Question on the need for a continuous care facility

Jerome Likes Pie

We are looking at senior communities for our mother who has early stage Alzheimer's.  It seems most senior living communities have AL and MC but do not have LT Care.  Do Alzheimer's patients typically need to go to a continuous care community that has LT care or can they be cared for properly in MC all the way to the end?  I have heard of Hospice services being provided in MC as well.  Curious on your thoughts.  Thx.

zauberflote

Jerome, welcome! It's good you're getting the show on the road, as it sounds in your profile as though your mom is moving towards some new territory. 

I can't really answer your question for "typical patients", but I can for my mom. She started at a charity Lutheran AL in her home village in NY state. On campus were also a rehab and a MC. There also appeared to be a few IL cottages but J never investigated. After a time, she moved 600 miles to a small but corporate-controlled MC in Virginia, near me. The sign said "AL, MC, Alz care". (There was at least one resident who clearly was only there for AL) This MC was sold as an "age in place" facility, and in our 17 months there it appeared to me that all the folks who lived there and then died, died on hospice right in their rooms there. Mom certainly did. It is also true that this MC did not provide skilled nursing. It was my impression that not many residents would have wanted life-prolonging end-of-life measures such as feeding tubes or ventilation. Mom didn't, and had a durable DNR from probably her late 70's (she died at 92). So, that's our story.  

I know people who've moved into CCF's while still perfectly independent, simply because they are tired of cooking and mowing the yard, and know there's a strong possibility they will have dementia and live into their 90's. The facilities I'm familiar with are large, very well-established, and if you have to ask how much it is you probably can't afford to live there. 

Price scale models vary, too. Mom's place cost $4000/month, which would include every level of care she might need unless she had need for skilled nursing. Another place I researched for her was typical of the large, well-established, expensive communities. The base charge there was $6500 for AL, and every added service cost a few hundred more. Also, the memory care wing was very unpleasant, and she would have ended up there fairly soon. I believe these prices to be very low compared to many other geographic locations. Especially the $4000! Nevertheless, you can't put a price on love, and most of the caregivers at Mom's place truly loved their charges. 

aod326

Hi Jerome. As zauberflote said, the thing you need to ask is whether the facility will let your mum "age in place". Many MCs do, unless someone needs additional skilled nursing care, such as a feeding tube. (I know most families wouldn't choose a feeding tube for a dementia patient - just an example.) I found it important to probe for details, though. Some MCs will ask residents to move if they need two people to move them, for example. Important to specifically ask what circumstances would lead them to expect you to move her. Also beware that some MCs will let her stay there, but expect you to pay separately for a personal aide if she gets to the stage of needing additional care. (One of the many things I learned the hard way!)

Also worth knowing that MCs vary in what they may expect when the resident joins - some will only take residents who are ambulatory when they arrive, even though they are fine with having residents age in place. Same with behavioral issues: if they develop while the resident is already in MC, they're prepared to handle them, but may not accept the person if they already present with major behavioral issues.

If your mum's general health is poor, she may ultimately need skilled nursing; if not, chances are she'll be fine in MC that is an age in place facility.

Best of luck.

Cynbar

All of the above are good points. My DH is still at home, but I have been researching local MCCs, just in case. The two that I am impressed with do allow residents to age in place, but they have different units with different levels of care. The cost is higher as more care is provided, and hospice is welcome when appropriate. Visiting nurse services can also be called in for specific needs, such as wound care or physical therapy. It seems to me that almost all residents can be cared for through end of life, but you would want clear information on what the cost increases might be and what would trigger them.

King Boo

A resident whose medical needs require the services of a skilled nursing facility will not have their care needs met at Memory Care.

All Memory Cares are not created equal.  Some can provide nursing home level care under the name of a M (with some procedural exceptions); some cannot.

Watch out for the typical PR/Advertising spiehl of : Yes, your LO can stay here until the end on hospice.    Because - what they don't tell you are the triggers that can get someone tossed out of MC - such as high acuity medical needs, frequent falls, or the need for increased supervision.

The other reason to strategize to a place, if possible, that has a good quality snf is to spend your money at a facility that will take your parent on Medicaid into their snf; most CCRC's have a benevolant policy recognizing that if a resident has met their entry requirements of however many years of care, and spent their life savings with that facility, to honor that commitment with a >LTC commitment in their nursing home.

Not everyone has this option, but if you have private pay for nursing home not a huge issue.  It is helpful to not try and get into a nursing home penniless, having spent your money at a self standing Memory Care.  Many vy for Medicaid beds; most facilities have limited capacity.  

More choice, more continuity of care.