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Deciding when to go from memory care to nursing home
Posted: Sunday, September 8, 2019 2:55 PM
Joined: 4/10/2017
Posts: 2

we have mil in memory care with 24 hour a day sitter. Mom total care except she can feed herself. My father in law also in assisted living. Their expenses are through the roof. Mil with Alzheimer’s sleeps 80%of time. Help we don’t know what to do. My husband brought up the subject of moving her to NH today and her response was “not good”. And when asked why. No comment. We are at a loss.  Hospice already in the picture and we consulted them and really didn’t get much advice.  When is it the time to go to NH?
Posted: Sunday, September 8, 2019 5:02 PM
Joined: 4/1/2014
Posts: 5052

If she sleeps 80% of the day-why is there a need for an extra sitter just to watch her sleep?  I don't know the situation but is the memory care facility requiring it? In most cases, NH is much more expensive than MC but with the sitter, I understand your increase cost. Can you hire less expensive aides for the sleeping time?

I would think in some cases, the need to move to NH would be when the cost a LO pays at the MC goes beyond the cost of a NH. Sadly, finances often beats out our desires. Good luck.

King Boo
Posted: Sunday, September 8, 2019 9:43 PM
Joined: 1/9/2012
Posts: 3231

From what you describe, she should be in a skilled nursing facility.  If you have to hire a 24 hr. sitter, that's clue#1 that her care needs have exceeded this setting.

Bedbound patients need medical monitering for skin breakdown, aspiration, etc.  Something a snf can do, most MC cannot.

Hubby doesn't get dementia if at this late stage he is still looking for his Mom's permission to do needed care.  Why would you ask someone and risk upset, when it is clearly time? He's the parent now.  

Caveat - if she is in final days and MC staff has superlative RN's and MD's on staff who are there, with hospice - it could work.   If it's just a joe ordinary MC without higher acuity medical care - time to go.  

Skilled nursing is not to get better, although skilled nursing failities often have patients who come in for rehabiliation for a short time.  Skilled nursing facilities also have long term care patients.  and a lot of nursing home patients who have hit spend down on Medicaid in MC

The amount of care a facility at MC level can absorb depends on the facility. If your MC has a snf affiliated with it, it may be ''sharper' and residency of longer duration.   We had a very high acuity MC that many residents were nursing home ready - however, when one was no longer safe alone in their room, even with a !:8 staff ratio and hourly room checks, there was greater supervision in the nursing home wing, greater access to medical care with many nurses, MD rounds, and trained eyes for aspiration, skin checks, and hospice ready signals.

Some self standing MC may not suggest moving on a snf ready resident as they like to retain the fees.     Hospice is a guest providing services in the current facility they are there with their permission, so they are not going to rock the boat and say why is she still here, it's self preservation.

Look to who you are asking questions of - a GCM can be hired to help you assess, but I assume you have previously toured and researched nursing homes and have your 1,2 and 3 choice chosen - you can also talk to their admissions coordinator.  

Posted: Monday, September 9, 2019 4:24 AM
Joined: 3/6/2017
Posts: 2156

Even though we were assured my aunts could "age in place" at memory care, both of them eventually moved to the SNF side of their communities. For the older one, the move came after a fall and broken hip made skilled nursing necessary. For the younger, the need was more gradual as she became less capable in following prompts around things like tooth brushing and self-feeding. She, too, needed a higher level of care. We didn't discuss or ask permission to make the move; in the case of the younger aunt, she still spend much of the day on the MC floor engaging in activities with staff and residents who were more familiar with her. Even so, her guardian showed up daily or hired someone to feed her lunch since it could take over an hour despite her loving food. 

Why does she need a sitter if she mostly sleeps? I understand brining in a companion or one-on-one help for showers, but sitters are typically for behaviors. Does she have challenging behavior?

Posted: Tuesday, September 10, 2019 9:00 PM
Joined: 10/21/2016
Posts: 2543

Not all memory care is created equal.  If she doesn't have MEDICAL issues, like IV's, wound care, etc., consider moving her to a better equipped memory care facility.  Nursing care facilities are really suited for medical issues.
Rescue mom
Posted: Wednesday, September 11, 2019 12:19 PM
Joined: 10/12/2018
Posts: 1475

If MIL is in MC, Victoria is right that “asking” what she prefers is not productive. They are no longer capable of that level of rational thinking.

All facilities can be different, but the NHs I’ve dealt with in several states are mostly for what I call physical problems, like wounds, heart conditions, blood clots, etc. (what JJazz said). Not cognitive diseases like Alzheimer’s that affect mostly the mind until maybe very late stages—and at that point she may well have physical problems resulting from her dementia and need SNH—almost always more costly than MC, barring Medicaid, which is another thing. But you did not mention anything like that....and hospice can handle many if not most her physical medical needs related to dementia.

Many MCs can provide a certain level of basic medical assistance, but a SNF usually handles more involved physical problems—and is more expensive than MC, which is also expensive, just not as much as when skilled nursing is needed.

There are also group homes that take a few PWDs, including the bedridden, that are often less expensive. If your MIL is sleeping 80 percent of the time, and does not need so much physical medical care (Hospice can also get involved and help with late-stage dementia medical issues) that might be something to consider.