Not thriving in MC

dbarrylewis

This is my mother’s sixth week in MC. There have been highs and lows in that time. If I’m being honest with myself the low periods are increasing in both duration and intensity. She rarely participates in activities and often needs encouragement to go to meals. We were hoping to see some improvement and it seems the opposite.

The advice has been to give it more time, that it often takes months for them to adjust. My worry is that it’s getting worse. Have others experienced this?? if so, did you ride through the low period, and see improvement? Or look for an alternative?

More background, my mother is in mid-stage Alzheimer’s. She knows who we are. At home she was having delusions that made her frantic and had extreme moments of agitation that sometimes led her to be physically abusive to my father. My siblings and I acted quickly when we realized how bad the situation was, and were notified of an opening at the MC very close by so my father can see her frequently. He goes every other day for a short visit (one hour) and one of my siblings or I will go on the alternate days. It’s been a lot of change in a small window of time.

easy23

I would give it more time. Do they have an in-house psychiatrist that could see her? Maybe she needs a medication adjustment to help her. What helped my DH was having a consistent staff that he could get to know rather than a rotating staff. That made the difference between two places he was in. It's good that the family is visiting to keep an eye on things.

dbarrylewis

https://alzconnected.org/discussion/comment/273797#Comment_273797

Unfortunately they don’t have a psychiatrist on staff. I moved close to my parents six months ago to help with the situation more full-time and don’t am not confident their PCP could diagnose or prescribe something. They are still new to me but just an impression.

I do have worries about the rotating staff. This has been on my mind. I’ll follow-up to request more consistency. I hate to move her again, but am just worried by the downward progression.

Thank you!

April23

When my dad was in MC AL, he rarely participated in the activities, for whatever reason. Sometimes he would sit with the residents but not participate. So that is something that may or may not happen. You might try timing visits around an activity and participate with her to see if that helps.

I see now that I have been absolutely blessed when it comes to my dad’s transitions. He had several (rehab, MC AL, rehab again and the RCF where he is now) and every one was seamless and he adapted quickly.

But that doesn’t mean that he is always happy. This disease is defined by ups and downs and our LO’s will experience many as they go through their journey. Apathy and withdrawal is also a big part of the disease and can occur in any setting.

I know it feels like the move caused decline but it could also be that you are seeing the effects of the disease more clearly in a different environment. That is common.

As long as you feel like she is safe and well cared for, I would give it more time.

SiberianIris

I'm in agreement that 6 weeks is still early days. Still, I can absolutely understand your feelings of worry about your mother's adjustment. My mom has been in MC for 9 months. We want our parents to be happy and safe, but with dementia, happy is often no longer possible due to the nature of the disease, so we must settle for safe.

Do you feel your mother is safe in MC and receiving good care? Has there been a reduction in her delusions and agitations? Is she less physically abusive to your father? Have you had a chance to speak with the loved ones of other residents - are they happy with this MC?

You mentioned this facility does not have a psychiatrist, but do they have doctor who sees residents? My mother uses the doctor who visits patients in her MC. I have been very pleased with his experience with the dementia patient population in prescribing medications to help her (and also discontinue medications when they are no longer needed).

My mother is in early stage 6 and she knows her family, however, she still needs prompting and encouragement to go to meals and activities. Once there, she happily participates in the activities she likes and falls asleep during the ones less interesting to her. She's a natural "joiner" who would rather be with people than alone, but due to dementia needs prompting to get her there.

Loss of executive function with dementia removes our drive to "get up and go" and ability to follow an internal schedule, like "it's morning - time to eat breakfast". Visual cues, like seeing people walk toward the dining room, often don't register in a mind with dementia.

Before dementia, was your mom an extrovert or introvert? The communal living situation of MC will be easier for extroverts, but introverts can find their place, especially if the staff know to encourage activities she likes while also giving her some peace and quiet.

dbarrylewis

Others appear very happy in the memory care facility. It’s recognized for all the activities it offers and the level of care provided. Overall, we’re happy with the level being provided and she’s definitely safe.

Before dementia, she loved meeting new people. If she ever took a plane up to see me, she would tell me the stories of everybody sitting around her - where they were from, where they worked, the names of their children/grandchildren. She became much more introverted in recent years. I think part of it was because she was self-conscience about her loss of memory.

My father visited today and said it was the worst day yet. Feeling very much at a loss. 💔 I appreciate the feedback. We’ll give it more time and also persue a review of her meds.

Emily 123

You're second-guessing the decision to place her, which is normal for everyone, as is the desire for your mom to be whole again. I agree with the other posters here to give it more time. I understand that you don't want her to be so sad. However, you said that she had these episodes of tearfulness prior to placement as well, that her delusions had resolved since she made the move, that she had activities to do and was well taken care of. I don't think it's tenable to bring her back to the care of your dad at home, especially as she was a wandering risk. Her needs outpaced what your dad, at 87, could provide, and it was unsafe for both of them to keep her in the home.

A provider attached to a MC is usually going to be pretty well versed in adjusting the meds needed. I'd bring up your concerns about your mom's unhappiness now so they can work on adjusting her meds—there's no point in letting her continue this way.

You had noted earlier that the family was visiting her every day for an hour. That’s a lot, and may be interfering with her ability to make the adjustment, since it's a daily reminder of the move and could be exacerbating the sadness. It might be easier for her and your family if you reduce and/or shorten the visits to give her a chance to settle in.

It may be that you had some expectations that your mother's decline would improve with the move. But a move to MC isn't going to revive any of the abilities she's already losing. Her ability to respond to what's going on around her (like independently engaging in activities or that it's dinnertime) her will be lost in the stage she's passing through. These losses might be more front and center in this new environment as she adapts, but likely was there but not so obvious with her at home. With dementia the goals have to be keeping your person safe and healthy—the disease will remove their ability to be 'happy', though sometimes they can be content. It's not easy to reconcile that with what we want for our loved ones, and it's hard not to feel guilty about moving them. Hang in there.