Why are so many folks who contribute totally closed to the idea of having their folks in a facility?

I think much of the mindset is ingrained in the adult children for years before the nursing home is even a remote option. I cannot tell you how many times I heard both my grandmothers tell their children and grandchildren to not ever, ever put them in a nursing home. I have found with my own family and others I have observed that there seems to often be a sense of entitlement (e.g. "I am too good for a nursing home," "my family owes me," "I can brag that my children are giving up their lives for me," etc). This isn't a conversation that happends quickly but is ingrained for years. My own grandfather swore the nursing home was coming any day starting when I was around 6 -- he passed away when I was 27. My grandma swore she would never make it past 50. She died at 91. She outlived my dad.

My friend's dad is in a supposedly very good and definitely very expensive nursing home. My mom is home and I take care of her. His dad has fallen many times, lost weight from hating the food and having trouble finding someone to help him eat, had many infections, been in an out out the hospital several times, and is generally in very poor health, though he wasn't going in. My mom has fallen only 3 times in ten years with no bad effects, eats likes several horses and has never been hospitalized, had no infections, and is generally in good health, though her mind has long since left us. She gets no strong drugs while his dad is on a plethora of prescriptions. I will keep my mom home.

I think that for many NH has not been in their experience growing up and there is a whole mindset that NH=Snake Pit and the fear of that image.

Both my grandmother's went into different NH and going to the facility to visit and doing the scheduled family activitiy days was just done and a part of my childhood. Where the NH ideal or nicer than their homes? No, but they were at the point of needing a higher level of care than living at home. The same was true for my DH and his grandmother. So I see the whole living in a NH as a part of the aging process. Not all NH are great or ideal but you have to do your homework to find the right one. Plus you can easily move them from NH to NH once they are on Medicaid, if the first one doesn't work out.

I do think that there is a whole largely unspoken issue of caregivers keeping mom or dad at home and beyond their caregiving abilities because they need mom/dad's SS & other income to live on. It's a terrible situation for all to be in and I really think is much more common that is realized. This is fundamentally a women's issue and the worth of caregiving by family is viewed by the state as given by love with no compensation by & large because it's "women's work". ( LOL with Caphardazz - excluded!).

I care for my mom in her own home, but we do know that could change. My personal belief is that facilities get a bad rap when in many cases it is not deserved. Homes play a key role when needed.

My mother in law for example, lived in our home for three years, long past the time when she even knew who we were. She became combative after three years, and began sleeping only 2 hours per day in a 24 hour time period. This behavior continued for two months, it was not a passing symptom. She went into a fantastic nursing home. We were no longer able to provide 24/7 care, and the combativeness made it a danger for all of us in our home.

She was happy there, so happy that we felt we had made the wrong decision in keeping her home with us. She lived 5 additional years, and the first three she walked the facility as if she were going to work, the combativeness ceased, and she slept only 2 hours per day. Her last two years were spent completely comatose. We have to admit when we are no longer capable of providing the best care..Personally, I have told my own children should I myself have Alzheimer's one day, to find a nice place for me to live, and come by with candy.

Beri, tell us more about your mother. Are you having trouble taking care of her?

There are different ways to "take care" of our loved ones. Many times I have the the caretaker spouse (the one who one would think have the better health) die first from the stress of caretaking. Then what? I think we all need to think ahead.. we either die young or get old...I prefer to get old, but don't want my kids to suffer. Looking into long term care insurance...I am sure my children would visit, care for me, love me no matter where I am.

I agree completely with Tess. Until you are in that situation, you don't fully l
know what you might have to do or the decisions you will have to make until you are in those shoes. I had always told my DH that if It was ever necessary that I would always be there if either of my parents ever needed me to be and that I would bring them to my home for care if it became necessary. When that time came, firstly for my father...he became physically violent and suspicious. It broke my heart that he had to be in a lock down facility and worse yet, that in his mind, I was responsible for doing that to him. But I could not let my mother take that blame in his mind and my mother was no longer safe to be at home alone with him and yes, I asked her. She would willingly have sacrificed herself for him. Two years after he passed away, my mother was diagnosed with age related dementia. Again, I tried to bring mom home but my mom needed to be watched 24 hours a day as she wanders although she is generally happy, I work full time and my husband could not deal with the changes in her (he has his own health issues now, diabetic, depression, neuropathy and high blood pressure). It was not a healthy environment for mom or my DH so we placed her in a memory care unit in a facility an hour away from me. Guilt is a big factor in many peoples decision and to be honest, my guilt factor is high as I would like to have been able to have the privilege of taking care of both of them but it was not possible for me. I wanted to move my mom closer to me when an opening came up but she settled in at this facility, is happy and adjusted in a way that would not be beneficial if I made the decision to move her again because it allows me to visit and do more with and for her. None of us the right to judge anothers decision to do what they feel they have to do in this situation. Be there, listen and try to be supportive. It is not right to add to their guilt in what we all know is already an extremely difficult situation.

My 2 sisters and I had to make a tough decision. Both my parents have dementia and were living in their own home last summer. My father suffered a stoke at home and neither of my parents recognized what had happened. My father was at home a month in bed, unable to walk and in terrible condition, with my mom trying to care for him but not understanding the problem. Neither of them ever said anything was wrong but I sensed something was not right. My sisters and I each live away but I was nearer with only a six hour drive home. When I found them, I knew immediately that my father had to be hospitalized and would never come home again. The house was too big for my mother to care for and her dementia was getting worse. When my father was well enough to travel, I had him brought to an excellent facility 15 minutes from my home. I closed the home house and moved my mother to my home. This worked well until my mother perforated her colon in January of this year and did not "bounce back" as a result of the surgeries. In fact, she did not remember any of it, refused to eat, and started to plummet. I had placed her in the same facility as dad with the hopes she would be there short-term for rehabilitation but it has turned into long-term care. I work full time and have many obligations but I still manage to visit both of them 3-4 times a week, do their laundry and take them treats. They appear happy and receive good, round the clock care. I felt very guilty at first because I could not visit for hours every day. But I have come to the realization that I am only one person and can not do everything without sacrificing my own family and my life. I was one of those who criticized others for placing parents in nursing homes and never visiting enough. But I now walk in their shoes and fully understand the dilema we face. We can only insure that they are getting the very best care possible and assisst when and where we can. Unless one is in a position to quit his/her job to care full time and have the tolerance for it - it is best to place them in a home. I am still struggling with financing everything because that part was not in order and I will depend on Medicaid assistance in part. But knowing they are in good hands is the most important thing. We must not judge the decisons others make-walk a mile in their/our shoes and you understand. From Tess in TN

We shopped like crazy for somewhere for my Grandma. Had found an assisted living that was really nice, but ironically she broke her hip the day she was going to look at it (had agreed to move there after driving past it and seeing the gardens-- both my aunts practically died of shock!).
She ended up in a 6 person board & care that is amazing -- great food, family are more than welcome all day long, any day, & she is "queen bee" because she doesn't have dementia, just physical issues. The dementia residents have to be well-behaved (for everyone's safety), but I think the 1-3 caregiver ratio prevents a lot of acting out that would happen at a larger "memory care" facility (1-17 ratios were common!)
The main difference is that the residents & caregivers become a family where everyone belongs. Every day my grandmother interacts with at least 7 other people who KNOW her -- residents & caregivers. They laugh & talk at meals, accept each other's limitations & care about each other (it DOES make it hard when someone dies, but better thinking that no one around cares about you).

The NH in my community is a lovely facility but the staff are overworked, and under paid, encouraged to be critical of other staff, most have little insight into how to deal with people with dementia and the head nurse runs the place like a prison camp. Most residents are in a wheelchair within weeks after entering. then they are pushed in lines in front of a TV with cartoons on for hours at a time. In no time at all the residents lose touch with reality. Who wouldn't? There will be no one to care for me when I get old. I sincerely hope I go toes-up in my flowerbed!

The more I read here from different posters from different areas of the US, I think the APS do have ulterior motives. And it sure isn't the welfare of the "client." I have also read how NH was able to gain POA over their client.

Weby, I hope you got a very good lawyer. I hope you win. Because once NH runs out of your aunt's money, they will dismiss her from their care. So, where is APS when this happens?

I can only speak to my own experiece. We were commited to keeping mom at home, but incresing anxiety and isolation made her so needy that there was a crisis a day. She has gotten much stronger and more accepting of life's ups and downs in independent living, and has better and more consistent medical care,

i think in many cases aps is in cahoots with NH and hospice to not only tear elders from their homes but seize control of their assets. a hospice patient who lives too long outlives the per patient cap that medicare will pay for hospice and hospice either begins losing money on the patient or increases their level of care. ( institutionalize them ) i do not trust the system and think elders should only be institutionalized when they are too far gone to suffer placement shock. i have an aunt in IL right now. she sleeps all the time, doesnt care about socializing and only dreams of going home. utopia it isnt..

Five years ago, when it first became obvious my aunt was deteriorating, we first placed her in a hospital, then in a nursing home while the family hashed out what was appropriate care.

This first nursing home, unfortunately, was a hell-hole of a place. I never saw any sign that anyone paid any attention at all to her. She was just warehoused. They over-diagnosed her, saying it was advanced dementia, when, in fact, it was mild dementia at that time.

It fell on me as the logical choice as primary care-giver at the time. When I announced this intention, her case worker became quite vile to me. She acted, quite frankly, as if I was stealing my aunt's money from them.

They announced that my aunt had advanced dementia (she didn't) and needed to be with them. I pointed out how terrified my aunt was of them, they said that was just her dementia speaking. They even investigated me for criminal connections or activity in an attempt to prove I was unqualified. This failed.

When they finally realized they had no way to keep her, they insisted that it was themselves who should line up all support service for her in-home care, and they needed to keep her another 15 days to accomplish this. I was required to fire everyone I had hired, and dismissed all other services I had lined up. The CNAs the nursing home lined up were almost as qualified as the ones I had hired, and they cost considerably more.

Five years passed, and circumstances necessitated a move. I placed my aunt in a nursing home for two months while I packed, moved, and set up. This time I did better research before picking a place. This place did pay attention to my aunt. Her hair, dentistry, nails and facial hair were attended to. She seemed, if not happy, at least complacent there. She had considerably deteriorated, tho, and I questioned my ability to care for her now. But, I decided to try. If it didn't work out, at least I wanted her someplace closer to my new home.

I met with a rude awakening when I went to pick her up. They would not release her to me. They gave me a list of what they wanted me to accomplish before they would release her. It took a month to accomplish this. When I finally went to pick her up, she was a mess. Although they had taken well care of her when she first arrived, they apparently stopped when they realized I was serious about taking her home. Her hair was long and straggely, as were her nails. Her facial hair had turned into a beard. She was in a wheelchair, and they told me she could no longer walk. Almost all her clothes and personnal property was missing although her name was on everything.

When we arrived at home, to my surprise, I was met by an investigator from the Dept of Elder Abuse. Since no one knew we were here yet, I presume it was the nursing home who called them.

I have had my aunt at the new house now two weeks. She has clamed down considerably, has expressed relief at finally being home. Ater two days at home in a wheelchair, she suddenly got up and walked around. In the nursing home, she would not interact with me and I never saw her interacting with staff. Now we were having conversations. She was delighted to see her cats again. I have no doubt it was a right move to bring her home.

Meanwhile, Elder Abuse has called me and I have been informed it is their choice to take her from me. My lawyer called them, and they told her they have no question of my plans and good intentions, only that they feel my aunt requires too much care, and they don't believe ultimately I can do it.

Meanwhile I AM doing it. The benefits to my aunt are obviously visible.

What's going on? I suspect money. Here are the figures:

The first nursing home (the hell-hole) billed me $1000 a day ($30,000 a month). Nursing homes are expensive, but NONE charges THAT much! The second nursing home charged me $13,000 a month. Also very expense. My aunt has enough resources to last a year there, no more. At home, her expenses are running $5,000 a month. Still expensive, but I can keep her 2 1/2 years at that price. Now here's the kicker! Whatever a nursing home charges private pay, Medicare only pays out one fixed rate: approx $7,000 a month. So, having a private pay client is a real plum for a nursing home!

I am not impressed that nursing homes seem to feel they have a right to claim my aunt's money as their right.

I am taking care of my beautiful Mother,she has osteoporosis,and stone.

this reading is very helpful and interesting my concern is unite estate and we live in Canada.

would you please helping me with advice.I will be very grateful.thanks very much.

,my mama is 89

BUT THERE IS STILL THE ISSUE OF OVERWORKED/UNDERSTAFFED FACILITIES...AND THAT QUALITY OF CARE ISSUE!!!

I HAVE TO SHARE I JUST LEARNED YESTERDAY THAT THERE WAS A RULING ON THE MEDICARE PLATEAU IN FEB...SOMEONE ON ANOTHER THREAD SHARED WITH ME. IF YOU GOOGLE IT, YOU CAN FIND THE DETAILS BUT I WAS TOLD IT WOULD PREVENT THEM DISCHARGING THE DIMENTIA PATIENTS FOR LACK OF PROGRESS!!! N CAPS CUZ IF THIS IS TRUE IT IS GREAT, IT HAD DISGUSTED ME TO THE POINT OF ALMOST VOMITING WHEN I LEARNED THAT HER QUALITY OF LIFE HAD NO PART IN THE EQUATION!!! I HOPE THIS WILL AT LEAST BE THE START IF NOT THE END ALL OF THAT PRACTICE!!!

I have to agree with jujubean. My mother was in a skilled nursing facility (snf) last fall when she fractured both bones in her lower leg. She has congestive heart failure and severe aortic stenosis and atrial fibrilation. She is 91 yrs old as of January 2013. What I learned is that they make physical therapy a priority because if the physical therapists don't work with the patient they don't get paid and if the patient can't do regular physical therapy then they may not qualify for medicare to pay for the nursing home and they would be given notice to leave. Anyway I could go on about that but I won't. Anyway I tried to tell them they were not allowing my mother to rest her leg. It was still very swollen and bruised and she needed time to lay down and elevate the leg. The routine was to get her out of bed and dressed and sitting in a wheel chair to have breakfast. Then they would leave her in the chair and not let her get back into bed to lie down. Then the physical therapists would come around and take her to physical therapy. The therapy was twice a day. After sixteen days of this my mother was sent into the hospital for exacerbation of her CHF. She was in the hospital for six days and then she went to a different SNF that said they specialized in heart patient care and had oxygen available. The same thing happened there with the physical therapy until I told them her story from the previous SNF. After that most of the physical therapists understood that my mother would comply with whatever they asked but if they didn't pace her and let her rest she would have a flare up of her CHF. The SNF was an hours drive from my home, but I went there every day and made sure she was getting the care she needed. I wasn't totally trusting of the care sometimes, but I had to get some rest so I had to trust that she would be ok at night. It is not easy at times taking care of her, but I want you to know that seven months ago a doctor at the hospital said she only had six months to live and this is eight months later and she is stable but does need someone to care for her to make sure she doesn't fall, etc. Home health care nurse has been seeing her once a week and she has regular doctor appts once a month now. It is not an easy job and if it wasn't for the fact I am retired and a widow I'm not sure I could do the at home care. My mother would not speak up for herself and trusted that the people taking care of her knew what they were doing. I think they know how to toilet people, take blood pressures, temp. and oxygen levels but beyond that it takes a special person to be a caregiver. My observation was some of them had the gift and others were there for the job. I hope this was helpful.

Well contrary to what I read here, I can’t afford to put my wife in a care facility. Back in Dec. she broke her hip, Spend 8 days in the hospital and the next 21 days in a care facility for physical therapy. It was only 10 minutes from our house so I was there every day. I first thing I notice that she was always over medicated, especially when it came to meals, she would sit there in her wheel chair head looking down with not movement or interest to eat. Everyday I tried to get her up and around with her walker to walk up and down to hallway. There was no consistency with the facilities Physical therapist either. In 3 weeks I had met 5 different ones trying to evaluate and work with her. At the end of 3 weeks she was discharged for not being a participant in her own therapy (always over medicated) and Medicare will stop covering this. That’s what they do if you have Dementia/Alzheimer at most Care facilities, wheel chair bound and over medicated. I care for my wife 24/7, I'm a Disabled Veteran and love my wife.

The reason dementia patients die if they are in a facility is the illness progresses so bodily functions cease. So, one's death certificate will not say cause of death dementia, it will most likely be congestive heart failure or respiratory failure, kidney failure, etc. Having said that, loved ones fear mom or dad dying without anyone around, and its their own fear of death that drives the resistance to place family into a facility. Discussions between parents and adult children need to begin BEFORE dementia robs the person of their wishes, and of course most people will say they do not want to go into a facility. But, the reality is, the adult child(ren) have to balance their lives around what they can reasonable do and what works best for them. Making sacrifices for an elderly parent requires strength and fortitude, but do not be ashamed if you cannot take care of a person with dementia. They won't know about the quality of care and do not forget this is a TERMINAL illness, for which one does not recover.

I just want to add before I forget when we were in the NH/Rehab having horrible issues in February. I consulted the orthopedist for advice and he sed by all means bring her home early if need be, they do so much better at home. That will resonate with me for a long time!!!

despite our efforts to keep elders in their homes as long as possible i read the statistic recently claiming that nearly 70 % of dementia patients pass away in facilities. our hospice nurse explained the other day that this is often the result of a stroke . i could envision the time when round the clock bedside nursing could get to be too much for family. at the same time i know that sometimes NH's are staffed with mental midgets. itll be a hard call when the time comes.
now i can tell a funny one on myself. 6 years ago when i started staying with mom i asked her what i should do if i found her in a low blood sugar coma. i told her i might inject her with pancake syrup. she laughed and told me the syrup in the house was sugar free so that wouldnt help much. my mom is pretty brilliant before the dementia worsened.

Also I have to say just so people are aware....My dr;s nurse told me her mother was raped in a facility up here and the only reason it was found out a newbie aide walked in on it and ran screaming and reported it to authorities or ?? never would have been found out....and Aide was subsequently fired of course..That one is hearsay but why would she make it up??? Just trying to make it real for y'all!

I know why I'm resistant. Being put into a living facility scares me. My grandmother went to one, and we believe she was abused. Also, I want my Mom to be happy and feel safe/secure, which means being at home for as long as possible. Also, though I know I am overwhelmed as her caregiver, I don't want to just dump her somewhere that may not take care of her.

I was of the opinion that just because an elderly person is in a care facility, the family can be as involved as they want. I know folks who spend hours a day with their loved ones, bring them food or special treats,have meals with them engage in activities with them, take them home on visits, etc. but they get to go home and sleep at night. Or if they can't make it someday are not worried their loved on won't be able to eat or be toileted, because they are at home alone all day. But where I live there are many places to choose from with a 20 minute radius, not everyone has those kind of choices.

It is a difficult and personal decision. Yes, there are many who think that placing a loved one is throwing them away and they make that judgement call without knowing who you are as a person. Others believe that "we take care of our own" at all costs even if it means going broke, filing bankruptcy and others it is the financial end as to why they don't place a loved one. Putting your life on hold and becoming a full time caregiver 24/7 takes a toll on ones physical and emotional health. Placing a loved one does not make the responsibilities go away. You still have to advocate for them, and if they are in assisted living, you are probably still helping with grocery shopping, dr. appts., laundry,etc. depending on the level of care your loved one needs. My mother has Alzheimer's Disease, she is mentally incapacitated can no longer make decisions for herself that are in her best interest to keep herself safe, fed properly. She is living in assisted living. I do her laundry, take her to appts., advocate for her care, I am still running back and forth between my life with my husband, work, home and seeing my mother. I actually spend more time with my mom than I do my husband. My mother participates in the memory care program daily, when I visit, I take her out of memory care...we have lunch in the dining hall on the assisted living side. Then we take her dog for a walk, and just hang out in her apartment with her dog. I can now spend hours with her, but when she was living at her home, I was running back forth several times a day and not really spending time with her. So far this is working for us and I know my mom is safe and she is being treated with respect.

Your question is a really good, fair and honest question.

All I can do is tell you what it means to me in my situation.

First I'd like to say that no one should ever feel guilty for putting a loved one in a nursing home. Often there is no other option. I do think that families who put a loved on in a nursing home need to remain vigilant about the care their family member receives.

My parents put my paternal grandmother in a nursing home after she started running away from her assisted living home. For years they invited her to come and live with them, but she always refused. At one point she and my mother had an argument and my grandmother really laid into my mom. It was from that argument that I found out how nasty my grandmother had been to my mom, my dad and even me (unbeknownst to me at the time) for decades. A lot of hatred spilled forth from my grandmother's mouth that day. I never knew she felt that way. In a way it was good she and my mother had that argument because it alleviated any guilt my parents felt about putting her in a locked facility.

That experience has guided my determination to care for my parents in their home. Without going into a long, winding story my special problems in life, my parents went above and beyond the call of duty with regard to always being there for me, supporting me emotionally and sometimes financially. They bailed me out of ridiculous situations time and time again and made it possible for me to be a good parent to my son. Without them in his early years, I'm almost certain I would have lost custody of him.

After I graduated from college I was hopeful that some day I would earn enough money to treat them to trips, vacations, etc., but I never got a job that paid enough for me to spoil them like I wanted to. So caring for them now is my way of giving back to them. It's that simple.

On a grander level, there's a lot of debate in our nation and internationally about how different cultures treat their elderly. I think everyone can agree that, in the US, we place much more value on youthfulness that we do on the wisdom and grace of growing old. This too motivates me to care for my parents and keep them in their home where they are most comfortable.

It's depressing and stressful to care for elderly, sick parents. I cry several times a day just to get the stress out of me. But it's also rewarding to know I'm doing a good thing. And fortunately I have a good relationship with my parents and neither of them has dementia. They are loving and appreciative and tell me so all the time. So I get a lot of warm fuzzies for what I do. But it's still hard for me to watch my father (my mother is quite healthy at 84 and it's safe to say she has more stamina than me) decline and have so many health problems. He's trapped in a body that failed him a long time ago.

The process of watching a loved one die is sad but it's also gracious.

If I could point to one thing that causes me the most stress about the current situation, it's the lack of assistance provided to my parents by a brother and niece who live not five minutes from them (I live two hours away). That single issue is causing me more grief than I ever imagined it could.

Otherwise, I find caring for my parents rewarding. So that's why I don't want them in a nursing home. In my situation it's not necessary.

As for myself, when I'm old...I don't want to be put in a nursing home. I prefer that my life end on my terms and that includes checking out on my own when the time comes. My family has been made aware of this and although they may not believe me now, they will when the time draws near. I don't want them to suffer.

We all suffer at times for the various people we love. Why not suffer for our parents if appropriate and doable?

My experience has been good, even in the nursing home. Family members do visit every day. But, my Mother was going to waste away, trying to live alone. She is not someone that any of us could live with.

But, she had all of her finances in order. She has Medicare, gap insurance and long term health care insurance. It is important for all of us to plan ahead.

Also, Mother has her own mind and is able to feed herself. Maybe that makes a difference, because she would raise a fuss, if the care wasn't good.

Some people are closed to it because the loved one in question is closed to it. Some feel guilty, like they're dumping their loved one in a facility, or they're afraid the loved one will feel abandoned. My MIL, who will probably have to go into LTC soon, does not want to go. She wants to be at home. She firmly believes that people get put in a NH because their families don't want to fool with them. She's in a hospital right now and told my dh she'd rather somebody just took her out and shot her instead of going into a NH. If she was going to die, she wanted to die at home.

I've seen cases where the family just doesn't want to take care of their loved one. Some feel like they're abandoning their loved one if they put them in a facility so they take on the responsibility themselves. Personally, I'm against it unless it is absolutely, positively necessary. In the case of my MIL, I want to be sure we've done everything we can for her before we put her in a home, so I've kinda been fighting it somewhat. But it's gotten to the point where she needs to go. She needs someone to not only watch her, but monitor her blood, vital signs, etc. She's not bathing as often as she should, probably not drinking like she should and I'm already monitoring her medication. My nephew puts the medicine in day and night pillboxes, like a week or two worth, and I give it to her twice a day. She lives by me, so I'm able to do that for her. I also bring her dinner. He buys her food that she can cook in the microwave or she can make herself a sandwich. None of us are qualified to do much more than what we're doing already.

My reasoning is purely fear of the level of care and loneliness she would feel their....I have had bad experiences already in our brief stints in Rehab....There is a small financial motivation as they did not plan for this/and I have gone thru my life savings, it could very well render me homeless after 8+ ys...BUT moms care is priority, whatever happens to me is 2nd .
I had planned to take care of her at home for as long as there was a lite in her eye "so to speak". Once she loses the ability to participate in Life is the time for us. She can still feed herself n answer when spoken to. Also these facilities are 25 miles away. If it was in my town where I could get there in a few minutes would be much more desirable. I
But basically after her injury and visit to one of these facilities, It would have to be just around the corner so I could check/visit on her everyday. Because I plain old don't trust them to care for her needs properly especially when if she cannot speak for herself...just like someone sed above they do not have the time to do the one on one care and interaction I believe my mother requires and deserves for $6-9k per month.....no matter who the heck pays the bill, us or the state. I don't wanna bash all facilities but 2 different times n cities both horrible... k.....