When is skilled nursing a better option than memory care?

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When is skilled nursing a better option than memory care?

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My sister has dementia and is bedridden and incontinent. She is in memory care now and really needs a physician and/or r.n. on staff because of her combative resistance to go doctor. Really would appreciate some advice.

Alzheimer's & Dementia Memory Care Refusing Care Skilled Nursing Facility

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Usually every facility has a doctor that oversees it. If she has a medical problem, bring it to the attention of the overseeing doctor. If she is combative, that can also be evaluated and treated by the medical staff... or a referral can be made for a psychiatrist to evaluate and treat.

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My sister's AL has a 24-hour nursing staff, but a doctor only comes in two days a week--and it's a PA, not a regular doctor. Honestly I am not sure the PA can really fill the same space as sister's regular doctor did, but we will see.

My MIL who is in IL sometimes has a doctor come to her through her Medicare plan. They have come to do x-rays, for instance. And telemedicine is big right now too. I have no idea if Medicare might offer a combination of "outside the box" approaches that might work for your sister. Perhaps the staff nurses would be willing to get involved, and work with a doctor through telemedicine/zoom calls.

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I can't imagine there's any nursing home anywhere that doesn't have a doctor on the staff. They aren't there 24/7, but that isn't necessary. Nurses do the lion's share of the work day in and day out.

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This is so true! Nurses and aides do the majority of the work.

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Hi. I would say it depends on her medical needs. Most memory care units have doctors who make rounds and some may arrange for labs or even X-rays (on occasion) to go there. But for consistent medical followup in the community she may need to go to a nursing home (what skilled nursing is called when they stay long term). They have more medical oversight and perform more treatments.
Best wishes 🙏🏽

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I used to attend an in person caregiver group and two women who attended had husbands who were told that their care required them to be in a skilled nursing home. Previously, they were in an assisted living facility. If they need special care they will be asked to leave assisted living or memory care.

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If she has been diagnosed with dementia, you should be able to get a Power of Attorney to grant you the ability to make medical decisions on her behalf. Including medications that make her less combative.

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POA must be assigned by the patient prior to becoming incapacitated. This patient sounds like she is incapacitated.

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Is she combative if you go with her? Is it only if she goes with someone she doesn't know? Could it be the doctor?

There are facilities that have their own medical group that will come to the facility and draw blood, see patients, etc.

I don't think it matters what the name of the kind of care that the place gives. It matters more what services they provide and how they treat their patients.

If your sister has her own PCP, like the others, I suggest you talk to her PCP. She might not be accepted at a place because of her combative resistance in addition to the level of care that she needs.

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Medsister: Pose your question to her primary care physician.

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Please make her an appointment with a Gastroenterologist and a Geriatric Psychiatrist who can prescribe meds to bring her combativeness to a simmer. These appointments may be available on Zoom.

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depends on your income.....going on medicade?

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Her care should still be consulted through her PCP
( primary care physician) . even though she is in a
" memory care" unit ( it sounds like from your description), her PCP should still be conferred re any other
" medical " care she needs; when you say she " won't go to the Dr." and is combative, these are unfortunately behaviors common to dementia patients. The
" memory care" facility she is residing in should be able and required to confer with her PCP and, arrange for her care on site or arrange for transport services to take her for other medical needs.
It is very UNSAFE, for her
( any dementia patient) to be transported by family in a car to doctor appointments. And, it is UNSAFE for family to try and do so.
If you are her POA, please confer with the facility staff and administration to arrange for them to confer with her PCP and arrange a POC ( plan of care) .
The POA, should be advised and included in regularly scheduled " patient care planning" meetings that facilities have ; ask about these if you are not presently being notified. Also, if you are the POA, call her PCP, yourself if needed to further advance the needs, behaviors you are observing.

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My DH aunt has dementia and is bedbound and incontinent. She is in a SNF. She is also on hospice. So she has a hospice RN and doctor and the NP that comes with the NH plus she has her own geriatric primary that we zoom with. Call around to other facilities in your area and see what services they offer.
Services are not all the same across the country.
You might be able to do zoom where she is now if her primary participates. It works well for aunt.
My idea of memory care is that more hands on is available than with SNF. However the hospice service she has provides a CNA that she has had over 10 years so there is a comfort level there. So each situation is different.

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Sorry your sister has dementia. Can the memory care nurses reach out to her PCP for a script for her combativeness? Or you?

I would imagine that the MC is used to dealing with this and should be able to give you some advice. Until her physical needs become too much for MC to handle, MC might be a better choice. Or if she starts to run out of money, then it will become a necessity.

Good luck.

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Thank you for your answer. My sister is totally dependent on others to care for her. She is fed, diapered and bathed like a baby. I am her POA and she only has one other sister. In our state, Skilled Nursing Facilities and Memory Care/Assisted Living Facilities have different requirements. The Memory Care/Assisted Living Facilities do not accept Medicaid in our area. My sister does have LTC insurance which helps a great deal. The memory care units here do not have physicians on staff but provide handicapped equipped vehicles for doctors appointments. Her physical condition along with dementia are making the office visits more and more difficult for her.

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Call her physician and also talk to the facility admins... usually LTC is assessed as medically necessary (and thus covered by Medicaid).

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Does a physician come to the memory care facility ? By me they do come at least once a week . Is she on any meds to calm her ? If memory care by you can not address her needs then I would think SNF is the next step. Good luck to you.
I see from your profile you have done a lot of caregiving . Bless you . It’s tough . Hug your spouse , kids , grandkids and take care of yourself .

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Not trying to argue but both the AL facilities my mother was in in 2 different states both had staff doctors. They weren't there every day but regularly dealt with issues as they arose.

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My sense of the situation from all I experienced with my late mother is that it is not likely a choice you can make but up to the facility to decide on placement. At the last facility my mother was in there was a resident whose daughter really wanted her mother in memory care but the facility had her in SN and would not put her in MC because she had an ileostomy bag. Not even sure that is the right spelling as I knew about colostomy bags but not the former.

I don't understand your statement of needing a doctor on staff as I find it hard to believe that a facility does not have one already there.

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Assisted living, of which memory care is a type of, do not typically, in my experience, have doctors on staff. SNF usually do.

When is skilled nursing a better option than memory care?

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