In between memory care and skilled nursing. Memory care does not seem to be working anymore. How do you know it's time for skilled?

Place her now in LTC. This is what I did. Its easier to get someone in LTC if you can pay privately even for a little while.

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 is able to get up and go to the dining room for a meal.
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.

You have basically described my MIL back in 2018. We transitioned her into AL because of short-term memory impairment. Once there she stopped participating in things and eventually refused to get out of bed (she could walk, just would not).

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.

Consider Hospice. They are skilled in end of life care. I think you are looking now at end of life care needs. They will provide bathing three times a week, medications for comfort, any equipment needed by the Nursing Home. She will almost certainly remain on bedrest until her death. They are very skilled and trained in what they do and will help get you Social Worker or Clergy if you or she require it.

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.

Your mom should be in a personal care home where different activities are offered. Have people or visit her more often. Not enough stimulation can be detrimental. If your mom doesn't have any terminal health issues, she may need a change of scenery. Definitely not Hospice. Once someone has a Dementia diagnosis, it's like their life is over and see ya bye! Not at all. We are all going to be in the same boat one day.

You are basically describing what we are going through right now with my 95-year-old mother. I am looking forward to the advice and help you receive here on this great forum, and sort of "piggy-back". I hope it helps you (and us), as all of these great people going through similar situations, have been doing a great job helping each other through very trying times. It is hard. It is exhausting. It is physically painful. Decisions that are complicated by numerous different doctors and a rehab facility that really does not update us or give us any useful information, and we are trying our best not to interfere or seem "pushy", but we are trying to make informed decisions. In our case, it is complicated by a sweet mother who seems to think she can still do everything, is very modest (and secretive), and is very particular and somewhat demanding and manipulating. She falls a lot anymore and has broken her finger and then her wrist in two separate falls in three weeks. She, also, has an infection in her foot, and a UTI. All of this has really brought her mental faculties down more, and she, also, sundowns. Her insurance changed this year, so the only rehab facility "in her network" that would accept her from the hospital is not close to us and "not up to her particular standards", so that does not help us with getting her mental state improved. She had lived in an assisted living with extra help, but we do not know if she will be able to recover enough to go back there. She recently got a roommate, so that really doesn't help her as she is a very private person and does not enjoy company. What a world, right? Good luck to us all.

Here is the VERY HARD REALITY.
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.

@ againx100
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.

You may be limited in options since her abilities with her ADLs sound adequate. A TRUE memory care facility only accepts dementia patients needing Assisted Living. They are experienced in techniques to deal with these issues. Her facility should have created a care plan for her when she was admitted and you should have been invited to a meeting for a discussion to give your input.

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.

Thanks to all. In Indiana and her home town there are only two Assisted Living facilities that have medicaid waiver. She can't go to either as they do not take Dementia patients now. So she is private pay in an Assisted Living that is locked memory care building. She will spin down her money and we need to move her end of Sept. Our attorney has a map drawn out on how all that works to get in Medicaid. So she will need a Medicaid bed in a LTC or they term it a skilled nursing home with Medicaid and roommate. She can get up and walk with walker. She can get up and dress herself. She just won't get out of bed and may go down for one meal a day. We can visit and she has become angry to me for leaving her there and an hour later my sister can go in and she does not remember me being there. Because she can do these things....that is why I say she is between her situation and moving her to NH. Guilt has set in and questioning myself. Thanks for all your replies. Peggy