If she has any awareness, you can't do memory care. If her main medical issue is falling but she is mobile, then assisted living with 24 hours aid.

SNF is for those immobile and needing actual medical care. They will try to keep/make her as immobile as possible since easier for staff to care for multiple patients.

If she is still aware, and you have the money, I would send her back to her apt and hire an aide/s. It is hard enough to be elderly and not very mobile, but still cognizant?? Being put into memory care would be like putting her in a prison.

If she is in an "apartment" I am thinking this is more Independent Living than Assisted Living. There are generally 4 levels:
Independent
Assisted
Skilling Nursing
Memory/Skilled Nursing

I would make arrangements with her assisted living facility to allow people to come in to help her.

I will add that she can probably stay in rehab for 90 days. After that, Medicare might still pay if she continues "to improve". If not, she either has to become a paid patient or moved to another skilled nursing facility. They aren't going to let her to lesser care if she still can't take care of herself.

I'm sort of going on here, but it sounds like your mom is not ready for memory care, but you are trying to make the transition easier. While admirable, I would worry that putting your mom in a "zombie" type place would be a horrible way to end life if Mom is not in that state.

We found that assisted living with an aide was better than memory care because in the latter, a private aide wasn't allowed. Both were expensive but assisted living plus 24 hours of aides was incredibly expensive...if you can't afford it then there's no point considering it. And my relative was always on the verge of getting kicked out of assisted living because she sometimes disturbed the other residents. In memory care, they would have heavily sedated her and maybe that would have been better. Honestly for the last few months of her life there was very little quality of life and there was nothing that could change that.

I had a relative in an assisted living place and they eventually asked her to leave with 30 days notice. She had early dementia but was too much to handle (annoying other residents by repeating things, trying to leave, etc.). It gets to a point where the other residents don't want someone with dementia around...which I get but it still was sad for my family member since it was her home. If i could do it over again I would have just have done memory care from the start.

I just wanted to mention that because sometimes you aren't given a choice. The assisted living place might not be able to meet her needs anymore. When you say they are "sub-par at assisting over residents" it makes me wonder if you might already be there. You can get skilled nursing and rehab at memory care, as well. They usually come on a schedule at most places.

If I were you, I would try to continue to tour memory care places and work with a geriatric care manager to help figure next steps that make sense for your mom (I recommend Heidi at Caring Considerations). It is probably too far, but Silverado would be a good option because 1) money is no object 2) they have 3 floors for early, moderate, and advanced so she could interact with residents at her level 3) I haven't found a place that takes care of residents better than them. I have also heard Goodwin House is amazing.

Moving her won't be pleasant, but keep in mind she doesn't know what is good for her anymore. I told my relative I was moving and she needed to move too so she could still live close to me. That worked for her, because she didn't want to be far away from me.

Anonymous wrote:

Anonymous wrote:Does the place she lives not have a skilled nursing facility? If she's not quite ready for memory care, that would be the next step. They are very sad, too though. Honestly, my mom is much better off in memory care than she was in the truly assisted living. Before that she was in an apartment like your mom, with really no assistance, then moved to a higher level of care, where she just sat in one room watching TV all day. Once she had to go to memory care--the decision is pretty much made for the residents where my mom lives--her life got a tad better. They make them leave their rooms and do little activities together, even half of them are pretty much completely sedated. Look into skilled nursing first. You will know when memory care is the next step, and it doesn't sound like it is.

What is the difference b/t SNF and memory care which would make SNF a step before memory care? I’ve only had experience with latter with our mom (went from living at home to memory care) but know this will soon be on horizon for ILs.

They’re similar, in that it’s a higher level of physical care, but SN is not a locked down floor, and SN has many frail older people, but not so many who are drugged to the point of being catatonic, which you see in memory care because of the highly distruptive delusions many people with dementia experience.

Anonymous wrote:I think it might be helpful to link to your other threads

12/24/2023
https://www.dcurbanmom.com/jforum/posts/list/1175489.page

I wasn’t sure if new threads or continuing on with the same threads were better (wondering about people searching for this info down the road). But I can see if they can merge if that’s better.

Anonymous wrote:Does the place she lives not have a skilled nursing facility? If she's not quite ready for memory care, that would be the next step. They are very sad, too though. Honestly, my mom is much better off in memory care than she was in the truly assisted living. Before that she was in an apartment like your mom, with really no assistance, then moved to a higher level of care, where she just sat in one room watching TV all day. Once she had to go to memory care--the decision is pretty much made for the residents where my mom lives--her life got a tad better. They make them leave their rooms and do little activities together, even half of them are pretty much completely sedated. Look into skilled nursing first. You will know when memory care is the next step, and it doesn't sound like it is.

What is the difference b/t SNF and memory care which would make SNF a step before memory care? I’ve only had experience with latter with our mom (went from living at home to memory care) but know this will soon be on horizon for ILs.

Anonymous wrote:I think it might be helpful to link to your other threads

12/24/2023
https://www.dcurbanmom.com/jforum/posts/list/1175489.page

11/4/22
https://www.dcurbanmom.com/jforum/posts/list/1092295.page

I think it might be helpful to link to your other threads

12/24/2023
https://www.dcurbanmom.com/jforum/posts/list/1175489.page

Does the place she lives not have a skilled nursing facility? If she's not quite ready for memory care, that would be the next step. They are very sad, too though. Honestly, my mom is much better off in memory care than she was in the truly assisted living. Before that she was in an apartment like your mom, with really no assistance, then moved to a higher level of care, where she just sat in one room watching TV all day. Once she had to go to memory care--the decision is pretty much made for the residents where my mom lives--her life got a tad better. They make them leave their rooms and do little activities together, even half of them are pretty much completely sedated. Look into skilled nursing first. You will know when memory care is the next step, and it doesn't sound like it is.

If she has the money (and you are lucky here - my ILs are destitute and 85 and we are spending our retirement on dealing with them) - I would send her back to the place she is familiar and comfortable with and add in the 24 hour aid. There is no reason to send her to memory care too soon other than saving money. She is equally at risk for falls in both scenarios but with a dedicated aid, her quality of life is arguably better. I would be focused on her happiness and quality of life.

My mom fell and died in memory care - top notch and expensive. Look at Memory Care at a nice place. If need be hire an aide with her. She will fall regardless of where she is, but she will be clean and cared for. Spend that $$ for her care. Good that she has it. Buys you some peace of mind.

We went through this with MIL. I will say that memory care was not a panacea. She still fell repeatedly and had to leave memory care to go back to rehab and lost more mental and physical capabilities. Memory care is often zombie land because they sedate/medicate the residents so they won’t move around, fall, and get hurt. It is awful but there are no good choices. If you can afford the 24/7 sitter I would do that but it probably will not work for very long.

I mean...do you think she will recover some mobility in rehab? If so, maybe she can go back to her apt-but she needs 24 hr care, sounds like. If she can afford, and find it.

If it was me, I think I'd be looking at SNF (nursing homes). Between the mobility and the dementia, that's probably where she needs to be.

I had an aunt who thrived in her SNF. She was 88 and had broken her hip-could not live in her upstairs apt anymore (never married no kids). The home was an older but very clean and cheerful facility (which has since been demo'd and rebuilt) and a shared room. Aunt, who had lived alone for many years, all of a sudden had people to talk to, went to bingo, crafts, performances...the aides loved her and would brush and braid her long hair. Extended family visited nearly every day. She was there 2 years before she passed, and we are certain she was better off than if we had parked her upstairs confined to her apt.

Another day another thread. If you’ve been following my saga my mom is the current hot mess of the board (she fell, broken pelvis, a host of other issues). She made it to rehab yesterday but I had to hire a sitter 24/7 for the first week or until she can get strong enough to not get hurt if she gets up unassisted. Getting old and infirm is incredibly expensive, highly not recommended, one star.

Since this is now my third rodeo I’m trying to stay three steps ahead if I can. On the off chance she can recover and make it out of rehab I now have to make some tough choices. She lives in “assisted living”- quotes because even though her place is beautiful and costs a ton each month it really is sub-par when it comes to assisting the residents. I had been starting to tour memory care places but frankly it’s like zombieland in those places and, while my mom is getting there, she’s not quite there yet.

Of course she wants to go home eventually- she loves her apartment and is familiar with the facility and how they operate. And she knows the people and the routine so it’s comforting. Dementia patients are incredibly anxious about change. But I fear that if she returns there she’s going to need an aide ($$$$) and she’s still going to end up in memory care eventually, probably sooner than later. It’s not about the money, she has the money and I’d spend every penny of it on her if I had to, but it seems like it may not be worth the expense to keep her there for just a little longer, and then ultimately have to move her when she’s (more) aware a move is happening.

So I’m considering just moving her to memory care while she’s in rehab and just telling her it’s the next step toward going home. Hospital to rehab to the next rehab (memory care). And eventually if she remembers to ask about her old place maybe tell her she’s not ready to return yet? The only issue would be explaining why her belonging were there but I could come up with a white lie I guess. She probably would notice, dementia is a weird beast.

It’s such a tough decision during a time where there have had to be many tough decisions. I hate lying to her and I’m not sure how much she retains or remembers or understands. I’m just trying to navigate this horrible road.

Any suggestions? I think I know the answer but I do appreciate other insight and sometimes I just need to write things down to see what I need to do. Thanks again for any and all responses.