Advice on care facility- institutional-yet-prepared, or welcoming with no memory care?

cmcc

Looking for advice on choosing an assisted living facility for my mother. She's 79 and was recently diagnosed with dementia. She has significant short-term memory issues, but she's able to care for herself in all ways and is very physically healthy. We found a place we really like for her--it's just two minutes from our home, the rooms and spaces are welcoming, and it's the least "institutional'' of the others we've visited. However, it doesn't offer memory care, and most of the residents don't have dementia (though staff are trained for it). Without knowing how quickly her disease will progress, we fear she might not have the services she may eventually need here, and we will need to move/disrupt her. We found a second facility near us, but it felt so institutional and not as "homey" as the other. Her room would be tiny, and the place felt like a hotel--a bit cold and medical. But here, she would definitely get the care she would need with trained professionals at every stage of her disease. But the thought of walking her into this place and leaving her there makes me feel horrible. Looking for others' thoughts and personal experiences with this dilemma. Thank you in advance!

Dave Cahail

Consider using a senior living service like "A Place for Mom" or "Clear Path Senior Living Solutions". You work with them to specify what you are looking for. They are a good source of information based upon your LO's care (near and long term) needs. They also vet facilities so less chance of your LO ending up in a bad facility.

Cynbar

Dementia is a progressive disease so you know it is going to get worse, unless a medical issue comes along first. How thoroughly did you discuss with the first place how they would care for her as she declines? If you haven't already, ask them several specific questions. Do they ask residents to leave when they get to a certain stage, such as becoming incontinent, needing help bathing and dressing or even eating? Or, do they add in extra care (usually for an additional cost)? Can they keep her safe if wandering becomes an issue? Do they have residents who "age in place" (usually a code for staying til end of life)? Have they had many dementia patients, even if they don't now, who stayed as their status declined? If it sounds like they would quickly ask you to move her when any of the above come up, I think you would need to look for a place that will be prepared to give her the services she will need, sooner or later.

jfkoc

Homey is one thing...training another.

King Boo

Assisted living without dementia patients is NOT a good place for  you loved one to go.  This diagnosis definitely requires understanding of the disease on the part of caregivers.

In my experience, the 'nice looking' facilities spent their money on appearances like crystal chandeliers and rose wallpaper to appeal to the family members that were placing.  Care was often lacking (they spend $ for appearances and not staff salaries, ongoing training, etc).

Shabby but clean is fine.  The quality of care is what you need. Can they redirect dementia behavior constructively?  Dementia specific activities?

Place her in regular AL and she soon will be a social outcast - cognitively normal seniors do definitely NOT want to hang with those who are barely holding onto AL status by their fingertips.  They don't fit in because a physicial limitation is different from a cognitive one.

Does the MC have a skilled nursing facility (a good one) affiliated with it?  While not always possible, this gives a continuity of flow to care.    It also makes you more attractive for entrance on private pay with more options. 

harshedbuzz

cmcc-

Hi and welcome.

I would caution you off "A Place for Mom". They are basically an advertising ploy disguised as a "service". If you contact them, they will give your contact information to the facilities in your community that pay them to include them in their service. In registering with them you will miss those facilities that don't need to advertise in this manner because they can attract residents based on word-of-mouth. IME, the ones listed locally were all the sort of corporate places that cherry-picked for "pleasant befuddled" and booted those who needed a great deal of dementia-informed care. They also, as a group, were less likely to accept Medicaid if a PWD outlived their assets. Once your contact information is out there, the sales agents will call; one facility changed ownership after a well-publicized abuse lawsuit and their new sales agent contacted me about 6 months after my PWD died.

IME, moving a PWD into AL unless a high acuity for MC is not a plan for success. My cousin did this with her own mother who was early stages of vascular dementia. I think family didn't realize how much scaffolding she had at home around prompts and routine that gave a false sense of where she was in the disease progression. She crashed and burned in AL. She missed meals, she was unable to participate appropriately in activities and conversations and was shunned "meangirl-style" by the other residents. She had a fall in the new AL, was on the floor for upwards of 10 hours with a broken hip and wrist and ended up too impaired to be accepted into a MCF. She ended up in a SNF and died 4 months later. 

Training is everything. I chose dad's MCF based on training. The place wasn't the fanciest of the dozen I toured, but the staff was well trained. They were also compensated a bit better than most and the DON doted on his staff- he drove them on snowy days if they wanted, allowed them to bring their kids in on scheduled days off if needed. (pre-COVID dad enjoyed seeing younger kids about- they often participated in games, snack time and crafts)

I can appreciate that it can be hard to imagine a LO in a MCF that allows a PWD to "age in place" because there will be many residents who are further along in the disease progression, but most places will try to match up residents who are functioning on the same level. My other aunts MCF used to allow her to spend part of the day with the AL and personal care residents doing crafts and going on excursions.

The other piece to consider is what pretext you plan to use to physically accomplish the placement. Most folks use some sort of fiblet to make this happen. Some will present MC as a "senior hotel" where you can stay while your house is tented for termites or the sewer line is replaced. We got dad into MC selling it as a high-end rehab facility his doctor ordered to get him stronger on his feet. To that end, we didn't want to decorate it with things from home immediately instead going for a hotel-like vibe and bringing in stuff from home for his stay. 

HB