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Old 11-18-2006, 08:46 AM   #1
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Nursing home vs AD unit

My FIL has been in a lockdown AD unit for the past year. He had started wandering outside in a regular nursing home and we were forced to put him in a lockdown unit in another town.

He was fairly strong when he was put in the AD unit and became violent early on, but in the past three months he has begun to use a walker and become steadily weaker. He is 85 years old and on some several drugs for anxiety, anti-depressants, etc. Although, they are weaning him off the drugs he seems very docile and all the nurses say he is easy to handle.

We have asked if it would be possible to move him to a regular nursing home in our town so we could visit more often, but can't seem to get an answer from the nursing home administrator. We don't think he is fast enough to get out of a regular nursing home and his lockdown unit has been enlarged so that it seems to be a regular nursing home floor.

The cost is another factor since the AD unit costs another $1,000 per month and is running $3,700 per month. We are paying this amount from his savings by check. I cannot figure out why the nursing home would care if we wanted to transfer him back to the original nursing home. Is there a difference in payment to the nursing home from those who are there on Medicaid and those who pay by check? Do we have to wait until the nursing home releases him before we can move him? Or should he even be moved?

The last time we visited the staff made a point of showing how much they liked him and the administrator dropped by to say how well he gets around now. I don't know what to think.

Jane

 
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Old 11-18-2006, 11:38 AM   #2
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Re: Nursing home vs AD unit

While he is still walking, he is still at risk and needs to have environmental restraint. When he stops walking it will be safer for him to be moved then. This is the 'typical rule of thumb' in these cases .. sorry .. I know it would be more convenient to have him in a normal nursing home, but he's still a big risk factor to himself whilst still wandering.

The time will come, soon enough however.

Cheers

 
Old 11-18-2006, 03:02 PM   #3
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Re: Nursing home vs AD unit

One of the advantages to my Mom's being in a huge faility (700 resident capacity) is that they take care of all levels of care. Some people are only there for rehabilitation after an operation, and go home in a few weeks. Some are there because of physical disabilities even at a young age, but luckily there are enough such people to make it worthwhile to have discussion groups, games, trips etc so they are not bored. Going to the far end of the scale there are patients like my Mom, incontinent, in wheelchairs, some needing to be spoon fed.

The advantage is that as a person moves to a worse stage, she can be moved to another building or floor with a minimum of difficulty, everything is still booked off the same account, the food is the same, the group activities and the garden in the center of the compound are still familiar and reachable. Mom moved from rehab to nursing home without ever realizing her status had changed. She only wondered where the 2 physical therapists were, who used to pick her up and take her to the gym every day. She was glad they had stopped coming - in her mind they were only causing her pain and discomfort.

My feeling is that a familair place outweighs the possible advantages of the move.

Love,

Martha

 
Old 11-18-2006, 03:04 PM   #4
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Re: Nursing home vs AD unit

I always figured there was a much higher profit margin on patients who were paying with cash than patients that were covered by medicare, but I'm pretty cynical.

My Dad was in the regular wing of the nursing home - with an alarm bracelet. If he moved any quicker I bet he would have wound up on the AZ unit - which was much more secure. Even with AZ - he knew which was the AZ wing and which was the Medicare wing, and kept telling me he didn't want to wind up on either one.

 
Old 11-18-2006, 04:35 PM   #5
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Re: Nursing home vs AD unit

When my mother had used up all her money, and Medicaid took over her NH payments, she was not moved to another unit, she still has her single room, she is still cared for in a loving manner, gets the same food, sees the doctor once a week, more if needed, and I would say basically nothing changed. I am almost certain that except for those in the financial office, no one on her unit knows which patients pay themselves and which are covered by insurance or a government program. I think it's a myth that they are not treated well if they are poor. After all, where did all her savings go? To this same nursing home, of course!

Martha

 
Old 11-18-2006, 07:00 PM   #6
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Re: Nursing home vs AD unit

Oh, I don't know which nursing home residents are on Medicaid and which ones pay up front. The nursing staff treats them all equally. I do know the administrator knows who is paying cash and who isn't. I thought maybe this was the reason she won't give us an answer on moving him. All she would have to do is tell us it would not be a good idea at this time and we would drop it. I guess I am searching for the reason she won't give us an answer.

As I said in my previous post, his AD unit has been expanded from 12 residents in a fairly small area to 24 with two lunch and activities area. He apparently does not interact with any of the other residents, according to the staff, so I am not sure he would be that upset with a move.

He is being weaned off some of his many medications so it would probably be better to wait and see if his behavior changes. Thanks for all your responses.

Jane

 
Old 11-19-2006, 08:11 AM   #7
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Re: Nursing home vs AD unit

My Dad stayed at a very good facility - but some things came up often enough to make me notice. The brand new wing was where the more alert and able patients were. This was where prospective families came on tours, and was where the on site day care facility took the children on walks or buggy rides down the hall. There wasn't much turnover on staff.

But it seemed when Dad would get a new roommate, he woudn't be there long, after about 60 days (when insurance ran out) they would move them to another wing. One guy's familiy told us he was going to be moved to another wing once their savings ran out and they were on medicare. The other wings were mostly 2 person bedrooms, while in the new wing there were more options.

There is a law (not sure if it's Federal or just this state) saying if you come in as a private pay patient they have to make room for you when you switch to medicare. I realize in the east Medicare pays twice as much as in the Midwest - so here they seemed pretty quick to cover the bottom line.

After a while my Dad wasn't as self sufficient and they had to move him to a different wing. There was much more staff turnover and the other patients were what you would imagine in a nursing home.

In a smaller facility - they also may have to corrdinate roommate compatibility. There were times when my Dad didn't have a roommate and we weren't charged for a single room - they really tried to find someone that would work out.

Since the place your Dad is in is smaller, perhaps they don't have a roommate for your Dad right now in the other area that would be compatible. There also could be some other patients in the other area that are high maintience and don't want to add your Dad to the mix.

Good Luck

 
Old 11-19-2006, 09:44 AM   #8
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Re: Nursing home vs AD unit

Hi everyone,

Actually it is Medicaid that takes over NH costs when the patient has exhausted his or her own funds. Medicare does not pay for NH care at all. It does pay for rehabilitation with a limit of 3 months or the point where the patient is "not meeting their goals." That's how my Mom got kicked off after only 2 months. No progress made = no more Medicare.

Medicaid is the government (State) funded insurance for the very poor. Mom had to spend her life savings down to a measly $1,200 before they took over her payments, and that was only with the help of a very expensive elder lawyer. The NH now gets all of Mom's social security minus a small allowance for her needs such as haircuts and personal care items. The rest is made up for by Medicaid.

Naturally they fight tooth and nail NOT to have to take over anyone's care, investigating their financial past for the last 5 years and quibbling over every item. The lawyer knew what they would be looking for, and he drove us crazy demanding this and that document, before he finally sent in the application - months after Mom's money had run out. The NH - knowing she had APPLIED for Medicaid - cared for her all those months. They knew it would be retroactive. Yet, what would they have done if Medicaid had not accepted Mom? The NH - on Long Island, NY - costs over $11 000 a month - so it is no wonder Mom spent all her savings between December 05 and March 06.

I hope and pray a more equitable system can be found. Why does a middle class, hard working person have to spend their last cent, while better off people can afford long term care insurance and get it all paid for, and the really poor who have no money at all get Medicaid right from the start. The thought comes - why did Mom scrimp and save so hard for those few thousand dollars, hoping to leave it to us? She could have used it for her own fun and amusement, travel, new clothes, a better refrigerator, a better apartment, etc.

Inequitable - in my opinion - maybe it would be fairer to have each person pay some amount based on their lifetime income. All would get the same care but the very rich would pay more for it, the middle class less, and the really poor nothing, just like now . Just a few thoughts.

Love,
Martha

Last edited by Martha H; 11-19-2006 at 12:21 PM.

 
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