patrick.net

Consider this:

So far gone they can no longer cook, set a table, hold a conversation, toilet properly, and delusions like thinking things on the TV are real and in the room. Prone to fits of anger where they may get so mad they could fall down and hurt themselves, or take a swing at someone. But very much not vegetative.

I know some dementia patients are calm and sweet, my relative is not one of those.

AL seems more oriented towards people earlier along the dementia curve, and nursing homes to much later.

I think the real problem here is that they really should be in nursing homes, but they don't want to spend the extra money on that.

That, or somebody needs to invent a new type of assisted living place specifically for dementia patients. I know that there are assisted living facilities that have sections set aside for that, and that's another potential solution. However, in the case of Emeritus, they aren't doing this right. If it's managed properly then that is probably the way to go.

Either that or send them to one of Obama's death panels.

zzyzzx says

Either that or send them to one of Obama's death panels.

The "death panels" of which you speak was a manufactured talking point created by the republican party. The actual point of law was that, under healthcare reform, patients would be allowed to go to their physician and speak with him/her about end-of-life care, advanced directives, DNR's, etc and it would be a paid visit.

Currently patients are able to have this discussion once - usually soon after they sign onto Medicare at age 65. A fairly healthy person who is speaking with a doctor at that age probably won't want a DNR and the decisions that they make regarding intubation, artificial nutrition & hydration, etc will be very different than those decisions they might make if they're 85 and terminally ill.

Due to the "death panel" bullshit accusations, the doctor is reimbursed only once for this discussion. So when a patient is old-old (late 80's) and sick, chances are that he'll be speaking with a hospice marketer or some other uninformed worker whose job it is to get him to sign the forms. In other words, by politicizing this benefit it had the opposite effect and the discussion that should be held with a physician is now held with someone who makes a commission getting the patient to agree to stop all treatment.

It might be the correct decision for the patient, but that's something that should be discussed with professionals rather than uneducated people shoving forms at the patient/family in an effort to get through the paperwork so they can get paid. Yay, Death Panels. Makes me proud to be "merican.

anonymous says

The nursing home I had experience with and similar ones I have seen over the years were not exactly what would come to mind for myself in terms of "skilled nursing". I think of a hospital as someplace with "skilled nursing".

A skilled nursing facility is a place that provides care that must be provided under the care of an MD by a registered nurse, physical therapist, occupational therapist or speech therapist. This could be wound care, specialty care such as new feeding tubes, sliding-scale diabetes (amount of insulin adjusted according to blood sugar reading), etc.

Many nursing homes offer skilled care and extended (or long-term) care. Medicare pays the first 100 days (as long as the patient qualifies under Medicare rules), and then remains with a different type of payment such as Medicaid, private pay, VA, long term care insurance, etc. The layperson won't know the difference between skilled care and custodial care (help with activities of daily living).

Patients with dementia aren't always sweet & kind, they're normal people with brain problems. There are many options:

SNF (skilled nursing facility) with extended care - this is the best option if a patient won't be able to pay out of pocket for long because the facility will charge private-pay until the patient runs out of money, then apply for Mediicaid on the patient's behalf. Most Medicaid programs don't pay for Assisted Living Facilities - or pay so little that the AL's don't want to work with them.

ALF (assisted living facilities) - provide help with activities of daily living. The often have a basic fee and charge ala carte for additional care. They often have wings for patients with dementia - these facilities can be quite expensive but are cheaper than nursing homes (snf). they generally don't take Medicaid.

Group homes - charge substantially less than the previous options - have caregivers 24 hours per day on premise but they sleep at night and are barely trained. There are some state programs that help to fund group homes.

anonymous says

Medical conditions ran from serious (bedridden) to diabetes, heart, paralysis and anything else you can think of in this place.

bedridden, heart problems, paralysis - none of these are skilled needs. the care can be provided by an lpn or nursing aides. Diabetes & injections can be administered in the same way under certain conditions. All of these are "custodial" needs.

anonymous says

There is a basic Medicare web tool on Ellie Mae's thread "Caring for the old: it could be worse" to help sort out the choices which is a start.

The medicare site he linked to only tells you the nursing home's survey results - often after they've appealed really bad findings. A more comprehensive source would be my book, which I wrote because of situations such as this. Another option is to hire a "geriatric care manager" to assist with decision-making and help you find a place. I would still recommend that you educate yourself about the process in order to make an informed decision.

It boils down to payment source and whether the chosen facility can provide the care the patient requires. Go to any facility and ask for a tour, they can show you around. anonymous says

You mentioned falls. That is what finally did both my father and step-mother in at the end. Each one of them tried to go somewhere in the middle of the night unassisted, took a severe fall and each died within 3-4 days of the fall. Both were in varying stages of consciousness during the last few days.

falls can happen anywhere. It's illegal to restrain a patient to keep him from falling; staff members are able to monitor patients and help them if they get up to try to keep them safe. However, if the patient is dead set on getting up it's gonna happen.

Vicente says

AL seems more oriented towards people earlier along the dementia curve, and nursing homes to much later.

Many ALF's are able to take patients in the beginning stages and keep them there until they die. It depends upon the patient's ability to pay.

zzyzzx says

That, or somebody needs to invent a new type of assisted living place specifically for dementia patients

There are many.