<p>My mom has lived in assisted living for the past six years. She is confined to a wheelchair due to poorly healed fractures and obesity.</p>
<p>Last year, she developed cellulitis in her leg bad enough to send her to the hospital. There was a new administrator at the facility who sent her to a hospital clear across town in Houston, but they had a geriatric unit that she wanted to “try out”.</p>
<p>After a few days in the hospital, mom was released to a skilled nursing facility, which was next door to this distant hospital, and did not offer laundry services. My brother lives locally, but he was unable to pick up mom’s clothes and launder them. My sister in law, of course, was no help. I had to fly to Houston twice in one month to take care of mom’s needs.</p>
<p>Yesterday, mom was admitted to a closer hospital and will likely stay there two more days. I have suggested to my brother that if she is transferred to a skilled nursing facility, she should go to the closer facility, which I did visit, and which does offer laundry services.</p>
<p>My dilemma is, should she go back to the assisted living facility, or should we move her to a skilled nursing facility permanently? </p>
<p>We will be private paying for all of this. She gets Social Security and has a medicare supplement, but does not have skilled nursing care coverage. I applied for it after her hospitalization earlier this year and was denied due to her medical condition. I’ve applied for VA benefits, which she may receive. The ball is rolling on that one. </p>
<p>Would appreciate any advice, anectodal information on what others with aging parents have done in this case.</p>
<p>I feel for you. My husband and I have gone through this for his father and now his mother. After seeing how much my FIL declined in the skilled nursing facility, we decided to keep my MIL in assisted living as long as we could.</p>
<p>I looked a lot of different facilities for mom, including but not limited to: Assisted Living/Skilled Nurse and concluded it would be the best for home care. We hired two caregivers and take care of mom 24/7. The cost is not going to be more than the skilled nurse facility, but the quality of care is unsurpassable. In any of these public facilities, you will get about 5:1 or some times 7:1 ratio. Home care is 1:1.</p>
<p>I think her assisted living facility had greatly cut back on staff, so there was a very poor patient/caregiver ratio. We have kept mom in assisted living as long as possible, but feel she is probably ready for a higher level of care now. Unfortunately, she no longer has a home that we could move her into and hire care. We had to sell it to pay for her assisted living. Because of her size and immobility issues, none of us can keep her in our home. I’m wondering if perhaps a senior apartment with round the clock caregiver might be best. She needs someone to bathe her and give her her medicine. She has mental issues and cannot live by herself.</p>
<p>Sorry you are going through this. There are different quality nursing homes and this is a big question in any such move. Some are really awful, and others not bad. The problem with a senior apartment with a caregiver is that no one is 100% reliable. They get sick, family emergency, vacation etc. Also there is the question of adequate social interaction (if she still is up to this). If her assisted living is ok, and they can manage her needs except for acute illnesses, why would you look for a nursing home? </p>
<p>Hopefully they treat her acute condition, and she stabilizes soon.</p>
<p>Assisted living is wonderful until you need more assistance than they are licensed or equipped to provide. Looking back over my mother’s decline of six years (she died in March), she should have been in skilled nursing sooner. If she’d had round-the-clock nursing care, someone would have noticed the signs of an infection immediately, she would not have been hospitalized so often, and she might even have avoided some falls. (Note: Her nursing home was excellent. We couldn’t have asked for anything better.) My personal bias is that for most people, skilled nursing facilities offer much-needed socialization and consistency of care–even for a person with advancing dementia, like my mother. And if your mom has mental health issues, you want a staff who’s skilled at dealing with these issues and a psychiatrist (or his/her physician’s assistant) who makes regular visits to the nursing home. You also want a facility that does not overmedicate at the drop of a hat.</p>
<p>Nothing about this is easy, and my heart goes out to you. I think I aged more than six years.</p>
<p>Sorry to hear about your mother. Do you have information about what functional level your mom is at for ADL’s, and how much assistance needed for each? (Bathing, dressing, toileting, grooming) How much supervision at night? This will assist in deciding what level of care she needs, and if the ALF can still meet her needs. Some ALF’s won’t take back residents if they have declined to a certain functional level, or they may charge more for increased services. Was she happy there? Have you spoken to a social worker at the hospital or SNF? Also, does your mother have a caseworker for Senior and Disabled Services (or whatever your state calls it?) They can be of assistance in both the placement and financial issues. About financial, what about Medicaid if she has spent down all her money? </p>
<p>I have worked on and off in SNF’s as a therapist and seen all sorts of discharge plans, it is difficult to know which is the best situation for your mother. So much of it depends on the personal situation, and also the facility itself. Just in my town there are some excellent skilled nursing facilities that seem to attract caring staff and some I wouldn’t even let my dog stay at. Don’t always go by the fanciness of newness of the place. Same with ALF’s and 1:1 nurses. Just because someone has 1:1 care doesn’t mean it is good care, and there is no one there to see what happens. The best thing to do is to go out and do some research and visits, and talk with the social services person at the hospital or SNF. There must be many facilities in the Houston area, or she could move to one closer to you, since you appear to be the more involved child. I do think it is strange that the SNF did not provide laundry services; I have never heard of that.</p>
<p>OP, I don’t understand why you aren’t applying o Medicaid for your mom. MANY SNFs in my area accept Midicaid, and the Soc Service director helps people with the paperwork.</p>
<p>I prefer ALFs or SNFs to someone with dementia living alone with private aides. I’ve seen too many cases of financial abuse. Also, if your mom is obese, she will need several people to shower her. One of my criteria is to look at the Administrator’s track record and the D.O.N.'s. At one SNF I worked at, the Admin. had won many awards. She ran a tight ship but there was little staff turnover.</p>
<p>Update: Mom is being moved from the hospital to a long term acute care facility. She is not well enough to go to skilled nursing and not sick enough to be in the hospital. Now a new level I have not encountered and need educating on.</p>
<p>My brother is being wonderful in helping this time around. While I dealt with paperwork over the phone, he will tour the facility before we give the okay for her to go there, although we don’t have much of a choice.</p>
<p>While she’s there, we’ll explore skilled nursing facilities and perhaps a different assisted living facility for her to transition back to. Hoping to find a place with both skilled nursing and assisted living wings that has Medicaid beds, as we will be trying to qualify her for Medicaid at this point.</p>
<p>She’s in the Houston area, so if anyone wants to pm any recommendations, I’m happy to hear them!</p>
<p>Just a note to say that in our experience, once my mother-in-law was placed in the skilled nursing level, there was no way she could be admitted back into assisted living. There was a more rigorous threshold in assessing her life skills at that point.</p>
<p>^^^I am hopeful that doctors will not release her back to assisted living. I am going next week to check out skilled nursing facilities, perhaps those that also have assisted living, as I don’t want to assume she will not go back there. Thank you for all your advice. I really appreciate it.</p>
<p>That all depends who is in charge and if the person is trained and experienced. If some thing happened to your loved one, in an ALF or SNF, with 7:1 ratio, there bound to be less attention given to the patient. Mom has been in and out of Hospital several times in the last few years, even at that level, I have observed the call light is ignored for 10 to 15 minutes at a time. I can just imaging what an ALF or SNF will do to a patient. Mom was also in a Hospital Rehab center, the Nurses there will leave un-cooporative/unreasonable patients in a wheelchair in the hallways and let them yell and scream.</p>
<p>We hire qualified, experienced live in caregivers on an 1:1 basis we think it is the best for mom.</p>
<p>So true. Mom was left in her wheelchair for hours, as she is unable to get from the wheelchair back into bed now. She is able to get from the bed to the wheelchair, which she does to go to the bathroom, but then she’s left for hours for someone to get her back into bed. Because of this, I really think she needs skilled nursing. But because she is able to get herself into the wheelchair, or will be in a matter of weeks, I’m sure, I’m afraid she’ll be cleared for assisted living again. Of course, I know, with skilled nursing, there’s no guarantee someone will be there to put her back into bed, no matter what the patient to staff ratio is. My mother took care of her parents in her own home after we got married or went away to college. I know she would like for us to do the same, but she weighs almost 350 pounds, and even if I did have a wheelchair accessible house, I would not be able to bathe her or move her back into bed by myself. Often, on hospital discharges, she would be prescribed home health and PT, but those have always been short term.</p>
<p>There are lifting devices your doctor can prescribe you may want to consider. And there are non-rinsable/rinse free shampoos/body washes you can use without get you mom into a tub/shower.</p>