Assisted living facility/memory care cutoffs

[Anonymous]

Say an 81-year-old has Stage IV cancer that’s spread to the brain. Can do all physical things, sound lucid over the phone and read a paper, but has no interest in food, cant order food off the rehab center menu for the next day, and, sometimes, in the evening, thinks he’s in a hotel and says he needs cash so he can tip the staff when he leaves the next day.

He’s on two pills per day plus monthly chemo.

He’s pleasant and doesn’t seem unhappy but has no real interest in leaving his room.

The rehab just did an evaluation and says parent just needs a little supervision, but maybe he’s deteriorated in the last week.

In the real world, are there obvious signs that someone like this will have trouble getting into an ALF and will have to go with memory care?

My father still wants to stick with active treatment for now. I haven’t even heard anyone talk about life expectancy. But, if someone like this wanted to shift into hospice, would there be a lot of risk of Medicare refusing hospice care for someone with cancer that’s spread to the brain? Is that really a case-by-case thing or something where, once the oncologist says it’s time, it’s time?

[Anonymous]

He’d have to go into a nursing home not assisted living. Hospice can work with him but sone don’t work with those in active treatment. Call and ask as rules vary.

[Anonymous]

When I was searching for a place for my father, the assisted living facility would go and do a nurses assessment of him before deciding if they would be a good place for him. They would also determine level of care that was needed.

My dad was very similar sounding to what you are describing, except for the cancer treatment. He started off in an assisted living facility with minimum level of support, really just drug management. But his memory issues quickly progressed and ended up in the memory care unit and then soon after hospice got involved.

[Anonymous]

Anonymous wrote:Say an 81-year-old has Stage IV cancer that’s spread to the brain. Can do all physical things, sound lucid over the phone and read a paper, but has no interest in food, cant order food off the rehab center menu for the next day, and, sometimes, in the evening, thinks he’s in a hotel and says he needs cash so he can tip the staff when he leaves the next day.

He’s on two pills per day plus monthly chemo.

He’s pleasant and doesn’t seem unhappy but has no real interest in leaving his room.

The rehab just did an evaluation and says parent just needs a little supervision, but maybe he’s deteriorated in the last week.

In the real world, are there obvious signs that someone like this will have trouble getting into an ALF and will have to go with memory care?

My father still wants to stick with active treatment for now. I haven’t even heard anyone talk about life expectancy. But, if someone like this wanted to shift into hospice, would there be a lot of risk of Medicare refusing hospice care for someone with cancer that’s spread to the brain? Is that really a case-by-case thing or something where, once the oncologist says it’s time, it’s time?

I'm sorry about your dad. I've read the bolded and I'm confused. (asking nicely) why would medicare ever refuse hospice, and what would spread to the brain influence their decision?

[Anonymous]

Maybe you already know this but hospice won’t take you until you have 6 months or less to live. Once the physician refers and says you’ve met the criteria for that particular hospice (6 months or less, maybe you need to have stopped active treatment like PP said, whatever the requirements are for the particular hospice you’re trying to get him into) then they will take him as long as there is a spot.

[Anonymous]

Anonymous wrote:He’d have to go into a nursing home not assisted living. Hospice can work with him but sone don’t work with those in active treatment. Call and ask as rules vary.

Thank you.

[Anonymous]

Anonymous wrote:Maybe you already know this but hospice won’t take you until you have 6 months or less to live. Once the physician refers and says you’ve met the criteria for that particular hospice (6 months or less, maybe you need to have stopped active treatment like PP said, whatever the requirements are for the particular hospice you’re trying to get him into) then they will take him as long as there is a spot.

Thanks. I know that, but I was wondering if, in practice, symptomatic metastatic cancer in the brain is pretty easy to put in that category.

[Anonymous]

Anonymous wrote:When I was searching for a place for my father, the assisted living facility would go and do a nurses assessment of him before deciding if they would be a good place for him. They would also determine level of care that was needed.

My dad was very similar sounding to what you are describing, except for the cancer treatment. He started off in an assisted living facility with minimum level of support, really just drug management. But his memory issues quickly progressed and ended up in the memory care unit and then soon after hospice got involved.

Thanks. My father goes through an ALF assessment tomorrow, so I guess I’ll know more what the standards are like tomorrow.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Say an 81-year-old has Stage IV cancer that’s spread to the brain. Can do all physical things, sound lucid over the phone and read a paper, but has no interest in food, cant order food off the rehab center menu for the next day, and, sometimes, in the evening, thinks he’s in a hotel and says he needs cash so he can tip the staff when he leaves the next day.

He’s on two pills per day plus monthly chemo.

He’s pleasant and doesn’t seem unhappy but has no real interest in leaving his room.

The rehab just did an evaluation and says parent just needs a little supervision, but maybe he’s deteriorated in the last week.

In the real world, are there obvious signs that someone like this will have trouble getting into an ALF and will have to go with memory care?

My father still wants to stick with active treatment for now. I haven’t even heard anyone talk about life expectancy. But, if someone like this wanted to shift into hospice, would there be a lot of risk of Medicare refusing hospice care for someone with cancer that’s spread to the brain? Is that really a case-by-case thing or something where, once the oncologist says it’s time, it’s time?

I'm sorry about your dad. I've read the bolded and I'm confused. (asking nicely) why would medicare ever refuse hospice, and what would spread to the brain influence their decision?

This could be wrong, but I’d think that a doctor has something like a flow chart to estimate life expectancy. It seems as if multiple metastases to the brain is so dire and so likely to lead to death soon that maybe it’s very easy to classify anyone who has that as someone with a life expectancy of less than six months.

Sort of the way Social Security Disability Insurance classifies anyone with some terrible conditions as automatically being eligible for SSDI.

But, maybe I’m wrong about how metastases to the brain are, or how Medicare hospice eligibility determinations work.

[Anonymous]

I am sorry you are going through this. We found they are willing to deal with a lot more with residents already there who declined while there, rather than starting with someone in challenging shape.

The thing that stuck out to me was food. I assume he is capable of eating without choking, but just doesn't want it. Will he eat at all? What do you want them to do if he doesn't eat? If he needs IV nutrition that is not something they usually do.

A lot will have to do with his prognosis as well. I certainly would not consider an AL or MC without a nursing home on the premises too because you don't want to have to keep moving him.

[Anonymous]

I would normally recommend a Continuing Care Retirement Community that has an ALF but also a memory care that he can transition to if his cognition deteriorates. However, it sounds like his cognition issues stem from his acute medical condition, which will ultimately be terminal. So memory care might not be a necessity - the ALF can likely manage his care for the remainder of his life. It doesn’t sound like he’s a wandering risk, etc. or requires a locked unit.

I disagree with PP that your dad requires a nursing home - that’s for people who require nursing care and assistance with most activities of daily living. An ALF should suffice, and you can always hire an aide to be with him if necessary.

If your dad wishes to pursue treatment for his metastatic cancer then it doesn’t sound like he is ready for hospice, even if he meets the criteria (estimated 6 months or less to live). Palliative care might be a good option - it offers a lot of the the same services as hospice, with the focus on comfort and quality of life. But the difference is that with palliative care, you must have a life-threatening illness but you DON’T have to meet the criteria of 6 months or less to live. And you can pursue full treatment while in palliative care, unlike hospice.

Medicare will pay for hospice if your dad meets the criteria, and he can receive hospice care while living in the ALF. But again, once in hospice it’s all about comfort Esther than treatment.

[Anonymous]

Anonymous wrote:I would normally recommend a Continuing Care Retirement Community that has an ALF but also a memory care that he can transition to if his cognition deteriorates. However, it sounds like his cognition issues stem from his acute medical condition, which will ultimately be terminal. So memory care might not be a necessity - the ALF can likely manage his care for the remainder of his life. It doesn’t sound like he’s a wandering risk, etc. or requires a locked unit.

I disagree with PP that your dad requires a nursing home - that’s for people who require nursing care and assistance with most activities of daily living. An ALF should suffice, and you can always hire an aide to be with him if necessary.

If your dad wishes to pursue treatment for his metastatic cancer then it doesn’t sound like he is ready for hospice, even if he meets the criteria (estimated 6 months or less to live). Palliative care might be a good option - it offers a lot of the the same services as hospice, with the focus on comfort and quality of life. But the difference is that with palliative care, you must have a life-threatening illness but you DON’T have to meet the criteria of 6 months or less to live. And you can pursue full treatment while in palliative care, unlike hospice.

Medicare will pay for hospice if your dad meets the criteria, and he can receive hospice care while living in the ALF. But again, once in hospice it’s all about comfort Esther than treatment.

^*rather than treatment

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Say an 81-year-old has Stage IV cancer that’s spread to the brain. Can do all physical things, sound lucid over the phone and read a paper, but has no interest in food, cant order food off the rehab center menu for the next day, and, sometimes, in the evening, thinks he’s in a hotel and says he needs cash so he can tip the staff when he leaves the next day.

He’s on two pills per day plus monthly chemo.

He’s pleasant and doesn’t seem unhappy but has no real interest in leaving his room.

The rehab just did an evaluation and says parent just needs a little supervision, but maybe he’s deteriorated in the last week.

In the real world, are there obvious signs that someone like this will have trouble getting into an ALF and will have to go with memory care?

My father still wants to stick with active treatment for now. I haven’t even heard anyone talk about life expectancy. But, if someone like this wanted to shift into hospice, would there be a lot of risk of Medicare refusing hospice care for someone with cancer that’s spread to the brain? Is that really a case-by-case thing or something where, once the oncologist says it’s time, it’s time?

I'm sorry about your dad. I've read the bolded and I'm confused. (asking nicely) why would medicare ever refuse hospice, and what would spread to the brain influence their decision?

This could be wrong, but I’d think that a doctor has something like a flow chart to estimate life expectancy. It seems as if multiple metastases to the brain is so dire and so likely to lead to death soon that maybe it’s very easy to classify anyone who has that as someone with a life expectancy of less than six months.

Sort of the way Social Security Disability Insurance classifies anyone with some terrible conditions as automatically being eligible for SSDI.

But, maybe I’m wrong about how metastases to the brain are, or how Medicare hospice eligibility determinations work.

I see what you’re asking/thinking now. I don’t think they have a flow chart. I think it’s more squishy than that. When my dad was sick, different doctors gave him different estimates. I was also able to find estimates by googling for medical journal articles. There were lots of articles that tracked how long from diagnosis to death for various types of cancer. I assumed his doctors were using those articles as their baseline and then adjusting upwards or downwards based on his individual factors and their own experience, but I don’t think I ever asked.

I’m sorry you’re going through this.