Skilled Nursing Facilities

LaurCT · January 6

Many of us could write a book! I have been a caregiver for my brother for the past year when he 'crashed' with Dementia. He's been diagnosed with Frontotemporal Dementia. He was repeating himself for years but 1500 miles between us made me quite in denial I guess of how he was progressing. In september '22 I flew to him because I was concerned, we found him very well, actually he took us everywhere and was happy, by december '22 he had lost his way and was in a hospital. I stayed with him and sold or gave away all his stuff. He now lives near me in an Assisted Living Memory Care private pay facility until he runs out of money by the end of this year. He has 'sundowning', it was always directed at me until recently. He's aimed at a staff member and 2 other residents lately. I could go on about the MC not doing it's job but I think this would be part of the 'book'.

I've decided to look into Skilled Nursing Facilities that will be more appropriate for him. A few won't take him, because his 'sundowning' wasn't being managed, so he wasn't stabilized. for a couple months I've demanded from his current location a Phyc evaluation. Finally they've done it AFTER I took him back to neurologist that told them to do so. He now is on medication management so hopefully I can find a facility that will evaluate him and take him. This is such a horrible process. I now have to research every facility, try to figure out why their ratings are either questionable was it 1 incident? 10? we all know the SNF aren't all that great but there really is no other way. UGH

What have y'all done to make sure you got the best one for your LO?

easy23 · January 6

In addition to the Medicare website, I would read google reviews; many (not all) states now have their courts online with free searches. You could search for lawsuits filed against the nursing homes. To find online courts google search: (State name) online courts.

Good luck!

harshedbuzz · January 7

If he's going to run out of funds, does his current MCF plan to accept him for a Medicaid bed? The money situation is going to make this harder as many places operate under a business model where you pay out-of-pocket for a couple years before Medicaid.

Sundowning is fairly common and unless he's violent, should be something a MCF can manage. If he trends towards aggression, a short stay in a psych hospital for medication management could improve his behavior to a baseline where he'd be fine where he is. Otherwise, the social worker at the psych hospital could assist in finding another placement. A SNF is going to be a lot more expensive, and he'll likely share a room which could be more difficult than being in a MCF. Another downside is that if he takes advantage of the activities at the MCF, it's unlikely a SNF would offer the same level or quality of programming.

If he is a veteran, I might look at a state veterans home. I found the one I toured to be exceptional-- the staff were nonplussed by difficult behaviors and maintained an atmosphere of calm.

It sounds like he's at quite a distance; is there any way to move him closer to you?

HB

MN Chickadee · January 7

Honestly if he doesn't require actual skilled nursing for complex medical (physical) needs I'm not sure I would choose that unless it's the only way you can get a Medicaid room. The licensing can vary a lot by state. My area has high acuity MC that aren't quite SNF but are a hybrid of the quasi-assisted living style MC and a SNF. The training and skill level of the staff can vary widely by facility in terms of how able they are to handle challenging behaviors. A good MC will be able to deal with sundowning. A stay in a geriatric psych in-patient wing of a hospital may be in order to get his behavior under control and give you more options as to what facilities would accept him. I would seek out support groups in whatever area you are moving him to, they may have feedback on certain facilities. Usually word of mouth from other families is the best indicator of how quality a place is over Medicare ratings (which have a huge self reported factor where facilities fudge their stats and can be very inaccurate.) When I toured places I hung around in the parking lot and asked families who were visiting their opinions of the place. Asking on a local Reddit page or Nextdoor or similar as to what people recommend may narrow your list of places to focus on. Good luck.

LaurCT · January 10

https://alzconnected.org/discussion/comment/193881#Comment_193881

He now lives near me about 10 minutes down the street. The MC does not transition into a Medicaid pay, It's all private pay. I am learning as I go. when I did research the AL-MC places all told me that I should keep him in MC until about 3 months left of his $$ then transfer him over to a SNF. Of course they tell me that for the $$. SNF around here is about 13k a month for self pay and the ALMC is now 11,500$ a month so not much different and as the SNF said the money has to be spend down anyway.I now know that SNF also like that self/private pay while you apply for Medicaid and unlike the AL/MC they cannot throw him out of the facility, which I don't know what that entails - putting him under a bridge with a cot?? What Al/MC neglects to say is the wait lists for SNF is 2-3 years. some will bump you up the list if you have $$ but others will not. I'm sick over it

Yes his sundowning has been aggressive that is why I was demanding they do something. He's been on Medication Management for about 10 days now and seems a bit better. At least if that is managed then it's one less for me to worry about.

thanks for your reply

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