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What are the things that we should be looking for/into when considering a NH placement for very elderly parent with dementia and mobility issues? Has been cared for in home with 24/7 caregivers for several years. How to know that this is the best decision?

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Sometimes finances force a decision. If father cannot afford to continue 24/7 caregivers, then something has to change. Focus on making the best placement possible.

If it is financially possible to continue at home, and you want assurance that a move is the "best decision" I think you'll have to explain why you are considering the move.

In selecting a care center, location is important. If it is too far away for frequent visits that is a negative.

If staff have their own loved ones there, I take that as a good sign.

There is always high turnover in care centers, but if the center has a lot of long-term employees, I think that is positive.

Don't be too influenced by attractive settings. I'll bet dad would rather have friendly and compassionate care than a beautiful new building. (Not that you can't have both -- just don't give the setting a lot of weight.)

Will you be private pay? Does Dad want a private room? Is one available?

Look at the activities calendar. Is there anything on there that Dad might enjoy? Bingo? Live music? Movie night? Ask about how they encourage residents to participate. No one should be forced, but no one should be ignored.

My mother will eat anything as long as someone else cooks it and cleans up afterward. She loves the NH food. If your father is a little more fussy than that, look at the menus. Ask about what alternatives are available if he doesn't like the day's offering.

Here are some AgingCare articles on the subject:
https://www.agingcare.com/articles/checklist-to-find-a-nursing-home-for-elderly-parents-137428.htm

https://www.agingcare.com/questions/how-do-i-find-nursing-home-for-my-father-155070.htm

This is an emotionally charged issue. Try to work on it when you are feeling calm.

Keep us informed about how this is going for you.
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Check Medicare website for useful info.
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Other things to help your selection between centers will be asking questions like:
-what is the patient to aide/nurse ratio
-what kind of patients does the center accept (are there a lot of complicated wounds, behaviors, bariatric patients, tracheostomies, tube feeds etc). These will all take extra time away from your father and should be considered when looking at patient/staff ratio
-ask to see the citations the center was given by State surveyors.
-do the staff and patients seem tense or happy?
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Check if the nursing home is a for profit versus not for profit. My mother was in a for profit NH and all they cared about was the money. Go with the not for profit. Some NH have special floors for dementia and also ventilator patients. Make sure there is enough equipment for each patient. My mother was in a nursing home that didn't have enough chairs for the patients to sit in so patients were put into a chair every other day. Also check on physical therapy. The NH my mother was in refused to do physical therapy for after 6 weeks. She is now bed bound and needs extensive physical therapy in order for her to walk again. Do a google search as sometimes you can find reviews from families of patients. They can be more helpful than Medicaid/Medicare. Check out what hospitals the nursing home uses for patients that require a hospital visit. Vary your NH visits to different days and times. The more you know about the routine the better. One of the most important things I learned is to have a POA for your parent in place before your parent goes into the NH. There was an article the other day about NY NH who are having the patients signing over their homes and money to the NH without the knowledge of the family. The families now have to sue the NH. The premise is that the NH won't have to sue the patient for unpaid NH bills. Let them know that you have a POA. Good luck. I took my mother home from a NH after they were unable to wean her off the vent. After 8 months at home, she is now completely off the vent and the trach tube was removed as well. She is better now than when she was in the hospital. Good Luck.
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I concur with the comments above, especially the one about don't be overly impressed with a fancy building--care & staffing is so much more important! Also some new facilities are built in completely new setting--do you know what the building next door will be? Will that nice forested scene soon be bulldozed down for a big-box store, or strip mall or fast-food joint? Some people might like those conveniences, personally l would not want my view obstructed or look out on huge flat rooftops, or golden arches complete with french fry aroma.
The comment about for-profit vs non-profit is good, I would go further and say there's a huge difference between some in business for 50 yrs and are upstanding members of their communities (perhaps church-based but maybe not), and some who (if you research you can find out) is a bunch of investors who got together to build a money-making machine.
Also ask what plans are in place in case of building evacuation. If there's a hurricane, mudslide, chemical spill, etc, how do they plan to provide care in these situations?
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Sometimes finances ARE an issue and you have no choice but to keep them at home. Board and care homes in my area start around $3000 per month, and the Memory Care centers are crazy expensive. Mom doesn't have even close to that, she makes too little to self pay and too much for help from the State (Medi-Cal). So my only option is home care.
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Personally I think thats a big mistake. He will go right down hill. I know it seems easier for us but they dont get good care. Do whatever you think is right but would you want to move out of your home?
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Cactusflower, your mom can still go to a facility and spenddown to MediCal eligible level, contact their offices to find out more. The original question posted seems to involve someone with a lot of money (they've been paying 24/7 care for years) so for them, money isn't the issue.
Reverseroles, I totally agree, its always 1, 000 times better to stay in ones own home. I wish the OP had given a few more.details why their current in-home system needed to change.
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alot of good suggestions but staying at home may not be an option. Maybe the spouse isn't capable of taking care of their loved one, the stress on the caregiver is tremendouse (I know my mothers blood sugars were all over the place), maybe there is no other family member than can help (maybe they HAVE to work themselves). Not everyone that goes into a NH goes downhill. It depends on the family and how they make it a positive adventure. If a person is always down on everything and the OMG on stuff, sure negativity will take a person downhill. No one wants to go into a NH but you know what, I would rather be in a NH where everything is done for me and I don't have to depend on when my children can come help or have them put their lives on hold just to take care of me. Sure its not going to be all roses in a NH; there are pros and cons to anyplace you may have to go to. Even your own home. not everyone is a movie star or billionaire where you can afford to eat off a golden/silver spoon or have a servant for each thing (eating, changing, washing, etc) than you deal with what you have and be thankful. sorry nothing intended against anyone. Its just you can't always look for the negative because you might pass up the good things.
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Wolf lover, certainly, yes, we need to keep on the positives, and one way the NH's can learn how to improve their "product" is if satisfied clients would write in their positve experiences. That is difficult to do, given the nature of a facility,which necessarily involves residents who can no longer care for themselves (not much positive there) and their families or spouses wore themselves out trying to take care at home (ditto). In my family's experience with 8 different facilities (both NH and AL, also 1 rehab and 1 hospice) the few positives had to do with individual staff mmembers who did an exceptional job, given the tough circumstances. There literally was nothing else positive--food was always meh, rooms too small or unfortunate roomies, elevators too slow, policies really wierd, and on top of it all, everything was always just too darn expensive for any of us. Actually the VA place was the best, but not everyone can go there. For my parents, having seen what their close relatives' experiences were, the choice is to stay at home as long as poss, or to shop around for some other place that would A) be better than the previously known 8 (plus 2), and B) at the same time do it all for a much better price. I don't think we will ever find such a place, so for now, the food is tasting really good, at home.
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Samara, I do agree the staff working with the patients have a lot to deal with, I have seen it first hand where my father is. But we all know that home food tastes better than anywhere else, we can't expect gormet food and they the kitchen staff (at least where my dad is) is regulated by what they are allowed to make and how to prepare (more than likely without any seasonings due to different allergy issues with residents). And I understand the rooms, my dad has a room mate but 98% of the time my dad is up front by the nurses, so he really don't need much room, remember its a nursing home not a hotel. I am NOT trying to down on your post but we have to be practical and understand why most people are there, they have dementia/alzheimers so they don't know that the room is not luxurious or the food is 100% like homemade. People's taste buds also change as we get older. just remember these places are not going to be like home, nothing is ever like home (not even a fancy hotel). but I am glad that you decided to keep your parent(s) at home for as long as you can. you need to do what works best for all and IF you have the time/strength/patience that is great. just don't let yourself get sick in the process. God bless all caregivers.
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No problem, wolflover, it is a Big Decision to consider "putting" a parent in NH, and I can only imagine the OP has run out of gas with the dementia having gotten worse to the point they can't manage (and mobility issues too). My sincerest wish is for everyone to live at home until their death, if at all possible. Perhaps the best is if people can actually afford to live in nice AL long enough (10+ yrs) to make it feel like home. But most facilities are incredibly well xpensive! So nobody lives in facility for very long...and it will therefore always seem like strangers in a strange place full of strangers, and strange food, even strange coffee! --that has to be the worst :( so yes God Bless the caregivers, we'll all need a caregiver someday if we live long enough.
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I keep reminding my Mom it's MC, Not NH for dad!! Somehow that makes it sound better.... She was fixated on the old school thoughts of a NH, and dad's place is nothing like that. We know it;s not home, but it may be better. Yes we wish it was less expensive, but he is getting better (less stressed) care. He is only on his first week, and stuck in the AL part with a companion as the MC is closed for a GI bug, but I think once he is in the MC it will be even better! The staff is great and they have called once a day (even though we visited) to let us know how he is doing, and he looked great when we visited today. So visit, get a feel for a place.. and make the leap if you need to. You can always change your mind.. that is why we a doing a month of "respite care" to get used to the idea. Also, if we looking into full time care instead of the few hours a week we were using.. HC was actually going to cost more
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Regarding "home food tastes better than anywhere else": My mother has said all her life "I don't care what the food is. As long as I didn't have to cook it and cleanup after it, I like it!" And indeed she really likes her NH food. When I visited my aunt in her care center and asked her how she liked it the first words out of her mouth were, "The food here is very good." Another aunt in a care center also loved her meals.

Just pointing out that not all old folks hate the institutional food.
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They told us Dad had a big breakfast today.. he has never been picky! and when I look at the 4 course menu I freaking want to eat there!! Mom did not like the rehab food because she was on a special diet... but Dad eats everything!
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Has father been spending time at senior center? If so, you can ask the family and staff members about different homes. Also, talk to local pastors and priests. They frequently know the better places. Visit and tour the place. Do the residents look well cared for and happy. Ask if you can pay to share in today's meal. That will tell you about food. Ask about staff credentials. Are most licensed profs, or are most volunteers? Talk to local Red Cross, So. Baptist relief, parish relief, etc. they can frequently tell you a lot about the homes I the area.
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My father was private pay in two nursing homes in two different states. Both of them neglected and abused him. The first one turned him into a zombie with three antipsychotic drugs given simultaneously. When he was in a NH near me, I visited him at least once a day every day. (I wanted him in my home, but my husband would not agree.) I was so upset with what happened in his nursing homes that after my father died, I wrote a book about this journey with him, Before the Door Closes: A Daughter's Journey with Her Alcoholic Father. Please become informed before you make this life-threatening decision for your loved one.
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judy I will try and download the book , thank you!
I have a friend who put her Dad in a nursing home, he has no dementia and is 95. They bragged how well he ate, etc and she dropped by and he was having a peanutbutter and jelly sandwich and said he has had it 5 nights in a row. Needless to say my friend was livid and went right to the administrator. A few weeks later she dropped by and he was having a ham and cheese sandwich for supper. They pay privately $10,000 a month. There is so much more that goes on there, and they are nuns that run it, awful. My friend and husband are in their 70s and cant do it at home. I told them to get an apartment for him with a chef and it would be cheaper! He was also quarantened in his room alone 2 weeks due to the flu !
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There is a quarantine incident in my book too. So many similar things. When will this travesty stop and how? Anyway, I pray my book does its part.
Reverseroles, I got a private message from you, but I could not figure out how to leave a message for you. I am new at navigating this site. I thought I was looking at your profile page. Any suggestions?
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Hi Judy. Click on. give s hug,
and then you can write me ok? Thanks! Click on my name from here first.
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samara,
re ; the ' coffee '
i think its pencil shavings and black - ish ink .
my NH advice is ; let the staff know you are listening closely to the patient , relay the patients concerns to the staff but dont argue with them or try to push them around . they are generally following age old protocol and you are the one in the ' learners ' seat . try to be a team player and an asset to the patient and staff .
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