If your loved one is in memory care, do you feel like it’s necessary to eventually transfer them to skilled nursing? Which is better suited for someone with dementia? Is there a certain criteria to even enter into a skilled nursing facility? I ask these questions because where I live it’s difficult to find a doctor that will go to her memory care facility. There is only one agency that I know of and they’re not very responsive, hard to get a hold of. Many times I end up, having to send mother to the emergency room because of their lack of care.

My mother lived in a Memory Care Assisted Living Facility right up until her death and there was no need to transfer her to Skilled Nursing; the staff, along with hospice, was able to care for all of her needs right there; that is the goal of Memory Care: to keep the resident until death without having to transfer them to a SNF. It doesn't always work out that way, however, if the resident winds up needing TOO much care, then a SNF is the only answer.

Mom was wheelchair bound, incontinent, had heart issues and fell 95x while in AL and Memory Care. That did not disqualify her from living there. What is the needs of your loved one? As Grandma1954 explained, Skilled Nursing is necessary when chronic and severe medical issues are at play. And/or if a Hoyer Lift is required to move her into the shower or the bed. Memory Care, as a rule, does not employ such a device HOWEVER, some do.

The Memory Care mom lived in had doctors come into the building to care for all the residents; including traveling lab technicians, xray techs, she was even able to get an echocardiogram at the Memory Care. All her meds were delivered and dispensed to her there as well.

According to your profile, you live in Corpus Christi Texas! A Place for Mom comes up with 14 Memory Care ALs near or in that city here:

Your profile also says you tend to micromanage your mother's life:
About Me
Living alone. I do my best to manage my mothers dementia. I have some health issues of my own. Mom is in memory care, however taking care of her doesn’t stop when placing a loved one in a facility. I find myself micro managing everything around her. There is really never a day off.

Perhaps that's an issue to address as well; no managed care facility is perfect, that you need to understand. Nobody will give your mother the level of care YOU think is 'perfect', so that's a notion to let go of entirely. What you want is 'good enough' in terms of is she being fed, medicated properly, socialized, showered, treated with dignity and respect, dressed in clean clothing regularly, living in clean quarters that are kept up regularly, laundry done 2x a week as well as bathing, an open line of communication with staff, things of that nature. Being in managed care should mean that YOU do not need to micromanage mom's life anymore; she's paying others a lot of $$$ to do that FOR you. Visiting her daily or continuously kind of defeats the purpose of being there in the first place. You need a life of your own, too, not just a life that revolves around your mother's dementia!

If the MC she's in now is neglecting your mom, then it's time to get her OUT of there and into a new MC, keeping in mind that you will not find a perfect one. A question I have is, has there been a true emergency going on the times you did wind up taking mom to the ER? If so, I'd report this MC facility to the Ombudsman and state your complaints of neglect clearly to them.

Wishing you the best of luck.
Helpful Answer (11)
Reply to lealonnie1
Bandy7 Jan 20, 2023
This is excellent information, VERY comprehensive and informative!
See 3 more replies
Skilled Nursing would be for chronic medical issues.
Memory Care staff can handle most things but there are some things that Memory Care probably would not work.
If your Loved One has any "tubes" (IV's, feeding tube, any "ostomy") they would probably be in Skilled Nursing simply so staff can monitor them more. Dementia patients have a tendency to pull out or off "tubes".
In some cases if equipment is necessary Skilled Nursing would be necessary. So the use of a Sit to Stand or a Hoyer Lift that would be done in Skilled Nursing. there are some facilities that if a resident began living there and was walking and as a result of decline no longer walked they might be able to keep them rather than transfer to Skilled Nursing but it would depend on their staff and their requirements. Some States have prohibited the use of equipment unless it is Skilled Nursing.
If your mom is not getting the required care then you should report the facility. Each State has an Ombudsman that you can contact.
The Memory Care facility should have a Doctor that comes in.
Your other option would be ...If mom qualifies for Hospice the Hospice Nurse would see her 1 time a week, more often if needed. A CNA would come and give her a bath and order supplies at least 2 times a week. AND the Hospice Doctor would be her Doctor and if it is necessary the Doctor would come to her. But in General the Nurse would be able to do what needed to be done after communicating with the Doctor.
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Reply to Grandma1954

Usually its money. When the money starts running out, thats the time to find Long-term care. All that was wrong with my Mom was Dementia and that made her 24/7 care. The only meds she took were bloodpressure and thyroid. OT was cranberry tablet and probiotic to keep UTIs at bay.

Mom had 20k left that got her into a LTC facility. That gave me the 2 months needed to get Mom on Medicaid. I had to spend down her money which was her care at LTC, and get them the info needed. I applied April, placed her May. June I confirmed caseworker had all info needed and her Medicaid started July 1st.

There does come a time when MC is not enough. The are not capable of caring for someone with serious health problems.
Helpful Answer (5)
Reply to JoAnn29

Skilled nursing practically killed my mother. I moved her to a Memory Care that was capable of caring for her through to the end, and she not only recovered from the neglect she received in the SNF, she thrived.

I would never but a dementia patient in SNF unless they were on Medicaid and there were no other options.
Helpful Answer (5)
Reply to MJ1929

There are many different types of care which often use the same or similar names but offer different levels of care which may or may not be covered by Medicaid and/or are private pay. And each State is different, in terms of how such facilities are named and regulated. This causes lots of confusion on sites like this.

A "Memory Care" facility may be any number of arrangements depending on how your specific State licenses and regulates such entities. In my mom's Medicare and Medicaid qualified Skilled Nursing Facility (SNF) which is regulated by both the US Gov (the Feds) AND the State, as part of State licensure: they are a fully qualified SNF, also a fully qualified Rehab (or Rehabilitation facility for post inpatient discharge); they have a fully qualified "Memory Care" unit on site and fully qualified Hospice too. It is all in one facility and depending on what the patient (short term stay) or resident (long term permanent placement) needs; it is all there except for actually inpatient hospital care if there is a new or emergent emergency; they go an actually hospital for that.

There are RNs, and various lower level nurses staff 24/7. Each patient or resident has an assigned physician who is on site many days per week. And there are various MD and other specialists on site weekly, some daily (cardiologist, geriatric psychiatrist, geriatricians, psychologists, social workers, dietitians, physical/occupational therapists, podiatrist and the dental van comes on a schedule too).

Some are private pay, others (many like my mom) Medicaid pays. Some short term patients either Medicare or their private insurance pays.

All to say, folks really need to figure out first how such facilities are named and regulated at the State level as to what they do or do not provide and which may be best for LO's needs now and into the future. And also which are Federally regulated and which may be Medicare and Medicaid approved or NOT. If NOT Medicaid approved; then when their private funds run out and they still need SNF or Memory Care; you'll need to moved your LOV. This later part of "how they will pay" -- private pay if there are lots of resources to cover the expense perhaps for years to come OR if no funds/NOT sufficient funds to pay privately for a long time -- have to be considered for your longer term planning for their care. As once they are spent down does, the facility take Medicaid? If NOT, you will potentially need to moved to a facility that does accept Medicaid.

My mom's facility costs about $15K a month or $180K for a year. She has been there over 2 years. After spending down all her assets; now Medicaid covers the expense. She is 86, has dementia and a host of other medical and psychological issues (clinical depression) and cannot safely/independently handle ADLs or IADLs. She is not a wander as she can only walk about 5 feet with a walker and she will not socialize or participate in any activities at all. Stays in her private room 24/7 other than when they take her to be showered. The "Memory Care" unit on site was not really useful/appropriate as she was not a wander and not a socializer or participator in any way in any activities, she is very oppositional and refuses to eat in their dinning room or do anything.

Sad, but this is not going to change. But some of the what is appropriate for your LO depends on so many things; what they need, what will help them, what they will do (or not), what options exist in your State near where you live, and how is this all to be paid for privately for how long OR is Medicaid likely to have to take over?

Your Area Agency on Aging may be of help. If you can find a good Board Certified Geriatric Physician near where you live, they too can be of help as they will know what your LO needs. Finally, a licensed Elder Care attorney in your State can help with the planning and legal aspects of Medicaid spend down if that is needed.

Good luck w/this.
Helpful Answer (4)
Reply to Sohenc

The memory care place should have a doctor associated with it at least ours did for my BIL. Ask if they have a doctor that comes in to take care of the people.

Helpful Answer (3)
Reply to Babs2013

In Virginia memory care cost about $6000 a month. When the money runs out you need to go to LTC…IF the person is not medically sick enough to qualify for a nursing home the family needs to take them home or place them in independent apartment with paid help! That is where we are..18 more months and my mom runs out of cash after 5 yrs of self pay..she currently may not qualify for a nursing home..dementia here is not generally enough to get you into a nursing home!!! Scary stuff…NYS where I worked for 27 yrs medicaid paid for assisted living. Tough decisions indeed. PS: most nursing homes give great care..check the state surveys. Families must ALWAYS be visible and advocate for your loved one in any care.
Helpful Answer (2)
Reply to Sadinroanokeva

My mom is in AL. She needed locked facility bcuz she climbed out window. Due to frequent falls they said she qualifies for hospice with her dementia and higher needs. Hospice visits 2xper week nurse and 2x per week aide. Plus the regular NP who visits. This has improved her care tremendously. They pushed to get mom on a med that works for her. No more calls with problems. No more trips to the ER. Her physical needs are now worse so hospice keeps up with it. Mom will age in place here til the end.
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Reply to Karenina

We were faced with the same decision when mom ran out of money and we had to find a facility that accepted Medicaid. The reason we did not choose the skilled nursing facility is because my mom is physically healthy. If she were diabetic or wheelchair bound or had some other ailment, we would have gone with the skilled nursing. My mom can't bathe herself, can't dress herself and can't find her way to the dining hall. She doesn't need a nurse for those things, just a good aide.

Those were our reasons for choosing one over the other.
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Reply to Jamesj

The hardest decision ever! Someone will say its easy to decide this but it isn't! anyway, I had my Daddy in a MC for about three months and it was not what I read and expected. I finally moved him to a group home and WOW what a difference! I was on a first name basis with the staff. They treated me and my Daddy like family. If there was a problem, like him getting up out of bed at night (due to sundowners) they would call me and give him the phone and I could talk him back to bed. He had ALZ and he had to be treated like a little kid. If you can talk to a Social Worker and check out the group homes in your area. This may be a better option or not but be pro-active in searching. Hugs and prayers!
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Reply to Ohwow323

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