Mom is confused, a high fall risk and a wanderer, where to place her?

Caring62

Mom is 83 and is entering a later stage of Alzheimers.  She is at a SNF in OT/PT after a sequence of falls (stitches, a couple of black eyes, one small brain bleed, etc.) with the last a hospitalization.  She is now under palliative care level as extreme medical interventions could be catastrophic due to her frailness.      

Due to her dementia (only self-aware, balance issues and impulsive) she is now considered a high fall risk.  Mom is also restless and anxious at times and is also now considered a "wanderer".  Mom doesn't go far but today at the SNF she got past the staff (w/her walker) into a central outdoor courtyard, where they found her on the ground, unhurt but cold.      

She is expected to be discharged within a few weeks to a location that is "safer" for her with  7 x 24 supervision recommended by doctors.  Adult Family Homes with higher staff/resident ratios has been the direction to-date.  Family is unable to provide direct care and can't afford 7x24 home care (she doesn't have a home).    

So...

Option 1:  Secure AFH - More direct supervision but she may need medication to minimize her anxiety and wandering.  

Option 2:  Secure High Acute Memory Care w/inside walking area - Keeps her active and may reduce restlessness and anxiety if she can move around more - but not as safe as due to her impulsiveness (she can be out without a Stand-By-Assist) and confusion.

Anyone have other options or ideas?

Ed1937

I'm hoping someone has POA. Do they? It sounds, with the limited information, as though whoever has POA needs to talk to a CELA (certified elder law attorney) to see what options are available to protect whatever assets she might have. Without POA, things will be much harder, and guardianship might be required. That takes time and money. I'm guessing that she's not capable of rationally making decisions, is that right? If she is able, that will make things much easier. It also sounds as if Medicaid is what she needs. A CELA can handle all of that for you.

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harshedbuzz

Caring62-

A couple questions.

Do you have the legal means to place her? Does she have money to self-pay for a time in MC? If she'll be using Medicaid funding for care, do you live in state that will fund a Medicaid bed in MCF? (My state won't, and you didn't flesh out your profile)

To your question. Neither option is ideal; there probably doesn't exist a perfect solution that would keep her absolutely safe. She's likely going to continue to fall if she's compelled to walk as some are. Medication might dial that urge back, but she can't be constrained by medication and the classes of drugs used to calm this kind of anxiety/agitation will make her even more of a fall risk.

AFHs aren't a "thing" near me so I can't speak to those. In a good MCF, there should be dementia-trained staff and dementia-informed programming and activities from which she might benefit. You might be in a place where the goal is quality of life until the next bad fall.

HB

CanyonGal

Memory care facilities are lock-in facilities due to the number of residents that can wander. There is usually a code to enter to the facility or someone to open the door for you. They try to offer activities to keep the residents engaged. Some wander in the building continuously and that is just the stage of dementia they are at.

Falls can happen ANYWHERE including hospitals and nursing homes. My mother was in ICU, standing on her bed! She didn't fall but that just shows that things happen, even under care. She is a high fall risk but doesn't always remember to use her walker, furniture walks, ...makes me nervous wreak and a nag with getting on to her. 

Is she under Hospice care? They can prescribe something for the agitation.