What’s best for mid-stage dementia: SNF or memory care?

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What’s best for mid-stage dementia: SNF or memory care?

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Hi everyone,

What’s best for mid stage dementia? SNF or Memory care? Mom is in hospital and will transfer out. Not sure what’s the best type of place. She has no short-term memory, she is not a wanderer, she still knows me and family members most of the time. But, the big but is she is very paranoid and aggressive. She moves around with her walker and likes to talk to people and go out. The facility wants to place her in memory care, I think she should go into SNF, then as she progresses, they transfer her to memory care. Any suggestions would be helpful. Thanks.

Alzheimer's & Dementia Care Decisions Memory Care Skilled Nursing Facility

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Memory Care is best.

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Even if you are a professional in this field I think you should go with what the professionals are saying. This is YOUR MOTHER, it is almost impossible for you to be objective. The paranoid and aggressive behavior cannot just be pushed under the rug. One of my best friends objected every time her husband was moved down to another unit. She never thought he needed it even though everyone else from the doctors to the lay people like me could see it. Her mind and heart was unable to accept his true condition. ((Hugs on this difficult journey))

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Neither

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SNF

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If she’s aggressive & gets agitated, the better place is SNF. Medicare can cover short term..& then apply for Medicaid. A memory care facility will not be able to handle the extreme agitated. Then they will evict her. It’s also all private pay..not covered by insurance. Good luck & hugs 🤗

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Thanks everyone for your responses and suggestions. I have made the most difficult decision of my life. I have mom in memory care. It took us over 5 hours of both she and I crying, and she was agitated and angry. She begged me not to leave her there, she refused to go in the room, all of the sudden she was extremely lucid. Anyway the staffed convinced me that was the best place for her. She was admitted on Friday, and I have been visiting her everyday so far. I am not able to sleep or eat, the guilt is killing me. Yesterday, Sunday she looked settled, didn’t know where she was but said “this is a nice place”. She’s already made some friends, so I feel a little better, but still have a knot in my stomach and can’t sleep at night. I have been caring for her in my home for the past 5 years, since she was diagnosed with dementia. I pray that I have not let her down and that I am doing what’s best for her. My God forgive me.

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You need accept the facts behind why you did what you did. Breath and move on, only then will you ever get back to finding your own new normal just as your mother will.

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M mother was in SNC after being hospitalized for pneumonia and a sharp decline into dementia at the beginning of the pandemic. After a few months the social worker recommended we move her to Memory Care which was a great decision. They parked her in her room in front of a TV and other than PT spent her days there.

In SNC she got very little social interaction, few activities and very limited contact with family. In MC she wasn’t allowed to sit in her room or have a TV. All residents were kept busy with 7 daily activities, even if they only sat and watched at least they were a little engaged. The change in Mom was dramatic, she loved the crafts and ate well. The doctors took her off several medication and she seemed much more alert and happy.

Each facility will evaluate potential residents to determine if their facility is equipped to handle their needs. And remember, you get what you pay for.

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Formama: The answer to your query will depend on your medical insurance coverage.

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My mom started in memory care. A complete mental collapse. They stabilized her and 12 months later she is in an assisted living doing great! Memory care is not always forever..if you keep involved and monitor for improvement. Once I saw mom clearer and not aggressive I looked for a less restrictive facility.

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What stage was your Mom when she went into Memory Care?

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Make sure she needs MC, but even so MC is often not covered so it may not be an option. SNF is often all that is available and often you do not even get a say where they go.

MC is best suited for dementia but in many places dementia is not a skilled need and thus getting insurance coverage or help is not exactly east. Also finding a MC that takes Medicaid that has availability is a hurdle in itself. As others mentioned it is less about what is best and more so what is available.

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Medicaid does not cover memory care

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What's SNF? Please don't use abreviations. They are hurdles for the novices like me.

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There are resources for that! Look around the site.

Or read the entire thread.

https://www.agingcare.com/articles/common-caregiving-abbreviations-and-acronyms-435589.htm

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Memory care is for memory and dementia related deficits. The facility basically evaluates how much care she needs and level of care determines which setting she is suited to/how much care they provide in each level of care. Pretty much, SNF is the most care - and would be at the bottom of the levels - you end up at SNF when you can't do for yourself and have other issues - you need 24/7 care. The other facility types are used for people with some issues, but not at the same level of SNF. SNF usually have an area where, when they require 24 hr basic needs care, also get a more secured area to live in to avoid the wandering outside.

Ask facility to explain levels of care in relationship to Assisted Living, Memory care and SNF to help you understand how they arrive at appropriate care.

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Not sure if you're willing to move with her so that she has you or if you are limiting your search to just your locale. I was looking at Memory Care in Mexico, but I don't have any trust in their government regulations or safety, so that's out. I went in search in Mississippi (because it is a low cost state) and found something special in Jackson, MS! Memory Care is about 1/2 the cost of what I've read and they have a special Dementia Center https://www.umc.edu/Healthcare/Alzheimers%20and%20Dementia/Alzheimers_and_Dementia_Home.html

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H*ll

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Skilled Nursing Facility

https://www.agingcare.com/articles/common-caregiving-abbreviations-and-acronyms-435589.htm

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If you explain what SNF is, I will give you an answer and some suggestions.

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Skilled Nursing Facility

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The wound care on my dad's legs was out of control in assisted living so he was moved to skilled nursing. His insurance paid for 100 days. After that, we were on self pay at $11,000 per month. After a number of months of this, I finally put my foot down and asked I be allowed to move him to memory care. He was bored to death and had no medical need to be there anymore. Personally, I think it was because we were self-pay - just my own opinion. The SNF was not dealing with his dementia properly. Since moving him to memory care, he is THRIVING. It took a bit of searching but we found a great one. It's a smaller facility - we did not go with a big fancy one - but my dad is not a 'fancy' person but still needed medical help. His facility is managed by an RN and any services he needs are brought in to him.

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Memory care will make sure her socializing stays safer - especially since she is paranoid and aggressive.

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Skilled nursing is the highest level of care. Your mother sounds like Memory Care is more appropriate. They know how to handle the common symptoms of paranoia and aggression (better, I think, than skilled nursing care). But also speak to her doctor about calming medications. There are natural medications that can be used if the case is mild, but finding the right meds may be by trial and error. A Memory Care unit can advise you on this. Also, her state of mind is likely to change over time. My mother went through stages with paranoia and aggression, and then passed through them.

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If you have a choice and believe she will end up in MC at some point why not put her there now? Less moving is always better for Dementia patients, it’s hard to adjust to new surroundings when your brain has a hard time processing them, especially when paranoia is a problem. I think as many patients progress their area of comfort and familiarity becomes smaller, I know it’s happening with my mom so establishing the place where they feel secure and people who know them sooner seems kinder for everyone. Now this isn’t always possible of course but if it is for your mom now that’s the way I would choose.

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As others have mentioned, some of this depends on her insurance coverage. If your mom has Medicare, upon discharge from an inpatient hospital stay Medicare may pick up the skilled nursing facility (SNF) bill for a period of time IF she needs post acute care (aka post hospital stay) medical services. For example, if she needs IV antibiotics, rehab or physical/occupational therapy type services, or wound care all of which require "skilled nursing" rather than more routine care -- help dressing, bathing and medication management -- that a non RN could handle.

Some times while at the SNF, that team can also do a fuller work up of her dementia status and other health conditions to develop a "care plan" in order to consider what's best following the initial SNF Rehab stay. That may mean staying at the SNF but moving to their "long term care unit" OR staying at the SNF facility, but moving her to the MC unit if they have one and have a bed.

Would be helpful to have the discharge folks (usually these are social workers at the hospital who know a lot about the various post acute care facilities their patients may be discharged to) to identify a SNF with Rehab, SNF long term care and MC units all at the same facility with beds/no waiting list for the long term care and MC units in order to obviate too many moves from one facility to another. Easer to move to different units at the same facility.

Also, depending your her insurance coverage (Medicare, long term care insurance policy if she has one (?), other "retiree" insurance, etc.) helpful if the facility is both Medicare AND Medicaid qualified especially if at some point your mom will not have the funds to be private pay at either the SNF long term care unit or the SNF's MC unit. Medicare does not pay for either and Medicaid only pays once one qualifies and that is a huge process but the SNF can help you with that if needed.

My mom's SNF long term care bill is about $15K per month or $180K per year, YIKES. My mom spent down over a 7 month period and, then qualified for Medicaid. So I was glad to have picked a SNF Rehab facility that was both Medicare and Medicaid qualified and which had a SNF long term care unit which is where she is. They have a MC unit (which is locked), if at some point they need to move here there, then it is just a move to the 2nd floor. But since my mom cannot walk more than 5 feet with her walker, not like she can wander which is why many have to go to the MC unit as the facility cannot have these folks just walking out the door with others.

Good luck, this journey is so hard.

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unless she has a major medical issues that she needs actual skilled nursing for, I would go with memory care. Skilled nursing facilities do not know how to handle dementia patients well, and my mother did not get better any time she was in a skilled nursing facility. She did much better in memory care, and they do have an RN on staff and can bring in therapists as needed for PT and OT.

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Thanks

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Personally I feel the question has more to do with availability, time frame, and income.

If you can afford it, and a MC has availability generally MC is better suited for those with dementia. If no available and cannot wait for a bed nor afford private pay then SNF is where people often send their LO. It takes some creative insurance work on the AL part but it can be done.

The sad truth is what is best for someone is not exactly an option when they do not properly prepare for retirement.

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I, and this is a personal opinion, believe that Memory Care is the more appropriate place for someone with dementia.
You say that m om does not wander but she likes to talk to people and go out. What happens one day if she is talking to someone and walks out with them...and does not know how to get back.
Or she is talking to someone and mentions wanting to go to the store. The other resident, not knowing mom has dementia says they are going to the store and would mom like to go along.....And she is unable to find the person or know how to get back.
Or waiting for dinner one evening she gets aggressive with the person in front of her that is waiting for the elevator....

Talk to the administration and find out why they think Memory Care is a better option than AL. Listen objectively and analytically like this is not your mom but someone else. I know that will be difficult to do as we see one thing and the staff sees another.

It also might be an easier adjustment moving 1 time rather than 2 times. Actually more moves than that if she is in Independent Living now then she has had a move to a Hospital stay then a move to rehab then moving to AL then maybe in a few months a move to MC. That is a lot for anyone.

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What is mom in the hospital for? Is rehab necessary?

You cannot just broadly say one is better over the other without more information. Even then, it depends on the person and what the facility will provide.

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she was admitted for seizures and agitated behavior problems

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In my part of the world memory care comes before the nursing home, it is mostly a place for people with dementia who would otherwise function well with an AL level of care. Memory care facilities generally have staff that is better educated about dementia and there should be programs and activities tailored to that demographic. Once residents begin to need a higher level of physical care they are encouraged to move on to the nursing home - it no only frees up a spot for those who would benefit the most in a memory care setting, the higher and more skilled staffing levels at NH should mean better care for their physical needs.

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My mother entered Memory Care with moderate dementia.

She was able to participate in activities, and on some bus rides to see a nearby lake.

There are people in her MC who are at very different levels. Activities are varied, depending on how a person’s dementia has progressed.

You may want to take some tours of MC facilities before you make the decision. We started with a virtual tour of Mom’s facility. Way easier than an in-person visit. If you find a MC that suits your fancy, then move on to an in-person tour.

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SNF means SKILLED NURSING FACILITY. Usually and in most areas people who are transferred still require nursing care for wounds, etc. It isn't LTC and it won't be covered as such. So I think you are looking at the possiblity of memory care. Some places have a sort of medium care where it isn't memory care and is more like ALF but the facility has LOCKED cottages. This is becoming more a "thing" as memory care cannot really be afforded by most. You might consider some board and care facilities as well. Good luck.

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The logical progression would be for mom to go from the hospital into a SNF for rehab purposes for 20 days, then to Memory Care Assisted Living afterward, if she's deemed appropriate for MC after she's finished rehabbing. IF she has the funds to private pay for MC, that is. My mother was in Memory Care AL for nearly 3 years and she wasn't a 'wanderer', knew who her family members were, and still required the services of Memory Care. I don't know why people feel the only residents 'qualified' for MC are those who are totally incoherent; that is NOT the case at all. What you'll find in MC is residents at all levels of dementia, from fairly mild all the way up to advanced, and everything in between. The purpose of Memory Care AL is to provide a safe environment for residents with dementia and to give them socialization and activities appropriate for their abilities. My main goal in life was to keep mom OUT of a SNF b/c she'd have had a roommate in Skilled Nursing (with Medicaid) and I did not want that for her; she enjoyed having her own lovely private room and bathroom at the MC which was a small apartment, really, and there were only 23 residents in all there vs. 100+ at the SNF.

When mom went to the MC, she had moderate dementia and at the end, she had advanced dementia. She always socialized with residents that were at her level of dementia, pretty much, and the staff was good at getting people together who were well suited to get along.

My advice is to speak to the social worker and the staff at the hospital and the rehab (if she does go to one) to get their feel for where mom would thrive best. Good luck!

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What’s best for mid-stage dementia: SNF or memory care?

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