Memory Care ALF

Katie S

I’m beginning to have concerns with my decision on a facility for my mother.
I need advice because I don’t know if I am being unreasonable and maybe what I’m expecting is beyond what this level of care offers.
When I visit, my mother has been wearing the same clothes since my last visit (3-4 days ago). Her clothes are soiled and she she’s not wearing underwear. I help her change and shower at these visits.

When I bring up my concerns the answer I’m given is because she refuses help changing and showering.

On the days when me or my dad take her out we call ahead to ask if they can help her get ready. Today, for example my dad found her in wet and dirty clothes. Not ready at all.

They say they try to promote residents independence as much as possible. But my mom cannot dress herself and increasingly cannot get to the bathroom on time. They ordered depends for her to wear but don’t help her put these on.

Are my expectations beyond MC ALF?
She can feed herself and ambulate independently.

SusanB-dil

So sorry you are dealing with that. It does sound like AL is not working, and further MC is needed. They are promoting independence, but she needs more.

Emily 123

Hi Katie,

Memory care staff should be trained to work around some resistance. Legally they can't force her, but they need to maintain her hygiene. Some facilities unfortunately don't follow through after an initial 'no'—even if they're calling themselves an MC they're more of an AL-style place.

My mom's first facility was like that—it touted 'dementia centered care' and keyed entry, but once Mom needed more assistance, they wouldn't push past her initial refusals (and it didn't help that Mom can be dismissive). The dementia journey is often one of those 'learn as you go' things—What I was told vs. the reality of what they were set up to provide were two very different things. In hindsight I should have moved mom earlier, but the management would make efforts and things would improve briefly before they'd lose staff and we'd be back to page 1.

First, review your contract. Our 'out' was that they couldn't keep up with mom's urinary incontinence, and it was in the contract that we could break it in that case.

They should have also prepared a care plan for her, which spells out what they're supposed to do, and should include hygiene care. Do you have a copy of that? (They should have given you a copy.) It's supposed to be done at intake then revisited at (usually) 90 days, and then at a set period of time or revised for any new needs.

I'd ask the director to set up a meeting, and have the care plan in hand along with a list of the specifics where the plan wasn't met. Get very specific with them about what they can provide and what steps they'll take to ensure things are done. Make sure they send you a copy of any revised care plan if they need to change what's already in place. If they can't meet the care plan then it'll be time to move.

Good luck,

psg712

I agree with Emily that you need a meeting with the director and with whomever supervises the direct care staff. And yes, "promoting independence" is not normally given as a goal in a true memory care facility. MC should not restrict independence (other than for safety, such as preventing elopement), but they should develop a care plan that includes all of the hygiene assistance necessary for each resident. The plan should be reviewed often as care needs change.

My mom also went through a period in AL where she did not bathe or change clothes. "Assisted showers" was added to her plan, but she rarely cooperated. AL was just not staffed or structured to work around her resistance. I tried to step in to assist with showers and soon was convinced of her need for a move to MC. She has done much better there. She still frequently refuses showers, but they are able to give her sponge baths, and I have resorted to the shower caps that have no-rinse shampoo in them for her hair. Once in a while we get her to the salon for a real shampoo and haircut - but that frightens her, so I don't know how much longer we can do that.

Even in an MC, you will still need to keep an eye on how she is being assisted with personal care. My current crusade for mom is her oral hygiene. Because she is quiet, mostly continent and able to.get herself to the restroom with a walker, staff don't see that she doesn't brush her teeth. Toothbrushes left on the counter inevitably show up filled with hair, as she uses them as a comb. Nor does she wash her hands after using the toilet. And so on. It's always something. I am overall satisfied with her MC, but still remain vigilant for things like these issues, especially when there are newer staff who haven't yet learned the needs of each resident.

I hope that you find the best care environment for your mom.

H1235

At my mom’s facility any extra help they provide we pay extra for and it is written into her care plan. Is help getting dressed and showering part of her care plan. I had trouble with medication (it was a cream for eczema). Because her hands were cracking and bleeding a medication was prescribed. Mom refused to use it and they just said ok. They didn’t push, tell her the doctor said she needed it, nothing. They tend to go along with whatever mom wants without clearing thing with me. They told her she could have a toaster over. They never asked why she wanted one(so she could bake cookies) or the size(full size that would probably not even fit on her countertop). They back tracked and told her they miss understood, but she still blames me. They told me they could provide care to the end of life. There is no way. If/when she gets to the point where she can not change her own depends I will definitely have to move her to some place that is able to provide more care. In my experience Al only really provides a minimum of assistance.