When is Assisted Living or Memory Care called for?

Walmartgirl

Hello, my dad has Alzheimer's. My mom is his primary caregiver. My husband and I are around a lot. We live 10 minutes down the road so we are very involved. 

My mom is very stressed out. As dad's faculties have declined, I've watched mom's stress increase. She is "at her wits end." 

So I started looking for a place that would give her some relief and that would take care of dad. I contacted A Place For Mom. They connected me with a local advisor. For the last week, Ive been talking with the advisor, looking at places online, and talking with someone from one of the facilities. They also referred me to a local home care company. Through my research though, it seems like home care is just a band aid. Last night, I had a talk with my parents, told them what I'd been up to. 

Today I'm questioning my timing. 

Also what can be expected from a memory care facility? What makes it different from assisted living?

Fairyland

Memory care in general is for people who can’t remember to I.e. go to dining room for meals, can’t initiate any activity, might wander off outside, sleep patterns messed up, dress inappropriately - it depends how bad his symptoms are but if your mom is at wits end that sounds ominous.

Assisted living is more for people who may need rollators to move around (but don’t forget they need them then fall every day), medication reminders but otherwise can decide to do (or not) self-care and activities, use the phone sensibly, etc.

My mom is on the borderline after recurrent recent strokes and her assisted living is trying to rehab and cue her enough to stay there, she would be aware and upset if she had to move to MC at this point. In some ways I would rather she was in MC being engaged in a more structured way, and on the request of the AL am currently paying for a daily extra aide to help and persuade her to not just sit immobile all day apart from going to meals. But she doesn’t wander off, knows where she is, can dress herself. They like her since she is easy I guess, comparatively, and she has made a couple friends with the other residents. She has Vascular Dementia but it is progressing slowly.

Fairyland

Also unless you have POA, you are going to need your mom on board.

Discussing it with the PWD is often not useful to the point where you will not be able to help your mom make any useful changes. I would pick out one or at most 2 options that I think are best, and show them to mom only. Many if not most have to resort to some kind of subterfuge to get the PWD placed. Or it happens after a hospitalisation which may land them wherever has a space at the time. 

A Place for Mom gets a big kickback from the facilities they have on their books, upon placement.  The institution’s fees will be high enough to cover that aspect of course.   I used Google maps and identified many more options who don’t feature with PFM. Some where more churchy-charity type places and some were high quality and work by word of mouth so don’t need PFM.

Quilting brings calm

Any facility ( independent living. Assisted living, memory care, or skilled nursing) will do an evaluation to determine his suitability.  They cannot accept someone who akreadt needs more care than they provide.  That does not always mean a dementia  patient needs memory care.  Assisted living is suitable for those who are in the MCI or mild dementia stages 

Is he capable of going to the dining room for meals, being alone in his room for a few hours at a time, able to make it to the bathroom as needed? Is he firmly within the normal reality- no hallucinations, delusions, or wandering outside?  Those are often the divider between assisted and memory care,  Assisted living will help those who have mobility or physical limitations with dressing or showers, but they don’t change diapers.  They will help fix the messed up tv channels and get things out of cabinets.  Someone  is on duty to answer call buttons etc 24-7. .  they provide housekeeping, laundry  and medication management services.   

sandwichone123

Sometimes the terms are different from place to place, so this is just my interpretation: Assisted living is a level of care for which a facility is licensed. Some places provide more than one level of care, and some don't. Memory care is a term that's used to communicate that a facility is focused on caring from patients with Alzheimers and other dementias. The facility may be licensed for various levels of care.

For instance, my dh is in memory care, at at assisted living level of care. The facility is locked, and activities are provided for patients with dementia. This facility also has two others levels of care that they're licensed for, so as my dh needs more care he will move to a more supportive level of care, but it will still be memory care.

Rescue mom

About a Place For Mom…as already mentioned, APFM works only with facilities that pay them. There may be very good facilities nearby they don’t tell you about, because the facilities do not pay to be mentioned.

 Some people have found facilities through them—and I don’t know about the other person they referred you to—but in my area, many of the better/best places do not work with PFM, they have good reps and enough business without paying PFM for more.

Again, APFM may find a good one for you; that has happened. Just be aware there may be others available they don’t tell you about.

About MC vs. AL…places do differ in the kinds and level of services offered. Some ALs in my area offer many of the same services as MC (also at greater cost). The biggest difference or deal-breaker is wandering. No AL IME will take a wanderer, or a PWD who tries to “escape.” If they do, then they have to go to secured MC.

One very general 2-part guideline I’ve heard, may not be always 100% applicable but often helps, is…

Part 1. AL is for people who can and will ask for help. They may have physical problems, but they know they need help, and will ask for help showering, or dressing, taking meds, or getting food, etc.

Part 2. If the person cannot or will not ask for help, they need MC. In other words, if they don’t have the cognitive ability to know they need help, then they need MC. If they have to be told and directed to bathe, eat, take meds, socialize, etc. they need MC. 

AL is usually best, IME, for people with physical problems. Cognitive needs MC. And again, different facilities may provide different services for all kinds. But in AL, IME, they’re more likely to be left alone unless they ask.

Often your local Alzheimer’s Association can give you a good list of facilities. Their only “restriction” is they don’t list places with serious health and safety problems. (Which we would not want anyway). They do not pick one or another, that’s up to you, but at least it’s a good list of decent places. For some reason Google is not very good (when I’ve tried around here) at finding/listing such facilities.

harshedbuzz

Walmartgirl wrote:

Hello, my dad has Alzheimer's. My mom is his primary caregiver. My husband and I are around a lot. We live 10 minutes down the road so we are very involved. 

I was very involved with helping my mom, too. But there came a time when unless I moved in and stayed 24/7 it wasn't enough to protect my mom's well-being. 

My mom is very stressed out. As dad's faculties have declined, I've watched mom's stress increase. She is "at her wits end."

Then it's time to get serious help. "We" chose memory care. Basically, I threatened my mother with the prospect of me placing dad in the first place that would take him when his care killed her. I had a SNF lined up that would accept him on-the-fly giving me time to line up MC as a Plan B.

So I started looking for a place that would give her some relief and that would take care of dad. I contacted A Place For Mom. They connected me with a local advisor.

I am not a fan of APFM. In my community they only represent places that pay a hefty "finder's fee" for residents they help place. Where I live, these are often the places that dedicate more to decor than training and staff retention (the 2 most important things I was looking for). The better run places don't need them here. Plus, once they give your contact information, you will get a lot of phone calls. OMG, I got one 4 years after I placed dad long after he'd died. 

For the last week, Ive been talking with the advisor, looking at places online, and talking with someone from one of the facilities. They also referred me to a local home care company. Through my research though, it seems like home care is just a band aid.

Home care can work for some families. It's generally a lot more money especially if dad needs 24/7. It risks turning their home into a nursing-home-for-one which might not be good for your mom. Your dad might not accept care from others if mom is "available". Another issue is that agency people can be all over the place in terms of skills. We started with agancy staff and it felt like they sent us all of the aides families with more seniority had specifically asked not to have. One even stole my mom's jewelry. 

 Last night, I had a talk with my parents, told them what I'd been up to. 

Probably best not to communicate plans to dad. 

When I was in your shoes, I toured a dozen places. You really need to see them in action to get a sense of the fit. Talk to staff not just the tour guide. Check out the activities and see what meals look like. Talk with other families about their experiences. Once I had my top 3 I brought my mom to tour them. 

Today I'm questioning my timing. 

If your mom is at "wit's end", it's beyond time. 

It took me some time to convince my mom that it was time although she never claimed she needed a break, I knew she did. It turned out she was more depressed and less functional than I knew and I was there daily. During the last months before dad went into MC, mom stopped taking care of herself. She skipped some doctor appointments and didn't refill 3 important medications which led to hospitalizations a couple months after dad died. Her self-neglect resulted in the loss of vision in one eye which ended her driving and ability to be really independent in widowhood. She is not living the Stage 8 she'd hoped for and frankly, I am having to be much more involved in her care than I had planned. 

Also what can be expected from a memory care facility? What makes it different from assisted living?

The differences are typically staff training and resident/staff ratios. Also a secure building. Programming is meant to engage PWD. Costs are higher.

HB