Living Transition Time

Caring62

Due to increased care needs and behavior challenges me and my siblings are working to prepare to move Mom (83) to either a MC or Adult Family Home setting.   She was diagnosed AZ many years ago and has been living in AL for 4 1/2 years after Dad passed.  We have been managing her healthcare and finances since then.   While a generally independent person, Mom has never lived without close family until Dad passed.  For a multitude of reasons we unable to have Mom live with any of us and frankly she wanted to live alone after Dad passed.

While Mom has had periods of intermittent agitation over the last 2-3 years, even w/ medication, she is increasingly upset.  During assessments with her PCP and a few new AL/MC facilities it has been reinforced that Mom is in the early stages of Stage 6, so MC is now appropriate.  

This is where I could use input.  Mom increasingly cries or is angry that she doesn't know "what's next?".  She wants to know how she is going to live and wants help with us getting her situated so she can live independently, i.e. drive her car, etc..   It is obvious she is now very lonely as she now needs to be out in the AL dining room at all hours.  This is such a behavior change as she has not wanted to be around anyone but family and has rarely been involved in any of the activities provided by her AL.  At this point I believe she only has the TV on for company and she doesn't seem to be able to read her novels anymore.

We all of know that any transition is going to be a challenge.  We are both evaluating both MC and AFH.   We have pretty much focused on helping Mom to feel safe over the last few years as she does not remember and "if told" doesn't believe she needs increased care and gets very angry.  All of us can see a situation where she will be upset after her move and may even be abusive (verbally at least) to staff.  

Any ideas on how to mitigate the challenges here? Thx

Ed1937

The very first thing that needs to happen is that the car keys need to be taken away from her. She is way past the time that should have been done, and it sounds like she has been very lucky not to have had a bad accident. If you are her caregiver, you can also be held responsible for any accident because you did not take the keys.

If she becomes verbally aggressive with staff, they've seen that before. As long as she does not become physically aggressive, they should be able to handle that. 

One thing that might help is an .mp3 music player that is easy to operate. There are some that are made especially with dementia patients in mind. Just load it up with her favorite music, and let her play it whenever she wants. Some will begin playing by simply opening the lid, and will turn off when closing. https://www.amazon.com/dp/B095XD8VQJ/ref=twister_B096WJ5MXL?_encoding=UTF8&th=1  

Caring62

Just to clarify, her driver's license was revoked by the State due to cognitive issues (doctor's request) car keys were taken away when Dad passed away.  I believe her mention of driving is part of the desire to be independent.  Thanks

harshedbuzz

I am sorry you are dealing with this.

Your mom likely has anosognosia and is unable to appreciate the ways in which she has had a cognitive shift. In her mind, she is as capable as she has ever been. As my dad's dementia progressed he became less aware of his difficulties with memory and cognitive tasks.

The other thing dad did was to sort of time-travel back to an era where he was a much younger and independent person. He still knew who my mom and I were, but sometimes told her she looked really old. In his mind, he was in his mid-40's and was shocked to have a wife who looked 80. He talked about the job and coworkers he had then, referred to my husband of 35 years as "that guy Harshed is shacking up with" and believed my nieces were still little even though he recognized them in their 30-something versions. Perhaps your mom's mind is more fluid in where she is in time, too?

I expect she'll take some time to adjust to a MCF, which I would choose over an Adult Care Home for many reasons, but she may do better within a few weeks. She is a poor candidate for AL. The staff are likely not as well trained in managing dementia emotions and behavior as those in a quality MCF would be. It's likely she is isolated and shunned by other residents as they would quickly figure out she's had a cognitive shift. My aunt was placed in an AL by her daughter and it was a disaster. She missed meals because she wasn't oriented to time or routine and didn't show up at the appropriate time. She was too impaired to participate in the activities with other residents or keep up with their conversations during meals. She was even bullied a bit by some geriatric meangirls there. 

A good MCF will have dementia training for all staff and dementia-informed activities she might enjoy. My dad wasn't an activities guy, but he did enjoy the musical performances and some of the sports-themed stuff like tailgate parties. 

Good luck.

HB

Iris L.

Caring62 wrote:

This is where I could use input.  Mom increasingly cries or is angry that she doesn't know "what's next?".  She wants to know how she is going to live and wants help with us getting her situated so she can live independently, i.e. drive her car, etc..   It is obvious she is now very lonely as she now needs to be out in the AL dining room at all hours.  This is such a behavior change as she has not wanted to be around anyone but family and has rarely been involved in any of the activities provided by her AL.  At this point I believe she only has the TV on for company and she doesn't seem to be able to read her novels anymore.

Two points.  Your mom doesn't know what's next because PWDs no longer can think ahead or strategize.  She is in a continual brain fog.  She needs CONSISTENCY to be a priority in her daily routine.  If you are discussing an upcoming move with her, forego this, it is anxiety-provoking.

TV is also anxiety-provoking.

PWDs gradually lose the ability to initiate activities.  This is one of the reasons that they do not participate in activities in AL.  They need to have someone lead them to the activity and then probably start them off, even sit next to them and coach through-out the activity.

Iris L