Do people choose a nursing home due to financial means and/or is it really based on care needed? I have been stressing about the 5 year look back but am thinking it may not be an issue if she can just go into an assisted memory care facility....just curious of the difference cuz the cost seems like a huge difference.

My mom has early dementia. I am hoping this is way down the road but trying to prepare. What would cause her to go into a nursing home versus just staying in a memory care assisted living? Do people go with nursing home care first cuz of financial means? I am trying to figure out the difference.


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A nursing home (or skilled nursing facility) IS a medical facility that primarily receives reimbursement from Medicare, Medicaid, and private insurance. The facility is licensed by the state to operate as a medical facility. An assisted living home (including memory care) IS NOT a medical facility and is private pay or Medicaid reimbursed, (Private pay means paid for out of pocket by the resident. Medicaid reimbursed means that the resident no longer has the financial resources to pay for their care and must rely on the state to pay for their care; in other words, the resident is broke. The Medicaid patient must qualify for Medicaid and there are very specific criteria that need to be met in order to qualify for Medicaid.) Assisted living licensing standards are not based on medical need, but service levels. Many assisted living homes provide a nurse for medication management and minor injuries.

Nursing homes are significantly more expensive than assisted living residences. They require trained medical staff on site at all times and are able to do medical procedures. Insurance can cover the cost of living there, but the amount of coverage the person receives depends on the amount of health care needed. A doctor typically prescribes treatment and admittance to a nursing home. The care in the nursing home is typically oriented to the medical condition(s) your loved one has and not towards the dementia.

If your LO is generally healthy (not needing injections, wound care, etc.), then assisted living (AL) is your better bet. ALs residences are more homey and pleasant than a nursing home. Since your loved one has dementia, you will need to look at dedicated memory care (or dementia care) residences with 24-hour care. The staff at dedicated memory care (MC) residences are specifically trained in caring for people with memory loss and are able to recognize signs and symptoms of illnesses (people with memory loss are often unable to express their symptoms), are able to offer life enrichment that is appropriate for memory loss, recognize what new behaviors mean, know how to keep people with memory loss safe, etc. The facility should have locked doors to keep the residents in--yes, that is right, keep them in. Memory loss takes away a person's ability to recognize where they are and walking out the front door of their facility immediately places the person's life in danger. MC services can be in a large facility or an adult foster care home (typically 6 or less beds) and can have private and shared rooms.

You are smart to look into your options now and plan for the future. Two things I recommend you do now. Contact your local Alzheimer's Association, They are a wealth of information and resources, including videos, classes, books, referrals and training. 2. Contact an elder law attorney so your LO's financial and legal matters are taken care of while your LO has some remaining competency. Plan for your loved one's needs and plan for the primary caregiver's needs. Caregiving is a BIG job and can easily entirely consume the caregiver's life. The attorney will help you plan for Medicaid as your LO's financial resources could very well be used up. The Alzheimer's Association should be able to help you find an attorney.
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Reply to MaddieMae

While we wait for someone who really knows their stuff to answer....My mom is in in a locked (secured) "assisted living with memory care" on a continuum of care campus in rural-suburban Maryland. Her small building has 12 private rooms all on one story. She has freedom to go outside to an enclosed courtyard garden, and freedom to stay in her room all day if she chooses.

Next door on the lane is another same building with the same population. All have some level of dementia and many have deteriorating medical conditions such as Parkinson's, but the facility tries to keep the resident there as long as possible once they've settled in, offering various supports and allowing / recommending the family pay for a private caregiver at difficult times of day or night, depending on the situation.

When their medical conditions need more care, when their disruptive behaviors get worse, and / or when their mobility declines so they are usually in a chair and can't transfer, they move to the village up the hill, about 6 buildings. They still call it assisted living, but these folks are much worse off than my mother's village, and they are not allowed to sit in their rooms alone during the day--instead they are in group areas so they can be watched. Maybe they are still able to feed themselves somewhat?

The final step below that village is the actual nursing home. I'm not sure of the boundaries between the advanced assisted living and the nursing home, but I'm guessing the residents in the nursing home can't do anything for themselves at all, plus have medical conditions that need more sophisticated care and monitoring.
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Reply to Beekee
my2cents Nov 2, 2020
That sounds like a great village! And they cover each stage of disability. Hope those in your area read this one.
The difference between an assisted living facility and a nursing home is level of care and payment sources. An assisted living is for people who need some help. For example, they have mild to moderate dementia but are still able to do basic things like going to the bathroom, or get dressed, or feed themselves (maybe they need some assistance with these things). People do not stay in assisted living when they get to the point that they cannot do their ADL's without total assistance. Or when they have to be monitored and supervised around the clock. Medicaid does not pay for assisted living facilities. They only pay for a nursing home facility. There is no difference between a nursing home and a memory care facility. 'Memory Care' is just a more pleasant way of saying 'the locked dementia unit in a nursing home'. They are one in the same.
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Reply to BurntCaregiver
disgustedtoo Nov 5, 2020
"There is no difference between a nursing home and a memory care facility. 'Memory Care' is just a more pleasant way of saying 'the locked dementia unit in a nursing home'. They are one in the same."

Not exactly true. There can be MC units within a NH, but strictly comparing a NH to MC and calling them the same thing with a different name is very misleading.

NH generally requires a resident to need skilled nursing care and there are many more nurses than a MC unit would have. Some may have to transition from MC to NH as their condition gets worse, but not always.

My mother has been in a MC unit within an IL/AL/MC facility almost 4 years now. It is NOT NOT NOT a NH!!! There is one nurse and many aides. Nurse is required for oversight and due to medication management, but residents can vary between mostly self-reliant but needing a safe environment, to needing more extensive help.

The cost different is also a HUGE factor. Last time I checked, the local NH was about TWICE as much money/month. During recent discussion about mom's care, I was happy to find out she won't have to transition to NH, she can stay to the end. Likely cost will increase, but it eliminates the hassle of finding a place and moving her.
My sister (dementia) was in ALF(90 beds) for several years. As her dementia increased, her ADL's decreased. After qualifying for Medicaid and the need to relocate, I decided on a small 6 bed-Care home. It was more intimate, less confusing. My sister loved watching visitors come and go and smelling food cooking. (yes, home cooked meals). After a 5 1/2 month of searching for an "open bed" a bed/room became available. I was nearing the end of the 6 month Medicaid rule to use it or lose it. LUCK played a big role in this adventure.
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Reply to Compassionate5
Compassionate5 Nov 3, 2020
Additionally. the 6 bed
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Your mother will need to medically qualify for placement. That might influence whether you choose a memory care assisted living facility or a nursing home. Most assisted living facilities are private pay. Most good nursing homes will accept Medicaid but their available Medicaid beds will go first to residents who have been paying privately and have run out of money.

Placement is not 100% up to the family.
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Reply to Marcia732

My understanding is that only patients who need skilled nursing qualify for a NH. To receive Medicaid for a nursing home, one must need skilled nursing and be financially impoverished.
ALF is usually recommended for those who need help with activities of daily living (ADLs) But not skilled nursing. Memory Care is more like ALF but for more advanced dementia. Memory care is a locked environment. Regular ALF not.
‘Medicaid seldom covers ALF but does in some cases. It’s usually private pay. Medicare never pays for room and board except during a limited rehab.
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Reply to 97yroldmom

Primarily it is the cost that would limit the amount of time. Most ALF are self pay, whether memory care or not, and most do not accept Medicaid when the person runs out of money (some do; important to discuss and have written contracts). Memory care, even in Assisted Living, spends most of its resources on caregivers; many more exist than in the non-memory care; often patients have "roommates" and are unable to keep as many of their own possessions. Memory care is a locked facility.
Nursing Homes are often much more like memory care, with fewer nice amenities. The other choice that many sadly overlook is Board and Care. People generally are approximately 6 elders to two caregivers round the clock, their own room, less costly.
A lot to think about. Nothing to prevent you looking around in your area to see what is currently available. I would recommend that.
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Reply to AlvaDeer
Invisible Nov 5, 2020
And ask friends, co-workers for recommendations.
People go into memory care who have dementia or alzheimers. They may be physically OK, but their minds are not OK. They don't make good judgments about their safety. They may wander and get lost (which is why memory care units are locked units). Usually people with dementia decline over time, and depending on the facility and person, they may have to go to skilled nursing eventually. Usually heavy people who need special equipment to lift them out of bed have to go to skilled nursing when they are no longer able to stand and walk. People in skilled nursing are physically not able to care for themselves physically, but their minds may be fine.
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Reply to NYCdaughter

I pray I never end up in a group home setting. I have enough trouble just living with one person or staying over night at one of my kids' house. I do not like to be in groups, I hate even going to the grocery store when busy but usually can not afford the shopping services or delivery. I hope I just have a massive heart attack or stroke and go out like a light. I am working on getting DNR and advance care directives put in place so that no one forces me to stay once my quality of life goes. I have been a caregiver to too many, watched the torture of slowly fading away...I totally understand why my late husband tried to "check out" once his quality of life started to decrease, ironically he failed each time then fought cancer like he wanted another ten years..
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Reply to LS2234
LS2234 Nov 5, 2020
Does it occur to anyone that maybe the dementia patients who "wander" and make "poor choices about safety" on some level, perhaps, know EXACTLY what they are doing and are trying to escape h3ll on earth?
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When you are looking at memory care, you want to ask 1) if they have a lift and 2) if they will puree food and help feed your parent if becomes necessary. (This is later stage dementia.) There are other questions, of course, but at this time, without memory care standardization, these two things are only offered in some memory cares and if the need develops, you may have to move your parent to accommodate them. I was told about these two things as I signed the lease and it eventually caused us additional problems. Not that moving a parent from one memory care to another is all that unusual.

We went to a place that offered independent living, assisted living and memory care. These places have nursing staff that will evaluate your parent to determine what kind of assistance they need. Assisted living means you contract to pay by the hour for additional assistance with any of the activities of daily living (ADLs) in addition to your lease. As your needs increase and can't be scheduled, you may have to transition to memory care to get 24/7 care. You may have to transition because of falls or incontinence. You may have to transition because of wandering. Memory care residents are locked into a limited area. Their meals are offered in that same limited area. They may be eligible for meals in the main dining room and participation in building activities with accompaniment but don't count on there being an aid willing and able to take them. Family and friends can come and go as they wish in memory care. They can take the resident out on excursions but need to alert staff. Memory care handles all dispension of medication and healthcare decisions.

Long term care (aka skilled nursing) - 24/7 assistance - is offered in nursing homes. It often involves specialized care. Memory care becomes long-term care.
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Reply to Invisible

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