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Trigger Warning-Diagnoses and Conditions that Hinder Placement in Personal Care and Memory Care (In Pennsylvania)



There are so many challenges that come with aging. In doing some simple research one can find that the probability that a person will be diagnosed with a chronic illness as they reach and exceed 65 years of age is astronomical.


Some people find out the hard way that with certain conditions and diagnoses, seniors aren't welcome to move into personal care or memory care in Pennsylvania and this can be incredibly cost prohibitive and upsetting for families and seniors. This sounds terrible, and it can be, so you need to be prepared to deal if this issue arises as you shop and search for options.


Terminology to be aware of:


Two person maximum assist:


This is exactly what it sounds like. This means that the individual needs two people to help them move from the bed to the wheelchair, get dressed, get clean, get showered, etc. If your loved one falls in this category and/or is in need of an assistive device to transfer, you might be out of luck with personal care. Most buildings will not allow someone to move in who is this progressed in their care needs, not because they don't want to help, but because they don't have enough staff to safely take on someone who needs this level of attention for all transfers during the day. It's very physically challenging for caregivers to move someone who is a two person max assist.


Some buildings will assess and add on a care level for this amount of attention, but it will definitely cost more than expected, and in my opinion, it's worth a serious conversation with the director of nursing to ensure that care can and will be administered. Unfortunately if someone is this progressed in their physical needs, they will most likely be best suited in a skilled nursing facility. SNFs are staffed differently and care professionals are trained to use assistive devices such as a Hoyer lift or sit-to-stand.



Lewy Body Parkinson's Disease and/or Frontal Temporal Lobe Dementia:


This is a terrible diagnosis to receive because it's vague and carries a heavy weight. Unfortunately if a nurse in assisted living or personal care sees this diagnosis on a potential resident's pre-admission paperwork, there is a good chance that they will deny. Lewy Body dementia often includes aggressive behaviors and hallucinations; therefore, buildings don't always like to take on the liability for their staff and other residents' safety. Even if the person has never showed an ounce of aggression, I've seen them denied from admission, so it's something to be aware of.


If you come across this diagnosis for your loved one and you feel that it's unwarranted due to them not having behaviors, ask the doctor to clarify or change the diagnosis on the paperwork to just "dementia" or "memory loss". This is especially true if you haven't sought a diagnosis from a neurologist yet. A family doctor doesn't always know the weight of this for placement in a memory care and it's not a cut and dry diagnosis.


Aggressive Behaviors:


If you know that your loved one is aggressive and will be a challenge for a community, it's important to be up front in the beginning for the safety of everyone involved. Though this can hinder placement, it's better to understand from the beginning if a community is truly able to care for your loved one.


Sometimes aggressive behaviors can be quelled with medications and a senior might benefit from a stay in a geriatric psychiatric hospital to help find a balance before placement in personal care. This is especially true if the person has suffered from undiagnosed mental illness throughout their lifetime and there is a true need for medication. It's common these days to find that people were able to mask their mental illness for years until they started to experience brain loss and with the right medications, they can regain a balanced baseline.


I am not a huge advocate of throwing medicine at behaviors as a band-aid, but there are times when anxiety and challenging behaviors can be helped with the right psychiatric medications. If your loved one is prescribed behavioral modification medications for any reason, it's important to ensure that you follow up with regular visits to a psychiatric practice to monitor behavior and make changes as needed. Some personal care buildings will have a geriatric psychiatrist or nurse practitioner come to see patients in their apartments. This is a good question to ask when you're shopping, especially if you know there is a need.


If your loved on is put on Haloperidol (an anti-psychotic medication often used for schizophrenia) for their hallucinations, please ask questions because many personal care buildings will not take a person who has this on their medication list.


If you are denied placement in personal care or memory care because of aggressive behaviors, you may want to consider skilled nursing dementia care or keeping your loved one at home with one-on-one care. If your loved one doesn't have finances, you may want to look into your state's Medicaid waiver program.



Brittle Diabetes:


Diabetes has come a long way and many people control it with injectable insulin, pumps, or prescription pills. Diabetes becomes a problem for a building when it's uncontrolled and requires someone to manage frequent blood glucose readings and injectable insulin on a sliding scale. Some buildings will not manage an insulin pump or a sliding scale, so these are important questions to ask if you know that your loved one is diabetic and requires insulin.


Personal Care in Pennsylvania does not require nurses on the premises around the clock, and while many have nurses during the day, the overnight is where it becomes a problem for someone with uncontrolled diabetes. Assisted living does require nurses around the clock but there are fewer assisted living communities and I can only name one off the top of my head in the Greater Philadelphia area, all the rest are licensed personal care homes.


Tracheotomy:


This is generally a hard stop for personal care homes and most likely assisted living, but that's a good question to ask. If your loved one has a trach, they will most likely be denied placement. A trach is really a skilled care need, and because of the lack of nurses around the clock, the buildings won't take on the risk.


Feeding Tube:


Once again, a feeding tube is a nursing care need and requires more skill than a personal care home can manage.


PICC Line or IV Medications:


This is sometime negotiable, and I have worked with someone in personal care who had a PICC line, but most places will deny because; again, it's technically a skilled need.


Pressure Wound or Bed Sores:


Wounds are tricky for the elderly and many personal care homes will want extensive documentation on any pressure wound that is unstageable or above a Stage 2. Some buildings won't take anyone with Stage 3 or 4 wounds.


  • Stage 1 ulcers have not yet broken through the skin.

  • Stage 2 ulcers have a break in the top two layers of skin.

  • Stage 3 ulcers affect the top two layers of skin, as well as fatty tissue.

  • Stage 4 ulcers are deep wounds that may impact muscle, tendons, ligaments, and bone.


An unstageable ulcer is a wound that has a green or tan scab of discoloration where the doctor can't determine how deep it goes. These can be tricky because obviously they can be much deeper than they appear on the surface.


The reason that a personal care home will ask questions about a wound is that obviously the risk of infection is high for a stage 3 or 4, and the less mobile a person is, the more dependent on staff for them to alleviate the pressure, which is a liability for the building. Once pressure wounds start, they unfortunately require a lot more attention that a personal care home might be able to provide.


You have to consider that while personal care and memory care communities can address some health issues with their residents, there are certain risks they are unwilling to take on as the liability and chance that something could go wrong are much higher.


If you find yourself in a situation where you're not sure about your loved one's chronic condition, be sure to get plenty of documentation and ask their health care provider many questions to ensure you have all the facts to present to the building of choice.


For many of the skilled needs, there is medical home care that is covered by insurance. A visiting nurse will come to the patient's home or personal care home and address the skilled medical needs. Many times when someone is discharged from a skilled rehab, they will have this option as well and most personal care homes will coordinate with skilled home care to help their residents transition to a more stable baseline. It's good to know your options when presenting your documentation to the assessing nurse of the personal care home.


There are even some skilled visiting nursing companies that will go above and beyond what Medicare and insurance will pay for and thus, you may be able to address some of the nursing needs, such as wounds and diabetes management with private pay services.


Methadone and other narcotics:


Though this doesn't always come up, I've seen it so it's worth a mention. Most buildings will not administer Methadone or generic versions of it for their residents. If your loved one is on Methadone for opioid or heroine withdraw symptoms, they will most likely be denied placement, especially if it has been a life-long prescription. I know this sounds crazy but again, I've had to sadly deny someone because of this.


Another mention is that all narcotics will need a physical prescription or e-script directly from the doctor and will not be filled with just the Documentation of Medical Evaluation form. If you or your loved on is on a narcotic, be sure to have all appropriate documentation from the doctor before applying for placement.



Medical Marijuana:


Now that medical marijuana is legal in Pennsylvania, some buildings might be willing to deal with storage and administration of it, but I haven't seen it yet. This might be because patients can't just get it from the pharmacy and it's not in pill form. Smoking and vaping in most buildings is forbidden and will result in a 30 day notice if the rule is not adhered to. I've seen residents evicted for smoking in their apartments. As we all know, nothing happens quickly with policy changes so if your loved one utilizes this form of medical relief, you may have to be more creative with how you go about administering it for now. As a general rule, these are good questions to ask when shopping.


As mentioned in previous articles, be sure that the medication list your doctor provides for the pre-admission paperwork matches your expectations for your loved one. This can't be re-iterated enough.


The bottom line is that there may be some situations that will hinder placement in a personal care home and it's important to understand the why behind the denial. Be sure to ask lots of questions and be up front about any and all medical issues that your loved one suffers from. Don't see denial as a set back, but an opportunity to find a solution that will be better suited for your loved one's care and your peace of mind.

















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