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GinnyK Asked March 4, 2024

Why are MC units typically associated with ALF and not SNF?

We’ve been looking at options for my mom who is starting to need more care, and I’m just wondering, why do they always seem to put Memory Care units with Assisted Living and not Skilled Nursing? Is it because residents of nursing homes are usually bed-bound so there’s little chance of them walking off even if they have dementia? Or is it because the level of care changes at a nursing home and they’re just not going to do as much for the person? Memory Care is very intensive from what I understand, or at least it’s a lot more expensive, but couldn’t some of those people do just as well in a nursing home? Is it about the money somehow?
Or maybe it’s about the level of nursing care they need, so MC gets the people who are physically well but mentally not-there? I’d assume then that people could be discharged from MC into a nursing home if their physical needs got worse, is that how it works? Any insight appreciated.

JoAnn29 Mar 4, 2024
This is hard to explain. ALs and MCs are residences that are private pay. They help with ADLs and are limited in how much care they can give someone. You don't put someone with lots of health issues into an AL or MC residence. Most of the staff are CNAs with no medical training with one Nurse who is in charge of meds and careplans. The person gets a room/apt of their own. Its like having an apt with added help. These residences do not take Medicaid unless like my State they may after two yrs of paying privately.

NH, LTC, SNF are where residents can get medical care and therapy. These too you pay privately but have the option of Medicaid if care is needed and you have no money. There are more RNs per ratio.

MargaretMcKen Mar 5, 2024
Where I am, MC is usually for people who are ambulant but are escape risks. They don’t need nursing care, and if they weren’t escape risks they would probably be in AL.

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AlvaDeer Mar 4, 2024
SNF means just that. SKILLED NURSING CARE is needed. It is in general more expensive care as they are dealing with things that required that a skilled RN be on duty at all times. This may includ IV medications, wound care for decubiti or open wounds on stump of amputations, and etc. In general this is a care required that is somewhere between Hospitalization and LTC (long term including ALF, MC, and etc.)

This is just a kind of generalization, you understand.
Individual places define in their own way generally.

freqflyer Mar 4, 2024
I remember when my parents were in two separate facilities. My Mom could not longer remember how to walk due to a fall which caused her mild dementia to accelerate to final stage. She needs a lot of physical help, thus placed in a Skilled Nursing Facility. It was costing my Dad $12k per month.

My Dad moved into an Independent Living facility and then into Memory Care at the same facility. Dad only needed help with showering as he was a fall risk, and his dementia was mild accept at night [Sundowning dementia] as he would try to leave the building at night. He needed to be in a building that was locked. His cost was around $7k per month.

Therefore, different skill sets needed for these different facilities.

Geaton777 Mar 4, 2024
ALs and MCs are often "connected" as part of a continuum of care strategy for the resident. Where I live there are free-standing MCs, ie it is MC and nothing else. It is for those who need more help than in AL but do not need any medical care.

Regarding NHs... I think it may be semantics since NHs and LTC facilities seem to provide the same services. NHs are for when someone needs medical care as part of their daily needs. They have 24-hr monitoring for people who may not have dementia or memory loss, but can't perform their ADLs on their own anymore, or have a profound medical problem or are bedridden.

My MIL went from AL to LTC in the same facility. She is bedridden.

Grandma1954 Mar 4, 2024
A few points...
Someone with dementia in Memory Care will possibly get more stimulation and activities if they are able to participate.
If a person with dementia gets to the point where they no longer are mobile, or it takes 2 people to transfer they may be moved to Skilled Nursing because most if not all Memory Care facilities can not use equipment to move someone. So no Hoyer Lifts, no Sit to Stand equipment are to be used.

Skilled Nursing is also a much more medically focused care and because of that the cost is higher. More aides are available to Memory Care as they are not doing the Medical Care that is done in SNF.

Many facilities have Continuing Care. This would take a person from Independent Living to Assisted Living to Memory Care then Skilled Nursing.
Often grouped in with Skilled Nursing is Rehab. Often places that do Skilled Nursing are used for Rehab because there is the Medical Care that is often required after hospitalization merging into Rehab.

Sarah3 Mar 7, 2024
Assisted livings is a relatively recent development that is very much corporate industry and all about the profit, they usually invest a lot into exterior show of fancy dining area, ornate sitting room etc but the level of care is often below par, residents are left waiting for attention for their needs, if they require assistance they charge an extra fee on top of the already exorbitant cost it’s an exploitative industry. There’s one close to my area that was sued by a family member who’s parent was harmed there,..another one I often saw paramedics in front they had some misconduct and changed the outside appearance and the legal name of the business, that is how some businesses escape legal issues avoid at all cost imo
GinnyK Mar 10, 2024
We also have some experience with AL for my FIL. He used a walker but got less mobile as time went on and ended up in the hospital because of severe edema (sitting too much with his legs down and maybe some heart failure). Prior to that he lived with us for two years.
Having him in AL definitely was a lifesaver for us since we were getting burned out at home, developing high blood pressure, tension, and able to give less than ideal care for FIL. We might have gone with adding some professional in-home care for him and did look into that for a while, but ultimately it seemed 1) expensive and 2) overwhelming to be bringing outside help into our own home. Also I just didn’t think it would relieve the stress on my husband as much as he needed if his dad were still here as he undoubtedly would still be taking a very active role in his care. Anyway, it was the family’s choice to have him go to AL, which was also expensive, and FIL went downhill fairly quickly there but he did have Parkinson’s and also was refusing to go to meals, take therapy etc. There were a couple of people who worked well with him, got him to go to meals, chatted with him, did the light wound care he needed, and he seemed to be adjusting better after about six weeks but it was too late with the edema.
I share all that to say that we also had mixed feelings about AL, but I don’t know that he would have qualified for a SNF and we had reached the end of what we could reasonably do at home. Everyone’s situation is a little (or a lot) different and we did see residents in the ALF who seemed well adjusted, stable and well cared for.
Now maybe he would have qualified for SN, now that I think of it, and maybe he would have done better there, but we were still thinking this was going to be a short stay for respite only. Probably we were fooling ourselves, it can be hard.
Also, when he left our home he was still pretty cogent and in great shape physically considering the Parkinson’s, as he had been exercising regularly and taking that carb-levo medication. He never tried to walk out of the AL, I think he’d lost his get-up-and-go by that point. The AL did seem expensive, and he didn’t get nearly the attention he was getting at home, but we just couldn’t do it anymore.
Midkid58 Mar 7, 2024
I can only speak to the ALF/MC place my MIL was in.

She started out in the ALF section, but as she went downhill incredibly quickly, she was being assessed for movement to the MC section of the bldg. She actually wouldn't have qualified for that b/c she had become violent and too much care for the MC level. I believe that an assessment was made to be moving her to some total-lockdown psych facility. She simply was too much care for the kids (who never left her alone, even after moving her) and on site nursing care.

Luckily, she passed 8 days after being moved into the ALF.

The A in ALF is for Assisted--which means the patient just needs 'assistance' not complete 100% hands on care. She could not do a single thing for herself.

IN MC the patient has to at least be somewhat 'with it' so as to not take 90% of the nursing staff to meet their needs. Even with 3-5 people dealing with her, she was a problem.

KPWCSC Mar 7, 2024
We have a MC facility nearby. I met the administrator and was asking some general questions. At least in our area, MC facilities are only at the Assisted Living level. I found out even though my husband would benefit from MC because he would receive a lot more stimulation, they can not take him because he has a PEG tube and that is considered skilled nursing. Yet, he doesn't exactly qualify for SNF because he doesn't "need" their level of care. I'm blessed with VA caregivers 28 hours a week to still be able to keep him at home for now and try not to dwell on what may happen down the road.

The SNF my father was in had MC patients but it also was a locked facility. I think most, maybe all, SNFs are locked now anyway. So sadly some, like my husband, who only need MC and some assistance are in SNFs with little stimulation. It takes a special understanding to be a caregiver for someone with dementia and not all staff members in SNFs have that experience.

Llamalover47 Mar 7, 2024
GinnyK: I was (wrongly) under the assumption that in the NH my mother was in that she would end up in their LTC unit. Just days after admittance they said "Ma'am, you're too well to stay here," which forced me to scramble to locate an AL. However, my mother suffered a life ending stroke AT the NH. Fortunately, I was able to get refunded the $12K/month AL fee.

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