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Hi . My dad has been diagnosed w aggressive bladder cancer w a prognosis of 6 months or less. I tried to get him to move up to New York w me many times and drs tried too to no avail. He’s sold his conson4 months ago before diagnosis, moved to independent living and needed more care than that after 5 days there he wound up in hospital and this has been followed by more hospital stays, stints in rehab and I’ve moved him at his reequest to 2 different assisted living facilities. Currently he’s in rehab trying to get enough strength to get himself at least out of bed. He’s deconditiined not due to cancer, but long hospital stays . His mind is sharp and his will is strong. He would not do well in a nursing home. There are some places that do assisted ( he’s in Philly burbs) living that is enhanced. And he’ll have a hospice nurse. If the assisted takes him, what are things to consider in terms of care at assisted vs nursing home.? The rehab he’s in also does skilled and honestly he just lays there all day waiting for their crappy food . I don’t see many great benefits. Looking at all options - maybe assisted with hospice and then a nurse or caregiver once a day ? He has Medicare and a supplemental and I’m investigating the VA because he was a marine at camp lajeune so he has decent insurance but that all goes away w a nursing home. Thanks.

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Is he not getting physical therapy in rehab?

Is he in acute or sub-acute rehab? If he is strong enough to get re-conditioned, he should be in acute.

What "goes away" if he goes to a NH?
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I am really sorry that your dad is going through this.

My father had bladder cancer but he caught it early and went into remission. Later on he suffered from heart disease and a stroke.

My father was given a few choices for him to select a rehab. Was your dad given a choice of where to go for his rehab services?

If it’s possible, it helps to research facilities beforehand. Even so, there can still be problems that arise that will need addressing.

Some assisted living facilities do offer rehab services. Are you interested in moving your dad to assisted living that has rehab services? Do you feel that he is capable of participating in rehab?

Wishing you luck in finding a place where your father is comfortable.
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Board and Care may be an option if they are prepared to deal with a dying patient, and in facility hospice is another option tho they are currently as rare as hen's teeth. Have you discussed with your father what care he would prefer for end of life care? He is going to have very intensive needs for care as this progresses and will be both more bedbound and more ill, with more needs for medication. You may be looking at Skilled Nursing Facility as I doubt a nursing home will be able to handle this near end of life.
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Buffalogal Dec 6, 2023
Thx for your response. The last assisted living he was in said they could take care of him but I know that no no facility is going to be “ great”. I don’t think he will ever be out of bed again and I see him deteriorating quickly. The new place we’re lookg at said they provide “ age in place” and they have bedbound guests and they allow hospice. Hospice can come in 5xs a week . I just don’t want him having to move again. The issue now is his mind is all there and so is his will, which makes this all harder
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The difference between assisted living and board and care facilities is size. Assisted living has 100 to 200 beds and one caregiver for 10 to 12 residents. Board & care facilities typically have between 6 and 12 beds. Typical staffing is usually two caregivers for three residents so your family member gets a lot more care. With hospice on board, all of their needs will be met. Most Board and Cares are in a home and a home like environment with fresh cooked meals three times daily. They have the exact same license that assisted living facilities have that are larger.
They are all private pay unless there is a Medicaid waiver in place.
Aide and attendance is what vets can apply for which will pay for their care in assisted living/ boarding care/ nursing home. You need to find out which facilities accept aide and attendance and the process to get it is tedious.
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Igloocar Dec 10, 2023
I understood the question to be the difference between an AL and a nursing home. The expected level of care is different between AL and nursing, regardless of size. There are variations in ALs in terms of the amount of care they provide; in some ALs, you pay according to the level of care. A nursing home can provide 24-hour care, but in an AL, you must be able to provide some level of your care yourself.
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This answer is in response to what you said about hospice in the facility you liked. I don't believe hospice ever comes as often as 5x/week, but I could be wrong. Hospice does NOT take over the care of the person in hospice; he/she will still need overall care. And as someone else asked, what "goes away" for your father with a nursing home?
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AlvaDeer Dec 10, 2023
You are correct, Igloo. Hospice used to run itself according to patient needs. It is now rote. It is by the numbers and they are being bought up by hedge funds fast as anything. That means they are about profit. Medicare pays huge sums for the 2-3 baths a week, 1 hour long RN visit, magic morphine bottle, call from Social Worker and call from Clergy. That's IT. If you need 24/7 care they won't even accept you without it and in facility almost non existant now. I have seen these changes. When hospice came to us during my nursing career from across the pond I was so thrilled. Now it is a shadow of itself. Sad. But true. And all we have.
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Sounds like he could do well in AL with private aides during the day to get him up and out of his room so that he can still participate in activities and interact with other people. He will also need hospice care as his medical situation worsens. This is an expensive path, but if the resources are there it will improve his quality of life for as long as he has.
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My 95 year old Mom is in an assisted living facility that provides enhanced care, in a small portion of the facility. Her mind is good, but she remains in a wheelchair. We didn't feel that a nursing home would suit her either.
If you can find a facility like that, it might be suitable for your dad. It would be very costly.
Best wishes
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lealonnie1 Dec 10, 2023
Morningstar Assisted Living facilities provide that sort of extended care, too. They are located in various parts of the country.
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Buffalogal: Perhaps he can find residence in a Board and Care.
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This may or may not help you although it could benefit others:
It doesn't specifically address your question 'if' there is something / some level of care 'in-between' these two. These are more about definitions and care provided.

The major difference assisted living has as a nursing home alternative is the type of care provided at the community. Assisted living is a great option for seniors who need extra support or assistance with day-to-day tasks. A skilled nursing or healthcare community, once referred to as a nursing home, offers more comprehensive support to seniors with extensive medical needs.

What Is Assisted Living?

Assisted living communities offer community living in a non-clinical environment. They can also offer some medical support services, help with diet and nutrition issues, and assist with incontinence. In most assisted living communities, a licensed nurse completes a comprehensive individualized assessment for each resident, and caregiving staff is on-site or accessible 24 hours a day.

Geriatricians and other healthcare professionals, such as dentists or chiropractors, will often see clients on-site. Some assisted living communities have even started offering physical and occupational therapy or wellness rooms supervised by licensed nurses.

Additionally, some assisted living communities offer specialized memory care units for those living with cognitive decline. A memory care solution is ideal for someone who has been diagnosed with Alzheimer’s disease or another type of dementia because staff members are trained in best practices of care and family members can get additional support and education.

It’s important to ask about the types of care the community offers, especially if your loved one has a chronic or progressive medical condition. Some assisted living communities provide different levels of care and support based on what each resident needs, and they many offer a continuum of care by contracting with skilled nursing companies or offering an on-site nursing home for residents whose support needs change.

Similar to skilled nursing or healthcare communities, assisted living communities deliver personal care, light housekeeping, and laundry. They also offer on-site restaurants that serve three meals a day, including special meals for those with medical conditions such as diabetes. In addition, both types of residential alternatives are equipped with safety systems, such as emergency pull cords.

Determining if It Is time for Assisted Living-An assisted living community is a good choice for a senior who needs additional support with their activities of daily living (ADLs). These activities may include dressing, showering, grooming, and toileting. Assisted living communities also provide socialization opportunities through events, programs, and excursions that make it easy to connect with neighbors and explore the greater community.

It might be time to explore assisted living if you or your loved one:

Has fallen in the past six months.
Lives with chronic pain or a complex medication condition.
Struggles with medication management.
Feels lonely, isolated, depressed, or anxious.
Struggles with nutritional needs, such as grocery shopping, meal preparation, or healthy eating.
Needs a helping hand when it comes to daily personal care or household upkeep.

Who Can Benefit From Assisted Living?

An assisted living community is a terrific match for someone who has some health problems or needs help with tasks such as bathing and dressing. Many seniors who choose assisted living remain independent aside from a few daily tasks. In fact, some assisted living residents drive their own cars, cook some of their own meals, and come and go on their own schedules.

Thanks to personalized care plans, residents of assisted living communities experience enhanced independence and a newfound peace of mind. Residents all have unique needs and preferences.

Gena / Touch Matters
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