Impact of a transition between Memory Care locations

dbarrylewis

This is a follow-up to a previous post I made regarding us reconsidering MC. The reality is that we can't provide what my mother needs from home but I still have concerns regarding where she's placed. I noted in my previous post I was concerned about her being sad. I've come to terms with the fact that she will be homesick and missing my father regardless of our choice but that ultimately, she is safer in MC and in some ways doing better (less serious delusions) and it's necessary for my 86 year-old father to no longer be the caregiver.

All of that said, my mother has dropped significant weight in a short time and I've lost confidence in the wellness/medical team at the current MC facility. We are assured she's eating but have dropped in during meals and see that she isn't. She sits there, once with her head just resting on her cane. The dining room worker told us on that instance she isn't eating and also didn't eat the previous meal. We were also assured of her getting Ensure (something we requested as her weight dropped) and it doesn't appear she's been receiving it.

I've become the squeaky wheel but am concerned we're the only advocates for our mother's health at the current facility. We widened our range and found a MC that is further from my father but appears to be ideal with RNs on staff 24x7 and a doctor at the facility twice a week that specializes in Alzheimers. It comes at a higher cost but we would all sleep much better knowing the facility has a stronger medical team.

Our worry now is about the impact of a transition. Moving her into the initial facility was the single worst day of my life. I'm not being overly dramatic. My mother kept saying "I can't believe you're just sticking me here" and was so so visibly hurt by the decision. Without going into the details of her delusions at home and reason for the decision, I knew it was our only option but it still is incredibly painful.

I'm curious if anyone else has made a MC transition and can share their experience. I understand the stress will take a toll, as it did with the initial placement. Have people seen this and regretted it. As a follow-on, she just began on an antidepressant two weeks ago and appears to already be showing some sign of improvement. Should we wait until she's in a better state to make the transition? Or is sooner better?

The new location is further from my father but there is no doubt will be better for her as the disease progresses. I feel the move is inevitable even if the sadness/agitation improve over time with the antidepressant. I'm just curious now about when to make the change.

cdgbdr

I moved DH to a new facility because the first one lacked leadership and professional care to put it simply. Planning him there was absolutely horrible for me. The thought of moving him was not on my radar. Like you I found a place a bit farther away and more expensive but I rest easier with him there. The transition was better than I expected. His sister took him to breakfast and then to the new facility at lunchtime. We wete getting the room together and the staff made a fuss over him. He slept in the common area the first night for some reason, but he acclimated. He has been there 6 months now. His decline has continued, as expected. It may be easier than you expect.

caregiving daughter

Supplements like Ensure should be documented in the resident's charting. If the facility indicated they would provide that or a yogurt, for example, and it doesn't happen, I would be concerned. I believe my mom was in a strong mc but the RN was only there during the daytime so 24/7 is compelling. I, myself, would likely make the move sooner rather than later.

ARIL

I moved my father from one MC to another after I found the care at the first one unsatisfactory (long story). I did give it a chance and try to work with the director the staff there, but it was clear that it was not going to get better. I figured I have only one father; this was not a trial run. So we moved to an MC-only facility that is more expensive but nearer my home. It is better.

The move itself went OK, and although it did take him a bit to get used to it, I honestly don’t think he remembered the old MC much at all. In fact, a few weeks after he moved, he said, “You know, they’ve really improved this place!” I agreed.

harshedbuzz

@dbarrylewis

I'm of 2 minds on this.

I'm not there and can't speak to whether your situation is one of a MCF that is lacking or if your dissatisfaction has more to do with your unhappiness with the situation that led to this place. It is difficult for any poster to articulate why they get bad vibe from a place, so I would say, if it's not good and unfixable trust your gut.

That said, sometimes we caregivers can be unrealistic about where our LO is in terms of progression and what that might look like. So much about dementia is framed in the context of memory that we sometimes forget that the brain is driving every function of the body including breathing and digestion.

Ensure is an option (there's also an "ice cream" version), but TBH, this weight loss is probably more about her not knowing how to go about eating and/or her digestive tract becoming dysfunctional. It sounds like you and dad are visiting a lot which is great. Are you bringing her treats to boost her caloric intake? Alternately, one of you could come at mealtime (lunch is generally the most substantial meal) and assist her with eating. When dad was in MCF, I always brought him a favorite meal from home, a takeout lunch and/or some sort of sweet treat. When my aunt was in MC the last 3 years, her sister or someone she hired came at lunch to hand feed her. I'd add handfeeding to the care plan and have someone come daily, if possible, so she can have one unrushed meal.

Weight loss in the late stages is typical. Dad probably lost 40lbs (about 18% of his body weight) in the last year of his life— 15 of those in the last 10 weeks despite plying him with milk shakes, soft pretzels, cake daily. That weight loss was enough to schedule a hospice evaluation for failure the thrive. At the time dad was still conversant and ambulatory. My aunt also lost weight having gone from a ladies size 14 to a very loose size 6 in the last 18 months before she died.

It's hard to say whether the change of facility will have an impact on your mom. If the new place is high quality with dementia informed care and well-trained staff she'll likely settle in.

I don't feel that having a 24/7 RN is really necessary in a self-contained MCF. Dad's had LPNs; IMO having the staff well-trained and paid well is the more critical piece. Dad's main aides had an average 15 years working at the same facility. They knew their stuff. A physician coming to the facility is very convenient and can help you avoid trips out for minor issues and cut down on ER visits.

I hope you can find a place in which you can feel confident in the care your mom is receiving. This is hard stuff.

HB

April23

Like many families, I first tried putting my dad in AL that proved to be way too much independence for him. It became apparent almost immediately that his needs were higher. Back then he still retained enough to sort of understand what was happening. But like everything with my dad, the move was easy and seamless and he settled in right away. A good place will help you and your mom in all the right ways. And that sounds like what you are headed for. Having nursing on staff will definitely help you sleep better at night.

PWD usually adapt quickly but remember it may take time. And even the best place will not ensure happiness.

There are some tricks to help with weight. I always show up with a calorie dense treat for my dad. Things like peanut butter and banana in oatmeal made with Ensure instead of milk, smoothies, protein ice cream, etc. all things you can try. PWD do end up needing assistance and cuing at meals and their appetites change also so it’s something that will become a challenge regardless. My dad loves for us to eat with him so we try and come for a meal at least once a week and have snacks together other days. Hopefully the new place will help with that and have ideas.

Anonymousjpl123

I’m sorry you’re dealing with this. It’s incredibly stressful!! I had to move my mom from one MC to another after about 8 months in her first MC. Like so many others, I too started her in AL and she had to move to MC (her first place had both) after about 6 months.

While her first place was gorgeous, well appointed, and I even knew some other residents, it was NOT really equipped to deal with advanced dementia - at least not the kind requiring intensive care. My mom got evicted.

I was so nervous, I visited like 7 places. I got recommendations from friends. When I found the place I ultimately placed her it was because, like you, I knew she would get much better care.

It has been night and day ever since. She entered the new MC on a high level of care, and is coming up on 2 years! She’s been on hospice almost a year. The new place is so much more well run, the care is so much better, the staff are better trained. Hardly anyone moves. There’s a wait list. It’s been literally a god send for me. And my mom.

PHysical distance matters so much less in this case than the quality of life and care. I went from being 10 minutes away to being 40 minutes away and it is worth every second. My mom has thrived in her current MC. She started out with us going out to lunch, for drives, etc, and her disease then slowly progressed. But she is not anxious or miserable, receives fantastic care, and it has literally been the balm we both needed.

I wasn’t even trying to move her. But what this did teach me is that the staff ratio, the training, the vibe, the level of care, and the environment - this is what makes a good MC.

That said, as others have mentioned, none of this has been easy. Your mom may not eat right away, may take time to settle in, and may even wind up being ok where she is. What’s important is to research the place, its reputation, and trust your instincts. Your mom’s transition is secondary to her being in a safe place e you both trust.

April23

https://alzconnected.org/discussion/comment/276602#Comment_276602

Well said and ITA 100%. If it is a move to the right place at the right time, then that makes all the difference and the PWD with can actually thrive. I found a similar place for my LO and I have slept through the night (almost) every night after not having done so for over a year. Even if the transition is hard initially, it can be worth it in the end.