Move transition issues

JAHawk

My mother was diagnosed with “mild neurocognitive disorder - possible Alzheimer’s subtype” back in Oct. 2021 at the age of 73.  She had lived by herself for over 10 years after caring for my stepfather who died of ALZ in 2010.

Early in 2020, we realized that mom was unable to handle her finances anymore (missing bills, paying bills twice, thinking every request for a charity was a bill). I have been handling her financial affairs since then. Mom had already had POA documents in place. I’m set up as her financial POA (I live 6 hours away) and my sister as her healthcare POA. My sister is a nurse at a religious AL community and lives in the same town as my mother. 

Mom was unhappy with living in her house and felt she needed a smaller apartment with less to deal with. She had expressed this to us and her PCP. We toured a Senior community with independent living, AL and MC units. A Senior living community was also something that her doctor had recommended that they thought would benefit mom. The facility also has community meals and activities. Mom would also be able to take her small dog who is definitely a support animal for her. Mom was no longer motivated to make even simple meals and could not organize a simple grocery list. We would visit and she would have multiples of some items and nothing of the essentials.

Mom had also had a few episodes where she lost her way while driving.  The first time I noticed a charge to her credit card for a gas station in a small town that we lived in 50 years ago.  It was very unusual for my mom to drive more than 15 minutes from her house and this would have been 45 minutes away.  She also had two other episodes of being lost in her town and having to call my sister to come get her and drive her home.  These episodes not only scared my sister and I, but my mom as well.  Mom agreed that she should no longer be driving on her own and my sister took the keys to her car. 

At the end of January we moved mom into an independent apartment at the senior living community.  The adjustment has been extremely difficult for my mom. She is often confused on what town she is in, thinks she is on vacation and is waiting for someone to come get her take her back home. She realizes that her mind is not right and will even say that she thinks she has sundown syndrome. Although I call her to remind her of activities for the day, she will not attend. Two weeks after she moved, my sister had a vacation planned. In order to help with mom’s anxiety and help her socialize more, we have a caregiver coming for few hours a day to hopefully get mom into a routine and become comfortable in her new apartment.  It has been two weeks with the caregiver support.  The minute I think things are improving (mom wasn’t calling me in tears for a few days), then the anxiety and depression return and she is packing items in her apartment to move back home.  She also lost her way taking the dog out for a walk and a neighbor helped her find her way back  

Any suggestions on how to help during this transition period?  I’m starting to worry that maybe mom isn’t going to be able to live independently and will need to move to AL. However, I want to give her the support and time she needs to try to be successful living independently.  We have an appointment with her PCP this week and mom is begging for medication to help with her anxiety. She is already on escitalopram, bupropion and recently added duloxetine.  

Sorry for the long rambling!  It’s been a rollercoaster today!

ButterflyWings

Welcome JAHawk, to the best circle that no one wants to need. 

Based on your description I think you are right, that Independent Living and her current dependence on others for ADLs and/or IADL’s are beyond your dear mom’s stage now. That likely contributes to her high anxiety. I hate to say this, but it really sounds like AL may not provide enough support either. 

Have you considered MC given the progression of her condition? My understanding is they would engage her more and initiate things she no longer can, providing more safety, support, and a better quality of life from here forward.

Wishing you and your family the best of this bad situation we all are dealing with.

harshedbuzz

JAHawk wrote:

Hi and welcome. I am sorry for your need to be here but happy that you found our little clubhouse. 

Any suggestions on how to help during this transition period?  I’m starting to worry that maybe mom isn’t going to be able to live independently and will need to move to AL. However, I want to give her the support and time she needs to try to be successful living independently.

This is an oxymoron. Independently means without support. If you have already had to take away key IADLs- driving and money management, she is no longer a candidate for independent living. The "I" in IDALs is independent. 

There's an old saying in this group that by the time one is willing to consider IL, it's already time for AL and by the time a family will consider AL, that cruise has already sailed, and MC is the appropriate option. We family members tend to view our LOs with loving eyes behind rose-tinted shades. 

I would move her to AL asap. If she's oriented enough, socially appropriate and capable of initiating things like meal times and activities, she might do well there. Be aware, though, that other residents could disinclude her if her cognitive shift is obvious to them- the resent it when PWD are moved into their midst. Sadly, my aunt was bullied by other women in her AL so I would watch for that. 

We have an appointment with her PCP this week and mom is begging for medication to help with her anxiety. She is already on escitalopram, bupropion and recently added duloxetine.

Who is writing scripts for 3 different psychotropic medications? If it's the PCP, maybe your mom would be better served by a geriatric psychiatrist. They are the experts for the management of these sorts of medications in the elderly and PWD. It's not that 3 kinds of meds is excessive, my dad also needed 3 kinds of medication to have a semblance of emotional ease, it's just that you'd want a specialist to balance the risks and side effects of the combination and that outside the wheelhouse of a PCP, internist or neurologist. I would ask about the Wellbutrin- it's a terrific medication for depression and even certain addictions, but it can be activating. My dad's geripsych added it specifically for that. 

Sorry for the long rambling!  It’s been a rollercoaster today!

Good luck. I hope you can find a plan to take some of the steeper dips out of your ride.

Lindsay22

Hello, I am sorry to echo what the others have said but I think it is correct.  She isn't independent enough for independent living.  It isn't safe for her to be out walking her dog if she is getting lost.  Does the community have MC? If so and she is able to afford it I think that is your best option.  MC is more structured and at her stage getting her on a routine will be beneficial to her. She likely won't be able to bring the dog but hopefully they will allow visits. I know this is a major issue.  When my mom moved to MC I was very worried about her separation from her cat (also very much an emotional support for her).  We were able to bring him to visit but after about a month she didn't ask about him anymore.

caregiving daughter

Memory care provides some great resources that your loved one does not have access to now. Caregivers will first ensure that your mom is safe and fed. There is no, "I'm not hungry" or forgetting to go. She will be brought to the dining room. She will also be put to bed in the evening. In waking hours, between meals, there will be lots of activities. In general, there is also no staying in the room. If your loved one doesn't want to talk in a circle about current events, they are likely able to sit off to the side and chat but there is no time alone. Keeping busy means distraction and therefore, less anxiety. Caregivers typically have a higher level of training and understand dementia. Routine, routine, routine is the name of the game, which is stress reducing, in and of itself. When you have dementia, it is difficult to follow a conversation or introduce yourself to someone new. Because of the apprehension that builds, a person withdraws because its too much to deal with. They become self conscious in a assisted living dining room where there are with residents without dementia. In memory care, things slow done and again, verbal cues assist residents. Memory care patients often do become friends with one another or feel comfortable with consistent dinner partners. This wouldn't necessarily happen in independent or assisted living. So the latter becomes very lonely and creates anxiety.