Should I move DH from MC to nursing home?

Marie58

DH has been in MC for almost 18 months. Three months ago he had a sudden decline (no, it wasn't a UTI) and has been bedbound since. He can't walk, smile, talking ended a long time ago, or feed himself. He's late stage 7. 

Here's the issue: He has to be hand fed and technically the MC staff can't do that. However, they are giving him breakfast and will fill in for me at lunch or dinner if I ask, which I'm thankful for. I'm responsible for lunch and dinner. I have a few friends and our son and DIL who have helped, but mainly it's me. It's a demanding schedule to keep up. In the beginning I felt like I could do this for a few months and I did, with a little help here and there. We're at 3 months and DH is stable with little change in the last 3 months. He's on Hospice (they can't feed him due to staffing) and his physical health and vitals are always good. So this could go on for a loooong time. I can't do this forever. Hiring a caregiver to come in would be very expensive, at least $60/day, probably more. And who knows if I can even find one these days. I haven't done a lot of research yet, but a nursing home would probably be about the same as what I'm currently paying for MC.

Any thoughts on nursing home vs memory care? I actually really like the place he's at, except for the not feeding him part!

Bill_2001

These are the sorts of questions that frighten me the most.

Memory care will not hand feed someone? It's not like the person needs a feeding tube. The limitations of these $5,000/month (and up) Memory care units never fail to shock me.

If we are expected to go there 2 or 3 times a day to help out, just what are we paying for? They will change a freakin' diaper, but not help someone eat? In that case, I would just bring my dear wife home. Gee whiz.

Each time I begin to seriously consider placing my dear wife into memory care, and start the retirement money drain, I read a question here like this one.

No thanks, my wife stays home. Cost is zero, and I can take care of her better than that.

I will be curiously watching this thread to see the input of others. I have no answer for you, and I wish you the best.

Joe C.

There are MC facilities that will hand feed residents. I researched MCs in my area long before I placed DW and realized they are not all created equal. In my area some MCs want to move people on once they reach a certain point but the facility I choose will keep residents as long as possible under state regulations. My DW is not as the point of needing hand feeding but I have been at the MC during meal times an observed other residents being hand fed. That being said, there will be an increase in cost once DW reaches this point.

Rescue mom

I am looking more at MCs for DH, and this has come up….some (most, that I’ve looked into) Will hand feed—but yes, you pay more for that. They will not “force” someone to eat though. I can see room for debate over  the line between “forcing” and coaxing/waiting if the PWD is very slow to accept the food. But IME this all depends largely on the facility.

By hand-feed, I mean someone putting food on a utensil or in a glass and transferring it to the PWDs mouth, or guiding their hands. I dont know if there are other definitions, but there often are….

ImMaggieMae

If a person is confined to bed, what are the differences between a nursing home and a MC facility? This is all new to me and confusing. It seems the advantage of a MC is that the PWD can get up and be involved in some activities and receive mental stimulation at whatever level they are. But they don’t receive medical care. At a nursing home there could be medical care, right?

ladyzetta

My DH was in a MC facility. There also was an AL in the same building. The MC did hand feed the residents that needed help and if there was not enough to help some of the aides came in from AL to help. The MC part of the facility was small, I don't remember how many were fed by hand, but I did see some being fed. I live in Oregon, and I don't know if all the facilities in Oregon are the same. Marie I am sorry I know this is not a answer to your question, I just don't understand why they can't feed the residents. 

Beachfan

Marie,

My DH is in a MCF since November.  His “cottage” houses 16 residents at capacity; DH is the most progressed of the folks in his residence.  During mealtimes, he is seated alone at a counter closer to the area where the caregivers dish up the food.  He has some adaptive equipment (plate guard, spork, non-slip mat under his plate, bowl). I have seen the caregivers assist him by re-arranging his food on the plate, feeding him food from the spork when he struggles, hand feeding him smaller bits of finger food and assisting him in getting a drink to his mouth. I have seen another resident in a second cottage who receives hospice being totally hand fed.  There is no additional charge for this care.

Having done the research, I have found that in my area in PA, a SNF would cost at least twice as much per month as his MCF.  He is exceptionally physically healthy and does not require skilled nursing care.  For that reason (and others), I fully expect that he will continue to receive the care he requires, and for which I am paying at his MCF, including hand feeding, if necessary.  

I don’t understand why it should be such an issue for staff to feed your DH, especially since they are able to give him breakfast and fill in occasionally in your absence. Is it because he is bedbound? Could it be that you are too readily available and they are taking advantage- -?  I hope you can sort this out; you are paying for a service that that is meant to provide care for your DH as well as some relief for you.  

JJAz

I always say NOT ALL MC IS CREATED EQUAL!  Continue looking for a MC or MC-small-group-home that will hand feed your spouse.  There is no need for NH unless DH has medical needs that can't be met in MC.  My DH was hand fed in MC until the end at no additional cost.  They made accommodations for his slowness and fed him during off-meal hours.  They were concerned about his welfare and it showed.

David J

In Connecticut, MCF’s are legally Assisted Living focused on memory care. They are not nursing facilities or medical in any way. They provide help with ADLs, dispense meds, and otherwise care for the resident’s needs. When I was researching MCFs, being able to feed one’s self was important for initial admission. In our case we chose a facility where my wife can live out her life and receive care in situ until the end. Compared to that, help eating is a minimal effort  

From observation, the CNAs serve all the residents, then go around to help those who need encouragement or physical help. They even take food into the rooms of bed-bound residents and assist them in eating. 

Jeff86

I looked at local MCFs here about 1 1/2 years ago, as I was formulating Plan B.  

 I checked out 3 of them.  The going rate here is $10,000 per month, more or less.  Two of the facilities will hand feed residents, the third will not.  My DW is not incapable of feeding herself, but mostly doesn’t.  And it takes a long time for her to finish a meal, with a lot of encouragement needed.  

This is a critical issue to check out, in advance.   

Crushed

Hand feeding is not medical care.  DW's facility will do it  but for various reasons I also pay an aide who does much of it.  (I pay for 6 hours a day 5 days a week.)

I go in on weekends a for a bit of quality control, evaluation  and food variety for DW.

The staff always reports to me when and what she ate at her last meal

In Md Assisted living  facilities are specially licensed on 3 levels. 

A level 3 facility is required to provide direct and sufficient  assistance with all ADLs and also administer medications.  DW's facility is level 3  The primary job of the aide is to get her enough exercise without a risk of a bad fall 

 

Beachfan

 Ugh! I lost my rambling reply, but in essence I checked yesterday with DH’s MCF regarding hand feeding with this post in mind.  I specifically asked whether DH would be hand fed in the event he could no longer physically feed himself. Even if he was confined to bed. The nurse was taken aback a little.  She said of course we would feed him. That’s part of his care. ( I was just checking. I have witnessed staff assisting DH with his meals and also hand feeding him some items.)

Marie, do you think if you met personally with the MCF  directors, they could explain their position more clearly? It seems unnecessary to consider a nursing home, if the issue is just feeding and  especially if they are feeding him some of his meals presently.  I hope you are able to get some assistance without having to move him. Please keep us posted. As Jeff pointed out, this is a critical issue.  For those on the forum who are not considering imminent placement, there is still time to do extensive and exhaustive research. It is so true that all MC is not created equal. Best of luck to you as you navigate this quagmire.  I hope you can keep him settled.  

harshedbuzz

My aunt's MCF did provide hand-feeding. Perhaps this is more of a reflection of staff shortages than policy where your DH is. 

That said, her sister/guardian eventually moved her to SNF because the level of care was greater all around- things like actually brushing teeth rather than just prompting her to do so. As Beachfan pointed out, the transfer pretty much doubled the monthly fee for board and care near Boston. 

Feeding in both settings meant a table of those who needed handfeeding at a table together with a single staff member doing the feeding. At times, even in this very nice and high-end facility, the pace was too fast for my aunt to eat as much as she would have. Her guardian or my cousin, who lived locally, would visit at lunchtime to feed her solo at a more leisurely pace to make sure she ate as much as she wanted but also got a dessert which she loved. If neither could make it, they hired an aide who had worked for another family member before and was now retired. This went on for about 3 years and overlapped a period when another sibling, who wasn't as well-funded, needed a sitter to keep her off her feet with a broken hip for about 3 months.  

The consequence of this experience has led my guardian aunt to stipulate "no handfeeding under any circumstances" in her healthcare directive- my cousin and I are named as POAs. She extracts this promise from me every time we talk.

Marie58

Update: I recently met with the director to revisit this hand feeding issue. I very carefully wrote out my concerns, cited the MC handbook a couple of times, and mentioned specific care that DH receives, or not, based on his service plan and level of care that we are paying. In other words, I did my homework before meeting with her.

The director said she didn't realize I was so concerned and stressed over this. I believe she was being very sincere. In our discussion, I was told that staff can't hand feed unless they have specific training, which apparently only some of them have. All the staff are going to receive this training this week and DH will be hand fed all meals except lunch on the weekends. (Staffing issues make that more difficult). I can live with that! And if I want to go out of town, I have friends who can cover for me. 

I'm so glad this has been resolved. I feel like a huge weight has been lifted off my shoulders. Now I can visit when I want to, not when I have to. As others have said, ask lots of questions before placing!!

Ed1937

Marie, that is a huge win! I'm glad for you.