A Place For Mom: The Best-Kept Secret in Long-Term Care

[NRSKarenRN, BSN, RN]

Assisted living becomes the patients "HOME". Under Medicare, when acute episodes of illness occurs, especially post hospitalization, ALF residents are eligible for skilled care via a home health agency.

Payment for Assisted Living Facility care is usually private pay. Some states are looking into medicaid payment in lieu of nursing home payment as a cost effective alternative.

I had my granmother in local facility just 6 blocks from my home. I repeatedly joke with my sons that I'm getting a red scooter if my arthritis worsens; if I'm unable to remain at home, make sure it turns left at the bottom of our street so I can zip into the ALF lobby to live.

[subee, MSN, CRNA]

At the point that 24/7 home care became cheaper than ALF, we admitted my mother to terrific facility. Her apt. had a lovely porch in the shade of palm trees. We were able to pay the first few months with the remains of her savings and were lucky enough so sell her apartment to pay for the rest. Medicare does NOT cover any cost of ALF.

[OnlybyHisgraceRN, ASN, RN]

I've worked at some beautiful ALF and some awful ones. I do love the idea of ALF and the independence the residents have.

[country mom]

Dear Viva: How is ALF different from Adult Foster Care? Thanks!

[Mulan]

As with anything else, make sure you do your research.

Owner of assisted living home charged with neglect - WCIV-TV | ABC News 4 - Charleston News, Sports, Weather

"NORTH CHARLESTON, S.C. (WCIV) -- The owner of Fair Havens Manor, an assisted living facility in North Charleston, was arrested Thursday morning and charged with neglect.

According to incident reports, the North Charleston Police Department was contacted by the South Carolina Long Term Care Ombudsman office.

The ombudsman office gave detailed reports and statements taken by their staff and told of one victim who was in such poor health that he had to be hospitalized immediately.

The report states that the victim was severely dehydrated and suffering from malnutrition along with having a 'subdural hematoma' on the back of his head that may need surgery."

"Every time I come here, the place is nasty. It's smelly and it shouldn't be that way," said Jackie Johnson who's brother lives at the facility. "It's not a good environment but this is the closest place we could find for him. Everybody there is sitting around in their little crampy room."

Thursday was not Magwood's first encounter with local law enforcement officers. In 2004, she was accused of beating and robbing a 65-year-old resident at a home she operated."

[Guest372004]

Assisted Living is NOT Skilled Nursing. Most assisted living facilities have extra help at a premium when needed. My parents were in assisted living for three years. The place was wonderful. The cost was huge. One needs to look at the entire picture. For instance, just having medications dispensed was $400/mo for each and my dad took about 4 pills/day. The cost for both of them with medication dispense was about $80K or more/year. One year when dad had to go to skilled nursing for a month, one month of care for both was $20K. My parents were not wealthy people. After dad died, I took mom in to live with me as all their funds were exhausted.

[VivaLasViejas, ASN, RN]

Dear Viva: How is ALF different from Adult Foster Care? Thanks!

ALFs are communal by nature....there can be anywhere from a dozen to hundreds of residents in a given community. AFC is usually done in a caregiver's own home with bare-bones staffing; it's definitely more intimate as they can take only a handful of residents, most of whom who need more extensive health services than is offered in ALF. A lot of residents in these settings have moderate to severe dementia or behavioral issues that a larger community cannot address, so they can be a godsend.

The advantage, obviously, is that residents in good AFCs receive more attention; the main disadvantage is the uneven quality of care in general. Some are wonderful---the caregivers really enjoy the residents and cook homestyle meals for them, sit and talk with them, do activities with them. Others, unfortunately, are basically dungeons where residents merely sit and stare at TV all day and there is little interaction with their caregivers, let alone the outside world. As an ALF nurse, I sometimes will recommend one or two of the local AFCs which I know to be good, as not everyone will do well in a large community such as ours.

[Ruby Vee, BSN]

I have nothing but wonderful things to say about the ALF where my mother lived for almost three years. The moment I walked into the bright, cheerful kitchen and dining room, I knew it was a special place. My mother's room was large, comfortable and clean. The staff were hard working and friendly, and they made Mom feel as if they loved her. They even took care of ME when I visited . . . confiding that the breakfasts at the Gretel's Griddle were the best in the county, but for dinner I should have a steak at the Farmer's Inn and even presenting me with a plate of bacon and eggs the morning I arrived well before Mother got up for the day. The time I drove across the country with my six month old pup and left him in the car (it was 20 degrees outside) so I could visit Mom before finding a place to stay, they insisted that I bring him inside and then all of the residents took turns throwing the ball for him to fetch. The place really was a home, and I cried when we had to move Mom to a higher level of care.

There are as many reasons for Mom to go to an ALF as there are Mom's and daughters, but even after decades in health care, I didn't know about them until we needed to move Mom out of her house. I am so thankful we found the place we did, and so grateful to the staff for making the place a real home.

[cienurse]

Assisted living communities are wonderful, for sure, but they come at a high cost. They take private pay only, and can exhaust a savings account very quickly. What they are also quick to do is to give families a 30 day notice of discharge when the funds are about to run out. I have given many tours at my LTC facility to families who have been told they need to find a place for their loved one who can no longer afford to be at the assisted living facility. For that reason, I have many residents who are very high functioning but who have outlived their savings accounts and now must live at a LTC facility paid by Medicaid.

[VivaLasViejas, ASN, RN]

My facility is about 40% Medicaid as of this writing. In fact, of the five companies I've worked for that manage ALFs, there have been none that took only private-pay residents.

[Guest372004]

I guess there are some medicaid out there.......but where my parents were it was strictly private pay. We even have skilled nursing here in CA that does not take medicaid/medicare. As for the ones who do, well one must get down to 2K left to qualify.