My mother and father live in an assisted living facility. My mother now needs more help with personal care.

Q: My mother and father live in an assisted living facility. My mother now needs more help with personal care. She is more forgetful and she is currently in the hospital. The administrators at the assisted living facility told me my mother cannot return from her hospitalization because of her medical needs; however, they've told me my father can continue to stay there. Do I have any rights to force them to readmit my mother?


A: Yes you do have rights. The assisted living facility is required to give you a 30-day denial notice upon a change in your mother's condition. On that notice will be information on how to appeal the decision. It is important to read the notice. It is also important to read the signed contract upon admission which describes the discharge process. Decisions like these go through the state Housing Court. Another resource is the state Office of Elder Affairs Ombudsman Office for Assisted Living.


There is something else that should be considered: If your mother needs more medical care, then it is appropriate for her to be in a medical setting. The assisted living facility has limits on the services they can provide.


Separating your mother and father is difficult for your parents and even more difficult for the extended family; however, a rehabilitation facility or nursing home has licensed staff who can manage your mother's care around the clock. If your mother were to return to the assisted living facility, she could be considered an elder at risk because she would not be receiving appropriate care.


Another possible option would be to try to negotiate an arrangement whereby you would hire one-on-one help for your mother at the assisted living facility, bringing in the Visiting Nurse Association for any skilled services. Most assisted living facilities will try to work with families if they provide additional services for their relative.


Lastly, ask the assisted living administrators if your mother would be able to come back if her health improves, and under what circumstances that could occur.


Q: My mother is in a nursing home and I am not pleased with the care she is receiving. Can I bring my mother to her own home and hire help there?


A: Absolutely. It is important to work with the nursing home's social worker and to have all services and any equipment in place before your mother is discharged.


It is also important to have a back-up plan if the person scheduled to come for a specific shift cannot come and the agency is unable to find another person. This can occur in the winter months or if someone becomes ill or has their own family issues.


If the staff at the nursing home does not feel comfortable with the plan, it is important to discuss their reservations. The nursing home has a legal responsibility to contact the state Elder Protective Services if they feel someone is going home and will be an elder at risk.


We hope that you have discussed your concerns with the appropriate staff: the nursing home's social worker, director of nurses or the administrator about your concerns and have given the facility time to try to improve the care.


ElderCare Resource Services is a partnership of geriatric nurses and social workers that helps families to investigate, assess and recommend medical and non-medical care and resources for seniors.


Send questions to SeniorSavvy@ElderCareResources.com or ElderCare Resources Inc., 29 Gano Road, Marlborough, MA 01752.