When is it time to move mom from an assisted living facility to long-term care?

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Mom has moderate dementia and liver cirrhosis, and has gone back and forth from ALF to hospital and rehab twice now. Falls are common, the last one resulted in several broken teeth. It feels like she is right on the border between the two types of care. We are also looking into building room for her in our backyard, but so hard to make that major of decision when you don't have any timeline. Any wisdom to share?

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Catwoman, most assisted living facilities have long term care available, very costly. if you choose to add on to your home , you would have the expense of that and hiring 24 care in the home which can be very costly as well. i would recommend with the next fall and she goes in the hospital, you can do nursing home placement easier from the hospital, but you need to get mom's name on a list at all your local places!! Good luck to you and good health!
I would go ahead and look into NH, because there is only so much a AL can do legally when a resident gets to a certain point. Talk to your state omsbudsman for assistance on your options. I agree with christie, taking care your mom at home can be very costly and can cause problems in the family. Good luck and God bless.
Knowing how to help your parent transition into the proper care is very difficult. And then getting a "timeline" is not easy and no one will tell you because they don't know. The biggest issue is her safety. BUT if she doesn't absolutely have to have around the clock care, I would look into some sort of intermittent home care before she gets so bad that there is no choice. Of course, finances play a major role in the decision. My mom went into a Medicaid program that paid for an ALF (but left her with no money of her own) but I only wish she could have been cared for at home as much as possible. I think she was actually traumatized by moving into an ALF when she did, but steps were taken to arrange this by my brothers before I was told (I live out of state.) I was trying to arrange home care but my brothers had already applied for Medicaid and got approved.and then my mother just went along. For now, be sure to get her a life alert system that she can wear around her neck (if she falls, all she has to do is press a button.) I am a big proponent of home care (aging in place) because my mother fell victim to a c-diff infection (can be very bad) and then pneumonia that she really never got rid of to say nothing of the emotional tab of no longer living in familiar surroundings. Infections are common in any sort of communal setting like hospitals, ALFS, rehabs and nursing homes. And the weak immune systems that many elderly have create a potential nightmare situation of their fighting their serious ailments and then constantly fighting potentially deadly infections. Be sure to talk to your county aging services or eldercare resources. And check to see if you have a PACE provider in your area. If approved (financial limitations) your mother can get limited home visits and then get healthcare services at an adult day center.

My 82 year old mother who also had dementia, but mostly on the mild side, just passed away (11/17/12) in the very early AM....just after midnight, primarily from congestive heart failure but had many complications (pneumonia to name one big one) and her body just broke down. She had entered an ALF in September after 90+ days of rehab for knee surgery during which time she had a couple of hospitalizations. And then during October and November she was mostly at the hospital and we finally had to move her to hospice. She just could not get well, was very weak, had lost about 50 lbs, and was ready to meet the Lord. Unfortunately she was alone (in terms of family at her bedside) when she died and I was flying to be with her the day she died. I have a brother who lived in the area and took care of things locally. I just couldn't get there in time, but then again, I don't think she wanted me to see her pass. I will miss her so very much.

I wish you all the best in your search for the best care of your mom.
my mom is 83 and has dementia,very combative,curses,puts little sharp knives,forks,spoons and etc in her chest,and walks away,she lives in her home.what can i do for her?
clwair, if I was you, I would talk to her doctor and see if she might need to be evaluated by a psychiatrist. My dad has mild dementia and was living in an AL when he attacked one of the nurses there and then cut his self with a fork. It could be the meds she is on and being placed in a senior behavior unit can just about make miracles. Dad's doctor there took him off all of his meds and re-introduced them one by one. Although he is now living in a NH, he is doing much better. Good luck.
This is almost too complicated of a question for you to take suggestions from this type of Q&A forum. Each person and each family is different. The question being, when to move from Assisted Living to skilled care-then I will not address the option of home care; although for some families this is a viable and rewarding option. If she is now in Assisted Living, the facility would be a key resource on guiding you and your loved one on when to transition. The facility likely has guidelines that determine when a person is no longer appropriate for Assisted Living. I would schedule a meeting to discuss this with the Director of Nursing or other person assigned with that duty in her facility.
I agree with sjsimmons. The Director of Nursing where she is will be able to give you detailed information about what services can be provided there and the signs that she needs more skilled care.

When considering adding on to your house and bringing her home, keep in mind that moderate dementia generally becomes severe dementia over time. It isn't enough that you feel you can handle her care now. Could you handle it when the dementia gets worse? Timelines are just not available! She may stay at a moderate level of dementia for years or she may start to decline next month. What is the prognosis for her liver cirrhosis?

If you do decide to bring her home, talk to a local real estate agent about how best to maintain your home value with the addition you will build. Also think ahead to how that space could be incorporated for different uses some day. If you consider moving Mom to skilled nursing look for a place where she could easily transition to dementia care if that ever becomes necessary.

The fact is, caregivers need a good crystal ball, and, darn, we are not issued one!

Bless you for doing your best to do the right thing. Our best is all we can ever do.
As hard as it may be she is better off in a facility, where you know she will be taken care of. My mother has lived with me for 9 years and it it really takes a toll on all aspects of your life, we all feel this is the right thing to do, but in all reality it is very hard, especially when there is no family to help.
The question that comes to my mind: 'does the AL where your Mom lives provide the kind of services she needs. ' Each AL is different and they provide different levels of services based upon the philosophy of the provider. At the memory care place my Mom is at she has fallen so-o many times I've lost count. But the same thing happened in the rehab that was part of a SNF prior to the AL move. The aides have to log where each resident is once an hour. This means that if someone falls or needs assistance, the wait would never be greater than an hour.

If you are comfortable that the AL is right for your Mom, bring in a hospice organization to assess your Mom. They have a lot of experience and can supplement the processes from the AL. They can provide an aide for your Mom up to 5 Xs a week and a nurse's visit weekly (or more as necessary).

I don't see any indication that your Mom needs nursing care from a SNF. Maybe she just needs more services from the Al. Think about it.
I will be facing this soon. Mom has mild dementia, but seems to be getting worse as the months go by. Since we have the means, and if Mom can't be at home I will take her to a place that can take good care of her. Sometimes it's just too dangerous to take care of them yourself. Also, you have to be right on top of what she is doing at all times. I will let the professionals do that. I feel it would be the best for Mom. I'm sorry you are going through this, yes there are gray areas to consider. There is no right or wrong answer. It just takes a good amount of evaluating her situation and make the best choice.
Good luck to you and warm hugs.

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