How to Know if Skilled Nursing Center/Nursing Home is Better than MC

valerieorr

Mom ended up in a skilled nursing center for rehab about 4 months ago.We didn't bring her back home because we felt it safer for her at the center. Each wing has a nurse, doctors and PA's, dentist, xrays, etc. are available there if necessary. Since she's been there she has become too weak to walk and is in a wheelchair most of every day. Diapers are being used because she won't always go to the restroom with the support of two CNA's to use her Depends. She has fallen several times because she will stand up from the wheelchair and either lose her balance or get tangled up in the footrests. The Director of Nursing said we should take her to a MC as they weren't really trained and appropriate for those with dementia. From my observations, they have quite a few residents there that have dementia.

Should we look into MCs again now that she's on Medicaid? I really don't know that she'd receive better care as they don't have nurses there 24/7, dentists, etc. We'd also have to provide her a hospital bed because she is a fall risk from trying to get out of bed and has fallen several times. they currently lower or raise her bed and have foam mats around it. there are a number of things I don't like about the nursing center, but I am not convinced it would be any better for her at MC.

psg712

The question that comes to my mind is: what skilled nursing need does she have that requires nurses and doctors on hand daily? MC aides are normally trained in dementia-informed care. Of course every MC is different in the extent of needs they can accommodate.

Hospital beds can be rented and billed to Medicare. That said,.many states have laws that prohibit care facilities from using side rails on beds. In my state they are considered a restraint. If your mom tries to get out of bed, rails up can make injuries more likely as she tries to go around or over them.

DotBern

There are nursing homes that have memory care units that are kept locked for safety of the residents. The staff in the memory care units are trained in dementia care. Skilled nursing is usually only for those having a temporary health issue. It doesn't sound like she needs to be in a skilled nursing facility. My aunt is in a nursing home but a separate wing called memory care for those with dementia.

harshedbuzz

@valerieorr

In order to figure this out for your mom and those who love her, I think you need to explore what care means to you.

Your mom has dementia which is terminal and progressive. She's not going to get "better" no matter the skills set of the care-team around her. You haven't mentioned any medical need that requires skilled nursing care like the need for IV medications or wound care.

Many MCFs do have affiliated doctors, dentist, podiatrists, etc. who make calls to the facility and limit the need for transport for routine medical care. Dad's MCF had very low beds for their residents unless hospice or a family wanted a hospital bed. But the reality is that most PWD at your mom's stage need custodial care— the same level of care she might get from family or minimally trained home aides.

A MCF does come with some bonuses. Staff should be trained in dementia care and in their roles because they chose this kind of care over a SNF or hospital. Programing and design would be dementia-informed and more appropriate to the needs of a PWD vs someone who is old and just physically ill. There might be failure free activities depending on her stage. It should be less expensive as well. If mom is self-pay, she'll likely have the privacy of a single bed ensuite rather than a shared room.

One caveat. Most MCFs only accept residents who are somewhat ambulatory and able to self feed. If she doesn't meet that criteria, she might not be offered a room in a MCF. An illness or fall can take this option off the table, so you might not want to wait if you want to make the change.

My dad spent some time in a SNF after a hospitalization and went into a MCF a few months before he died. The SNF was a 5-star facility and very nice, but the MCF was better for his needs with dementia. The spaces were smaller and calmer. He slept better in his own room vs shared. There were activities; he enjoyed the musical programing and the weekly "take-out" activity of things like pizza, fast food and Chinese dinners. They also had a weekly outing for those interested that might include lunch and some shopping or a visit to a local park.

HB

sandwichone123

SNF is great with medical needs: feeding tubes, catheters, wound care and the like. They are less good at providing activities, encouraging patients to do what they can (SNF will dress the patient efficiently, MC will encourage the patient to participate to the extent they are able—that type of thing). MC staff are more likely to be patient with the annoying behaviors of dementia. In my experience, MC staff are also more likely to promote mobility vs. putting them in a wheelchair because they require extensive assistance.

These comments are based on my experiences, not on official recommendations.

valerieorr

thank you! we will check with the MCs again to see about availability and best fit for her. Appreciate your comments greatly!