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Old 05-13-2019, 10:26 AM
 
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Hello

Can anyone direct me to a source to find what level of care we should expect from the nursing home memory unit at this time in our Mom's condition? She is physically well other than age related issues and very active so it is more comfort/custodial? care than anything. Her age is 92.

It is medicaid and we do not have 24/7 nursing care. We do have a companion visit three times a week and each sister (three of us) rotate weekly visits at random times.

something reasonable so that we are not hitting them (staff) on the head for minor stuff but addressing what should be addressed. runswithsissors, could use your guidance if you are still onboard.

She is in TN so if there is a state specific source that is great. Or standards of practice would be better.

We are trying to be fair with expectations so doing a little homework.

thank you all
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Old 05-13-2019, 10:31 AM
 
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Is she already in a home, or is she going into a home? When my dad had to go into a home, there was a detailed questionnaire that we went over with the nursing supervisor to determine the level of care the was needed and what that entailed.
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Old 05-13-2019, 11:00 AM
 
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Originally Posted by theoldnorthstate View Post
Hello

Can anyone direct me to a source to find what level of care we should expect from the nursing home memory unit at this time in our Mom's condition? She is physically well other than age related issues and very active so it is more comfort/custodial? care than anything. Her age is 92.

It is medicaid and we do not have 24/7 nursing care. We do have a companion visit three times a week and each sister (three of us) rotate weekly visits at random times.

something reasonable so that we are not hitting them (staff) on the head for minor stuff but addressing what should be addressed. runswithsissors, could use your guidance if you are still onboard.

She is in TN so if there is a state specific source that is great. Or standards of practice would be better.

We are trying to be fair with expectations so doing a little homework.

thank you all

If she is as you describe, she would not be admitted to a nursing home. Nursing homes require that a person cannot meet certain activities of daily living (ADLs). If she is "very active" and "physically well" I assume she is handling her own meals, dressing, bathing etc and would not qualify for nursing home care.


Maybe assisted living. But Medicaid doesn't cover that.
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Old 05-13-2019, 11:22 AM
 
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Originally Posted by wasel View Post
If she is as you describe, she would not be admitted to a nursing home. Nursing homes require that a person cannot meet certain activities of daily living (ADLs). If she is "very active" and "physically well" I assume she is handling her own meals, dressing, bathing etc and would not qualify for nursing home care.


Maybe assisted living. But Medicaid doesn't cover that.
That isn’t true at all. I’ve been working in nursing homes for 20 years. There are many people who have mental disabilities, psychological disorders or dementia who are otherwise mobile and can dress themselves. There are people without mental disorders who are mobile and can dress themselves in nursing homes to, often people who have had falls at home or might forget a burner is on, and would be more appropriate for assisted-living but do not have the funds for assisted-living. But there really is no criteria to be accepted into a nursing home.

It is also not true that Medicaid doesn’t cover assisted-living. My mother is in an assisted living facility and which she private paid for 18 months and the facility agreed upfront to let her stay once on Medicaid after that. She’s been there on Medicaid for about 2 1/2 years. There are other assisted-living facilities which will except Medicaid right away, although it is not easy to find a place in one if you don’t have the ability to private pay at all first.

In OP’s case, her mom has a diagnosis of dementia, there is no reason at all that they’d have to wait until she declines to any specific level to get her into one.

OP, I’m not really sure I understand your question. What you can expect is that she will have help with showering, dressing, bathing, taking medications, toileting, meals based on what she needs. If she doesn’t need help dressing then she’ll be allowed to dress herself. If she needs someone just to come in and lay out her clothes and tell her it’s time to get dressed and maybe give her some cues to initiate or intermittent supervision, they’ll do that. She’ should get a shower twice a week, that’s pretty standard.

They will make her bed and clean her room. She’ll be encouraged to attend activities, but won’t be forced to. She’ll be allowed to do as she pleases in terms of staying in her room, unless they consider her a fall risk. The main complaint that people in nursing homes have is that their call lights are not answered promptly enough. But also make sure they’re sticking to the shower schedule. And check to make sure the kitchen has her preferences down correctly and are carrying through. For instance if you’ve made it clear that she wants tea not coffee and she keeps getting coffee. If there are preferred things she likes to eat, such as a specific flavor of yogurt, they will let you keep a few things for her in the nurses refrigerator with her name on it. She can have all the non-refrigerated foods and beverages she wants in her room. Not all nursing homes have salt available, so if she wants salt and is allowed to have it, you can get a shaker for her to keep in her room.

Sometimes there are issues with roommates, so if you can try to find out who they’re considering putting her in with before hand. The two biggest issues among roommates, are volume of TV and keeping the TV on all night, and one person who’s always cold in a room with one person who is always hot.

With a dementia diagnosis, she may have a wander guard on her ankle, which she will set off an alarm if she goes outside the door. This doesn’t mean she can’t go outside, just someone needs to know she’s there and most likely someone would have to accompany her unless it was a contained courtyard.

Last edited by ocnjgirl; 05-13-2019 at 11:54 AM..
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Old 05-13-2019, 12:00 PM
 
4,408 posts, read 3,421,896 times
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Originally Posted by ocnjgirl View Post
That isn’t true at all. I’ve been working in nursing homes for 20 years. There are many people who have mental disabilities, psychological disorders or dementia who are otherwise mobile and can dress themselves. There are people without mental disorders who are mobile and can dress themselves in nursing homes to, often people who have had falls at home or might forget a burner is on, and would be more appropriate for assisted-living but do not have the funds for assisted-living. But there really is no criteria to be accepted into a nursing home.

It is also not true that Medicaid doesn’t cover assisted-living. My mother is in an assisted living facility and which she private paid for 18 months and the facility agreed upfront to let her stay once on Medicaid after that. She’s been there on Medicaid for about 2 1/2 years. There are other assisted-living facilities which will except Medicaid right away, although it is not easy to find a place in one if you don’t have the ability to private pay at all first.

In OP’s case, her mom has a diagnosis of dementia, there is no reason at all that they’d have to wait until she declines to any specific level to get her into one.

OP, I’m not really sure I understand your question. What you can expect is that she will have help with showering, dressing, bathing, taking medications, toileting, meals based on what she needs. If she doesn’t need help dressing then she’ll be allowed to dress herself. If she needs someone just to come in and lay out her clothes and tell her it’s time to get dressed and maybe give her some cues to initiate or intermittent supervision, they’ll do that. They’ll make her bed and clean her room. She’ll be encouraged to attend activities, but won’t be forced to. She’ll be allowed to do as she pleases in terms of staying in her room, unless they consider her fall risk.
OP didn't mention mental disabilities or psychological disorders. Wouldn't they have mentioned that in the description of Mom? They mentioned memory care unit but that in itself doesn't mean eligible for Medicaid nursing home.


Per CMS the person must have a "medical need" to qualify for a nursing home. Each state has their own criteria.
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Old 05-13-2019, 12:06 PM
 
50,135 posts, read 35,792,448 times
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Originally Posted by wasel View Post
OP didn't mention mental disabilities or psychological disorders. Wouldn't they have mentioned that in the description of Mom? They mentioned memory care unit but that in itself doesn't mean eligible for Medicaid nursing home.


Per CMS the person must have a "medical need" to qualify for a nursing home. Each state has their own criteria.
If she needs a memory unit then quite obviously she has a diagnosis of dementia or at least just showing signs of dementia. That is more than enough to qualify even if she does not need to require physical assistance at all. But we have people that are mobile and stay in our nursing home after rehab simply because they were homeless before and have nowhere else to go. Medical need may be very loosely defined, I don’t know but I’ve never seen anyone turned away because they aren’t needy enough. If she has dementia and may not be able to call 911 if she needs it, may burn the house down, etc, she will be able to get into a nursing home even if she can walk a marathon.
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Old 05-13-2019, 12:12 PM
 
4,408 posts, read 3,421,896 times
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Originally Posted by ocnjgirl View Post
If she needs a memory unit then quite obviously she has a diagnosis of dementia or at least just showing signs of dementia. That is more than enough to qualify even if she does not need to require physical assistance at all. But we have people that are mobile and stay in our nursing home after rehab simply because they were homeless before and have nowhere else to go. Medical need may be very loosely defined, I don’t know but I’ve never seen anyone turned away because they aren’t needy enough. If she has dementia and may not be able to call 911 if she needs it, may burn the house down, etc, she will be able to get into a nursing home even if she can walk a marathon.

LOL OK Ocnjgirl. I'm not going to get into all the different variations of what defines medical need with you. All I can tell you is that I personally know that the resident will be evaluated and may not qualify. I know people who have been "rejected" for admission based on these ADL requirements.

OP, I'm just saying that the nursing home may not be possible based on the picture you painted. I wish you the best of luck in your search for the right solution.
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Old 05-13-2019, 12:13 PM
 
5,544 posts, read 8,269,850 times
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Originally Posted by joe from dayton View Post
Is she already in a home, or is she going into a home? When my dad had to go into a home, there was a detailed questionnaire that we went over with the nursing supervisor to determine the level of care the was needed and what that entailed.
Thanks Joe

good idea of a checklist kind of what we are looking for.

Mom has been in a facility for years, once we could no longer take care of her in the home. She worked her way up from assisted living, to intermediate, to memory care now. She has clearly hit another down turn and I am just not sure how to proceed.
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Old 05-13-2019, 12:29 PM
 
50,135 posts, read 35,792,448 times
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Quote:
Originally Posted by wasel View Post
LOL OK Ocnjgirl. I'm not going to get into all the different variations of what defines medical need with you. All I can tell you is that I personally know that the resident will be evaluated and may not qualify. I know people who have been "rejected" for admission based on these ADL requirements.

OP, I'm just saying that the nursing home may not be possible based on the picture you painted. I wish you the best of luck in your search for the right solution.
Looks like we both wasted a lot of breath. And keyboarding, lol. I should wait until people give sufficient information before I take off on one of my long winded responses LOL.
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Old 05-13-2019, 01:26 PM
 
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I apologize that I may not have included enough information. I did not want to bog down the question with too much data. Hard to tell what is needed but experts do get clues from the data.

Mom now has advanced dementia (it has been a gradual decline). Probably vascular. She does not snap back occasionally or sometimes remember. Her self is gone but her spirit and strength remain. She has no clue who she is (sense of self gone) or who we are. She is in a memory care unit of a nursing facility (with tracking band) and has been in a facility of one sort or another for 6 years. We never thought she would make it to 92, the way she is going she may be there till 100 physically. With this dementia, I am not sure how much more there is to lose. But as things have evolved, there is always another lower level.

She is helpful by nature and curious. She puts miles on her wheelchair. Her mind remains analytical so she gets herself into situations hence the tracking band and "where is she now?" kind of thing. She is a handful for staff and they consider her one of their challenges. But she has been a favorite up until now I think. Compliant, friendly, sweet, tries to help but bound to explore or 'fix' things.

She has no memory except maybe something like 'muscle memory' as put a toothbrush in her hand and she can use it but she doesn't remember what a toothbrush is for example. Put her on the commode and she can use it, but she grabs the toilet paper putting it on her head. Therefore her self care capability is limited. She can feed herself with coaxing using her hands (sandwich cookie, etc) but I haven't seen her feed herself with a spoon in months.

So she is either wheeling around in her wheelchair or playing with her baby dolls. Her cognition is fuzzy in some ways but she thinks. She observes. She feels. She understands. But it is gone in a flash. She tries to talk but she hears herself and knows what is coming out is not what she is trying to say. She is sympathetic to others distress, I can see it in her eyes.

So...

She has clearly had a dementia downturn which makes it harder for staff because she can do less for herself but we are also finding events that seem like they should have been caught by staff and addressed/recorded. So lately sisters and I are seeing things that we wonder "Is this too much to expect staff to take care of"? We want to advocate for Mom but we don't want to hound the staff with unreasonable demands.

Example, I found leg wounds that were untreated, unreported and apparently 'unknown' to the staff. I requested they be treated and it turned out they were infected as well as bloody. To me, I shouldn't have been the one to find them. I shouldn't have had to ask for them to be dressed or that a doctor check them. I shouldn't have had to ask them if the wounds were reported or recorded.

Does this help with my question?

Is there a way I can find the balance between what should be the expected care vs unrealistic expectations?

Thanks much

Judy
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