What Can Families Do When Dementia Patients Are Kicked Out of Care Facilities?

By Judith Graham | November 9th, 2018

The phone call came as a shock. Your aunt can’t transfer into memory care; we have to discharge her from this facility, a nurse told Jeff Regan. You have 30 days to move her out.

The next day, a legal notice was delivered. Marilou Jones, 94, who has dementia, was being evicted from Atria at Foster Square, an assisted living facility in Foster City, Calif. The reason: “You are non-weight bearing and require the assistance of two staff members for all transfers,” the notice said.


Regan was taken aback: After consulting with Atria staff about his aunt’s deteriorating health, he and Jones’ husband, William, 88, had arranged for her to be transferred to a dementia care unit at the facility. A room had been chosen, and furniture bought. But now, Atria was claiming it couldn’t meet her needs after all.

This action isn’t unusual. Across the country, assisted living facilities are evicting residents who have grown older and frail, essentially saying that “we can’t take care of you any longer.”

Across the country, assisted living facilities are evicting residents who have grown older and frail, essentially saying that “we can’t take care of you any longer.”

Evictions top the list of grievances about assisted living received by long-term care ombudsmen across the U.S. In 2016, the most recent year for which data are available, 2,867 complaints of this kind were recorded—a number that experts believe is almost surely an undercount.

Often, there’s little that residents or their families can do about evictions. Assisted living is governed by states, and regulations tend to be loosely drafted, allowing facilities considerable flexibility in determining whom they admit as residents, the care they’re prepared to give and when an eviction is warranted, said Eric Carlson, directing attorney at Justice in Aging, a legal advocacy organization.

While state regulations vary, evictions are usually allowed when a resident fails to pay facility charges, doesn’t follow a facility’s rules or becomes a danger to self or others; when a facility converts to another use or closes; and when management decides a resident’s needs exceed its ability to provide care—a catchall category that allows for considerable discretion.

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Unlike nursing homes, assisted living facilities generally don’t have to document their efforts to provide care or demonstrate why they can’t provide an adequate level of assistance. In most states, there isn’t a clear path to appeal facilities’ decisions or a requirement that a safe discharge to another setting be arranged—rights that nursing home residents have under federal legislation.

It’s very frustrating “because state regulations don’t provide sufficient protections,” said Robyn Grant, director of public policy and advocacy for the National Consumer Voice for Quality Long-Term Care.

Sometimes, evictions are prompted by a change in ownership or management that prompts a re-evaluation of an assisted living center’s policies. In other cases, evictions target residents and family members who complain about not getting adequate assistance.

We see this regularly: An assisted living [facility] will say your mom isn’t looking well, we’re sending her to the hospital to be re-evaluated, and then, before she can return, they’ll say we’ve determined her care level exceeds what we can provide and we’re terminating her agreement.

Amy Delaney, a Chicago elder law attorney, tells of a client in her late 80s with dementia admitted to an upscale assisted living community. When her two daughters noted deficiencies in their mother’s care, managers required them to hire a full-time private caregiver for $10,000 a month, on top of the facility’s fee of $8,000 a month.

One day, a daughter went to visit, saw staff napping and took pictures on her cellphone, which she sent to the facility administrator with a note expressing concern. “A few days later, she got a call telling her that her mom had become combative and needed to be taken to the hospital for psychiatric treatment,” Delaney said.

The daughters went to the facility and took their mother to one of their homes. “They found another assisted living facility for her a few weeks later,” Delaney said, noting that she found no record of behavioral issues in the woman’s record when the daughters contemplated suing.

“We see this regularly: An assisted living [facility] will say your mom isn’t looking well, we’re sending her to the hospital to be re-evaluated, and then, before she can return, they’ll say we’ve determined her care level exceeds what we can provide and we’re terminating her agreement,” said Crystal West Edwards, an elder law attorney in New Jersey.

Assisted living operators argue that transfers are often necessary when residents’ health deteriorates and that good communication about changing needs is essential.

“We believe providers should be upfront with consumers about their care abilities [and limitations] and encourage a robust, ongoing conversation with residents and loved ones about their needs — especially as they evolve,” wrote Rachel Reeves, a spokeswoman for the National Center for Assisted Living, in an email.

Atria Senior Living, which operates assisted living communities in more than 225 locations in 27 states and seven Canadian provinces, declined to comment on the circumstances of Jones’ eviction in keeping with its policy to protect residents’ privacy. In an email, a spokesman explained that “we conduct regular assessments, in accordance with state law, to ensure residents are receiving the appropriate level of care and to determine whether we can continue to meet their needs.”

In Jones’ case, Regan said his uncle William was told by a marketing manager that his wife could “age in place” at Atria at Foster Square since a wide range of services — assisted living, memory care and hospice care — were available there.

The couple was willing to pay a considerable amount for their move to the upscale community in July 2017: an $8,000 one-time entrance fee, $10,000 monthly for a two-bedroom apartment, $500 a month to have medications administered, and extra charges for help with transfers, being escorted to meals and more frequent bathing, among other kinds of assistance, that sometimes totaled $2,300 a month.

But Jones was becoming weaker. “My biggest mistake was not getting her into memory care sooner, where she would have received more attention,” Regan said.

In the weeks before Atria’s eviction decision, Jones had fallen several times, been hospitalized for an irregular heartbeat, and started on a new blood thinner medication.

After Atria’s action, “I lost all confidence in them,” Regan said. Within two weeks, he found another community, Sunrise of Belmont, for his aunt, who moved into memory care, and his uncle, who moved into his own apartment — at a combined cost of nearly $20,000 a month.

While his aunt is now receiving good care, his uncle was shaken by the move and is depressed and having difficulty adjusting, Regan said.

Elder law attorneys and long-term care ombudsmen recommend several strategies. Before moving into an assisted living community, “ask careful questions about what the facility will and won’t do,” said Carlson of Justice in Aging. What will happen if Mom falls or her dementia continues to get worse? What if her incontinence worsens or she needs someone to help her take medication?

  • Review the facility’s admissions agreement carefully, ideally with the help of an elder law attorney or experienced geriatric care manager. Carefully check the section on involuntary transfers and ask about staffing levels. Have facility managers put any promises they’ve made to you in writing.
  • If a resident receives an eviction notice — typically 30 days in advance — don’t move out right away. If the facility says it can no longer manage someone’s care needs, bring in a physician to evaluate whether assisted living is still a viable option, said Anthony Chicotel, staff attorney at California Advocates for Nursing Home Reform. Try negotiating with the facility if you can suggest a solution to the concern managers are raising.
  • File a complaint with your local long-term care ombudsman’s office, which will trigger an investigation and usually slow down the process, said Joseph Rodrigues, the state long-term care ombudsman in California. Ombudsmen represent residents’ interests in disputes and can help advocate on your behalf, he noted.
  • Consider bringing the matter to landlord-tenant court or civil court in your area — a legal option available when other avenues for appeal are not available. Or ask for a “reasonable accommodation of the resident’s needs under the federal Fair Housing Act.”
  • Staying in place and waiting for the facility to initiate legal action will buy you time, which should be your goal. Don’t rush to move into another facility without checking and making sure it will be a better fit, now and in the future, Chicotel said.
  • Also consider whether you want to stay at the current facility. “Do you really want to be someplace that doesn’t want you?” said Jason Frank, a Maryland elder law attorney. For most clients, he said, the answer is no.
  • Finally, consider adjusting your expectations. “Success for some families is ‘I bought three years of good care for Mom in assisted living’ and now she’s moved along in her illness and it’s time for skilled nursing care,” said Judith Grimaldi, an elder law attorney in New York City.

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.



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15 thoughts on “What Can Families Do When Dementia Patients Are Kicked Out of Care Facilities?

  1. How lame is this business of care for people with Alzheimer’s over here. It is so greedy it makes me sick. I am a professional geriatric nurse in my country of origin with totally different options and fortunately we have none of the greedy ‘business’ with elderly like over here. Most places there are none profit and look at the elderly needing care as valuable human beeings that get care until they pass on in the same place preferrably without the exaggerated
    amounts of cost for care, but yet they are able to pay their caregivers and nurses a decent income. The upper administration and directors are paid well but not to the point of greedy amounts like over here.
    Human beings should never become a business that has part on the stock market. Shame on all that see it as an opportunity to get or stay rich with the lives of people with Alzheimers and other tragic ailments.

    1. Thank you! I await the day we here in the USA can address our healthcare issues and our eldercare needs.

  2. Assisted Living & Nursing Homes are two different types of facilities. Nursing homes are better equipped/educated/staffed to take care of someone with dementia & dementia with behaviors. Assisted living is just that “assistance with living” not providing total dependent care of someone. And are able to be staffed with less people per state regulations. Assisted living facilities have less state/government rules then nursing homes & are only inspected every 2 years where nursing homes are inspected every year. This is in Wisconsin.

  3. Keep sharing more informative content. I really appreciate your work and your services. Thanks for sharing!

    1. Some families don’t want to accept their loved one needs more nursing services than assisted living centers provide because they don’t like the sound of the words “nursing home”. That’s unfortunate because they are denying their loved one the skilled services and extended care their loved one has come to need. End of life care is end of life care. What’s the difference where it’s gotten. Unfortunately we all don’t pass away peacefully in our sleep in our own homes. I’ve got news for you, they are all nursing homes except assisted living centers call themselves assisted living centers. Stop fooling yourself.

  4. A very informative blog post for families whose loved ones is in care facilities. This information would help them deal with such a situation. Great work!

  5. i have yet to see any site really answer the question of what do i do when i/they can no longer afford to stay at home? There’s no amount of insurance to significantly cover facility care. They cannot afford facility care. Where do they go? What services are available?
    There is no answer to what do I/we/they do when they can not afford a nursing home or care facility?
    Skip all the legal lectures and county/state resource sites and centers that does not address the question.
    I have scoured the web in search of a direction to reasonably locate an answer. I cannot find any answers.
    The only suggestion I have discovered is to call the police and her/him/them picked up and held for mental health reasons but thats only good for 72 hrs. Where do they go from there? Totally incapable of caring for himself/herself/themselves. CAN NOT AFFORD ANYTHING…so where does one go?

    1. I have found a skilled nursing facility near me that also has long-term care, but only accepts residents with medicaid (I’m in Cali and it’s called Medi-Cal)… perhaps there are facilities like this near you? I would not have known about this unless I called them – it is not really advertised… I had thought that this particular facility was all skilled nursing…

    2. Your state has ava program for those who can’t afford care in a facility. In Calif. its called MediCal. They will find a place that can provide needed care and pay the difference between what the patient can afford and the cost of the facility. Start by getting the MD’s statement of the patients’ condition. The MD’s office usually can help you start the process.

      1. I know this isn’t very timely, but I have fought this war. Often the ONLY option is too find a way to qualify for Medicaid and use a Medicaid home. This usually requires some help from an attorney to make your loved one poor enough for medicaid. I know. It’s not a good solution but that is what we have in the USA.

  6. I received an eviction letter for my Mom because of her aggressive behavior. I understand. Where to know? She is on Medicaid and in southeastern Wisconsin. Any suggestions? Thanks for your help

  7. My sister is getting violent and they are talking about kicking her out. Where do I take her? I need help. She has Medicare and nursing home Medicaid and I can’t take care of her.

    1. I had this with my father in a nursing home years ago. The answer is sedation. I’m sorry but when we lose our faculties our brain goes into fight or flight mode. The aggression is the fight. You give the home permission to sedate a little & you make sure your loved one isn’t overly sedated…sleeping all the time.

  8. Has anyone thought the reason for violence is the fact that they have been locked away and lost their freedom. My Uncle has the money for such services but greedy family members rushed to his aid during the middle of dementia and took over power of attorney. Knowone can even visit his him because we can’t afford flight and motel to his homestate.

    1. So sorry to hear this, Gail, and great point. Thanks for being here. Sending our best wishes for you and for your uncle.

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