Choosing a facility for memory care

painted lady

I’ve been taking care of my mother for the past three years. Although I raised concerns to her various doctors about her cognitive problems since at least 2017, she was only diagnosed at the beginning of this year with mixed dementia (AD and VD). I am at a point where I will need to make a decision on placing her in a memory care facility, by early November. I wanted to hold off as long as possible, but I have a major surgery scheduled this winter and I need to get a lot done before then. I have durable POA and medical POA. I’ve researched and toured various places, and nothing’s quite right. She is very bitter and angry and paranoid. I think she is middle-ish stage wise. I am the only one helping her and no other family is available to do anything, so everything’s on me to get everything as right as possible.

She is very concerned about her house and all her stuff, and of course the MC rooms are very small. Also concerned about distance for friends to visit. Sadly, however, she barely ever has any visitors anyway. I know I can’t reason with her about any of this, but she insists on being involved in picking a place. Right now, I guess it’s down to two- one (call it A) looks fancy and slick, and I don’t trust that she will get good care there. Salesperson is really vague on staffing, no details on MC training, nor do I even see many residents out. Plus it’s a year long contract. The second place (call it B) is in a location that she has an irrational dislike for, thinks it’s too far from friends, also hates how small the room is. The fancy place has a bigger room and is much closer to a couple of her friends. But, again I’m concerned about what kind of care she’d actually get there. I’ve been to both places several times now. Unlike Place A, I saw lots of residents actually doing stuff outside of their rooms and the staff appears friendly and engaged. The room does look rather crummy in comparison, not gonna lie.

How to choose? I really have no one other than my college-aged daughter to hash anything out with, and I don’t want to burden her with helping me in this decision.

M1

Go with your gut. Staffing is everything. And i wouldn't discuss it any further with her, though I know how hard that is. If you have to say anything, tell her its temporary until you've recuperated.

SDianeL

What a tough decision. I will have to make this one soon. Her care is the most important thing. If something happened due to lack of care you would be devastated. You will make the right decision for her. Agree to tell her it's temporary until you've recovered and then keep making up fiblets to keep her there if you have to. Hope she likes it there.

BassetHoundAnn

As M1 said, staffing is everything. Have a sit-down with the director of nursing and ask how they train staff and to what degree they use aids from outside agencies. Ask about levels of staffing at night--how many aids per resident overnight. Ask about the number of CNAs that they have. Ask if there is an RN on duty 24 hours. Ideally they will do extensive training of aids themselves and use outside staffing agencies only in emergencies.

Will the MC allow you to put a camera in your mother's room to monitor her care?

If the facility will not address these questions with you look elsewhere.

I would be leery of any MC that required a one-year contract.

And as others have noted, if your mom's dementia is advanced enough for MC, she is not capable of making decisions like this one. It's fine to use fiblets to give her the sense that she's the one making the decision, but in the end it should be up to you. If she's not getting many visitors now, she will get fewer when she's in MC. My mom's old friends, neighbors and relatives visit her about once a year, if that. In the past year she's had maybe 2-3 visitors besides me and my husband. You should select a MC that's convenient for you to get to because you're going to be her primary visitor.

Finally, if there's a Nextdoor local to your area you should consider posting a question on there. Every so often someone posts on Nextdoor asking about memory care facilities in our town and they get hundreds of responses. Including from aids who have worked at some of the local facilities, nurses and social workers. Plus the users of Nextdoor tend to be older than users of other social media, i.e. people in the age range of those caring for parents.

Good luck. It's a tough process, a hard journey. Always go with your gut.

forbarbara

I’m so sorry you’re going through this alone. It’s not easy even when you have a village. I found my village on this forum and I hope you will too

when I put my MIL in memory care the room seemed so important - it was her new home and I really wanted it to be nice for her. But less than a year later she’s barely aware of it, because her world keeps getting smaller. It’s like her clothes - she was always very fashionable but no longer is aware of what she’s wearing. The level of care and level of activities is far more important.

I agree that fiblets are useful. Tell her there’s a bigger room but it’s not ready yet. Or that she’s on a waiting list for the other MC facility.

good luck with this. Make the choice that gives you the most peace of mind.

terei

Quit trying to get her to agree with your proposals. Tell her ‘this is what is available now’ + as soon as there is something better or different or closer, you can make a change. Plan the move + take her there … a done deal. it wont be very long before she has little interest in her surroundings.

Don’t move much into the apt…only ‘explain’ if she insists on one. ‘We cant move all of this more than once’. ‘as soon as the other place is available, we can move whatever’

Choose the place that you feel has the best care + is most convenient to you. Trying to appease a PWD is a never ending, fruitless effort.

harshedbuzz

@painted lady

Your mother no longer has the cognitive bandwidth to make so important a choice, so it's best not to engage with her further around this.

One thing you didn't mention is whether your mom could potentially need Medicaid as a safety net should she outlive her money or her LTC insurance. In many places, MCFs operate using a business model that depends on residents paying out-of-pocket for 2-3 years before converting them to a Medicaid bed at a lower monthly rate. To that end, if this might apply to you, (I suspect the slick'n'shiny hard-sell facility doesn't accept Medicaid) I wouldn't tour places that don't take Medicaid.

Beyond that, I would prioritize the staff-- are they well trained, are the paid relatively well to insure staff retention, how is staff scheduling done (Dad's MCF split weekends so he always had one of his 2 familiar caregivers on the first and second shifts).

We moved dad in under the guise of him needing some PT to get stronger. To that end, we didn't knock ourselves out moving all his stuff to the MCF. I decorated as one might a chain hotel room. For his sake and ours, we wanted him to feel like this was temporary rather than his new home.

HB

LJS45

My mom is in her 4th memory care facility. She was initially placed in a brand new beautiful facility. It was understaffed and she had multiple falls and transports to the ER. The 2nd was a RCF and that did not work out with the staff there. The 3rd was another RCF and she was fine for awhile there, but then staffing issues became a problem and my mom was being neglected developing bed sores and not being changed. The 4th is a RCF and it is a husband and wife team that are absolutely wonderful. STAFFING IS EVERYTHING. Forget how new or pretty the facility is. Your mom will eventually adjust. And as others have stated I would not discuss it with her any longer. Good luck to you going forward.