thanks,
bela

I need answers too. For Mom, since she's in late stage and can no longer walk or communicate, would a nursing home be our only choice? I don't think Assisted Living would be nearly enough help. More than half the time, she isn't able to open her mouth to eat unless we work with her, then she feeds herself.

I don't intend on EVER placing Mom, but intentions aren't the same as unforeseen problems or needs, and I want to be ready.

Also, I found out on another thread that Medical (CA Medicaid) will pay for a Nursing Home but not an ALF, so that might be an issue in the future when we run out of money.

Felicia

Regular ALF - forget it. Not a fit for people with dementia. Personally, I include small dementia units inside regular ALFs in the same category. They are OK in the early stages but can't handle the later stages. Generally have no licensed healthcare staff at all - CNA, LPN/LVN, RN, physicians on staff or calling in.

Dementia-care ALF. Just what it sounds like. Generally halfway between regular ALF and NH in terms of capabilities.

They'll usually have some degree of nursing staff, for example, plus physicians that call in every week or so (depending on specialty). Some or all CGs are often CNAs.

However, many states don't allow them to provide certain kinds of ongoing care onsite (IV would be one example), although sometimes hospice can provide that care even though the dementia-care ALF is not licensed to do so.

Admission criteria - typically anyone admitted to an ALF has to be able to ambulate (even if it's just a step or two with everyone hovering around them) when admitted. However, if they later lose that ability, they can usually stay in a dementia-care ALF.

These things vary based on a combination of state regulation and corporate policy, so you want to ask about developments that would prevent them from being able to keep your ADLO.

They can definitely handle the late stages of dementia (hand-feeding, etc.) and generally are very open to bringing hospice in at the end.

NH - ideally, for folks who actually need skilled nursing on an ongoing basis that can only legally be provided by licensed healthcare providers. Don't confuse skilled nursing is with needing assistance with ADLs, no matter how much ADL help your LO needs.

My mom is in a NH in Iowa but I recently took a look at ALFs that have opened in the past year. Both of the ones I looked at are for dementia patients. A person must be able to feed themselves and need only one person to move them from chair to the bed. Once they need to be fed or need more help moving they will have to leave the ALF. The exception is that they can get a Hospice waiver but the family has to be ready to accept hospice rules like DNR.

One ALF is private pay only and the other does have Medicaid. The one that is private pay say they have applied for Medicaid status but it takes a while and they have not been open long enough.

NHs have more licensed nurses on staff 24 hours a day than ALFs. My mom is in a NH that has 3 separate wings for dementia. She is in the first wing where all of the people can ambulate and feed themselves. As they decline they can be moved to the other wings where the patients need more care. Her ADL skills are fine but her memory is really bad so she needs to be prompted for many things. We felt an ALF was not appropriate for her and she will run out of money so we needed to get her in a NH before that happens.

I did not see a lot of difference between the smaller ALF and the NH wing where my mom is. One ALF has room for 70 patients and I think that would not work for my mom. Just too many people and too much confusion.

The NH where my mom is also has a section with 60 general NH patients and it is really a zoo in that part. All types of patients and a lot of noise and yelling. I would not want her in that situation. She would be very lost and confused. There are really differences in the places so you need to visit them and see if they would be a good fit.

Also, the NH where my mom is also has regular apartments so some of the spouses live in an apartment. There is also an ALF in the complex. But I think there is not a guarantee that a patient can move from the ALF to the NH if they need to so that is something to ask if you are looking at that type of setup.

There are also small, private home ALFs, or Adult Care Homes, as they are called, and licensed as, in our state. They range from 1 resident to 6, depending upon the home and license. The majority are private pay only, though some of the larger ones will accept Medicaid.
Legally, mom can stay there as long as she requirer no IV or or daily skilled nursing care, requires only a one-person lift or assistance. Physical therapy, if needed, can be "brought in" through visiting nurse services. My mom has forgotten how to feed herself, so she must be fed. Also toileted, showered, and heavy assistance with dressing. If she becomes terminal, hospice can be brought in.

The home does not provide transportation to/from doctor's appointments; that is up to me. However, mom's Medicare Advantage plan does have a visiting nurse service, so except for emergencies, they can take care of most everything.
Like all care facilities, you need to do your due diligence before selecting one. I hope this is helpful to you.

Bela and Felicia -

These are excellent descriptions.

I found in my own research for my father that there's another intermediate solution - a group home. I'm not sure if these are available in every state but there are several in Maryland. They offer skilled nursing but in a small, home-like physical setting. Most of them are geared for mid-stage AD, but I foudn one that had made arrangements to provide hospice care and (unusually) was Medicaid-eligible. So it's conceivable that a place like that would have been my father's end-of-life solution.

We decided against it and in favor of a nursing home because my father is extremely sociable and talkative - and also a bit unstable. He would have strained the patience of residents and staff in a group home. He needs the greater depth of resources that a nursing home provides. Fortunately we were able to find a nursing home that specializes in dementia care and has an excellent staff and physical setting. Several other that I saw were either profoundly depressing or downright dangerous. It pays to shop around.

Felicia - I know what you mean. I'd meant to keep my father in his apartment to the end, but now he's deteriorated and I've had to move to another city, so that won't work. I just found out today that he's been accepted at the nursing home. I'm not exactly celebrating. But things change, and he changes, and the right solution yesterday isn't the right solution today. Sad, to put it mildly, but that's the nature of the illness.

Hope this helps.

Best,
Alan

Because she's my mom...

Looks like we posted at the exact same time. Yes, the adult care homes you describe are the same as the group homes I was talking about. And some of them, as you mention, have good medical services.

Just wanted to bring all the threads together.


Best,
Alan

I forgot to mention the ALFs are usually cheaper than NHs. But the one here that said they would take Medicaid is $220 a day and that is more than the NH. The other ALFs I talked with have a variable rate depending on their assessment of the patients needs. As they need more help the daily rate will increase.

If there are any smaller group homes around here I have not heard of them.

The difference between Assisted living and Nursing Homes.

http://alzheimers.proboards.co...=display&thread=7169