How did you know it was time for memory care from assisted living?

meolson13

My mom moved into assisted living this past January. She has progressively declined since then but loves her new apartment and seems cheerful and happy when we visit and talk (which is multiple times a week between my sisters and myself). However, she has lost the cognitive skill to engage with the activities. She frequently shares how some of the other residents have been rude or impatient with her or seem "cliquey" but I imagine it's because she isn't able to form new memories so she probably asks them the same questions over and over and she doesn't seem to remember anyone's name. The staff at the assisted living space are pushing for us to move her into memory care. They cite concerns because she will leave without signing out to go for a walk and they said she visits the front desk several times a day- seeming like she is looking for someone or something. She also checks her mailbox constantly throughout the day. They feel she would thrive in memory care. I have noticed she always wears the same pants but I think she is still showering. I am struggling because she has moments of seeming very clear. She still uses her cell phone and recently commented on last day of school photos, etc. With family, she does well. I know the staff there is worried she is isolating more and it's true that I don't know what she does all day. (She seems to fill in gaps that are not necessarily true events.) The staff manages her meds because she could not do that anymore and I manage all finances since she was struggling with that. I'm just so worried that she will understand and know we are moving her to memory care, which was always her biggest fear (both her parents had AD). I don't want to wait too long but I also think she will be so upset about moving into a studio apartment (the only available option). This is breaking my heart. I thought it would be more clear or straight forward as to when the right time would be.

sandwichone123

Your mom seems to be about where my dh was when I moved him to memory care. In a good facility, I think it's generally reasonable to follow the recommendations of the staff—those behaviors are all things I would find concerning. Another consideration is that if you decline to follow the suggestion to move her to memory care and she continues with concerning or dangerous behaviors, they may ask her to leave.

meolson13

https://alzconnected.org/discussion/comment/274470#Comment_274470

How did your DH do? Was he aware he was moving to memory care or did you frame it differently?

SiberianIris

We moved mom to MC 10 months ago. Prior to that, she was living with 24/7 caregivers in her CCRC apartment. As the dementia progressed, we kept adding shifts of caregivers trying to hold off a move to memory care. When it got to the point she needed 24/7 supervision, we realized a move to MC was inevitable, but the MC was full, so we had to wait about 6 months until a spot opened up. She was in early stage 6 and declining fast due to frequent falls. (She had just zipped through stage 5 in a matter of months.)

Mom is better off physically and cognitively in MC than she was with 24/7 private caregivers. Ten months later, she's still in early stage 6, and she's had only one fall. She's made friends and she takes part in most of the activities. She goes on field trips. She proudly shows me her art projects. She was always very social prior to dementia, but most of her friends had either died off or stopped seeing her as her dementia progressed.

Mom never would have willingly moved to MC, so we told her "the doctor wants you to stay at this special rehab place for physical therapy for a few weeks". Mom loves PT, so this went over pretty well for her. Ten months later, she's somewhat aware she's been there awhile and has accepted it. Sometimes she will still ask if I can take her back to her CCRC apartment (which she no longer has) to get some things, and I'll say "yes, but we'll have to do it another time because I need to get to a doctor's appointment". One day out of the blue, she said "I'm probably too old to live anywhere else. It's ok here, the people are nice, and the food is good." She's 97, but for some reason thinks she is 102.

Her past 10 months in MC has been a far better quality of life than the previous 2 years, however, I don't think we could've successfully moved her any sooner. The "right time" to move someone to MC is unique to the individual and other factors like where they're currently living, their support system, etc.

harshedbuzz

@meolson13

The point to remember in all this is that, at the end of the day, you are not making this decision— her dementia is.

What you are seeing with your mom is exactly what happened with my aunt. Due to some communication issues, she was placed in an AL apartment when she was beyond that level of care. The other ladies were annoyed by her. Elders with intact cognition resent their community being turned into a MC. Aunt's "cheating" (she forgot rules) at games and repetitive unfiltered comments at meals made her a pariah. These ladies were unkind to the point of bullying so aunt spend more time in her studio.

Because the level of care meant a daily well-check when meds were given, nobody knew she's fallen and broken a hip for what might have been 18+ hours.

At my other aunt's CCRC, the staff offered a hybrid option for auntie. She was sweet natured and social, so she was included in some of the AL activities (crafts, matinees, sing alongs) and day trips while officially being a MC resident. She usually had breakfast and dinner in MC but had lunch with the AL group. Perhaps that might be an option.

HB

meolson13

https://alzconnected.org/discussion/comment/274501#Comment_274501

Thank you- I appreciate the first line of your post so much. . .

H1235

It’s so hard to make these difficult decisions. You don’t know how quickly this will progress or how she will adapt. It’s probably hard to even truly tell how she is doing where she is at. I was surprised at some of the things I found in moms Al room when we moved her to a nursing home. You can only do the best you can. Don’t beat yourself up if you later feel like you made a mistake. We are all just figuring this out as we go the best we can.

psg712

I started asking about MC when I noticed that my mom would no longer shower or change clothes in AL. She had also stopped particpating in activities and could no longer find her way to the dining room without being escorted by staff. When I approached the director about this, he told me that mom was on the "watch list" for transition to MC but she was not high priority because she wasn't exit seeking or aggressive. An MC room became available while she was in rehab following illness and hospital stay. She moved without resistance, seemed to have forgotten completely her room and friends in AL.

April23

If the staff is hinting that it is time, I would listen. They are well versed in the behaviors and may be seeing other things they aren't even mentioning. For me personally, I knew my dad would not fit in socially in AL because he could no longer follow conversations and needed assistance toileting, sometimes chose the wrong utensils, etc. He would not even have been able to find the dining room or activities room without assistance. She could be isolating because it's too overwhelming for her to navigate without assistance or is being shunned when she tries to participate. If Mom is not fitting in socially with the AL residents, that to me would be a big indicator that it's time.

sandwichone123

https://alzconnected.org/discussion/comment/274471#Comment_274471

My dh did fine after the first couple of weeks. I had talked a little about needing to get him more care, but he did not understand. I framed going to MC as going to see the doctor—the MC doc would see him and write admission orders for him. After we got there and were waiting for the doc, he said angrily, "I see what this is, and I'm not staying!" We got him seen, and an activities person took him around while the admissions person and I went to set up his room, and then I disappeared.

SDianeL

safety is the primary concern. She could wander off. AL does not provide 24/7 care. MC does. MC is locked. I would trust the nurses’ recommendation. Have you asked if she’s showering? She also may need medication for delusions.

ARIL

I moved my dad to MC on the advice of care staff, at the point I moved him across several states. I agreed to a “trial period” in MC, but I saw pretty soon that he needed that level of care: for personal care, for safety, to be with others at the same level of ability.

I also realized in retrospect that the staff at his AL had been caring for him at an MC level—which is something that would not have happened in the new place. So one reason I thought he wasn’t ready for MC was an unrealistic notion of what AL and MC meant.

The move to MC was hard for me—but not for him. In time I came to see this is what was needed, and to see that it wasn’t “game over,” as I had feared.