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 When to move From ALF to SNF? 
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Joined: Sun Jan 06, 2013 7:37 pm
Posts: 7
Post When to move From ALF to SNF?
Hi all. My mom, 72, is currently living in Assisted Living. Due to multiple falls a day (from a wheelchair) whenever she isn't being directly supervised, I hired private caregivers, now for 13 hrs a day. The other 11 she is sleeping. She has become increasingly weak and rigid, and I assured staff that there would be no falls at night and there haven't been. We are also recently on hospice.

Her LBD is marked by no hallucinations, but *extreme* fluctuations. She has no behavioral or psychiatric symptoms either. But she is now very weak, speech is nearly unintelligible, and dysphagia is very bad. Trying to keep her on mechanical soft with thickened liquids, but there is more and more coughing/choking at meals. Depending on her current state, she can need help with feeding.

So in the past week, I've been told that there was one incident where she needed to go to the bathroom at night, and a 2 person assist proved very difficult and an aide hurt their back. Then after a couple of "good" days, she needed much help going to the bathroom in the morning, and she couldn't stay on the toilet, and she was lowered to the ground to prevent a fall, but her ankle got twisted and she required 3 people to lift her. Social worker said she is "a max assist x 2 for all functional activities"

They promised they wouldn't move her to skilled nursing, but I have a conference today and I think that is what they are going to order. Is this the point many of your LOs get transferred? I feel like she is just gonna die if she has to move. She is so happy and comfortable in her apartment with her caregivers.

Annie


Fri Mar 15, 2013 8:31 am
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: When to move From ALF to SNF?
Many ALFs will keep residents until their passing. Others, especially those with affiliated SNFs, will insist the patient move when they can no longer self-transfer or feed themselves. If they insist, you will have no choice. There is probably a written guideline stating under which circumstances they cannot care for someone.

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Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Fri Mar 15, 2013 3:06 pm
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Joined: Sun Jan 06, 2013 7:37 pm
Posts: 7
Post Re: When to move From ALF to SNF?
Thank you for your astute reply, mockturtle. That's exactly what happened. The director, social worker, and RN, with tears in their eyes, told me mom has to go. And naturally, there is no bed available, even though she is a life care resident. They are doing major renovations, so there might be multiple temporary moves. Her private caregivers feel they can handle her almost all times, but the couple of times the AL staff had to help her at night she was unable to move. Administration is feeling pressure from overworked staff yada yada.

I am not 100% sold on the need to move her to skilled nursing, but I don't feel like I have many options. As a point of reference, this is a CCC where we paid a $220,000 entrance fee! So you can only guess what the monthly AL fees are.... Ugh.

Annie


Sat Mar 16, 2013 9:57 am
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: When to move From ALF to SNF?
One good thing about a SNF is that, when the money is gone, they usually accept Medicaid. Most ALFs do not.

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Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Sat Mar 16, 2013 10:26 am
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Joined: Sun Jan 06, 2013 7:37 pm
Posts: 7
Post Re: When to move From ALF to SNF?
Blah. So they moved her yesterday. I had sworn over the weekend I'd try one time to fight it, and was assembling some arguments for a meeting. But then she fell off the couch Sunday afternoon when a caregiver had stepped away and needed 3 people to lift her. And then Monday she asked for privacy on the toilet and fell off with another caregiver right behind the door. The second fall led to a pretty nasty forehead injury. So there was no more second guessing and they moved her to a room in sub-acute because they don't even have a bed open for her in long term. At least this is the nicer building.

I was there for the transfer yesterday and it just felt so pathetic. She had a home in the ALF and then everyone gave a bunch of tearful goodbyes and we wheeled her to a new building and she's sitting in some new plain space, with just the few pictures I grabbed on the way out. I can't get there right now because I'm at a 4 hour allergy test with my 3 year old and my 5 year old is home sick with a fever (my husband had to stay home with her).

I'll go over there later and check. I have a private caregiver there with her still, but for some reason they're charging her maximum private pay rate,like she's in off the street, and I don't know what happened to my $220,000 entrance fee. The list of charges are unbelievable. 2 bucks for every bandaid, phone service is like a hotel rate. $75 a month just to have a phone number! She's just sleeping so much now it's freaking me out. She ate half an English muffin and had half her juice this morning, I guess that's good? I don't know how much longer I can keep private care... That was supposed to help her stay in ALF, which she's been kicked out of. But now I'm afraid of leaving her alone in this therapy facility. UGH, sorry, it just sucks right now.

Annie


Wed Mar 20, 2013 12:59 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: When to move From ALF to SNF?
You're right, it does. :cry: Some of these places are rackets, if you ask me. Maybe you could write to 60 Minutes or something and have them investigated. :P I'm so sorry you are in such an awful position--a sandwich mom/daughter/wife. It must be very stressful. Hugs! God bless you.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Wed Mar 20, 2013 2:43 pm
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Joined: Sat Jan 03, 2009 2:59 pm
Posts: 1978
Post Re: When to move From ALF to SNF?
Pat,
When I read your reply above it made me think of this:

http://www.sandwichgeneration.com/

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Irene Selak


Wed Mar 20, 2013 3:30 pm
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Joined: Sun Feb 17, 2013 11:41 am
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Post Re: When to move From ALF to SNF?
you need to sit down with them in regard to the $220,000 and if you do not get a satisfactory answer, contact your state attorney general.

my mother is in a very high end ALF and did not have to pay an entrance fee; only a small deposit.


Thu Mar 21, 2013 7:31 am
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Joined: Fri Jan 15, 2010 9:33 pm
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Location: Vermont
Post Re: When to move From ALF to SNF?
CCCs all seem to have their own rules, don't they? My aunt was in one that cost about the same entrance fee as you are talking about, and at one point was spending another $2,000/mo for her apt. there, but after a medical issue was paying an add'l $10,000/mo. to be in a SNF, with the hopes that she could go back to her apt., which never happened. At that particular place, their contract prior to moving in, was that the facility would cover "hardship cases". If the resident runs out of money, they will not be kicked out, but they have to spend every last dime before the facility picks up the bill.

I'd try to find her contract and see what it says, and if they aren't following it, get a good eldercare atty. in that state.

Sorry for what you are going through. The emotional stress as well as the financial issues can just be too much some days. Lynn

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Lynn, daughter of 89 year old dad dx with possiblity of LBD, CBD, PSP, FTD, ALS, Vascular Dementia, AD, etc., died Nov. 30, 2010 after living in ALF for 18 months.


Mon Mar 25, 2013 8:00 pm
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Joined: Sat Jan 03, 2009 2:59 pm
Posts: 1978
Post Re: When to move From ALF to SNF?
Many of these places that are charging a large entrance fee are banking on the fact that by the time the person runs out of monies , their health will get to the point of needing a NH. This is common practice in FL, I remember when looking for ALF for my mom some yrs ago !

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Irene Selak


Mon Mar 25, 2013 8:14 pm
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Joined: Thu Apr 18, 2013 7:37 pm
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Post Re: When to move From ALF to SNF?
The ASL place took the choice away from me too! Coinsidentally it coinsided with moving both my parents to Medicaid. We paid out of pocket for 2 years, and for the last month out of pocket they gouged me for 14K for Dad, & 2K for my Mom. The month before they were 6.5k together! The minute they were officially told that my parents would be on Medicaid they gave me 15 days to move their things out. You're right it's a "racket". They don't care about the residents, it's all business, and they're there to capitalize on the misfortunes of elders. I was so upset and had no place to move them that would take both of them now since their needs are so different. I ended up finding a SNF for my Dad that is next door to an ASL I was able to get my Mom into. Mom has some dementia, but it's very different from DLB which is what my Dad has. I was so upset that I ended up calling the hotline and reporting them. Here's the number if you or anyone needs to make a similar complaint.

Complaint Hotline: 1-800-792-9770 (leave a message & they WILL call you back) :-)


Thu Apr 18, 2013 8:53 pm
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