SNF vs MC

Jeanne C.

I'm curious about the difference in the level of care between a skilled nursing facility and a memory care facility.

I think my confusion is because MC counts as assisted living and I'm concerned that's not sufficient. My husband needs help with all ADLS and must be supervised at all times. To get him to eat, I need to prompt almost every bite. He's in diapers full time. And he sleeps easily half the day. Is that appropriate for MC? In order to qualify for longterm care Medicaid, he was determined to need "nursing home level of care" and that was 4+ months ago - he has progressed a lot since then.

I feel like I should know this by now, but I'm really not sure.

M1

Jeanne, a lot of state Medicaid programs including mine do not cover MC or AL at all, only SNF. Anand they make it pretty hard. To qualify for a SNF there generally has to be a skilled need, such as needing wound care, catheter care,or use of GI tubes. You might google the phrase nursing home level of care in your state to see what you get.

I know you have been pleased with the home Medicaid benefits, this might be something you can discuss with the care coordinator too.

wizmo

MC is a specialized form of AL with focus on dementia - Alz and other types. MC facility usually is licensed as AL. They can handle ADLs, incontinence, whole range of cognitive deficits. They usually can keep going to end stages and hospice can take over without leaving MC. Staffing at MC is lower skilled caregivers; some have only the most basic credentials and correspondingly low wages. I was told by several MCs I visited their tipping point is ability to feed; they can do pureed foods and spoon feeding but if it gets to feeding tube then it is move to SNF or bring in hospice if not already engaged. Ours can administer oral meds but not most injectables except simple ones like insulin.

SNF is a higher level of care that can handle same as MC plus all kinds of more complex medical issues, surgical rehab, and more drastic measures to prolong life if that is what family desires. They will have more nurses and higher skilled staff, and usually cost more but both have a range and there is some overlap.

I have read that in most places Medicaid pays for SNF, not MC, and to qualify you must have some higher level needs that necessitate facility vs. home care.

ICalE

For Medicaid in Florida my understanding is that an ALF and MCF are treated the same, which means that it would be the Medicaid Waiver program and would pay for the medical component of the bill, not the room and board component (ALFs and MCFs usually split these on your monthly bill so that Medicaid can pay for the medical portion). In South Florida this translates into Medicaid paying about 25% or so of the total monthly bill given the current average rates.

As far as ADLs I think MCFs assist with all of them from what I can gather. My Mom is currently at an ALF under hospice care and gets assistance with all ADLs. She got to this point after being admitted to the ALF, so the ALF said she could age in place as long as hospice can help bath her and so on a few times a week.

For long-term care such as a nursing home my understanding is that my Mom would now qualify for such Medicaid since she cannot do any ADLs anymore even though she does not have an additional medical need such as requiring a feeding tube; the loss of the ability to do any ADLs is sufficient. This type of Medicaid is coded as ICP for Institutional Care something something, and requires some medical or hospice assessment to be submitted with the Medicaid application.

If already on Medicaid Waiver at an ALF or MCF, then I'm not sure if it's a whole new Medicaid application to get into the Medicaid ICP program or just an update like a change-in-circumstance or something.

Jeanne C.

Thanks, all.

@M1 yes, I'm pleased with the support we're getting. I'm trying to think in terms of "what if" - like what if I become ill or what if I can no longer care for him at home. It feels like each step of this awful situation has been jarring, so I'm just trying to plan ahead.

@wizmo Interesting that feeding is often the line. He made his wishes clear in his advance directive about drastic measures, so that's one issue off the table.

@ICalE thank you - very helpful info. Medicaid here in Delaware is similar to what you described in Florida.