Follow
Share

We are searching for a nice assisted living home in California, roughly San Francisco area. Our family member has early Alzheimer's, but has been declined by AL homes because she has (and needs) a diabetes sensor and pump. Not sure if this is a liability issue or medical support issue. Any guidance would be very appreciated.

The answer is with state scope of pracice rules
My brother and I had a similar issue in MA. ALs usually do not have RNs 24/7. ALs only have LPNs whose scope of practice is very limited. With medications that constantly need shifting and complicated with a device that is meant for people who can self operate a device, there needs to be a doctor or trained APRN to be available on call. That requires a skilled nursing facility. Nurses need to have an order to make any adjustments.

Mom's state rules for ALs will have none of that. To get around that adjusting insulin requirement she uses a once daily dose of Lantus and with that she is 100% supervised to self inject. Staff verbally walk her through disconnecting the contaminated needle but cannot inject her by law. That means a little more diet control and tolerances of a higher sugar level.

So if you are looking from AL to AL, you may want to ask that question if it is a state regulation. Otherwise the next step is to look at nursing homes and ask the same thing. If it is the device maintenance issue, you may have to go back to the PCP about discontinuing the device and looking at alternative dosing.
Helpful Answer (1)
Reply to MACinCT
Report
WJC609 Sep 10, 2018
Thank you. I will try to find out what are CA regulations.
(0)
Report
Thank you so much.
We were looking at AL locations with memory care programs so that she would have the proper care going forward as a first choice.

She does have type 1 diabetes. The AL rejection due to diabetes equipment was a complication that we had not anticipated. Scheduled injections were an option at one AL, but doctor believes the pump and sensor are necessary at this time.

Again, thank you for you help!
Helpful Answer (0)
Reply to WJC609
Report

I'm a CGM wearer, Type I and I do realize how challenging that would be. Is your LO Type I?

I take daily injections, but, I worry of how someone would be able to assist me if I had dementia down the road. I would think that a nurse would be able to monitor and handle your family member's pump and CGM, but, you have to be trained on it. I'm not sure if ALs have nurses in your state. In my state, they aren't required.

I might check with the American Diabetes Association to see if they have any suggestions AND the Alzheimers Association. They have referrals and resources.

Also, I'd inquire if due to your love one's condition and needs with pump and CGM, she would qualify for nursing home, rather than AL. Usually, nursing home is for those who require Skilled nursing care.

Maybe, I'm partial, but, I tend to favor Memory Care Special Units, which are considered ALs in my state, for people who have dementia. That's based on what I have seen offered in my state. The Memory Care units often provide a lot more hands on care and supervision, which the person with dementia usually needs as they progress.

A big concern for me would be if the LO would be able to continue with a pump and CGM as she progresses.

I would talk with your LO's doctor about her pump and CGM going forward. While they are awesome devices, it may become unrealistic for your LO to wear them as she progresses. I'd ask the doctor about the risks. My concern would be that people with dementia often remove things and hide them. They may remove and hide their teeth, eye glasses, compression stockings, hand brace, etc. They can't recall doing it and there is really no way to make them remember or convince them to stop. If the items are replaced, they do it again. I know it sounds difficult to imagine, but, it does happen a lot. So, I'd explore if she will be able to continue with the pump and CGM long term.
Helpful Answer (2)
Reply to Sunnygirl1
Report