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Mom has fixed income, small savings, and dementia.  She lives in CA. I have POA, but also 5 siblings close by that are very involve with decision making. Two of us think mom should be in a lower priced facility, vs. others that want her in a much nicer place (~$2000 a month more), until her funds run out; ie: live very nicely for a shorter time (then deal with Medi-caid?) vs. nicely for a longer time. Anyone have advice?

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If you can private pay for two years, facilities are more willing to admit your patient. Shoot for something in that price range if you can. All facilities are required to help you apply for Medicaid. You still have to dig up the documents, like birth certificates, marriage certificates, property deed and titles and 5 years of financial records including cancelled checks and tax returns.
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Do try to find a nice place that will accept Medicaid after the private pay funds run out. Moving Mom to a different facility after a year or two may be very hard on her.
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I was exploring this with my aunt's future care. One of the things that is important to her is her privacy and ability to have time alone to pray and listen to her worship tapes and Bible, so for her one of my focus points was how much a private room would cost. Most facilities require private pay for a certain length of time (I've encountered from 1 to 2.5 years) before Medicaid in order to get the private room. So figure up, counting her monthly income and her savings, how much she could pay for 1, 2, and 2.5 years, so you know that when you call the homes. Be aware, not all facilities can accept Medicaid (at least in Ohio) because they have to pay the govt for those "beds" whether they are occupied or not, and that gets expensive and in turn, they get less income from those beds once a resident goes on Medicaid.

Consider what is important to your mom. Private vs sharing a room, taste and/or variety of food, staff-to-resident ratio, kind and amount of internal and external activities, and general looks of the unit. Some memory cares have a "busy" look and some a very simple clean look. Some allow you to decorate their doors to help them find their rooms, some don't. If she's that far to need memory care, she may not care that the overall look of a place is plain or not so modern if you are allowed to decorate her room with pieces of her personal furniture, pictures, trinkets, etc.

IMHO, it's not about what kind of place you or your siblings would want, it's about coming together to discuss about the environment your mom would be the least stressed in and then searching for a place that matches as many of those criteria as possible.

As long as your mom is not a wander risk, she may have the option of a custodial-type nursing unit. My dad has late moderate/early severe AD , and he does well in a nursing unit with a wanderguard. Up until May when he went on hospice care, he was still self-mobile, but he stopped trying to get out a long time before that (relatively speaking).

One thing I've learned, I am no longer impressed with what a facility looks like (as long as it's clean), but I do care about the level of love and compassion.
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Medicare has a site evaluating many aspects of nursing homes and allowing comparisons of three at a time in great detail. Check 0out the homes you are considering
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As dementia progresses, it doesn't matter since the person doesn't really care about surroundings, only the relatives care where they visit.
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I took care of my Mom in her home until it was no longer possible and then moved her in with me until she passed. No facility. If you have 5 siblings, maybe this could be am option for your Mom. There is no place like home with your loved ones caring for you.
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My son and daughter are arguing now about the care their father (my ex-husband) should receive. He has dementia and falls a lot. The Eldercare lawyer said that my ex's funds could cover nursing home for about 5-6 years, and he can't stay at home because it is a wreck with mold in the walls, broken pipes, etc. The kids plan to sell house to one of those places that buy houses in disrepair and fix up to sell, so it won't bring much money. But they are fighting big time over what nursing home, which "sitters" (he can't be left alone because of the falling, already he locked himself in bathroom and fell and door had to be removed). My daughter wants a more expensive sitter that her father seems to like and obey, my son wants a cheaper one so that the money will last longer. I am glad to be out of that one! But, even with dementia, my ex does seem aware of his surroundings (although still thinking he is going home when he gets well), so I think they ought to give him what he wants--that's what I want them to do for me!
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My advice, what would your mom want? There is no way to know how long your mom will live. So to try to stretch the funds may be a mute point. What type of environment would your mom do best in? Busy, quiet, lots of activities, minimal activities, compassionate employees or not so much, etc.
I have siblings that are trying to do what is best for them, not for mom. I'm the only one who takes into account what mom would want. If placing your mom in a facility is the end game, then I agree with the others as far as checking out facilities and their requirements when and if you have to move your mom to Medicaid. Ultimately, the sooner you place her the better in most cases. Again, what would your mom want for her environment to be. That would be your answer. Good Luck and take care.
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ferris1

Good point. Many facilities place residents in a semicircle in a big room with nurses nearby, in front of a tv. They only "move" for meals and activities,
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durinda1

It's nice that you were able to do this for your mom.
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bluecube

You're right. There are more 3 or lower star rated facilities than 5 star.
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My mother stayed 'in her home' for so long, she didn't know where she was living. we had to put signs on the doors saying 'bathroom' and 'bedroom' - not that it did any good, she didn't know her own house, was falling down and smearing poop all over the floor like fingerpainting. She went to a nursing home, where she also didn't know where she was living. But they changed her diapers, fed her, and she was perfectly content - even sitting in a half circle in the 'day room' playing balloon toss or some such.
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This will sound bad, but sometimes the children have to do what works for them. Not everyone can be a caregiver in their parents home. We never asked our parents the question about caring for them when we still had to work etc. I know my parents would not have been for that and if I get dementia, I do not expect my children to be my caregivers. Go through my long term care insurance, retirement, etc. in a "facility". I hate that word. There are many nice places.
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Caregiver812, I think You should opt for what You can afford. If the Others want to put Your Mom into the EXPENSIVE NURSING HOME CARE FACILITY at $2000 a month extra, Let Them write the cheque. You have five Little Ones to rear and to educate. Good Luck, I know Your Mom will be very well Cared for.

Durinda, soooh Many Caregivers on this A / A Site Cared for Our Love One's at Home, simply because We were able to....BUT....different strokes for different Folks..NOT Every One is as fortunate as Us. Many more would do the very same but Their circumstances do not allow.
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Whether the money is used up fast or slow, the person will still be eligible for Medicaid when the money is gone or almost gone. When my Mom needed to go into A.L. her attorney said to find the nicest place possible that WOULD accept Medicaid when it was time. Go in as private pay, and when the money is low, they will help get her qualified for Medicaid. With a diagnosis of dementia and needing Memory Care in the end, unless there has been 'gifting' of her money, such that there would be a penalty period, she would be approved for Medicaid at the start of the next month after the month in which all her paperwork was turned in and she was approved. So payment starts fast if there are no 'hang ups'. We had to do an extensive 'spend down' for my Dad, who needed Memory Care, so he was private pay for about $75,000. You can contact your state health department/assisted living dept...and usually, can get a list of which facilities take Medicaid in your area. That's what we did with Mom. Then we toured them all and made a list of her 'wants'...asked all of them the same questions and wrote down the answers...so she could compare. She chose a facility where she could have her own 1 BR apt, and could have her cocktail every evening....for the same price as others where she would only have a bedroom and bathroom to herself.
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Thanks to all who've taken time to respond, I am now much more optimistic because of the advice provided by 4him4Him, DonnaF and especially joannes for (that were for me) wonderful, insights and practical, useful info...however, still waiting for siblings' help, other than "will try and look into" possible sites. At this point, looks like the beginning of the new year will be timeline for definite memory care placement mom.
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I did want to make the point that if your Mom is already in a 'nice' place, when she needs medicare, that place would rather keep her than lose whatever income they get for Medicaid. And, it gets harder each time for one with dementia to change living situations. IF you waited until she were eligible, or until there was an emergency about placement, then you are stuck finding any medicaid eligible place that has a bed opened. If you think about that, you can just imagine what those places with empty beds might be like. If it were horrible, then there would be another move to find a better place. She might not be able to notice her surroundings, but YOU surely would as you go visit. We looked at many places for my Dad, because he was judge-ordered into a facility after police removal from home for safety reasons. The ones with empty beds were HORRIBLE in Tucson. I assume, that was WHY they had empty beds! We had to move Dad x3 before his last and permanent home that was great for him. He got a little worse each time. And as for those who you are still waiting for help from....perhaps they need an email with a deadline stated in it. My brother had died, so I was alone and without the sibling issues. But it sure seems, on these blogs, that some siblings are like thorns in the side when it comes to getting involved. I would be inclined, if I had one like that, to say, I need info by March 1st, or she's coming to live with you....or something equally as sarcastic! It galls me that some cannot help with even a simple internet or research based search for info. I never had to do direct caregiving for either parent....and I was still so busy and stressed with doctors, app'ts, applications for Medicaid and VA etc, and paperwork to help the lawyers make decisions....plus all their bills and investments, maintanance on the house, caregiver issues for my mom, at home alone and on and on.....that even in my situation, I could not just stop and do some simple research due to time. How anyone does it with their parent or spouse etc, right in the home with them, needing 24/7 care is beyond me! Other siblings should be helping with time, respite care, money and doing whatever else they can to help, if they are not the primary caregiver, POA or trustee. But no one asks me! I do see just how fast they all show up at the death and want their share of the inheritance though. I should not say ALL....that is not fair....but it shows up on these blogs often enough. It makes me wonder how it would work out, if everyone in the family were told straight out that the law required that the estate be proportioned out exactly according to the effort paid in the end to provide for the parent!! Bet there would be a lot more help then.
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