Assisted living or skilled nursing?

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My dad is 67, with progressing dementia. Currently hospitalized due to escalated behavior at home associated with anxiety and frustration. Couldn’t get the TV to work so he busted it, couldn’t turn deadbolt on door, so he took a hammer to it. We are now working on placement. Without current Medicaid coverage, difficult to find nursing home for placement because he doesn’t need PT or OT. I have contacted an assisted living facility that is affordable, but it is not a locked unit. They asked firsthand if he has problem with wandering. He hasn’t while he’s been at the hospital (goes out to smoke) but lived through a similar incident with my grandmother (his mother) where she basically walked out the door on the first days there and wandered off. How do you go about deciding which level of care is safe and would be a good fit? I don’t want to end up right back at hospital at square one. This is his third admit in two months after 2 failed attempts to go back home. He does pretty good in the hospital because it’s relatively stress free and safe to him. But if he encounters any difficulty, his anxiety escalates.

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Catgetsdown - sounds like you are comfortable with the current arrangements for your mom. If you are comfortable with the care and your mom seems to be doing ok, then continue with your current plan.

One thing about ALs is there are a number of options available, depending on the individuals needs. Each of these options cost additional money. It is important to obtain a list of available services and the fees.

NHs are generally not short term facilities, as suggested by another. There are short term units, generally within NHs to provide rehab following a hospitalization or severe illness.
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Reply to DarleneRN93
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You're correct, ImageIMP. It takes two doctors to recommend the patient enter hospice. My mom has lost weight, is no longer mobile without assistance, doesn't want to eat (not hungry) , needs help with toileting - while she is still able to do her business herself, she needs someone to hold her on the commode because she has very little strength. All this has happened within the last 2 months. Neither doctor had any issues with qualifying her for hospice. Hospice eligibility will be re-evaluated every 3 months. I hope she can move out of hospice at the next review but right now, she needs all the help she can get and Medicare pays for all of the hospice services. The best thing for us is not having to take her to the ER or doctor's office for constipation or UTI issues. The hospice team is available 24 hrs/day to treat any ailments she has - unrelated to a cure for COPD/CHF - which is what has been making her the most uncomfortable. AL has a lot of services but they really aren't as diligent as they say they are and we have Mom in a really nice/smaller facility.
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Reply to Catgetsdown
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Assisted Living is definitely a cheaper alternative, and in many ways better to a nursing home. Some assisted living facilities have memory care lockdown units. Don't stop with just one facility. Research some others because the next one might have just what you need. Plus, assisted living is a better alternative if they are able to still perform basic activities of daily living.
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Reply to rwbpiano
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Catgetsdown: I don't know if there are different standards in different places, but from what I've been told hospice care needs to be documented by medical professionals for patients with anticipated mortality of 6 months or less... There can always be adjustments - or improvement in patients which would no longer qualify them for hospice care. Otherwise, if hospice was available simply to provide more personalized care, with open-ended duration, that would obviously be the way to go for anyone?
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Reply to ImageIMP
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To my understanding, there shouldn't be a choice between assisted living or skilled nursing care... Skilled nursing is only for a (probably temporary) urgent medical situation until that problem is resolved... Assisted living assumes a level of individual ability on a daily basis, although a lot of "extra" help is usually available for extra charges (help dressing, getting in & out of wheelchairs, assistance using the bathroom, etc.). If there are medical issues - i.e., wounds or problems requiring medication beyond what the assisted living pharmacy services can provide - incoming nursing help can be obtained. My Mom was in a skilled nursing facility following surgery and damage from a fall/broken hip & wrist (covered by Medicare Part A, 20 days paid totally, then up to an additional 80 days with a co-pay - in her case, $157.00/day). Remaining in that facility, at that level of care, required a necessity for actual nursing and physical and/or occupational therapy, with meaningful improvement documented. I don't believe any Assisted Living facilities would be equipped, however, for the current issues of anger and acting out you describe with your Dad. I agree that a geriatric psychiatrist should be seen for assessment and potential meds to help with confusion and aggression issues...
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Reply to ImageIMP
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Stanley07: Is your dad on any psychiatric meds or did I perhaps miss that?
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Reply to Llamalover47
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Check around.....there is an assisted living facility near where I live that has a specialty section just for dementia / Alzheimer's. This was not an option for my mom because she fell and broke her hip or we were going to get my mom a room there, because they did have specialized therapy specifically for dementia
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Reply to Leeharper2000
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We were facing the same decisions with my mom, though different circumstances. She's in assisted living (AL) now and they're able to increase the service level now that she can barely walk anywhere and doesn't want to eat. She is 90 with COPD, CHF and extreme vascularitis on both legs. She really likes having a 1:1 aide and gets extremely agitated when there is no aide; but we wan't afford that plus the AL facility so we got her into hospice services. We learned a lot about what hospice really is - it doesn't mean they're going to die within 6 months, though we never know. It means they get a LOT of extra services and attention which sometimes has a positive affect and they can move out of hospice. Some residents have been getting hospice services for 4 years! Now that she's in hospice (we just started the process) she'll be visited by social workers, home health nurses, the doctor will visit at least once/month, volunteers - and the nurses are available 24 hrs/day if there's an urgent situation. She has a lot of problems pooping. The last ER visit was simply because she hadn't pooped for 3 days and felt blocked. The AL couldn't administer an enema because there was no doctor's order,etc. Now, the hospice nurse can be contacted for these types of situations (UTI, pooping issues, coughs) and they can administer whatever on site- no more ER visits! She's been in the ER 5 times and admitted for 5 days this month! All for simple things like a UTI and pooping problems. I wondered how we could get her treated at the AL and this is how. Hospice. If she gets better/stronger, we'll move her off hospice and hopefully not need it for awhile. Hospice is not just for someone on their deathbed. Check it out. It is a lot of services and Medicare covers EVERYTHING! (not the AL but everything else) Mom still gets all the services from the assisted living place - it is now supplemented by all the hospice services. Fingers-crossed.
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Reply to Catgetsdown
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I moved my parents into a memory care facility a few weeks ago due to the assisted living facility not being able to provide the care my mom needs with her Parkinsons due to her being wheel chair bound. It is an adjustment going to a memory care facility but these places tend to have more care available and are trained to deal with residents roaming and know how to redirect them. I am saddened to see so many younger residents in their 60s living here. Both my parents are 88 and have dementia and my mom also has stage 5 Parkinsons. Sounds like your dad would not be a good fit for skilled nursing because he does not require extensive medical care. Assisted living places typically do not take dementia residents who wander.
The memory care facilities are locked so your dad would not be able to wander so that could give you piece of mind. My advice is to go visit some of these options and get a feel for yourself. Spend time going to activities there and having a meal to get a good feel for what each place is really like. The place where my parents live offers adult day care. Maybe try this out for a day and see how he does there. Good luck. You are not alone out there.
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Reply to Marysd
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My mother with dementia is in Assisted Living without locked doors. I had similar questions to yours about placement level. I am very, very happy with Assisted Living. At some point in the progression of her dementia, I realize she will need to move to locked facility. I guess what I'm saying is - just because Grandmother needed locked facility, your Dad may not at this point. I just want to add that I'm 61. i can't believe you are having to endure this when your father is so young. I'm sorry.
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Reply to Mjlarkan
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