How do I know which decent facilities to put my mom in, in future considering she only has Medicare and Medical(California Medicaid)?

You need to find a place that takes Medicaid. With no money its going to be a Longterm care facility. You are going to need to check them out. The first thing I noticed about Moms was the big common area they had for visiting. The dining area and activity room were nice and big. The people were clean and no smells. Staff friendly and seemed to enjoy their jobs.

When you find the place, ask about getting Mom in with Medicaid paying. In my State u have 90days to spend down, get info needed to Medicaid and find a place for Mom. The home maybe able to help you get started with the application but do not totaling rely on them.

Its time for u and husband to get your lives back.

I can understand that you're facing a literal complex of options, choices and decisions.   It might help to do research first on the nature of the various care facilities, identify some, contact them with a checklist you've created and specifically ask which services they provide.

You've asked for a lot of help; that's reasonable.   But many of the people here are stretched to the limit caring for their own families.   I've always though it better to give instructions, and have the specific family do its own research.  

Medicare used to (and perhaps still does) list facilities by category, and ratings, so you can identify ones to avoid.   

I can't address the Case Manager issue; I have no experience in that area.   But what I did after some good and bad experiences with rehab was to create a checklist of issues, contact facilities highly rated by Medicare, and ask and ask questions.

I won't deny though that this kind of research isn't foolproof, or that it didn't take me awhile and a few different facilities before I learned the issues.  I interviewed one that was highly rated, was impressed with the facility and the person with whom I was interviewed, and with a resident who gave high recommendations.

Then I found out after placement that lies dominated the description of the facility.   The food was freeze dried and rehydrated, and inedible.   I forgot to ask about staffing ratios and learned the facility was understaffed.  The nursing staff lost Dad's chart, he didn't get his Coumadin, and by the time (2) days before I found another place, he was already in danger. 

Long story made short, interviews, on-site tours and representations aren't always true.   Next time I did even more questioning, and touring, and made a good choice.

BlueMoon, I've checked my files and don't have any of the questionnaires i created available; they're either filed away or in a older computerized file that's saved, somewhere.     I'll have to do some research to find the information you seek.  So, for right now, it's "off the top of my head".

1.   Research online to determine first the type of facility on which to focus.   It's not clear to me whether you're considering Assisted Living, or a facility with memory care.   Start by researching each of these, identifying the care that most corresponds to your mother's needs now, and anticipating those in the future.

2.   Either start with the Medicare site and go through the very long list of either or both facility categories in your area,  copying into a spreadsheet if you have Excel, or creating some other kind of reference document to which you can repeatedly refer.

3.   Each physical category of your mother's condition can be linked to the most appropriate facility, i.e., the dementia to memory care, but the other physical issues to AL.  

4.   Then start calling facilities near you.    These are just selections of what to ask, based on memory:

a.   How long in business; whether independently owned or franchised?  This makes a difference in how issues are resolved, decisions made, i.e., whether at the facility or corporate level.   There can be advantages and disadvantages to both.

b.   How many staff in nursing, CNAs, visiting doctors (and the type of practice), and other related occupations?

c.   How many admins, and if you can get the information, how long they've been on staff.    I found that facilities which go through Administrators every year or so aren't the most desirable ones.  

d.   Meals:   are they prepared on site, by a chef, or prepared elsewhere, frozen or kept warm and brought in?    Are there menus from which patients can choose?   Are meals served in a dining room or in the patients' rooms?  The former can offer social interaction, the latter more isolation and separation from others.   

e.   Activities: are there regular animal visits and musicians?  If so, how often? I've found these to be the most important.   What other activities are there?   Discussion groups (more for AL), religious activities (if that's important to your mother), seasonal and holiday activities?    How are the providers selected?  I.e., are they people who perform at ALs and rehabs regularly?  This makes a difference in the presentation and type of music.

I've found that music from the 30's, 40's and other years in those eras create more response from the residents.    They relate to them easier than  more contemporary music.    I also found (when I took my music and played the onsite pianos) that these old tunes can inspire people more; one man actually got up and did a solo waltz when I played one of my father's favorite waltzes.   But the  military hymns really appealed to the  men.   I recall a few even standing and/or saluting.  

f.   Medical treatment; get names of visiting doctors if you can, specialties, how long they've practiced at the facility, and how often they make rounds.    You can try to research them online, but lately the primary research engines have changed priorities and I haven't been able to access medical firms as easily.   Some junky appointment sites have replaced them, with only nominal information about the doctors.

Something we had to do was spend extra time in the rehab unit just so we could meet the doctors, after discovering that one shrink was billing for nonexistent visits.   (I reported him to Medicare, and after initial resistance, it eventually advised that he was being investigated.)

g.    General:   clothes usually need to be marked with a permanent marker if you want to take laundry home and do it yourself.    If they're not marked, they can disappear.  That happened to us.   But even if they are marked, they can be mixed up with someone else's laundry.

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h.   Pandemic protocols.    We're still not free of this scourge, so anticipate that it may continue for sometime or that another mutation may occur.

Find out how the facility handles lockdowns, if family will be able to visit in person, or only by phone.   Ask for details on visits, i.e., length, frequency, whether the facility checks vaccine cards and allows only vaccinated people, etc.   This could be critical given the vulnerability of those residing in either AL or memory care.

Ask what protocols exist if someone becomes infected. 


HOME CARE:

I have had home care, it wasn't a very positive experience except for one  highly qualified individual.  The other two were basically worthless.   

1.    I got lists from the local Alzheimer's Assn.   Area Agency on Aging also sent lists.   The AA list arrived by e-mail w/I 45 min or an hour or so (don't remember for sure).  the AAA took a whole week.    I stuck with AA from then on, it also has good lists of other health care related issues.   And it will ask for a donation, either shortly after, or at the end of the year.

2.   My home care checklist was 3 pages; this is the one that's not available right now.   So I'm just guessing about the categories.

3.   First inquire whether or not they'll participate based on the conditions your mother has.  I found an excellent one I was ready to hire.  They even sent a nurse to participate in a care conference.   But when it came to medical issues, they decided they wouldn't participate in any kind of dysphagia care, and they backed out.

The alternate and less desirable agency sent 3 people, 2 of whom claimed to have dysphagia food prep experience.   One did; the other one lied.   I DID not appreciate that! And she was lazy on top of having lied about her experience.

4.   Just as you've identified in your opening thread, list the issues of care your mother needs, and how often.    Distinguish between what you and your husband may or will do, and what you'd anticipate the hired staff to do.      Identify the best times for staff, i.e., getting Mom ready for the day, or during meals, or for bed, etc.

5.   Try to give estimates for visits, by hour, and by day, i.e. how many hours and for how many days.

6.    Be sure to address nonmedical issues, such as bathroom assistance.

7.    Ask similar corporate questions of a home care agency, i.e., how long in business, whether franchised or privately owned, etc. 

8.   Be sure to confirm they have liability insurance for their staff.  This is not something you should provide.

9.   Obviously, hourly rates, and minimum hourly visits.  

10.  Substitution policies if one caregiver becomes ill.   This could also include pandemic management, how they monitor their employees and what action is taken if someone becomes infected.  Ask about vaccination status as well.

10.   There are other issues, but that's all I can remember right now.

I hope this helps; I'm not sure if it meets your needs, but your questions are quite broad, and I don't have experience in some of them, specifically with Medicaid, so I won't address those aspects.

Another issue, raised by JoAnn: 

Onsite inspection:   A few of the most promising candidates failed the inspection test.     One had an unclean shower area; two others smelled.  One was undergoing some type of remodeling and the exterior doors allowed cold air in.

Tour at different times of the day, but definitely during mealtime and especially afterward.   That could be when aides are stretched thin and toileting assistance is delayed, significantly.

Sadly many aren't that good, but what choice do you really have if you want to maintain your health?; even the best higher rated ones can have a few bad apples.

Just place and pray

Good luck