haileybug Asked December 2016
All of the facilities we have checked have denied my husbands brother. Why is this happening and what can we do?
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My husband's brother has dementia and needs to be placed in a skilled nursing home. However, all of the facilities we have checked have denied him, Why is this happening and what can we do?
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Has he been evaluated by a professional to see what level he needs. Most of the facilities that I know of require that a doctor or health care professional complete a form that states what daily activities the resident needs assistance with and of course, if they need skilled nursing care due to a physical problem. If he wanders, he may need a Secure facility. I'd read a lot about the differences in regular AL, Secure Memory Care AL and nursing homes.
I've never heard of a person not being able to find some facility that meets their needs, even if they have to get on a waiting list. I will say that depending on his level of dementia, he could need a Memory Care facility. You might explore that. They are focused on those with significant dementia. Some residents in them are mobile and can talk, while others are bedbound and have to be hand fed, so there are various levels. In the Secure Memory Care unit where my cousin resides, they do everything for the resident, except they do not provide skilled nursing care. As long as they do not require skilled nursing care, they live there until the time of their death. Hospice comes to the facility and they are kept comfortable and supported throughout the rest of their lives. You might visit some and see if they could accommodate his needs.
Sorry I don't have any better ideas. I haven't been in this situation.
If BIL is on Medicaid, the nursing homes that you are checking with my not accept Medicaid. Some facilities do not. Most of the places that I know of, try to assist the resident in finding a place to be transferred.
Who is in charge of your BIL? I'd have them ask a lot of questions. For example, are there any behavioral problems with BIL that has caused the facility to reject him?
Then you need to know ALL the details of his health history and any criminal history he may have. Nursing homes are now insisting on background checks on their patients prior to admission. They are insisting on checks for any communicable diseases including STD's.
Any history of assault, menacing or harassment is a real problem.
The folks trying to answer your questions here all have first hand experience - some of asked you some pretty basic information about your BIL which maybe due to your stress you're not capturing so in an effort to help organize your next steps I'll try to summarize
1 does anyone have power of attorney- health and financial
2 does BIL have financial resources or does he need government funding I.e., Medicaid not the same as Medicare
3 even if BIL doesn't walk much his behavior could be an issue - yelling and hitting
4 is BIL taking any meds for any health issues incl dementia and anxiety it causes
5 does BIL have his own doctor or is he using the ALF Doctor
My mom is in a private pay multi-state memory care facility - folks fall all the time - they cannot do IV or certain other things as they are licensed as an ALF not a SNF - they will put up with behavior issues to a point but they will call 911 to put someone on a 72 hour or longer psych hold
Try to provide us with a bit more information and the knowledgeable folks here may be able to better direct you
As one poster suggested please look for your county agency on aging - there should be a link to it on this site if you can't find it in the Internet
Don't give up hope - these are difficult problems to solve on your own
Doctor wants BIL out of AL, asap for the same reason, protect themselves and others. If horror for horror BIL has a fall and is seriously injured and the result of the fall causes his death, AL could be sued. Both doctor and AL want to avoid this.
But "JUST OUT OF MY CURIOUSITY" if "someone" with dementia had behavior problems and they have been in a facility for a couple of years, I am so certain that they would have that patient evaluated, on meds and a proper treatment plan to manage their behavior.
Now, on the other hand, these skilled nursing homes with a secured unit that says they "SPECIALIZE" in alzheimer's and dementia and they are special trained to "manage" behavior problems caused by Alzheimer's and dementia.
So great .... the patient with dementia that has been living in a ALF has received the care they need for their dementia is ready to transition to a skilled nursing facility that specializes in dementia and properly trained to manage any behavior problem. Okay, then that means there should be no problem, right? Wrong.
Besides, how is someone that not able in their body to be violent be harmful to someone else? It is impossible.
I'm surprised that the ALF never makes any contact with the family, only if family calls them. It is sad.
But I am so thankful that this support group has been so kind and generous to me and have offered so much good and helpful advice. It's just been so frustrating trying to do this without help. Thanks you all
Your last post does make me wonder about what your BIL is reporting. He may not be providing you accurate information, especially, if he is cognitively impaired. He may think he has made inquiries, when he has not.
He also may not want to live in a AL, NH or MC, so he reports that none are available. That would be my guess. If no one is authorized to act on his behalf, then I don't know how you can speak to them, unless you just call a place on your own and ask if they have an opening, costs, etc. just to get general information.
I understand your frustration and don't want to keep asking you to provide us with more information but it is difficult to try and answer your questions without knowing some of the basics
You can't assume that the ALF is in charge of BIL and will monitor and medicate him accordingly - is there a family member responsible for him or is he a ward of the state? Are there family care meetings being held every 6 months or so ?
Just because BIL doesn't walk doesn't mean he is not a harm to others or himself - he can yell kick punch and be non compliant with bathing and going to the toilet
The ALF is not responsible for creating a care plan - I don't hear from my mom's memory care unless there is a problem they need me to address but I'm in contact with them on a regular basis at least 3x a week either in person or on the phone
We want to help you
There is probably some information on BIL's report that shared with the facilities contacted, and not with you, hence the rejections. This can and does happen.
Often family has "willful blindness" when it comes to family (or politicians…). Then add onto this that BIL is in an AL so in theory he is still able to take care of his ADL's with assistance and is viewed as cognitive & capable in his decisions & actions. So its likely that whatever he is doing that the "problem" is viewed as beyond what this or any other AL or SNF will accept. If I had to venture a guess, probably something sexual.
If your hubs & you live miles away and BIL has been in a facility now for years, and you & your DH haven't been visiting every week or couple of weeks or taking a long weekend to visit every mo or so, then you don't have a relationship with nursing staff or the activities gal or the guy who does PT or workers who do evening meal clean-up to get off-the-record insight & "heads up" as to what's what with BIL.
So what to do, if it were me, I'd ask the DON (director of nursing) and social worker for an off-the-record meeting regarding BIL and tell them you are doing this as hubs will be seeking guardianship. If you do not have DPOA, MPOA or HIPPA authorization for BIL, they are very limited in what they can state or access you can have to his medical chart but they can share with you anecdotal insight …. like another resident complained that he was doing XYZ, or he has threatened residents or staff, or was found doing inappropriate behavior on an outing. For dementia some become hyper sexual. There's a lot of sex going on in facilities and it's a hard subject for both facilities and families to deal with (the NYT had a series on this last year). There are posts on this site from caregiver daughters or DIL who find that "dad" says sexually inappropriate things to them, exposes himself, etc. Stuff that nobody wants to talk about.
If this is the problem, then the choices are stark. He is going to need to be in a speciality locked ward LTC SNF. Unless you all really want to become his guardian and go the guardianship route with the expenses, mandated reporting, arranging for paying for his care, etc., pause and give some thought into having him made a ward of the state. You will have to work with the facility to get this done. Probably start with him sent to the ER/hospital for a involuntary psych evaluation and neither the facility or family picks him up. The code for this varies, like in CA it's a 5150, PA a 302, a "72 hr hold". For where I am in New Orleans, it still referred to as a "3rd floor" referring to the old 3rd fl locked psych ward of the Charity Hospital, which has been closed since Katrina (2005). The hospital then finds him a emergency placement via social services dept. Often in situations like this, being a ward of the state can actually be a good thing as the court-appointed guardian can get him placed into a facility much faster.
You need to find out an unbiased reality on what he is doing. Good luck.