My sister will be 61 in March, but to look at her, you would think she is 80 and in poor health. She is currently in an ALF; she moved there 10 months ago with my mother, and my mother passed away shortly after.My sister is on SSDI, and has several significant health problems, some of them neurological. She has deformed feet and cannot walk well; she uses a motorized wheelchair, paid for by Medicaid, to navigate the ALF. She has severe facial pain that is managed with meds, and is a constant fall risk because of weakness in her legs and dizziness. She is on seizure medication, which the doctor hopes will help with her instability. She shakes very badly, both her hands and the rest of her body. Sometimes to, that has been diagnosed as essential tremor, but not Parkinson’s at this time. I do expect an eventual Parkinson’s diagnosis. She is also morbidly obese, and has never been a very competent person. Without someone literally yelling at her, she does not take care of herself or her surroundings. Her AL apartment is a total dumpster fire. Since my mom passed away, she does nothing. This is not dementia, it is a different kind of competency issue.So that’s the background. My question is this: at what point should I consider a nursing home for her rather than AL? I chose this facility because after two years of self-pay, the facility will transition a resident to Medicaid. It was my hope my sister could stay there for the rest of her life. She has not even completed the first year, and I am seeing that soon she might not be competent enough or healthy enough to stay in this facility.I have been reading articles here, and it seems that when you are no longer able to perform your ADLs, it is time to start thinking about a transition to a nursing home. I think she is reaching that point. In the past, she was able to navigate her apartment without help, but it is looking increasingly like she will even need help making it to the bathroom. As I read, it looks like the ability to get yourself to the toilet is sort of the dividing line. Because of inheritance money, my sister would have been able to be a self-pay just barely to the two-year mark in this facility. So we were cutting it close. I think some people have said on this forum that the ability to be a self-pay even for a few months might get you placement in a better Medicaid facility. I am wondering if it is better to get her into a Medicaid NH as soon as possible, as she could be a self-pay at least for a while. I’m sure most here won’t understand this, but I think my sister would rather be in a nursing home where everything is completely taken care of for her, than try to continue living on her own. Especially if she could blame her situation on poor health, and not incompetence. She knows she should be able to keep up with these basic things, but for whatever reason she’s not able. This has been a lifelong problem. She is not even going down for meals. She orders junk food from Amazon, and lays in bed and watches TV. Again, her apartment is a mess that’s hard to even describe. Who makes the call as to whether a nursing home is required? Do I need to contact a social worker in her state? I am 10 hours away. I have an elder care attorney.
At that point they will suggest the appropriate level of care needed. I.e., Memory Care, Skilled Nursing.
If you think it is more than the staff can manage now you can request a meeting with the facility nurse of administration and discuss options.
(If you have seen or heard anything that makes you feel that your LO is not being cared for safely say something ASAP.)
I am, in all truth, surprised she can currently be in ALF.
They will tell you what their capacity is to care for her. In my brother's facility she would not have been kept due to her needs taking so much caregiver time.
I would also ask you attorney for options for Sister, as I agree with you that the time is coming before two years.
How is it that her apartment is a disaster? I'm surprised that the housekeeping staff hasn't informed the director about the state of her apartment. Or maybe they have?
Talk to the ALF director and get a transition plan going to a nursing home. Your sister is only going to get worse and her needs are only going to increase the longer she is enabled to do nothing.
After my mom with dementia passed away, and my sister had been caring for her to the extent she was able, I think we were all hopeful that my sister would stabilize emotionally and begin to get herself on track. Especially as she is now living in a place where all of the IADLs were taken care of for her, and also meals and housekeeping. That just hasn’t happened. I think I have officially given up hope. It’s time to make some very hard decisions.
Nursing home is for people who can not take their medications without the assistance of a nurse. They do need a nurse for their care.
If in doubt, talk to her doctor about your concerns. He/She can help you with the determination of "when".
Each should check what AL offers in their area.
As my mom's dementia as well as her physical health both deteriorate, I wonder which type of care her AL is going to eventually suggest to me - MC or SNF?? I'm taking bets. JK!
I wish you luck with your mother! I will be interested also to see what direction the Medicaid placement specialist goes with my sister. Memory care does not seem appropriate to me, it is bad health and low competency. But I am not sure what is required for acceptance into a Medicaid paid nursing home. I am so happy to finally have some financial resources to work with as I address this problem. A difficult one for sure!
No communication might yield no action. But the nursing staff are the best ones to assess her needs and recommend ongoing treatment options. A meeting will give you an opportunity to voice your concerns, and have an open discussion with health care professionals. This should result in a care plan which you all agree to.