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Old 06-09-2008, 06:27 AM   #1
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Assisted Living Dementia Unit vs. Nursing home Dementia Unit

Hi,
Mom may need to be placed soon; living with my brothers on a month by month basis, I feel my sisters-in-law are getting frustrated with caring for my mom. Mom is very clingy, still eats good, walks good but a little wobbly (doesn't need cane), health is pretty good, needs very little assistance in bathroom, still showers, doesn't know who her family is and constantly wants to be around someone which is annoying to my sister in law who works on her PC while my mom is walking around.

In my mom's condition would you recommend assisted living dementia unit (to be paid out of pocket until funds run out, then nursing home on medicaid - what a journey that will be) or go right into nursing home dementia unit (out of pocket until funds run out).

What is the different care between them and does nursing home have outings and activities? I picture nursing home like a hospital.

I did check out an assisted living near me and it seemed okay.

When I drop my mom off, she will panic and go nuts as she will be among strange faces and surroundings - how do you get through that? I know I will break down as no one in my family has ever been put away. But she is the first one with this disease.

thanks
maryann

 
Old 06-09-2008, 06:52 AM   #2
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Re: Assisted Living Dementia Unit vs. Nursing home Dementia Unit

Dear Maryann,

My family was very satisfied with a Nursing Home. It is true that Mom had to spend down her savings before Medicaid kicked in - we used an Elder lawyer to fix that up, and although expensive, his services were invaluable - but it all worked out perfectly.

Taking her to live there was not a big deal. In her case she had fallen and broken a hip, and after an operation and short hospital stay, she went to this same NH as a Rehab patient. Although her Dementia was far enough advanced that she did not understand that she had to do certain exercises and cooperate with the therapists, she never questioned why she was now living there.

When the rehab didn't work, she was transferred to a regular unit for people in wheelchairs (both physically and mentally impaired patients). She sometimes spoke of going home, but was always satisfied with the answer, "as soon as you are 100% well again."

I suggest making it seem to her like a temporary thing - "you are going to stay here until your xxxx is all better." Whatever other problems she may have, heart, blood pressure, diabetes - anything but Dementia! Then, whenever she asks, ''pretty soon. They say you are getting better. The routines here are getting your --heart, kidneys, etc -- under control. You may be able to go home soon." In a month or two the question comes up less and less, then never. Only at the very end my Mom asked to go home - home to her childhood family. Except for one of her sisters, who is still alive at 95, Mom is now with them all ....

Love,

Martha

Last edited by Martha H; 06-09-2008 at 11:18 AM. Reason: spelling

 
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Old 06-09-2008, 07:31 AM   #3
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Re: Assisted Living Dementia Unit vs. Nursing home Dementia Unit

There are definitely more opportunities for outting in AL than in a nursing home. There is also more one on one care in a nursing home than in AL. So the decision is based on what your Mom needs. I am sure the local NH and AL facilities can give you guidance here. When we were investigating where to put Mom and Dad the NH suggested we check out AL and that is where they ended up.

By the time Mom and Dad were moved to AL there was no choice. They could not live at home. At first Mom convinced herself that she wanted to go but Dad would never agree. Dad was totally oblivious to what was going on and we were sure that Dad would panic and go nuts. At first Dad wanted to go back home and Mom was happy being the social butterfly. We would just tell Dad that we would talk about going home tomorrow and we did use antianxiety medication for him. Tomorrow never came and he has adjusted well. He has said several times lately that he is having a good time living on top of the hill. (they live on the third floor) The only time he mentions going home now he is talking about his childhood home and going to see his Mother. Now Mom wants to go home. She is slipping further into her ALZ and in her memories there was a time, when she was at home, that all was well. It is obvious to us that she wants to return to a time with no ALZ, not home as she is today. Again, we just postpone what she wants with excuses because we know she is where she needs to be..... and supplement with her depression (which she has been on for years) and anti anxiety medication. Since the last medication adjustment they seem to be doing well.

There is no hard and fast rule about helping them adjust. It will be up to your Mom, you, and the facility. Make sure you have good communication with the staff. You will probably have a care contact person that will help you to know how to help your Mom adjust. Just know there is no right or wrong and anything can be changed. I wish you luck in your search and hope you find the right placement for your Mom. I will keep you both in my thoughts and prayers..

Love, deb

 
Old 06-09-2008, 08:56 AM   #4
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Re: Assisted Living Dementia Unit vs. Nursing home Dementia Unit

Quote:
Originally Posted by marypar View Post
Hi,


When I drop my mom off, she will panic and go nuts as she will be among strange faces and surroundings - how do you get through that? I know I will break down as no one in my family has ever been put away. But she is the first one with this disease.

thanks
maryann
maryann,
I am new here and I hear ya...... my mom is still at home with my dad and doing pretty good at the moment. When I read your thread I can relate cause in the near future I will be facing what you are now. I think that maybe instead of thinking "no one in my family has ever been put away" that instead you should focus on the wonderful place that will take care and watch over your mom and give her the watchfulness and understanding that she needs.....reading some of the threads on this board sometimes they seem harsh but in reality they tell it like it is..We as the caregivers just need to get our mindset around the the idea of "putting them away". for in the end what is best for our loved ones is best for ourselves...

 
Old 06-09-2008, 10:13 AM   #5
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Re: Assisted Living Dementia Unit vs. Nursing home Dementia Unit

Excellent point Jags. We are not "being put away". They are still loved. Because they are loved they are being given the best care possible.... and the best care possible is not always in our homes. I will wave my white hand towel and accept the fact that multiple professionals can do a better job of giving Mom and Dad what they need than I can.

Love, deb

 
Old 06-09-2008, 12:29 PM   #6
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Re: Assisted Living Dementia Unit vs. Nursing home Dementia Unit

Maryann-
I placed my husband in an ALF that limits its residents to dementia patients. He has deteriorated since placement and now is in a small unit on the premises that is under the auspices of hospice. It is roughly the equivalent of a nursing home. I suspect he will be there for an extended period as his physical condition is excellent. Many of the residents in the main part of the facility are as you describe your Mother. I chose this setup because I did not want him moved when the inevitable decline began.
As far as his introduction to the facility was concerned I made arrangements to bring him, at first for two days a week (to a "club"), increased it to every other day and finally suggested that he stay over night. By that time the concept was not frightening to him.
Incidentally I go to see him on a daily basis just to make sure everything is being taken care of. I rarely stay more than 20 minutes and I vary my time of arrival.
Hope this has given you some ideas.
Beatrice

 
Old 06-09-2008, 01:02 PM   #7
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Re: Assisted Living Dementia Unit vs. Nursing home Dementia Unit

Thank you all for your advice.

Beatrice, you are very lucky that the ALF has that kind of care (meaning the nursing home setup with hospice). I don't think all ALF's have that and the one I am interested in may not. Then she would have to be moved to a nursing home when her money runs low - it is such a nightmare - I worry about her and I worry about how my sisters-in-law are coping with caring for her. I have to work so they watch her alternating months and I see it is getting to one of them.

Martha, I would interested to know how difficult it is to get Medicaid. I do have an elder care lawyer that I am happy with - I am trying very hard to keep impeccable records and don't want to be refused the first time. It is so worrisome every time i write a check out from her account that I have to account for every little dollar with receipts.

Also, when you signed your mom into the nursing home, did you make sure you didn't sign your own name? How do you sign in order not to have them bother you later for money. Did your lawyer see the application before it was finalized?

Thanks again
maryann

 
Old 06-09-2008, 02:11 PM   #8
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Re: Assisted Living Dementia Unit vs. Nursing home Dementia Unit

Mom was taken to the NH directly from the hospital, and was supposed to be covered for 3 months of rehabilitation by her Medicare insurance. When Medicare decided she was not 'meeting her goals" (a silly statement, Mom HAD no goals, it was THEIR goals they wanted reached!) they switched her to 'self paying patient'.

My brother went to the elderlawyer immediately. That was late December 2005. It took until April 2006 before her money ran down enough to get into Medicaid, and it also took that long for the lawyer to go through her financial records of the last 2 or 3 years, mainly kept by me since I lived with her until June and she fell in September.

He had a lot of good ideas (such as using her own money to prepay a nice funeral , even the flowers! since that was an allowable expense before Medicaid took over, and also his own fee, also an allowable expense) and he made sure the papers were in order so she would not be refused. He said if anyone is rejected on the first application their chances are poor to impossible to ever get in. This was all in NY state, and it varies. I spent many hours on the phone trying to get copies of things like health insurance payments made, other insurance she had, bank accounts (eventually my brother had to go to her branch in person), calling the social security office and being put on hold for THREE hours --- but it all worked out in the end.

There was never a question of her children being billed for her care, that is not the way it works.

Good luck!

Love,

Martha

Last edited by Martha H; 06-09-2008 at 02:14 PM. Reason: sp

 
Old 06-09-2008, 09:29 PM   #9
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Re: Assisted Living Dementia Unit vs. Nursing home Dementia Unit

Hi,
I read the posts on this board frequently, but don't post often. I do however wonder if I am making a mistake. I am honoring my mom's reqest to 'never be on medicaid' by using her funds (I have POA, am her only child and only living relative). I have a contingency plan for POA to transfer to by DH if I die 1st. I plan to pay her expenses in full with my money, when and if hers runs out. Am I wrong to believe in doing it this way? I thought if you wanted to, that it would be allowed, but after reading you posts, I am unsure. She has adequate funds for several more years, and if her expenses stay around the same (AL facility $3,570/mo, rx $300, ins $300, misc $150), I can handle this. Does medicaid require you to go that route if you don't want to? Perhaps I should use an Eldercare lawyer, but my friend who is a lawyer seemed to think I had everything under control. Now I'm not so sure.
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Old 06-09-2008, 11:32 PM   #10
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Re: Assisted Living Dementia Unit vs. Nursing home Dementia Unit

There is no law that says you are required to use Medicaid. If you would prefer to pay for the expenses yourself, after her monies run out, that is your choice. Most people do use Medicaid because it is available.... and most families cannot comfortably pay for the long term medical expenses. You might also want to consider, if your Mom should need to be moved to skilled nursing care, the bills for the facility could range between $5,000 and $8,000 a month. I am not sure of your Mom's condition or age but your Mom could live a lot longer than a few years. You should know that there is no difference between private pay and Medicaid nursing home beds. When I worked in LTC we had private pay patients and medicaid patients in the same room. Medicaid is only available to those that are of a limited income and have spent all of their resources down to $1,000. I provides care those those that can no longer pay for it themselves. It does prevent the burden of care from being placed on the extended family. But again... there is no law that requires your Mom to be on Medicaid.

Love, deb

 
Old 06-10-2008, 03:33 AM   #11
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Re: Assisted Living Dementia Unit vs. Nursing home Dementia Unit

I've been making some calls and researching what is available for DH, even though we're probably a year or two away from needing a facility. One Admissions Counselor spent a lot of time with me on the phone, and gave some good tips. She said that if a facility has a day care program, it can get the person adjusted to the facility to make it a little easier. She also said that it's important to check out what happens when the patient's condition worsens. AL facilities are temporary for AD patients, since their condition will worsen with time. Some AL facilities are linked to NHs, and others will place the burden on the family to find a NH for a 2nd move.

My DH doesn't talk much, but some of the patients described here are very verbal. Some of them might be told that the facility was a Senior Center or even a hotel.

Last edited by Beginning; 06-10-2008 at 03:35 AM.

 
Old 06-10-2008, 05:35 AM   #12
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Re: Assisted Living Dementia Unit vs. Nursing home Dementia Unit

Hi again,
Martha, in regard to Medicaid again. My mom has about nine months of money put away for nursing home care (figuring $10,000 a month). When do you advise I go to my lawyer to get the Medicaid application going?
Wasn't there a gap that the NH didn't get paid while waiting for the application to get accepted?
Who pays for the care if the application is refused? Do they evict her and put her in the sstreet in her condition? So refusal doesn't mean the family has to pay? What does it really mean?

Also, I have all her bank statements stapled to receipts for the last four years. I have all her insurance payments showing the deposits into her checking account, I have all her social security statements.

I got the caregiver agreement to pay my brothers for her care.

Should I get her funeral paid now?

I am in New York - can you give me your lawyers name or is thatnot allowed on the board.

thanks for everything and your patience in answering.

maryann

 
Old 06-10-2008, 05:56 AM   #13
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Re: Assisted Living Dementia Unit vs. Nursing home Dementia Unit

Jencat-
Medicaid is a form of government insurance for those unable to pay the very steep costs of medical care, obviously including dementia/AZ etc. I pay for my husband's care in an ALF. He is now in the hospice unit there but I still cover his "rent". We are fortunate enough to be able to afford this. Most are not.

I am concerned about your statement concerning your Mother's POA. You said something to the effect that if you are unable to continue as her agent you have arranged it so your husband can take over. Run that by your attorney friend. A POA authorizes YOU (the named person) to act as an agent of the person whose POA it is. It is not something that you can pass on to another person.

It does sound like you have everything under control.
Thoughts are with you.
Beatrice

 
Old 06-10-2008, 11:43 AM   #14
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Re: Assisted Living Dementia Unit vs. Nursing home Dementia Unit

Maryann, Sorry I do not think I am allowed to give you the lawyer's name. My brother lives in Farmngdale and I think that is where his practice is. He very strongly advised us to pay for the funeral in advance - as it turned out, nearly 2 years in advance. And it was true - absolutley everything was covered, even the food served after the viewing (covered cold platters to be taken to the hotel where the families were staying.)

My brother started applying for Medicaid in Dec 05 when it became clear that Mom was never cming home. It took until April and the NH, knowing it had been applied for, did not charge their usual high fee for March and April, assuming the Medicaid payments would be retroactive. I don't know what would have happened if Medicaid had NOT accepted Mom. I guess one of us would have had to take her home with us, to a life of boredom and resrictions for her, heavy lifting on the part of the family member, no round the clock care, and no built in friends, no group activities and entertainment. She was confined to a wheelchair, totally incontinent, and lacking most of her memory and common sense. I shudder to think of it.

But if the person REALLY has no money left, (my Mom never owned a house, there was nothing hidden) they will usually be accepted.

The NH was in a town called Woodbury. We got advice there about getting an elder lawyer. By one of those strange coincidences, the head of the accounting and financial department was the mother of a child I had taught the year before in Queens! She went out of her way to make sure everything got done right.

I would start looking now. Mom's savings lasted for half of December, and January and February. What she looked at as ''a lot of money" went very fast at $11,000 per month plus the cost of a supplementary health insurance and Medicare Part D. My brother also spent a lot of his own money on all kinds of things not given by the NH, shampoo and toothpaste and haircuts, and outings with the NH which cost extra, etc.

I just looked up the NH on the net and the pictures of the beautiful courtyard with old trees and wonderful flowers brought back memories .. every time I visited Mom we spent many happy hours out there.

Good luck.

Love,

Martha

Last edited by Martha H; 06-10-2008 at 11:45 AM.

 
Old 06-10-2008, 12:38 PM   #15
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Re: Assisted Living Dementia Unit vs. Nursing home Dementia Unit

Martha, thanks so much. Please don't mind if I ask a couple more questions:

I thought you apply for Medicaid when you are down to a certain amount of money like $2,000 not months before that. Can you get the paperwork ready months ahead when you still are paying the NH from mom's funds?

And who pays for my mom's AARP supplement and Med. Part D when her funds run out? Does the NH pay for the medications and the insurance?

thanks again,
maryann

 
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