Memory Care Tour

White Crane

Yesterday I toured the only memory care facility in town.  I live in St. Joseph, MO.  There are several MC facilities 50 to 75 miles away but this is the only one close by.  It is a private pay facility and charges $5,375 a month for memory care. The tour got off to a strange start when the director confused me with someone else she had talked to and called me by the wrong name and had the wrong phone number down for me...and asked if my husbands name was Fred!  No, his name is not Fred.  I finally got her straightened out on who I was and that I had scheduled a tour.  As we walked the short distance to the building that housed the memory care unit, she made the comment that "Everyone has some dementia."  Hmm, I don't know that I agree with that but she certainly seemed like she might.  She showed us...a friend came on the tour with me...the assisted living facility first and one of the suits.  It was roomy and very nice.  The director told us she would not recommend memory care unless the person was prone to wandering.  If they didn't wander, she would recommend assisted living because it was only about half the cost of memory care.  I questioned her about that asking if a resident in assisted living would have to know how to get to the dining area on their own.  Her reply was that after a couple of weeks they should be able to find their way around.  I don't know about that but I didn't argue with her.  We got to the memory care unit and she entered the code to unlock the door.  The unit was clean and nicely decorated and smelled nice.  There were several residents sitting together and the director greeted each of them by name.  One resident came up and gave her a big hug and the director told her she would take her for a walk outside very soon.  I thought that was nice.  It is as ten bed unit with two staff on duty at all times.  They have crafts once or twice a week.  There was a patio and the day before, they had gone outside and roasted marshmallows.  The residents all eat together at a large square table and get two snacks a day.  They all seemed content and the two staff people seemed friendly.  All the rooms are private with only one occupant. 

 I asked the director if the staff had any special training on dealing with Alzheimer's.  She said they hadn't but they were all very good at distracting...I think she must have meant re-directing.  I asked about residents who might need help feeding themselves and she said if a person could not feed themselves they would need to be in a skilled nursing facility.  She further said it was illegal for them to feed someone.  That surprised me!  I asked about lifting or helping someone who could not get up by themselves.  She said they do not do any lifting and if a person needed to be lifted using a Hoyer lift then they needed to be in a skilled nursing facility.  She also said they do not take anyone who exhibits aggressive tendencies.  When I asked her specifically how the staff would respond to a resident who wanted to visit their mother who had been dead for a long time, she just said once again the staff is very good at distracting.  That part worried me as how you respond to things like that can set the tone for the whole day and can either calm a person with dementia or agitate them.  Other than that, I think it is a very good facility.

 Some of you have LOs in MC.  Does this sound like a typical facility?  My DH is not ready for MC but after his recent bought with an emergency appendectomy, I see that things can change quickly and I need to have a plan in place.  Thank you for any comments or suggestions.

 Brenda

David J

Hello Brenda (White Crane)!

I chose an MCF that is s close by, and I am glad I did. Can’t beat the convenience, and when something goes wrong, I can get there quickly. My wife is in a dedicated memory care facility with about 60 single rooms, divided into 4 wings, each with it’s own dining room and serving kitchen. Their direct care staff consists of CNAs and LPNs who have gone through a training program, and all staff take continuing training programs. The place is clean, all the staff including administrators, caregivers, maintenance, food service etc seem to know every resident’s name. It works on an assisted living model, so there are limits to what they can provide medically. They have medical oversight by a local general medicine practice, mental health practice, a dentist, and podiatrist, all of whom make frequent visits. They have several residents who are bed bound and they use a Hoyer lift for those residents, and will turn and reposition to prevent bed sores. When the time comes for hospice, they work with them to provide care. They will send residents to the hospital when the required care exceeds their physical or legal constraints. For example, my wife had a UTI, and they sent her to the emergency room and she spent a week in the hospital. 

You didn’t mention whether the facility had programs to keep the residents active and engaged. I find this very important. I don’t want my wife warehoused like in a SNF. A strong and well staffed memory care program is a necessity. 

Most places will ask for a deposit to hold a place in the wait list, and will want to do an assessment of the PWDs physical, mental, and emotional condition before acceptance. 

Good luck going forward!

Dave

jfkoc

Good for you for looking ahead.

Here is a site with a phone # which may help.

https://www.memorycarefacilities.net/assisted-living/missouri/saint-joseph.html

I would start a search with a phone call to find out the specific training used. There is no point in a placement with no/undertrained staff. A good facility will  be happy to tell   you about their  initial and  ongoing training. 

I would also ask to be sent a copy of their current license and contract.

Next check for inspection violations.

If all seems good then go look keeping in mind that bright and shiney does not trump good care.

In answer to your question, unfortunately that facility is not atypical. Facilities are popping up everywhere and many of them will screen and take only residents that require basic care. 

Here is another site that looks helpful;

https://health.mo.gov/seniors/nursinghomes/alzheimersscu.php

Gig Harbor

I think he will not be able to stay in assisted living by himself. It is concerning that they can’t feed, lift or otherwise assist him with moving. It will only be a matter of time before you have to move him to a skilled facility. A larger memory care facility with more staff should be able to handle his needs for the rest of his life. They will also have more activities for him.

harshedbuzz

Brenda-

A couple of thoughts from a daughter who toured a dozen places and who drove by nine on the way to the MCF we eventually chose.

It kind of sounds as if your tour guide is either real new or filling in for someone. IME, the guide is generally a sales person and the slickest individual associated with the operation. I got way better information from the aides who provided hands-on care and the families I grilled in the parking lot.

It's fairly typical of even good facilities to avoid certain kinds of residents- not just those who are known to be physically aggressive, but also younger men and individuals with FTD (dad's accepted PWFTD, but limited them to 1 per unit because of their need for constant supervision). Dad wasn't accepted at mom's first choice because of the nature of his mixed dementia- the ARD has a reputation for aggression and acting out even though dad was well past that.

The price seems very reasonable, but do ask what's included. Some places I toured nickeled and dimed; there were additional fees for incontinence care, medication based on the number of meds taken and 2 person lifts (Ideally, everyone is a 2 person lift for safety).

AL is not a bargain substitution for MC. It's not just about finding the dining room, it's about knowing when to turn up there. AL went horribly wrong for my aunt. Residents were only checked twice daily aside from medication times. And the other residents quickly figured out she had dementia and had nothing to do with her. Staff wasn't great at dementia care as they had no real training or experience.

If Medicaid is your safety net, it's best to keep looking. Many places want 2-3 years of self-pay after which they will convert to a Medicaid bed. You don't want to spend that money in a facility that will show you the door when you run out of money. 

HB

ladyzetta

Dear Brenda,

I agree with Gig Harbor, MC should be trained to take care of all their residents. Once your DH is placed you do not want to have to move him again. 

My DH was in a small MC facility and they are trained to take care of him for the rest of his life. I do understand they will not force feed him, but if the resident is capable and wants to eat they will feed them.

 My DH was fed for a few months till he passed away. All the help he needed was there. They also had Hospice on call for any of the residents that qualified. 

This may look and smell like a good place, but the training and the compassion for the resident must come first. 

Take Care, Hugs, Zetta 

White Crane

Thank you all so much for your replies and for sharing your experience.  I appreciate it so much!  jfkoc, I will be checking those sites you shared.  Thank you.  David J, Gig Harbor, harshedbuzz, LadyZetta, each of you helped me.  I didn't have a chance to talk to any of the staff as they were busy.  And there were no cars in the parking lot.  I saw no visitors that I could talk to and get their opinion of the MC.  I agree, the director who gave me the tour was more of a salesperson and her advice to place DH in AL was way off.  I will continue to look into what else might be available in maybe a 50 mile radius.  Again, thank you!

dayn2nite2

There is almost nothing I care for in the tour you described.  If you have to go through the absolute agony of placement, it should only be ONCE.  One of my questions is "can you take care of my LO until death?"  If the answer is no, they are removed from consideration.

I don't care if they need to be moved to another wing or unit, but with the limitations this one your toured already has stated, this will be a short (in the context of dementia) stay.

Even if you have to drive farther, please find a different facility.

June45

dayn2nite2 wrote:

One of my questions is "can you take care of my LO until death?"  If the answer is no, they are removed from consideration.

Yes, this is the first question I ask (unless it were to be only for a respite stay). As White Crane discovered many of the MCF's associated with an AL do not do a 2-person assist. I found that every MCF is licensed differently.  The one I am currently looking at will care for my husband until death. And when he needs a 2-person assist, they charge a flat $500 extra a month.  One facility told me I would have to bring in an outside caregiver if my husband were to need a 2-person assist...$$$$$$.

Beachfan

I have been researching MC facilities on and off for 2 years now.  There is a retirement village within walking distance of our home.  They have a “Memory Care wing”- - however, a prospective resident must be evaluated for suitability- - no aggression, no wandering, extra fee for assistance with bathing, toileting, eating, and of course, you absolutely cannot die there!  They advertise MC residents happily engaged at a computer, dining in a room reminiscent of a Middle School cafeteria and some gentlemen boarding a small jitney for a golf outing!!!  I think not.  

My two favored facilities are 44 and 45 miles from our home;  they do nothing but Alz/Dementia care.  They are all inclusive; no additional fees for extra care and residents can age in place there with Hospice assistance, if desired.  I have bombarded directors and staff with questions, “what if” scenarios, and have been satisfied with their replies.  I plan to request a copy of their contract for a thorough review by our CELA prior to a placement consideration. It all takes time and some aggressive vetting, but if and when I need to place DH, I will approach it like a marriage- - I only want to do it once.  Good luck to you; keep looking and widen your horizons.  

LadyTexan

This thread has been so eye opening for me. 

I toured 4 facilities when DH was in the psych hospital and I was reluctant to bring him home. 

• The Memory Care facilities near us are private pay at about $5,000 and up per month. Financially, that is not an option for us. 
• Several skilled nursing facilities are in our community that accept Medicaid. One looks more appealing than the others.

Fortunately, several people explained to me that DH could be kicked out of a facility for aggressive behavior. This has stuck in my mind so much. It could make our options extremely limited because DH has been especially verbally aggressive in the past.

I never considered the question about will he be able to stay at the facility until he dies. It certainly is an important question to ask.

This forum is so incredibly informative. You all are so very helpful. THANK YOU!!

Joydean

As I read many of you say to have a plan b, I am learning a lot from you wonderful people! We are in Texas and live in the country, which is what we wanted for our retirement. Closest house is 5-6 miles away. There is a memory care in Rockwall, that’s 25 miles from us. For a simaprivte room it starts at $3600. A month. Out of question. That does not include personal use items, including tissue paper for bathroom, bath soap, nor bedding. You have to bring your own sheets, towels, etc. nor does it cover laundry. I was surprised by that. Do the ones you guys use are visited do the same?

White Crane

Thank you all again for your insights and help.  Like Lady Texan, it didn't occur to me to ask if DH could remain in the facility until death.  I need to make a list of questions that need to be asked before I look into any other facilities.  And June talked about a 2 person lift and that it cost a lot extra.  Wow, good to know!  Beachfan, you and others have said to ask for a copy of the contract.  Good idea.  And Joydean, the facility I visited said their fee was all inclusive so I assumed it included the sheets and towels etc. but I didn't think to ask.  That will go on my list also.  Thankfully, my DH is not ready for placement but I know it's important for me to have a plan in place in case that time comes.  Hugs to each of you.

dayn2nite2

Joydean wrote:

As I read many of you say to have a plan b, I am learning a lot from you wonderful people! We are in Texas and live in the country, which is what we wanted for our retirement. Closest house is 5-6 miles away. There is a memory care in Rockwall, that’s 25 miles from us. For a simaprivte room it starts at $3600. A month. Out of question. That does not include personal use items, including tissue paper for bathroom, bath soap, nor bedding. You have to bring your own sheets, towels, etc. nor does it cover laundry. I was surprised by that. Do the ones you guys use are visited do the same?

Lately, I've noticed that nearby communities have very large, multi-bedroom homes that look more like estates and have been converted to adult living facilities.  Even if the mortgage was a few thousand per month, if there are 4 bedrooms and you put 2 adults to a room at the tune of $3600/month, that's $28,800 base you're making per month.  Staff it minimally, 1 or 2 people, pay them minimally, insure it only to the very minimum, your residents have to supply everything but food.  The loved ones are doing all the laundry, the owner gets to charge more and more money as the residents become more debilitated....what a racket.  The reason they're requiring the LOs to do laundry is because if they did it they'd be required to purchase far more expensive commercial laundry equipment so the laundry is sanitized properly (and also be subject to inspection by the state).

If you are told you have to include basic human needs like toilet paper, tell them no thank you and move on.  That's ridiculous.  Toilet paper, bedding and soap should be included but expect them to be generic-type things.  If you wish to provide better quality items, that is fine.  If you wish to do laundry because you don't want the facility laundry to ruin the clothing you provide, that's fine too, but at least it's your choice.