SummerHope Asked June 13, 2024
Memory care vs. skilled care for mild cognitive disorder?
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Does anyone have advice or experience with memory care for mild cognitive disorder? Some long-term facilities near where my mother lives tend to have only assisted living and memory care and not skilled care. Is memory care a new trend and what are people's experience with memory care for people with mild to moderate cognitive disorder?
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In my brother's ALF in So Cal, just at the end of his life, they were making a whole difference in the cottage model it was built around. Originally it had cottages for MC and cottages for ALF. Then they got some that were "inbetween" in that there was some tendency to wander so the resident couldn't be in ALF, but there was still an ability to manage a whole lot themselves, and to have their own room. Staffing went according to the needs.
More and more this in now happening. More and more aging seniors in need of care, and different types of care.
Explore. They will give you tours, sometimes even serve you lunch. You get a real feel. You can ask questions, ask for admission packets, read the details.
There are levels of "facility" living
Independent Living...for residents that need no help. The residents are free to come and go as they wish, most do require signing out when they leave and in when they return.
Assisted Living...for residents that need some help with ADL's. Residents are free to come and go as they wish, facilities will require signing out and in as well.
Because residents are free to come and go if a person with dementia (or MCI) is at risk of wandering off this is not advisable.
Memory Care...for residents with cognitive issues, those that may wander off.
Skilled Nursing...previously "nursing home" this is for resident that have chronic medical conditions that require skilled nursing. This would also be for anyone that has "tubes" or an "ostomy" of any kind. Some facilities will only allow oxygen in Skilled Nursing and not in IL, AL of MC.
Rehab is often included in Skilled Nursing.
All levels of facility living will have activities that residents can be involved in. Most will have outings of some sort
The "fancier" the building does not necessarily have anything to do with the quality of the staffing and care.
Mild Cognitive Impairment patients are generally in Assisted Living. They can function fairly well, except maybe 1 or 2 ADLs they need help with, like taking medicine correctly, paying bills, or they just need reminders. They base it on ADLS, which include being ambulatory (can get up and walk), can eat, bathe, and toilet themselves without help or problems. Assisted Living is for fairly independent patients, but may need "assistance" sometimes, like help with showering a few times a week, or medication reminders.
If a Mild Cognitive or Dementia patient has a history of wandering, escaping, or combative behavior, they always go into Memory Care. MC has tighter controls and restrictions for safety reasons. Patients can't come and go without strict supervision. MC has more scheduled activities to keep the patients busy and they watch them closer.
Skilled Nursing (SNF) is for seriously ill patients, that are fairly helpless, may need daily injections, IV medication, catheters or have incontinence problems, or are bedridden. They need nurses help daily. Patients with late stage cancers, need (or have had) major surgeries, or need Hospice are in a SNF.
Unless the person has been diagnosed by at least 2 doctors for dementia type diseases (including Alzheimers, Parkinsons, Vascular or Lewy Body Dementia) they are called Mild Cognitive Impaired. They can get worse over time, or not.
Best to start out in Assisted Living and see how it goes.
California doesn't like to "lockdown" or overly restrict Mild Cognitive patients, because it tends to be basically overkill and kind of unfair. Facilities charge more for Memory Care, so this is to keep MCI patients from getting unfairly placed in Memory Care and the much higher costs.
THIS IS IN CALIFORNIA, not the entire country.
Memory care is a locked down facility for more advanced dementia.
Skilled Nursing memory care can accommodate those with more health issues, incontinence issues, late stage dementia, etc.
Assisted living is much less labor intensive, since residents live independently in their own apartments. And they can charge a lot of money for these luxury apartments.
Memory care has become more available, as more and more memory deficit patients have been identified, and should have specially trained staff, as well as a more secured environment - so patients can't wander off and get lost.
But some memory care facilities are not able to provide the same hands-on level of care that is found in a skilled nursing facility.
Skilled nursing deals with the physical more than the mental; assisting residents with toileting and changing diapers or tubes. Many of their residents are in wheelchairs, and require significant help with mobility, getting in and out of bed, help with feeding, and some sort of specialized medical care which requires a nurse to oversee.
I would recommend a memory care for your mother with mild cognitive disorder. They specialize in just such conditions.
I found I needed to pay extra to have a caregiver go 3 times a day to make sure he ate. After he was there a week on their medications he could no longer use his arms to feed himself. They try and give one bite and move on.
I moved him home this March 2024 and have caregivers which is not much more than the facility with ALOT more one on one care. I do believe he would have been dead by now if I had not hired the extra eyes while he was in Memory Care.
During her hospital stay, a move to a SNF was recommended since she became bed-bound from her illness, barely ate and wanted to sleep most of the time. She also had brain swelling (UTI related) causing severe cognitive decline which was diagnosed as end-stage dementia.
At the SNF, Medicare approved one week of PT, OT and/or speech therapy which we appealed each week and received a total of only 3 weeks. In the hour of allotted therapy time each day, Mom was able to regain ability to stand with walker assist and take a few steps. However, nursing staff at the SNF treated her as bed-bound the remaining 23 hours of the day. The SNF was more like a hospital environment with nursing care and no help with ADLs.
We knew family could no longer care for her at home, options were explored including the possibility of calling in hospice as Mom’s desire to get better was very low.
The decision was made to move to a Memory Care facility with more of a home-like environment, that offered the physical assistance Mom needed - help with getting in and out of the bed each day, with dressing, toileting and transferring to a wheelchair, down to the dining room for meals, medication management, engagement activities, etc., all for one monthly price.
Home Health provided further therapy (3 months) and the HH nurse visited weekly. Mom has steadily regained much of her cognition, some of her strength, and now calls her little room with her furnishings “home”.
We strongly feel that had we left her at the SNF, she would no longer be with us as her will to live was very low at the time. Is the MC facility all we had hoped for? Far from it (staffing problems, promises made and not delivered, medication administration issues and other things), but her basic needs are met and she is content for the most part. Of course she misses family but so far, one of us has visited every day.
One of many things that we have learned in our journey is that the residents of Assisted Living facilities must be able to self-evacuate, while those in Memory Care or Skilled Nursing will have assistance. We also have a cam in her room to check on her, which for some can be frustrating, yet to others gives peace of mind that Mom is okay and cared for.
Caring for aging parents is emotionally challenging, for sure, and finding the right care, be it in-home or facility care, I wish you the best.