A colleague asked for advice about placement for his father-in-law, who was in an independent living facility, also known as retirement community, where was being assisted with bathing, grooming, medication management, and other necessary functions. He stated that Dad had “advanced dementia,” but was “not ready for NH/lock down placement.” There are alternatives that could be explored, but “advanced dementia” and “not ready for NH/lock down placement” are mutually exclusive. If Dad has advanced dementia he will need to be in a locked ward of some kind. Whether the facility is a “nursing home” or “assisted living facility” or “protective bed-and-breakfast” is more semantic than existential. The family will have to get past their resolution that they will “never put Dad in a nursing home.”
Dad will not care what the place is called. He needs three hots, a cot, and a code pad on the door. There are excellent “assisted living facilities” that are adapted for dementia care. They are generally less expensive than long-term care facilities but they are usually not certified for Medicaid. A “nursing home” will cost more, but Medicaid would be available (if the family does not buy the line about a two-year waiting list). Dad would be just as comfortable at the nursing home as at the ALF. Furthermore, well-run LTCFs will have activities for the residents similar to those at ALFs. It would be the family members who would feel guilty about putting Dad in a “nursing home.”
The most important consideration is whether Dad will be able to stay where he is placed. It is far better to put Dad in a nursing home and let him get used to it than to place him where it is a little less restrictive and then have to move him again. Moves for dementia patients are devastating. Dad has already been uprooted from his community and put into an “independent – but not really – living facility.” If he is now moved to an ALF and later to an LTCF, that is three moves when two are already too many. The third move would be particularly harmful because his dementia would be more advanced. Is it more merciful to cut off the hand one finger at a time than all at once?
It is necessary to take the long view. If Dad will already has significant dementia, moving him gradually from one placement to another that is only slightly less restrictive is doing him no favors. Resisting a placement because it is called a “nursing home” is unrealistic and counterproductive. Place Dad where he will be comfortable and protected, without regard to what the facility is called.
John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
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