My mother's Alzheimer's seems to be advancing. How will I know if she should continue in assisted living or move to a skilled nursing facility?

Many people with Alzheimer’s are able to stay in an Assisted Living (AL) facility or at least a Memory Care facility through the end of life. I consider Memory Care as Assisted Living on steroids; better staffing ratios, more training about dementia and working with the unique needs of people with one or more types of dementia.
Skilled nursing is for those that “require” 24/7 nursing care. Patients need a higher level of medical care. Many also have a devoted memory care section that is quieter and less stimulating to those with dementia.
AL’s provide multiple levels of care and one of their primary jobs is assisting with Activities of Daily Living (ADL’s); bathing, dressing, toileting, grooming, feeding, transferring.
In my experience, AL’s and Memory Care communities are happy to have the help of Hospice once the individual qualifies for this Medicare benefit. You can always request a Hospice Assessment for your loved one from a quality, local agency.
Home Health is another benefit ordered by a physician and paid for by Medicare. There are very specific rules for these benefits; medical necessity, etc.

Contact the Alzh Association.
Lots depends on the cognitive abilities of your mom and if she is making any decisions about her life. Discuss options (and guidelines/regulations/ governmental requirements at AL. Administrators/social workers there should be talking to you about options. I would be very surprised if you asked for their input if they did not advise you. Decisions may also depend on her advancing needs of care and who and how they can be managed. And, considering, if you know, how close the end of life is - it might not be advised to move her - if you are comfortable and trusting of the current situation/care provided-skilled nursing or other facilities aren't the same. The care your mom is getting now might be a better fit - for everyone. This is a determination you would need to make by doing research. I'd think calling the Alzh Association and getting support/counseling from them would be the first step. gena.

The the social worker or someone in administration will let you know when your mother needs a higher level of care, you should talk with them. In addition, if she isn't receiving hospice care services, you should inquire as to if the assisted living she's in right now would allow hospice. Hospice can come and be of great help to your mom and also to you and the family. Sometimes they may act as home health services. That help would include help with bathing, and other issues with your mom's activities of daily living.

If I were you, I would talk to the facility about if and when she would be a candidate to go to skilled nursing. I would also inquire as to whether or not they would allow hospice to come in to assist with her care. It's possible, depending on the state and the licensing laws, that your mother may be able to stay where she is with the added help of a hospice/home health, and that would help to maintain continuity of care for her and disrupt her life less.

My my sister and I faced the same situation with our father. We were able to find an assisted living service in a home that also allowed Hospice in. Both my mother and father were able to be placed on hospice. They lived there until they passed away, only about 88 days apart. The hospice people and the staff in Assisted Living were great! I hope that I've helped. My thoughts and prayers are with you as you go through this.

mccollum1: Has your mother had an MRI, a PET scan and a SPECT scan? What do they reveal? It seems to me if you're already asking this question, then the time has already arrived for your mother to move to an SNF.

I go on to explain SPECT here:

Single-photon emission computed tomography (SPECT, or less commonly, SPET) is a nuclear medicinetomographic imaging technique using gamma rays.[1] It is very similar to conventional nuclear medicine planar imaging using a gamma camera (that is, scintigraphy).[2] However, it is able to provide true 3D information. This information is typically presented as cross-sectional slices through the patient, but can be freely reformatted or manipulated as required.

Depending on what people can afford to pay .live in caregiver great..going to a place 5 star community is fun .but its all up to if she likes people .or if shes like living in her home change is hard for older people sometimes accisted living is a good posative move..depending on how much money they can spend on care ..5000.00 6000.00 for good care ..

Obituary if you are POA, & you’re with her on a daily basis so you can see her decline, the decision is yours. Mom mom lives with us & We made an agreement the day she moved in that if she became incontinant or didn’t know who I was, then it was t8me. That was 2-1/2 years ago & she’s still going strong. Don’t get me wrong, she has her bad days but I just sit in her room & we reminisce then get to what’s going on right now & by then she’s okay with where she’s at. In fact she’s greatful for her surroundings & the family that come to see her. No matter what you decide, & as long as it’s what’s best for your mom, you shouldn’t feel guilty. I know. Easier said than done. I’m sure I’ll be facing the same thing one day. My prayers are with you, your mom & your faimily.

My mother's assisted living told me my mother could live there as long as she wanted BUT if she started wandering, she would have to leave.

If you are asking the question, then perhaps the time has already come. Basically, when the person can no longer perform their ADLs independently, it is time for a higher level of care than Assisted Living can provide.

Assisted Living assumes that the person still has a certain amount of independence and can dress themselves, bathe/shower themselves, feed themselves, and are oriented to time/place/person.

As others have said, you should put your name on the waiting list, as almost all facilities do not have open beds on short notice.

My mother is in a memory care AL. She will stay there until the end with the support of hospice. You need to talk with the facility to see what their policies are. She has been on hospice since March and is slowly declining.

assisted living provides better food, more privacy, and better hygene. how important are these things? Of coarse finance must be considered but it must be weighed against quality of remaining life.

If she is in a good facility they will usually let you know. If they aren't doing that then I would move her. That shows they aren't watching her. Other note is if she is looking like her grooming is not usual or she is looking weight. A good sign she isnt able to take care of her needs. Is she falling or getting lost or wandering is another good clue.

Is she located in NC? Is she already in a Memory Care unit in AL or regular AL? Most of the time, the facility is able to explain to the family how things are working. Are they able to meet her needs where she is? Does she need a higher level of care?

It's my experience that a certified Memory Care special unit in NC is better able to meet certain needs than a regular AL. But, if she's going to need skilled nursing care, then, a nursing home might be needed. I'd discuss it with the facility and her doctor to see what she's likely to need as she progresses. It's my understanding that the resident can stay in a Memory Care Specialized Unit, as long as they are not on tube feeding or IVs.

I think that Hospice can become involved, regardless of the facility.

I moved my LO from regular AL to Memory Care AL, with doctor's orders, because they were not able to provide her with all the care she needed, which was pretty much everything. She could still feed herself then, but, that was about it. I saw a big improvement. When the resident is getting their needs met, you can see how much better they do. It's amazing. If you are getting a lot of franic phone calls from the facility about how they are struggling with her care.....I'd have a meeting and figure out how to address it.

This is not a decision you should have to make all by yourself. You are entitled to call a Care Conference with the people at the Assisted Living and brainstorm with them about how they feel Mom’s future looks. You can also speak with the doctor who tends to her care there. And, of you have family, talk to them. Keep in mind that beds at SNF are not always readily available. If Mom is going downhill quickly, you may want to get on the waiting list at your chosen SNF. In addition, since Mom has breast cancer, you may want to ask about the availability of Hospice Care.