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Hello! My Father has been diagnosed with kidney failure, heart failure, and renal sarcoidosis, which causes extreme calcium levels (delusion, confusion, weakness and more), his heart is working at 30% and kidney levels are around 4.5 typically. He got discharged from the hospital and they ordered in home physical therapy because they believe he's not weak enough to be in rehab so I'm doing 7 day, 24 hour supervision with him. He doesn't understand how to take his medications and when I quiz him on how much meds he's suppose to take, he never knows, so I don't want him doing his medication on his own. He has random good days and bad days but overall he's able to go about his daily tasks (bathroom, changing, eating, very mild cooking). In 4 months he's been in the hospital 2x, very unwell and was admitted for 2.5 weeks both times, so I worry that we will move him into independent living and something will happen again in the next few months after we sign a lease on an independent living community, then will have to end it just to get assisted living anyways.
I know he's capable of living on his own most days and its about 3-4x cheaper than independent living, It's just his medication and weak days that I'm worried about. Is it worth it to move into Assisted living when its not deemed as "needed"? He also wants to move an hour away from me because he likes the area, which isn't smart if he moves into Independent Living.

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Wellll....

He's not going to get 'better'. The best you can hope for with myriad health issues is that he is living in a place that cares for him appropriately.

IF you move him to IL, likely he will not be there long. A fall, simply decline in overall health, and he'll have moved into the need for AL. He really isn't 'independent' at all. If you have concerns about him keeping his meds straight and he's been in the hospital twice in the last 4 months, for fairly long stays--IMHO, he's about ready for AL. If he has 3/7 days where he's fairly 'ok'--that's not indicative of him being able to live w/o 24/7 care on site.

Yes, it costs more. But if you move him to AL and stick with it, you won't have to move him again. There are upfront costs associated with AL and IL, both. You might lose the 'down payment' of the IL if you need to move him within, say 6 months. I don't know.

Doctors are just looking at the immediate 'fix'. They see a pt for 20 minutes and make a recommendation--but it's just that--their opinion. YOU are much closer to the situation and have a clearer head about this.

If he is living an hour away from you, that makes your involvement in his care almost a moot point. 2 hrs driving --how many days a week? You'll burn out quickly.

This is not an easy decision, but I wish you the wisdom of knowing what to do for your dad--what is 'best' may not be what he 'wants'.
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My 92-year-old grandmother intended to move into Independent Living because she was in reasonably good health and lived alone successfully. The problem was that she had "company" in the form of her nieces or me every day for two years.

It didn't matter whether she called us company or caregivers (which is what we really were), she wasn't living independently, and that's your dad. With you supervising him 24/7, he's most certainly not independent.

As another poster mentioned, he's not going to get better, so set him up in AL so he won't have to move multiple times as he declines.
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You need the level he needs on his worst days. Because those are the days that will be more frequent as time goes by. Also just because they are in IL or AL, doesn't mean you are hands off or uninvolved regularly, especially if you are POA. You will get called if there is a fall, or other issues, or if he needs you at doctor visit. Most places provide transportation but can he comprehend doctor alone. Close by us better for you
My mom's place had both Independent Living and Assisted living apartments. Independent had a full kitchen and balconies., a little bigger. Assisted had kitchenette,, no stove just microwave, both studio and 1 bedrooms. All dining and activity are mixed. Check the pricing. You could add services like med management, to Independent Living, but lowest level Assisted Living is close in price to Independent Living with all the add ins, and if you end up needing an aide to stay in Independent Living that's costly also.
Most places require an assessment before move in, your Dad might not qualify for IL at this point anyway.
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I think you are wise to realize he truly needs assisted living. As he ages his needs will increase and he won't have to adjust to moving from one level to another. My father only needed medication management and greater supervision due to multiple falls and needing Home Health to do various lab tests etc., so we moved him from IL to AL.
Your dad's doctor is not the determiner of what is best. With all the health issues your dad has moving him to AL truly is the best option. Look for one that has a good atmosphere, lots of activities. Interview the director of AL and have lunch there to check out how the meals are.
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Move him to a place where he can transition from AL to memory care as he declines further. It does not matter if he “likes the area” that is an hour away. He won’t be seeing much of it. Make him move to a place as close as you can to where you live. Don’t listen to the doctor either. His issues are why people go into AL: can’t keep meds straight, need supervision and meals. The doctor has no idea. Make sure you have the POA for healthcare and finances in place.
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I would vote for AL.  He is only going to get worse, and moves, even if adjacent building are not good for the elderly.
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I think that you see what is coming, know it is close, and are thinking ahead. Covid-19 times is not a time to make a move. I would not opt for independent when you do. My brother felt he could have done independent living, as well, but opted for Assisted as it was more available, and soon enough it was what he really needed as well. I think moves are very disruptive and adapting to the moves is difficult. I think this is the time to discuss what care he will accept in future, to get POA in place that will not change when he cannot make decisions, so you can keep operating for him. Support him in home while you can as any way you look at it, even with some 30/hour care from Visiitng Angels or others like that, it would cost less to stay in home. If he already cannot take his medication you do know what's coming. Decide at what point palliative and hospice are appropriate, as that will give him a lot of extra support as well. Wishing you good luck.
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The best thing about AL for my Mom was having them supervise her medications and get her to take them as ordered. The other was regular, healthy meals. The cook made great soups which Mom loved. She was capable of her personal care and only needed someone to sit outside the bathroom when she showered just in case. The social aspect was good for her too, she had never been very outgoing but enjoyed Bingo and other games. I will never regret her moving into AL.
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This reminds me of my mother's doctor who keeps insisting she's not 'ready' for a hospice evaluation yet. She's 93.5 and has more issues than Newsweek, in addition to chronic pain & dementia. They said the same thing about my father......by the time he was deemed 'ready' for hospice, he lived for exactly 19 days.

Your father is ready NOW for Assisted Living. If you don't think so, try letting him live alone and then getting calls 24/7 about what he needs, what medications he should be taking, how he needs to go the ER, and about 99,000 other issues that will crop up.

It's only common sense that your dad needs help available to him 24/7, even if he's not using it 24/7. The one thing neither of you wants is to have him NEED help and not have it available.

Good luck!
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Please opt for AL. I just moved out of a senior independent living community (I’m still a young 71 year old and just couldn’t adjust). What I observed: one neighbor who attempted suicide because it’s easy to get depressed and no one checks on you, another neighbor who was confused and simply not able to function (kept her apartment door wide open, trash everywhere), another neighbor with increasing dementia who set the microwave for 45 minutes instead of seconds to do oatmeal. .setting off smoke alarm when it burned, another neighbor with cancer who was constantly falling and no one could hear her cries for help.

Your dad needs assisted living. Seniors who need support shouldn’t be in an independent living community unless a caregiver is employed to be there with them.

Hope this helps.
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