When to go from AL to Memory Care?

Woolnerd · July 15

Wondering how we determine when the right time is to move mom from Enhanced Assisted Living to Memory Care. The plan is to move her to the Memory Care wing at her current Sr Living bldg where she is in the Enhanced Assisted Living setting.

She has always been an anxious person, is currently on Zoloft and Olanzapine(antipsychotic) but has been very disoriented the last 45 -60 days. She has Vascular Dementia. Two weeks ago the staff found her hiding in a closet under a blanket. She calls me once a week and sometimes more thinking she is at work, waiting for my father (dead 5 years), says she heard me in the hallway and I should just come in, etc. She is under hospice care that comes to see her at the facility and is in a wheelchair tethered to an oxygen concentrator so is unable to “wander”.

they currently have 4 rooms open to pick from. I say we should move her before something bad happens and while we have a choice of rooms. Siblings are more inclined to wait. When we move her do we tell her it is to Memory Care? Or tell some fib like they are painting the room, etc.

psg712 · July 16

Agree with moving now, while rooms ate available! And using a gentle fib like the room is being painted.

Why do your sibs want to wait? Often this happens with family members who aren't close by and haven't had as much exposure to the PWD's daily struggle as you have. Or they just have a bad view of memory care ... too institutional...or just don't want to believe that mom can be at that stage yet. She is. Keep advocating for the more secure, less complex environment of memory care.

fmb · July 16

Assuming they can provide the same health services in MC as they do in EAL, I suggest moving her now and using the fib about painting the old room. It sounds like she is overwhelmed and disoriented in the AL environment, while MC usually has a better staff:resident ratio and provides more structure throughout the day than AL. I'm sure your siblings do not want to wait for a real crisis and a forced move, especially since a room may not be available at that time. There is no stigma is requiring a MC setting for a disease that is robbing her of the use of her brain. If she had a strictly physical disease, they would want her to be in a setting where she would get the best care.

Woolnerd · July 16

https://alzconnected.org/discussion/comment/215977#Comment_215977

funny thing is the locals want to wait, and they are the ones that provide the most care for her. I believe that when my SIL visits my mom “ puts on a good face” and doesn’t really let on how confused she is. My mom also purposely is very pleasant and cooperative with the staff so they don’t see how confused she is either. She frequently says “I can’t ask them. I don’t want to be any burden, etc.” . I am 6 hours away by car.

fmb · July 16

https://alzconnected.org/discussion/comment/215984#Comment_215984

She is probably showtiming for them. This is when the PWD is temporarily able to function well above their actual abilities for other people. When my mother was in AL, we talked on the phone nearly every evening, and I saw no real issues other than occasionally repeating the same stories. We siblings all live hours away from her, and none of us were able to be with her for any length of time. We had no clue how bad things were until she suddenly seemed to fall off the ALZ cliff last December. Like your mom, my mom has always been anxious by nature and didn't want to be a burden to anyone, least of all her children. Staff at the ALF reported that she was becoming increasingly anxious and paranoid, couldn't find her room, and was found walking around the halls carrying her badly soiled incontinence brief. She actually requested that she be moved to MC, a move that we kids all agreed with, and she was moved to the care system's MCF in January.

Anonymousjpl123 · July 16

I think people get caught up in their perceptions of memory care versus assisted living, the costs, and the idea that a unit is locked. It get it. It is different. And it is a hard pill to swallow/hard choice. I don’t believe memory care is anyone’s first choice.

For me, it comes down to the level of staff care and interaction she needs. AL to me is like for people who need very little in the way of support during the day. Maybe they need help getting dressed, and bathing, but not with getting through the day.

If my mom could have managed in AL I would have kept her there, but she was calling 20 times a day in a panic and I was going 5 times a week and basically functioning as her part-time aid. Which actually would have been fine, until it wasn’t.

If the close siblings think she is fine, it may be because they want to believe that. Are the staff recommending she move?

harshedbuzz · July 16

@Woolnerd

It's really hard to say. She clearly qualifies for a secure MC unit given your description but whether a move is "necessary" would be dependent on a lot of factors not fleshed out here.

How different is the training and staff ratio between the two areas? Sometimes there's a great deal of overlap in terms of what is provided. AL can be anything from a hospitality model that's more like staying at an all-inclusive resort to full-on MC without the passcode access. If EAL staff has dementia training and operates at a similar level of staffing it might not bring much to the party in terms of a person already on hospice.

How often are the close sibs visiting? Are they there daily?

Do they have "local knowledge" you don't? Like maybe the MC isn't up to the same standards as the EAL (sometimes one unit in a facility isn't as well run as others— the top hospice facility near me has a lousy rehab and the nicest of the ALs has issues in MC)

Are finances a concern? MC is generally a lot more money. At the places I toured that had both six years ago, the ALs were around $4500/mo compared to $6500+/mo for MC. Maybe they're hoping to avoid her moving to a semi-private Medicaid funded bed.

HB

HollyBerry · July 16

My mom's story was similar toward the end. We didn't recognize how much her vascular dementia was affecting her because she also had 3 hospitalizations for other health problems and those took their toll.

She was in AL in the more capable unit of 2 that were available, and the nurse manager assured me that she could stay there "til the end," and she did. Hospice came in for the final few weeks at their recommendation. The AL staff was generally experienced; there was some overlap with the MC staff but I had the impression that their MC was meant for people farther along than she was.

You've talked with your siblings but have you talked with the nursing staff in her AL unit? What are their thoughts? Is there a social worker? They may also have inside scoop on staffing, supervision, the individual residents in the MC group right now, and other things we wouldn't know about.

When to go from AL to Memory Care?

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