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During the phone conversation from the Social worker, the assessment criteria was not explained to me when the assessment was reviewed over the phone . My understanding of the word extensive was that my wife needed a high level of support with caregiving in all areas of daily living, self care ongoing around the clock seven days a week basis. She remains the same since the last assessment.

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Is your wife still at home or in Memory care? Is the SW a Medicaid caseworker or someone in MC?

What is the difference from Total dependence to extensive? What more do they have to do for her? Are you paying xtra for the Extensive care vs total dependence?
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I would ask for a meeting with administration, SW and caregivers to go over the care plan. They should be able to explain the needs. You might also then spend a day there, watching what she is having done. Just the bump up from medication nurse needed to no medications can bump levels up considerable. There may also be balance concerns that mean shower assist now suggested or appropriate.

I hope you will be able to work this out with the facility, and wish you good luck.
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