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Sorry in advance for being so wordy …My 96 year old mother has late to mid stage dementia, had a mild stroke two years ago and is now wheelchair bound and unable to do almost anything for herself. She lived in an ADU in our backyard for 14 years and has had the money for me to hire four fantastic private caregivers who have been with us for the last 5 1/2 years (24hr the past 3 1/2). For financial, physical and burnout reasons we made the decision to move her to a nice private board and care home four minutes from us. She lived like a queen here at our house but now is living in a drastically less stimulating environment, thus my question:
What should I most realistically expect from a board and care home? Has anyone had/have personal experiences with these places? I’m distressed and thinking of moving her elsewhere but not sure if this is how they will all be.
Not sure what I would do without this community ❤️

I am slightly surprised that board and care will take someone with mid-late stage dementia as I would not have thought they were equipped for someone needing that level of care. Perhaps a memory care facility would provide more of what you expect and avoid having to move her as the dementia progresses. Good luck in finding the best for her - which may require a modification to what you expect knowing what she has had being able to be close to you, but may be closer to her needs as her dementia progresses.
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Isthisrealyreal Nov 22, 2021
Many board and care homes will take anyone and allow them to remain until death. They have a better patient to staff ratio, making it easier to deal with behavioral issues.

The only thing that I found that would create an eviction was physical aggression that couldn't be controlled. They all gave a chance with treatment before they said "out!".
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My mom is the same age and also has mid to late stage Alzheimer’s disease. I kept her at home until three years ago and I regret not having moved her sooner. She is flourishing at a group home and is much happier. We were a family living together, my autistic sister,, my daughter and me, but because of limited mobility Mom was essentially stuck in her room all the time. We had no downstairs bedrooms and the stairs were very difficult for her to manage. I considered memory care units as well as a group home and decided that a group home was a better fit for her because of her mobility issues. I was very thorough in my questions about what levels of care they could provide, types of activities and engagement they offered and how long she could remain there based on her health conditions. The home was quite frank with me and told me what they were willing to accept and what would cause a change in residency. The owners were a known entity to us. My sister and mother had known them for years and their reputation was well established in the community. Mom has her own room with her own furnishings and her own bathroom. She lives with 3 to 4 other people and has made some very close friends there. She has a daily social life, regular activities and prior to covid they were even able to bring in religious services for her. They even do charity work filling bags for the homeless and hungry in our community. When the severe arthritis in her hip is really aggravating her, she is not forced to walk to the dining room. They are willing to bring her meals to her and bring her daily afternoon tea and pastries. There is no extra charge for this. The administrators are excellent about communicating with me and will let me know about ANYTHING unusual that happens during the day or night. Like any other memory care units, large or small, they have had their challenges maintaining staff, but the administrators are always there because they live in the home. There’s been tremendous continuity. There is one significant challenge to keeping a family member in a group home. If there is a medical emergency, they do not have the staff to send someone along in the ambulance. They send a folder with the patient’s medical records along in the ambulance and contact family members. This can happen in the larger places as well as staffing can be very difficult to maintain at any size care provider. As with any service, not all service providers are equal and it’s really important to ask a lot of questions about the care your LO will receive and to visit anytime you wish. You should at minimum occasionally pop-in – – that way you know what’s really happening. If the place has a problem with pop-ins, then you probably don’t want to put your family member there.
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Reply to MaddieMae
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CleanupBatter: Imho, perhaps your mother's "late to mid stage dementia" warrants a higher standard than what a board and care offers. In addition, no place is going to treat her akin to a gueen.
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In addition to a clean environment, you should expect nutritious and delicious food, a "homey" atmosphere, individualized care, and of course, stimulating environment with a range of activities, music, art, gardening, cooking, and conversations. No restrictions on visits from you, family, and her friends.

Your state will have regulations that apply to care homes. Talk to your local Ombudsman's office or your state's health department. Also, be aware of "Residents' Rights" http://www.nursinghomealert.com/residents-bill-of-rights.

I also encourage you to stay involved with your mom, not just standard visits, but group gatherings to help her connect with other residents. Maybe you could offer a weekly group activity, like a sing-along.
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Reply to DrLokvig
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Your post suggests that you were paying for 24/7 carers (very expensive!) before the move and that the move was less expensive (hence the financial reasons). You had four ‘fantastic’ carers, and at least one of them might even be missing her. Perhaps it might be financially possible to hire one of them to visit her, perhaps twice a week for a couple of hours, to provide her with a bit more one-on-one and make it a bit less of a change. Worth checking?
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Reply to MargaretMcKen
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I have not had any experience with small group homes myself, but I have heard relatively positive things word-of-mouth about one or two such facilities in our area. They seem like a great option if they can provide safety and cleanliness and attention.
Good Luck in your search. I hope there is a wonderful small Group Home in your area.
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Reply to RedVanAnnie
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you have to look very carefully for a small caring place usually expensive
that might be a good fit … if your mother still enjoys interacting and activities this usually better situation than isolated with caregiver at home. But if she doesn’t and just
wants be left alone with tv and likes someone beside her all time it probably not best … she maybe too old to make change now .
best luck
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No matter where your mom lives, she absolutely must have her physical needs met: hygiene, nutrition, medications... An ideal location will also have activities that she enjoys and can participate in. No place is ideal.
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Hi CleanUpBatter,

I had to place my loving and amazing grandmother in a nursing home. She begged me to see that she wasn’t taken to a home. My mom tried finding a group home (not a nursing home) and when I visited (this was in AZ, I live in IL) I saw horrible things. Despite my mom’s best intentions, it was an awful situation. My grandma lost 40 lbs in the shortest of time. It was not clean and no stimulation except the TV. It killed me seeing her this way. So I arranged to be the POA and swiftly moved my grandma to a nursing facility about 20 minutes from me.

I visited five days a week and hired someone to spend time with her on Sundays.

There’s a lot you won’t like to see. Residents who are ambulatory get the best care, as there’s more risk for falling. The awful truth is there is always staff shortages. But most staff want the best for patients but simply don’t have the resources.

I recommend stopping by unannounced and seeing what is wrong or right and swiftly take your organised list to the head of nursing. You really must be vigilant.

Be friendly with the staff and memorize their names. Let them know you’re there and sadly but true, your mom will get more attention. The squeaky wheel gets the oil — this could never be more true than in a nursing home.

Also, I decorated my grandma’s room with her own things. (Her side of a shared room) Curtains, photos, comfy chair, stuffed kitty (which she thought was real and it kept her company. She would pet it all the time.) And I asked the staff to call it her “apartment.” Some complied others didn’t. I even left soothing music playing for her (with the permission of her room buddy’s family).

People will thieve, not knowing they’re doing so, so things will get lost but typically you’ll find them again, in someone else’s room. (Put your mom’s name on everything!!)

To finish my story, six months into my grandmas new residence, she gained all the weight back and more! She was designated hospice when I first moved her here. My goal was no matter how much longer she has, she must know she’s loved and have visitors.

She live four more years!!! And her last words to me were: “Thank you for bringing me here.” Which was the biggest gift she could’ve ever given me.

I hope this is helpful to you! It’s difficult but please don’t let the guilt get to you. I wish you all the very best and I’m happy to help anytime if you have follow-up questions/comments.

Blessings!
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Reply to TheirWorld
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DrLokvig Nov 21, 2021
Thank you so much for your input. You are so right.
The key to your grandma's successful stay was your attitude and actions. I spent over a decade at care facilities with clients, interacting side-by-side with staff. Every facility was understaffed;. With only one exception, every one of the individual staff members were kind, compassionate, and caring. The exception was a CNA who found "less than perfect" people disgusting. Fortunately, she left after a few weeks.

I saw first hand how important small gestures can be: a thank you note, a box of homemade cookies, or gift cards - even for as little as $10. -

And I strongly urge family members to find ways to be involved with the community. Offer a weekly program, such as story telling, joke-sharing, sing-along, or simply tea and conversation. There's generally a major void in activities right after dinner and on weekends. Talk to the staff for ideas.
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Sorry to have to say this but all Nursing type Homes are an awful place to live.
They are all understaffed and your loved one can lay in their own urine and feeces for up to an hour before being changed.

You can't keep anything nice as it seems to walk away.

Thints go to the Laundry and never come back.

It's the last place you would want to put a loved one or even an enemy for that matter.

You should re think it and If there is any way possible to let her move back,, DO IT!
Seniors in Nursing Homes only live, more like survive for approximately 6 months.

When you go to tour the place, they show and tell you everything you want to see and hear as they are wanting your business and trying to make a Sale but the truth of it living there is Pure He'll.
She would be better off moving back, installing a Camera, I used Nest Cameras so I could check in by my smart phone or lap top at any time and then since you mentioned money reasons, just hire someone to be there to check on her a couple hrs in the morning, afternoon and evening instead of 24 7.

Believe me, you will see your Loved One go down hill fast!

Prayers
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RedVanAnnie Nov 21, 2021
You must have had some terrible experiences with Nursing Facilities as your comments about them are always very negative. It would be encouraging to hear a story or two from people who have had better experiences. Once in a while a poster will describe much less dismal situations than the ones you have seen.
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Thanks to both @isthisrealyreal and @cwillie for your responses. Each adds to my bank of knowledge and expectations! I didn’t expect mom would still be treated like she was before but Isthisrealyreal states exactly what we are experiencing and it sounds kind of like it’s normal. I don’t care for 2 of the caregivers that came in as a couple right after mom moved in but you’re right, the place is only as good as it’s caregivers and they can change on any given day. Maybe the good outweighs the “bad” rather than being in a memory care facility. As of today I have asked one of her old caregivers to start visiting two days a week starting next week. Thanks again!
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Reply to CleanupBatter
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Thanks to both @isthisrealyreal and @cwillie for your responses. Each adds to my bank of knowledge and expectations! I didn’t expect mom would still be treated like she was before but Cwillie states exactly what we are experiencing and it sounds kind of like it’s normal. I don’t care for 2 of the caregivers that came as a couple right after mom moved in but you’re right, the place is only as good as it’s caregivers and they can change on any given day.
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Reply to CleanupBatter
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Is "less stimulating environment " the only issue?

Exactly what does that mean?

You will never find any place that will treat her like a queen.

You can expect that her needs will be met ie, fed 3 times a day with snacks, getting her up and dressed with basic hygiene daily, 2x a week showers, her room cleaned, bedding kept cleaned, bed made daily, medications managed, that type of care.

If she needs activities all the time and more one on one care, a board and care is not the place for her. You will need to step in or hire someone to be with her.

One of the reasons they are cheaper then a big facility is because they don't have the overhead of activities and the space and employees to run them.
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Reply to Isthisrealyreal
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No matter how good a facility is it can never replace the personal one on one attention that can be given in the home, staff needs to divide their time and attend to the diverse wishes and needs of all the people living there.

I think one of the pros of these types of home is that there is limited staff so they get to know the residents personally, and there is a less "institutional" mindset.
On the other hand the intimacy and small number of staff can also be the greatest deficit because everything depends on the care and reliability of those few people. Even if there are excellent people working there there is no guarantee that they will still be there 6 months down the road, and if there are slackers there is less oversight.
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