<p>I know this could go in the “parents caring for parents” thread but it’s a specific question about a specific sub-issue in that realm and I’m interested in the general response to it. My FIL is in a descending spiral of senility, has gone from independently living at home after my MIL’s passing to in-house caregivers to assisted living to the next step becoming imminent. As a result we’re looking at the options which include board and care in a private home, which in California is limited by some regulation to six residents per home, and larger “memory care” facilities.</p>
<p>He doesn’t have Alzheimers but he is senile: can’t remember anything, can maintain a fairly lucid train of linear thought some times, but other times is almost incoherent. It gets worse over time; not consistently but by fits and starts. Lots of people here have been “there” and it’s an irresistible process with only one ending.</p>
<p>So my question is, do folks here think that the elder in question will be happier in a converted suburban house overseen by three live-in caregivers (in this area, almost exclusively Phillipino with one or two fluent in English and a couple less so) or in a larger, more “clinical” setting? I’ve toured both and I understand that my FIL isn’t going to “recover”; he’ll die within a few more years and he’ll be confused most of the time until then. Money isn’t really an issue; the cost differential isn’t great and there’s enough to cover it for any reasonable lifespan he might expect. This is just a query about what might provide the best quality of life for a man whose quality of life isn’t going to be stellar in any event.</p>
<p>In the places I’ve toured I’ve seen people who seem nice and caring in both settings. My FIL is an old-school Midwesterner; knee-jerk racist except for people he knows personally, sometimes irascible, sometimes charming. I get that a lot will depend on the individual personalities of those he will encounter wherever he goes, but the “small vs. large” question (which mirrors some of the happier debates here on CC) is one I’m struggling with.</p>
<p>Where he would be happiest is a difficult choice, but where he might be best taken care of might be easier to determine. Then, where he is best taken care of might lead to being happier. In the smaller setting I would be concerned about them being able to take care of all of his needs as they change. I know with my mother (not senile, but with physical impairments) what she needs seems to change frequently, so a place that offered the highest level of care was important to us. Is the smaller place as secure as the larger one, so that he can’t go wandering off, or use things in the kitchen that wouldn’t be safe for him?<br>
You mention that some of the people who would be caring for him don’t speak fluent english. Would this be an issue when he is confused and needs redirecting? Having fewer caregivers can be nice because they can really get to know him, but can be a negative if they don’t get along well, or leave…how long will it take t find a replacement? Will they be shorthanded?
The larger place can tend to feel less personal, but with my mom, we have found that she usually has the same caretakers most of the time. The memory car section is probably a small part of the larger building, so may have much of the feel of the smaller place. I guess I just like the oversight and structure of the larger place. I like having a supervisor to go to is something isn’t going quite right…of course all of that depends on the place and the people they hire.</p>
<p>He already has what sounds like moderate dementia, and it’s only going to get worse. I’d be concerned that as his dementia worsens, the board and care place will no longer be able to care for him, and he’d have to move. And for a person who has dementia, moves are going to be confusing and disorienting, so it’s better to minimize them. So I’d suggest the larger facility would be better for him as his dementia progresses.</p>
<p>A larger facility will have more services and if it is a true “memory care unit” they will have plenty of activities to keep the residents active and occupied.</p>
<p>We actually do a combination of the two things you describe. My mother who has moderate alzheimers lives in a studio in a memory care unit where she has round the clock supervision. However, we also have retained a private aid who takes her out 3 days per week. They go to lunch, shopping, the park or to a movie. We feel it gives her some semblance of a normal life, and she does not feel confined to the facility. In fact, she is not even aware that she can’t leave on her own. The aid is also an extra set of eyes to insure she is being well cared for.</p>
<p>Sorry to hear of the downward trend, but glad to hear that there are viable options for your FIL. I have cared for several elders with cognitive issues and here is my opinion, recognizing that your mileage may vary. I have a father in a skilled nursing level memory care unit. He is not disoriented, recognizes people and can carry on a conversation that makes sense, has humor, and is socially appropriate. He does, however, have almost zero short term memory now (at 89) and quite good physical health. He moved to the higher level of care from assisted living when it was clear he could not connect the dots to be social and active as independently as AL required and also started to benefit from more prompting on personal care issues. </p>
<p>For the profile and phase of illness you describe, I would lean to the more clinical setting where medical issues can be thoroughly tended with nurses/docs on the premises, as this will be one transition and one-stop shopping for care. I was almost waiting for the other shoe to drop with my father in AL, whereas now I have complete peace of mind knowing that he will never have to move. There are multiple institutional checks and balances; it is a high quality place. We can both bypass the formerly tiresome trips to the podiatrist or dentist. We have a very positive relationship with the staff and his unit has about 25 people and the care is personal, with a homey atmosphere. There are activities available all day every day (music, bingo, group crossword puzzles, etc.), with residents able to attend the ones that best match their capacities (wide range here). He is happy there and appreciative of his quality of life.</p>
<p>Two weeks ago we placed my 88 year old mother in a 10 person memory care unit that is part of a larger continuing care facility in California. The move was extremely hard on her, and she has had delusions and is frequently incoherent now. The facility has a 24 hour medical clinic and they were able to quickly contact her doctor and provide her with medication that calms her down. She wears a bracelet that sounds an alarm if she ventures out of the memory section. They do provide quality activities during the day, but the nurses and aids are busy and there is a fair amount of down time when she is alone in her room. We had thought she would enjoy being part of a larger community, but she deteriorated so quickly that she will probably never benefit from the many amenities available to residents. It’s possible that a very good quality board and care home with the right group of people would have been less traumatic for her. As it is, she thinks she is in a hospital and wonders when she can go home.</p>
<p>The situation reminds me of when we were looking for child care for our toddler daughter. A very high quality home care setting would have been ideal, but sadly the vast majority of private home daycare providers left us feeling uneasy. We opted for “Kindercare”, with their institutional guidelines, protocols and oversight.</p>
<p>Kluge, I am sorry to read about your fil situation. I dont have the answers and I know your question is going to be personal for me in the near future. My dad’s social worker says my dad has one move left that he can handle.</p>
<p>I think my situation is most similar to what momsquad described. My FIL has been in a large scale assisted living facility of the past 8 months and he frequently calls to ask about what “this hotel” is that he’s in and how he got there - sometimes he thinks he’s in a VA hospital or back at the plant he worked at 25 years ago. It’s clear that he doesn’t perceive his surroundings as a “home” environment and that’s stressful for him. He’s never taken advantage of the numerous activities available. That’s why I’m thinking that a smaller scale - less than 10 people, residents and caregivers combined - might be a happier place for him. Fewer people to recognize and deal with on a daily basis, more of a “home” style atmosphere.</p>
<p>The facility he’s currently in has a separate memory care unit with locked doors so the residents can’t wander off but the highest level of medical staff they have on site is an LVN. The board and care homes we’ve visited all have residents with dementia and they seem to have experience coping with them. (All have alarms on the exterior doors in case of folks wandering off, but an 87 year old with a walker can’t exactly dash away in any case.) One is run by an RN (no openings there, though.)</p>
<p>I suspect he’ll end up in a corporate-style memory care unit. It’s more pleasing to the family (well decorated and lit, staff in uniforms, etc.) and consensus is easier to reach for that decision. </p>
<p>Can’t complain about being the “sandwich” generation, though. We had a solid 6 weeks between our youngest graduating from college and my FIL wandering off and having to be moved into the assisted living place. :)</p>
<p>Have you read about the assisted care places with bus stops? It turns out, people with dementia are less likely to wander off if you provide a fake bus stop. You tell the person to wait for the bus, and they wait for a while but of course no bus comes, and eventually the person wanders back their room. For women, providing baby dolls to take care of also is a huge success.</p>
<p>Essentially, the idea is to keep the person with dementia happy. They’re not going to get better, or be brought ‘back to reality’ or anything like that, so telling them that the way they see the world is wrong only causes distress, and what are essentially white lies can keep them much happier. I’ve never been on a course, but when my own grandfather was ill with dementia-like symptoms we found that using some of the techniques was very helpful for producing a happier, more ‘pliable’ person who was never medicated for his memory problems. It’s a controversial idea in some quarters, but everyone who I’ve discussed it with who has used it themselves (including some former nurses) has thought that the technique has merit.</p>
<p>In another thread, LasMa wrote about how her father, who has dementia, was agitated, thinking that he was trying to deal with a business problem and not getting satisfaction. When LasMa assented, and assured him that she would take care of the issue, he calmed down. What you say is right, boomting. The person with dementia is not going to get better. There is no point in trying to persuade them that their perceptions are wrong; rather, you should go into their reality.</p>
<p>dstark, he’s actually out in the valley now although we’re considering bringing him down to the east bay in the 680 corridor. Memory care seems to run $4K - $6K depending on whether it’s a share or single room, with extra for additional services. Board and care seems to go $3.5K to $6K for single rooms.</p>
<p>boomting, that’s pretty much what we’ve been doing. It leads to some funny conversations. Once he was convinced that he’d been travelling around the state, staying in hotels, but the funny thing was, the rooms he stayed in were all furnished and arranged exactly like this one he was in right now. My wife told him with a straight face that I had made special arrangements to have all of his hotel rooms prepared for him that way before he arrived. Recently he’s been agitated about a drone project at the company he retired from 25 years ago (a food company) and how he might be “implicated.” I assured him that since that project was handled in a different department I was sure he was in the clear, but I’d keep an eye on it. I think sometimes he incorporates things he sees on TV into his memories and it all comes out in a sort of mashup.</p>
<p>The Vet retirement home in Yountville is supposed to be amazing. The costs are tied to a percentage of income so a person shouldnt run out of money.</p>
<p>However, I believe there is a waiting list for people with dementia of a couple of years. And of course you have to be a vet to join. </p>
<p>So, this probably doesnt work for your fil, but maybe other posters might find this of interest.</p>
<p>Through this link I found several board and care homes near me. Not sure why they specify “a place for mom”, except that most in assisted living are women:</p>
<p>We kept my mom near her home of 25 years, thinking her friends would continue to visit her. It only took one or two visits where she mistook an old friend for the nurse assistant before they stopped coming. My brother visited yesterday and she told him her mother was coming to get her from the hotel. When he told her that her mother had been dead for 50 years it was as though she grieved all over again for her. Very interesting concept of conforming to their reality, we’re going to have to work on that.</p>
<p>My mom went “downhill” mentally very, very quickly. She had other issues that seemed to exacerbate her short-term memory loss. She would call me and complain that I never call her when, in fact, we’d just hung up an hour prior. I wish now that I would have just apologized. Instead I would say “But we just spoke an hour ago - remember, I told you about S1 doing X?”…clearly she didn’t remember and now I wish I’d just let it go :-(.</p>
<p>I know it’s frustrating, but treasure the moments you DO have!</p>
<p>@Cardinal Fang - very much common sense stuff about feeding them bacon and chocolate. I don’t think long term physical health concerns (that will likely never have an impact) should be eclipsing shorter term care concerns. </p>
<p>At points where my grandfather was better, he reverted to type and liked to have a bottle of beer, as he always had every night. He shouldn’t really have been drinking given the medication he was on, but to be honest it wasn’t a battle worth fighting. He had his little pleasures, and what eventually finished him off had naff all to do with either his diet or his memory. No regrets!</p>