Dad is 66 years old and is switching skilled nursing homes. However, I'm worried about a "test" that he needs to take that may place him in memory care. Any advice?

There should be informal assessment going on all the time of someone suspected of memory loss, and in my experience with my LOs, the doctors and others in charge are very alert about this.

For instance, a casual question might be asked, as I did the other day, of a friend "Addie" that I've known since childhood. I asked Addie, "How is "Rose" (a mutual friend since childhood that we've both kept in touch with frequently) doing?" Addie began talking about something else entirely, and her hearing is good, so she heard me. She cleverly worked herself out of that segment of the conversation and redirected it. That and some more things during the conversation clue me in to the fact that Addie has no knowledge of who Rose is anymore, and I can also tell that her short-term memory is fading because, due to her response about Rose, I tested Addie a bit during the same conversation to find out how much she was retaining.

Then, my LO was asked by his doctor recently what job he retired from. LO segued into a whole paragraph about how he's done many jobs in his lifetime, some of them harder than others, starting when he worked for his dad in grade school, and in many different places. Big long talk, but he never did say the job he'd retired from, which was a high-profile job that he loved and performed for 35 years. The doctor then restated the same question in the same way. He got the same response from LO almost word for word. My LO no longer remembers the job he retired from but can put on a great dog-and-pony show to keep you from finding out that he doesn't know. So....it's not just the standardized tests. It's the dementia patient's overall awareness of who they are, what they do or did, how they figure things out nowadays, and how they relate.

One thing I learned... my husband has bifocals but also has a special pair of reading glasses due to his Parkinson's... if he does not have those on he does not do as well. Without them, he did horrible when it came to drawing the clock, yet the next time (a year later) the drawing was so much more appropriate when wearing his reading glasses.

The tests a facility gives are very basic memory skills. If he fails and they insist on MC, I would suggest trying to find a neuro-psychologist who can do an extensive battery of tests. My husband was tested and I better understood his type of dementia relating to his limitations and actions. As a 24/7 caregiver, I asked to be tested when I became concerned for myself. I learned more about myself and was told my issues were stress and anxiety related. In both cases, she told us she did not see Alzheimers inclinations but could not say it would never be an issue. The tests begin basic then followed by tests that seemed to be chosen based on how the previous one went. Some were hands on puzzles, some were listening and answering, some were pencil and paper, etc. In other words your strengths and weakness are able to show through. If you do this, ask ahead of time if the neuro-psychologist or a social worker will be giving the test. You definitely want to go to an office where the neuro-psychologist administers it because they can observe first hand how he struggles or excels in various areas during the testing. My husband has had both and the one with the social worker only revealed... No Major Problems!

A friend had been told her husband had PD related dementia and after being tested was told he had vascular dementia which requires a different approach. With TBI, your husband may exhibit dementia like symptoms but with proper testing it may be revealed it is only the brain injury which may need to be treated differently from true dementia. Even if the facility decides he does not need MC, you may want to pursue testing by a neuro-psychologist. Unfortunately, you may have to drive further to find one but it is worth it for what you can learn.

They asked my mom various questions including to subtract seven from 100, then seven more, then seven more, and so on. She did fine, and I'd have failed after getting to 93.

They also asked her who the president was and got credit for her answer "The man with the pig eyes." (This was in 2019, and she got credit because she had an awareness of the president and that she didn't like him.)

What she failed was after the official test when she asked the nurse who administered it if she'd met Mom's new husband. (This husband was entirely conjured up out of thin air, and the nurse already knew about him.)

I think you have a bad impression of MC, and maybe the one where he may go isn't a good fit. My mom's place had three levels of care, and those at the highest cognitive level were able to pretty much do as they pleased, plus they were in a different aiea from the others. They had their own TV, snacks and coffeemaker and could come and go to their rooms or outside in the yard as they pleased.

Perhaps consider looking into a different MC for your dad, because if he's in assisted living with his issues, you might find he'll be isolated when others without memory problems don't want to hang out with him.

I think it's safe to say that nobody 'wants' to go into Memory Care Assisted Living or onto the Memory Care wing of a nursing home, but oftentimes, it's in the interest of the resident to shrink down their world to fit their abilities. The 'test' that will be administered to your father is likely a MoCA or SLUMS mini cognizance test and consists of 30 questions designed to test the person's memory skills AND his executive brain function at that time. The executive brain function is like the conductor of the orchestra; if there is damage to it, then the rest of the orchestra has no idea what to do. So when EB function issues go on with an elder, you'll often see him struggling to figure out what's going on in everyday life. The portion of the test that checks the EB function is the Clock Test: He'll be asked to draw the face of a clock showing 3 o'clock or something of that nature. When my mother was asked to do so, she drew a blob; nothing at all resembling the face of a clock. That's when I KNEW she was suffering from dementia, as I had suspected all along. She scored an 18 on the MoCA test. Scoring is as follows:

18-25 = mild cognitive impairment,
10-17= moderate cognitive impairment
less than 10= severe cognitive impairment

So while your dad may be asked who the president is, they're not looking to hear 'a demented old man' as much as Joe Biden so they can see if your dad is cognizant enough to know his name.

It depends what score your dad gets on the cognizance test as to whether he's deemed 'ready' for MC or not. If he gets a 9, I think you would agree he's in need of a memory care floor. If he gets anything less than 17, I'd argue with whomever it is who insists he DO go into memory care. By the time my mother wound up going into MC, she was scoring a 10.

The test is comprehensive enough to where it won't be suggested your father go into MC if he doesn't belong there, I would venture to guess. And again, you will have the final say over where your dad lives. If you are THAT dead set against him living in MC, then say so. There does come a point in time, though, where a person DOES need MC and the shrunken down world it offers where life is MUCH simpler for them to deal with. It's not intended to be some horrible punishment or torture chamber where he'll be miserable, though.......so you should try to remove that thought process from your mind. Your father's best interest is paramount in this whole process.

I will say that mom felt she did NOT 'belong' in Memory Care the majority of the time she lived there, which was nearly 3 years. She felt that the other residents were 'stupid idiots' and she was smart & savvy. Meanwhile, she needed help with 100% of everything she did during the day. There are criteria that go into who needs to live in MC, not just 'scores on MoCA tests'. It's also about how much care they need on a daily basis, how often they fall, all sorts of things.

I hope things work out for you and your dad, and you wind up agreeing with whatever decision is made with regard to his care. And if not, that you move him to where you DO think he 'belongs.'

Bryant2016,

This is your family's and your dad's call, end of story. The Admin is trying to maximize the amount of money they can garner from him and is not acting in your dad's best interests.
I would get him to an Elder Care Team for full assessment, including social needs. Get an MD (his 'new primary) to state that his needs for social interaction will be better met on a regular floor. If they refuse to allow his MPOA and DPOA to facilitate this transfer to a regular unit, you need to report this to the state agencies on the Aged, the CMS (centers for medicare services), the state ombudsperson for the aged, the healthcare fraud and abuse hotline, and def get his attorney involved! They are using a wrong primary diagnosis as rationale for sucking his bank account (which I pray you haven't given them auto-access to, if so, cut them off).
You can research all of this and inform the Admin (I've worked with some total sleazeballs) of what actions you'll take in the event that they try to force this move to their MC unit and if they're stupid enough to call your bluff, then let the chips fall where they may.
Ultimately, you may have to move him to a different facility or delay this move closer, one where it's about quality of life, not only the dollar. You may have better options in that locale. It's even possible that an AL can handle his needs, but you may have to hire in more help. Gawd, I hope there is a sizable amount to draw on for his care; he's so young! I'm 65 and the MC unit my Mom is on would drive me insane.
The cognitive tests they use are like the BIMS - research that - and they are simple tests that can be skewed by the person doing the test. They do show changes over time and are used for resident classification. An Elder Care team will evaluate him for many aspects of function by and OT.
DO NOT be pushed around by this admin. Your dad has some quality time remaining and he needs to be where his needs are best met; he doesn't want to be with aged ALZ and dementia residents. A 'WanderGuard' can be placed if there are any concerns about him eloping so don't allow that to be used an an excuse to place him in a secured unit, NHs use them all the time.
I'm so sorry that tragedy has touched your family so severely and I truly hope that you can get him placed where he'll have a modicum of a decent life, and closer to family.
Best to you all.

That memory test may be the best thing for him and you. It can go either way - confirm Dad's limitations, or not. Most importantly it will give you an assessment along a continuum, as his functioning/needs will change over time. So it can be a baseline for future comparison. It's not a pass/fail thing.

If he really does need memory care, a proper diagnosis of 'memory impairment' is the key to getting the proper level of supervision and services he may need. If it's the Alzheimer's label that worries/scares you, understand that there are different forms of memory impairment, not just Alzheimer's. Ask yourself, is it the label or the environment/setting/program that "doesn't feel right". It can be hard to accept such a devastating diagnosis at such a young age.

Alternately, the facility may be trying to 'pigeon hole' your dad into whatever type of care/unit they have available; the 'best fit we have for him'. So maybe that's not the place for him. Are there other alternatives available in the community or nearby? Knowing your Dad is younger, and sufficiently observant to his surroundings, he may perceive that he doesn't 'fit' with these older people. That's understandable. If the fit truly doesn't feel right, don't settle.

When I first placed my 88 yr old Dad with ALZ, (we had to get him out of the hospital after having a urinary catheter implanted, he needed constant supervision), the unit he was placed in simply did not feel right. Most people were not alert or independently mobile. My Dad was still telling jokes and ballroom dancing!! I brought others who knew him well, to come observe, and we all agreed, this was NOT the right place for him. So I endeavored to find a proper place for him, and luckily, I did. He had a safe and meaningful life at a wonderful memory care facility, and I could be his daughter, not his nurse.

Good Luck

There are various assessment tests they may use

https://www.alz.org/getmedia/9687d51e-641a-43a1-a96b-b29eb00e72bb/cognitive-assessment-toolkit

(I'm not sure I could reliably pass some of the memory ones 🙄)

I suppose whether or not a move to memory care is a positive or a negative depends on what memory care looks like in your area and facility. Almost all nursing homes here manage to care for those with dementia without the benefit of dedicated units, lets face it very few living to a great age don't have some level of cognitive decline. Memory care where I live is where they place people with behavioural issues (violent and/or resistant to care) as well as those who are actively exit seeking, and among staff it's known as the most difficult shift.

There are many forms of dementia caused by different things TBI is one of them.
Dementia is 1 term like saying I drive a car. Then there is the type of car, the color of the car.
Dad has dementia caused by a TBI.
I would like to think this new facility will take all aspects into consideration but SAFETY will be their first goal.
They may even be willing to move him if they find that they are overly cautious to begin with. You can ask about that.
Keep in mind he may be uncomfortable with the move anyway. Most people with dementia want routine and do not like change (no one really likes change) so the move may put him off so hopefully they take that into consideration during any testing as well.
But whatever they do, where they place him will be with his safety in mind. The last thing they would want is for him to wander off. I know you said he does not wander but there can always a first time.

I was able to find a rare residence that offers two levels of memory care. He loves the programming and socialization at the first level. I sure wish all AL/MC residences offered this. Many articles have been written about the need for more specialized MC. Please talk with the supervisor of MC at any facility. Reach beyond the frontline sales team to ask specific questions about programming for different levels of dementia. Sending blessings your way.