AL 5 min from me or AL with MC 2 hours away with brother? Need advice. Help please.

Marianne*

Hi there and thanks for reading and giving feedback if you can.  I have two options I'm weighing and need help deciding.  (Mom is in Stage 5.)  What do you all think?

Option 1:  Park Merced (PM) Assisted Living in Merced, CA.

https://www.amiesseniorcare.com/parkmerced

Pros:

• She's 5 minutes away from me and granddaughters
• She can see the one friend who still spends time with her
• About half the cost of other option

Cons: 

• Mom says it's old, dated, and dirty and she'd rather die than live there.
• The apartment is a studio and smaller than other option ( mom doesn't like)
• Not as many staff as other option
• No MC to easily transfer when needed
• Amenities are slim

Option 2: Eskaton in Roseville

https://www.eskaton.org/eskaton-village-roseville-senior-living-retirement-community

Pros: 

• Mom really likes how nice, new, and beautiful everything is
• There is a MC 
• Lots of staff
• The staff is better prepared to deal with dementia issues
• 10 minutes away from my brother
• Lots of amenities
• High involvement of community; (there was a violin recital yesterday)
• The apartment is a small kitchen, den, and separate bedroom instead of studio
• PWD are evaluated every couple of months to see if they need more or less care (she may need more at the beginning and then less after she adjusts)
• More activities for residents
• Eskaton in Roseville wins awards for their level of care and love for their AL/MC community

Cons:

• Mom is two hours away from me
• The cost is double.

Yes, I've read the lists.  Eskaton wins; that said, the two hours away from me is huge.  My brother has been "away" living in that area for 30 years.  I am my moms emotional support.  I am the one who does mostly everything for her.  My brother has never taken her to a Dr. appointment, done grocery shopping, had to drop everything to deal with a melt down, etc. I'm her person.  She has always done holidays and such with me and my family.  This will be very emotionally hard on me to "let go" some and yes, I realize this isn't about me; it's about what's best for her.  

So, here's what I'm thinking.  Try Eskaton for 6 months to a year.  If she misses me desperately and she wants to move back to where I am, then that's when I'd move her back.  I'm sure though that she'd need to be placed though in a MC rather than AL though.  

Thoughts?

May flowers

A few more you might consider:

https://www.caring.com/senior-living/memory-care-facilities/california/merced

jfkoc

I looked at both sites as well as Pacifica in Merced. Before you decide please find out what the training is for new staff as well as on going. Experience counts for very little as does "we have our own training program". Get a contract from each and read carefully...very carefully. 

It is one thing to look nice but what you want is staff that actually provides the best care.

towhee

Okay, lets start with financial considerations. I am going to assume that your mothers money is for her care and that no one is worried about an inheritance, just making her money last for her lifetime. Second assumption, she is otherwise healthy, not in her 90's yet and early stage 5. Third assumption, even though dementia is unpredictable, lets say she lives between 5-10 more years. Fourth, lets say two more years in Assisted living, with increasing costs for increasing levels of care, 3 years in memory care and 1-2 years in Skilled care. Add in expenses for 3 months or so of private sitters for exit seeking, rehab, hospital stays etc. 

If at all possible you want to have enough resources left for private pay nursing home care for at least 6 months, more if possible. If you try to place on medicaid you will have very little choice about to which facility your LO goes. Knowing that expenses will go up, try to place where her costs will be close to her current or expected income, and draw down her assets slowly. If she has a significant income and assets this becomes less of a problem. If you don't think her income/assets will last that long try to find a nice AL/MC that accepts Medicaid and move her there while she is still able to private pay. In some states medicaid will not pay for AL/MC, or there is a waiting list. I don't know about California.

From my own personal experience it is very rare for a level of care to go down at AL. Often they start you at their most basic level and reevaluate in one month. Unless your LO has not been taking their meds, has been dehydrated and had a poor diet, and is now getting physically better, care needs are unlikely to go down. Also, care is not just physical care, but  such things as meal reminders.

Comparing quality of care- You have been reading brochures, reviews and talking to facility staff, right? These are great for getting a feel for the facility, and getting answers to specific questions, but they don't give you access to information about what is going on behind the scenes. When I look at glossy brochures espousing shining philosophies of care these days I literally growl. Sometimes there can be such a difference between what they say and what they do.  I strongly suggest contacting your areas' long term care ombudsman. They visit these facilities, they hear peoples complaints. They know all the facilities in your area and might be able to recommend some you are not considering. You can find a list of ombudsman at www.theconsumervoice.org/get_help/state_resources/ca  You could also try talking to a geriatric care manager, the ombudsman might recommend one, just be careful they are not associated with particular facilities. If there is a family council or family support group at any of these facilities, they are good to talk to. Also, www.canhr.org/factsheets, look for Evaluation checklist, and dementia care checklist. One thing they list on here is very important and that is staff retention. You want a place where the direct patient care staff sticks around for a while. And the upper level of staff too, if the director of patient care is new, ok. If the director of patient care and the administrator are both new, you might have a problem. If some of the other top staff are also new, there was either a bad problem or there is still a problem.

Closer to you or closer to your brother-Who is Health Care Power of Attorney? Who will be going with your mom to the hospital? Where will the hospital be that your mother will use? A lot of the other things you have been doing for your mom you won't need to do anymore. You will still of course want to visit once a week or so. Will your brother visit your mom? You need to decide who is going to do what before you make a decision to place, you'll avoid a lot of family arguments and ill feelings later. This is important for your mothers care. Talk to your brother. Truly, if there is a good set up somewhere geographically in the middle between you and your brother, it might not be a bad idea. Think about it. 

Take care

windyshores

My mother is also stage 5 and in assisted living. Honestly, she could benefit from memory care but moving her is tough. I would suggest finding a facility that is only memory care, with no assisted living on campus. In my search for the best place to move my mother, I have found that the memory care-only facilities have higher functioning residents (they haven't "failed" assisted living), and are set up with smaller neighborhoods, activities geared to dementia, an individualized approach, and well-trained staff.

Since you are her "person" and your brother is not as involved, I would not underestimate your own importance in the picture, regardless of the quality of the facility.  I would really try to find a facility that you would be able to get to easily, say,  two or three times a week minimum. Sorry!

A facility an hour from you and an hour from your brother would mean he could participate as well but given a choice between close to you or close to him,  I would choose the former.

Are these really your only two choices?  Maybe look at memory care only facilities and start there. It is much better to enter MC early than late. She is still able to connect with people and establish routines and will be able to participate.

King Boo

Expand your search area, it can't just be 5 minutes or 2 hours are your only choices.  Those are both either or extremes.

Marianne*

Hi everyone and thank you so much for your insights and suggestions.  Yesterday I drove mom to Eskaton for a tour and to stop in and see my SIL, brother, and teen nephews.  The "tour" and talk of AL has really stressed her out.  On the way she literally didn't know where she slept that night.  She thought she'd been living at Eskaton and I was driving her home.  She was so confused.

At Eskaton it's newer and beautiful of course, twice the cost of Park Merced.  What I noticed that like before and like Park Merced, nothing was going on.  I saw one employee that looked to be taking care of garbage and one employee walking in a hallway.  A couple of people in a "community room" watching a movie.  I was given the May calendar of activities and it's the same level of stuff my mom doesn't like that Park Merced has: bingo, jeopardy, movie time, Brain Fitness, blackjack, Work category.  They do have a craft scheduled once a week and one paint day in the month which less than Park Merced.  

Issues with brother in nutshell: In Sept. we had her go to Eskaton and she was there for 3 days.  We had to wait days at my brothers while her lost Covid test was found and results given. She was on the biggest bender I've ever seen her on.  Crazy.  When she went to Eskaton, it was the worst she's been.  She had been there for 24 hours and my brother and I agreed it was bad timing and we were taking her out.  I was in the car leaving to get her and I got a call from Eskaton and my brother.  It was his friend who works there as a sales rep.  She said that we needed to spend 4 grand for her to be watched a few days but to hang in there it would work.  We said ok.  That night the person with her freaked my mom out.  She called me crying about the stranger watching her sleep and how she scared.  The next morning my brother texted if I was going to come visit her.  I said, "I want to go get her."  He said ok.  He'll take care of things on his end.  The next day, he texts me all mad that I made this choice without him and didn't give it a chance.  He hasn't talked to me since then.  He finally talked to me on Thursday about selling the house.  I told him that if I considered Eskaton I needed to know what his intentions are.  What will "family" look like when I'm there with my family?  Will I sit in the car out front if he's around?  Are we separating as families?  (My brother has never been close to me.  He's aloof; his family is his drinking friends from high school he's had for decades.) He said he's not that much of an a** and we would have a clean slate.  

Yesterday after Eskaton when we dropped by invited and expected from SIL, he wouldn't look at me.  For 45 minutes he ignored me.  When I looked his way and asked him a question he ignored me.  His wife said, "Robert...." at which point he looked up at his wife and answered the question.  He was "busy" when we left.  More importantly though, when he saw my mom she was sitting on the couch.  No hug.  When the boys saw my mom, no hug.  NO physical contact.  This broke my heart.  

He has no clue the care that is given both physically and emotionally for my mom.  So, Eskaton is out for sure.  My brother wrote his only grandma off 10 years before she died.  She was healthy and doing well up to one year before death.  I think he's incapable and not able to deal with what's needed and I don't trust him.

I have POA for health care and he has POA for finances.  We are both Co-Trustees of the trust.  He has said that he'll step aside and write checks and I make all of the decisions.  

Park Merced has a poster out front for ombudsman and the lady who runs it is loved and respected by the community.  Residence leave Pacifica to come to Park Merced.  There is more art and such done at Park Merced.  

So here's where I'm at.  I think I'm going to try Park Merced, use the caregiver that already helps too, arrange for "busy" stuff for my mom.  When it goes south and she needs MC I'll cross that bridge then.  In a town 30 minutes away, there are better options then Pacifica.  

Any more insights?  Sorry for the length and thank you for the help.  

King Boo

Well, so know you seem to know you need to not count on your brother.  Progress has been made.

He holds the purse strings though.  

Taking Mom on the tours probably not productive.  

You might benefit from hiring a professional casemanager, Geriatric Care Manager to help you make care decisions and moniter care.  It also serves as a buffer between siblings.

I was a caregiver who got caught in a spiral of 'overthinking and overanalyzing'.  It was paralyzing, like spinning a Rubics cube.  The 'you can't see the forest for the trees' sort of thing. 

Cold facts:

At Stage 5, Assisted living is not appropriate unless it is a 'stepped up' AL with lots of extra support for early dementia, or different levels and wings of AL.   That was a very expensive $4000 lesson last time.

I am not even sure why the facility near your brother is on the list if you had to pay $4000 extra for care.  If they had a MC, why the heck didn't they move her there?  If it was to cater to the families' very inaccurate perception that Mom belonged in AL (apologies if this is too harsh, I feel you, I was there at one point)    this is also not a good sign of a good quality facility.

A good facility will INSIST that a resident be at the proper level of care because of liability and the fact they represent the care delivery to their resident.   A good facility will suggest a resident leave if after working with family, they do not concur with care level. 

You seem to expect that a lot should be going on.  At Stage 5, this will vary by person, but most cannot keep up or do well with overstimulating activities.  There should be some activities, but not a h ub bub and a steady stream.   Yes, the activities are the same because persons with dementia thrive on a schedule and predictibility, not change.

So, music half hour, the same time, same day, same songs = a good thing.

Refocus your list of 'shoulds'.   Quality, compassionate care, with healthcare on site, and the ability to absorb Mom's decline should be your priority.  Good luck.

windyshores

Not a good idea to take mom on tours. I did that once too. Never again. 

Just want to repeat that stand alone memory care units can be really the best option in your situation.  Better services, higher functioning, and avoids a move down the line.

Maybe you could find one close to you or within an hour's drive.

Cynbar

It sounds like Eskaton is off the list, probably the right decision. But Park Merced also doesn't sound right , with a big reason that there is no memory care to transfer to. If your mom is really in Stage 5, that will necessitate another move before too long which can be really disruptive to a person with dementia. Your last post says that there are more options 30 minutes away. I would definitely investigate those, even if they are not quite as convenient as 5 minutes away. It's important to choose the best facility for her needs , and it doesn't sound like either of your 2 listed options is the one.