EPISODE 4 - How to know when to consider Memory Care for a loved one.

Here we take a deep dive into dementia and Alzheimer’s in consideration of assisted living and memory care. No two cases are the same, but we hope to give you some insight into when to make those hard decisions, and explain the risks of waiting too long. We call this the ‘Sweet Spot.’

Transcript

 Hi, this is Jamie Callahan with the Team Senior Podcast. Our goal is to simplify aging society, grooms us to plan for retirement, but what about life beyond retirement, where the rubber meets the road? Perhaps you've had a stroke or you've been diagnosed with cancer, or maybe you're forgetting things and now you have dementia.

That's our area of expertise, and we are here to share our insight. And now the Team Senior podcast. Hi, this is Jamie Callahan with Team Senior, and today we're gonna talk a little bit about how to know when you, it's appropriate to move your loved one into memory care. This is a very difficult topic for most families.

To consider because sometimes when an individual is diagnosed with dementia or Alzheimer's, they're still very physically capable. And so moving them into an assisted living or a memory care community sometimes feels like a betrayal of. Maintaining their individual integrity in terms of the individual that would be moving into memory care.

But there are definitely some things that you need to know. And so I wanna go over those today. And then of course, I always like to encourage you to remember that you don't have to remember everything that I'm gonna share with you right now. All you need to retain is contact information for team Senior if you ever have any questions.

Even the simplest question, you are welcome to give us a call and we'll help you take a deep dive into your personal circumstances. So I wanna dive right into knowing the importance of having a memory care diagnosis. And that is critical in consideration of memory care communities because there is a law, a legality that revolves around those types of communities.

And memory care is important in consideration of dementia and Alzheimer's because they have a locked facility. What we found is that folks that have dementia or Alzheimer's, if they leave. They many times cannot find their way back. So it's very important that we have locked doors in both the front and the back.

I wanna talk with you about this today though, because families oftentimes feel that they wanna keep their loved one at home for as long as possible. And sometimes too, they're not pursuing those diagnoses with the doctor because they feel that they can care for their loved one at home indefinitely.

But when things start to get difficult it's never too late to get the diagnosis in place, but it becomes more challenging because sometimes there's agitation aggression, increased anxiety. Just simply getting that person to the doctor to get that diagnosis in place at that point might become more challenging than you could ever anticipate right now today.

It's also very important because those communities, those memory care communities need. To have that diagnosis in place in order to admit them. Something that you need to get in place before you ever get a diagnosis is power of attorney, because the assumption is that. When someone that has a dementia diagnosis moves into memory care, they can't they don't have capacity to say, yeah, I'll pay the bill every month, or sign the contract to move them in.

So someone needs to have power of attorney for them to move in. In other segments, we're gonna talk about. Power of attorney and guardianship and conservatorship. All of those things can help execute someone moving into memory care. But again, it is very important for you to have power of attorney in place and a diagnosis of dementia or Alzheimer's in order for someone to move into memory care.

So let's assume that you have all of that in place for a minute, and let's talk about finding that. Sweet spot of when to decide to move mom or dad or perhaps it's your spouse, or help your neighbors navigate what that looks like. What we hear very often is that I wanna keep my loved one at home for as long as humanly possible.

And while everyone in the long-term care and healthcare community wants to honor that, there is a risk in waiting too long. If this person that needs to go to memory care becomes a high acuity of care, let's say, for example, that they have wound care or they now are bedbound or they are a BRI diabetic or any of those things, I can't say enough times that at the rate that our population is aging, which is approximately 14,000 people a day that are turning 65, supply and demand is at risk right now. So when you need memory care, there might not be a place for your loved one to go. So that's part of the equation when we look at.

Pulling the trigger on moving that individual in the sweet spot. So let's go back to diagnosis and conditions that might interfere with your ability to find care for them when the care becomes very high. Like this person. That has dementia needs a lot of additional supports in place in order for them to just survive in their room in memory care, it's going to be difficult to find a place that wants to care for them.

Sometimes, even if that individual has. 10, 20, $30,000 a month that they could spend on memory care when their healthcare needs then become combined with behavioral challenges like agitation, verbal aggression, increased anxiety, elopement risk. I. Maybe being inappropriate in any way with the staff or other residents, it will become increasingly difficult to find a memory care community that will take them.

So common misconception in the community is that they're a memory care community and they should admit my loved one because all of these behaviors or healthcare challenges are as a direct result of them having this memory care diagnosis. But the simple fact is that they get to pick and choose.

I'm a memory care community owner. I'm not, but I'm. Pretending for a second that I am, and I have 15 rooms that can accommodate someone with a dementia diagnosis. And right now I have two rooms available, but I have 10 people that want those two rooms. I am going to choose the residents that are the highest functioning before I'm going to look at residents that are going to create a problem for my staff or other residents or have lots of, required caregiving needs. So that's a part of the sweet spot here. When we look at when you want to execute the move for somebody that has a memory care diagnosis, you don't want to wait so long that I. Their healthcare needs or their behavioral needs become such a challenge that they too now, meaning the community, they don't want to take care of your loved one now that it's become very hard for you to take care of your loved one.

So that's something that you definitely want to keep in mind. We also wanna talk a little bit about. What the pay source looks like in consideration of moving someone into memory care. Oftentimes when I get that first phone call from a family and we are navigating, how are you going to pay privately what it costs for your loved one to move into memory care.

Memory care right now starts at about $7,500 a month depending on the setting. That's the private pay rate. Many are going up to pretty stationary rates of 8,500 or 10,000. That is super common. So when I'm talking with a family that is going to need to put in an application for Medicaid, I always want to encourage them to consider moving in under the private pay umbrella because it does open your.

Possibilities of being considered. Again, you have two rooms available, meaning that memory care facility, and they're looking at 10 possibilities that could take those two rooms. They're going to consider admitting a private pay resident before they consider admitting a Medicaid resident. And the reason is that the Medicaid pay rate is significantly lower than the private pay rate.

So Medicaid in a memory care setting that charges $8,500 a month. For your loved one to live there would only be compensated under the Medicaid umbrella about 7,000, maybe a little shy of $7,000 a month. And so you can see why they would be motivated to take that private pay person. But I will also share with you that part of my initial dialogue when I get these incoming phone calls is to ask when someone says, my dad, who is losing his memory and he has a dementia diagnosis.

And we think he needs assisted living. If I can pivot to memory care, I will do that every single time. And the reason that we immediately go there in consideration of Medicaid is because memory care communities actually receive a higher pay rate for a Medicaid resident than they do for assisted living.

So let's take dad. Who has dementia, and we're gonna look at two different one bedroom apartments with a private bathroom. One is in assisted living and one is in memory care. If dad is receiving Medicaid in the assisted living community, the assisted living community is only going to receive maybe.

2,500 or $3,000 a month under the Medicaid umbrella, whereas in that exact same bedroom, they could offer that room to somebody that is paying privately for probably somewhere between five and $8,000. Major disparity. So it is very difficult to move someone into assisted living that is under the Medicaid umbrella because the pay rate is so much lower.

But in memory care if we can move them to memory care, the pay rate is it closes the gap a little bit. So if it's 8,500 for a private pay person to live there, but I know the Medicaid rate is going to compensate that memory care community approximately $7,000 a month. You can see that the disparity is only about $1,500.

And so the likelihood of me being able to convince a. Memory care community. To take somebody that is straight Medicaid or is going to spend down or convert to Medicaid anytime in the near future is going to be much, much easier. So that's a part of the puzzle that, I wanna plant that seed, but I also want to share with you, again, you don't have to remember all of this, all you need to remember is to call us.

We can in five minutes, walk you through all the things that you need to know just basically by asking a few key questions about your personal situation. Sometimes when we're helping folks on the backend. So all of these things have already come together and you're moving dad or your spouse, or you're assisting your neighbors and moving someone into memory care, and you're wondering, first of all, how are you gonna convince them?

I. To go to memory care or how are you going to help them feel like these are their familiar surroundings when they get there? We coach families all the time on how to prepare the room for that individual. We want you to bring. Prior to the day of move familiar photos, particularly photos of their parents familiar smells, maybe music playing that's familiar to them.

Maybe an artist that they really liked when you first walk them into that room. Celebrate the move if it's. An opportunity where you can create an environment where they walk in and they see faces there that they still recognize. And then what we would recommend is that kind of one by one.

Perhaps folks try to exit so that they don't see everybody leave all at once. What we wanna do is we want to be able to argue, we wanna give the staff the tools also to make the argument when this person that has a dementia diagnosis, your loved one when they start saying, this isn't my home.

I want to go home. When are my parents picking me up? When is my wife picking me up? Or whatever that looks like, we wanna be able to lead them back. Into that bedroom and show them that they do live here. Here's the pictures of your parents on the wall. It smells like things that they're very familiar with from maybe their childhood.

We want to create an environment where while we all know that this is not their home, that bedroom reflects something very similar to what they might have been living in their own home. So this is a good segue for me to share a personal story that I experienced in my own family. My brother-in-law, so my husband's brother.

His name is Craig. He's since passed away. Absolutely lovely human being. He was a record producer for his entire life, and he had some absolutely fabulous stories to share. I can remember sitting in front of the television in the years leading up to his passing and us having to move him into memory care and watching some documentaries that had been made on Netflix.

And he recognized so many of the people that were in these documentaries, like Mary Chapin Carpenter who had been in his living room and another, other real. Really big artists that you and I, just intrinsically know. So he, retained his older memories, but not his. Most recent memories, and that's very common for people to know, is that you, when someone has dementia or Alzheimer's, they oftentimes lose their memories in the reverse order of what they learned them in.

So in a perfect example of that would be if you are a husband who has kids you. The husband that has dementia is going to first forget their children because they came last. Then they're going to forget their spouse. They'll forget their parents last because they knew their parents first so many times.

What we witness with somebody that has dementia, when it gets very progressive, they start asking questions like, when are my parents going to come and pick me? Me up. The person that's saying that might be 95 years old, so clearly their parents probably passed many years prior. But again, because when somebody has dementia, they forget things in the reverse order of what they learned them in.

So taking my brother-in-law into consideration he, remembered his brother my husband very well, but he didn't remember really anybody else in the family for the most part. Part. So when the time came to move him into memory care, we set the stage for obviously moving all of his familiar possessions into his bedroom.

But we also took this opportunity to. Share with him that we were taking him out for sushi. That's his absolute favorite food. And rather than going to a sushi restaurant, we had lots of different players involved here. We sent one person to get a whole bunch of his favorite sushi, and we set up this party-like environment in his room at the memory care facility that we moved him into.

And lots of familiar faces were there that he knew from when he was in high school. And folks. That we knew that he interacted with still on a semi-regular basis that he would know. So it felt very welcoming and warm when he walked into that room. And then of course we shared a meal with him, his favorite food.

We played some records from folks that he had produced music for, and slowly but surely, one or two people left that room at a time and eventually we were all able to leave and eventually he. Was there in a space that felt very good to him, and it was weeks before the question even came from him that he wasn't sure that was where he belonged.

And you should understand that he was still pretty high functioning. Could carry on a great conversation. Still walked his dog on a semi-regular basis, but we also knew that. We had received many phone calls from the sheriff's department who had found him when he had gone missing or he had fallen down in his driveway.

He couldn't really feed himself anymore. Laundry wasn't getting done. Incontinence had become a thing. And so we knew that. He needed to move and because of my expertise, we were able to execute that without there being an issue. And I am sharing that with you because he was also a very aggressive communicator when he didn't like something.

Something. In fact, when he moved into memory care, things did escalate with his diagnosis to the point where he was becoming somewhat combative with the staff. And that's where, we really start communicating with the. Physician around how to develop the right cocktail for somebody that allows them the highest level of integrity and independence, but just taking off that edge of aggression so that they can continue to thrive and live a very fulfilling life without being comatose.

And I will tell you there are a number of communities that do not do that well. There are a lot of facilities that are absolutely fabulous at this and there are a couple of different communities that have physicians that rotate in and their specialty is really dementia and Alzheimer's, and they help the family and the facility and the person that requires this kind of care to navigate this with the absolute highest level of grace.

So I just wanna again, assure you that we are barely scratching the surface here in terms of information that I could share with you around how to identify the sweet spot. But what I really wanna encourage you to take away from this is don't wait too long because it is very often that we start hearing from a family who has a loved one that we know is probably pretty close to needing to move into memory care.

But they wait until there's been a substantial fall and now there's lots of healthcare needs. Or the person goes to the hospital and they were very aggressive with their spouse, and now that aggression is documented in their medical records that they punched the son and they tried to strangle the wife and they ripped out their IV on the way to the hospital.

What I can tell you is that when those types of behaviors get documented into someone's medical records, because you waited. So long to execute the move into memory care. Again, remember that statistic. The facility only has two rooms available at the rate that folks are aging and needing memory care.

They get to decide who they want to admit, and they don't want to admit that person. It becomes very difficult for us to find somebody that will, a community. To find a community that will admit someone that has documented behaviors in their medical records. And so that's another area where we really coach families on.

If somebody is going to the hospital and they have those types of behaviors in place, make sure it's very clear that, if dad became really aggressive and beat up mom, maybe dad had a UTI, but it has to be very well documented in his medical records that the behaviors were a direct result of the UTI and now that the UTI is resolved, dad doesn't have those behaviors anymore because if it's not documented that way and it just looks like dad is a monster, there is no memory care community that is going to want to admit dad.

So that's a really important part of the puzzle. Again, you don't have to remember all of this. We are extremely accessible. I always encourage folks to call if they have any questions. Again we essentially answer the phone every single day of the week. And we are a pretty robust team of folks that can get you connected with essentially any resource you would need, even in consideration of keeping data at home for as long as you would like.

Again, this is Jamie Callahan. I'm gonna wrap it up and I look very much forward to chatting with you again next week. Thank you for listening to the Team Senior podcast. We're here every week sharing new and relevant information. Remember that we're just a phone call away. Team Senior can be reached at 541- 295-8230.

Again, 5 4 1 2 9 5 82 30. Until next time, this is Jamie Callahan.