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My husband's brother has dementia and needs to be placed in a skilled nursing home.  However, all of the facilities we have checked have denied him, Why is this happening and what can we do?

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Hi I went through this also with our mother. She had a history of bipolar disorder and as soon as facilities would see this they would say no. She also was on Medicaid and we learned quickly that it is very hard to find a decent place that will accept Medicaid and then that has an opening. They often only allow for a small amount of rooms/beds to be allocated to people with Medicaid so the waiting list can be very long. Also some places require them to pay as private pay for a year or so and then they will accept the Medicaid which I never understood because if they are on Medicaid it means they have little resources or money so how do they expect them to pay, but that is another matter. I just know that any history of mental illness is always a red flag to many facilities and as much as it sucks, you just have to keep calling. If he has Medicaid he must have a social worker assigned to his case so just keep hounding them to help you find a place. It is their job to help you. In the meantime it is hard and all the being turned down can start to really get you down and frustrated. There will be a place that will take him. If you get on your states DSHS site they have a list you can print that has just facilities that accept Medicaid and print it and just start calling. Best of luck.
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Thanks for the advice BarbBrooklyn.
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Unit, not init
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If he is assualtative, he would need a secure psychiatric facility. You nned to talk to the geriattic psychiatrists who have evaluated him

Best case scenario, in my mind, he's admitted to a secure senior behavioral init and behaviors gotten under control with meds.
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If a secured locked down LTC SNF will not accept a patient with dementia, what do you do? Maybe, I am wrong, but I would think a facility such as this would be able to manage any type of dementia problems? (wanderer, combative, verbal etc)
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Igloo Great advice. Thank you
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In my MILs instance, she was coming from another state, Florida, to GA. The five facilities that were tried never actually told us that they didn't accept her secondary insurance.
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OK He is covered by insurance. When he has injuries, the facility doesn't call you so it sounds like you do not have POA or health proxy for him. They want to move him, probably due to liability since they raised the issue when an injury was noticed. The fear is that they will move him somewhere even farther from you. Why not get a signed POA from him, since he has not been deemed legally incompetent. Do this before he becomes incompetent. Also do this in the hopes that they then can not change his location without at least notifying you. hmm..... He has to be competent to sign it, but INcompetent for you to have full health proxy. I suspect facilities can pick and choose without needing a reason in order to refuse someone, they base it on either protection for fellow resident or for more care than they wish to provide. I find this to be prevalent, lots of leeway and favoritism. If his insurance is enough to cover, you should be able to find a nice facility. Someone mentioned nursing notes, and I agree that is the key. That is what they wanted to see when I was looking for something for my Dad. Best would be able to get your hands on a copy of those notes. Make a friend at a NH and try that. or - Why not try a NH - if the insurance will cover it, which it probably won't since as stated, it needs to involve a medical condition.
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Hailey - you've been given pretty spot-on advice from others but imo zythrr answer nails it….. something in BIL's chart is a total red-flag for any facility.

Often family has "willful blindness" when it comes to family (or politicians…). Then add onto this that BIL is in an AL so in theory he is still able to take care of his ADL's with assistance and is viewed as cognitive & capable in his decisions & actions. So its likely that whatever he is doing that the "problem" is viewed as beyond what this or any other AL or SNF will accept. If I had to venture a guess, probably something sexual.

If your hubs & you live miles away and BIL has been in a facility now for years, and you & your DH haven't been visiting every week or couple of weeks or taking a long weekend to visit every mo or so, then you don't have a relationship with nursing staff or the activities gal or the guy who does PT or workers who do evening meal clean-up to get off-the-record insight & "heads up" as to what's what with BIL.

So what to do, if it were me, I'd ask the DON (director of nursing) and social worker for an off-the-record meeting regarding BIL and tell them you are doing this as hubs will be seeking guardianship. If you do not have DPOA, MPOA or HIPPA authorization for BIL, they are very limited in what they can state or access you can have to his medical chart but they can share with you anecdotal insight …. like another resident complained that he was doing XYZ, or he has threatened residents or staff, or was found doing inappropriate behavior on an outing. For dementia some become hyper sexual. There's a lot of sex going on in facilities and it's a hard subject for both facilities and families to deal with (the NYT had a series on this last year). There are posts on this site from caregiver daughters or DIL who find that "dad" says sexually inappropriate things to them, exposes himself, etc. Stuff that nobody wants to talk about.

If this is the problem, then the choices are stark. He is going to need to be in a speciality locked ward LTC SNF. Unless you all really want to become his guardian and go the guardianship route with the expenses, mandated reporting, arranging for paying for his care, etc., pause and give some thought into having him made a ward of the state. You will have to work with the facility to get this done. Probably start with him sent to the ER/hospital for a involuntary psych evaluation and neither the facility or family picks him up. The code for this varies, like in CA it's a 5150, PA a 302, a "72 hr hold". For where I am in New Orleans, it still referred to as a "3rd floor" referring to the old 3rd fl locked psych ward of the Charity Hospital, which has been closed since Katrina (2005). The hospital then finds him a emergency placement via social services dept. Often in situations like this, being a ward of the state can actually be a good thing as the court-appointed guardian can get him placed into a facility much faster.

You need to find out an unbiased reality on what he is doing. Good luck.
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MsMadge I understand what you are saying. Thank you
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Halley

There is probably some information on BIL's report that shared with the facilities contacted, and not with you, hence the rejections. This can and does happen.
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Hailey
I understand your frustration and don't want to keep asking you to provide us with more information but it is difficult to try and answer your questions without knowing some of the basics

You can't assume that the ALF is in charge of BIL and will monitor and medicate him accordingly - is there a family member responsible for him or is he a ward of the state? Are there family care meetings being held every 6 months or so ?

Just because BIL doesn't walk doesn't mean he is not a harm to others or himself - he can yell kick punch and be non compliant with bathing and going to the toilet

The ALF is not responsible for creating a care plan - I don't hear from my mom's memory care unless there is a problem they need me to address but I'm in contact with them on a regular basis at least 3x a week either in person or on the phone

We want to help you
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Haileybug,
Your last post does make me wonder about what your BIL is reporting. He may not be providing you accurate information, especially, if he is cognitively impaired. He may think he has made inquiries, when he has not.

He also may not want to live in a AL, NH or MC, so he reports that none are available. That would be my guess. If no one is authorized to act on his behalf, then I don't know how you can speak to them, unless you just call a place on your own and ask if they have an opening, costs, etc. just to get general information.
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I do not mean to sound like I'm repeating myself but it just baffles my mind if it is behavior issues. If it is I would think medications and treatment plan would help.

I'm surprised that the ALF never makes any contact with the family, only if family calls them. It is sad.

But I am so thankful that this support group has been so kind and generous to me and have offered so much good and helpful advice. It's just been so frustrating trying to do this without help. Thanks you all
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It is probably a question of finances. You need to call the Aging Resources advocate in your area. (you can google to find out who that is) to go to a skilled facility, he will either need to be able to private pay or he will need Medicaid. In Iowa, we now have 3 MCO's (managed care organizations) who run Medicaid. They all have "preferred providers" they use. So you have to find the right provider for the right MCO. I can't believe the social worker at the ALF is not helping you with placement. You can call the ombudsman for the facility, (they are required by law to give you this information) and tell that person what is going on, and they can light a fire under the staff at the ALF and hopefully get them to help you.
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Yes, you are exactly right. It was shortly after my husband had made a visit to see his brother and saw that he had seriously injured is head and face from falling, did the ALF say he needed to go in a skilled nursing home. Mind you, the ALF had never even made a call to the family to make them about what happened.
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Of course and most definitely all persons need to remain Safe, no doubt. I do not know that he has behavior problems. I know he has "dementia" and I know he is "not able to walk much". Therefore, how could he possibly be a harm to someone?

But "JUST OUT OF MY CURIOUSITY" if "someone" with dementia had behavior problems and they have been in a facility for a couple of years, I am so certain that they would have that patient evaluated, on meds and a proper treatment plan to manage their behavior.

Now, on the other hand, these skilled nursing homes with a secured unit that says they "SPECIALIZE" in alzheimer's and dementia and they are special trained to "manage" behavior problems caused by Alzheimer's and dementia.

So great .... the patient with dementia that has been living in a ALF has received the care they need for their dementia is ready to transition to a skilled nursing facility that specializes in dementia and properly trained to manage any behavior problem. Okay, then that means there should be no problem, right? Wrong.

Besides, how is someone that not able in their body to be violent be harmful to someone else? It is impossible.
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NH are going to "protect" long staying (and paying residents) residents first and foremost from newbies who may be a threat to them. They're also going to protect themselves from any legal situations, possibly lawsuits, etc, if BIL is admitted and something bad happens to him or possibly his actions cause harm to others. NH knows they have the power to accept or deny new patients, and the ones you have contacted are using that to their advantage

Doctor wants BIL out of AL, asap for the same reason, protect themselves and others. If horror for horror BIL has a fall and is seriously injured and the result of the fall causes his death, AL could be sued. Both doctor and AL want to avoid this.
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I appreciate all the helpful advice. It may take time but we will get there.
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Hailey
The folks trying to answer your questions here all have first hand experience - some of asked you some pretty basic information about your BIL which maybe due to your stress you're not capturing so in an effort to help organize your next steps I'll try to summarize

1 does anyone have power of attorney- health and financial
2 does BIL have financial resources or does he need government funding I.e., Medicaid not the same as Medicare
3 even if BIL doesn't walk much his behavior could be an issue - yelling and hitting
4 is BIL taking any meds for any health issues incl dementia and anxiety it causes
5 does BIL have his own doctor or is he using the ALF Doctor

My mom is in a private pay multi-state memory care facility - folks fall all the time - they cannot do IV or certain other things as they are licensed as an ALF not a SNF - they will put up with behavior issues to a point but they will call 911 to put someone on a 72 hour or longer psych hold

Try to provide us with a bit more information and the knowledgeable folks here may be able to better direct you

As one poster suggested please look for your county agency on aging - there should be a link to it on this site if you can't find it in the Internet

Don't give up hope - these are difficult problems to solve on your own
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BarbBrooklyn Just curious why psychiatric unit for evaluation and treatment?
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Can you get him admitted to a psychiatric unit for evaluation and treatment?
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haileybug, there have to be other issues that have not been disclosed to you. First you need a healthcare Proxy, but if his dementia is advanced he cannot sign one and you will need court-ordered Guardianship.
Then you need to know ALL the details of his health history and any criminal history he may have. Nursing homes are now insisting on background checks on their patients prior to admission. They are insisting on checks for any communicable diseases including STD's.
Any history of assault, menacing or harassment is a real problem.
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We have had a lot of skilled nursing homes to deny BIL admittance with no explanation, However, was informed by one facility yesterday, that his skilled nursing Memory Care with lock down that his care exceeded what they could offer him there.
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The BIL started falling a lot with his dementia. Actually, when my husband visited with him and saw that his face and head had been hurt badly, (supposedly after a fall) is when social worker said doctor has ordered for him to moved to skilled facility. The nursing homes are denying him admittance at the referral level. We think it is probably because of some behavioral problems from the dementia is why he may be getting denied. However, he has gotten where he is not walking much so not sure how this could interfere. Also, if we have checked with a skilled nursing home that has a secured/locked down memory care unit for dementia patients and they are supposed to be specialized in that area and they deny him, what is wrong?
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Your BIL has dementia and physical health needs exceeding what can be managed in an ALF. Therefore, he cannot be making these enquiries and arrangements himself; therefore, somebody must be doing this on his behalf. That's the person you need to be speaking to. Who is it?
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haileybug, what stage is your husband's brother in with his dementia? Does he have any outburst, can he be uncontrollable, etc.? Sadly those can sometimes be side effects of the dementia. I was wondering if that is the issue, that is the reason the doctor wants him in a skilled nursing home, as the medication for control of outburst need to be under strict control. Just curious.
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The ALF never contacts us we are always contacting them. The ALF is not making any efforts to give us any information or suggestions. In fact, we feel like we have been left in the dark. We are trying to get him moved closer to home. If we depend on ALF, they will probably move him further away from home. We just have know idea what is going on.
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I'd get a copy of the doctor's orders and see what the medical condition that requires skilled nursing care is. For example, if the family said they they want him to be tube fed, he may have to go to a skilled nursing home to get tube feeding. Other families stick with handfeeding, which a Memory Care AL, can do. It's a lot to consider.

If BIL is on Medicaid, the nursing homes that you are checking with my not accept Medicaid. Some facilities do not. Most of the places that I know of, try to assist the resident in finding a place to be transferred.

Who is in charge of your BIL? I'd have them ask a lot of questions. For example, are there any behavioral problems with BIL that has caused the facility to reject him?
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Can the discharge planner at the ALF give you any suggestions or help in placing him? Also, when nursing homes turn him down, ask them if they can point you to a facility that might be more appropriate to his needs.

Sorry I don't have any better ideas. I haven't been in this situation.
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