Part 5B: Memory Care and Nursing Homes
By CarePatrol of Northern DE & South Chester County
Dementia is an exploding health problem in the U.S. According to the Alzheimer’s Association:
- More than 5 million Americans are living with Alzheimer’s (which is only one type of dementia)
- It is the 6th most common cause of death (more than breast & prostate cancer combined)
- 1 in 3 seniors die with Alzheimer’s or some other form of dementia
- In 2020, $305 billion will be spent as a nation on Alzheimer’s and other dementias
- By 2050, the amount could be $1.1 trillion
- 16 million Americans are unpaid caregivers for seniors with dementia
- These unpaid caregivers are estimated to provide 18.6 billion hours of care
- Two great resources for caregivers can be found here and here.
These are staggering statistics. While all LTCCs have residents in various stages of mental decline ranging from normal forgetfulness to various forms of dementia, they are often able to remain as a resident without moving into an MC unit. There are certain behaviors, however, that will force a move to a secure Memory Care community. Wandering and sundowning are such behaviors. Aggressive behaviors present an even more difficult situation, one that may well trigger a stay in a psych unit where medications are worked out to address the behavior(s).
When assessing seniors for signs of dementia, it is important to differentiate between dementia, which is irreversible and worsens over time, and delirium, which is sudden onset and often related to a temporary condition such as a urinary tract infection. Dementia is an umbrella term that covers many specific diseases such as Alzheimer’s, Parkinson’s, Huntington’s and others.
With the level of care and assistance needed rising once again, Memory Care communities are usually more expensive than AL. There are also fewer choices for room type with most communities offering only studio apartments with no kitchen at all. This is done for the benefit of the residents since reducing choices and keeping layouts simple are important pieces of caring for seniors with severe cognitive issues.
The care approach to dementia has changed radically in the last 30 years. Corrective approaches - “No! That’s wrong!” - have no effect and are not only counter-productive but cruel. A great video explanation of what happens to the brain with, specifically, Alzheimer’s can be found here.
While researchers continue their search for early diagnosis factors, treatments and even cures, there are also some interesting natural ways that may help in preventing or delaying onset. Blue zones are enclaves scattered around the world where residents live longer and ALZ is practically non-existent. Diet, lifestyle and much more are being studied to better understand these communities and why they are so healthy.
The current approach is kind, empathetic and loving; striving to use eye contact, touch and verbal communication to convey respect for the patient as a human being. Every attempt is made to keep the seniors out of their rooms and engaged in various light activities, many designed to elicit pleasant memories or just exercise their minds to whatever extent possible.
SNF - The Long Term Care Nursing Home
SNFs undoubtedly have more of an institutional feel about them and are much more expensive than AL. There are two main types of SNF and they often cohabitate in one facility. "Rehabs" handle rehabilitation for patients who are usually coming from a hospital environment (think injury or illness). These patients usually expect to go back home. Different rehab levels (acute, sub-acute, etc.) are determined by the amount of exercise (therapy) a patient can tolerate in a day. If a stay is preceded by a hospital stay of 3 or more days, it will be paid for by MediCARE for 100 days; the last 80 of which you pay 20%. After that, if you need to stay it becomes 100% private pay, or if you are qualified, Medicaid will pay (although you may have to move to a shared room with beds licensed for Medicaid).
Nursing Home, on the other hand, is a term usually reserved for facilities where patients live permanently - a LTCC. It is important to understand that Medicare will not pay for long term care (other than the 100 days following a prior 3-day hospital admittance). Nursing homes are paid for privately unless the resident has applied for and been approved for MediCAID.
If you must go to a Nursing Home for long-term care and have assets like homes or investments that have not been properly protected through estate planning, the nursing home will take it all and it may be too late to protect anything. On the other hand, proper estate planning done in advance will stretch your resources for your own use while protecting part of your estate for your descendants. We always ask clients about estate planning and, if appropriate, refer them to elder law attorneys we know and trust.
While most people in a nursing home are not there for dementia, there are some who are but very few MC (AL) communities have Medicaid beds, meaning the resident must go to a nursing home that handles MC once their money runs out. Sadly, most Nursing Homes do not have secure MC areas so even if you do have some choices, beds are limited and demand is rising rapidly.
Next: A look at different pricing models that LTCC's use.