89 with vascular dementia. She knows the staff in AL memory care can't make her do anything. She stays in bed most of day. She might come out of room for one meal. Hair does not get done. No communication from facility on bathing, staying in bed, not eating. I go in a couple days a week and can't get answers from her obviously and staff seems to not know details. She will have to go medicaid in a couple months once we spin her money down. Thinking of moving her to NH when goes on Medicaid. Will she be considered Skilled Care do you think? My sister and I are POA and we have elder care att.
Mid April of 2017 I applied for Medicaid for Mom who was in an AL. She had 20k left. I placed her in LTC May 1st. She paid May and June. This gave me time to finish the application and get all info needed to the Medicaid caseworker. June I proved Mom was now spent down and confirm the caseworker had all info needed. July 1st Moms Medicaid started.
The time is now to apply for Medicaid.
If mom can eat that meal without help and without choking.
If mom has no other conditions that require nursing skill she would not qualify for Skilled Nursing facility (aka "nursing home")
I am a bit confused by your term "AL memory care".
Is mom in Assisted Living or is she in Memory Care?
In Memory Care the staff is more used to getting people up out of bed, getting them to shower, getting them ready for the day, hair done, dressed et al.
Assisted Living generally does not "push or urge" residents to get up, get dressed since most residents are more decisional.
All that said...
I also think she should be evaluated for Hospice.
Hospice would have a Nurse come in 1 time a week to check on her. A CNA would be there at least 2 times a week to give her a shower or bath (bed bath can also be done) and the CNA would see that she is dressed and her hair is at least combed/brushed.
Hospice would also order all the supplies that she would need incontinence products, gloves, wipes, pads....
Hospice will NOT hasten her death. What they will do is make sure that she is comfortable.
Hospice also has Volunteers that could come and sit with her or take her for a walk around the facility. So she would have a little company.
We tried everything to incentivize her to do PT and move. The staff helped a lot with encouragement. Eventually she had a minor fall and then the facility allowed her to go into LTC where she is now and bedbound because she lost all her muscle tone. Usually a person's doctor assesses them as requiring LTC, or the facility (because they have to have an open bed). Often being on Medicaid means sharing a room, so be prepared for this. My MIL's facility has ample Medicaid beds so she has been in her own room since covid.
Even after going into LTC she refused to participate but eventually the staff was able to coax her out to do things and now she does everything -- but it took quite a while to get to this point. Meds also helped her.
I do not think your LO is a candidate for hospice.
If you are speaking of a Skilled Nursing Facility, that is more for people requiring skilled nurses for such things as ventilator care, suctioning, advanced wound care for decubiti, IV support and etc. It is for patient with acute needs who are attempting to heal or recover, not for the end of life process.
I wish you good luck in finding good care. What she is going through is in the normal spectrum.
I agree with a hospice eval.
Best of luck to OP.
It is not the facility it is sadly your mom.
She no longer has the will to live no matter how hard you and your sister attempt to cajole to want to live for you.
You can talk to the doctors and staff, you can transfer to another facility but nothing you do will change her mind that she is just waiting for her life to end.
I'm living a similar situation with a 73 year old sister who is a non compliant insulin dependent who refuses to believe her diet of carbs and desserts (ice cream, cookies, powdered donuts, processed meats, diet colas, etc) have anything to do with wounds not healing and other related illnesses.
I went to counseling to help me redefine how to accept her inability to properly care for herself regarding her health, finances, mental health. Bottom line, if the loved one does not want to accept the suggestions for a better life then we need to accept they are an adult (regardless of cognitive ability because that decision was made a long time ago) and wish to continue their slow suicidal behavior.
It is their delusion that the world, the doctors, and everyone else except their enablers is against them. At one point in their lives they did say if they were ever in poor health unable to take care of themselves they just wanted someone to put them out their misery (I heard the phrase often Just shoot me).
Well, I'm not pulling the trigger but I am getting back to my own life because at present I need to muster all the emotional, mental and physical strength to overcome the health crisis I'm faced with.
I know I'm sounding harsh but you are not responsible for her decision to not wanting to live -- no matter how often she claims that is not the case. Her complaints against staff at the facility is her justification for not wanting to live.
the term years ago "nursing home" was a facility that housed many people all at different levels of care need. this is where people get the idea or impression that patients are lined up in the hall and they remain there until lunch then they are lined up again until dinner. Many possibly over medicated (this is going back many years but the image remains)
Now with facilities with different levels of care what is not a Skilled Nursing facility limits residents to those that need hands on medical care, have conditions that other levels of care can not handle. And that may be dictated by laws that were not there in the past. (where I am a memory Care facility can not use equipment to transfer a patient. If a Hoyer or Sit to Stand is needed that patient goes to Skilled Nursing or Rehab)
Generally if a person has "tubes" or an "ostomy" they will not be accepted in Memory Care mainly because memory Care residents may pull out "tubes".
In some areas a person on oxygen has to move from AL or MC to Skilled Nursing as the use of oxygen may present a danger. (this may not be in all places but I have heard of a few)
But you are right that Skilled Nursing facility is a "Nursing Home" but the term nursing home seems to be like "bandaid" or "xerox" it has become a generic term.
If you don't see your concerns being addressed ask for a copy of the care plan if you don't have one. Go over it with a fine tooth comb to see how/if those issues are suppose to be addressed. Unless exceptions are somehow made... she has the right to refuse to get out of bed and/or eat. However, there should be notes as to how often this happens. FYI... the notes in my father's chart often reflected he ate well when we know he didn't because we returned his half empty tray to the cart... and no one ever asked us.
My husband has PD related dementia and has a PEG tube. Because of the tube he can not go to Assisted Living. Because of the dementia... he needs Memory Care but can't go because it is only Assisted Living. Because of his tube, he can only go to a skilled nursing facility... however a feeding tube does not qualify as skilled care! Should he ever qualify for a Skilled Nursing Facility his dementia will probably only be addressed for safety with a locked door on the building exits or on his hall. We are between a rock and a hard place at this time we not qualifying for Medicaid for assistance to even pay for a SNF if we needed.
Praying he can stay at home and never require a facility, but I am always trying to learn as much as I can about the processes in case it needs to be seriously considered.
I wish you the best in getting the best care for your loved one and would love to hear how your situation is handled.
Please don't take on the mantle of inappropriate guilt. Guilt belongs to felons, not to you. Guilt implies you caused this. You didn't. Guilt implies you can fix it. And the truth is that nothing can fix it. This is about survival. Pure and simple.
Your loved one--I am assuming your mom(?)-- has had her life. You have a right to have your own. You aren't god and you aren't a Saint. You are a human being trying to do the best you can for her and still have a life.
Whatever terms they use, if that is assisted living in your area it does sound like this is the way it is going. Your attorney is good in guiding you and I am relieved you are using one so you get the options and the help.