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My husband's brother has dementia and needs to be placed in a skilled nursing home. However, all of the facilities we have checked have denied him, Why is this happening and what can we do?

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haileybug, there have to be other issues that have not been disclosed to you. First you need a healthcare Proxy, but if his dementia is advanced he cannot sign one and you will need court-ordered Guardianship.
Then you need to know ALL the details of his health history and any criminal history he may have. Nursing homes are now insisting on background checks on their patients prior to admission. They are insisting on checks for any communicable diseases including STD's.
Any history of assault, menacing or harassment is a real problem.
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I'd get a copy of the doctor's orders and see what the medical condition that requires skilled nursing care is. For example, if the family said they they want him to be tube fed, he may have to go to a skilled nursing home to get tube feeding. Other families stick with handfeeding, which a Memory Care AL, can do. It's a lot to consider.

If BIL is on Medicaid, the nursing homes that you are checking with my not accept Medicaid. Some facilities do not. Most of the places that I know of, try to assist the resident in finding a place to be transferred.

Who is in charge of your BIL? I'd have them ask a lot of questions. For example, are there any behavioral problems with BIL that has caused the facility to reject him?
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Hailey
The folks trying to answer your questions here all have first hand experience - some of asked you some pretty basic information about your BIL which maybe due to your stress you're not capturing so in an effort to help organize your next steps I'll try to summarize

1 does anyone have power of attorney- health and financial
2 does BIL have financial resources or does he need government funding I.e., Medicaid not the same as Medicare
3 even if BIL doesn't walk much his behavior could be an issue - yelling and hitting
4 is BIL taking any meds for any health issues incl dementia and anxiety it causes
5 does BIL have his own doctor or is he using the ALF Doctor

My mom is in a private pay multi-state memory care facility - folks fall all the time - they cannot do IV or certain other things as they are licensed as an ALF not a SNF - they will put up with behavior issues to a point but they will call 911 to put someone on a 72 hour or longer psych hold

Try to provide us with a bit more information and the knowledgeable folks here may be able to better direct you

As one poster suggested please look for your county agency on aging - there should be a link to it on this site if you can't find it in the Internet

Don't give up hope - these are difficult problems to solve on your own
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Can the discharge planner at the ALF give you any suggestions or help in placing him? Also, when nursing homes turn him down, ask them if they can point you to a facility that might be more appropriate to his needs.

Sorry I don't have any better ideas. I haven't been in this situation.
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Hailey - you've been given pretty spot-on advice from others but imo zythrr answer nails it….. something in BIL's chart is a total red-flag for any facility.

Often family has "willful blindness" when it comes to family (or politicians…). Then add onto this that BIL is in an AL so in theory he is still able to take care of his ADL's with assistance and is viewed as cognitive & capable in his decisions & actions. So its likely that whatever he is doing that the "problem" is viewed as beyond what this or any other AL or SNF will accept. If I had to venture a guess, probably something sexual.

If your hubs & you live miles away and BIL has been in a facility now for years, and you & your DH haven't been visiting every week or couple of weeks or taking a long weekend to visit every mo or so, then you don't have a relationship with nursing staff or the activities gal or the guy who does PT or workers who do evening meal clean-up to get off-the-record insight & "heads up" as to what's what with BIL.

So what to do, if it were me, I'd ask the DON (director of nursing) and social worker for an off-the-record meeting regarding BIL and tell them you are doing this as hubs will be seeking guardianship. If you do not have DPOA, MPOA or HIPPA authorization for BIL, they are very limited in what they can state or access you can have to his medical chart but they can share with you anecdotal insight …. like another resident complained that he was doing XYZ, or he has threatened residents or staff, or was found doing inappropriate behavior on an outing. For dementia some become hyper sexual. There's a lot of sex going on in facilities and it's a hard subject for both facilities and families to deal with (the NYT had a series on this last year). There are posts on this site from caregiver daughters or DIL who find that "dad" says sexually inappropriate things to them, exposes himself, etc. Stuff that nobody wants to talk about.

If this is the problem, then the choices are stark. He is going to need to be in a speciality locked ward LTC SNF. Unless you all really want to become his guardian and go the guardianship route with the expenses, mandated reporting, arranging for paying for his care, etc., pause and give some thought into having him made a ward of the state. You will have to work with the facility to get this done. Probably start with him sent to the ER/hospital for a involuntary psych evaluation and neither the facility or family picks him up. The code for this varies, like in CA it's a 5150, PA a 302, a "72 hr hold". For where I am in New Orleans, it still referred to as a "3rd floor" referring to the old 3rd fl locked psych ward of the Charity Hospital, which has been closed since Katrina (2005). The hospital then finds him a emergency placement via social services dept. Often in situations like this, being a ward of the state can actually be a good thing as the court-appointed guardian can get him placed into a facility much faster.

You need to find out an unbiased reality on what he is doing. Good luck.
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Hailey
I understand your frustration and don't want to keep asking you to provide us with more information but it is difficult to try and answer your questions without knowing some of the basics

You can't assume that the ALF is in charge of BIL and will monitor and medicate him accordingly - is there a family member responsible for him or is he a ward of the state? Are there family care meetings being held every 6 months or so ?

Just because BIL doesn't walk doesn't mean he is not a harm to others or himself - he can yell kick punch and be non compliant with bathing and going to the toilet

The ALF is not responsible for creating a care plan - I don't hear from my mom's memory care unless there is a problem they need me to address but I'm in contact with them on a regular basis at least 3x a week either in person or on the phone

We want to help you
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What reasons are the facilities giving you? What do your BIL's doctors and other supporting professionals suggest?
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Is he private pay or does he have insurance to cover the cost? Why does he need skilled nursing care? I don't understand why he would need skilled nursing care for dementia and falling. Nursing care is for medical problems.

Has he been evaluated by a professional to see what level he needs. Most of the facilities that I know of require that a doctor or health care professional complete a form that states what daily activities the resident needs assistance with and of course, if they need skilled nursing care due to a physical problem. If he wanders, he may need a Secure facility. I'd read a lot about the differences in regular AL, Secure Memory Care AL and nursing homes.

I've never heard of a person not being able to find some facility that meets their needs, even if they have to get on a waiting list. I will say that depending on his level of dementia, he could need a Memory Care facility. You might explore that. They are focused on those with significant dementia. Some residents in them are mobile and can talk, while others are bedbound and have to be hand fed, so there are various levels. In the Secure Memory Care unit where my cousin resides, they do everything for the resident, except they do not provide skilled nursing care. As long as they do not require skilled nursing care, they live there until the time of their death. Hospice comes to the facility and they are kept comfortable and supported throughout the rest of their lives. You might visit some and see if they could accommodate his needs.
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Can you get him admitted to a psychiatric unit for evaluation and treatment?
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Hi I went through this also with our mother. She had a history of bipolar disorder and as soon as facilities would see this they would say no. She also was on Medicaid and we learned quickly that it is very hard to find a decent place that will accept Medicaid and then that has an opening. They often only allow for a small amount of rooms/beds to be allocated to people with Medicaid so the waiting list can be very long. Also some places require them to pay as private pay for a year or so and then they will accept the Medicaid which I never understood because if they are on Medicaid it means they have little resources or money so how do they expect them to pay, but that is another matter. I just know that any history of mental illness is always a red flag to many facilities and as much as it sucks, you just have to keep calling. If he has Medicaid he must have a social worker assigned to his case so just keep hounding them to help you find a place. It is their job to help you. In the meantime it is hard and all the being turned down can start to really get you down and frustrated. There will be a place that will take him. If you get on your states DSHS site they have a list you can print that has just facilities that accept Medicaid and print it and just start calling. Best of luck.
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