Trade with someone living in Nashville?

sdepolo

hi there this is my first post and I’m so grateful to be here and for this community. My dad has recently been diagnosed with mild cognitive decline though once he quit drinking, I’m hoping he gets that diagnosis revisited.

I’m exploring alternatives to the horrific options that I see in terms of forcing him into memory care eventually, as recently my mother who has been caregiving for him over the last year suffered a traumatic brain injury herself, and is now in need of significant rehabilitation with a lot of uncertainty about how much functionality she will recover in the future. I live in San Francisco and my sister lives in Singapore so we are really scratching our heads trying to figure out how to assist them and Nashville given the complexities of navigating Medicare and skilled nursing facility premature discharge and what not.

so I have a idea and I’m putting it out here and everywhere I can find: if I could find just one family who has a loved one somewhere in the San Francisco Bay area, but who themselves reside in the Nashville area perhaps we could do a trade and I could check in on their loved ones while they check in on my parents.

I know it’s a longshot, but I’m just just putting it out here to see if any of you have connections or ideas around this experiment I am proposing. My mom is staying at a skilled nursing facility and old Hickory Village just outside of Nashville and my dad is in a private home in Hermitage, I’m not sure when they are going to discharge her but sending her home might be her best option even though she’s a fall risk because none of the assisted living facilities in the region are acceptable to us.

I’m at my wits end having explored many different options and not finding any solutions that are acceptable so fingers crossed that this leads me to my dream solution. I’m open to any other suggestions and curious if any of you have found somewhere that is better than assisted-living once you’re being kicked out of skilled nursing in the Nashville area.

Thanks and blessings to you all,

Stacey

towhee

Hello sdepolo, welcome to the forum. This particular group, "Caring at a distance" gets very little traffic, you might want to also post on "Caring for a Parent". An idea here could be a geriatric care manager with a nursing background, one should have the experience and knowledge to be a local advocate for you. They can be pricey, but the right one should be worthwhile. Another information source should be the Area agency on Aging and Disability, specifically the long term care ombudsman. https://www.tn.gov/aging/resource-directory/aaad.html What you need seems to be above the level of a friendly check in visit. It is hard to tell what level of care your mother may need, as she is hopefully still recovering.

Are there specific problems with the assisted living facilities in the area, or just the general concept of AL?

sdepolo

Hi Towhee,
Thanks for the reply and info. I'll post in the Caring for a Parent" board next.
I am in touch with the Agency on Aging and the woman Holland there has provided some resources.
I am awaiting the longterm care ombudsman call back after having applied to get their help.

Mom currently needs 25-50% assistance with activities of daily living and at least one or sometimes two people to assist in sitting/standing. She's getting better at bathrooming, but not completely in control, yet.

The SNF where she is keeps insisting that the standard for her discharge should be whether or not she is improving. Today they said that her progress is very very slow and that they have to show improvement or she'll be cut off by Medicare. When I pressed them they said that her cognitive deficits prevent her from being able to maximally benefit from therapy. However, they won't give her neruopsychological evaluation or Cognitive Rehab Therapy beyond minimal speech therapy daily.

but my research indicates this is not the correct standard.

According to https://downloads.cms.gov/medicare/Your_Resident_Rights_and_Protections_section.pdf "You do not have to improve to qualify for Medicare coverage!
Restoration potential is not necessary. Medicare coverage “does not turn on
the presence or absence of a beneficiary’s potential for improvement, but
rather on the beneficiary’s need for skilled care. Skilled care may be necessary
to improve a patient’s condition, to maintain a patient’s current condition, or
to prevent or slow further deterioration of the patient’s condition.” CMS
Transmittal 179, Pub 100-02, 1/14/2014; Medicare Benefit Policy Manual,
Chapter 8, Sections 30.2, 30.3. See also, 42 CFR § 409.32(c).

The family has researched the Assisted Living facilities in the area and they all seem to suffer from poor staffing ratios and are horrifying. I've learned that only the state of Oregon has passed nursing home staffing ratio requirements so I hope to entice them to move there. It's a hard sell.