How do I deal with delays in care at assisted living?

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How do I deal with delays in care at assisted living?

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My LO is in assisted living. When a change in medication may be needed or another issue/question requires the facility doctor to authorize/consult, there is sometimes a 5-7 day wait. Doctor is only in the building once per week. The nurses might message him on a Wednesday and by Saturday or Sunday, they still haven't heard from him.

I have been asked to step back and not contact doctor directly — let the staff work through the proper channels. How do I do that when each day that passes, I watch my LO fail even more, waiting for info/consult/medication change?

Assisted Living Medical Care

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I would document in an email what you were told and cc it up the line.
”Dear DON,
On July 18, 2025, I was told by Janie Jones, LVN, that I should never contact the facility physician of my mother, Sally Sage. I was told to leave communication with her doctor to the facility’s staff.
Is this in line with your policies, state and federal regulations? If so, please provide the documentation for my records.”

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If you are using the facility's doctor, terminate the relationship between your LO and the doctor and use a different doctor. However, before you terminate the relationship, make sure you have another doctor that will accept your LO.

If the facility requires you use their doctor, then start looking for another facility for your LO.

If the doctor was working for you and your LO, he should be willing to talk to you directly, regardless of what the facility says. Find a doctor that you can work with who can give you the straight answers, regardless of how painful the answers might be.

You will have to put more effort into keeping up the relationship with a new doctor (which may mean that you only contact them once per day), however, not getting medication, or communication problems between doctor and facility and you, just creates extra stress for you in addition to having your LO in a facility.

The other option, if you feel that you are in a "good, trusted" facility, is to back off and let the facility and their doctors do what they are trained to do. Do follow ups once a day, and document, document, document and make sure you have another facility that your LO can transfer to, if required or suggested.

Then if you feel that you are still not getting the service you want, please contact LTCOP, Long Term Care Omnibudsman Program for mediation. The answer might be, pay more and get better care.

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Request an emergency meeting with Assisted living's Senior Adminstator/Director, explain the medical urgency as your grounds. If you don't get any satisfaction there, contact your area Long Term Care Ombudsman Office in your area. The Long-Term Care Ombudsman (LTCO) serves as an advocate for residents of nursing homes, assisted living facilities, and other long-term care settings. They investigate and work to resolve complaints made by or on behalf of residents, ensuring their rights are protected and their voices are heard. Document EVERYTHING and take pictures if needed. Put your request in writing and try to obtain written response. You may need thess records later.

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I expect numerous people to object to my comment, but this situation is just another of many examples of why many people are better off aging in place outside of "institutional care." The loss of control, and leaving dependent and vulnerable people in the care of people for whom caregiving is "just a job" is a recipe for subpar care and a reduced quality of life.

With the technological options available today (e.g., food and meal delivery; prescription delivery; telehealth; GrandPad; Lyft & Uber; Echo devices), along with some in-care care -- more and more people should be able to remain at home as they age.

I'm not saying everyone can avoid institutional care, but IMO it should be the last choice.

*** Always check applicable laws (state laws for ALFs, and both federal and state laws for NHs) -- to become familiar with residents' rights in institutional care.

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Agree completely. The way A.I. is progressing, aging in place will most likely be the norm for the upcoming generations. Hopefully facility/institutional care will be a thing of the past.
The lack of care that I have witnessed in various facilities with my loved ones is gut-wrenching. Older people deserve so much better.

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When my father was in a memory care facility, I was hands-on with his care. I took him to his specialty doctors, but used the facility doctor for daily/weekly care. I will say I had the facility doctor's number on speed dial. I didn't always trust the process. I knew every med he took and was aware of what the doctor chose to delete or add. The facility may have found me annoying, although they appreciated my eyes and hands-on approach due to staff shortages. My advice is to be mindful and watchful because you are your LO's advocate. Never stop. It's incredible how many individuals in care centers do not have that. Sad

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Oh yes. You must be able to keep an eye on your loved one if they are in assisted living or a nursing home. If you are not visiting on a regular basis - better if it is at different times/different days of the week, they probably won't get the attention they should. The staffing shortages seem to be epidemic - not sure if it is because the budget in "for Profit" facilities limit the number of nursing assistants or because it is such a hard job with low pay and people burn out.

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Drive her out to her own doctor or drive her out to a walk in clinic.

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The normal channels staff use obviously take too long. What you see as needing quicker response is definitely not high on their list of priorities.
Is is possible your person is now at a level requiring more hands on than assisted living provides? This might be a question to ask both doctor and director....and start with doctor. You might find out from dr that messages to him are not really submitted to him as timely as staff would have you think.

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You could find your own doctor or nurse who will visit your LO in the assisted living, who can get prescriptions ordered.
It might be time for a move to skilled nursing facility. Assisted Living may not be able to meet your LO's needs.

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Baywrangler: Speak to the social worker.

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Send a letter to the DOR and administrator that you are afraid of your parent’s safety. Document when request was made and date of your letter.Documentation gets the job done. Safety can be tied to just about everything. ( sorry LO- IDK what that means?).
good luck!

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I think LO is Loved One.

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In AL and MC we kept my moms usual MD…I took her to her doctors office…The nursing home she has been in for last 10 months…we accepted their medical director..Good Luck..

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This is what I do, too, bc I do not want to give up control to facility doc whose loyalty is to facility, not my mom. By maintaining our own doc, we maintain medical control. My mom can get in and out of car. If she could not, we’d have a different situation.

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Hi Baywrangler. My mother has been in 2 ALFs in the last 7 years. She had to go on Medicaid and moved to the most recent one about 18 months ago. They didn’t accept Medicaid at the first one. At both facilities they provide medication assistance. However, all prescriptions have to go through a certain pharmacy to be distributed. But they do provide that service. Check in to medication service, and if you can, have Mom see her own Dr. rather than the facility Dr. Her Dr. can send the prescriptions directly to that pharmacy. Mom and I both live in Florida.

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AL usually doesn't do their prescriptions and maybe this is what's happening? Mom is forgetting to take them? Memory care will make sure she takes them! It does take time to get someone out to the facility as Dr's have other facilities to go to. Are you new to this? When they asked you to go through channels,it seems you are getting uptight? You may or may not see a decline when a loved one goes to a facility but it does happen more often. It's a change of living arrangements and maybe sadness that they had to leave their home, depression.
Who's making sure mom is taking her meds and eating? Does she have a social worker that checks up on her? Staff should be able to notice if she's having problems or regressing. It takes time to adjust to a care facility, for mom and family and the staff,too! Moms there because she's getting older and she's declining because of old age, you can't fix that. Dr's can't fix old age either. It's hard to wrap your mind around the fact that you have no control, they're not the same LO as before. You did everything possible for her,you got her a safe place to live out the rest of her life,awesome job caregiver!

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Julia, where I live, AL absolutely does do meds and they have facility doctors that you can sign up for but, it's not required.

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This is common. It does take a while for these doctors to get back with concerns. I got Hospice Care involved with my mom's care. We had a doctor that was only in the facility once a week too. I was impatient, but it also takes a long time for an appointment outside as well. If it's urgent, they will send your loved one to the Emergency Room at your request.

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Use your own doctor. Get mom to a geriatrician immediately and have someone else oversee her car. Alf isn’t prison and you are not obligated to use their physician.

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It sounds like your LO should be in a nursing home, not an AL facility. She needs to go to her own doctor and they can sort out her medications. AL facilities aren't medical facilities.

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Most ALs do not provide medical care, you should take her to outside doctors.

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Moms AL did not have a doctor associated with them. Mom used her doctor and the RN on staff talked to Moms doctor. RN never seemed to have problems.

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I pulled my dad out of memory care almost 5 years ago and never looked back. Trust your instincts and don't be afraid to advocate for your loved one!

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What sort of crisis, for a few instances, are you wanting immediate action on, can you tell us? Even with your own MD (if your care is anything like San Francisco, you are going to wait 24 hours to hear or be advised to go to an ER, and then you will wait for an appointment also.
I am trying to guage how realistic your expectations are. And I would encourage you to discuss this with the administration yourself. Ask them honestly if they will reassure you that an emergent situation will be addressed with a call to be seen emergently or with a transfer to the EMS.

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I suggest that you contact the agency in your state that regulates assisted-living facilities. You can probably make an anonymous report and you might get some advice for dealing with the situation in the meantime.

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Doesn’t sound like assisted living is assisting much. Can you use an outside doctor or is transporting your loved one an issue?

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Probably easier to use facility doctor.

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Bay, how long would you wait if you weren't dealing with the facility doctor?

I think that you should be able to speak with the doctor and find out how to get things addressed sooner or does your loved one need to be transported to the hospital for more immediate help.

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How do I deal with delays in care at assisted living?

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