No brainer! 1) What does LO want in care as you ALL look at options. 2) How does LO's care in whatever facility you choose match her/his needs. (My sister is in an expensive locked MC unit; they don't cut her toenails so she asks me to do it; she sleeps in her daytime clothes) She has no history of wandering so needs no locked doors. 3) How does facility address your concerns about care? Are you heard or dismissed or made promises not kept? 4) Most important: What are you hearing from LO about comfort or care?
You've been told already that a podiatrist cuts the toenails in nursing homes, not the staff. Request an appointment for your sister.
Also, ALL memory cares are locked facilities. While you sister might not wander, others there do. A board and care home for dementia patients would do the same.
As for her sleeping in her clothes, have you seen her in the same clothes in the middle of the night that she wore during the day? I'll bet not. You're taking the word of someone with dementia, right?
I think you need to stop meddling in your sister's care. You're going to be like the helicopter mom whose behavior follows her child's folder throughout their school years. I understand you want your sister to have the best care, but your interference isn't making things better.
I worked with the elderly providing long term care care management for many years and our mantra was have the person in the least restrictive environment that best meets that persons needs. I myself am a fan of adult care homes. Granted there are really good and not so good homes out there, so you will need to do you homework. Many areas have businesses that help you find adult care homes at not cost to you. Any fees for finding a home are paid by the Adult Care Home. There are Adult Care Homes that do have and will take individuals with memory care needs. Adult Care Homes are the next best thing for a person than being in there own home. The cost also is much less than a memory care facility.
Absolutely spot-on. My mom has had dementia for 10 years. I was losing my mind trying to manage my mother's care for the past 4 years. My sister and I were both doing it for a few hours a day, alternating. Then she had some kind of event last August that left her mostly incontinent, unable to remember how to turn on the TV, sometimes unable to find the bathroom, etc. We alternated 24/7 care until we could not go on with it any longer. I found a good Adult Care Home, and we moved her over one day without telling her what we were doing. She questioned why she was there, then a couple hours later she just settled in and watched TV. We kept her home available for two months to make sure it worked. Tomorrow we go over to patch holes and shampoo the carpet. Then we lock the doors and walk away. When I go to visit her in her new home, it will be as her daughter, not the one who wipes her butt or listens to her scream "I hate you" when it's time to take a shower. All for less than half of the cost of a MC or NH. What a relief!
It all depends on the area you live, too. Where I live there are no Board and Care that I am aware of. The first thing I would check out with places like this is if they are licensed by the state. What certification does the staff have. I would want my Aides Certified and at least an LPN on board better an RN. Certified Nursing aides are not medically trained. They cannot distribute medication unless they have additional certification asca Medtech. Definitely cannot give shots and in some States either can an LPN. What I consider a Board and Care? A place where the number of residents is small. Meals can be made according to diet if not extreme. Its clean, the residents are clean and seem happy. That there are outings and maybe some type of activity. That the Staff seems to enjoy their jobs. I don't think these are places for the very sick or very into Dementia. More like an in between place.
MC...I think by the time you get to this point a really nice Longterm care facility is just as good, but it will cost more unless you qualify for Medicaid.
Its really a money thing. Board and Cares should be cheaper than MC. MC is more expensive than an AL but cheaper than LTC. What you need to do is visit these places and list the pros and cons. Eat a meal there. Look at the residents, do they look happy? Are they clean? No smells. Meaning that residents are changed regularly. Place is clean. Staff personable.
We chose a Board and Care home. Mom has severe dementia as does another man there. The other woman in the home is wheelchair bound. There are 4 more men who are residents that are not as bad cognitively. At first I would call before going over, now I just pop-in whenever I need to. Everyone has always been clean, well-fed, happy, and there are no smells. I have been there when the meals were being prepared and all was good. We are very happy with the choice and she does not need MC. They even told us they would keep her through hospice if the need ever arises. We are SO thankful for the care she is getting.
It really boils down to the place. For a person who is really cognitively and/or physically limited, I have been impressed by some board and care homes when I was seeing patients. They usually had an owner and one staff member round the clock (obviously, I saw a limited sample) and a person received a lot of "mothering" care, really. There were a very few residents, maybe 3 or 4. It seemed much pleasanter than some institutional settings. These patients really needed someone to keep an eye on them most of the time, simple activities, pleasant food, and good physical care. It can really be a nice homey setting. However, as in any home, it is entirely dependent on the individual running it. I personally would prefer it if I became more incapacitated. I am in a pretty good place, mixture of independent and AL living. I notice that some of the more incapacitated residents have a caretaker in addition to the staff. This allows them to enjoy all the activities, etc. and still have hands on care much of the time. Obviously, very expensive, but the board and care homes are not inexpensive when they are good. If a loved one is in any setting, keep your eyes on it, if they are not able to do so. Visit often, if briefly, know the staff, and let them be aware of your vigilance.
My parents are divorced so we have dealt with this twice. My mom was at a board and care home and it was an awful place. When it was time for dad, we put my dad in MC. He has flourished. More stimulation than mom had but also more expensive.
This depends on what does your LO need? What are their conditions (medical or otherwise)? Which ADLs or IADLs can they (or cannot) handle safely and independently? And your LO's resources to pay for what is needed?
In-home care -- mostly private pay -- if you want more than a twice a week helper and for maybe only a few hours. If a good long term insurance care policy exists, that may cover more days/hours. Medicaid (if one has qualified) may help pay, but there can be long wait lists (where we live, the wait list is 5 years for a Medicaid-paid-aide). If full day in-home care is needed; agencies can help find an aide. If 24/7 in-home care is needed (this can get to be very expensive). We have an Aunt in New York City who has 24/7 aides (she has the funds to cover this) but it runs $6K a week! She is 96, has severe cognitive and physical decline (cannot walk, transfer, cook, has to be fed).
Board and Care may be fine if your LO needs basic help: someone to cook/provide meals, clean, do laundry and is fine with limited personal care help (can still toilet and shower). These facilities are state-regulated, so depending on your state they may be fine or not so great if inspections and quality assessments are not up to par. These where we live (expensive east coast urban area) run about $9K a month. And this is still private pay for the most part. Some states have waivers for their Medicaid programs to cover such placements or AL placements; but again the waiting lists can be years long to snag a spot.
Assistive Living (AL), are generally private pay and so-called "high level" AL have more help including help with things such as bathing, dressing, medication management BUT these generally are NOT for those who need more direct medical care (IVs, wound care, PT/OT) and may not have a physicians of various sorts and other medical providers on site. Where we live high end AL facilities often require and up front entrance fee and then a monthly fee that is dependent of the size of the "apt". The up front fee for a healthy individual who can do most ADLs and IADLs where we live might be $50K and then $3 to $6 K a month depending on the side of their apt (studio or 2 bed/2 bath). But most ALs ONLY are for those with resources as once the funds run out; they generally do not take Medicaid.
Continuum of Care AL are those facilities where one enters healthy and independent and as time passes and one might need more care; the facility guarantees you get it including memory care and/or skilled nursing care. BUT this is VERY EXPENSIVE. A friend considering this in Houston, TX was quoted $500K entrance fee and then a monthly $5K fee for a 2-bed/2-bath unit. She is 72 and needs no help at this point of any sort. The more independent/healthy one is and the younger one is when entering; the cheaper the price tag.
Skilled Nursing Facility (SNF) are generally the last resort places (other than end of life = hospice) that have a full range of actual medical services, physicians and other licensed health care providers on site. SNF patients need much more care; medical and otherwise and generally have many issues with ADLs and IADLs. They cannot safely or independently handle several ALDs or IADL and they need 24/7 help and supervision. Some folks go into a SNF following a hospital stay and Medicare may pay initially for a month or so. Then if one needs to stay, one goes private pay. In time once all assets and resources are "spent down" Medicaid can cover if your LO meets the "level of care required" for your state Medicaid program.
My mom went to a SNF after 2-wk hospital stay. Medicare covered 60 days. Next she went private pay, $14K a month. After a $90K spend down, Medicaid picked up. Mom can keep $93 from monthly SSA and annuity; rest goes to the SNF. Mom is 86; has dementia/other medical conditions, walks a few feet w/a walker, use of only one arm, cannot shower alone, behavior issues; SNF is only option now.
In my experience, I have seen both. Now there are many different kinds of places. But I’ll say what I've experienced.
In a memory care facility, they have different activities to stimulate the mind and social interaction. Plus, they help with the many needs the person has.
The board and care that someone I know is in, is more for people who want to sit and relax. They help with different needs, and they have activities here and there with art projects. But it's mainly relaxing with tv.
And/Or...what about in home Caregivers vs Board & Care or Memory Care? My Dad's Board & Care sucked. He was a retired Doctor. My Mom couldn't handle him at home. He had a couple falls when she was there with him. She was mean to him. My Stepsister & Stepbrothers decided better to place him in a neutral environment where they could visit and he could have personal Caregivers 24-7. Only thing that was good was the room was on a single level floor. Food was Godawful. We would bring him in some meals & snacks. Decor was so ugly & the cost was upwards of 4K just for the room. We tried to make him room more homey. Caregivers were just as much monthly.. I say work to be independent or live at home with Caregivers. These AL & Board & Cares price gouge. The AL's near to my Mom are upwards of 10K monthly. Come on...
These AL facilities need to be stopped with the gouging! It's elder abuse how they charge thousands of dollars per month, have minimal concern for their care, unless you pay an additional fee and the food is disgusting and unhealthy. It's a business to make money, not a place to provide good care of these poor ppl. After you move them into a place they raise the rents yearly at up to 25%, it's truly almost criminal at this point. They are privately owned and operated and don't have ANY laws or regulations regarding how much they can charge. Something has to be done about this!
That's like asking what's better? Pot roast or meatloaf? The answer is a matter of individual preference. You can get advice on the right side of your screen from the Care Advisor named "Karen" about which Memory Care ALs exist in your area. You can also go visit/tour the various facilities in your area and find one that you feel best suits YOUR needs in particular.
1) What does LO want in care as you ALL look at options.
2) How does LO's care in whatever facility you choose match her/his needs. (My sister is in an expensive locked MC unit; they don't cut her toenails so she asks me to do it; she sleeps in her daytime clothes) She has no history of wandering so needs no locked doors.
3) How does facility address your concerns about care? Are you heard or dismissed or made promises not kept?
4) Most important: What are you hearing from LO about comfort or care?
Also, ALL memory cares are locked facilities. While you sister might not wander, others there do. A board and care home for dementia patients would do the same.
As for her sleeping in her clothes, have you seen her in the same clothes in the middle of the night that she wore during the day? I'll bet not. You're taking the word of someone with dementia, right?
I think you need to stop meddling in your sister's care. You're going to be like the helicopter mom whose behavior follows her child's folder throughout their school years. I understand you want your sister to have the best care, but your interference isn't making things better.
MC...I think by the time you get to this point a really nice Longterm care facility is just as good, but it will cost more unless you qualify for Medicaid.
Its really a money thing. Board and Cares should be cheaper than MC. MC is more expensive than an AL but cheaper than LTC. What you need to do is visit these places and list the pros and cons. Eat a meal there. Look at the residents, do they look happy? Are they clean? No smells. Meaning that residents are changed regularly. Place is clean. Staff personable.
In-home care -- mostly private pay -- if you want more than a twice a week helper and for maybe only a few hours. If a good long term insurance care policy exists, that may cover more days/hours. Medicaid (if one has qualified) may help pay, but there can be long wait lists (where we live, the wait list is 5 years for a Medicaid-paid-aide). If full day in-home care is needed; agencies can help find an aide. If 24/7 in-home care is needed (this can get to be very expensive). We have an Aunt in New York City who has 24/7 aides (she has the funds to cover this) but it runs $6K a week! She is 96, has severe cognitive and physical decline (cannot walk, transfer, cook, has to be fed).
Board and Care may be fine if your LO needs basic help: someone to cook/provide meals, clean, do laundry and is fine with limited personal care help (can still toilet and shower). These facilities are state-regulated, so depending on your state they may be fine or not so great if inspections and quality assessments are not up to par. These where we live (expensive east coast urban area) run about $9K a month. And this is still private pay for the most part. Some states have waivers for their Medicaid programs to cover such placements or AL placements; but again the waiting lists can be years long to snag a spot.
Assistive Living (AL), are generally private pay and so-called "high level" AL have more help including help with things such as bathing, dressing, medication management BUT these generally are NOT for those who need more direct medical care (IVs, wound care, PT/OT) and may not have a physicians of various sorts and other medical providers on site. Where we live high end AL facilities often require and up front entrance fee and then a monthly fee that is dependent of the size of the "apt". The up front fee for a healthy individual who can do most ADLs and IADLs where we live might be $50K and then $3 to $6 K a month depending on the side of their apt (studio or 2 bed/2 bath). But most ALs ONLY are for those with resources as once the funds run out; they generally do not take Medicaid.
Continuum of Care AL are those facilities where one enters healthy and independent and as time passes and one might need more care; the facility guarantees you get it including memory care and/or skilled nursing care. BUT this is VERY EXPENSIVE. A friend considering this in Houston, TX was quoted $500K entrance fee and then a monthly $5K fee for a 2-bed/2-bath unit. She is 72 and needs no help at this point of any sort. The more independent/healthy one is and the younger one is when entering; the cheaper the price tag.
Skilled Nursing Facility (SNF) are generally the last resort places (other than end of life = hospice) that have a full range of actual medical services, physicians and other licensed health care providers on site. SNF patients need much more care; medical and otherwise and generally have many issues with ADLs and IADLs. They cannot safely or independently handle several ALDs or IADL and they need 24/7 help and supervision. Some folks go into a SNF following a hospital stay and Medicare may pay initially for a month or so. Then if one needs to stay, one goes private pay. In time once all assets and resources are "spent down" Medicaid can cover if your LO meets the "level of care required" for your state Medicaid program.
My mom went to a SNF after 2-wk hospital stay. Medicare covered 60 days. Next she went private pay, $14K a month. After a $90K spend down, Medicaid picked up. Mom can keep $93 from monthly SSA and annuity; rest goes to the SNF. Mom is 86; has dementia/other medical conditions, walks a few feet w/a walker, use of only one arm, cannot shower alone, behavior issues; SNF is only option now.
In a memory care facility, they have different activities to stimulate the mind and social interaction. Plus, they help with the many needs the person has.
The board and care that someone I know is in, is more for people who want to sit and relax. They help with different needs, and they have activities here and there with art projects. But it's mainly relaxing with tv.
Wish you all the best
Only thing that was good was the room was on a single level floor. Food was Godawful. We would bring him in some meals & snacks. Decor was so ugly & the cost was upwards of 4K just for the room. We tried to make him room more homey. Caregivers were just as much monthly.. I say work to be independent or live at home with Caregivers. These AL & Board & Cares price gouge. The AL's near to my Mom are upwards of 10K monthly. Come on...
Best of luck.