The First Month in Assisted Living: What to Expect and How to Help

The first days are mostly about learning. Staff are learning your parent's routines, and your parent is learning new faces, a new room and a new timetable for meals and medications. Some people settle within days. Others are tired, tearful or cross for a few weeks and then find their feet. Neither pattern tells you much on its own in week one.

What you can reasonably expect from the home in that time is set out in California's rules for residential care facilities for the elderly (RCFEs), the license held by assisted living communities and board and care homes alike.

Title 22, section 87467 requires the home to arrange a meeting before admission or within two weeks of it. The resident, the resident's representative if there is one, facility staff and a home health agency representative if one is involved take part. The purpose is to prepare a written record of the care the resident will receive and the resident's preferences about services.

At a minimum the record must show the date, who took part and the services agreed. If your parent has a regular physician, the home is to send the physician a copy. State law gives residents the right to take part fully in planning their care and to involve people of their choice.

After that, the regulations require the home to update its appraisal as often as necessary and at least once every 12 months, and to meet again when there is a significant change in condition. California Advocates for Nursing Home Reform (CANHR) suggests asking for a review every three months, and requesting a meeting any time the plan is not working. Our guide to the care assessment explains how the appraisal is done.

There is no formula, and your parent's own temperament matters more than any list. These are things families commonly find useful.

• Make the room familiar on day one: photographs, a known blanket, a clock and calendar that are easy to read.
• Visit often but briefly at first, and vary the time so you see mornings, meals and evenings.
• Learn the names of the caregivers on each shift, and tell them what your parent likes to be called, eats, watches and talks about.
• Join a meal or an activity once or twice. It gives your parent an easy way into the group.
• Keep outside routines going where you can: the same place of worship, the same phone call on Sunday.
• Listen to complaints without rushing to fix or dismiss them. Write down the ones that repeat.
• Tell staff about anything new you notice: less appetite, poor sleep, a change in walking or mood.

The Alzheimer's Association says a change in care setting can cause temporary behavioral changes, such as increased confusion, and that a person living with dementia will need time to adjust. It lists temporary sleep problems, wandering, falls and appetite changes as things that may follow a move, and suggests asking staff how they can help with the transition.

That makes the first weeks a time to watch closely, not a time to judge the home too quickly in either direction. Ask what the staff are seeing at night and at the end of the afternoon. If changes are sharp or do not ease, tell the home and your parent's doctor. For the difference between a general assisted living setting and a dementia program, see memory care compared with assisted living.

Read the first bill against the admission agreement. CANHR notes that any fee, whether charged before or after admission, must be clearly stated in the agreement, and that most homes combine a fixed rate with extra charges that rise with the level of care.

A new resident's needs are sometimes reassessed in the first weeks, once staff have seen what help is really required. According to CANHR, if the agreement allows it, a rate increase for a change in level of care can take effect within days, and the home must give written notice within two business days of first providing services at the new level, with a detailed explanation and itemized charges. Ask to see the assessment that led to the change.

CANHR's fact sheet also says a portion of a pre-admission fee must be refunded if a resident leaves during the first three months. That is a question of contract and law, so check the refund clause and ask an elder law attorney if the amounts are large.

Early, and with the person who can fix it. A missed shower or a cold meal goes to the caregiver or the manager on duty that day. A pattern, or anything about medication, falls or how staff speak to residents, goes to the administrator, in writing if a conversation has not worked.

California's bill of rights for RCFE residents says residents may present grievances and recommend changes without restraint, reprisal or other retaliation, and that the home must take prompt action to respond. It also gives residents the right to contact the Department of Social Services or the Long-Term Care Ombudsman about a grievance.

Call 911 if anyone is in immediate danger. If you suspect abuse or neglect in a licensed home, complaints go to California's Community Care Licensing Division at 1-844-538-8766. Our guide to complaints about assisted living explains each route.

Hamssa Benrekia is a senior living placement specialist in Torrance who works with families in the South Bay and Harbor area of Los Angeles County. Checking in after the move is part of how she works, whether she helped with assisted living placement or with memory care placement. She is not the home's staff and cannot direct care, but she knows many local homes and their owners and can help you work out who to talk to.

If the first month leaves you unsure about the home, contact Hamssa to talk it over, including whether to look again. The California Assisted Living Placement Guide has the rest of the series.