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My Dad is in a VA facility, locked ward, there because of occasional dementia that he can get angry when he feels we are all in danger from it and that we are not acting in a manner that will save us. OK, that's what got him in there, but he hasn't exhibited it but once, and very mildly, in the six months he's been there now. He has late onset PTSD, seriously he was in WWII and after that had a healthy career and after the career fell apart, began to talk about war experiences, and as the family learned about PTSD, discovered many of the problems we had as a family were due to his personality affected by PTSD. Anyway, he also gets tremors that resemble Parkinsons and they are usually triggered by stress, but with really chronic memory loss, who knows what stress triggers it. By that I mean, he can carry on a conversation about what's in front of him, but can't remember much beyond a half hour if that, and never remembers the day before. He has times when he is lucid and we have nice conversations, but in his environment, the staff care deeply for him, but don't have time to talk to him, and so when he is awake and lucid, not much to do but stare at a bunch of vets who are really gone mentally. He's the best of the lot, but now he wants to sleep almost all the time. I don't know if he would do that if he were at home, or if it is a way of dealing with his environment. We can't bring him home, he doesn't sleep at night when home, so requires 24/7 and can't be left alone for long because he gets anxious. Have realized they are giving him "palliative" care, because we have said that we don't want extreme measures if he needs, say, intubation or breathing apparatus. Yes, a partial DNR, if you want to call it that, and don't tell me it's not possible, I've dictated the specifics myself, it's a very standard form that the VA uses. Since he isn't predicted to die within six months, probly not eligible for Hospice (though some say just incurable dementia is enough to quality) but regardless of whether he can qualify, let's say he can. Is there any value to being in actual hospice, does it p rovide more than just palliative care? I have heard that there is some therapy offered for the family and besides that, is there a legal ramification to being in Hospice? It sounds like a silly question, but I'm just wondering what the difference is. Thinking he might be happier in a nursing home, he might get more one on one time, and would hospice help with the funding of that do you think? He has several thousand in the bank, and the family home is in his name. Might need to go to spend down too..... just thinking out loud here, all comments welcome!

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I would be concerned if he says he may leave the facility, as your post indicates. I wouldn't assume that he understands anything. Even if it does, that could change quickly. Plus, the fact that he says he could call a cab and leave would be very concerning for me. I would be very cautious about a facility that is not secure, considering what you describe.

Is there some reason that him being in a nursing home would make it easier to visit than where he is now? I'm not sure I understand. What benefit would there be? Does he need skilled nursing care?
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Thanks Babalou. I know the question rambled, not sure how to include everything and not ramble! LOL They are definitely not looking at curative treatment, his doctor out and out told me he was getting "palliative care:. We did not understand hospice when my mom was ill three years ago, and we could still use that aspect of hospice, help for us left behind. The things the hospital did wrong were downright negligent, and we were so upset as to not react properly at the time, to get them to respond right, I wish we could handle Dad's illness better, but we are still reeling.

He doesn't need a locked unit for dementia, when he 'wanders' it is because he understands he could go home if we'd let him and he threatens to leave. He is not looking for forgotten things, he is clear enough to want to call a cab and go home, but how to explain that to someone who doesn't know him. We've looked at lots of places where he might stay and the ones we can afford are on a par with what he gets for free now, the tradeoff is that in the paid ones, they attempt a cheery environment and activities, but you don't know how good the medical is. In the free one (the VA), they medicate him as he needs it and then they just sit around in a dining room. They attempt recreation for a few hours every morning, but the room is so full of unresponsives, they don't get much done. And it is familiar to him now, don't know what effect a new environment might have on him. I think it would mean it would be easier to visit him. That is my thing, making visiting more doable, and I fear the family is concerned with the money. Don't know how to approach that without them thinking I'm sounding accusatory, I found out that I am secondary POA quite by accident. I had never signed anything or been notified, but the POA document clearly says if the first is unavailable or unable to sign for Dad I can. I asked the office for a copy of the document but they haven't given me one. I guess that's a pretty weird request for them. So someone else handles all the money and I guess I feel that I should be able to check and advise that the expenses are proper, since his money is being used to maintain the family home with adults living in it. One of whom is the caregiver and visits him regularly. eh, now I am rambling! Take care.
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Tough to discern if your dad would be eligible for Hospice, I think you should just ask for an evaluation from a local hospice provider to get your answer.

Hospice does not pay for "room and board" at a NH; dad's funds or other private pay funds, or Medicaid would be used for that.

Does he need a secure (locked) environment? Some nursing homes have secured memory care units, but not all.

Hospice goes beyond DNR and DNI. It indicates that the patient (and the family) is accepting the fact that there will be not curative treatment offered. I think you should read a bit more on the Hospice Information part of this website, and talk to some local hospice providers.
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