Memory Care and Outpatient Assisted Living

jdawg206

Hello,

Wondering if anyone has experience with a parent/spouse/LO in memory care needing to be critically hospitalized (in our case pneumonia and atelectasis) and then discharged to an assisted living facility to recover that's not their memory care home.

Wondering more about the logistics here: what is the typical experience for the resident and family: do we simply keep paying for the space (with the understanding we'll be back in 30/60/90 days)? Is there a time limit? Does the fact we have to put my mother into an assisted living facility signal a red flag that the memory care needs to better staff up for RN assistance? (Last point slightly editorial but I do have to wonder why we can't just bring someone in to help with this.)

Sorry - couldn't see any earlier threads that might have mentioned this and I'm talking this over with family as to the best course of action/what's fair and equitable to us as customers + resident of the memory care facility.

harshedbuzz

@jdawg206

This is a fairly common occurrence.

IME, what usually happens is that the PWD is released from the hospital to a SNF/rehab on a Medicare-qualified rehab stay. I have never personally heard of someone being discharged to an AL for recovery rather than their usual MC. Transportation van is arranged by the hospital's discharge team to the facility. This is one of the reasons everybody 65+ should have a mental list of their top 3 SNF/rehab facility choices in their back pocket.

Once in the rehab unit at the SNF the PWD will stay for a negotiated time assuming they are capable of participating in their rehab and are hitting certain benchmarks around improvement towards their baseline. Often, these stays aren't very long. There's an old saying that a day in the hospital for an elder takes a week of PT/OT to recover from but most folks don't seem to get that much.

I don't think you'll need to worry about 60 or 90 days. You will be expected to hold the apartment or room while LO's in the other facility just as you would pay rent on an apartment or your mortgage if you found yourself hospitalized.

A friend's mom (no dementia) had pneumonia and a fall and was discharged a week out. Another friend's mom broke a hip and had 4 weeks in rehab. Here situation was a bit different in that she lived in a CCRC with a waiting list, so even though she was paying her monthly fees on her IL cottage, the non-profit that ran it gave her a 2 month deadline to be able to return to IL or find herself turfed to AL or PC instead. The company would have been happy to re-sell her unit to a new resident for a higher price than she'd been paying. My dad got 7 weeks of rehab; my mom has exceptional medical insurance.

You said: "Does the fact we have to put my mother into an assisted living facility signal a red flag that the memory care needs to better staff up for RN assistance? (Last point slightly editorial but I do have to wonder why we can't just bring someone in to help with this.)"

I don't think so. IME, and this may be specific to the states in which I have had LO's placed, MC is a residence not a sub-acute medical unit. It's custodial- not medical care. It's a more like being at home-- you need someone to keep your LO safe, fed, helped with ADLs (dressing, hygiene, toileting) and engaged with social programming that is appropriate to their level of function. It's probably not a popular outlook, but I think of it rather like having a babysitter or day care for a child- you want them safe and engaged. You would trust the the caregiver to dispense a Tylenol or abx prescribed for an ear infection. It's not a task for whom someone would insist on hiring an RN.

FWIW, dad was in a very nice free-standing MCF. He had excellent care. There wasn't a single RN in the building. Even the DON was an LPN working on a BSN; they had 5 LPNs to cover 3 shifts with days off. If there was a medical emergency, 911 was called. If a patient had an emergent medical issue, the nurse would call in the affiliated geriatric specialist.

That said, sometimes families do hire additional medical staff for their LOs who need a level of care beyond what is customary in a MCF. I saw this happen at dad's MCF when a resident had ambulatory surgery and returned to the MCF as they would not have qualified for a Medicare funded rehab stay.

HB

jdawg206

Thank you so much for this insight! It's invaluable and I'm sharing it with family. The good news is that she got a tad well enough to leave and also that we're able to take her back to MC and have an OT come in and work with her to get her moving again. It's slow progress but she's been doing a lot better considering.

mommyandme (m&m)

Thanks for your update, good news!