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Are there any care facilities (in California) for higher functioning vascular dementia patients who need considerable help with ADLs but a much higher level of intellectual and emotional interaction than is typical in memory care facilities? In-home care costs are so high here ($20K/month) that facilities are more affordable in the long term, but typical memory care facility residents are not her peers. I am aware of Belmont Village "Circle of Friends" level of care, also not a fit.

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Cblolo, you might want to look at Independent Living facilities that offer "options" where a patient isn't quite ready for Memory Care but needs a bit a help during the day.

It would be best to find a facility that offers all three "steps"... Independent Living, Assisted Living, Nursing Home. That way the patient is familiar with the buildings, with the Staff, with the meals, etc.
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FF took the words out of my mouth! An IL facility with an "add-on" caregiver for showers, etc. At my mom's IL, there were plenty of folks in that category.
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Check out some of the Assisted Living facilities in your area. Some can be quite tolerant of people with early stages of dementia, as long as they don't wander.
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Thank you for your comments and suggestions, much appreciated. She needs close to 24 hour care with DLAs which is a very expensive add-on to IL. She has been in MC for almost 2 years after being rejected from AL application. She is miserable there and it is true the residents are not her peers. I'm wondering if any facility supports the vascular dementia subtleties in particular, we have visited a lot of facilities and most of the residents seem Alzheimers-affected and more advanced dementias more than vascular.
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My dad has vascular dementia and was in regular AL. However, the facility's regulations says if they need more than 50% support with ADLs then they have to go to LTC. Sucks and he hates it.
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I'm sorry i cant help you as i live in Australia but i wish you luck and hope you find what your looking for. A lady named Teepa Snow who is an excellant educator on dementia, shes an American, she may be able to direct you.
My mother had vascular dementia and my grandmother had Alzheimers...i found they were very different.
My mother was so aware of her situaton even towards the end. Our dementia care in Oz is PATHETIC and in my opinion its starts at the top...Geriatricians...i wont get started...we looked after my mother at home...not easy..but for me very rewarding...she was and still is the most wonderful person ever!
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Check out home care AL facilities, my dad is in a 8 person max house. One of the other residents is paralyzed from the chest down, mentally very there but needs assistance with everything. My dad on the other hand can do everything except remember to take meds, cook, clean, do laundry lol, all of the residents are very verbal, all but my dad and one other guy go on day trips using the paratransit system. It is an age in place home.

Larger facilities do have some added benefits but I found the cost far to much for the benefits.

Best of luck finding a solution. Finding a place is such a challenge.
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I would think that someone with Vascular Dementia who needs help with all her ADLs should qualify for nursing home level of care, often people of all ages and cognitive abilities can be found living together there.
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Check out The Eden Alternative for member communities near you. edenalt.org
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The best place to start when looking for information is to call your local Area Agency on Aging- AAAs provide a service called Senior Information & Assistance or Aging & Disability Resources. Because they're a branch of government, they provide unbiased information (some other referral services might not be entirely unbiased, as they usually get a "kickback" for making referrals). AAAs are also local--covering every county in the US. So your local office will probably have information on places in your area or nearby which may be a good fit for your mother, such as someplace that has a "continuity of care," meaning they provide multiple levels of care. For example, there are some places that provide from independent living up to skilled nursing care, so someone does not have to move as their care needs change (though they may have to move rooms/floors/building etc within the same facility or campus).

You might also want to look at places that will accept Medicaid in the future, even if mom has enough to pay privately for a time. I've gotten countless calls from family members in a panic because their loved one has outlived their money, and they're in a private-pay only facility and have been asked to move...then they can't find another facility that will take their loved one straight on Medicaid. Very sad, but it happens every day.
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cblolo, my sister has vascular dementia and lives in a memory care facility in California. They only have dementia patients, but understand dementia comes in many forms and appear to treat each resident accordingly. It is secure, which my sister needs, to prevent wandering. There are several activities daily, including supervised group outings, with about half geared toward higher functioning residents. At meals, my sister is seated with others who can carry on a conversation. There is plenty of staff on hand around the clock. I appreciate their philosophy toward all dementia patients; they keep them safe but allow them to be 'themselves.'
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Thank you cblolo for asking about this. I’m in the same boat with my husband but he has fronting-temporal dementia. He can barely speak and rarely understands what is said to him. He is younger and is a retired professor with very distinct tastes. He’s a a vegetarian who abhors Elvis and gospel music, typical selling points of the assisted living facilities around us. He’s living at home now, still knows where he is and recognizes people, but I wanted to start planning for the future. Unfortunately, there is nothing out there to suit him and as a result I’ve stalled on looking. His dementia is rare enough that even a lot of folks in elderly care are not familiar with it. There are many overlaps with the other dementias but also many differences. I feel for you and will be keeping up with this thread. I appreciate all the suggestions.
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As others suggested, some of the "home-based" facilities who have limited residents might be of interest - we did not explore these (was not aware of them, and do not know if there are any in our area.)

As for MC facilities - the best you can do is check out those in your area. There really is no way to determine what level residents might be at in any facility. The causes and progression rates vary from person to person, so even if you found a place with all higher-functioning residents, 6 months later that could change drastically!

The place we chose was recently rebuilt (includes IL, AL and MC) and mom was actually the first to move in to the MC unit. A woman who came in shortly after seemed to be about the same level at that time. Within months, the other woman has progressed to the point that she likes to talk to us, but it is all gibberish. Our mother on the other hand made a step down after about 9 months to remembering a previous residence (sold 23 years ago) and asking about visiting her mother or how she is doing (gone almost 40 years!)

There are no rules about how or when regression takes place. Our mom needs no real assistance with personal care or walking, but is not safe to be left alone or in a non-supervised place (AL.) Another woman there is 6 years older (just turned 100!!!) and is more "with it" than our mother. Now that the unit is filled up, there are so many levels of cognizance that can be observed.

There may be several reasons why the places you have looked into only have low functioning residents:
- others have not chosen to put loved ones there or keep them home
- once higher functioning residents have regressed
- remote possibility it is just a lousy place and maybe cheaper for those who need it

Do check out more facilities, even if it means moving further away from you.
Do check these places at different times
Do inquire about activities, etc

One other note: after some meals or specific activity, some residents go back to their room or for a walk around the loop - mom will note that it seems like everyone has "gone home." So, if residents have retired to their rooms or are joining in activity outside the main area (mom's place does take residents to other areas and even outside the facility, if they can manage it and want to go), you might only be seeing those who cannot join in those activities.
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Your first step should be the town in California's Council on Aging.
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I go to a support group where all dementia spouses or parents are different. We get lots of ideas from others who maybe have gone thru our problems. They have a name many have used who will introduce to places to fit your need, no chg as when placed that place pays her. Also the Alz office here in Palm Springs has large list of possible places. Amazing how many affected by different kinds of dementia have been top of crop bosses. We meet weekly.
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its a painful, difficult decision to make, whether or not to place your parent in AL. We moved our mom to Colorado; a beautiful AL facility plus 24/7 cargivers hired separately ($21,000/month!). She was always depressed and had anxiety issues. With broken bones in her back, and dementia setting in, we felt it was best to move her close to family and grandkids. She hates it, is even more depressed, thinks we forced her to move here (she did make the decision but does not remember) always grumpy, thinks everyone is out to get her, feels locked in, frequently walks the halls (with her caregiver) yelling to get out, she is mean and has regular outbursts of rage and wanting to bolt. (part Oxy/ part dementia). Because she begs and demands to go home everyday since she's been here (10 days) we may very well send her home and have 24/7 in home care there. Some folks still have the presence of mind to decide where they want to live out the rest of their days. So along with 24/7 care, nanny cams/bi monthly visits from family and eliminating any valuables from the house, sometimes "moms do know best!" They have a right to be happy and live how they want as long as you know they are safe, well cared for.
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Thank you all for your various thoughts. We have consulted public and private agencies and visited more than a dozen facilities over the past several years. Mom has lived for almost 2 years on a memory care floor of a top rated, and incredible, assisted living facility. The comment that resonated most for me was how dementia (esp. vascular) differs from Alzheimers. The facility and caregivers are excellent but geared to lower function and Alzheimers behaviors, the residents are not her peers and there is not enough to keep her occupied. We have part-time companion caregivers plus daughter visits. 24/7 home is cost-impossible, we supported it at home for almost 4 years. The "6-pack" board and care we have seen so far does not seem like enough care and support since she needs all DLAs. I continue to welcome comments but wanted to let you know we've been down many of the suggested roads one or more times already. Thank you for thoughts.
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vcupcake - although your mom seems to be highly agitated and gets worked up about moving, is 10 days really enough to change that decision? Our mother harped on my younger brother whenever he visited for about 9 months (thankfully she never asked me) why she could not go back to her condo. Even if he ever did hit on a reasonable argument, it would not matter as minutes later she would forget!

Mom's usual demand to leave when we were not there (so they reported to me) was often in the evening, adamant with coat and purse in hand that she was going to leave and walk to her mother's. I was just there tonight for a bit (I usually do not go in the evening as this is when sundowners typically hits - there was at least one, possibly two residents who were worked up about something or other - these same residents are okay mostly during the day (maybe not initially, but more recent times they have been fine when I was visiting.) Funny too, about the time she regressed a bit and started asking about going to her mother's or a previous residence, about 9-10 months after moving in, my daughter and I joined her for lunch one day. After lunch we went to see her room. She says to my daughter "this isn't bad and it is FREE!" (we pushed the idea that the VA would cover the cost, even though it won't and we have not been approved for the survivor benefit yet, but she is not aware that she/we are paying for it, which works fine!)

I am NOT a big fan of medication, but I know they requested one soon after the move in (Lorazepam aka Ativan, which is used sometimes to manage anxiety.) She was never doped up and there was no repeat in the order as I manage all her Rx orders. Perhaps a little something to help bridge the transition? Moving again could trigger even more trouble with her, and as the condition progresses and she becomes more "needy", it seems that handling care-givers remotely might become difficult and even more expensive?

If it is a nice, affordable (hah) place with good staff, I would give it some more time - it can take months to adjust. Sometimes even after you think they have adjusted, there can be flare ups, but a good staff knows how to handle it.
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