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Memory Care vs Skilled Nursing
I agree - memory care is not for the comfort of the visitors. The whole point is that it's an environment designed for the comfort of residents. Its normal for family members to feel like "our dad isn't THAT bad". If you feel he isn't getting the stimulation he needs, then you should talk to staff. If it's a mixed AL facility, there is a chance they could include him in AL activities which might help. But they should be equipped to work with residents at all levels if they are in MC.
SNF are medically oriented - they are usually a much more medical, hospital, clinical, less-homey environment, with fewer activities and opps for socialization. Generally people go from MC to SNF when they need more medical attention than MC can supply.
It’s ALOT of information to take in. We’ve all been there. My mother became Medicaid qualified a few years ago which was a lifesaver. We live in Florida so my information is based on what is covered here.
Some ALFs will accept Medicaid up front. They generally reserve a certain number of beds for Medicaid recipients. Others won’t accept it up front but will qualify the resident after he has exhausted all his personal funds. Some facilities do not accept it at all.
Not all facilities accept Medicaid for their MC unit. Some do. We actually had to move my mom to a completely different facility when she was ready for MC.
We’ve now progressed to a LTC/Skilled Nursing Facility (SNF). If your family thinks a MC unit is depressing, wait until they walk the halls of a SNF. It’s been almost 10 weeks and I’ve learned to turn a blind eye to the various sights and smells. I struggle with language barriers of many of the CNAs. Most of the residents are wheelchair bound and most of them have dementia of some form or other. So that won’t go away.
In my mom’s MC unit, very few residents were in wheelchairs. Most were mobile, and most could communicate. The unit was intimate, only caring for about 25 residents. At the SNF, there is probably 75 residents just on her wing. Most everyone is wheelchair bound.
It doesn’t sound to me like your LO is ready for a SNF. I would concentrate on figuring out how to manage his remaining assets so that you can get him Medicaid qualified. Your elder care attorney can counsel you on that. When he is Medicaid qualified, at least his room and board will be partially covered by Medicaid . When he is physically ready for the SNF, you will know it. Medicare will pick up the majority if not all of his expenses once he goes Long Term Care.
My advice would be to keep him in MC as long as you can! If you’re lucky, he will pass peacefully in this smaller, more homelike environment. Hope this helps and wasn’t TMI!
My father has been in a memory care unit for a little over a year. Like your father, he was higher-functioning than the majority of the other residents when he arrived, so I understand how your mom/siblings feel. Being around residents who aren’t at the same stage as he is has definitely had a negative impact on my father both physically and mentally. He was really better suited for an assisted living situation but for his dementia diagnosis. I can’t say for certain how much of my dad’s decline over the year is related to the disease, the amount of medication he’s on, or the facility’s inabilty to cater to a wide range of stages, but I do think it’s a good sign if your father is adjusting and seems content. I also would be surprised if your father would be admitted to a skilled nursing area if he wasn’t really in need of that kind of care because it seems that once a diagnosis of Alzheimers or dementia has been officially made, facilities don’t want the liability of the issues that Alzheimers/dementia diagnosis bring with them and memory care becomes one of the only options. I could be wrong but this is what I was told when I asked about other choices for my father. The only time skilled nursing is available for a memory-care patient in my father’s facility is when someone comes out of the hospital or is bed-ridden and needs the extra nursing care. His memory care unit includes people who require a high level of nursing, which demands a lot of time from the staff and probably contributes to the need to keep everyone at a similar “level” of activity to make things a little easier. I don’t know that there is any facility that is affordable that isn’t depressing on some level unfortunately, so I try and visit daily and take my dad out as much as possible.
As other people on this thread have said, not all facilities accept Medicaid and it’s common to have to move a loved one when money runs out. I’ve been advised to start researching early as many places have long wait lists and you want to make sure you don’t end up scrambling to find a place for him. I have heard there are facilities that offer Medicaid “beds” once a person qualifies, and that preference is given to residents who come in as private pay and then exhaust their resources.
The terminology can be really confusing. Sometimes people use terms in casual conversation that aren’t really correct (like calling all elder care places “nursing homes”). And for some facilities, there is no formal official term, the services and operation can vary enormously. You almost have to see for yourself, or at least get careful detailed explanations.
But at least in my area, skilled care nursing home refers to places where they have more “physical”ailments, like a hospital. People who are more physically healthy, but do have dementia, would almost certainly do better someplace else.
Momto3boys, I am not a lawyer, but I can tell you that at least in my state, in order to get Medicaid coverage, you have to qualify in two ways. The person has to qualify medically. They have to need skilled nursing care. They also have to qualify financially. In my state they have to be broke, and I do mean broke. I was told they can have no more than $2500 left to their name. That does not include joint assets, but those you have to spend down by half. So if the person and their spouse have a joint bank account, half of it has to be spent on the person's care and be gone. If they own two cars, they have to sell one of them.
You need to be sure your attorney knows what he is telling you, and be sure you understand fully.
And echoing what I think others have said here, I would far prefer MC to SNF for my own LO. (This is not to judge you! Just saying that I think most people find MC to be much more pleasant than a SNF.)