Memory Care & Diagnosis

calmmorn

Hello everyone,

I have a question about the memory care placement process. I have heard from other caregivers that having a dementia diagnosis may actually put you at a disadvantage when applying to memory care facilities as it may prevent your loved one from being accepted and/or may increase the cost of care. I also didn’t realize that memory care facilities charge separately for board and care. I have met many caregivers who did not pursue a dementia diagnosis for their loved one and I am wondering if this is the reason why. 

The diagnosis issue is sort of moot for us because we got a diagnosis for our mother as soon as we noticed significant cognitive decline. But I was wondering if there may be some caregivers here who may be willing to share their experience of the memory care application and placement process. Do they typically ask whether your loved one has been diagnosed and ask for all medical records? And does this impact whether they will be accepted?

Thank you so much in advance.

loveskitties

If you will share your location...country/state...it will help others to better answer your questions.

My experience with my father...Memory Care facilities are those who deal with patients with cognitive decline be it from a form of dementia or other cause.  

Any care facility will require medical records as they will be the ones to handle any medications required.

Costs and how they are calculated depend on the facility...some are flat pay...some are by level of services required.

harshedbuzz

calmmorn-

In my state, MCF serve only PWD. A hospitality-model AL is for people who might need some assistance because of physical frailty or vision issues or has a profound disinterest in food prep. The latter is not an appropriate choice for a PWD.

FWIW, when I toured a dozen places to find one for dad, many of the MCFs did have a tiered pricing schedule where there was a base price to which medication supervision (separate from the price of the drugs), incontinence care (supplies could also be added), and 2-person lift. Other places had a single price depending on the room chosen-- private or semi-private. The state VA home charged on a sliding scale fee based on income/assets. 

In those with a tier pricing system, it is determined by the MCF-- not the family. Often a kind of bait-and-switch practice is used where they accept a resident for AL knowing they'll "fail" and be moved to the more supportive MCF within the month. 

The place I chose for dad was all MC and charged a single fee for any resident. You could pay extra for weekly excursions for lunch or if you wanted them to provide incontinence supplies. 

As part of the admission process here, we made an application to the MCF and dad had to have a state-mandated physical ahead of the transfer. The DON from the MCF will also come and assess the PWD ahead of offering a bed.

We ran into a situation where dad's specific kind of dementia (he had mixed-- Alz and an alcohol-related dementia that can be associated with "behaviors" that dad was well-past at this point) was seen as an issue and he wasn't offered a place at mom's first choice. I'm still happy we were up-front about his diagnosis because I wanted him in a place where staff was well-trained and experienced to handle issues should they arise. You want to avoid the fancy decor and cherry-picked residents if your LO might have behaviors at times. That said, even dad's wonderful MCF was careful around the number of residents with FTD they accepted as these people needed a lot of hands-on attention and they didn't want to short-change them or others. 

HB

calmmorn

Thank you so much for the replies.

loveskitties, we are in California and the caregivers I spoke with are all local so maybe it is how facilities here are structured. Yes, I found it odd that that having a diagnosis would be an issue since as you mentioned, memory care facilities are specifically for people with cognitive issues.

harshedbuzz, thank you so much for sharing your experience. It is so helpful to have some sense of what to expect when we start talking with facilities. It may be the tiered pricing schedule that I heard about. It sounds like you did so much research and due diligence in finding the best care for your father. I am so glad you had a wonderful experience with the place that you chose.

Our hope is to keep mom at home for as long as possible, but I think we need to start thinking about MC because everyone keeps telling us that things can change very quickly.

I have a harder time asking people in person detailed questions about their experiences, especially when they are just as stressed out as I am, so I really appreciate having this forum to ask the more in depth questions.

harshedbuzz

calmmorn wrote:

Our hope is to keep mom at home for as long as possible, but I think we need to start thinking about MC because everyone keeps telling us that things can change very quickly.

That was our goal as well. 

But I did start researching and toured over a dozen as soon as dad's diagnosis was confirmed in order that I would have a Plan B that could be implemented on-the-fly in the event something happened leaving my mom would be unable to care for him. Since dad day-traded away about $350K in the earlier stages of the disease while my mom was in denial and fighting me on an evaluation, hiring 24/7 help in the home wasn't sustainable for long. 

I would urge you to tour both MCFs and also SNFs. Should your mom ever have a qualifying hospitalization and need rehab (SNF)-- say after a fracture of some kind-- you'll want to be able to give the discharge planner 3 facilities you like best.

I toured about a dozen places. Since there was a possibility dad might outlive his assets, I mostly toured those places that accept Medicaid with a plan that dad would be able to self-pay for about 2 years before being converted to a Medicaid bed in an affiliated SNF. (my state doesn't fund MCFs, so he'd have gone to SNF). I usually dropped in at random times and toured paying attention to interaction between staff and residents, meal options and what activities were taking place. I also spoke with the families of other residents about what the liked and didn't-- I got a lot of good information this way. 

Timing placement is always a gamble. On one hand, if you're good for now, I can see delaying entry. But on the other, some folks feel it's best to make the move while the PWD is still aware enough to enjoy the activities, social interaction and for the LO to bond with caregivers. There's also often a "window" during which she would be appropriate for MC that can close in an instant as the result of a stroke or fracture. Most MCF expect their incoming residents to be ambulatory and able to self-feed. And even though they do typically allow a resident to age-in-place, there's an expectation that family would provide additional help in the later stages of the disease. That help is often hospice services. 

MN Chickadee

Memory care facilities will expect someone to have a dementia diagnosis. Assisted Living however will not. AL may be choosey about someone with dementia and would likely only take someone in the early stages, and rightly so. It is not the level of care a PWD would need. Memory Care as a term varies by state as to whether it is licensed as an enhanced AL or skilled nursing or other but generally the memory care umbrella is your best bet, they will have a higher staffing ratio and better training in dementia. You will want to ask about staffing ratio and dementia training as you evaluate them, they are not all the same. During the intake process they do request official medical records. They usually require the person's physician to sign off as well as sending complete medication orders. They will ask all kinds of questions to determine how far along the person is, their symptoms, behaviors, preferences etc. Some people are more challenging than others. One may require little assistance right now, maybe just being escorted to meals and reminders for showering. Others may need help with everything from toileting to feeding. So they want to know up front the person's needs to make sure they are staffed to the right level for their residents. As for fees, this varies by state and company. I had my mother in two facilities. One had 3 tiers of care, and as her needs moved up these tiers the charges increased. Needing help more with ADLs and number of medications per day moved you up. The rent was a separate charge, perhaps because of state law. I know we were able to apply for a renters tax credit on her rent portion. This can also come into play if a person leaves the facility for a while, for hospitalization for example. Sometimes they will only charge you the rent then since they are not needing the care portion for an extended time. This would all be spelled out in the contract. The other place we used was just a flat fee for everyone, and it was higher than the first place that had levels. You may find a variety of fee structures as you research different facilities.

CarolynATL

The facilities I looked at had both AL and MC because I wanted to be to transition dad within the same facility.  My dad had the formal diagnosis, which I shared because they need to know what services he'll need.  They also do an in-person visit to assess his abilities, and that gets done quarterly.  For our area, the AL side was tiered based on needs (medication management only, help with bathing, etc.) and there were 4 tiers.  Once he moved to MC it's a flat price whether he just needs medication or full service.  The 2 facilities he has been in had both actively tried to keep him in AL as long as possible before moving him to MC, so additional revenue wasn't their motivation.

I hope that's helpful to you.  And best wishes in finding the right place for your LO.  It's a stressful process for sure.

calmmorn

harshedbuzz, MN Chickadee and Carolyn ATL, thank you so much for sharing your experiences. I apologize for the late reply as well. It has been a rough few weeks with mom. The information you each provided is so helpful and has made this road a little less scary. Thank you!