Level of Care

Daisie · August 5

So in considering what kind of facility my mom needs, and as part of the Medicaid approval process, do they assess how much care she needs to know where to place her? This may be a stupid question, but as I search the few MC facilities in our area that accept Medicaid, they all seem like the patients are VERY high need. My mom needs more help with the IADL functions than ADL functions, and it's mostly her memory at this point that's affected (like delusions, not remembering who I am in relation to her, etc.). For example, she can dress and wash herself and eat, but she can't do the shopping. laundry, cook, or pay bills.

I still want her placed somewhere because, emotionally, it's just getting too hard for me. She really needs somewhere where she can engage with others on some level, and I worry she won't get that in MC.

Right now, I work from home, and she doesn't understand that. She thinks I can just get up and go whenever, and I can't, nor do I want to. If she were living somewhere else, at least there'd be activity around her, which may be more stimulating (I think). I just worry it won't be that way in a small MC facility.

M1 · August 5

Daisie you need to specifically investigate what is covered in your state. Our state Medicaid does not cover any AL or MC facilities, only skilled nursing homes. It's a real problem.

fmb · August 6

https://alzconnected.org/discussion/comment/218158#Comment_218158

Keep in mind that your LO may showtime both for you and during the evaluation. Showtiming is temporarily performing above their actual level of ability and is unsustainable in the long term. If you can, try to be full time with your LO for two or three days prior to the evaluation. You will have a much better read on her actual ability than you do now from long distance. It is best to remove any rose-colored glasses and plan for your LO's worst days rather than their best. Best of luck!

mabelgirl · August 6

I live in FL and as part of assessment it really wasn’t about level of care as much as it was to verify the condition. We will be moving my mom in the next week to an ALF that does an assessment for level of care as it’s part of the cost structure, less care less money. My mom is similar can bath , dress and get about just fine. Just needs prodding to eat and have medications handled. They assessed her at the lowest level. The facility has a separate MC that I pray it will take awhile for her to require that. I too hope she gets encouraged to socialize as in the AL portion there are others without dementia as well (monkey see monkey do mentality).

Kat12345 · August 8

https://alzconnected.org/discussion/70159/level-of-care

Not sure if I'm leaving comments in the right spot (sorry)! Don't kniw what is available in your area but My Mom (& I), benefited from "Day Programs" that had social activities and were geared to those with Cognitive decline (dementia, etc…). They are usually sliding scale $, and pick-up / drop off. Family Caregiver Alliance Social worker provided us with a list. https://www.caregiver.org

kblau · August 12

My mom sounds a lot like everyone else’s on here. One thing I did not anticipate is the impact the move was going to have on her. After 3 months, she still requires a lot of redirection and navigation in AL. Remember everything will be new. And learning new thing is a challenge. I didn’t want her in MC right away. Hoping she could do well in AL and then later transfer. I regret it now. Now, I am moving her to another facility in MC (bc the AL’s MC unit is full).

Please consider this. Moving twice is a lot harder than once.

mabelgirl · August 14

https://alzconnected.org/discussion/comment/218952#Comment_218952

Did her AL up her level of care needs or did you decide on your own to move to MC? My mom just moved into AL yesterday and I am concerned with her ability to find her way, although the AL uses resident ambassadors to help guide her for awhile but without memory I don’t think she learn. However I’m sure I’ve coddle my mom this last year and she may be more capable than I let her.

Daisie · August 14

https://alzconnected.org/discussion/comment/219228#Comment_219228

My mom was living at home and progressively getting worse. She's been on a huge decline in the last 7 or 8 months, let alone the last month or so, when it seems to have gotten exponentially worse. So, she's going straight from home to MC. I think I coddled my mom too much, too, but at the same time saw that she couldn't handle cooking or following a recipe, shopping, or paying bills (she had gotten way behind in credit card payments and was sending the wrong payment to the wrong creditors). I kind of just took charge of everything. I worry that I made her decline faster (I'm sure not, but it's just my guilt mechanism).

psg712 · August 14

Sometimes when we step in and start providing more support for our LOs, as we get more involved we become more aware of the depth of their decline. It doesn't mean that our decisions caused the decline. Our support may allow them the security to live authentically where they are in the process. Less need to fake better function than they have. Regardless of our actions, the disease marches on its downhill course.

This is just an observation, not a research-backed conclusion. Open to more expert thoughts. I just hate to see friends blaming themselves for the damage of dementia in their LO's lives. Be kind to yourselves, you are doing your best in a bad situation.

kblau · August 15

https://alzconnected.org/discussion/comment/219228#Comment_219228

She was assessed to be on a level 2/5. I realized early on that what she needed help with was really not included in any care level. The constant redirection and anxiety getting around the place coupled with the nonstop phone calls from my mom, made me call a meeting with the social worker. They suggested 1:1 aide to get her acclimated. Every time I tried to reduce the aides hours, my mom would get worse. It finally got to the point where she yelled at another resident (her friend) and I asked about MC. A week later, the director and social worker called me and said I really think this isn’t working for her.

So I do feel like i wasted 3 months and A LOT of money on aides. Just to move her to a new place. The move is in 2 weeks and I am so worried about how she will do. I wish I had more time the first go around and wasn’t in a ‘crisis’ bc of her living situation and needed to find a place urgently. If I had more time, I would have had her in MC from the get go.

ALF help with ADLs but not anything else really. If the community is smaller maybe she will do well. But the many choices and people were too overwhelming for my mom to ever settle.

M1 · August 15

I'm so sorry kblau, but yours is a pretty common story. I think many people think assisted living IS memory care when really it's pretty much independent living with meals and activities offered - but the resident is still expected to have the wherewithal to get themselves to meals and to be able to choose whether or not to participate in activities. I just answered your question about scaffolding on the other thread. MC will provide a LOT more structure for her and i bet she will do a lot better.

mabelgirl · August 15

https://alzconnected.org/discussion/comment/219376#Comment_219376

Thanks for the reply. I am sorry she has to move from the facility to get the care she needs. It is such an ordeal. I pray she will transition smoothly and that you’ll get some peace of mind.

kblau · August 16

https://alzconnected.org/discussion/comment/219388#Comment_219388

I hope so. Thanks for the positive encouragement.

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