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Reported on this already, but after a couple of hospitalizations for pneumonia, the doctor said my Alzheimer's dad should go to a nursing home as memory care would not suffice. The difference being 24 hours nurses in nursing home versus nurses during regular hours but only nursing assistants with nurses on call after that. Yet the nursing home he is now at has one LPN for the whole floor during evening and night hours, not a big improvement over the memory care. Plus, the nursing home is twice as much money, and in a nursing him he shares a hospital like room where in the memory care he would have a private studio type suite. I can hardly imagine the extra cost is worth having one LPN on staff in the evening. What are the chances an LPN could prevent a problem versus nursing assistants not doing it? Even if something did happen to my dad, it would be in a comfortable place, not a depressing nursing home. Why did the hospital doctor insist he needed a nursing home. I contacted my dads primary care doctor and even conceded a nursing home was not a big step up from memory care. Furthermore, if I understand correctly, the intaking memory care needs to make an ethical and professional assessment that they can indeed provide the needed care. The memory care is a half a mile from my moms home, versus eight miles for the nursing home. I think his quality of life would be better at the memory care. In addition, the hospice services would visit him at either place. What am I missing?

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Unless a doctor is actually working in a facility they probably don't know any more about how they are run than the general public does. Just because the doctor assumes the level of care required can only be provided in a nursing home doesn't mean you can't use your own common sense and first hand experience, if a facility says they can provide what he needs and you feel they are living up to their promises then that trumps the opinion of anyone on the outside - even if they are an MD.

edit: Be aware that some facilities promise much but deliver little, I know of places where caring staff is stressed to the max because they can not deliver what management is expecting and as a result the residents suffer.
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Just happened to get on here right as you posted. Thanks for pointing out dysphagia issue, though I would have otherwise thought MCs would do this as dysphagia is often an issue for dementia patients.
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Karsten, I just remembered that Dad's MC was not able to accommodate Dysphagia diets, so that could be a concern. Though that was what Dad prob should have been on, he had already chosen to eat what he wanted. Because the facility was so close, I was able to go every day and took him shakes, ice cream and lots of other treats to keep him happy. And I became very friendly with all the staff and fed him when he couldn't feed himself. So, if there are dietary restrictions, make sure the MC can handle them. And also find out how much he can decline before they will ask you to move him. Dad became a 2-3 person assist bc he couldn't help with anything just before he passed. But when we knew he didn't have long, they assured me I wouldn't need to move him.
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If the doctor has other reasons, and she may, I do not know what they may be. I guess my reasoning is the more hospice philosophy that even if they did nto have the capability of prolonging my dads life as much, it is far more comfortable, basically within walking distance from my moms home (we had tried to get her to move in with him to another MC nice apartment, but she refuses) so my mom could be there a lot which is important. I really wish we could bring my dad back to his own home, but in addition to higher cost, which I would contribute to, my mom is not comfortable with other people in her home and feels it will still be a burden to her, and while I think my mom can be selfish at times, I do see her point on this. But my dream would be for him to be home with all the care that is needed.
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If you haven’t already read it, pick up Atul Gawande’s book ‘Being Mortal: Medication and what matters at the end of life “. This helps you understand the back story for most drs. They are trained to keep their patients alive regardless of all else. Many are out of their league when a patient needs to take stock of where they are in their life and not be as concerned about another procedure that ‘ might’ extend life but at what cost?? It’s not always in their ( the doctors) skill set.
Dr Gawande talks about the questions our loved ones need to have an opportunity to answer at the end of life for what’s important to them.
For a dementia patient I think it can also give you confidence to make the quality of life decisions and feel good about it.
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If the doc thought that he should move because he is at high risk for aspiration pneumonia, that's not an appropriate reason. Services for this problem should be available at either facility. However, if the MC facility isn't properly preparing his food, assisting with feeding, etc., maybe a different MC facility would be better.
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He can be in the MC with hospice services. We have already got the hospice services set up at the nursing home, but they said if he moves places, they would simply move with him, so he would be getting hospice there. I think the MD thought he is at high risk for aspiration and pneumonia, and that is true, but I thought the whole idea of the hospice stage is that you are not necessarily trying to prevent a life threatening event, you are trying to make the patient comfortable in the time he has left. Maybe my dad doesn't know the difference, but it doesn't look comfortable to be in this shared room, very old fashioned hospital like, verus a private room, with room for furniture from his home and other comforts at talkey said.
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With the facts that you present, I don't see why a SNF is needed. Perhaps he can stay in AL and have hospice services. Hospice is covered by Medicare. Is there something else that the doctor is considering?
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Thanks talkey, very helpful answer. That had been my thinking, but just wanted to know if I am being naïve or missing something. Sounds like a very similar situation.
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Dad's dr first suggest a SNF, but I opted for MC. Private room and bath, his own furnishings, access to many options in attached AL if I wanted to take him out of his unit. And the staff-patient ratio was better too. An LPN was on duty 24/7. AND the MC was 7 minutes from my house, and cost was very do-able too. If he couldn't be home or with me, then I believe I gave him the best until he passed. I believe his facility hired some of the most caring people too. I think that doctors do their best, but they're not 'boots on the ground' care-givers. I can't imagine why a nursing assistant can't handle meds and potential crises.
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