Are these common signs your LO has to move from AL to MC?

TrumpetSwan

I just moved both parents to Assisted Living last month. The Director of Nursing called today and told me that both have declined rapidly since her initial assessment when they moved in and that both should move the Memory Care section.

First, how likely do you think it is that both parents declined so rapidly in six weeks? Is it more likely parents were "show timing" at the first meeting and really had greater needs that were not recognized earlier?

Secondly, what does not help is that neither of my parents have been assessed by a neurologist to get a diagnosis. I asked the DoN about an assessment, but said I did not want anything extensive but wondered about something observational or a Q&A analysis just to get some idea of what stage each may be in. She said she would ask the doctor. Is this an appropriate as a next step?

Last, the DoN did state some aspects the staff reported back to her. Some were not that concerning in my opinion, but others were. I did agree to prepare their move to Memory Care and scheduled a meeting next week to discuss finances and other needs for their new space. However, of the items she reported back to me I am wondering if these are common triggers to move your LO to MC?

She said they just sit on their sofa all day and do not engage with other residents, and they wander the halls at night. I did not find those two aspects particularly concerning as they can be unsocial and always stayed up late at night anyway and I thought they might just be bored from sitting in their room all day. Then she continued on saying when they wander the halls they do not know where they are. She also said the staff has to repeatedly answer their questions. The really awful thing was she said both are double-incontinent and go through several changes of clothes each day and that they have been walking to the dining room "covered in urine" and not even aware they need showering or changing. Yikes. That convinced me.

I just wanted to ask, is this common? Thank you.

M1

yes, I think this is pretty common. I think it’s also common to think/hope that your loved one is well enough to get by in AL and not MC, but to discover pretty quickly that that’s not the case. To give the staff the benefit of the doubt, they probably couldn’t tell enough about your parents at the outset, but I give them credit (and you) for moving quickly when they realized their true support needs. Incontinence and wandering, as well as inability to interact with other residents all indicate that the DON is correct. Hopefully you will be pleasantly surprised if they do better in MC.

Anonymousjpl123

ditto to what M1 said, my mom started in AL and sharply declined in 8 months. I think she was “showtiming” for the assessment, and I was in denial about how far she had progressed. Their behaviors sound much better suited to MC. For what it’s worth, my mom is getting much better care in MC than she did in AL, and I have found it to be well worth the extra money.

TrumpetSwan

Thank you M1 and Anonymous. I guess I was questioning the validity of what the DoN was saying regarding them both moving to MC.

I am so new to this, but question how they would be doing any better in MC. For example, in MC their room is going to be smaller and will no longer have a kitchenette. So, dad no longer gets to keep milk or orange juice that he likes so much in a refrigerator easily at hand. Also, what I saw when I walked through MC, was about 12 residents collected in wheelchairs in front of a television not interacting with each other, not talking, and several of them were blankly staring in the distance. One woman was walking in the hallway alone talking gibberish very loudly to herself. That environment hardly seems suitable to offering anything "better".

The DoN said my parents are unlikely to notice the difference. I actually believe they will indeed notice the difference. The only positive thing my dad mentioned about the AL is that the dining room offered great meals, and he really liked the breakfast oatmeal with brown sugar along with the sweet rolls. Now, in MC, they will have a small cafeteria with limited food options where they select prepared plates off a buffet table.

The DoN said staff will be engaging with them in more activities, but if my parents already are not engaging in activities, I do not see how MC will change that.

It sort of feels a bit like they just do not have the available staff to tend to my parents increasing need for bathing and grooming due to their incontinence, nor do they have the staff trained in dementia to adequately respond to my parents' needs for guidance getting around in their new environment.

It just seems like the move is going to be easier for the staff, but worse for my parents and we are not being given any choice.

M1

That may in fact be correct; your choices are limited. I don't know that it will be "easier" for the staff, but the staff in MC will be more prepared to deal with their needs.

There is no ideal solution. Short of providing 24/7 care in their own home, any use of a facility involves compromise, and as is always said here, safety has to drive the decision making.

I completely understand your reaction to seeing the apathy of other residents in MC. But the fact is: you parents are exhibiting that same apathy, just in slightly different format. Remember that there is turnover in MC all the time, so that there will be a new mix of residents fairly quickly.

I guess the other alternative would be for you to provide a one on one companion/caregiver for them in assisted living, but that is likely to be prohibitively expensive also.

harshedbuzz

@TrumpetSwan said:

I am so new to this, but question how they would be doing any better in MC. For example, in MC their room is going to be smaller and will no longer have a kitchenette. So, dad no longer gets to keep milk or orange juice that he likes so much in a refrigerator easily at hand. Also, what I saw when I walked through MC, was about 12 residents collected in wheelchairs in front of a television not interacting with each other, not talking, and several of them were blankly staring in the distance. One woman was walking in the hallway alone talking gibberish very loudly to herself. That environment hardly seems suitable to offering anything "better".

I can appreciate that it is hard to picture one's own parent in a secure MCF among others who are further progressed in the disease process. Such is the nature of a facility that allows residents to age-in-place. The population tends to turn over rapidly in MC; there could be a new batch of residents more like your parents soon or it could be the ones who are still functioning at a higher level were engaged elsewhere. Or it could be the place you chose is great for AL but not so hot for MC. Perhaps it makes sense to tour other facilities and see if something seems better for your parents.

The families of other AL residents who see your parents in urine-soaked clothing or wandering lost late at night probably feel much as you do— "My LO isn't like this".

Would the MCF be open to allowing your dad to have a mini-fridge in their room? A few places probably do so long as open containers aren't a problem i.e. housekeeping/mouse/insect issues.

The DoN said my parents are unlikely to notice the difference. I actually believe they will indeed notice the difference.

They might notice. Dad was oblivious to his own cognitive changes and general progression, but the spotting the poor function in others was like a superpower for him. Being observant doesn't necessarily mean they don't need the higher level of care.

The only positive thing my dad mentioned about the AL is that the dining room offered great meals, and he really liked the breakfast oatmeal with brown sugar along with the sweet rolls. Now, in MC, they will have a small cafeteria with limited food options where they select prepared plates off a buffet table.

If this is the same facility, it's probably the same food from the same kitchen minus the theater of ordering as it can agitate many PWD beyond the early middle stages. Oatmeal seemed always to be offered at dad's MCF as well as handheld treats like muffins and honeybuns. IME, anytime dad didn't like what was served, staff was quick to take it away and offer something else. They always had a few other options. They also allowed us to provide drinks and treats for dad which were kept in the hall's kitchen.

The DoN said staff will be engaging with them in more activities, but if my parents already are not engaging in activities, I do not see how MC will change that.

This may or not change. MCF tend to offer failure-free activities that allow residents who participate feel successful. Even so, given the apathy that is characteristic of dementia, this probably won't change. Dad wasn't an "activities guy" but he did enjoy the live music and parties they offered.

It sort of feels a bit like they just do not have the available staff to tend to my parents increasing need for bathing and grooming due to their incontinence, nor do they have the staff trained in dementia to adequately respond to my parents' needs for guidance getting around in their new environment.

On the AL side of things? If so, it's because AL tends to follow a hospitality-model offer meals and minor assistance to those with mobility-type issues. Only someone in the earlier stages of dementia who is still reliably able to manage their own ADLs would be a potential AL candidate.

It just seems like the move is going to be easier for the staff, but worse for my parents and we are not being given any choice.

It's not going to change the workload overall for the facility. It may for the AL aides who are responsible for a greater number of residents than the ones in MC. To that end, it might be that other residents are not getting the attention they should since their aide is overworked and spending extra time attending to your parents. Other residents and their families may feel they're getting short changed and make this known to the DON and management.

HB

housefinch

Yes. These are all signs they are needing a greater level of executive functioning support and safety monitoring than AL is designed to provide.