My 94-year-old dad has advanced Alzheimer’s. After my mom passed away, we kept him at home and had different people caring for him through the day and night. But we had to move him due to the house not being conducive for a walker in too many trip hazards. He also became more combative when anyone tried to get him to do something he didn’t want to do. He has been living in an assisted living facility for almost 9 months. He fell a few times at night in the beginning, so we have hired a private person to stay with him overnights when the staff does not check on him that often. He is in continent now and uses depends. He is now at the point where he wants to just sit and sleep in his recliner and very seldom get up to use the bathroom, even with help and go to dinner. He now uses adult Depends and gets aggressive at times when they try to get him up to go change him so the staff does not force him to do anything, and he may sit in his recliner in a wet depends for many hours at a time. We have been fortunate that he doesn’t have any sores. We kids are very involved, and at least one of us goes by every day and spend a few hours with him, usually at a mealtime when they are just bringing his food in to the room and setting it on a TV tray when he refuses to go to the dining room. We help him eat. He’s not verbal but does interact through different sounds and expressions. We are lucky if they can get him to allow them to give him take a shower at least once a week. But we still we can enjoy him and laugh with him, and he seems to be happy.
My question is, with his declining abilities. I’m thinking they will soon want us to move him into a true memory care facility. They haven’t said anything yet, but I’m thinking a memory care may have more staff to check on him, be more equipped on handling him and keep him from sitting in wet depends for so long. Does a memory care force the resident to get up so they can change him and shower him, even if they are combative? Do they use more medication to pretty much drug them, so they are more acceptable? What have you guys seen in the difference between a memory care and assisted living? Up to now we have really liked the assisted living facility. I just think dad is going to need more care soon. And then I’m wondering if we are still going to need to keep the private person overnight in the memory care Because dad likes to get up and walk around and we’re afraid he will fall? Or do they keep a better eye on the residents? What has your experience been between assisted living and memory care? Thank you so much.
MC has additional staff on hand to do medication management, bathing, incontinence, ensure that the person has eaten enough, help that person eat, deal with the "needy" behaviors as well as locked external doors. My Mom's MC also does laundry (included in the basic fee), wellness checks (extra fee). Her one complaint is that she does not have any "friends" in MC other than the caregivers. However the truth is that my Mom, and others on the ward, are unable to sustain a friendship. My Mom can no longer comprehend the written word in sentences. She can read individual words and know what they mean, however, cannot comprehend when put together. Other people in my Mom's MC have memory related disorders like food obsession, Parkinson's and memory loss due to some other medical condition. The caregivers also check in more frequently to ensure she is okay (not fallen) and in this facility, ensure that she gets at least 1 hour a day of face-to-face individualized conversation.
AL on the other hand allows for more independent living. Those people are able to sustain friendships, know the difference between clean clothes and dirty clothes and can tell when they need to go to the toilet and most of all, are not people who lose track of where they are.
So to specifically answer your questions:
1. In our state, any resident can refuse medication. In my Mom's case, after 3 times, they quit trying and tell me. If she was in AL, they would quit trying and not be required to tell anyone.
2. Yes, in MC, they check for incontinence. However, that is also true in AL, for a fee.
3. Getting up changing and showering: That is true with any extended care, not just MC. It is also true of Skilled Nursing Facilities.
4. If your father is combative, they have 2 options: 1) talk to you to have a doctor diagnose the condition 2) no longer allow him in the facility. These options are available whether AL or MC. In AL, there is less tolerance for combative behavior
5. Medication can not be prescribed without a doctor' authorization. Many of these facilities have doctors on call, and it is up to you whether they call the doctor without your knowledge or whether you continue to choose an outside doctor. In my state, no facility, hospital or other, can give medication without a doctor's authorization, even if it is a vitamin.
6. My Mom used to get up a lot at night and is a fall risk. They put a bed monitor on her to let them know when she got out of bed and that way they would know when to check on her. We trained her to pull the cord first, before getting out of bed. That at least gave them some warning. This was a large reason why she had private care at home at night, prior to going to MC.
7. Yes, at least at the facility we have chosen, they keep a better eye on my mother than at a AL or even me. In addition, I don't have to worry about getting meals for her, cleaning up her messes and being 16 hours a day entertainment. My mother can no longer comprehend what is being said on television, however, even though she has no friends, she likes watching what other people do and say. That is her entertainment.
I highly encourage you to start touring and researching MC and AL facilities. Many have waiting lists. If you are private pay, you will have more options than someone who is "government pay". When I put the numbers together, I found out that staying at home was more expensive that going to MC or AL. However, I live in a place where cost of living is quite high.
Good luck in your travels and it is great that you are asking those questions now, rather than when you are forced to place him....which could happen if you wait for a "horrible" fall.
She started roaming and dumpster diving, collecting rocks, sticks, metal, dead leaves and more, so off to MC she went,
Same building. We had to move her last year as we had to stretch her money, She did just fine with move, she didn't even know that she was in a different home.
I took her out to lunch and my brother moved her.
We are happy with her care!
Her cognitive functioning level has gone down since this move.
Question: is it true that a dementia diagnosis in CA means a newly diagnosed person must be in MC?
In NJ the it's the symptoms of dementia rather than the dx. that dictate where you reside. Many of our residents had a dementia dx but you wouldn't know it just looking at them or chatting with them. They were able to participate in most of the regular AL activities. It was only when they started to wander or could not keep up with the regular activities that they were moved to the secured MC unit. Yes.... the staff on that unit had more dementia related training and the staff to patient ratio was greater so aides had more time to cajole residents into bathing or toileting. Continually aggressive residents were a danger to both staff and residents and they were sent out for psych evals right away. They could not come back until the hospital got the med cocktail right. Rooms were bright as were the moods of the residents. Even some good places are suffering from staff shortages now after covid. Nursing staff - RNs, LPNs and CNAs just burned out. Moreover, while I am the first to admit that the industry is an expensive one in which to operate, most of the private entity onwerships are funneling the bulk of the fees received to the owners. A bit trickles down thru administration (admissions, marketing) and maintenance (lots of money spent there because that entrance hall has to look great to entice you in) but by the time it gets to the nursing staff and the CNAs (they are ones doing the grunt work, cleaning feces and sometimes having to duck to miss a swing) that trickle is just mist in the air. While you don't have enough money for me to take a CNA job, I think you would find a few more people who would be willing to try it if they got $20/hr and there was career ladder for upward mobility,( not just the big leap from CNA to RN). Additionally, the backlog in processing the admission of legal immigrants into the country is also affecting the staff situation because many immigrants will find a way to afford the CNA certificate and start their careers there. If your current facility has an MC, I'd follow what others have suggested and tour that (try to tour at least twice.... once at mealtime to see what staff is available and what they do). If they don't have an MC then it would be wise to start looking for other facilities now. As someone suggested, perhaps check out your Office on Aging or state Dept of Health for a listing of home/board residences that may be available. This is not an easy journey for anyone but hang in there... you will get through it.
As an aside to this question and to show you what money can get you both as a resident and in terms of staffing....went to a facility over 15 years ago somewhere in VA (I will try to get the location but they don't advertise.... don't have to).... totally private pay with only 10 medicaid beds. If I had money, I'd shoot myself so I could go there! It wasn't nice.... it was fabulously awesome! Went there at the request of the activities director as they were having a "hunt ball" for the residents (many of whom had fox hunted or played polo in their lives) and he wanted some " fox hunters to come galloping out of the woods on their horses to enjoy the morning "stirrup cup" drinks before we galloped off into the woods to pursue the fox. That evening (early at 5 pm) was invited back to the "ball" . A few people was slowly shuffling to the music '40s and some aides were "dancing" with some residents including those in wheelchairs. One guy was like Fred Astaire... great moves and danced with everyone. All the ladies (including the Medicaid residents) were in formal gowns with jewelry and makeup. The gents were in black suits or tuxes. The food was unbelievable. I tried my best to convince them I was a resident but they made me leave! It is still a beautiful memory for me. Lowest pay there was $16/hr. at that time!
My Mom was in MC 3+ years, passed in 2021..A lot of experience here. Bottomline, I would move your Dad to MC, keep your private duty nurse, bring Hospice in & put a camera in the room..The more “hands-on-deck,” the better..
Mom’s facility was very clean, but always short-staffed, under-paid. The good aides almost always started in MC, then moved to AL side..So frustrating!
Lmk if you want me to expound..You/family are doing great with your Dad. He feels your care & presence. ❤️😇🙏🏻
" ALF" Assisted Living Facility, has different level of care expectations defined; in other words , the patient is cognitively appropriate and can perform ADL needs etc.
Talk with the facility and they can give you the " level of care needs' description for each level of care. You may also want to go ahead and have the patient 's PCP provide an updated assessment of pt care needs so that you can be pro active instead of waiting for the facility to make the call. And, of course, start being prepared for the increased cost associated with " Memory Care" vs "ALF".
Practice good self care !
I would look into that before the AL gives you notice.
No place is going to force dad to do what he refuses, it's the law. However, a good aid can get seniors to do what is needed and that is important.
I prefer the smaller board and care that offer services until death. They don't have the activities that larger facilities have, they feel more homey, tend to have less turn over in staffing and it is easier for people to get to know one another, among other benefits.
As hard as it is, sometimes we have to see and say, it is good enough because there are no good options. We do the best we can and pray that it all works out without to many hiccups.
Oh, one thing to be mindful of, maybe, dad has pain and he should be changed in his bed or recliner, he may be more receptive to that vs getting up and going to the bathroom.
Best of luck, this is a tough situation.
The residents don't normally get any better care then they do in AL. They definitely use more drugs in memory care because it's often necessary when dementia worsens and someone gets more violent, aggressive, and combative.
If you've never been to a memory care (formerly known as a dementia unit) be prepared for the experience.
For starters memory care facilities, wings, units, whatever they're calling them are going to smell. I have never seen one that didn't stink of pee, crap, soiled bedding/clothing, and unwashed people.
They're usually very dingy looking if not downright dirty even when they are located within a rehab, nursing, or AL facility and the other areas are very clean and well maintained. The memory care parts usually aren't.
The residents in memory care usually smell and look like their hygiene isn't kept up on as well as it should be because it isn't. They also don't offer the level of baby-sitting services you may be expecting for people with dementia either. Residents wander into each others' rooms. They take each other's belongings. It is not uncommon for a resident to be wearing clothes that aren't theirs too.
Be prepared for what you will see and know that this is what memory care is.
If you have to place your father in one, keep that aide you hire privately for him.
I'm sorry to be the voice of doom here, but please, be sure you know what you're getting. My sister works at a very posh facility in another state, and the care level is much better, but even then, she has to chase down aides to change people, etc. (She is an admin, not a health care provider.)
You're not being the voice of doom here. You're being the voice of honesty and reality.
Doe his current ALF have a wing that is for MC patients? If not, then I can see why they are "hanging on to dad". But if they do have a facility for MC I would guess you are close to their asking you about this advancement.
You are so correct that they are much better staffed in MC for your Dad. He may also qualify for Hospice care help and that is a help to the facility.
I am so sorry you are at the place for these decisions. I wish you the very best of luck.