Today I spoke with the care team at the small assisted living home my brother lives in now. We pay some out of pocket to have him live there and today's conversation confirmed for me that it was a good choice.
They have rules and expectations. And if the rules get broken or expectations aren't met, there are consequences. They also ask that the people who live there not be taken out for any fun activities until they settle in and show they aren't a risk to others when go out. They use fun activities and being allowed to go out into the community as incentives and rewards for good behavior.
My brother is outraged that he isn't free to come and go, free to not shower, free to make a mess everywhere, free to lash out when he's told no.... That and he is expected to take care of himself, his own space and contribute minimally to the the group.
I think they're on the right track with him. Everyone there has their own space. The expectations are in line with capabilities. And they are consistent. And yet some families feel their loved ones should have more freedom. They should be allowed to "be themselves." They shouldn't have to do things they don't want to. That the family should be allowed to take them out whenever they want. Everyone is there because they've had issues living in the community that have or could have had dire consequences. I was having a hard time imagining how a family could have someone placed there and then act like the place was the problem. My husband said it's like A&P. They see their family members as being entitled. And see the tantrums, aggressive, violent and dangerous behaviors as part of who they are.