MC or SNF

Anewsunset

I’m faced with moving a LO from AS to either MC or SNF. I can’t seem to find anyone to help determine which would be best. Mom is in late stage 5 and personality has changed greatly from the recent move to AS. I’m 225 miles away and need her to be in my city so I can provide day to day care if needed. Thoughts

sandwichone123

The terms for facilities seem to vary a lot in different areas. I suggest visiting facilities in your area to get a feel for what they are, and having them describe the patients they care for. Also ask how they decide who to admit and what would cause a patient to be discharged.

BassetHoundAnn

In general someone who needs a skilled nursing facility usually has a serious health condition beyond dementia that requires intensive care. It was explained to me that if someone requires two aids and a Hoyer lift to be transferred from bed they need skilled nursing. I know someone who had diabetes, and was having trouble transferring from their bed to their chair, and was unable to maneuver the bathroom by himself, so he was transferred to skilled nursing.  I've had relatives with dementia and when they've reached Stage 7 when they stop eating and are bedbound, they've been transferred to skilled nursing. Being self-ambulatory is one criterion which enables a patient to thrive in memory care. 

But it varies a lot and as Sandwich pointed out it varies tremendously from one facility and one area to another. So you need to ask a lot of questions when you tour these places about what will lead them to discharge a resident to skilled nursing. 

Over the summer my mom was hospitalized. She was set to be moved to a local memory care and at the last minute they decided they would not accept her. They claimed she needed more care than they wanted to provide, and that she needed skilled nursing. The social worker at the hospital was somewhat aghast and said my mom most certainly did not need skilled nursing, that she should be moved to memory care instead. We ultimately found another memory care that gladly accepted her, and it turned out that my mom was actually pretty low maintenance compared to most other residents there. 

Some memory cares select residents that initially will not need a lot of care, and then bump them out when their care needs grow. That's something that's very important to take into account when you tour these facilities. Look at the other residents and see how far along they are in their Alzheimer's journey. Do you see a lot of wheelchairs and walkers around or does everyone seem to be quite ambulatory? Do you see residents wrapped up in blankets and wheelchairs quietly watching TV, or does everyone seem to be quite active, bopping around and enjoying activities that might be beyond the capabilities of those who are farther along in dementia? Those are all clues. 

Something else about skilled nursing... They may not have aids that are trained specifically to work with dementia patients. And they may not have the personnel to provide all the hands-on attention a dementia patient requires. I've heard of people who've had to hire aids to sit with a loved one to keep them from climbing out of bed and wandering the facility. In fact some relatives were taking 24/7 shifts for over a year to watch their mom who had Alzheimer's while she stayed in a skilled nursing facility. This is also something to ask about when you tour facilities. Do they ever require that the family hire additional aids to watch a loved one? 

These are just some thoughts. Good luck! It's a long tough process to find the best place. 

Anewsunset

Thank you all for your responses. 

I’m also challenged by the fact my mom doesn’t have much money left. Most MC facilities do not accept Medicaid, whereby the SNF’s do. I hate to move her twice if I don’t have to. Has anyone had to deal with this issue too?

Lor2014

I would check with a dementia support group in your area and ask them for advice and referrals. Also, if there is a doctor who will oversee her care, what facility does he/she go to? I would start calling facilities and do a virtual zoom or facetime tour and start asking questions. In my area, the fees varied greatly, with one facility being 40% more than another one. It's really your decision, and if you can, I would pick the one that is closest to you so that it is convenient.

It's preferable to only move her once, but I've moved my mother twice. However, there are sometimes a large one time, non refundable deposit with the fees. Also know that the facilities will sometimes negotiate a lower fee, depending on their census.

BassetHoundAnn

Anewsunset wrote:

Thank you all for your responses. 

I’m also challenged by the fact my mom doesn’t have much money left. Most MC facilities do not accept Medicaid, whereby the SNF’s do. I hate to move her twice if I don’t have to. Has anyone had to deal with this issue too?

When you call these places to ask about getting more information and tours I would ask right off the bat about whether they accept Medicaid and what their procedure for that is. I found varying degrees of forthrightness and yes honesty about financial requirements for residents in MC's I visited. You don't want to waste your time on in-person tours and filling out lengthy applications for places that may reject your mom right off the bat for financial reasons. 

Some MCs and SNFs want 1-2 years of private pay before they will accept Medicaid. Some SNFs want all that money in a lump sum up front. Some will make no guarantees that they will accept Medicaid after these 1-2 years of payment are up. 

A friend who placed her husband in a SNF received invaluable help and advice from an elder law attorney in her area who specialized in helping families place loved ones. She got his name from members of a local support group of family caregivers. Local support groups can definitely be helpful in these matters. 

JJAz

Not all Medicaid-facilities are created equal.  Many of the good ones have a limited number of Medicaid qualified beds, and the balance of their beds are private pay.  When a Medicaid bed becomes available, they will first offer it to those who are already residents.  As a result, it's hard to find a good facility that will accept a transfer patient into a medicaid bed.  Lesson:  move into a facility while she is still private pay so that she gets first chance when she needs Medicaid.

Lindsay22

Going from private pay to Medicaid is also different by state.  As others have mentioned you may be required to prove you can pay for a certain amount of time (here in PA most places told me 5 years) before they will admit them with the agreement not to kick them out when they run out of money and have to go to Medicaid.  Because of this the qualification for who needs a SNF seems to be more lax to me here in PA.  They know that most people cannot afford $6-8k a month for 5 years private pay so SNFs take people who probably don't really need that level of care because there isn't any other choice on Medicaid.  My mom is in a private pay MC now with VA benefits helping and me and my husband paying for the difference.  We have a kid who needs to go to college in 3 years so once that happens it will likely be a SNF facility as our only option.   Your local Area Association on Aging is also another good resource for figuring this all out where you live and they are free.

dayn2nite2

My mom was on Medicaid, so the choice was made for us, as my state doesn't pay for assisted living or memory care placement.  So SNF it is.  Over half of the residents had some level of dementia anyway, and the staff was very good as far as handling behaviors with the lowest level of drugs possible.

Anewsunset

Thank you all for the insight. It’s too bad that you not only have to deal with the strain and stress of Alzheimer’s but also the financial side of making all the decisions and hoping you make the right ones for your LO.

Cynbar

Here in Massachusetts, Medicaid won't pay for MC or assisted living. So, that narrows the decision to a SNF. But there's more. The prospective resident also has to be screened by the state to determine if they qualify for SNF level of care (if they will be on Medicaid.). It's possible they could be denied, if they are independent with bathing and dressing, have no big safety issues, don't need med management (maybe because they don't take any.) Granted, most advanced dementia patients will likely need assist in those areas, but a small number may not. Honestly, it amazes me everyday how poorly dementia is understood in this country and how its toll is minimized.