Assisted Living Facilities (ALF) vs. Memory Care vs. Skilled Nursing Facilities (SNF)? When you're unable to care for yourself any longer, these are the main options offered to you. There are others, Board and Cares and In Home Care but these aren't really options for us for a multitude of reasons I wont bore you with.
Assisted Living Facilities are pretty much hotels with massive room service options. You can have help with medications, bathing, dressing, cleaning and an escort to take you places within the buildings. Most offer three meals a day in their dining rooms along with snacks and drinks that are available all day. Some even deliver meals to your room for an additional fee. To live in one of these places, you must not be a wander risk and should you have a diagnosis of Alzheimer's or Dementia (Alzheimer's is a form of Dementia but there are multiple forms of Dementia) it needs to be the secondary diagnosis, NOT the primary diagnosis. This is VERY important. Even with it as a secondary diagnosis, some facilities will not accept you into the Assisted Living programs. Others will allow it but you have to pay an additional fee to have someone check in on you twice a day. A select few will allow you to try living in their facility and re-evaluate you after a period of time. This is what Mom is currently doing. Medicare and Medi-Cal will not pay for this option although there is a trial going on in a few counties (Alameda and Sacramento as well as a few in Southern California) where Medi-Cal will pay for you to live in certain ALFs IF you are not a wandering risk. Long Term Care Insurance can help with the cost of these facilities, should you have it. Mom does not.
Memory Care is where most facilities want you if you have a diagnosis of Alzheimer's. They have locked doors and the care is more intense. Some options are included (meds, dressing, escorting you to meals and activities) but most are still an additional fee (bathing, toileting, etc.) Memory Care is dramatically more expensive than Assisted Living and can be a wonderful option for most people. For others, like Mom, it can be viewed as a prison. More on that later. Medicare and Medi-cal will not pay for this option. Again, Long Term Care Insurance can help, should you have it.
Skilled Nursing Facilities are for people who need more help medically whether its IVs, feeding tubes, infections, etc. Rooms are usually shared and are much more hospital like than the other facilities. Some SNFs will take Alzheimer's patients if they need medical attention and are not at risk for wandering or being aggressive. Medi-Cal WILL pay for this option if it's medically necessary.
Now here's where all of this affects us. Mom is only 66. She currently has a diagnosis of Mild to Moderate Alzheimer's though her incredible diagnosing NP wrote mild and wrote it as a secondary diagnosis so she could be in an ALF. While mom has trouble with some of the day to day things (medications, remembering to wash her clothes, thinking things are broken when she really just forgets how to do them and repetitive behaviors, (going through her clothes all day every day moving them from one bag to another) she is not aggressive, she is not angry, she is not at risk for wandering right now and she has a great sense of humor. The lines of whether you have mild or moderate or even severe Alzheimer's can blur. There is no 'You are definitely HERE.' at this point in her (or anyone's) diagnosis. One of her main issues is anxiety and her anxiety comes out as tears at this point. This is much improved with medication as it was a lot more difficult a few years ago whether it was just her stage in Alzheimer's or just time. She knows she's different. She knows she's at least 20 years younger than everyone in there. She sees people in wheel chairs barely lifting their heads. She remembers how she was years ago and that's where she still sees herself today. Should we have put her in a Memory Care unit, she would have just given up on life. I know this and thankfully her Memory Clinic team knows this. They have been incredible and are doing what they can to make life enjoyable for her while she can still enjoy life.
So now for why these three options have been the bane of my existence for the last few months. Let's start with the financial first.
Mom has worked her butt off her entire life. She went back to school at some point while working full time and raising a family. She paid her bills on time. She followed The Plan. She never made loads of money but she made enough to pay everything on time, put a little aside for savings and splurge occasionally on things like a towel warmer. Little did she know that being middle class was going to screw her down the line. As we searched for the perfect place for Mom, we learned that to qualify for Medi-Cal, the only way you could have over a couple thousand dollars was if it was in property. Mom didn't own her place. You can't just give away the money because they look at your finances 5 years back. She will need to pay down her money towards living expenses and medical care in order to qualify. Once she qualifies, Medi-Cal will only pay for a Skilled Nursing Facility so whether or not Mom has progressed in her disease, she's going to be stuck in a hospital type room for the remainder of her life. Based on what she has now, we have a year and a half for a miracle to happen. A year and a half. Part of me wants her disease to continue to progress rapidly so she wont know any better. I feel sick even admitting that. I know what moving my mom to a place like that, should she not be much farther along that she is now, will do to her. Of course we have the option of moving her in to our house but we're already 5 people in a three bedroom townhouse and Mom gets overwhelmed with even the mildest chaos. Living here will push her over the edge. Also, my kids. It's been hard enough on them, mostly M, watching their Grandma because more and more disoriented and anxious. They've recently lost another family member and I don't want to put them through that again. I know it's inevitable but I need to protect them from as much as I can. At 8, 4 and 1, they've experienced too much already.
So here I sit, waiting on bated breath, hoping that some magic option will come to me in the next 18 months. I also have constant concerns that the ALF she's in will deem her 'Too advanced in Alzheimer's' to live there. I panic every time she calls me crying or tells me something isn't working. I bite my tongue when she tells me how she went down to the front desk to have them help her because she couldn't tell if her shirt was on backwards. I've been going over at least once a day trying to toss empty containers or all take of the clean clothes out of her laundry bag and hang them up because she only heard the 'clothes go in the laundry bag' portion of me telling her that when she takes off her dirty clothes from that day, they need to go in the laundry bag. I worry when she says someone came to talk to her because I don't know if it's some sort of evaluation. I worry when I don't hear from her. I'm used to her calling between 10-20 times a day. Is she lost in a stair case or did she decide she wanted out and is trying to walk to my house? I know the call is coming, I just don't know when. Is it going to be when most of her money is gone and we really have no options left? Is it going to be in a month when she's finally feeling like she's adjusted but they decided it's just not working out. Good lord. I don't even worry this much about my kids.
The waiting game continues. I'm hoping my fears and anxieties will fade. I know moving her will take an adjustment period, for both of us.
No comments:
Post a Comment