AL or MC

*Ollie*

What made you choose one over the other?

We've been visiting AL facilities and MC places and one day think she'd do better in AL and the next day we think MC.  She's in that in between stage of dementia.

The MC places in our area we've visited house people who are pretty impacted by dementia.  My mom can still get herself ready in the morning and can do most ADLs on her own. AL seems too independent for her though.  Not sure she would be able to get to the dining room on her own. for example, and would need lots of help navigating the building because her memory is not good.  

We've found great AL facilities but the MC portion of the places are either not good or they don't accept Medicaid once her funds run out.

Do we go right to MC or put her in AL and then move her to a different MC place?  Of course the ideal would be the same facility but we have not landed on that yet after touring 12 places.  

JJ401

*Ollie* wrote:

What made you choose one over the other?….

We've found great AL facilities but the MC portion of the places are either not good or they don't accept Medicaid once her funds run out.

Do we go right to MC or put her in AL and then move her to a different MC place? 

Since this is a progressive disease that does not follow a predictable path, I think you have to consider her worst day when deciding (as worst will become usual).

If you chose AL with the intention of moving her later, and know she will eventually require Medicaid, check the facility requirements carefully. The best Medicaid accepting facilities here accept Medicaid after a certain number of months of self pay. 

AZ-daughter

*Ollie* My Dad was in between as well. It was very hard to decide without something pushing the decision and it created a lot of stress and guilt. He was also doing most ADLs. The staff at his facility have been amazing and constantly check in on him and prompt him for meals or showering. I didn't think he would ever go down to the dining room on his own, but amazingly started doing it after 2 weeks and he has NO short term memory. I think if you can find a great AL facility with staff willing to assist it could work. Many AL's expect your LO to do everything but meds and cleaning. My Dad has aggression issues which makes it harder than it needs to be. I dread the day he needs to move to MC because he will be very angry being locked in. Depending on what stage your LO is in, MC may seem cruel but in the end save them from a traumatic 2nd move when they are even more confused. Many others on this board will urge MC for this reason. Unfortunately it really depends on each unique individual. Best of luck to you and your mom.

harshedbuzz

The short answer-

If you have to ask, you already know the answer.

Some thoughts:

Most ALs follow a hospitality-model. Think a hotel for elders who don't want to cook and clean. Would dad do OK if you dropped him off at the Hyatt for a week?

While it is hard to see your parent in the context of people who are further along on their dementia progression, MC is probably the safer bet. The staff there should be well trained in validation and other strategies to provide a setting that feels safe for him.

My cousin made the mistake of placing her mom with dementia in AL. She didn't realize how much scaffolding she was providing at home in terms of prompts and assistance and had a rosier view of mom than was realistic. It was a problem almost immediately. The other residents quickly surmised that aunt had had a cognitive shift and were quite unkind- lots of middle school mean girl stuff like not letting her sit with them at lunch. My aunt wasn't oriented to time and lost weight because she missed meals; the AL allowed folks to come and go or prepare something in their own little kitchenette so a person who didn't show for a meal was presumed to have made a different choice. The facility did a daily check on residents in the evening as part of their medication round rather. My aunt suffered a fall and broke her hip and wrist which was not realized until she was found one evening. They think she fell sometime in the early morning hours as she'd not come to meals that day.

HB

Suzzin

We are at the same junction with my parents. For now, they are in an IL to AL place (that doesn't provide MC) with supplemental carers in the late afternoon when they seem to sundown. Our next move will be to a facility that offers AL to MC, which is meant to help with that transition. The AL apartments only have a fridge and a sink, you can bring your own microwave but there's no stove. Everyone is trained in dementia care, and they will provide assistance with meds, bathing, directing to the dining room etc. They say the biggest dividing line is if they wander/try to escape.

Anonymousjpl123

Similar to Suzzin, I found a place that has both AL and MC. What I truly appreciate is that probably 75% of the people at her facility have memory issues of some kind and are at various stages. For me, this has worked well because while my mom is in AL, she has an occupational and physical therapist visit 3 x per week, she has been able to go to meals and socialize, and she loves her space. However, this works mainly because I am 10 minutes away and provide A LOT of scaffolding/support. I was terrified my mom was going to have to move in with me (we visited a lot of places that were flat out “no’s” for her). Frequent visits have been key, but truthfully we lucked out because the building staff are all trained in dementia care so we are in touch fairly frequently. For example, they do her medication management which helps a ton. They are very aware of her changing cognition and call me whenever something seems “off.” Everyone situation is different. The place that has worked for us might be terrible for someone else. You know your mom best. 

One thing that really helped: once we found a place she liked, I called the Alzheimer’s Association hotline and told them my fears/concerns. We literally went through the contract, and stages of care, to see if it would be adequate. These are the types of things to consider. My mom has some cognitive functioning left but it is declining fast. It was important for her to have some sense of independence - however superficial - and time to acclimate to the building with some autonomy and privacy. We looked at like 6 places. Mind you, moving was not her first choice but feeling like she had options helped us make it happen quickly, which needed to happen.

All of this to say you are asking all the right questions! Best of luck I know this isn’t easy.

Anonymousjpl123

Also you mentioned you haven’t found someplace with both AL and MC. If that is the case; I would truly go with MC. The AL only, without MC, places I visited were far too independent and my mom would have been lost. I would have chosen MC. 

In truth, no place will be perfect. You are going for best fit, based on your situation. Please post and let us know how you do. 

*Ollie*

Thank you all for weighing in on this difficult decision.  

JJ401 - The Medicaid issue is big and we've made sure to look for places that will take it once her private funds run out.   Do you think we should talk to a CELA to learn what our state's particular Medicaid is?   I'm wondering if I can do research and find that out myself as CELAs are pricey here - like $400/hr!!

AZ-daughter - Yes this decision is creating so much stress and guilt.  It's so difficult to be the one to make these decisions for our LOs.  We found an AL facility that we think would accommodate her needs and were thinking we'd move her in there.   They have MC there as well.   Our issue is that the MC facility is not as good as places that only offer MC which means another move.   

harshedbuzz -  I have wondered if her condition is worse than I think because of all the scaffolding and assistance she gets from us.   The facility we are considering will come here and do an assessment to determine if they think she would do better in AL or MC. It'll be interesting to see what they think. My guess is AL because she is not a wanderer as Suzzin had mentioned being the dividing line.  

Suzzin - The place we are considering sounds very similar and it also has a MC part.   Our issue is that the MC facility is not as good as places that only offer MC which means another move.   

Anonymousjpl123 - I wish my mom could be involved in making this decision but she can't as she is completely opposed to leaving our home.   The facility is close and we understand that her moving won't be the end of caring for her but it'll take the intensity and need of her care down a few levels for us, which we need! I love the idea of calling the Alzheimer's Association and going through the contract with them.  You are right, no place will be perfect and I think I'm a bit paralyzed by this.   I so wish this wasn't just up to me but that is my reality.  

harshedbuzz

*Ollie* wrote:

AZ-daughter - Yes this decision is creating so much stress and guilt.  It's so difficult to be the one to make these decisions for our LOs.  We found an AL facility that we think would accommodate her needs and were thinking we'd move her in there.   They have MC there as well.   Our issue is that the MC facility is not as good as places that only offer MC which means another move. 

This is big concern if you don't have unlimited funding. Many facilities will have an entrance/move-in fee up front that can be close to the cost of a month's care. So if you'll be moving in less than a year, it is something to consider.

Related to this, many facilities operate on a business model that works only because their residents can pay out-of-pocket for 2-3 years before converting to one of their limited Medicaid beds. If you show up at your first choice MCF having spent all her money at the AL facility, you may not be able to get her into a Medicaid bed there as these beds are so limited. This is a real gamble. 

It's also possible that you are being set up for a bait'n'switch where a combined facility lures you in with the amenities and lower cost of AL knowing your mom won't do well there and come to you in 4-6 weeks insisting she be moved to MC when she's struggling with the care level available in AL and the loss of the scaffolding supports you are providing intuitively at this point. This happens a lot because it's really hard to get some families to agree to MC from the outset.

harshedbuzz -  I have wondered if her condition is worse than I think because of all the scaffolding and assistance she gets from us.   The facility we are considering will come here and do an assessment to determine if they think she would do better in AL or MC. It'll be interesting to see what they think. My guess is AL because she is not a wanderer as Suzzin had mentioned being the dividing line.  

It's really hard to get a sense of how she'll do until you move her. Some people seem to have a significant downturn in function with any move; my dad didn't but others swear it happens. FWIW, dad had an in-home assessment and wasn't offered residency based on potential behaviors associated with his particular diagnosis. We expected a lot of exit-seeking but it didn't happen.

That said, if you haven't seen a CELA are you certain Medicaid even covers memory care in your state? Mine does not, so if dad had outlived his assets, he would have had to transition to a SNF semi-private room assuming he met the criteria for that level of care. We also found it useful to ask our CELA to read the community contract once we decided. She was also familiar with most of the facilities in the area and was a great source of information about them. 

HB

Suzzin

Ollie, if you haven't already, please make sure you have health care and regular POA for your mom. It makes things so much easier...well, as "easy" as this mess can be.

As for the memory care in one place being not as good as in another--can I ask how you are evaluating that? If it's things like staff or cleanliness then that would probably be reflected in the rest of the facility. If it's decorations and activities, then (and I say this as someone who has had to do this myself, just about every day) remember that when your mom is ready for locked-in memory care she probably won't be making the move based on art classes or furniture. The things I thought were important to my parents when we moved them from their house to IL/AL turned out to be overblown hopes and expectations on our part. They don't care about the classes, the happy hours, the lunch outings, even the in-house church services aren't of interest to them. They like that it's clean, and the appreciate that the staff treats them with kindness and respect.