AL or MC

NizhoniGrrl

My 89 year old mother has been living in IL for about 5 years since my father died. She plays bridge a few times a week, but otherwise her activities are eating meals in the dining room with her friends and watching tv. Over the last few months she’s stopped taking out her garbage, washing her dishes, or doing laundry. Her management of her incontinence products has gotten ugly: she tears the wet parts out and flushes them, she hides the poopy ones occasionally under the sink, and she leaves poopy washcloths on various surfaces in the bathroom. She continues to eat sweets that cause the diarrhea. I’m at my wits end! She has had daily medication management for 2.5 years, and I’ve added garbage and dish cleaning. I also just added weekly housekeeping to thoroughly clean her apartment and take care of her laundry, but I don’t think it is enough. She’s made herself very sick eating either bad food or something contaminated with feces. While I want to keep her as active as possible for as long as possible, I’m wondering if she is safe, and the stress is getting to me. I have a camera in her apartment and I can see she is up at all hours and sleeps about 12 hours a day, and she’s lost quite a bit of weight. The cost of more caregiver hours will equal the cost of AL soon. But should I be looking at MC instead?

sandwichone123

Hi NizhoniGrrl, the behavior you're describing is not going to be compatible with assisted living, which presumes a fairly independent level of functioning. Once they're hiding poopy ones and leaving poopy stuff around they need memory care.

Quilting brings calm

MC. The AL staff are not equipped to handle someone who handles their poop inappropriately.

Have she seen her doctor recently? The weight loss is concerning.

harshedbuzz

@NizhoniGrrl

Given the time that has elapsed since her initial MCI diagnosis and the incontinence behaviors, she sounds to be beyond even the care level of hospitality-model Assisted Living. The weight loss and double incontinence suggest she's likely progressed to stage 6 dementia.

I would question whether she is truly included at bridge at this point. Loss of IADLs and ADLs is LIFO— if she regressed to losing the most basic toileting skills, it is not likely she has maintained the ability to play as complex a game as bridge. Sorry, I don't believe it. The other piece is that if she's still resistant to dental care as you wrote in 2021 and is incontinent, it is unlikely she is still included by the other residents at this point. FWIW, my dad swore to me that he'd spent his days playing golf with friends or at the pool when I pulled him out of Florida and moved him north. I felt terrible at disrupting his social world but need to for safety reasons. When I went down to handle the sale and moving of his place there, the neighbors all stopped by to chat and reported that they'd not seen dad golfing, swimming or out of the house in 5 years. A few thought mom had been widowed.

When my aunt with dementia was inappropriately placed in AL, she crashed a burned. She struggled to turn up at mealtimes and lost weight and the other ladies quickly recognized that she couldn't keep up with their conversations or activities and shunned her like so many middle-school meangirls.

HB

H1235

I just moved mom to AL. They provide meals, clean her apartment, distribute medication, do laundry and offer activities. But I was surprised at how free she is to make decisions for herself. If she doesn’t want medication it’s no big deal, her choice. She is free to come and go as she pleases and I doubt anyone would even try to stop her if she decided to walk into town with her walker. If you do find an AL that can handle what she has going on, she is probably going to be towards the limits of their ability. Then what do you do when things progress. I have heard of facilities that offer a AL side and a MC section. I would be very upfront with any AL you talk with. Keep in mind that if they are not offering these additional services regularly they may not be as well trained as the staff at MC that deals with it all the time. Getting used to a facility’s routine can take time, changing facilities down the road will be disruptive for her. Tough decision, but it definitely sounds like it’s time for a change. Good luck.

NizhoniGrrl

https://alzconnected.org/discussion/70339/al-or-mc

Thanks for all the feedback. She really does play bridge and she’s also a back up player. I’ve seen her playing pinochle (while I’ve been doing her laundry), and my son and his girlfriend have visited and played 5 crowns with her. It’s a part of her brain that has stayed very sharp (she had a math minor and earned a computer science degree later in life as a second degree). The recent cognitive assessment said she needs 30% cognitive support (I don’t know what level that is), and daily check ins to stay independent. I've already done all the other things (completely manage her money, shop for her, unplugged stove, taken away scissors, etc). I was surprised last night when I saw her hamper out and she said she did her boyfriend’s laundry. He’s a resident who has become quite addled lately and they eat together, but a big part of her mood management (when they are on the outs, she gets very cranky). I said, "you won’t do your own laundry but you do his?" And she said, "well you took that away from me!" She’s mad about moving to a smaller apartment even though it is literally only steps away and keeps her there longer. But we’re going to start looking at places, both AL and MC. She is lucky she managed to stay in IL for the last 2.5 years. I never thought she would manage it but agreed to give it a try because BRIDGE is her life.

NizhoniGrrl

https://alzconnected.org/discussion/comment/219929#Comment_219929

See my reply below. She does play bridge, for real. Bridge players are snobby (including her). They can't play without 4 competent players, and I've seen her playing and leaving the apartment at the times of her games. Also, an update, we did have her teeth removed and it was a hellish journey. The long story short is she only wears her upper because of her vanity, and she refuses to use or try to use the lower, because it is an uncomfortable adjustment period (yes, she's had the liners replaced and fit adjusted, but that is just money down the drain). It fits with her personality and dementia has deepened this.