-to-face with the question of what I am paying for. What part of the caregiver burden is the community assuming, and what remains my responsibility?

I assumed, of course, that three meals a day and medication management and basic security were foundational.

I assumed they would take responsibility for getting my stepfather socially integrated into the community. More than just inviting him to activities but encouraging him, motivating him to participate. Helping him find reasons to participate.

I assumed the community would utilize mealtimes to connect him with other residents to foster communication and friendship.

I assumed they would make sure he was showering on a regular basis, since there was an extra charge for standby assist with showering.

I Got Most of It Wrong

The meals and med management happened as promised. The rest … not so much, not at all.

Life Enrichment

There are activities happening every day, and at least some of the time, I guess they are inviting him to activities, though I am not at all certain that invites are regularly happening. I do know that if he says no thanks, they move on. The thinking is that residents have the right to refuse to participate, which is legally 100% true.

Except that he has dementia. He doesn’t understand he is living a less quality life than he could otherwise have. It would take some time, some effort to encourage him to participate. I thought I was paying for that, but I guess not.

Mealtimes

As near as I can tell, when he goes down to meals he ends up sitting alone, because no one has time, no one cares enough, to use that time to improve his quality of life. It is a great opportunity and would only take a tiny bit of time and effort to make mealtime into something very special, very meaningful.

I thought I was paying for that, but I guess not.

Showering

After about 10 days, Gary moved from memory care to assisted living. One afternoon a couple of weeks after the move to assisted living, he called me up to say he had some pain in his groin area. I assumed he had another UTI. I called for the nurse, the executive director, or the assisted living manager — none of whom was available, or they wouldn’t take my call.

I headed down to the community, asked again for the nurse to come see me, then went to his room. It only took me a few minutes and a little nudging to get him in the shower. When I went into the shower to get it turned on for him, it was clear it had not been used since he made the move.

I felt guilty that I had not checked this more carefully earlier, but then realized that while he does have the right to refuse a shower, as the one who is responsible for his care, his wellbeing, I should have been told that he was refusing.

I thought I was paying for that. I guess not.

The Role of the Family

Families go the senior living route because caregiving is difficult or impossible at home and they want their loved ones to have as good a life as possible. A significant part of that value is transferring a large portion of the responsibility for the day-to-day care and well-being from the family to the community.

In my case, I am responsible not only for his well-being but for constantly double-checking to make sure the community is doing what they are supposed to do. They have increased the burden, not reduced it.

It might be that someone from the community or the management entity will read this and respond (privately, since I have not and will not name the community or management company) that, in fact, they were doing more — that they were urging him to bathe, that they tried to seat him with others, that they did all they could to get him to participate. But if that were true, then they had an obligation to let me know, to allow me to help.

In particular, the not bathing and not notifying was dangerous and a violation of regulations. It would be a citable offense.

I know this is one community and one organization, but I promise you these are widespread problems, and they make people not trust senior living.