The time has come-transitioning mom from AL to MC

lisn2cats · March 11

I'm at a loss with my emotions and smarts. My mom's AL nurse called today to let me know that they ran a few tests and screenings, and my mom scored low across the board. The staff has been monitoring her and is seeing a noticeable decline with her memory, increased confusion, and also depression (mostly loneliness and feelings of abandonment).

But when I visited her over the weekend, she seemed fine - she was cheery, proudly showed how she was keeping her space tidy, asked me to replace a couple of beauty supplies, had a very healthy appetite (I brought in her favorites), and was recounting how much she enjoyed the little party I had for her over a week ago and some other gatherings we had during the past 3 months. And her stories and musings had clarity (and accuracy).

Not sure why I'm posting. I guess I would like to be prepared, especially since she still does have some independence, cogent thinking skills, and feistiness. What does moving her to MC mean - will she feel more isolated? Will she be mad because it means a loss of independence? Does it mean she is even closer to not being herself (memory loss, cognitive skills)? What if she refuses (can she refuse)? What if she won't let me visit (she's my last link to what I know to be family)? Will she decline because she'll sink further into depression and feelings of "nothing left to live for"?

IDK. I'm all over the place.

pamu · March 11

It sounds like she really enjoyed your visit! Is there MC at her AL facility? My mom is sometimes still "with it" or can appear so for a short time. She takes care of all her hygiene and is very tidy. She still dresses nice and is very conscience of her hair and nails. The charge nurse says she's the cleanest resident in MC. With this said her cognitive functions and behaviors are all over the place. Some days she seems very alert and engaged and other times she's agitated, confused and has delusions. She is a wandering risk (she wandered from her AL and was found at a house down the street)…which is part of the reason she is now in MC. She doesn't like being at her MC, most of the other residents on her unit are more advanced in their dementia so she doesn't really have friends. She enjoys the activities (daily exercise, therapy dog visits, manicures, baking, movie nights). The staff there is wonderful to her. If your mom moves to MC be sure to get very familiar with the staff. My mom's daytime charge nurse will text me throughout the week to give me updates and will send photos. My sister and I both visit twice a week. It's where she has to be to be safe 24/7. If she wasn't an exit risk she would be able to socialize on the other floor. If you haven't already, read The 36 Hour Day which will give you insight as to what to expect as your mom progresses. I wish I had advice for how to handle the emotional part (for both you and your mom) but it's a continual changing thing…what works today won't work tomorrow. Keep coming back to this forum. It has been a lifesaver for me - I log on every day for a daily dose of support and info. Wishing you the best!

SusanB-dil · March 11

I'm glad you posted… no worries about that.

Is the staff seeing things you are not through the week? Just a thought, but wondering if mom is showtiming for you, even if just a little? Are they giving you any specifics, or noticing any worrying behaviors?

If you notice she is depressed, wonder if that could be causing something 'off' and maybe staff is noticing because of it. If she is, maybe let her doc know?

lisn2cats · March 11

https://alzconnected.org/discussion/comment/267887#Comment_267887

Thank you for your comment and questions. I think you're right - my mom definitely puts an effort into "being normal" with me. I think partly because she knows I worry and partly because she also knows I am responsible for her care and decision-making. The nurse has been keeping a list of what the aides have been reporting as they started to notice the decline. I can't say enough for the AL team - she had a few of my mom's regular aides on the phone to share some of the more worrying things they've been seeing.

I spent some time thinking about this (and talking with one of my colleagues) and I guess I am getting past denial. Good idea about having a doctor/psych also meet with her. I kind of know why she's depressed. It's been a year since my dad's passing, she has been thinking a lot about the past and what used to be (like her home, her belongings, etc. She never really had closure to leaving her home since we left because of a house emergency and she never got to go back, relying on me to bring certain things to her AL room), and her friends have sort of moved on. They still visit but not as often as they did when she first moved in - and they can't take her out anymore (she's too unsteady even with her walker).

After reading the comments you and and @pamu made, I made an appointment to visit the nursing staff and the MC staff and to take a tour. Sigh. I know that, because of dementia/alzheimer/old age, we will all lose pieces of our LOs until they pass….but it's so painful because of having to watch the (slow) downhill progression. I suppose all we can do is make the most of our time and try to make each minute one to remember with love and smiles. (Still hate it.)

lisn2cats · March 11

Your comment touched me. I see so much similarity with the erratic "with it" and totally confused. Luckily she won't go outside (she still has the freedom to do so) so she's only gotten lost on the first floor of the AL facility. I guess, also luckily, she's not big on exercise and taking walks.

I've read parts of The 36-Hour Day; I should finish it - it really is a great resource. We are lucky that the MC floor is within the AL facility. I took your advice and made an appointment to tour the space and rooms and meet with staff. (It turns out, the head of the MC floor is someone I talk with all the time when I visit - I just was never aware of what she does!) She plans to work in a mini tour for my mom on the pretext of something else to allay the misinformation she received from resident chitterchatter.

SO happy to have found this forum! Thank you!

SDianeL · March 12

can you fib to your Mom about why she’s moving to MC? No need to discuss it with her. She needs to be safe. I doubt a tour will help. Maybe say the doctor ordered it so she can get PT??

ARIL · March 13

The range of feelings you describe are very familiar to me. When I started getting recommendations from AL staff to move my dad to MC, I listened but felt resistant inside. In retrospect, those feelings had more to do with my own fears and my own desperate desire to stop this disease from progressing, even though intellectually I knew that was not possible.

MC has not been nearly as frightening as I thought it was going to be. It is really AL+. More care, greater safety, also more $$.

As my dad has continued to decline, I know that he is where he needs to be and has been for a while. But it was hard for me to admit that he was ready for MC even on the day I moved him in.

And I do think he showtimes for me. He has said as much himself. He recently told me, “I try harder with you.” Lol

caregiving daughter · March 15

If the condition is beyond mild cognitive impairment, your mom likely already feels isolated in assisted care. She likely is unable to keep up with a regular pace of conversation or follow the daily rules of the dining room. Regular cueing and a softer pace of memory care is likely more of a match and may reduce distress that she currently is unable to communicate to you. With impairment, she likely won't understand an explanation on the move so keeping it simple to something like, "the home thought you would like this room better".

I think there will be less isolation because mc residents are guided to daily activities including music and basic crafts.

You will be the decision-maker on when to visit. Hopefully, a calmer environment will enhance the time she is content and looks forward to seeing you. There were occasional days where it wasn't a match for me to visit my mom. She may have been unhappy or absorbed in an activity. I would handle by finding another resident who just wanted to talk. It brought me peace and caregivers saw my presence which I think is imperative in a memory care facility.

The time has come-transitioning mom from AL to MC

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