Move from AL to MC?

livefree2 · May 15

My mom (94) is in a wonderful AL she has COPD and is on oxygen support. Mom has short term memory loss She can’t remember if she ate, what she ate, or who visited that day But …she remembers family members

The problem: she is refusing showers, hair wash, changing clothing, going to dining room and has become incontinent. She will only do those tasks if a family member (me or cousin) is there to talk her into it. We cannot be there everyday. Usually am there 3 days/week with no help from other 3 siblings. Thank God her cousin comes at least 1-2x week Her case worker assured me that they can take care of her as long as she is not wandering or violent They take care of many dementia patients

However it’s getting harder and harder to keep her clean. If I go out of town to visit my grandchildren, she will remain in the same clothes till I get back I don’t think she’s showered in a month.

Question: is it time to move Mom to MC facility which is further away? I’m afraid she will feel like we abandoned her. I don’t want her last place on earth to be a lonely one. How much more care will a MC facility have that’s different than the AL?

Thank you!

fmb · May 15

Have you considered enrolling her in hospice care? One of the services they provide is a bath aide who will come in 2-3 times a week to give a shower (or bed bath if unable to shower) and provide other hygiene assistance. This aide is also trained to spot skin problems (beginning bedsores, rashes, etc.) that are brought to the attention of the hospice nurse for treatment. My DH's bath aide can persuade him to accept assistance even when he won't cooperate with the AL aides.

livefree2 · May 15

I didn’t know this was available. Will the AL facility know how to contact hospice care? Does it have to be authorized by a Dr?

She also has very bad cradle cap. I’m hesitant to try and treat it by myself because she will scream like a kid when I try to cut her fingernails. So I’m afraid to tackle the cradle cap.

Thanks so much! I wish I knew about this forum a year ago when I was tackling the Medicaid and application process for AL !

M1 · May 15

You do not need a doctor's order for a hospice evaluation, you can call yourself. However, you might check with the AL administration about whether they work with hospice routinely. They may not be willing to let her "age in place" if she is not able to accomplish her activities of daily living independently; for example, they may not be willing to take on incontinence care. If that is the case it would in fact be better to move her now. That is likely to be the necessary outcome. A memory care or skilled nursing facility is going to be more focused on assisting residents with ADL's than an assisted living facility.

livefree2 · May 15

https://alzconnected.org/discussion/comment/209203#Comment_209203

Thank you for the info. Her AL strives to keep everyone until they can no longer walk and need a two person lift. My mom walks better than me! It’s just her self care and her automatic response to everything is no. I am learning so much on this site. Everyone is so very helpful. I love reading everyone’s stories and how they are managing and coping.

psg712 · May 15

The changes that you are describing are things that led my mom to move from AL to MC. Things like meal prompts, showers, incontinence care are included at MC and the staff is used to handling refusals. These things were extra charges in AL, and there was still no guarantee they'd get done - there just wasn't the staffing for them.

fmb · May 16

https://alzconnected.org/discussion/comment/209197#Comment_209197

The AL facility can tell you which hospice agencies they have contracts with, but that does not necessarily limit you to using only one of those agencies. No referral is needed, you can initiate the process. I would suggest talking to more than one agency to find out their philosophy and exactly what services they provide. When you choose an agency, the hospice intake person will walk you through the admission process, including getting the necessary physician authorization. I signed the papers for DH's hospice admission the same day he moved from rehab to AL (the day before Thanksgiving). By evening a hospital bed was in place, and the hospice nurse evaluated him the two days later (the day after Thanksgiving). Services started almost immediately.

In considering a move to MC or a SNF, check which hospice agencies they use. A SNF should have no problem with your mom's health needs, but like AL facilities, many MC facilities are not equipped or staffed to deal with higher levels of care. DH's AL facility provides higher levels of care for an additional charge, but is still less than half of the price for a SNF. This facility also allows residents on hospice to remain in place as long as they can meet their needs.

livefree2 · May 16

https://alzconnected.org/discussion/comment/209234#Comment_209234

psg712

Thank you! I do think we are heading to MC sooner rather than later.

livefree2 · June 16

Following up….ALF Administrator & Case Worker called me in for a meeting. Mom is indeed headed to MC and they were being proactive to get the family prepared. It might be a couple of months before everything is in order. Her facility feeds into higher level care at nursing home . The choices arent the best…11th MCfloor in nursing facility or ASL with MC similar to where she is now but she probably wouldn’t fit there for long as she is declining fast. Case Worker and Admissions say that only one move would be best for her.

psg712 · June 16

Livefree, it's a hard thing to face that change. I hope it's for the best for your mom once it is done. It turned out to be exactly what my mom needed. She's only been in MC five months but I can't imagine her functioning anywhere else now. Blessings to you as you navigate this part of the journey with your mom.

harshedbuzz · June 17

@livefree2

It's unfortunate that the AL doesn't have a MCF that allows residents to age-in-place attached as many do.

Does the ASL with MC allow her to age-in-place? Many do. That said, most operate under an admission policy that requires a PWD to be ambulatory and self-feeding on admission in order to balance workload of the aides. And many will also require family to provide additional private aides/engage hospice in order to remain in their facility until they pass.

Given her stage 6 behaviors around hygiene, I would prioritize training of staff in choosing a place. A well trained and experienced aide can make a huge difference around this. Dad refused care at home like it was his job, but after a week or so in MC, the aides were able to get him to shower and brush his teeth.

Nail care is the one thing they didn't do. Podiatry managed his toenails, but mom did his fingers. A file might be easier than clipping. Many woman in the MCF enjoyed weekly manicures which killed 2 birds with one stone being both a hygiene task and social activity.

HB

irene912 · June 17

https://alzconnected.org/discussion/69216/move-from-al-to-mc

My mom doesn't remember eating, etc either & is skipping meals in the dining room too. And won't let the aids help her bathe. I feel like you'll know when to move her. I've been wondering the same thing, about when to move my mom lately. Where I am, MC makes sure they bathe, makes sure they eat. I don't think it's an option to 'come to dinner.' They are encouraged to be out of their rooms & they will go bring them to meals. I don't know. I'm no expert. Good luck.

Move from AL to MC?

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