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Monday I am meeting with the direction and RN to review dads care plan. Since moving in July 2014 he has received increasing assistance and his monthly charge is increasing to reflect this care.
What questions should I be asking.
He is in later stage Alzheimers but still mobile and not yet incontinent.

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Ferris1, I'm not familiar with Medicare paying for assistance with ADLs. And I didn't find anything on the Medicare website. Can you elaborate?
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He is at an AL that is an CBRF. While not a strict memory care place many residents do have dementia/Alzheimer's. Unlike many AL they have several aides during the day for the 22 residents. At least five not counting, kitchen, activities, nurse or director. I know he is needed more care with bathing, he is still eating well by himself. Some littler details I need updating on.
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I take it that he is private pay. Will he eventually go to Medicaid? Is he in regular Assisted Living or Memory Care. I think that Memory Care is more expensive due to how much assistance is needed.

I know that when my loved one was evaluated to see what level of care she needed, they looked at how many days per week she needed care and if the assistance was extensive or limited. It was divided into these categories, Bathing, Dressing, Mobility, Toileting, and Eating. They rate if the resident can do this with limited assistance or extensive assistance and how many days a week it's needed.

I guess I might ask how often they bathe dad, shave him, can he dress himself if prompted, do they cut up his food for him, do they help clean him after BM, do they brush his teeth for him, etc. You might ask to see logs they keep of what they are doing for the resident, if there is an extra charge for it. I wouldn't be rude, but just to confirm it if there is some reason they are not doing what they claim. I haven't had any problem with any overcharging at the two places I have encountered.
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If he needs help with ADLs (activities of daily living) the doctor will order this and Medicare will pay. Any assistance with companions is paid by you. As the dementia progresses and he becomes less mobile, Medicare should pick up 80% and your expense (or other insurance) will pay.
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My dad lived in assisted living for 20 months and has recently passed away at 90 years old. Over that period of time, his care needs increased and so did his monthly bill. I was able to keep my dad in AL the last several months of his life by hiring one on one day helpers (7am-7pm) which made the cost the same as a nursing home but I did not have to move my dad from a place he liked. I would ask the director and RN about what point you dad would have to reach to no longer be able to live in his current ALF. I would be prepared for them suggesting that he may need a one on one helper for parts of the day. I would be prepared for additional costs to be spent on your dad's care. In my case I could not figure out any other less expensive way to take care of my dad and luckily he still had the funds to pay for it.
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For full disclosure, Mom is at Atria Assisted Living, Cranford, NJ. I wanted to move to another area and move Mom as well, but I didn't find this type of deal in the areas I wanted to move to. I hope there is an Atria in your area that has this kind of arrangement.
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I found an Assisted Living facility with a "Life Guidance" program which is primarily for residents with some degree of dementia. Mom is 92 years old and requiring varying levels of assistance at different times. She is not very social, happy to sleep, resistant to being involved in activities even when I took care of her in my home. Although at times she seems more "together" than some of the residents in the general (non-dementia) population of the facility, this condition can and does change. I got a one-price-package deal that is more expensive than the base price in the other side of the facility but not as expensive as it would be to fund all of the "extra" services that Mom would need on top of the base price. This worked out well. At some point, Mom needed the assistance of three CNAs (Certified Nursing Assistants) and I had the choice of either hiring an outside CNA or performing the work myself which I did for two months, 16 hours at the beginning but that quickly tailed off to just at specific times (morning tasks, evening tasks, and I came by for rehabilitation work because I could motivate Mom and also inform the tech about her capabilities and personality as well as model how to motivate her). This care is only different from Nursing Home care because the facility does not perform invasive therapy (like intravenous fluids). The current cost of this in Eastern-Central NJ is $6700 per month. Compare that with Nursing Home which is at a minimum $11K per month. I do not know what the base price for general Assisted Living would be but I am guessing it is over $4000 per month.
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