OFF TOPIC-a place for Mom

In 2014, I requested off-topic input that proved to help tremendously. Please offer thoughts on a decision I need to make quickly: my 93-year old mother has been living for three years in an assisted-living apartment located 12 miles away. She self-pays $4,000 per month exactly covered by her monthly teacher retirement income. Down a long hall is the skilled-nursing section, small private rooms, where the head nurse says Mom needs to move to for more supervision. The monthly charge there is $8,000 per month. This charge would dip in and burn through Mom's savings account in short order with the potential for ending up on financial assistance. Coincidently, I received a phone call from a quality nursing home located 40 miles away saying Mom has been on their waiting list for three years and has reached the top of the list for the opportunity to be a resident there. Their ceiling price is $5,000 per month thus more likely being able to be a self-pay resident for life. I trust the level of care at both facilities. The move will be hard on Mom either place even though she is in good health; it is her memory that is failing faster. She is no longer able to make the decision on her own. She needs care beyond what I am willing to take on in my home. Confidence in both places equal, I am leaning toward saving the $3,000 per month significant price difference and picking the $5,000 per month nursing home over the $8,000 per month nursing home. Sound logical?

Hello selhard:

I'm sorry that you are in this difficult situation where you have to make a rapid decision in the best interests of your mother. Although I have not faced this issue as yet in my life, I work in the field of Geriatrics and have experience with this type of issue.

Fortunately, you have two excellent options open to you -- two skilled facilities with health care that you trust and that are reasonably close by.

Things you may want to consider in making your decision include:

1. Will the less expensive facility provide a private room for your mother? If not, do you think your mother would adapt better to having the company of a roommate or is she a more private person?
2. What is the nursing staff and private care assistant ratio to patients in each facility?
3. Would your mother's primary care physician change? Does that matter to you or your mother? Is there a physician at the facility during regular hours at either facilty?
4. How do the recreational activities schedules compare between the two facilities?
5. Have you toured both facilities to see overall daily functioning, cleanliness, etc?
6. Will the distance of each facility from you (12 vs 40 miles) impede your or others' ability to visit your mother?
7. What is the dining arrangement at each facility? Is both communal dining and the opportunity to eat in one's room available?
8. How receptive are staff members at each facility to family involvement in the care of the residents at each facility?

Please keep in mind that when individuals have cognitive impairment, like your mother does, there may be an initial decline in memory and physical capabilities with any change in environment. In most cases, this is temporary until the individual acclimates to the new environment. Your mother probably will have some temporary disorientation even if she stays at the same facility since she is moving to a different part of that facility which most likely has different staff members.

I hope this information helps you to make a decision that is good for her and one that you are comfortable with. If I can provide any further assistance, feel free to PM me.

Best wishes to you in making this decision and to your mother on her upcomimg move.

Thank you for this. I will likely be facing this for my DH in a few years (Alzheimer's), and this will be very helpful in evaluating options when the time comes.

Good luck with a tough decision!

If you are comfortable with the care at both places, it would seem that the lower priced place would be a better option because it allows your mother to be self-pay longer and it seems to me (opinion only, no facts/data provided to support, that in many places individuals on assistance to do not the same quality of care as insured/self pay. The other thing is that the move from 12 to 40 miles would probably impact your ease of getting there to monitor her care/visit, consider the additional impact to you of the longer drive time (as well as to her of a change in visit frequency if there is one).

Adulting has days where it sucks, doesn't it?

What makes this decision difficult is there are plus and minus points at both facilities: Place A=$8,000 per month currently living down the hall from Place B=$5,000 per month and farther away from Mom's local community.

To loosely answer Luckyloser's numbered questions: 1) A and B both would be private rooms and preferred 2) B is a large city facility with 60ish residents. A is a small-town, local facility with 30ish residents. Ratio equal. Mom is already well-establshed at A with some staff having an emotional attachment thus treating her like a rock star because they had her as a favorite teacher...is that worth paying $3,000 per month more for, however. Local visitors has fallen off to very few and rare. 3) Mom is in excellent physical health so changing doctors is not an issue. Neither A or B has a doctor on-site. B is located across the street from a hospital, however. 4) Recreational activities plays a small part because Mom sleeps most of the time and cannot hear or interact well 5) familiar with A and B viewing them equal 6) the 28 mile distance difference in A and B will have some impact on how often I visit. Keeping her in the same building would be easier to move her, the driving distance for visiting her would be nice but, again, probably not worth paying $3,000 per month extra. 7) A and B both require communal eating with rare exception 8) equal

Question: Once she runs out of private funds, can the nursing facility kick her out or will they be required to keep her with Medicare paying? If so, that might be a relevant consideration? If I were making this decision I think the distance would be a major factor.

When an individual's funds are going to run out, the individual usually applies for Medicaid. This is state-based financial assistance for health care. Medicare does not pay for long-term custodial nursing home care. It can pay for a short-term nursing home stay after an acute hospitalization.

But nursing homes are obligated to accept Medicaid for someone already there correct?

No. Most do, but not all - they're not legally required to. So I need to make sure when it's our turn to go to one, they don't kick people out when they run out of funds!!

P.S. that is, unless things have changed. There was one I really wanted my dad in, but they did not deal with Medicaid, period. I didn't want to take the risk in case he lived a lot longer than expected. Most will take it as long as you're private pay for x number of years - they won't kick you out. And some will take it from the get-go, but not too many, as I recall...

I had to make this choice and it's very hard. I too checked out the Nursing home and was comfortable, but then my Dad's money did run out after a year. He had to move to the Medicaid wing and that was like living in the land of the Walking Dead vs. active life. No care, different food, everyone stealing clothes from you... I walked in one day to find my Dad's neighbor wearing an expensive Bull's jacket and his shoes I gave him years earlier. The NH actually accused me of a false report, even after I showed his name in both items. It was like two different facilities in one. I prayed for him, as I couldn't move him easily at that point. He lived like that for almost a year before illness took him (I'm not even going to think about whether they hastened that illness - likely did due to poor care and cleanliness). Worst decision of my life and I'm not sure how I would have seen this side of the facility (never thought to ask, as all the conversations pointed he could stay in place after going on assistance). Check every angle and don't assume anything would be my advice. Knowing what I do now and if facing your decision - I'd see if I could cover the $3K out of my pocket for as long as I could. Unless you are absolutely sure the NH is quality - even on assistance levels and not self-pay.