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My mother is 90 and takes walks in 100+ heat. Yesterday it was 106 in AZ.
This has happened prior.
She calls us afterward saying she is sick.


She refuses to drink.
I contacted the assisted living and was told “it’s her right”


This is a Patient who is so forgetful. Refuses to use her walker, has fallen and spent a month in hospital and rehab.


I thought they are there to take care?!
I understand if she doesn’t want to eat a salad but she could get heat stroke!

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Imho, your mother is no longer suited (perhaps she was IN THE PAST) for an AL. She requires more care than an Assisted Living can provide. Your mother can NO LONGER make valid decisions about her personal health. What she may have perceived as a conscious decision to go on a walk in such sweltering heat was not that at all. She put in her health in peril/at risk of having a medical emergency.
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It appears your mother needs to progress from assisted living to something a little more advanced care.
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I agree about contacting her doctor. With good cause, the doctor can prescribe Secure Memory Care. They are secure units.
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You really struck a chord here.

My mom, at 88, moved to Independent Living (mostly due to anxiety, depression and Mild Cognitive Impairment).

It was a great fit for her with ONE exception; she wouldn't use the Air Conditioning and went out walking on hot days. Her doctor and I explained endlessly to her that hot temperatures were very bad for her heart and her blood pressure and that not exercising caution was going to result in a poor outcome.

She had a stroke on July 1, right after she turned 90. The AC in her apartment was turned off because it was a "lovely day" heading up into the 100s in Southern Westchester NY. I am fairly certain that the temperatures that she was subjecting herself to had a part in this debilitating stroke.
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Cactus - you’ve gotten very spot on advice.

long story short - your mom is NOT suitable for AL.
She needs to get an needs assessment to determine what exact level of care is best for her. Needs assessments ime are done by a duo of RN and SW 1-on-1 with her solo first and then a chart review from the facility for her, then maybe a discussion with family. The AL should have info on companies who do need assessments. If it shows she’s needs SNF or MC, it is what it is. I’d suggest that you try to get her moved or on a waiting list of MC/NH ASAP. And then she moves into the facility again ASAP.

We in the South & SW US are right now in the out lying surf & undertow of Covid-19 Wave 1.0. She needs to be ensconced into her new place before Covid-19 Wave 2.0 hits in Oct or Nov. Otherwise think what room she going to live into in your home and where to store that rooms contents.

Please please realize that as she’s only in AL, the AL can fully discharge her from the place like manana or by a 30 day notice with no repercussions. It’s AL so in theory she’s good on the ADLs with perhaps a bit of help in putting on clothing or doing a back zipper or transitioning in & out of the tub. It’s not a SNF - which if Medicare is involved in her care - has pretty tight standards for “safety net” exit from a NH with comparable / lateral discharge required.


Please please make doing this your priority for July.

and yes, I do realize that MC or SNF/NH is oodle$ more monthly in costs than an AL. You cannot use costs are the determining factor for where she goes as the facility will ‘86 her in short order if she’s not able on her own of meeting the standards of ability for AL or MC.
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There are some good fall detectors your mother could wear which would notify you and the facility she has fallen during her walk, many even support 2-way conversations.

I understand your concerns over your mother walking in 100 degree heat. I have also tried to get my mother to work in the yard during cooler parts of the day. That said, there's another way to look at your mother's mortality risks during a walk. My personal ideal death is one I witnessed as a young adult. My 93 year old neighbor lived in a house about 50 ft higher than his barn. When a snow storm began moving in he walked down his driveway to the barn, let his horses in, fed and watered them, then started back up the driveway hill carrying four 2x4x8' he planned to use with some plastic to protect the back porch from the expected snow. About 2/3 the way up the drive he went to his knees, dropped the lumbar, and sat down. His 89 year old wife watching from the kitchen windows saw him sit down, called the local EMTs and a neighbor, grabbed a quilt off the bed and went down to her husband who was still conscious when she got to him. EMTs found the couple lying together wrapped in the quilt, the husband dead from a heart attack. Mr. S died suddenly and until the day he died was able to live the life he chose in his home with his wife of 72 years. You may think he shouldn't have had horses at his age or tried to carry lumbar up a hill in 20 degree windy weather just after exerting himself in the barn. You could be right. But would he have been as happy to live another 4-5 years where he weaken and had to give up his horses and perhaps become bedridden in the home he built and loved?

The fact your mother is getting out for a walk says she is still functioning with a level of independence. Will restricting her quality of life in order to increase the potential quantity of life really serve her best interests?
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If she is in Asst Living, they can not legally restrain her from going outside even in the heat. They may have attempted to redirect her to stay inside but in point of fact, it would appear that she has moved beyond the Asst. Living criteria and need the higher level of care (including monitoring) that comes with Memory Care. I would talk to the facility and see if Mom can be transferred within the facility to their MC unit. It will be hard to get her transferred to another facility at this time due to the pandemic so I would go with this one if you have been content with their actions up until this point.
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assisted living is *NOT* a nursing home. She may need a higher level of care: You can take her to your home, or nursing home. See a social worker
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Contact the Ombudsman for your area if your mother is a fall risk.
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worriedinCali Jun 2020
Why? If she’s a fall risk, she needs to move to memory care. OP needs to move her mother to an appropriate setting rather than call the ombudsman.
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She needs more than assisted living. I would ask her to be transferred to the Memory Care Unit. My aunt was in Assisted Living, found her miles away near a ditch. She was moved to Memory Care. She had dementia and it was the best her family made in her behalf.
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If she has dementia you should ask for her to be moved to memory care. Assisted living is just that - help with med reminders, housekeeping, meals. If she has progressed beyond that check into memory care (lock down - closely watched).
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Let me share a similar anecdote from here at home. My mom with Alzheimer's lived with us, and she'd often attempt to go out in 90 degree heat, dressing as if it were 10 below. I'd always coax her back with some excuse, like one of her friends was going to call. (I call it a "phone-y" excuse, LOL, (or, ha, ha, ha, if you prefer). I wrote a book about taking care of her called, "My Mother Has Alzheimer's and My Dog Has Tapeworms: A Caregiver's Tale." Reasoning with her about being "over-dressed" didn't work, so I just had to come up with excuses so she wouldn't go outside until later at night, when it was cooler. Once she was inside, she'd instinctively take off some of her layers of clothing, and I'd tell her I was putting them in the wash, so when she went out again, the outer layers were conveniently still wet, so she was dressed more appropriately, with let's say shorts and a top, rather than shorts and a top and a sweater and an overcoat. I was close to reaching my limit with these outer layers, the "Outer Limits" I guess. I agree with the other posters: you might want to talk to your local Area on Aging and the local Alzheimer's chapter. They might have suggestions regarding steering you in a certain direction. Best of luck.
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Assisted Living is just that. They are there to assist with dressing, showers, medications. They offer activities and try to get their residents to engage in the activity. That all being said, the resident has rights. They don't have to attend activities, they can refuse to take their medications. If they fall, you are notified. The facility can make recommendations to the family and to the resident. Now, if your loved one is going out in 100+ heat it is their right because the door opens for them. If the loved one has serious memory problems and other things like walking off property, and a host of other things, the facility can recommend moving the resident to their memory care unit. Memory care can keep your loved one from going outside unassisted and can say no to your loved one when the loved one wants to do something that can be a danger to him/her self or another resident. The memory care unit is locked from the inside and outside.

There are a host of other things that assisted living can or cannot do and also memory care has a host of things that can be done to protect the loved one. I would advise that you talk to the facility or the county/state ombudsman. They can help you understand the resident rights for assisted living. I work in an assisted living/memory care facility in Florida. I work in activities and how I've kept residents inside with all the heat is I've said it's too hot for me to be outside. And I've been lucky because they all say "ok", and they follow me back inside to do the activity. They can identify with me because I am 72 yrs old. LOL. And another thought is that the facility has a/c and usually it is very cold in the common living areas. And probably 90% of the residents are on blood thinner medication. That makes them very cold and they go outside to get warmed up. They can control the temps in their own apartments, but the common areas have to be comfortable for the staff. I've listened to many complaints about this problem. When we play bingo I turn up the temp so they are comfortable. I sweat like crazy, but I try to help them be comfortable, because after all, it is about them, and not about me.

I don't know if I've explained this to you well enough, but I strongly urge you to talk to the facility where your loved one is living or an ombudsman in your county.
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geddyupgo Jun 2020
Thank you for an excellent explanation! I was director of Admission for a county run facility for about 8 years and Dir. of Guest Relations for another two. In addition, I am a Cert. Assisted Living Administrator. I've rarely seen such a concise and accurate explanation of the rights of residents and the responsibilities of facilities. Well done!
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She should be in Memory Care not Assisted Living.
In Assisted Living if she walked out of the building and down the road on her way to lunch or the store they could not stop her.
In Memory Care the units are locked so the residents can not leave. There may be an outdoor area that is fenced so she can still go for a walk but there is typically staff to monitor the situation.
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Based on your post it sounds like your mother belongs in a secured memory care unit. Assisted living is for those who need monitoring and assistance. If she has been diagnosed with Dementia,then it is time to place her into a secured unit. Otherwise it is her right to vacate the facility, BUT COVID19 Federal + state regs haven't been lifted for nursing facilities, yet.
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Cactus, which facility is she at? My mom was just released from The Forum at DH. Tho she was in SN due to breaking her hip, the COVID-19 stuff kept her in her room all by herself for the entire time she was there. Even the AL side had rules to follow for COVID-19 safety reasons. With that said, I agree that she should probably transfer to MC and personally, I would have some sort of medical alert tag on her with your info. Good luck!
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She may be at the AL for awhile since AZ is now a Coronavirus hospot with cases outpacing every country in Europe.
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A patient with dementia should be in a facility that has a Memory Care unit not AL. Memory Care offers more hands on care and locks up unit to keep residents from "wandering" outside the facility. Your mother should not be "taking walks" on her own in the heat or otherwise. Needs to be moved to MC.
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shad250 Jun 2020
Easier said then done, since AZ is one of the states with spikes of Covid 19
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They are endangering her and I would be looking for another place for her.

I would also be calling APS about them not redirecting her to a morning walk or cruising around the facility halls. Yes she has a right but come on, this is endangering her very life. I know that it is hard to know what to expect from AL in AZ they will tell you anything to get you in, but this is criminal.
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Take her out of there & put her into memory care unit or skilled nursing facility. Assisted living facility is for residents who can do most things for themselves & not fall risk or can go for a walk without getting lost. Believe me please..she’s not in the right place. Her condition is too advanced to function at ALF. When my mother was in SNF & it was that hot, they did not allow residents to go outside. They watched them. Being in an air conditioned place better for them. Now that my mother..93 yo with dementia, immobile, incontinent...is home, I would not take her out when it’s that hot. Besides, my mother needs help from my private pay aide in transfers from wheelchair to stairlift chair. We use lift machine for transfers from bed to wheelchair & wheelchair to commode.
Hugs 🤗
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Assisted Living is not locked down, she would need memory care if you want that; and it sounds like she needs it.
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Assisted Living is not a nursing home. Unless the mother is in memory care she will not have this kind of care. She will be allowed to make her own choices while she is able. If you feel she needs to be bumped up in care it is time to have an assessment, and perhaps memory care. Dehydration is ever so common in the elderly; we actually lose the drive to drink and understand we need to. At my brother's assisted living they were required to sign out and sign back in, but no one monitored them once they walked out the door.
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shad250 Jun 2020
Lol Out of sight out of mind.
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