How to choose?

Ammogirl

I’ve started touring facilities for my mom. My question is how do you decide which one will be ok? I have no real idea of what stage my mom is in. I take care of her 24/7. Here in MT, they say she can either go to AL or MC. I’m so torn on which to choose. She doesn’t communicate well so that’s a huge concern of mine. Looking for opinions/advice.

ebplionis

Hi Ammogirl, this must be a really difficult time for you.  I haven't had to make that particular choice myself, but I think it might give you a sense by asking each individual facility.  The individual facilities might have different definitions on what happens in MC, and their answers might also help shape your opinion of the facility as a whole.  Are they straightforward about the challenges of choosing?  Do they steer you automatically to the more expensive choice without much detail as why she might need that?  That's at least how I'd start, I bet the more facilities you see the better sense you will get.

harshedbuzz

Ammogirl-

This website might help you determine which stage. The general rule for placement is to choose a level of care based on their worst days not their best.

Stages of Dementia Dr. Tam Cummings

In terms of stages, a person is considered to be in the latest stage for which they meet the criteria. It's common for families, and solo caregivers, to consider a MCF around stage six-ish when incontinence, sleep disturbances, and communication become especially challenging. 

I'm not generally a fan of a hospitality model AL for a PWD unless their own caregiving spouse is living in the same apartment. I have seen this go breathtakingly sideways in my own family. ALs are not staffed to the same degree as a MCF should be. Residents might have a well check daily, but are mostly free to come and go. A resident would need to be self-directed to show up at meals and activities; staff might not check on someone who didn't turn up for lunch assuming they had a sandwich in their suite when, in fact, they have fallen and broken their hip. IME, AL can be a bit like middle school where the cool girls don't want to hang with the girl who clearly has dementia.

Sometimes facilities that have both, will "allow" the family to choose knowing they can insist on moving the resident in a few weeks after it's gone badly in AL. Often the AL side looks more inviting with nicer decor and a little downtown area with hair salon and coffee shop seating area. Plus the other residents, not having dementia, will be better groomed and outgoing so it's easier to be drawn to that setting because it's hard to wrap your heart around MC if the many of the other residents are in later stages.

What your mom needs more than what is appealing at first glance is dementia informed care. This means generous staffing levels. Dad's MCF had 8 residents in a wing with 2 aides 7am-11pm and one overnight. They scheduled the aides so that they had different days off meaning there was always a familiar person on hand. You'll want to ask about training and what circumstance might trigger being asked to provide additional help (common in the later stages, typically hospice but sometimes a private duty aide) or being asked to leave (generally more common at for-profit corporate places) because of "behaviors". Ask about activities- what are they and are they actually happening? My dad's MCF had stuff going on pretty much all day- a mix of crafts, gentle exercise, some sort of musical activity, an afternoon matinee and snacks. They got fun take-out food one day a week and had a bus trip to a restuarant for lunch/shopping weekly as well. 

I toured a dozen places when I looked. I did tour a couple lovely corporate places, but decided against as I feared dad might outlive his money and need the safety net that is Medicaid. He didn't, but had he, the MCF would have moved him to their SNF on the same campus. I got my short list of candidates from the members of mom's local support group. 

Good luck.
HB

Rescue mom

There are huge gray areas in AL services, and different facilities can handle it differently. But in general, IME with family in 2 states, AL is best for people who know they need help with (whatever) and will ask for help. 

That’s a general, maybe over-simplifies, but IME. The help is available in AL, but the resident needs to recognize they need that help, and ask. They also usually need to get themselves to activities and meals.

Those who do not ask for help are assumed to be taking care of themselves, or not want to do it—and it may be OK not to want to, but sometimes, like the meds or bathing or some socializing,  they really need to.

MC, in general, is needed when the resident does not know or realize they need help. They need staff to at least urge them to bathe (maybe do it for them), dress, or take them socialize, help them toilet, etc. The staff can handle those duties, along with upsets and other things. 

If a person does not realize they need to bathe, for example, or won’t ask for help, then MC might be needed, 

The gray areas come in when some ALs will do more, like an MC, but they also charge more and have a “menu” of those special extra MC-like services they provide, and the cost for each. Don’t just take their word when they say “of course we’ll do all those (extra) things,” make sure it’s in writing/the contract.

Salsam

I was very traumatized because they did an assessment of both of my parents and my mother qualified for AL.  At the time I was surprised, but almost proud, like I had a "Gifted and Talented Alzheimer's parent."  Since the assessment was so professional and the assessor so confident, I agreed.

However in one week they called me and said they needed to reassess her.  My mom is very articulate, but her vision is deteriorating due to macular degeneration, her hearing is very poor, and she cannot put in her own hearing aids.

The problem in AL is that in general they have to know how to ask for help, and they do not have as much staff to help them.  My mother could never learn new tasks, even though she could appear quite capable.  She wandered into other people's rooms because of low vision. 

She was much better in Memory Care, but it has been a rocky adjustment there, too.

search4innerpeace

I have been in this situation which figuring what level of care to pursue and it can be difficult to navigate.  MCF are typically for a person who requires more supervision and provides 24/7, plus they specialize in memory care services and some units are locked to address wandering. Staff are also trained in memory care and provide therapies and activities specific for memory care.  The enviroment may also be better set up for those with memory care.  AL provides the same services with activities of daily living (bathing, eating, etc.) but potentially with much less supervision and memory care focus.    

Facilities should be assessing to determine what level of care is appropriate as well.  I did consult with our local Alz association and they did help me talk through my mom's needs and compared to what both AL and MFC provide.  They also provided a local list of facilities.  

When you tour facilities, ask a lot of questions!  I asked questions about staffing levels, person centered approach to care, staff training, examples on how they respond to challenging behaviors, if people can choose their own schedules, policy on visitation, what activities they provide, how are medical appointments handled, special assitance available, fees, access to food any time, community activities, etc.  When I toured I also observed the enviroment and how staff were interacting with people.  I also found it helpful to tour a few different times.

Hope this is helpful and good luck.  I know how hard these decisions are.

jfkoc

Please remember to check what initial and ongoing training is provided for all staff!