Assisted Living vs. Memory Care (Early/Mid Stage)

djg001

Hi all,

First time posting here.  My dad is early stage, but the latter part of early stage I think.  He still lives at home alone (my mom passed away last year).  Dad is 92 years old and in good overall health (knock on wood).  He has someone that comes to the house M-F from 2-7 to make sure he has dinner, takes his medications, house is kept up, etc.  And he also goes to a day program twice a week.

For now the arrangement seems to be working ok and he is still getting by on his own.  He can get himself dressed, showered, eat breakfast and lunch, etc.  We took his car (which he reminds us of every day in protest), and he basically just stays home all day doing nothing.  He's lonely and depressed, being on his own and having lost his wife of 52 years less than a year ago.

I want to find a way to get him more active, but want to also keep him at home as long as possible.  At some point as the disease progresses and we get to the point where he can no longer be alone, we will have to find an option for him.

Assisted living seems like it could be a good next step, but I'm wary of how they will deal with someone with memory issues  - he won't know when it is time to eat or where to go, where to go or when to get his meds, etc.  From personal experience with my MIL, I've seen how easily AL facilities can kick you to the curb with nowhere to go just because the resident has become too much "trouble".

Memory care seems to be fore more advanced patients, and I cannot envision sending my dad to one of these facilities until / unless he gets much farther along in the journey.

Any thoughts on options for someone at this stage?  He really is right in between at the moment.

Thanks in advance!

May flowers

If he needs more stimulation, maybe more days of daycare would be appropriate.

My FIL was physically active/healthy and could do all his daily personal care (with reminding) when he went to MC. It was not below his level of care, because he needed the ongoing interaction and someone to take him to activities and dinner. There were some at his level and some more advanced. 

Lindsay22

Hello and welcome to the boards.  I would look at AL that can step up to MC.  There are many facilities that offer this so that you aren't in the position to need to find somewhere quickly when your dad's needs become greater than AL can accommodate. Many of those types of facilities will also evaluate dad to see if AL is appropriate right now. 

I also would like to challenge you a bit on "keep him at home as long as possible".  As you say he is lonely, depressed and isolated. If he is still early stages he will be able to participate in many of the activities and social opportunities at AL or MC and it may improve his quality of life.  AL and MC offer a routine which PWDs thrive on.  When I see people saying they want to keep someone home as long as possible this is often to assuage your own guilt surrounding "putting dad in a home" instead of actually considering what would be best for him.  

When my mom moved to MC she adjusted to the routine quickly.  I think that the removal of the burden of trying to remember all the things that home requires actually lessened her anxiety.  Now there was food ready for her 3 times a day, there were people around and activities happening, there was scheduled time for "lights out" when she was getting her days and nights mixed up.  All of this actually made it easier for her than trying to figure it all out at home with caregivers coming in. 

Of course that isn't the case for everyone but a facility can certainly help to evaluate where he stands right now. 

Phoenix1966

I agree with Lindsay22 suggesting to look at AL facilities that have a MC attached. They will do a good job at figuring out where your father would best fit.  

I’m sorry for the loss of your mother. Something to keep in mind is that the surviving spouse can sometimes decline more rapidly with the absence of the spouse who was their “scaffolding” and helped keep them together.

He’s lucky to have you in his life, worrying about his well-being. 

May flowers

Ditto what the others said about the AL with MC wing (as long as they are trained in dementia, low caregiver to resident ratio, nursing, etc). Another benefit, at least for my FIL’s  place is that some of the higher functioning folks in MC did some activities with the AL.

TammyCA

I was fortunate to find a AL/MC facility that offered an enhanced program and support for residents with mild/moderate cognitive impairment within the assisted living facility. My mom successfully lived in AL with this program from stage 4/5 through early stage 6 for almost 3 years. I just moved her to their memory care unit a couple weeks ago as she has progressed solidly into stage 6 and now needs a secured environment.

MN Chickadee

I am also of the opinion that often the idea of keeping someone home as long as possible is sometimes for our own guilt/fear and not necessarily in the best interest of the PWD. Each situation is of course different. It's a scary step to take, and images from the nursing homes our parents or grandparents were in make us cringe, but much of long term care has drastically changed in recent years and honestly can be a really positive thing for some PWD.

Increasing the number of days he goes to the day program may be a good stop gap, that's what we did for quite a while before the move to MC. Most AL cannot handle dementia. They don't have the staffing ratio or training to deal with it. There is some nuance in them though depending on company and area. My area has a couple places that are continuing care campuses, with one area that is kind of a hybrid AL/MC wing for those in early dementia.  Then they can move on to the higher levels of care. You might look for high acuity AL. Be upfront and honest about his abilities or lack thereof and the facility can help  determine if it's a good fit or if they can handle his issues. Being alone in his house, worrying about the logistics of life can be very stressful for a PWD and unnecessarily take a lot of their brain power.  My mom had a hard time adjusting to MC for a month or two but once she settled in she really thrived on the structure and routine and not having to worry about anything. Choose a place based on his worst days, not his best or average. Otherwise his stay will be very short and you will be moving him again quickly, which in my opinion is harder on the PWD in the long run than initally moving to slightly more care than necessary. The idea is to settle in somewhere for the long haul and ride that routine and familiarity through the changes of the disease. The state of the other residents ebbs and flows. Today there might be many neighbors in early or late stages, next week it may look different. My mom's facility had some EO younger folks from time to time, and sometimes someone very early in the disease. Mom was one of the healthier and more with-it people when she first moved. Of course that wasn't the case a year later. It's a constant cycle. There is always a lot of turn over and changes can happen quickly. The quality of the staff is really what matters. A good place will know how to get him engaged regardless of how much earlier in the disease he is than the rest. My mom was friends with the staff in the beginning, and helped with setting the dining room and things like that to keep busy. As she progressed she made friends with some of the other residents around her. And since our LOs can change quickly and many things can jump start a decline it's important to have this research done ahead of time and have options, so kudos for doing this now before a crisis.

djg001

Thanks everyone for the replies.  It's good to hear first hand experiences with this situation.  Unfortunately my perception is skewed by seeing how my MIL was treated, and how much she declined, while in AL.  She was not a dementia patient, just a lot of physical issues - but she did start to decline cognitively towards the end as a result.  The AL started sending her to MC during the day, and whenever I would visit, it was depressing, and she was like a different person changing to her environment.  Then they kicked her out and left us scrambling to find a new place for her to live.  

The situation was definitely very different, and I appreciate the perspective of trying to find the right place that can work with us upfront, set expectations and have a plan for how to best engage with my dad understanding his situation and how it can/will progress.  

I am going to start contacting facilities so we are prepared once the time comes to make a move.  My dad is very good at "convincing" us that he is fine when we know of course his actual current state.  Makes it tough to be sure of what the right thing is for him and how he might respond or adapt to a new way of living.

King Boo

Don't get too bogged down with the what ifs.

When all is said and done, care needs drive the decision making.  Have to leave the emotions out of it (at least temporarily).

There are long wait lists, financial qualifications and care fit to deal with.

Having your first and second choice of both a Memory Care and a skilled nursing facility (bonus if you can find a place that has both) ready to give to the hospital social worker UPON ADMISSION drastically improves your chance of a good placement outcome.

That means getting that information now, because there will be no time to research during the time of a hospital admission.

Most likely, this will be your time to act window, as it has been for so many of us.

He is MC ready now; after the stressors of a hospitalization, even more so, even possibly a snf.

RobinNicole

Hi,

I agree with looking for an AL/MC facility.  I recently (as in 10 days ago) had to put my mom into respite care which will become permanent.  Definitely confirm the staff ability / training in dementia.  My mom’s place has two levels of AL and then MC.  

 She too is independent in many ways but is very social.  We had to move more quickly than we originally planned (which in my mind means its always good to have backup plans.  So far she is participating in and enjoying the social activities.  I plan to use the doctors on premise and while its sad to leave her house of many years (and the independence) I know she is taken care of, socializing and happy most of the time.  She asks about her house - but we actually had to move her out due to safety / construction so we remind her its being worked on.  Many folks use that as a good fiblet- for us its reality- although we will keep it going as we see now how much better it is (no stairs, hot meals, company).  She does get cues for activities and meals, but she has free range over the facility (based on their assessment).  I know that can change at any moment but the changes would not be really noticeable.  We got the only room open and it happens to be on the memory floor.  She talks to everyone anyways and they let her go to main floor (she has not balked at the “code” to get on the elevator because I told her its a very safe place. And its now part of her new norm.  This is our experience 10 days in.  I am sad at what was that will no longer be, but I do know they are giving her more of a life than I could.  And she can age in place.  Good luck on your research and decisions.

buckeyenut

I totally agree!!