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My father-in-law was at home on Hospice care for about a year. Taking care of him the best they could was really wearing down his wife and 2 sons, and he was miserable, too.
Now, he's been in a wonderful NH for just over a year. His own health has improved to the point he's no longer on hospice. The staff treat him so well, keep track of what he's eating and doing. They get him up and dressed every day (which the family couldn't do).
He is encouraged to participate in activities as much as he is willing. He has some social interaction with other residents and staff.
He was private pay for a month while we got Medicaid approved. A large portion of the residents at his NH are on Medicaid, but the company owns a couple more facilities that are mostly private pay residents. I don't know if that enables them to hire and retain better staff, but it might.
My mother-in-law visits every other day, if she's able, making sure hearing aids have new batteries, etc. 
Although he'd never admit it, he's far better off there than at home, both physically and socially.
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GerryM, I am visiting her every day (she still in rehab) and I think I should visit may be every other day, she got more agitated with me because she starts immediately blames me in all troubles that she feel and I got almost in crying....When my son is with me, he sometimes send me to the library and after said observed that she is much more calmer than with me. i think that because she is she, she was completely depending and demanding on my dad and when he died, she came to live with me and became the same demanding on me...probably my fault for the last 15 years that I allow that and now she just taking advantage on it, although understanding much less because of dementia...So, of course I would visit often, I just think that may be less than now....I have helper who came every day to be with her 3 hours, she is much calmer with her, than with me...As to the stuff, they like her when she is good and they tired of her, when she is in bad mood, especially because they can not understand fully what does she want because of language barrier.
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The home in which my 93 y/o mother is living is not overly fancy but it's adequate, and she has been there nearly 5 years. Because she is bedridden, she wouldn't be in a position (both figuratively and literally!) to appreciate a fancier facility. The CNAs vary; there was one who had absolutely no personality which bothered my mother somewhat (I told my mother that maybe she was really a robot, but from having seen her outside the place I suspect she is simply a person who is very unhappy with her life) while others are so kind my mother gives them a hug and kiss. This place has both private pay and Medicaid residents; we're private pay and expect to be indefinitely (unless she sets a new longevity record for the Guinness record book!); I think the staff treats everyone the same and most probably don't really know who is on Medicaid and who isn't. I only mention it casually to administrative people if they get slow or less than cooperative because they should be doing their jobs (such as making sure necessarily repairs are scheduled and made in the room). Some residents leave for fancier places although these usually have waiting lists while the one we're using always has empty beds.
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Both my parents were in nursing homes because their needs grew too much & my home would need extensive remodelling or I would have to move

Mom [wheelchair, diabetic, semi-blind, dementia] was in 1 place for over 5 years & I would not have moved her but for the distance from me as she is now 4 minutes away not 40 - I would recommend something close to you - I spend less in 'visitation time' now than before as I only need a short time in stead of 1/2 a day & I now go about 4 to 5 time a week not twice - I spend more time with her but lose less time in the travel - so if I now go & she is sleeping then I just leave & return later or next day - mom interacts with others & is sociable - both places I would recommend to others

Dad [wheelchair, hip replacement worn out, etc] - was 20 minutes away - his care was great - the staff found his skin cancer which was treated successfully - I would do both mom & him which was basically a whole day as I would see dad in AM, go to a pool over their lunch time for my exercise, go see mom in PM or the reverse - he did not interact with other residents but that was his choice - he was there for 15 months before he passed away

I need to add that I live in Ontario where much of nursing home is regulated like each resident gets a bath 2 times a week, how much each type of room costs, what is included - here I pay $2599.00 per month for a private room in a newer facility & that includes nursing, food, room, recreation, depends, cleaning, heat/AC & laundry ... basically everything but clothes, hair, outings & meds [gov't pays most so mom is about $200.00 a tear that is not covered] - because of the regulations there are not as many differences but the atmosphere can be different but all I visited[10+] before mom & dad went into care seemed to be run by truly caring people - one big difference was that there are some run by ethnic groups so that the food is familiar & there are those who can speak their first language as many loose their 2nd language with dementia but they are not limited to only that group so if that is an issue look around 

Yes I would do it again - I'm 69 while mom is 92 [dad died last Aug. at 94] so I physically could not do it - I DID NOT FEEL GUILTY ABOUT THIS & YOU SHOULDN'T EITHER - you also should not visit every day because of several things :
1 - she will be absorbed better into the community & the activities when she has that time free from you
2 - she will be used to you not being there every day so if you get sick, injured, go on vacation or are just too damned tired that day she won't sit there waiting for you
3 - you will need some time to establish your 'new normal' routine in your home
4 - plus some others but you'll find them out yourself

REMEMBER YOU ARE NOT ABANDONING HER RATHER YOU ARE MAXIMIZING HER HEALTH & SAFETY FOR THE REST OF HER LIFE - you will become a better visitor & actually talk about things other than what she wants to eat, her BMs, etc so now you can take her back to when she was growing up, things she loved to do so she can relive some good memories - good luck
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My mom's been in Assisted Living for about 6 months and will be moving to to their Memory wing shortly. In addition to dementia, she also has multiple complicated physical issues requiring a lot of nursing and aide assistance. I was actually surprised they accepted her in the first place. They take very good care of her. I visit 2-3 times a week at various times and she is always clean, has her teeth in, make up on, and dressed nicely with her much-loved costume jewelry. For me the biggest thing was letting go of control. For a decade I took care of her and of course, no one will take as good of care of her as her child, but now she is getting professional care 24 x 7. The staff treats her with compassion and dignity. Facilities have come a long way in the last 20 years when my grandmothers were in them. They have lots of rules and regs with frequent state audits to oversee their operations. While it was a tough decision it was the right one. She is safe, protected and well-cared for. I do not regret my decision in any way.
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My mom went into memory care in September 2016. She passed away in November 2017. It was a wonderful place. The unit was only 2 blocks from my parents house. My dad went EVERYDAY at 3 p.m. and stayed until 4:30 when he took her to supper. He then came back at 7 and stayed until 10 or so when he put her to bed and waited until she fell asleep. I was there every day from 6:30/7 until 9/10. We got to know the other residents, staff, and other families very well. The staff was amazing. My dad got to know each one and what they were doing with their life. He talked to them, offered advice, knew the car they drove (so he knew who was working), etc. This probably helped a lot with mom's care. We treated them as friends and not just staff. I still see them around town and we hug and catch up. The unit only held 18 residents and had its own kitchen, courtyard, laundry, etc. We could all access the kitchen and get what was needed. The staff was always bringing in food (potluck, desserts, etc) and sharing with families and residents. Some residents wouldn't eat supper or didn't come to supper and the staff would make them eggs, waffles, toast, hot chocolate, popcorn later if they wanted. When mom died, we didn't just lose her, we lost part of our family. Dad and I were both so lost for weeks because we had no where to go at 7 p.m. My dad struggled at the end keeping mom home because she had become an escape artist. It was wearing him down and I was afraid I was going to lose him before mom. Memory care was a godsend. We didn't regret any of it.

Once mom got into the memory care, she actually knew who dad was. Dad always took care of the yard and worked. Mom was your typical 50's housewife - cooked, cleaned, took care of everything. Once she got sick, dad had to learn to cook (some), hand out meds, laundry, etc. He wasn't her husband. When she got to the unit, he wasn't doing that anymore. He would sit and chat with the residents and then mom and dad would go to her room, sit on the loveseat, watch the Andy Griffith show while dad read - just like it had always been. She started knowing him again. Called him by name, joked and laughed again. Best thing for my dad.

We never regretted placing mom in memory care - it was the best thing for her and for us. I would have preferred my mother never got this awful disease but she did and we were lucky to have such an amazing facility in our town.
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In my immediate area, we have 3 nursing facilities. I toured all three and when I walked into the last one, I knew it was the one. You came into a large Common area. The furniture was set up in conversation areas for privacy. There was a large dining/activities area. Activities we pretty much all afternoon and after dinner. A movie regularly. The residents were clean and friendly. Mom was kept cleaner than the AL she had been in. Staff was friendly and usually told me how Mom was doing. In hindsight we feel maybe Mom should have gone here initially. Nothing will be perfect.
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I do have one with an AL which has a neighboring facility if my mother has to move to NH. This is her second AL in a different state and much better than previous one. She spent a short time in their NH after an operation. I just got off the phone with them for a 6 month follow up and it was such a pleasant conversation. The first bit of good news after a difficult month on various fronts. If you want more sharing I can but it is AL so I dont know if that answers your question.
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I’ll add to my earlier comment that at the nursing home my mother was in, I’d swear that the staff had no clue which residents were private pay or had LTC insurance or were using Medicaid. The business part of it was very separate from the care part, and the care was definitely the same no matter how one was paying
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I never wanted to place my Mom in a long term care facility but after 3 years caring for her with dementia I had to. Much to my surprise, she was happier there! She felt safer, ate better, and could relate to the other residents with similar cognitive abilities. Nurses were giving her meds and trained caregivers were bathing, changing and dressing her rather than me. I could still spend as much time as possible with her as her daughter. If you are present often and show appreciation for the staff, your Mom should get excellent care.
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poetry21 Jul 2018
Dear dmasty, what about infections in NH, how often they occur? much more often than at home?
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I am so sorry that this has happened in your family. My mom was as strong as a bull and as stubborn as a bull.
She was also for all of her life that I can remember, a severe agoraphobic and severely anorexic.
She had a hemorrhagic stroke at the age of 85, refused to stay in the hospital for more than 3 days, and sent me home to my husband after she’d rehabbed herself for a week. She managed to live by herself for the next 5 years until a badly broken hip sent her back to the hospital, and following her hip replacement, it was clear that she was too confused to return home.
My home was “ideal” for her care, so following 6 weeks in rehab, that’s where she came, and the next nine months were spent caring for her night and day.
My 2 high school aged kids, husband, and I threw ourselves into her care, and for a short while managed OK. That was quickly followed by her descent into a period of increasingly belligerent and negative behavior, towards her cherished grandsons, adored son-in-law, and me, her only child.
After sleeping next to her on the floor for months, she became an even more significant fall risk, and I became a zombie.
In tears, we decided we’d have to try residential care. BEST DECISION WE EVER MADE FOR HER.
The closest local placement was a private nursing home where she’d had her Medicare rehab. She would have therapists and aides whom she knew, and the place was clean, bright, and pleasantly busy.
She entered as self pay, but would have become Medicaid eligible when her personal funds were exhausted. It cost several hundred thousands of dollars, all the money she’d saved from fourty years of marriage, but the money was all hers, and to us, worth every cent.
The staff loved her and included her in everything, the food was good, and she THRIVED. I remember an evening party with entertainment we all attended, and she sang along with the WW2 songs.
I too needed to request changes or extras once in a while, but I was almost always grateful for all that was done for her.
We describe this process as “.....making the best choice from a selection of terrible choices...”. But sometimes good things can happen too.
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Poetry 21, my heart goes out to you for the situation you are in. If there is a Christian Care Center Nursing facility in your town or very close by, I highly recommend them. Although my husband was only in the nursing home for 13 days, he was treated with love and respect. He had Late onset Vascular Alzheimer's, Parkinson's Disease and was a type 2 diabetic on insulin. I knew that he was getting the kind of care that he could only get in a nursing home. I visited for about an hour most every day and always found him clean and in good hands. This NH has lots of things going on each day, field trips to those able, even in wheelchairs and needing incontinence care, there were church services, entertainment, special popsicle afternoons, bingo and the list goes on. However, my husband wasn't able to fully get involved, they still encouraged him to mingle and to eat in the dining room instead of alone in his room. There was always someone to help him with his meals, and I was called by phone anytime anything happened that was out of the normal days routine. He always got his insulin and other meds right on schedule and could have snacks when he wanted one. If he didn't care for the menu on a particular day, he could request a different meal. The entire NH was always clean and neat and in good repair. The best thing is I NEVER smelled the smell of urine there, that usually indicates this place is kept clean as are the residents. They called me early on the morning of June 27th to let me know that he was being taken to the ER by ambulance because they found him unresponsive when going to get him ready for breakfast. He passed away peacefully on the evening of June 29th. By the way, we were able to get him admitted to this facility as 'Medicaid Pending' and that way we didn't have to put out any money. He was on a 5 day respite care with hospice and they visited him every day both in the NH and the short time in the hospital. We had been in the process of having our attorney file for full Medicaid coverage because we felt he would be a resident for a long time. God had other plans for him and took him home sooner. Oh yes, at first we had him in a NH in Arkansas, our state, but was advised by our attorney we stood a much better chance of getting full Medicaid coverage by moving him to a NH in TX. Both places are about a 20 mins. drive from our home. Good luck and many hugs and prayers to you.
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I am surprised to see so many positive responses, i am crying reading them, but in the same time I am saving the link and will read and re read them over and over when I will think that i just abandoned my mom putting her in NH. But I feel as many of here commented that either I should abandon 3 other people, who is my son, my daughter and my husband (not saying about myself as only one year away from breast cancer treatment), and care for her 24/7 or put her in NH. Crying and crying. But after reading your posts I feel much better. Yes, I found already the best one, but I lost bed there, not being able to transfer her immediately, so now on a waiting list, have another one in back up, but still will wait for that one. Thank you all for support and I will re- read your comments over and over now.
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My sister is sixty-six years old and being cared for in a long term care facility. She is on Medicaid, is physically disabled (cerebral palsy since birth), and in a wheelchair. Mentally, she is very capable. Most of the other residents are elderly, many with dementia. There is an entire floor for memory care, so it certainly isn't a walk in the park for the staff, but the facility is very clean and some of the staff members have been working there for years (I think that says a lot). My sister has a social worker at the facility who genuinely tries to help her toward a positive future - like researching groups to join -both on and off-site - encouraging her to get involved. It feels like a happy place to work and I think that happiness spills over to the residents. My sister has made friends there and has even found a wonderful private spot outside in the enclosed courtyard to read. This facility was highly recommended by the local hospital and has approximately one hundred and fifty residents. So, my sister's nursing home is a good one and proof there are good nursing homes out there even if they do take Medicaid. We're in Washington State.
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Mthr's memory care is the best place she's ever lived! She is very happy. We brought her there completely confused and dirty from her hoarding. They took her as she was and bathed her, threw away her clothes and put her in all the new things we'd bought for her. And things got better from there!

They had her dressed and ready for her doctor appts, pre-scrubbed her with the iodine before she had surgery, and gave her dessert with every meal to make her happy. When she tried crawling out her windows when she thought she saw her car in the parking lot, they moved her room, furniture and all, to a courtyard view so if she did go out, she'd be within the fence (we were on the other side of the country with our teens and unable to come back). They have suggested what clothes to buy, how to get her to use a walker, and basically, made her one of the family, and us too.

Mthr is no longer verbal so there is a language barrier too, but the staff pantomimes to get through. She has a smile on her face always, and even when she is mean they like her. It's as if the staff is talking about a different woman when they tell me about her - she was horribly abusive, but now that she's on the right drugs is actually nice to them. (If only she'd had those drugs 60 years ago!).

It's perfect for her and for us, and we are so thankful. Part of this was realizing we had to let go and let the facility do what they are good at. Part of this was accepting she needed drugs for her psychological needs. I ask what do I need to get for mthr, and the manager tells me. I am good with that as the manager has seen hundreds of patients come through, and this is still my first rodeo.
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My MIL was in a Manorcare nursing facility for 12 years. We visited her every day for several years, gradually twice a week till she passed peacefully in her sleep. We kept an ongoing relationship with the staff (through the good & the less than satisfactory, never bad) and three rounds of hospice. We opted out of feeding tube when her weight decreased and chose hospice instead. Hospice would take over, give her extra care and dedicated feeding and she would gain weight. Then they would discontinue hospice and she would return to regular care. LTC was the best choice for her. She had several years of living in a protected, social environment that she never would have experienced living in her own home in an unsafe neighborhood.
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Your situation seems almost identical to mine, including no help from brother. My advice is search until you find a small ALF. The one I finally found for my mother has 12 residents, the owners work there with 2 aids per day shifts and one at night. The cost is less than large facilities, too. Go often, ask lots of questions. There will be problems, but you will be heard and the problems will be addressed.
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This is not a personal experience but an observation. I sing with a small group that does gospel music programs at care facilities, and so we have been in and out of a number of these places several times a year over more than five years. We make a point of visiting the with the residents when we can, and there places that I wouldn't mind living in--some of the residents have been here for the whole time we've been there, and appear to be happy, busy, and well cared for, and have no complaints. Yes, there are some that we don't get good vibes from (we do try to go there as a service), but yes, there are some varied good ones out there. Most of our favorite ones are ones that are associated with churches or families--our favorite one is one run by a family but with larger, more facilities than the small family board and care.
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My dad resides in assisted living specializing in memory care for 4 years. This was a brand new facility. They have a different philosophy and provide more skilled care that a typical assisted living. From beginning to dad’s passing the care was top notch. Facility was spotless. The care from the aides was excellent. They aides were smiling, willing to help. I couldn’t have been more happy with the dad my dad received.
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Doingitalone, I did found the small one (only 40 residents) but unfortunately we are only on waiting list there. So I have some other in mind but will transfer if waiting list come to reality.
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My dad went into NH from rehab after his third bad fall (due to stroke-related LBD he couldn't remember that he couldn't walk/climb stairs.) We were very happy with the facility, the staff was wonderful and caring. Understaffed, to be sure, but everyone who worked there was qualified and well-trained. Other homes we looked at did not have strict policies regarding staff using their personal phones while on duty and did not provide the level of care that we wanted. We did visit him daily -- my mom went in the morning and stayed until early afternoon, I went after lunch, and my husband went after dinner 3-4 nights a week -- and maybe this influenced the level of care he got, I really can't say. The staff seemed to be as attentive to other patients IMO. We could not have cared for him at home, we were just not able to provide 24/7 care and my mom could not stand to have aides in the house around the clock.
After my dad died, three of the nurses came to the service. So I would say, yes, there are definitely good nursing homes with caring and dedicated staff.
Best of luck to you and please keep reminding yourself that you are doing the best for your mom that you can. Take time for yourself or you will be too burned out to help her.
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As a nurse I read these post and see things from other views. As a mom with a son at 36 who is in a nursing home I understand. With aging parents refusing in house help ...My patients we rarely know who is MC and who is private pay. The homeless lady or the lady who has doctors for children all get the best possible care I can give, it is my honor to help them.To sit and listen, I ask their advice on cooking or car problems. It lets them feel needed. To let them tell me of the new great grand child.. or just hold a hand as they go to sleep. My greatest memory years ago a 100 year old patient gave me advice on how to find a man on learning I was a widow, she said it worked for her three times. lol. And slipping money to staff is a big no-no if caught that cna would loose her license even possible jail time please never do that. A pizza to staff or coffee and donuts is fine. my son is a difficult patient but the staff are amazing...they allow him to hold on to what dignity he has left and be as independent as possible even though he falls almost daily. The nicest carpet and decorations have nothing to do with quality if care. Ask how long the nurse has been there nurses stay when they feel the can meet needs of the patients. watch as they walk by are they happy looking . Is everyone walking as on a mission, in a hurry, goal directed this can mean understaffed. Happy staff smile to your mom as they answer the call light for the 20 th time that shift. Ask are personalized meals available to fit ones culture...if your from Jamaica and in an Italian home...pasta every day is not a thrill. My son was a marathon runner very picky about nutrition his home worked with him to make sure he had choices he eat and control over his diet as much as possible. I have seen the bad and good in NH..but the most part nurses really want to give the best care they can...they give up holidays, birthdays, sleep to make sure our lived ones are cared for tell them thank you it goes a long way in a bad day it had brought me to tears.
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poetry21 Jul 2018
Thank you so much, I will pray now for such nurses and CNA who you described....I don't think all are the same but let's hope that mst do the job that they like.
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