Rehab to Memory Care

daughterheather

Hello, my mom is 77 and has advanced dementia. She has been living in memory care since this past March. She had lived alone for 20 years but was getting progressively worse, then couldn't stand up, ended up in the hospital last Jan. Then rehab for 2 months where she got better physically. The Dr's there thought she needed 24 hr care and she had money issues (can't afford 24 hr aides), and my brother and I can't take care of her. We sold her condo and she moved to memory care. She hated it for many reasons,but after 6 months I think, finally adjusted. It's not perfect. However, she can't afford most places in the area, and at least she's very close to me. Anyway, last week she fell and broke her hip. Now she's in a rehab, hopefully for only a few weeks. Her memory is getting worse though, and she was so aggressive to a roommate that she had to be moved. She did something very disturbing which I won't go into. I've heard about hospice, but she can still eat and talk. She can't walk because of her injury. She's having problems showering. Can she go to a hospice facility? It's heartbreaking to see her like this. 😔

terei

Only the Hospice orgs can give you that info. It is very rare that people are accepted into ‘in house’ hospice and that is usually for a very brief period of time when someone has a critical aggressive terminal physical illness.

I would be looking into getting Medicare coverage at the MC. Talk to the rehab place and the MC facility first about this and then go from there

terei

correction. Medicaid coverage, not Medicare

daughterheather

https://alzconnected.org/discussion/comment/262664#Comment_262664

Thanks. At my mom's MC you have to private pay for 2 years before going on Medicaid. My mom has enough to live there for a few years. She hasn't even lived there for one yet. I just hope that they can help with her increased needs after the rehab- showers and moving around. They're supposed to do that there, but until now my mom's been active and walking. They are not good at communication with me and my brother. We'll see. I think living at the rehab full time is over 10k a month instead of the 7700 we are currently paying at the MC.

Thanks for listening.

SDianeL

many times trauma causes a decline in PWD. She may or may not return to her baseline. Ask for a hospice evaluation. They may accept her because she has a a terminal disease. They offer so much help but not 24 hour care. If she is having behavior issues and aggressiveness ask for her to be put on medication to calm her and control her impulses.

AmandaF

I would ask the MC facility if there is a hospice group that could come see her where she is (either rehab or MC) and evaluate her to see if she qualifies. My understanding is that qualifying for hospice can be a little different for dementia patients, since it’s considered a terminal illness itself. My mom also broke her hip and can no longer walk, though she still eats and talks, and she qualified for hospice. They come to her at her MC facility five days a week to check on her, help with showers etc., and have been great. Medicare pays for hospice.

I might also see about speeding up her return to MC - she’ll probably do better behavior-wise if she’s back in a familiar environment, especially if you can get hospice on board to help out. Good luck, I hope you figure something out.

daughterheather

https://alzconnected.org/discussion/comment/262698#Comment_262698

Thanks. I actually want her to stay at the rehab longer because I think they're taking better care of her, but it's the plan to release her when she can walk well again. My brother is power of attorney so we make decisions together. I'm much closer to her emotionally and lives 5 minutes away so see her more often. I'm a very anxious person and feel responsible for everything for her. I didn't realize that hospice services came to memory care.

harshedbuzz

@daughterheather

It would make sense that you perceive her getting better care in rehab. That's because it's the level of care she'd likely get in a SNF. The number of staff to patient is greater and there would likely be an RN on site. The trade-off is the loss of dementia-informed activities and staff training usually.

My aunt who was well funded, moved into a SNF the final 3 years of her life for the extra attention in stage 6-7. In MC, they prompted her to brush her teeth and might do a hand-over-hand assist. IN the SNF, they brushed her teeth for her.

Hospice services are funded by Medicare if she's approved. These can be offered in her current MCF (or at home for those who are at home with a spouse or child) or in a hospice facility. Hospice facilities are often used by folks who need around the clock nursing care for comfort. Medicare does fund the hospice portion but the patient pays out-of-pocket/Medicaid for the room & board portion of the cost.

HB

daughterheather

https://alzconnected.org/discussion/comment/262705#Comment_262705

Thanks. My mom barely does any activities at her MC. They're very limited. The staff there barely talks. I know they're overworked but they seem miserable and are not helpful. They basically just clean her room, do the laundry, and give her meds and meals. Maybe another MC that she can afford will open up.

Anonymousjpl123

@daughterheather it is so hard at this stage. Your mom needs both a safe and hopefully caring environment for her dementia, and of course the help with all ADLs. My mom’s last MC was a lot like you describe. It was very very hard for her. I wound up having to move her (they couldn’t handle her needs) and her new place is much better. One major difference is staff being authentically engaged and not sitting on their phones. Ironically, it’s less expensive than her first one.

If you have options near you, I would look at other places just to see what they are like. And if her MC is the only/best option, at least you will know that. Treats, visits, cozy blankets: I believe it all helps.

Also yes, hospice does come to MC facilities and can help a lot. It’s so hard. I wish you and your brother luck in this transition. Keep us posted.

tboard

https://alzconnected.org/discussion/75013/rehab-to-memory-care

It is difficult to get a person with dementia into hospice. The doctor wouldn't even allow my DH, also 77, to be evaluated for hospice because he isn't having trouble swallowing and is eating and walking. He has all of the symptoms your mother has. He has been living at home until last week when he was hospitalized. He is now in a transitional care unit where they are experimenting with medications to reduce his anxiety and anger. He has also been violent and very hard to take care of.

terei

Unless you have some sort of state law that mandates that a doctor approve hospice, (which I have never heard of) you do not need a doctor’s approval to have a hospice org come and assess your LO with dementia. It is NOT difficult to have a PWD helped with hospice services. They come into the MC facility with aids, nurses, etc. There are very few people who actually are IN an inpatient hospice facility, but they can be under hospice care in your home, or a facility.

If your LO is losing weight or cant walk, refuses meds or food, has outbursts, or other uncontrolled behaviors, excessive sleep or many other symptoms, there is no harm at all in having them assessed for hospice services. If they are not approved, they should be able to explain what symptoms to look for for future assessments.

MN Chickadee

I would call a couple hospice agencies, they will come to wherever she is living and evaluate her. If she doesn't qualify today they will track her and check in every couple weeks. If she is losing weight that may qualify her already. They kind of look at a combination of signs of decline such as weight loss and losing things like mobility and language. Many MC facilities see people through to the end so maybe the current place will work at least for now. Your dear mom may not recover to the point of walking. Unfortunately a broken hip is very hard for a PWD to overcome. Not sure what that means for rehab discharge. I'm sure they still have to be able to prove she is benefitting from rehab for medicare to pay it. FYI there will be out of pocket expenses after the first couple weeks of rehab. Medicare pays for the first 20 days in full and then there is a daily co-pay. I believe it's around $200 per day, so make sure you factor this into her financials for this month. After day 20 they get antsy about discharging people because so many have a hard time affording the coinsurance. Hopefully either facility has a social worker who can help navigate her discharge. They cannot turn her out on the streets and they cannot make you take her home, they have to find a place for her. If the current facility cannot take her back you will have to work fast to find a new one but they have to send her to a safe place. Good luck to you as you move through this. I know it's a lot.