Nursing Home Time?

TK67

How did you know it was time to put your LO in Memory Care or Nursing Home?

Is there a point in this disease that a LO should go to a Nursing Home INSTEAD of Memory Care?

May flowers

I’m new to the placement stage (just placed my FIL last week). I would say it depends on the situation.

When my FIL was sleeping all day, not eating well or taking meds we moved him to our house. Wandering, confusion is another concern. We might have moved him to memory last year  if not for covid. He lived with us for a year. There were two things that made us decide MC was a better fit: one is that he needed more activity and interaction than he was getting here (he was no longer watching TV, just sitting and staring or sleeping) and the other was that he was prone to wandering and started becoming argumentative. We did not get a live-in caregiver because he hated that when we did it for my MIL.

We could have waited but he is alert and communicating enough now to adjust better to MC and even make friends, which he is. We did not want to wait until there was a crisis to place him. Apparently, that happens often according to the nurse. He is safe there and busy all day with activities and interacting with those at the same level he is. So far, it’s going well. 

As for nursing, the place we chose will house him all the way to hospice but they do not do major nursing care such as feeding tubes and ventilators. If he needs that kind of treatment, he goes to nursing home. The MC we chose does toileting, dressing, bathing, feeding, wheelchair, 2 person transfers, medication management and physical therapy. They have visiting geriatric doctors and podiatrists as well.

Rescue mom

This is kind of general, and brief, but re: SNF vs. MC....I’ve had family in both.

The ones who went to SNF had other “physical” health problems in addition to dementia. The nursing care was needed for their various diseases/illness. They needed IVs, PT, ventilation, regular  medical care. 

My mother, however, went to MC. She was physically a model of health, but her mind was gone, to be blunt. She was fully ambulatory, but could not care for herself, could not  do any of the daily life activities—meals, med, cleanliness, finances, keep herself safe, etc—that must be done, and I could not do it myself. Sometimes family can do all that, or hire help. But it’s family/hired help, or MC. There’s many posts here about making the decision to place in some kind of facility vs. keep at home.

To me, SNF vs. MC seemed to boil down to how much care their “body” needed, as opposed to whether it was more of a mental/cognitive issue. If both are involved, then (again, just IME) it largely depends on what a facility is able or willing to do.

zauberflote

TK, I don't have personal experience with SNF, only a friend who was placed there by her sons after her second big stroke. My mom was in a MC just like the one May describes-- they were well prepared to do it all, until things like ventilation or feeding tubes were called for. Mom did not want (in writing) these extreme measures, so it was never an issue. The folks in her MC stayed there right through hospice, as a rule. So did Mom. We were very fortunate to have had a hospice RN who considered "wound care after a hip replacement" to be comfort care, wink wink. She took the staples out too!

SNFs generally have roommate situations, which we wanted to avoid for Mom. Thankfully, we didn't have to deal with it. 

Dunc1129

TK, at some point in the caregiver journey,  you as an individual will become emotionally, physically and spiritually bankrupt. You will know it is time. In retrospect, I now feel I should have placed my LO earlier than hold on until I had nothing in the tank anymore.

harshedbuzz

TK67 wrote:

How did you know it was time to put your LO in Memory Care or Nursing Home?

I think sometimes a first line caregiver has trouble seeing that the time has come in part because there are no absolutes in dementia and so many variables in caregiving.

My short answer would be that transition should happen if the care given in a facility would be better and/or safer- trained staff who work 40 hours a week instead of being on call 24/7, geridocs, dentists, geripsychs, podiatrists, therapy and even hair stylists that come to the PWD instead of the other way 'round and if an uncooperative PWD would accept showers, meds and food from professionals more readily than their child or spouse.

I pushed my mother towards placement of my father because he did not respond favorably to her as caregiver. He'd been the alpha in their relationship and sensed he no longer was, so like the man-toddler this disease had reduced him to, he refused to eat, drink fluids, shower, change his clothes sleep normal hours or take necessary medication when she asked it of him. He was self-aware enough that he was pleasant and cooperative with staff as a rule, and thus, his care was better. 

What I didn't recognize, even though I was at their house several times a week and spoke daily with my mother, is that she was so spent her own considerable medical needs were being subsumed by his lack of cooperation. As a result, she ended up not taking certain medications because they expired and she didn't call for refills. She ended up in the hospital with off the charts BP and a COPD exacerbation not long after he died. The end result of her lack of self care are worsening CAD, valve disease and a damaged optic nerve that has left her blind in one eye and unable to drive. Her stage 8 is not what she'd hoped for and I wish I had pushed harder for placement sooner- I knew it was coming and had already vetted a dozen places to create a Plan B.

Is there a point in this disease that a LO should go to a Nursing Home INSTEAD of Memory Care?

There are a couple things in play here.

1. If the person is on Medicaid, in some states they automatically go to a semiprivate room in a SNF as Medicaid does not cover MC. Likewise, if a person starts out as self-pay at a MCF and outlives their assets, they will need to be transferred to a Medicaid-bed in a SNF in those states.

2. Many MCFs have requirement around ADLs for acceptance to their memory community. A few I toured expected residents to be ambulatory or able to get around independently if using a wheelchair upon admission. A few required self-feeding. I have known a few people who wanted to keep their LO home as long as possible only to find the MCF they liked was no longer an option.

3. While many MCFs have a policy of allowing a resident to "age in place" (aka live out the rest of their lives and die there), there is almost always an expectation that the family will bring in additional private-pay help to cover some of the care needed towards the end. At the very least, they would encourage some hospice care as soon as the LO would qualify. 

That said, when my aunt was guardian for her sister, she made the transfer to the facilities SNF a couple years before she died. While the MCF staff were terrific at engaging and encouraging my aunt to, say, brush her teeth, there came a time when skilled nursing had to take over and do it for her. Same with feeding. It was easier and cheaper where they lived to move to a private SNF bed than hire in extra help twice daily for several hours. The facility was very accommodating, early on they included my aunt in the MC wing during the day for activities and outings because she enjoyed them.

HB