While each state has it's own definition of assisted living, and each has it's own set of resident guidelines, most assisted living facilities will refuse to accept new residents with the following behavioral problems or care needs.

It's a good idea to be honest with any facility about whatever your elder's problems and needs may be. The residence will find out soon enough, and relocating your senior, who now may have a "history," will only be more difficult. Although they may be in competition for business, these residences do share information with each other.

The resident poses a danger to him/herself or others

If your senior is in the habit of hitting, kicking, biting, or spitting the residence may decline in the best interest of their residents and their staff. Assisted living residences are not equipped to manage adults who are violent.

If your elder has expressed thoughts of self-injury or suicide the assisted living residence will probably say they are not equipped to care for someone who needs continuous observation and psychiatric care.

If a resident begins this kind of behavior after having been admitted, many assisted living facilities will use emergency services to have the resident removed. The resident will usually go either to the closest emergency department for evaluation, or in some cases directly to an inpatient psychiatric hospital. Unless the facility is convinced that the problem has been resolved they are unlikely to permit the resident to return. If it happens twice, return is almost never an option.

The resident is an "elopement" risk

If your parent is confused and likely to wander out an unlocked door a good facility is likely to say "no." If the residence offers purely assisted living, with no provision to keep residents from leaving, a resident who is likely to become lost is an unacceptable risk. Too many elderly assisted living residents have wandered away from their facilities and been found too late.

Seniors who are confused, forgetful, and likely to try to leave are usually referred to locked dementia facilities. The residence you are considering may or may not have a dementia unit.

The resident acts out sexually

If your elder is in the habit of self-stimulating in public, "grabs," wants to climb into bed with others or is verbally very inappropriate in public, most assisted living residences will not admit him or her. These behaviors are more common in dementia residences, where the staff is better able to monitor these residents. Even dementia facilities have limits to the behavior they can manage, however.

"Assistance" will not be enough

If a senior needs help with activities of daily living such as bathing, dressing, transferring, meals, and medications, assisted living may be an excellent solution. If the resident cannot do these activities at all, then a higher level of care is probably called for. The resident who can put weight on one foot to transfer from a chair to a bed will probably do well in assisted living. A resident who can't bear any weight at all and needs to be lifted in and out of the bed or chair is not a good candidate. Likewise, the resident who needs help cutting up food will fit in perfectly. The resident who needs to be fed will not.

The resident has medical needs that require professional care

If the resident has medical needs that can't be managed independently, or that can't be met by a visiting medical home care agency, then the resident is not appropriate to live in assisted living. Tube feeding and deep pressure ulcers are common reasons for being denied. Often a home health agency can assist with insulin requirements. However, if the resident is prone to severe diabetic reactions an assisted living residence is often reluctant to admit because they do not have the staff to deal with a medical emergency.

If your elder has any of these issues the best thing to do is be as open and honest as you can right from the beginning. The facility may tell you immediately that they cannot manage your senior's needs. In other cases they may want to meet your senior and make a personal evaluation. If the facility can't manage your senior's needs, they may be able to refer you to a more appropriate placement option.

If you hide your senior's needs in the hope that once admitted he or she will be permitted to stay, you may be setting yourself up for a dramatic and unpleasant situation. A facility that can't meet your parent's needs is likely to use the first opportunity to have him or her transferred out to a medical facility. The odds are good that they will then decline to allow your parent to return. You will be faced with finding an emergency alternative, which is difficult to do under the best of circumstances. 

Cover Photo Credit: "Cuttlefish"