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BoodaGazelle Asked April 2021

Alternatives to ALF. What options do we have?

Hello all.


My FIL is in a self-described "senior living community". He is 86 and has mild dementia with bi-polar. He is on meds for an enlarged heart plus his bi-polar. He has had COVID and recovered. He is on Medicaid. Here is the issue: he was diagnosed as being incompetent and needing 24/7 supervision by a psychiatrist (13 months ago).


He understandably wants to go home to be with his wife (MIL) who, although better, still shows signs of dementia and who would not be able to live alone without the help of her two local daughters.


My wife is his POA for financial.


There is no way that the two of them can live alone without help. She is no longer able to help care for him, and she needs help too.


The problem is that he now seems to be too high-functioning for the facility he is in now. There are many people there who are really "out of it". The family has looked for other places, but this one actually does seem to be one of the best near them.. i.e. clean, staffed by good and caring people, etc.


The family is very involved, and wants to do the best thing for both of them. They have been apart for the last 13 months, not least due to COVID.


But no one in the family can be a full-time caregiver, and without that, it does not seem possible for them to live in their own home (where MIL still lives for now).


What options do they have? They have been told that some ALFs will not even take people with the dual diagnosis of dementia+bipolar, due to liability or other reasons. His bipolar is well under control as long as he takes the meds.


There is a little bit of money, but not much, and it needs to be managed for both of them. There is no expectation of any inheritance from the family!


My wife has looked at in-home help, but even a few hours a day might not be enough, and the cost could be prohibitive.


I hope this makes sense... any comments welcome!

Geaton777 Apr 2021
It sounds like your FIL is in an independent living community that doesn't offer any other level of care, correct? If this is true, then Medicaid doesn't pay for IL, so did you mean Medicare? Or, is he really in an AL-only community and needs to go to a different one? Can you please clarify? In many states Medicaid doesn't pay for AL, but some do.

"They have been told that some ALFs will not even take people with the dual diagnosis of dementia+bipolar, due to liability or other reasons." Who exactly told them this? I think they have to ask each facility what their individual policy on this is.

If it is accurate then your FIL is already on Medicaid then this means if he is moved out of his current facility, and then tries to go into a different one, he may be on a waiting list for a Medicaid bed/room. If he is NOT on Medicaid yet, I would look for a nice facility with a spectrum of care levels (IL, AL, MC and LTC) AND that accepts Medicaid (many do not). This way his wife can also live there, but maybe in a different section. But it sounds like she may need AL as well. They can go in on private pay and then your wife can apply for Medicaid for him, if FL Medicaid pays for AL (my state does not). They cannot kick him out if they say they accept Medicaid.

ArtistDaughter Apr 2021
Since the place he is in now accepts medicaid and funds are low, think about moving your mom there too. Being together might solve the high-functioning issue he has with other residents and let the two of them remember with each other their past life together. As memory issues worsen, it would be good to have them together unless one of them becomes combative. My mom is referred to as high-functioning in the memory care home I moved her to a little while ago. The term high-functioning is confusing to me, as she really needs help with everything.

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AlvaDeer Apr 2021
I think that given the age of these two elders and their needs alongside the assets they have a board and care placement for both while they have any money may be a good idea. However you say that he is on Medicaid already. That not only means that there is a "little money" but that there is a VERY LITTLE money for both of them. Whatever there is of both their assets, it may now be a good idea to let them be together in ALF or Board and Care while they are able, then to move together to a nursing home that accepts medicaid, if that is possible. With Medicaid I think there will not be enough support for them for in home service, nor enough money (to be frank, in home services for two? I think you would be needing to be in the 1% in terms of money to afford that for two elders).
None of this is pleasant or fixable in our society today, when our elders are kept alive to live in these circumstances. I sure wish you good luck, and I sure hope others have some ideas better than, or more hopeful than mine.
BoodaGazelle Apr 2021
Thank you... it is indeed horrible to have so many people who would explicitly said they did not want to end their lives this way to be in his position.
Daughterof1930 Apr 2021
Given your FIL’s age and diagnosis it’s inevitable that his condition will only decline, more dementia and more medical needs. To put your in laws back in their home together would create a mess very hard to undo. I’d say your choices are to have MIL move in the same facility so they can be together more, maybe separate rooms or together depending on their co dependence or ability to have a reasonable healthy relationship. Or continue as is, asking the activities director to help with his contentment. The place my mom lived would involve higher functioning residents as unofficial help. They were given roles to be leaders in helping those who could do less, it helped both sides in fostering a sense of being needed and providing assistance for others
BoodaGazelle Apr 2021
Great ideas! Thanks!

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