Advice on placement. Is it better to get dad someplace where he can stay until he passes, but has less attention and care?

If it were me, I'd move my mom to the private pay smaller resident home for the next 3 years for a higher quality of one-on-one care. You don't know if your father will live past that 3 or 4 year window anyway to have to move onto the Medicaid SNF, so why not give him the best quality of life NOW? That's always been my motto. I can move my mother to a SNF that accepts Medicaid now, or leave her be in the private pay Memory Care ALF where she's been living since 2019 until next summer, which I'm going to do. It's not that the SNF is going to give her a poorer quality of care, per se, but she will have to contend with a roommate, and I KNOW she will not like that at all. So the MC wins out for a better quality of life in general. If she's still alive when her $$ runs out, then I will move her to the SNF.

Wishing you the best of luck; I know how tough it is to feel we're making the 'right' decision for our parents and to constantly second-guess ourselves in the process. It's exhausting. You are a good daughter *I assume you are not a son* for caring so much!

Definitely look at all your options. Don’t assume that because a place accepts Medicaid the care will be poor. My mother went from private pay, using a LTC policy, to Medicaid all in the same bed at the same place. She wasn’t treated any differently when it was Medicaid paying, I’m doubtful the workers had any idea who paid which way, she received kind, competent, and compassionate care throughout. I’d decide on the place you feel best about, and not bite off the issue of a possible move until it’s a must. The NH industry, like most others, goes through cyclical changes, with some being better or worse at differing times. What you find best now could change, it’s the nature of it. I wish you wisdom and peace

I will simply tell you what we did.

Mom moved into Independent Living, stayed their happily for 2 years and had a stroke. We tried to moved her to an Assisted Living place; didn't work, she fell, broke her hip.

The wonderful discharge planner at the hospital highly recommended moving mom into a NH (the level of care she needed) which would take her as a Medicaid patient after a year of private pay. Mom initially was in a private room for rehab (because no, especially not me, expected her to live much longer after the hip) but she surprised us all, regained her ability to walk and we made the decision to move her to semi-private. Having a roommate has some benefits. They were each able to call for help in situations where the other couldn't.

Yes, at one point, there was the roommate from Hell. We got that fixed (they moved the hoarder, mentally ill roommate). When mom was dying, we discretely asked for roommate to be relocated for a couple of hours (my brother sent in a LOT of ice cream, the flavor he knew she liked) and it all worked out well.

It depends on what your LOs level of care need is. Mom had heart issues, UtI's and other medical stuff going on. We greatly benefitted from having skilled RNs, APRNs and geriatric docs on site to see her and give good advice.

My mom will be placed in a Nursing Home from her Assisted Living when appropriate.We talked about this when she was well and not in dementia. Moving takes a huge toll on old people. As a 27 yr clinical staff member of numerous long term facilities I found them to be loving safe places. Family visits are crucial. It is important to develop a relationship with staff. The average stay in a nursing home is 5 years. Medicaid will pick up the bills after all money runs out. Good Luck…these decisions are difficult to say the least.

I would give him best quality care
you find now !!!
and that includes private room with bath …skilled staff opportunities to interact
and stimulating activities.
it’s important for him to enjoy quality
of life while he still can.
nobody knows what’s more than 3 years down road !!
good luck !!!

What about moving to a nursing home and paying for extra outside help as needed?

Eexcellent question. Following. We have enough $ for 3 more years 24/7 at-home care. Advice we got was to place mom in a nice place while she can pay full rate with the thought she can stay when it's Medicaid paying.

In my family's experience: my 85-yr old MIL who is bed-bound is in a very reputable, non-profit facility in a private room and has been a Medicaid resident for the past 3 years. She gets all the same attention as all the other residents. When we initially moved her there from another facility to be closer to us, she had roommates, as is mostly the case with Medicaid. Most of them were not a problem because they were in the very end stages of their disease (dementia) and were mostly non-communicative & non-mobile. The facility had been in an expansion project and then covid hit. After covid (which my MIL survived and has recouped 100%, thanks to the staff) they moved her into a private room where she has been since. My MIL is very sweet, and won't get out of bed, so she technically isn't ill with any problem, and she has some mild/mod dementia and memory impairment. I think they realize she's there for a long time (given that her own parents and grandparents had amazing longevity) and since they must have the available Medicaid beds, she gets her own.

At her facility (which is on a beautiful property on a lake) they've taken her on field trips (great pic of her being "kissed" by a llama) and fishing on their pontoon boat, plus visits with therapy animals, singers/balladiers, special concerts, events, games, raised vegetable gardening, you name it. I realize not all places will have resources and activities like this but NHs have been ramping up and remodeling anticipating the baby boomers needing these residences. My point is: don't assume you think you know what's out there for Medicare recipients or facilities in general. A lot has changed in the past few years.

I don't think you should be stressed or worried about making a "wrong" decision here, since you cannot know what the near future will bring for your LO, nor what experience he *would have had* at the places you didn't pick. Just do ample research on the ones you're considering, especially through Nextdoor.com, an intranet of your actual neighbors who are not anonymous. They'll give you current and objective opinions of the places where their LOs are reside currently. Wishing you great clarity and peace in your heart as you make this decision.

Here's a different way to look at it.
Visit nursing homes and small care homes in your area. A place that is convenient for family to visit often, that is welcoming of visitors and has a calm atmosphere and staff who interact with residents (instead of rushing by in a harried hurry!) are signs of a welcoming and caring place.
Based on age, functional status, and chronic illnesses, life expectancy really is unpredictable.
There is stress to moving - both positive and negative. True at any age.
Make the choice that seems the most right one. Then try not to second guess yourself.Good luck to you and your dad in this process.

I have had loved ones in both types of facilities and a couple things that I noticed that you should consider. Both fulfill a need and have their purposes and their good and bad points.

1st - a NH has staff for everything, cooks, laundering, caring for residents, meds, etc. A board and care has the aides cooking and cleaning, so they aren't always available for patient care, you may be led to believe they always have two people but, they are doing other things and the reality is one caregiver available. Some I checked out fed processed food for every meal so they could have only one caregiver onsite.

2nd - when a board and care has a very needy, high care patient, the other residents care tends to be less, the aides are tasked with everything . A NH has a nurse and doctor/NP visiting daily, so needs are addressed more timely, meds can be introduced same day. They have more support staff that can and does step in if needed.

3rd - if you can private pay for a couple of years, it really gives you better choices for NH. Be sure and specifically ask every facility, NH and board and care, if they allow hospice, not all do, and then you are trying to find a place at the worse possible time. Ask about Medicaid board and care homes, they do exist.

Mostly, go with your gut. If you walk in and smell body waste covered with chemical smells, well that is a red flag that people are not being taken care of. You don't get that smell when care is good. Is the place generally clean? Dust bunnies, stacks of stuff, rooms overflowing with residents hoard, nurses station a wreck? These all indicate whether business is being tended to.

My Granny was wheelchair bound and she was quite mobile shuffling around the NH. This would not have been possible in a board and care, they don't have big hallways and courtyards. Typically small living-room for residents to get out of their bedrooms. Some have patios for fresh air.

My grandmother was completely mobile, yet she was violently aggressive, so she was strapped in a wheelchair, this was 4 decades ago, she too would walk that wheelchair around the NH all day. It kept her and others safe, which was a priority because her mind was completely gone.

My dad was unable to take proper care of his needs, was completely mobile, not mentally gone, just starting so executive function minimal and physically ill with CHF, blind in one eye, wildly fluctuating BP and other old age, hard living issues. So a board and care that he could take his little dog to, his room had a door to the back yard, he could walk around the neighborhood, go out and live a relative normal life, it was within his budget, was the best solution. It was working fine until they got 2 very needy residents and everything turned to a s***show. The staff were kept busy dealing with patients that should have never been accepted. They needed a NH environment because they were to sick to do anything by or for themselves, completely bedbound (one after an injury described below*, he was paralyzed from the neck down) and both ended up dying, from issues I believe wouldn't have happened in a NH. *The poor man had his toe ripped almost off from being wheeled through a door, yes by a caregiver that didn't notice it and it wasn't properly cared for, covered in flies. I called APS about that and was never allowed to visit him again.

Do the leg work and research, visit multiple times if you are interested in the place, at different times. Find out about meal vouchers, so you can join your loved one for a meal, have a meal before making your decision . My dads board and care said you could but, didn't have the space, nor did it ever appear that the residents wouldn't have been shorted portions with another mouth to feed. Pay attention to the interaction of the staff with the residents, my granny got a hug and kiss every time a caregiver crossed her path, they spoke to her as an adult woman, not a child, which I saw doing my research.

I do not have direct experience with what you describe, but my mother is in a "continuous care" facility where she began in independent living, then moved to assisted living for about a month, and then to memory care, all in the same campus. Every time she moved, she did have difficulties getting adjusted, even though the moves were in the same facility. She felt anxious and insecure about whether she'd have to move again. I'm hoping that she'll be able to stay in memory care and won't have to move to skilled nursing. I'm inclined to agree with your attorney that fewer moves are better. Look for the best place you can get that will accept Medicaid.

I am sort of going through that decision right now.
my mom is 97, and I am getting ready to place her in a Memory Care facility.
I am deciding to place her in a facility that will give her the best quality of life, activity wise, for the next 3 years. Which I figure she will have enough $ to cover. That will take her to 100, in which point I’m figuring her dementia and health will have diminished somewhat and at that point will have to move her to a place where she will need more care and accept Medicaid. It’s a gamble I’m taking now, but I want her to have the more stimulating environment now when she’s aware if it.
Good luck with your decision. It’s a hard one.

I would not place him in a Nursing Home as they are all understaffed and not very good ratings.
I would say in a Nursing Home your Dad might survive 6 months probably less.
But even the place with 2 Caregivers to 6 people doesn't guarantee better bur at least he has a better chance.

It would also be great if they would let you install a camera in Dad's room so you can watch him anytime from your cell phone or computer and see what is going on.
He'll need someone feeding him like mt 97 yr old Dad and that's a good 30-45 minutes.

Since your dad had COVID, he is probably weak from fighting this disease. You might want to see if he can be placed into rehab to strengthen the muscles he can use. Rehab will continue to use all the necessary durable medical equipment and staffing to meet his needs.

I suggest an added consideration. If the skilled facility is good/adequate/safe AND accessible to your (or a paid care manage/part time private aide?) close supervision it might make a difference. It could be a way to make daily/weekly visits to “keep an eye on things”. In an end of life case, hospice services would be available to provide more care.

Here is something I want you to think about - I can't answer this. It sounds as if he is quite in need of assistance and his body is breaking down rapidly. Therefore, ask yourself this. Being it is as it is, do you want to see him live like this for longer time (almost helpless) and suffering or do you want to help him but let nature take its course perhaps in a lesser time but he would finally be at peace. There is your answer.
I personally will see to it that I won't live very long if I get to the point where I am so helpless. Right now I am disabled with many physical problems but I force myself to do the I'm possible against odds that are almost unsurmountable but I succeed - why? Because I am 100% with it (at nearly 88) and extremely determined NOT to give in. I have-not a soul in the world left so I do everything - but my mind is sharp as a razor. But if I go down, I will end it at once.

Courage, not all NH are understaffed. There are laws that require a certain ratio. What you want to look for is a facility that is going above and beyond the minimum required by law.

For profit facilities are to greedy and many of them are corporations, I would stay away from those. Look for private, religious based and non-profit ones.

Courage726: In all honesty, the private pay facility seems like the best option FOR YOUR FATHER since you would want the best level of care for him, lovingly.

I toured as many places as I could and am waiting for the small care manager to come evaluate my dad.
We finally saw a neurologist today and instead of waiting for his second appointment they went ahead and diagnosed him with dementia today.
She said I should focus on the best care he can get now and not think about down the road since he is in the advanced stages of dementia.

Is he going to live beyond another three years or is his decline such that this is unlikely. Depending on the medics view of that might help you decide. Personally I would go for the better care now and leave worrying about if you have to move him until it is much closer to happening. Good luck xx

Courage, thank you for the update.

I pray that it works well for your dad and he finds some contentment.

Remember to take care of you during this difficult time. It is a sad time for you and I recommend keeping a happy face for dad, it does make a difference for the resident.

I also recommend bringing some treats that he can share with everyone to help him meet his new mates. My dad was adored because I brought homemade desserts for everyone. Even if he can't understand, others will associate him with a good time and tasty goodies.

I would go with highest level of care now. The smaller residential home.