How does one decide between assisted living facility and skilled care?

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Mom, who is 84, has been residing in an assisted living home for the last four months. Recently, she suffered a fall, which resulted in a fractured pelvis. Presently, she has entered a rehab facility to regain her strength and mobility so that she can return to ALF. Her balance is very poor, and this seems to be resulting in more frequent falls, although this is the first time there has been a serious injury. The problem is, she is very resistant to physical therapy, and not at all interested in getting stronger. As her family, we have addressed this with her, as have the PT personnel, and neither of us have been able to make any headway. As the primary caregiver, at what point do I just give up having this conversation with Mom, and what are the options? She does have a mild form of dementia, but I don't think she truly needs skilled nursing care, yet with this attitude, she certainly doesn't appear to be a candidate for returning to assisted living. I am at a loss, and my family, who is, by the way, very supportive, will be looking for answers to how to address the problem with Mom. Has anyone else faced a similar situation, and how did you handle it?

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I too have a similar dilemna...my 95 year old aunt suffers from dementia and currently lives in AL facility....as her dementia worsens what is next? She doesn't socialize and thinks all her AL neighbors want to hurt her. She doesn't remember where she is most of the time. When and where do we move her. She still have some money left but will go through that in a Dementia care unit within 6 months...after that is gone will Medicaid pay for Dementia care? or will we have to move her again....she receives SS and VA aid and attendance now....
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Perhaps what she really needs is a memory care unit. Dementia only gets worse and it gets harder and harder to keep relocating.

What does the staff at the rehab place think she needs next? Have you attended a care conference for her yet?

Have you talked to the staff at the ALF about what they would expect to see before she returns to their facility? Is she going to require more personal care than she did before the fall? Is it within the range of care the ALF provides?

Medicare will not continue to pay for her rehab stay until she is making some progress, so you may need to make a decision sooner rather than later. My heart goes out to you. This is not at all an easy call!
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