My mother has mild dementia and is in assisted living. They leave the front desk at 8:30 pm and anyone can walk outside. Is this allowed?

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My mother has mild dementia and is in assisted living. They leave the front desk at 8:30 pm and anyone can walk outside. Is this allowed?

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My mom has not tried to get out at night but who knows if that might change. Are there regulations on assisted living facilities requiring someone monitoring the front door? You can walk out but can’t come back in. Also, if I come back with her after 8:30 it’s difficult to get anyone to to come to the door. The say to push the emergency button at the door but no one comes . I’ve just had to wait until I happen to see a person working there way down the hall and bang on the door. I don’t want to move her because she’s comfortable there, not happy about being there, but at least used to it and the staff are very nice. I just don’t know if I can get the management to change this. I’m in Colorado.

Assisted Living Care Decisions Mild Dementia

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At the point where Mom isn't safe to know when it is safe to leave then ALF isn't the right place. Some now have locked cottages or units and that is a sort of halfway between ALF and MC (memory care). If you know that Mom isn't safe should she leave the facility, and if you fear she is too confused to know whether it is safe to leave or not, it is time to talk with the facility about another level of care. The very sad thing is that without an inbetween care such as locked cottages the cost goes up greatly for memory care due to staffing needs.

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AL is not the same thing as a nursing home or memory care facility.
The residents are free to go as they please. There is supposed to be someone to let them back in if they are going to be out past desk hours but the person is supposed to let someone know they will be back. I worked in a lovely AL years back and every resident had to be accounted for after the desk closed which was around 8:30 at my place.
There is supposed to be night staff who do regular security rounds. They check on all the residents periodically, mind the doors, and make sure all is well. If the AL your mom is in doesn't have this kind of staff, someone should have a word with their administration because they're supposed to.

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Sami, AL is not prison, people can come and go as they please.

If mom is at risk of wandering, AL is probably not the correct level of care. You say she hasn't done this yet, so what is your concern? Is she starting to have behaviors that lead you to be concerned?

My grannie was in a wheelchair and she was a flight risk from the NH. They had to put an ankle bracelet on her so they could catch her if she took flight.

She was in a room that was far from the front door, only door that actually exited the property but, still managed to go missing a couple of times :-( fortunately, they knew right away that Elvis had left the building :-)

I would like to encourage you to not borrow trouble. Deal with things as the become problems or you will wear yourself to a frazzle trying to stay ahead of a very unpredictable disease. She may never become a wanderer.

I would get with the ED and find out why you can't get a response from the emergency buzzer. That is a concern for safety.

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Yes, assisted living facilities leave doors unlocked to get outside, but not in at night. The assisted living facility's caregivers should let you know if your mom is trying to leave on her own. As soon as my mom started wanting out at night in the assisted living facility I had to move her to memory care. There was an overnight caregiver on duty, but they were usually sleeping. It was sad and very hard because Mom was happy in assisted living and it was in my neighborhood. Even during covid lock down I could visit her easily at her window every day. Memory care was way more difficult for me because it was in another city and they only allowed visits twice a week, even at the window, but she adjusted to it fine. It is very much more expensive for memory care, but the doors stay locked for in and out. Usually there is an outdoor courtyard with locked gates. And at my my mom's memory care facility there was an awake staff working in the common area kitchen at night who could see everyone who came out of their rooms to lead them back to bed. I'm in CO too.

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Nope, no regulations in Colo stating that someone has to monitor the front door at the ALFs after 8:30 pm. My parents lived in an AL in Colo for years and never had an issue wandering outside at night, even when mom had moderate dementia. Then we moved her into their Memory Care building which had locked exterior doors, so that's your choice when your mom's dementia advances to where she IS an elopement risk.

The whole point OF AL is that the residents can come and go as they please. Once the level of care increases, then they have to move accordingly. When I had a hard time getting into the AL at night by ringing the bell, I'd simply call the front desk and that would alert the staff that someone was trying to gain access.

I seriously doubt you are going to get the management to change their policies based on one person trying to gain access after hours! Try calling the front desk when you need to get in.......that's your best bet.

Good luck.

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Thanks. I did call the front desk number and no one answered. I have brought this to the attention of management.

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Sami1966, back in April you had mentioned that your Mom cannot remember back 5 minutes ago. If that was the case, I was surprised that the senior facilities where she currently lives accepted her for "Assisted Living". https://www.agingcare.com/questions/mom-is-in-denial-that-she-has-dementia-what-to-do-474472.htm

My own Dad moved into Independent Living in a senior facility. Much to my surprise later down the road the Adm had a meeting with me where they suggested it was time for Dad to move to their Memory Care section, as Dad was found on numerous occasions trying to leave the building at night, and not coming to the dining room for his dinner.

Dad always acted pretty sharp for his age whenever I visited. Apparently he was "showtiming" when I was there. And now he was "sundowning". So we quickly choose a room in Memory Care for Dad. It was easy to move Dad as I told Dad a "therapeutic fib" that this new room was less expensive and Dad was always trying to save money :)

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My mom lived in regular AL at a great place in Colorado for 4 years and had pretty moderate dementia going on (but no wandering). It's difficult for the administration to make the resident move into Memory Care; it normally takes some event to force the move. Like with mom; she got pneumonia and went to the hospital, then off to rehab for 20 days. Then the AL nurse came to the rehab to 'evaluate' mom; that's when she said 'we cannot accept her back in AL and she has to go into Memory Care.'

That's how we made the move; by being forced; that's how it may have to happen with this OP too. In hindsight, I WISH we'd waited another year before moving mom to MC b/c she disliked it a lot & wanted her old apt back in AL very much so. :(

In my opinion, the family should wait until it's ABSOLUTELY NECESSARY for the parent to be placed in Memory Care before making that move b/c it's very difficult for (most of) them to transition (unless they are VERY far advanced). AL is freedom, while MC is another world entirely with many restrictions, etc.

I can def understand about your dad FF, with the wandering and stuff, why he had no other choice but to go into MC. Mom was the queen of Showtiming too, which makes things SO MUCH HARDER!! :(

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What we usually see is a key code for the door, certainly for getting in - your mother's facility should be able to give it to you if you regularly take your mother out at any time, not just in the evenings.

In facilities for people who are at risk of wandering, a key code to open the door (going in or going out, i.e.) is standard. But for people who do not yet have a formal assessment stating that they are at risk from wandering, preventing them from coming and going as they please would be a deprivation of liberty. At this stage, if you're worried about the issue and your mother is happy to wear one, you can always provide her with a personal tracker.

There's still the point about security in general and if access to the building (as well as out of it!) isn't monitored at all I think I wouldn't be very happy about it. What has the management had to say on the subject?

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Thank you . I thought about a key code as well but they have big automatic doors and they would probably need to install another type of door but it makes sense to have a key code. I can’t find a tracker she would keep on and keep charged.

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If she is not in Memory Care then yes she can leave whenever she wants to.
Memory Care is typically a Locked wing and residents in that area can not leave without being accompanied by a family member or someone that is "approved".
And adding to this...with her in AL anyone that wants to can sign her out, or she can sign herself out, she can leave with anyone. It could be a stranger or family member of another resident. Or another resident themselves, residents come and go at will.

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When I moved my mom (who has Alzheimer's, mid-stage) to AL a year ago, they told me that if she ever wandered, she would have to move to their locked Memory Care floor.

Mom and her friend in AL would take walks around the neighborhood. After a few months, they started getting lost. Each time, they were able to figure out how to call my best friend for help. (Mom didn't want me to know what had happened, but of course my friend told me right away.) We would find them and bring them back home.

After about the third time they got lost, the AL staff realized that telling my mom and her friend not to go out on walks wasn't working because they couldn't remember that they weren't supposed to go. So the staff set up the medical call buttons my mom and her friend wear so that an alarm is triggered whenever either of them tries to exit the building. I only found out when I picked Mom up for a doctor appointment, and the concierge told me they have to keep her call button so she can leave the building. They have a set of hooks behind the counter where they keep the pendants for the residents who leave the premises for appointments, etc.

Mom's cognition continues to decline, but she still lives in AL, which has exit doors everywhere, and she hasn't left the building without a staff member or family member since the change to the call pendant was made. I do not know if this sort of arrangement is common in ALs, but it's working for now with my mom. I'm grateful that this technology is available, since it gives Mom the maximum "independence" she can handle while still keeping her safe.

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Thank you for the response. I’ll see about the pendant. That would be great if she would wear it.

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ALF are usually not on any kind of lockdown. My brother could leave his cottage any time he wished. He had to sign out and sign back in. At the point he was not able to care for himself he would have moved to another cottage where the doors were locked at all times; this cottage was for residents who could not safely leave and return at will. Many residents in my brother's assisted living still drove in fact, and had their own cars. I think you may be thinking of memory care, which normally is locked. ALF and MC facilities are not regulated as are Nursing Homes and other facilities that accept patients on government funds, and so on. An ALF should tell you all about the residences and how things operate, what levels of care there are, what expectations you can have of any special diets, about the raises you can expect, and etc. It is a contract between resident and facility. The facility can ask that the resident leave under certain circumstances, as well.
I think, if you are POA, it is important that you arrange a sitdown with the management to discuss the contract, rules, and expectations in order to see if this is the correct facility for you. But do know the facility makes the rules, not the residents or their families, and usually not the government, either.
Nursing Homes operate very differently. Good luck in finding what the best facility is for the one you love.

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My Moms AL was small, 39 rooms all on one floor. They had a mixture of residents some in early Dementia others had their minds just needed help physically. For those who had their minds and family, there was a key pad. We all had a number we used to key into the pad to get in and out of the facility. We pretty much knew which residents should not be let out when we were coming in or going out.

You may want to talk to administration about the buzzer not bringing anyone to the door. Maybe its broke or can't be heard in parts of the building or in a residents room. Maybe suggest a keypad to help when coming back after 8:30.

As said, if you are afraid of Mom wandering out the door, maybe time for MC.

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Basically, each facility is different and they call the shots. Most facilities do not have 24 hr reception services. Because when AL first started in this country back in the early 80s they services mostly independent seniors who didn't want the responsibility of home maintenance and enjoyed the social atmosphere and fine dining offered. Most AL's today are doing more than they did in the 80s but in terms of secured units, they have developed Memory Care units (MC) to prevent wandering. MC monthly rates are generally slightly more expensive because of the monitoring system and because there is usually more staff on these units.

You can certainly make a suggestion about a keypad for the front entrance but considering the price of entryways, they will probably not put that into place until they are ready to rebuild the entry. The pendant idea is great if the facility has wiring and an operating system in place to handle it. You should make an appt. to speak with the Administrator to see what, if anything, is available but be aware that their only fallback might be the suggestion to move her to an MC level of care.

Peace

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I expect they answer the phone.
When residents go to the emergency room at night and return, the staff are notified by phone so they can open the door.
Ask what number to call.

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Unfortunately, phone calls usually go to the front desk. If no one is at that desk, then those calls go unanswered.
There was one night a few years ago when my fiance was in a rehab center after having had very serious surgery. It was his first night there. The anesthesia had made him have delirium and he was very scared, thinking that strangers were coming into his room, that the woman continuously screaming across the hall was being murdered, etc. He called me eight times that night in absolute terror, begging me to come get him. Each time I tried to call the staff so that someone could check on him and comfort him. No one ever answered the phone. Finally, at 3am, I got in the car and drove 10 miles. Through a plate-glass window I saw the nurses on duty sitting in the eating area, so I knocked on the window. They told me that there was no phone in that area and that the front desk closed every day at 5pm! I was outraged and wrote to the out-of-town Corporate Management of that facility, but I seriously doubt that anything changed. No one even responded to me.

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Interesting issue. Our assisted living locks the door 5pm til 9am. We families have a code to get in. Residents can have an alarm bracelet if they are at risk of leaving. Maybe you should request a bracelet..Good Luck.

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That’s better but still with the astronomical fee the facilities receive there’s no excuse these places don’t have overnight staff to be at the door. I would feel more secure that in addition to an alarm bracelet etc there be staff who’s sole duty is to be at the entrance

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Just what very expensive service is your mother paying for?? No AL front desk nor other help after hours, ever? This is not a safe facility option, except for front door keypad combination, and needs to be reported.

This is really about required residents' safety 24 hours, 7 days weekly. However, it's time to move her to memory care.

And, is any staff limited because of Coronavirus restrictions? I hate that "excuse" to use for social distancing.

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this is unfortunately not at all uncommon for assisted livings. There extremely expensive for the purpose of being a safe place supposedly that there will be assistance, however they really lack in doing so. Not only is it common for residents to be able to leave there is also oftentimes an additional fee for a resident to have assistance w such things as showering, on top of the astronomical high cost to be there. It’s really a huge sham that markets itself as existence is to be a residential facility to provide assistance and supervision yet if a resident needs actual assistance they will charge additional fee. The grounds and decor is usually very fancy but when it comes down to it you have most of the floor staff who interacts w the seniors are underpaid there’s often a high turnover, the corporate level take most of the huge fees for a loved one to reside there, leaving often subpar care- family members report their loved one having to call multiple times for help, not having assistance to change their clothes, wearing soiled pants, little one to one interaction so while there’s a lot of people around the residents are in a institutional type environment another number. There is a correlation between placement in an Al and rapid decline which is due to change of long time environment for many of them, going from the home they knew to a unfamiliar place w many people coming and going; lack of one to one interaction, they’re shuffled from day room to cafe, with underpaid aids who also come and go high turnover due to most of the money going to the corporate level. It is what it is, it’s unacceptable but people continue to pour money into the market this doesn’t motivate the industry to make changes

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ALF are regulated primarily by the State, CO in your case. Some ALF may also be Medicare and Medicaid qualified in which case the US Gov would require additional compliance. That is, the answer to your question -- "Are there regulations on assisted living facilities requiring someone monitoring the front door?" -- frankly depends on how your mom's ALF is licensed.

In CO, ALF are called Assistive Living Residences (ALRs) and they come under the CO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT Health Facilities and Emergency Medical Services Division STANDARDS FOR HOSPITALS AND HEALTH FACILITIES CHAPTER 7 - ASSISTED LIVING RESIDENCES -- 6 CCR 1011-1 Chapter 7 https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=9550&fileName=6%20CCR%201011-1%20Chapter%2007. Part 25 spells out what a ALF "secure environment" is:

"PART 25 – SECURE ENVIRONMENT

25.1 An assisted living residence may choose to provide a secure environment as that term is defined in Part 2. A secure environment, which may be provided throughout an entire assisted living residence, or in a distinct part of an assisted living residence, shall comply with Parts 1 through 24 of this chapter, in addition to the requirements in this Part 25.

25.2 An assisted living residence that uses any methods or devices to limit, restrict, or prohibit free egress of one or more residents to move unsupervised outside of the ALR or any separate and distinct part of the ALR shall comply with this section regarding secure environment.

25.3 An assisted living residence with a secure environment shall include all the services provided in an unsecured environment plus any additional services specified in this Part 25."

The key here is that the ALR (assistive living residence) "may" choose methods or devices to prohibit free egress. That is it appears to not be generally required but then again this goes back to how your mom's specific facility is licensed to figure out what is or is NOT required. Further, if your mom's ALR has a qualified and licensed "memory care unit" (some have and some do not have this); then other regulations would apply. Skilled nursing facilities (SNFs) have different requirements at both the state and federal level.

All of this can be confusing for sure. IMHO talking with the admin staff to have a clearer understanding of how your mom's facility is licensed and what they are required to do or NOT; and how does that fit your mom's needs now and over time as her dementia progresses would be good so that you can plan accordingly.

Yes, moving her may be hard but it may be necessary in the later stages of the illness if her current ALR is not equipped -- much less licensed -- to handle the care level needs she may have at a later date. Perhaps researching the best Medicare and Medicaid qualified SNF facilities w/high memory care marks would be helpful so if/when the time comes; you'll know what facilities would be best if she has to be moved.

Best of luck with this. Your area agency on aging and/or a licensed elder care attorney is your state may also be helpful to map out any next steps.

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I'm in Minnesota, and what you describe is exactly how assisted living is supposed to work.
Assisted living is just that: assisted. It's meant for seniors (or others) who need occasional assistance with things like cooking or cleaning. It's designed for independent adults who just aren't able to complete some household or personal tasks. Just like in my apartment building, you are free to leave whenever you want-- it's not a jail, and it's not designed to be.
What you are in need of is memory care. It may be an option in your mother's building and it may not be. MC units are locked and staffed 24/7. We specifically chose a building with MC for my parents when my dad had mild Alzheimers, knowing that it would progress and he would eventually need 24/7 MC.
The plan was that when my dad required MC, mom would still be in the same building and be able to see him every day.
Unfortunately (or fortunately), his disease progressed very quickly, and he died before we could move him.
Once he was diagnosed, he could never have lived on his own in AL. If my mom turned her back, he would dump hot coffee or wander off, or anything else to put himself in danger.
I'm sorry for what you're going through. I can definitely relate. I felt like I went through 3 years of hell, mainly trying to help my mother survive my father's disease. There are a lot of us out here, so keeping reaching out and be sure to take care of yourself.

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Assisted Living is not a lock-up facility. Residents are free to come and go as they wish.

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I know what you mean about getting back in. Moms facility was open till 4pm and we had to be back by then. Sadly/Gladly mom went into memory care a few months later and no worries about getting out. Sadly because the rent went up about $2,000. Now, they issue key fobs to immediate family and I can get into the main door and her security section door at any time. I wish they would've given me a fob a year ago. When calling for someone to come to the door our facility usually forwards the call to memory care where they are there 24/7. Maybe they can do that where you are at?

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In assisted living, your mom can come and go as she pleases. People can visit her and leave with her without anyone's approval. If your mom is a "wanderer" and / or further along in the stages of dementia and you think she is going to walk out of the facility, she may need to be in a different level of care. Its for folks who want some socialization, but can no longer grocery shop and cook and maintain a home. My mom was not inclined to wander at all so this level of care worked for her for almost 10 years.

Some of the newer facilities have a key fob that allows you to unlock the door after hours. We had one of those at moms first place and it was so convenient. Unfortunately, most places do not have them. The memory care mom is in now does not have anything like that and it is very time consuming and frustrating to get in and out at any hour.

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Remember the old proverb, "When in Rome, do as the Romans do?"

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If a person is allowed to come and go as they please then they should have a key/fob to enter after hours not having to wait for someone to come to the door. I would ask the management about key access.

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@Ohwow323

AL does not do that because it is a security risk. There cannot be say 50 individual keys to the main doors of a facility.

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Sami1966, even with Independent Living, the main building door is usually locked after a certain time. No different than any of us checking our front door or back door to make sure it is locked after hours.

If one knows that the building locked their main entrances at a certain time, it is important to try to get back to the building before that time. Yes, I remember ringing the front door bell and having to wait until a Staff person came to the door, but I expected to have to wait.

I am glad the building rules at set up that way. No one wants to find strangers roaming the hallways.

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People in assisted living can come and go as they please. Many of them even own cars and drove themselves. I think you are confusing assisted living with memory care. In a memory care all of the doors are alarmed and people are not allowed to wander.

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It will soon become time for memory care. I suggest you start looking around without your mom first

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That’s hard when she doesn’t want you out of sight. (Scared)

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I keep seeing " residents can come and go as they please", but if they can't get back in, that's an issue. It would make sense that there is number to be called after hours so someone in the facility can open the door.

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I worked in a very high-end AL facility for quite a while. The protocol in the place I worked was that is a resident was going to out past around 8:00pm, they had to let the desk know.
The desk closed at 8:00pm. This is when we locked up for the night, checked on all our residents and did a head count because we had to account for everyone every night.
If we knew someone was going be out past the desk hours, the night staff knew to expect them and we'd watch for them.
If a resident wants to come back during the wee hours at 3 in the morning, they will have to stay out until the morning whrn the dest reopens.
This is the usual practice of AL facilities. There is also a number they can call and a staff member is supposed to answer.

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Sami1966: Imho, that is standard protocol for an assisted living, e.g. residents are allowed to come and go. Perhaps your mother will require a higher level of care at some point, which would be a secured facility.

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You should not trust these places. Dont let the smiles on the staff fool you. You should have your mom at home, in familiar surroundings, and you should get help from a life insurance policy which under long term care they can provide someone to help you 24/7

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That’s great if mom/ dad has a long term insurance plan. If OP has a home big enough for care. OP doesn’t work. And if OP is physically/ mentally/ emotionally able to do that. Certainly not black and white…

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TO SAMI 1966

WHAT YOU DESCRIBED ABOUT THE NURSING HOME YOUR MOM IS IN...IS
UNACCEPTABLE AND SHOULD BE REPORTED THE THE COLORADO HEALTH DEPARTMENT. IT'S ABSURD AND UNSAFE. STAND UP FOR YOUR RIGHTS.

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TO EMPATHIC

THE OP's (SAMI1966) MOTHER IS NOT IN A NURSING HOME.
SHE'S IN AN ASSISTED LIVING COMMUNITY.
ASSISTED LIVING AND NURSING HOMES HAVE ENTIRELY DIFFERENT LEVELS OF CARE.

I'm all for people standing up for their rights, but really let's stand up for literacy first here.
At the top of Sami1966's post there is a big, black, bold headlining letters spelling out that the mother is in assisted living.
That is not a nursing home.

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I am hearing this complaint more. A friend would visit his mother in the evenings prior to her death). If he visited her after a certain time "NO" one was available.

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My mother has mild dementia and is in assisted living. They leave the front desk at 8:30 pm and anyone can walk outside. Is this allowed?

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