Mental illness and memory care

Crudenduck · September 24

Hi all! I'm facing a decision about increasing my mother's level of care, and I'm getting very different messages from professionals. I'd appreciate any advice or input you have about what questions to ask or factors to consider.

My mother has longstanding mental illness with various diagnoses that features an explosive temper. She also has mild to moderate vascular dementia. She lives with my father in a studio apartment in assisted living. Right now, her only supports are medication management with meals and transportation provided. My mother is becoming more and more confused, and, as a result, more agitated.

My father is struggling to manage and understand her symptoms. They have not had a healthy relationship for years, and he also struggles with a memory impairment and lifelong major depression.

I am considering memory care for my mom. The director at the assisted living thinks it is too soon for memory care and suggested more supports, including having aides accompany her to meals and activities. Yesterday, I had to take her to the emergency psych ward because she was very agitated. The psychiatrist there urged me to move her to memory care. I don't know how to evaluate their input and make the decision.

H1235 · September 24

Welcome. I wonder if the Al director is simply trying to keep her there as long as possible for the financial benefit of the Al. I would tend to believe doctors at the emergency psych ward since they have no skin In the game. The dementia is only going to get worse and she is only going to need more care. The latest person to move into mc is probably going to be the person that is able to function at the highest level. That doesn’t mean they don’t belong there. I think your parents relationship has to be considered as well. This should be about what is best for both of them. In my experience Al did not have well trained and knowledgeable staff. I see it as a place for those in the very stages of dementia. The care offered was very minimal. I don’t think a good mc facility will take someone that doesn’t need to be there. I think they would come to her and do an evaluation or ask Al for information about the care she requires. If the latter happens I would make sure the mc facility receives the accurate information. So based on the description you have given my advice would be to move her to mc. Dementia is so complicated and decisions can be difficult. You are clearly thinking this through. Just do the best you can.

harshedbuzz · September 24

@Crudenduck

Hi and welcome. I am sorry for your reason to be here but pleased you found this place.

The intersection of mental illness and dementia is a challenge. Having 2 parents with dementia with competing needs simultaneously is also a special challenge.

In reading your post, I came to much the same conclusion as H1235 did. I wonder if the director of the AL has different priorities than you do. She may be concerned she'd be losing 2 residents if you opt to move them both together. Would the enhanced care she's suggesting be privately hired or something the facility would arrange and bill you for?

I would take the advice of the mental health experts about the sort of care mom needs now and going forward. A purpose built MCF with dementia-trained staff and dementia-informed programming might help your mom be less triggered. Transferring her directly from the geripsych unit with the help of the social worker will be easier than doing tis on your own. They would presumably know which facilities are willing to work with people who have more challenging behaviors.

Good luck.
HB

Crudenduck · September 24

Thank you so much for your comments! The AL actually has an on-sight MCF, and that's the one my mom would go to so I don't think there's a financial motivation at play. However, today my mom's AL case manager said he didn't see any signs of memory issues with her. That is just bonkers. She re-sets about every 30 seconds on a bad day and 5 minutes on a good day. So I think that answers why the director said what she said!

SDianeL · September 25

great advice here already. I would be concerned about the Case Manager making that determination since your Mom has a diagnosis of dementia. Unless the caregivers are with her constantly they may not realize what stage she is in. PWDs can showtime for periods of time which causes people to second guess the diagnosis. I would trust the Geri Psyche doctor and move her from the hospital into MC.

cdgbdr · September 25

The AI director obviously doesn't see the big picture. Your mother's objective testing results should be used to determine her MC appropriateness. My DH was evaluated at 2 facilities, and, trust me, the rudimentary assessments they completed supported the need. Unless your mom can ace memory tests, the clock, etc. that will validate her condition.

Victoriaredux · September 26

If they are getting two adult fees in one studio unit that's a nice account for them.

Is AL in a secure part of the complex? If not she could wander.

Have you considered a week or two stay for her in a geri psych ward where they could evaluate and hopefully come up with a med mix that would help her with her underlying mental issues with the newer dementia overlay. Then you'd have a better idea of her next best housing option - with the 5 minute fade out MC does sound the best .

Another benefit- you'd be able to see how your Dad does without the stress of her around . Get a true baseline for him.

Crudenduck · September 27

Mom got discharged from the psych ER yesterday, and I placed her straight into the locked MC unit. She's now added risperadal and trazodone to the mix, which seems to be really helping. I'm having second thoughts about her staying there permanently, so I'm telling myself that I will give it two weeks and re-visit whether she still needs this with her new medications. That should also give my dad a break.

Thank you all so much for your thoughtful comments! It helped so much to have a place to talk this out with people who understand.

MN Chickadee · September 27

Devils advocate here - You just did the hard part! Getting someone transferred from the psych ward to a suitable memory care can be really challenging (emotionally, logistically, the timing of having a bed open when you need it, getting the person stable etc.) and I would not take lightly the decision to move her out of it. It sounds like she could benefit from the added structure and supports of memory care. Make sure you are making decisions based on her worst days, not her best. The worst days will become the new normal in no time as her dementia progresses. Think about what you would say to someone else in your shoes. The move to MC went so well they were going to move the person back into a situation that had become untenable and where the caregiver spouse also has cognitive impairment. Keep in mind both of them are going to continue to decline, the impairment will get worse. Is her moving back into the apartment best for your dad? His needs also need to be factored in. When I was making these decisions for my parents I operated on the idea that making changes to levels of care are better early than a day too late. So many families get into full on crisis mode eventually. Do give her a few weeks before deciding what to do so you can get the full scope of how both of them are doing. Good luck, none of this is easy and no matter what you do you will have self doubt. We didn't ask to be making these decisions and it's hard.

H1235 · September 27

You should also keep in mind that the mc structured environment, not just the medication may be some of the reason for improvements you see. My mom of course didn’t like freedoms being taken from her, but over time she has done so much better without the weight of these things on her.

Mental illness and memory care

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