Do corporate run AL facilities have a strategy to gradually ramp up patient care levels?

You can pay for additional levels of care but that does not mean that the care will be provided.

Before Covid, families could visit frequently to see if care was provided. Now, you can not visit to even know if basics are being performed, like bathing.

I have had chronic issues with my mother’s hygiene even when I was able to visit. One time I had to pay a home health agency to go to Mom’s Assisted Living to give her a bath.

Also, if you express concern, things can get worse and you and your loved one will stand a huge chance of being run out. Then you try another facility and it is the same thing all over again.

So I predict that if you continue to oppose the facility in any way, things will get worse for you and your loved one. If you move your loved one, odds are not good that things will be any better.

So now I am looking at different strategies - delivering donuts to staff, tips to helpful staff - maybe that will help.

Should depend on the needs of the patient and how much effort / time they are needing to give to them. Unfortunately our loved ones needs don't remain a constant they do deteriorate. If you feel the changes are excessive sit down and talk to the manager, but I would expect changes to be necessary at times.

When someone becomes a resident of any facility the family should expect an increase in fees as just the move will cause a decline. The facility bases the initial fee on a very brief assessment of the new resident.

Dementia is a set of progressive diseases and they will sometimes develop an additional type of dementia or other medical issues. The level of care needed will also increase causing increase in fees. All facilities have the same policies in place and is necessary because of the increased staffing and time required to care for residents. Transfers to nursing homes often becomes necessary then fees likely increase from 5 to 10K to more than 12 to 15K a month.

It is reality that care needs will increase.

I have not had that specifically happen. What did happen was my LO was sent to the hospital after a fall and then we were told by the AL she could not return due to needing a higher level of care. This has happened twice at two different facilities. She lived at the first facility for about three years before a hospital stay and being told not to return, and she lived at the second facility for about a year before a hospital stay and being told not to return.

(And just as a side note, we had good relationships with both facilities. Staff were nice, friendly and caring. However, once I was informed that LO could not return, these very same people were no longer friendly, were cold and very uncaring toward us - despite obviously putting us in the very difficult position of having to find a new facility for my LO in the midst of a pandemic. Overall, in my experience, when our family was looking for a new facility for our LO to move into and then I was writing the monthly check, staff were friendly and warm. Once we were told that our LO needed more care and must move out, the facade disappeared. Staff’s true colors appeared. It has been a real learning experience for me. I guess I was more naive than I thought.)

My understanding is that AL facilities are not regulated very much. Sure, there are people you can complain to (such as the Ombudsman) for help resolving a problem. But ultimately, I feel as though families are overall at the mercy of these facilities who basically hold all the cards.

Needless to say, the pandemic is making very tough situations even worse. It is difficult to tell how much care your LO needs when you cannot spend much quality time with your LO.

I’m sorry, I wish I had a solution for you. I am glad they have not told you that your LO must move out of the facility to one where a higher level of care can be provided.

Yes ... your experience of battling with oddities is valid. Remember it's all about money... and psychologically torturing residents.
Examples of unethical facility actions have appeared in many realms at my facility all examples were used with permission:

My facility has verbally evicts residents. the worst example happened when the "social worker" + Admin teamed-up to lie to a resident by saying that resident's Medicaid would stop paying "maybe by the end of that day" if not, then, "as early as next week."

That resident had just learned that her husband was divorcing her, and thus she had no place to go. The social worker and administrator knew about the divorce, since notice was served the previous day, and they knew that Medicaid didn't operate in a sudden stop-payment manner.

That resident didn't know that she had been approved coverage in 6 month increments. And thus was led to believe, that she was going to be evicted immediately with zero place to go.

It was a sick and twisted if not illegal thing to do, but the social worker and administrator. kept stating that lie for 30 minutes, with the Director of Nursing and M.D. and Physical Therapy director listening and standing in the same room, b/c it was a "care conference."

The M.D. quit due to that "shitshow" and apologized to the resident, by saying it was inexcusable. The Physical Therapy Director told the resident that he had no idea that it was "an eminent situation." In reality no urgency existed.

Lies were stated, 24 hours after the resident was served divorce papers. She was young-enough to navigate online resources and old enough to know a solution existed somewhere. She contacted Medicaid and everyone she could at the state level, who could clarify and assist.

Medicaid stated she had been approved thru August 30th which meant she had 3.5 months remaining in her current approval period. Medicaid would do another 6 mo. evaluation before that August date.

Medicaid re-assured the resident by clarifying procedures and coverage laws, etc. The social worker said she and the director did that, to "motivate," the resident to find a place to live, which didn't make sense until she heard the facility was trying to get rid of any Medicaid resident to make room for a private payer seeking admission. $$$$

The ethics in these facilities = zero.

A few months later the D.O.N. told the nurses to ignore that resident's "call light."
That resident is a 42 year-old CVA stroke survivor with all of her cognitive capabilities in tact. The nurses together refused to comply to the Director of Nursing's verbal directives, instead, they let that resident know what the D.O.N. said, and re-assured the resident that her call light wouldn't be ignored.

Another odd example happened when one of our LTC residents mentioned he is allergic to essential oils. The in-house YoungLiving MLM sales rep, refused to stop selling to residents and instead, with the social worker, told other residents to deny the presence of MLM essential oils, whilst directing them to diffuse those oils no matter objections.

BUT He would always have severest reactions, when supplies were replenished in neighboring rooms. The facility's generalized response was to lecture him about "resident rights" to which he would respond by saying he had a right to breathe air free from toxic stuff. The facility did zero to stop the ongoing sales to residents.
He wasn't abusive, he was consistently persistent trying to solve the facility created problem.

During that essential oil era, instead of stopping MLM sales, the social worker, started fabricating an essential oil based eviction case against him. Fortunately the main MLM sales rep (the activities director) was fired, before the social worker successfully evicted him. He still resides at the facility.

The aforementioned illustrates that deliberate unethical actions occur in facilities at various levels

Staff at different levels have different types of training. Perhaps your dad is too much for the staff at his current level to handle. Plus, the more attention he needs the less they have to give to other less disruptive residents.

Is the staff to resident ratio higher at the next level? That would of course increase the costs, plus the cost of more training, higher wages because of higher responsibility, as well as hazard pay for a stressful job.

There would be no way we can judge this behavior for all ALFs. My own experience with my bro in his place would be no, they did not. The rules were VERY specific and you were told what the levels would be before entering.

You have done a great job of negotiating.   Inability to visit may result in decrease in cognitive ability.  Sorry about situation.

I do think that many times administrators focus on filling beds and they will promise a level of care their staff and the facility itself is not able to handle. I also think that many families downplay or are perhaps unaware of the level of care someone needs both on admission and over time, so input from front line staff and periodic reviews will result in moving to a higher care level.
Beware of his "lashing out at staff", that is a red flag for potential eviction (and sometimes increasing fees is a way to get family to move on when they resist suggestions to do so).