Inspired by this thread: Euthanasia of dementia patients - Great Debates - Straight Dope Message Board
If you can’t be in your own home and you can afford
private pay…are the memory care “communities” of assisted living facilities
much nicer than Medicaid-funded skilled nursing homes? Some of them
even offer private studio apartments.
My mother spent her last 13 months in a very nice memory care facility The place was well staffed, had decent rooms, and people were well cared for. Her Long Term Care insurance paid for all of it. (she bought the policy in the 1980s. Probably couldn’t get one like it today)
I wouldn’t want to live there, but it wasn’t hell on earth.
I’m hoping I can afford in-home care.
I would hope that something quick and painless would happen to me before my dementia progressed to a point where I was aware of it.
(And even before that if I got fronto-temporal dementia, because one of the characteristics of that very cruel disease is that people’s self-awareness is the first thing to decline.)
Probably a place like this Dutch Village:
The place is designed like a little village. The residents can wander around familiar surroundings like the shop, park, restaurant, etc. They have a pretty good quality of life even though they have dementia.
Thank you for your responses!
I honestly think the best place to end up if you’re old with dementia is six feet under.
I agree with that statement, but I am also aware of the fact that despite many people saying this, few seem to kill themselves. I wonder why this is so, or if it is so at all (maybe the suicide cases are declared as accidents or otherwise misreported?).
No you cannot. LTC insurance used to be great, but that was because the actuaries totally fucked up the pricing. Once data started coming in on how the policies were used, the policies were severely cut back in benefits and the premiums increased quite a bit.
My mother had in home care. Her mother was in a nice memory care facility. They both have advantages and disadvantages. Dementia sucks.
We just went thru this with my father-in-law. MIL didn’t want him in any facility, not that they could have afforded it. Instead, my husband was constantly driving to their place to help his mother when his dad became unreasonable or violent. His mom was sure if they found the right pill, he’d be OK. We were researching facilities and had it not been for her, that would have been our plan. We know we’re not equipped or able to deal with who FIL had become. The kind, gentle man he was became a foul-mouthed, vicious creature who attacked his wife of 73 years.
As cold as this sounds, we were fortunate in that he fell and hit his head, then wound up in the ER and the hospital. He was brought home for hospice and died within a week.
Dementia well and truly sucks. My husband is now fretting that the same thing will happen to him and he doesn’t want me to have to deal with it. Time will tell…
Facilities vary widely.
It pays to investigate.
All are expensive.
I work in the insurance industry. An underwriter told me that when he considered insuring a facility, the first thing he did was visit it. And the number one thing he paid attention to was whether it smelled of stale urine.
Facilities vary a LOT.
Yes, and the turnover in staff can be enormous. So a very well-run facility can pretty quickly turn into a not-well-run facility if they change administrators, directors of nursing, or just have a big exodus of their competent nursing staff.
As far as facilities go - anything is likely to be better than a Medicaid -funded nursing home. There’s an independent living/assisted living community I’ve looked at - it starts at $4325/mo for independent living and $7920 for assisted living. It’s possible that this is a particularly luxurious set-up ( it’s definitely apartments rather than rooms) but it’s hard to imagine that memory care will be less expensive. * And that means “can afford private pay” is going to be a sticking point - those prices are almost certainly for one person in a studio apartment. I have a good pension and both my husband and I will have social security and retirement savings and there’s still no way I can be sure we can afford even assisted living for both of us indefinitely. For a couple of years, sure - but people in my family tend to live into their late 80s and even 90s. I can only hope that if I live into my 90s as they did that I can also live relatively independently into my 90s like they did. They didn’t all live alone but for the most part they were able to stay out of institutions by living with their children.
* I know everything is more expensive in the NYC area - but my kids are in the NYC area and there’s no way I will end up in a facility far from them.
So… Don’t live too long?
My grandmother’s place stayed pretty similar for several years, fwiw. I hated it, mostly because i hated what she had become. But in many ways it was a good place for her. She really liked the organized activities. They did arts and crafts and exercises like you might do with little kids, and those gave her pleasure.
Yeah, pretty much. I think the average “stay” at a long-term care facility is at most a year or two, although some certainly stay longer.
And I don’t mean to knock these facilities. While expensive they do provide a critical service to patients that just can’t remain at home. Most of the really bad stories I hear from my wife, who works in the field, come from patients that stayed at home for too long rather than from patients that are in sub-par facilities.
As to which are “the best”? From what I’ve seen it pretty much comes down to “you get what you pay for”. The more you spend, the better it will be, broadly speaking.
Googling for the cost of memory care facilities, I’m finding that they can cost $5,000 to $10,000 per month. I think they’re more expensive than “regular” nursing homes. So I’m guessing the best place to end up if you develop dementia is to start with a fat bank account.
Definitely the correct answer - for everyone involved.
But there are plenty of places that are happy to take as much money as you are willing to give them, to warehouse the sell of a human in luxurious surroundings. Beyond a certain point, I honestly do not know how much difference it makes to the dent patient how nice a space is. IMO, A LOT beyond simple cleanliness, health, and safety is for the family members.
I have not heard of a single situation in which caring for someone with advanced dementia at home impressed me as a favorable open-ended situation. Sure, there were fleeting moments where the old person seemed to derive comfort from the familiar surroundings, but there were far more moments of just vegetation, and far too frequent moments of fear and distress - which seemed unavoidable no matter what lengths the family went to.
Because the vast majority of people fail to plan, do not wish to anticipate such an eventuality, and are selfish about what others ought to do to care/pay for their needs/wants.
When you say “many people say this,” do you really suspect that is a sizable percentage of people? Because I have heard far more people say they want extreme steps taken. At the most, some people will execute living wills/DNRs, expressing a wish that no extreme measures be taken.
It always seems odd to me, that so many folk profess to believe in a wonderful afterlife, yet seem so reluctant to get there! 
Well, there’s always your children’s homes. Ugh
Bad, bad, bad
Yes, I believe so. But my observations are admittedly just anecdotical: all my friends, and all acquaintances that have had first hand experience with a family member who had alzheimer that I have spoken to about this subject. The score is in the mid double digits to nil.
Plus the cognitive bias that stems from my conviction that alzheimer is about the worst thing that can happen to a person, at about the same level as a devastating stroke that leaves one paralized, incontinent and mentally impaired.