One of the primary reasons someone moves to Assisted Living is because of limited mobility. But there are varying degrees of limited mobility, and it is important to understand them all. This is true because the need for assistance with mobility can change over time, whether due to simple aging, the progression of a known disease or disability, or due to unexpected illnesses. My goal is always to anticipate identifiable problems in advance, where possible, and to help families plan for foreseeable issues. In this way we can hope to avoid a second, unnecessary, move.
Effectively there are four levels of mobility assistance; we will explore each in turn.
Walker or Cane
Someone who doesn’t need help rising from a chair and can fully bear his own weight is someone who doesn’t need transfer assistance. However, many seniors in this category will need a cane or walker as they age, simply to increase stability and help prevent a fall. And many seniors should be using these assistive devices, but don’t, either out of pride or denial. I commonly hear of seniors who practice what is known as furniture surfing around the house, where they go from counter to chair to table to seat and back as they move about the house. And yet many of these seniors decline to use a walker.
Regardless, the salient point is that these individuals are able to stand up without assistance, and their mobility isn’t significantly hampered. But they are at risk for a fall and use assistive devices as a precaution.
Walkers and rollators are common in all levels of Senior Living. For example, I know of Independent Living communities where the architects have designed special rooms next to the entrance to their dining room as a garage for walkers and wheelchairs. The point is that this level of limited mobility isn’t necessarily a factor that excludes someone from any level of Senior Living.
The next level of mobility issue is the One-Person Transfer. This is where things start to get interesting. A person who is considered a one-person transfer is someone who sometimes—not necessarily always—needs help getting up from a seated position such as the bed, couch, chair, or toilet and this assistance can be safely provided by one caregiver. I say “sometimes” because we have to plan for the bad days, not just the good days. This could also be an individual who needs assistance transferring from a wheelchair to a bed, couch, chair, or toilet.
If we don’t plan cautiously enough, a senior will likely try something unsafe to get up, and while it may work sometimes, eventually it will catch up to them.
For safety reasons, a one-person transfer is not appropriate for Independent Living, whether as a new resident or even if they have been a long-term resident. This is true because in Independent Living, care from the outside agency must be “schedulable.” An outside agency caregiver cannot be summoned for care on demand, such as when someone needs help to get to the toilet or needs unanticipated assistance moving about. When a person is a one-person transfer, they need to move to an Assisted Living community.
The third level of mobility is the Two-Person Transfer. Most often, a person requiring two caregivers to help transfer is mostly wheelchair-bound. This is where things really start to get problematic. The major reason this is difficult for a community to handle is staffing. Having two caregivers off the floor and helping one resident at the same time can sometimes make for unsafe conditions for the other residents. Especially if it is necessary several times a day.
Even the staffing levels on the overnight shift have to be considered when choosing a community because situations can certainly arise requiring two caregivers, and overnight shifts are pretty much always lighter-staffed. Therefore many communities decline to take two-person transfers as new residents. And while most communities will allow a person to “age in place,” and will care for a long-term resident who has declined to this level, some communities simply aren’t able to handle this level of care.
This brings up the need to talk about a less well-known Assisted Living regulation. In Texas, there are “Type A” and “Type B” Assisted Living licenses. In a Type A Assisted Living community, all residents have to be healthy enough to self-evacuate within 13 minutes. In Type B Assisted Living, the community has to have enough staff to make certain all residents can evacuate within 13 minutes. Functionally this means a Type B Assisted Living can care for less healthy residents than a Type A community. This certainly applies to residents who are two-person transfers, and therefore Type A communities are often not an appropriate place for someone who is a two-person transfer. As a side note, all Memory Care communities are Type B licensed.
The final and most severe level of mobility challenge is the bed-bound resident. This is generally someone who cannot bear his own weight or assist with his transfer. Often this type of resident would require a mechanical lift device such as a Hoyer Lift. This is sort of a personal crane with a sling that can be placed under a person who can then be safely lifted from place to place.
This is again where regulations come into play, and where we have the most problems placing and maintaining residents in Assisted Living or Memory Care communities. As a guiding principle, an Assisted Living or Memory Care community cannot accept someone who is bed-bound as a new resident. Bed-bound residents are supposed to go to Skilled Nursing facilities instead.
The exception to this rule is that residents can age in place, meaning that so long as they weren’t bed-bound when they first moved into the community, they can stay even when they have become bed-bound.
Options for Bed-Bound Residents
To be clear, a Skilled Nursing facility is not the only option for bed-bound residents. First of all, the regulations are not completely specific, giving some communities leeway to interpret the regulations favorably. The problem can be solved by having enough staffing, training, and nurse supervision in an Assisted Living setting. This is quite rare, but such communities do exist.
Second, Independent Living communities are able to accept bed-bound residents because they are unregulated. But the resident’s family still needs to find an outside caregiving agency that can handle the resident’s needs. This often is an expensive solution. I once helped a quadriplegic successfully move into an Independent Living community. This person was unable to be admitted to any Assisted Living community due to state regulations.
Third, small 3-bed Personal Care Homes can sometimes handle a bed-bound resident since they are unregulated as well.
So while there are ways to avoid having to go to a Skilled Nursing home with a bed-bound senior, there is an important consideration for families. There is a point beyond which it is unwise to keep your loved one at home. That point is when they are bed-bound and your only option may be to go to a Skilled Nursing home, which is a less enjoyable environment and usually more expensive than the alternatives.
Remember, it is important to match a prospective resident with the right Senior Living community, otherwise, your loved one may have to make a second disruptive move.
- Walkers and rollators are accepted in all levels of Senior Living.
- One-Person transfers are not appropriate for Independent Living.
- Two-Person transfers are not accepted at all Assisted Living communities, and when touring a community, you need to drill down with the admissions person on what levels of mobility they can accept, both upon move-in as well as down the road.
- Bed-bound residents usually cannot be accepted by Assisted Living communities as new residents. While there are exceptions, they are hard to find and may be expensive.
If you are interested in Assisted Living, Independent Living, or Memory Care in the Austin Texas area, please call Michael at (512) 630-7133.