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Memory Care vs Skilled Nursing
Posted: Friday, February 1, 2019 1:56 PM
Joined: 1/12/2018
Posts: 8

My Dad has been in a Memory Care facility since the beginning of January. He has seemed to have adjusted pretty well. My Mom and other siblings are a different story(but that's for another post). We visited an elder law attorney who is suggesting placing my Dad in a skilled nursing facility (or a convalescence/nursing facility)  for several reasons. The first would be financial (medicaid would cover it) and also the environment wouldn't be so "depressing" (my Mom and brothers word). Where he is now everyone has Dementia/Alzheimer's or some brain injury. It can be sad when visiting. I say hi to every one I pass in the hall, some respond but most do not (which I completely understand given their situation). My Dad is definitely one of the more social residents and he doesn't understand why people don't respond to him. Has anyone had experience placing their LO in a skilled nursing over memory care? If so, how did it go. He is not a wanderer at all. I'm just concerned that they could possibly ask him to leave skilled nursing when his dementia worsens.
Posted: Friday, February 1, 2019 3:02 PM
Joined: 10/25/2018
Posts: 190

Skilled nursing is really more for end-stage. If you think memory care is depressing, wait til you walk into a skilled nursing facility. When I was looking at places for my dad, I insisted on viewing all of the levels, and person doing the tour was very hesitant to let me see that floor. It was pretty much what I expected, just people sitting around or slumped over, quietly sleeping or watching TV or staring into space.
Posted: Friday, February 1, 2019 3:06 PM
Joined: 12/4/2011
Posts: 16580

In MC you at least have a chance of trained staff.
Posted: Friday, February 1, 2019 6:06 PM
Joined: 9/7/2017
Posts: 757

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.  


Posted: Friday, February 1, 2019 6:35 PM
Joined: 1/12/2018
Posts: 8

OK maybe I am a little confused. Maybe it isn't skilled nursing, but I swear that is what the lawyer was saying "skilled nursing". The attorney also said a convalescence home, which I am guessing is just a nursing home. He said it would be just like that memory care facility where residents do activities and remain as active as they can be, but there are more nurses on staff and not everyone has dementia. But I don't think that would be covered by medicare, and I know the attorney said he would like my Dad in a place where medicare pays for it. This is getting confusing and frustrating. Again, my Dad doesn't wander now but I'm afraid as he gets worse he will "graduate" out of a facility like this, sooner rather than later. I'm going to visit one (hopefully next week) and we'll go from there I guess. It just gets very frustrating that I thought we found a nice place (pricey I know...but nice) and now we're going to move him again...and for how long with this last.
Posted: Friday, February 1, 2019 6:36 PM
Joined: 10/21/2016
Posts: 2190

Momto3boys wrote:
 The first would be financial (medicare would cover it) and also the environment wouldn't be so "depressing" (my Mom and brothers word).
Medicare doesn't cover skilled care for dementia.  Your attorney might have been thinking of Medicaid?

Posted: Friday, February 1, 2019 7:43 PM
Joined: 1/12/2018
Posts: 8

Yes. You are right it is Medicaid. I was given so much information today. I am just trying to comprehend it all and focus on what my next step is going to be in the labyrinth of Alz care.
Mimi S.
Posted: Friday, February 1, 2019 7:49 PM
Joined: 11/29/2011
Posts: 7000

I do hope you consulted a Certified Elder Law Attorney.
I would prefer to see placement based on the needs of the resident rather than what is financially better.  And I would be concerned if a skilled nursing facility admitted a patient who did not require that level of care.


Posted: Friday, February 1, 2019 8:11 PM
Joined: 12/4/2011
Posts: 16580

MC accepts Medicaid also. Go for the best fit for your father.
Posted: Saturday, February 2, 2019 4:24 AM
Joined: 3/6/2017
Posts: 1346

If this wasn't a CELA, it might make sense to get a second opinion.

Medicaid rules around care vary state to state. In PA, Medicaid will not fund a MCF. The gambit here is to find a facility that allows for a seamless transfer from self-pay MC to a Medicaid bed in the SN wing when the money runs out/more care is needed. Across the river in NJ, you can use Medicaid funding for MC but I'm told there are waitlists. 

When I toured a dozen or so facilities ahead of placing dad, I looked at both in case he outlived his money. IME, most of the people in SNFs are sicker. In some places they do both SN and rehab. Some of the subacute rehab patients seem fine but they tend to have short stays and tend to work on their rehab and keep to themselves. IME, MCF tend to have more social and cognitive programing than SNF.

Daughter in Florida
Posted: Sunday, February 10, 2019 11:41 PM
Joined: 4/15/2018
Posts: 71

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!

Posted: Monday, February 11, 2019 10:08 AM
Joined: 6/8/2017
Posts: 2

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. 

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