How do you know when it's time not to let a senior live alone?

I would continue to keep your mother with you as long as possible. If a mild memory problem exists one sure way to make it worse is to place her in an unfamilar setting with strangers (the ever turn over of ALF staff and/or NH staff).
She probably is getting more supervision with you than any of the ALF will provide at inflated costs. ALF are normally for younger people than your mom.

I would get a companion or home health aide to be with her while you work and if possible limit overnight absences. She may need a home health aide or another family member with her if your job requires travel overnight.

I think you are doing a good job with her care. I kept the life alert button for my dad, some said it was useless but my dad felt better having it on him. He wore the necklace. It is a small monthly bill if it gives you or your mom comfort. He spoke to his friends urging them to get a life alert type device. I was told he had some memory issues at the end but I found him to be alert for the most part. He continued to read parts of 3 newspapers a day and had an interest in political issues to the end. Sometimes we caregivers have a better understanding of the elders mental abilities than the so called experts who have minimal time to spend with the elder. In other words, go with your heart and head--you know what your mother can and can't manage at this point. Overtime she will need more and more help--that's normal aging.
Again, keep up the good work. Your mother is lucky to have you, so many seniors don't have a caring person in their final years.

Elizabeth

JaniceChris is exactly right. If she has dementia and doesn't remember what the lifeline is for, then it is worthless. At this point she needs 24 hour care for her own safety, whether it be split between yourself and a home aid or an assisted living facility. If she gets hurt because she was left unattended, you will feel much worse than you do now with the decision you are facing. It is best for the both of you.

Thanks, ba8alou and laurie1261 - the 240 (!) comments made on that Jane Brody article from across the country were also interesting and helpful - big issue, caring for our elderly, I sure don't feel alone with this issue. Many gave Jane a bad time about quoting a very cheap price for her aunt's "daycare," I believe. Thanks again for bringing this to my attention.

I would look into the Area of Aging and Disablities or any Elder care programs. They can assess and maybe get you qualified for some help. I get respite 20 hours a month according to my mom's income. But there are lots of government funded programs out there that we can resource. Just look for one. Or you could call a hospital, social worker that might be able to direct you to the right channels.

I think you are doing great and I agree with Laura 1261 above that you may want to hire someone to come when you go out. Call your county and they can help set you up with program connections or if there is money just to hire out of pocket. I found my first caregiver helper in the local Christian newspaper. When money ran out assitance was given through govt. Although it's not free money, you and others can recieve a paycheck for your help. They help with a budget after an assessment. I have bought myself a handicapped van for the woman I care for who is in a wheelchair. Pray for everything from what to do and caregiver help and a vehicle so she can accompany you easier. A woman from church sold me her old handicapped van for exactly what I had in my savings a few years ago which was only $500.00. I had been saving for a sewing machine and it still wasn't enough for that. TBN network (Trinity Broadcasting Network) is a good spiritual connection for everyone. Speaking truth over her helps much especially over her mind that is what the devil tries to steal with dementia. See Joyce Meyer Book, "Battlefield of the Mind." My prayers are for and with you and your mom!

Thank you Laurie for for providing the link to the article!!

I think given your mother's age (almost 90) you need to consider having a companion with her when you're at work or perhaps have her participate in an adult day care. Some friends of mine do a combination MWF a companion in the home and T-thursday are adult day care days. I would continue to let her do as much for herself as she can. However you are already helping alot with taking care of her by supervising her personal hygine,meals and meds which is wise. Some of these programs for social/medical adult day care are not expensive and if you have a long term care policy you can often pay for these services and home health aides. I started having home health aides with my father at age 90 and it was worth the investment and he was able to stay in his home where he was most comfortable. Without such arrangements I could not have continued to work--we also lived together. While adult day care can be good by the time the elderly hit 90 yrs old they frequently like to sit up for awhile and then nap for awhile. Often adult day care facilities don't have a bed for them to take a nap while you're at work, something to consider. Your know your mom's normal routine.
The life alert is a good choice too, I had one for my dad but he never pushed the button.
Good luck:)

Elizabeth

I was in your situation about 5 years ago. I would call in to check with mom every few hours while working. I did not leave her overnight. There is another reason besides safety to consider. She may need someone to help her stay occupied--which will help slow the progress of decline. If you see that she hasn't done anything useful or can't tell you what she did while you were gone, it's time for a companion while you're gone, and even sometimes when you're home needing to do paperwork or other things she can't participate in. You don't want her staring into space or not knowing what to do--those may make her worse in the long run. So don't hesitate--earlier is better than later. See if there are other things she doesn't know besides the function of the lifeline. That's an early sign, but it could be just things she has not done that she cannot remember to do. Can she use the phone to call you? When she forgets routine activities, that's more serious. My mom has had setbacks, but she bounces back and is not on any medications. Institutionalization and drugs have been detrimental, in my experience. Diet, supplements, exercise, and mental stimulation/social interactions seem to help. My mom walks several miles every day with her walker. I accompany her. When you do find someone to stay with your mom, make absolutely sure it is someone who will engage with and interact and do things with her. Most are too passive--they are preoccupied with their cell phones, etc. and/or doing things TO your mom instead of WITH your mom. She needs a teacher more than a babysitter to keep the mental functions she has. I would also recommend a surveillance camera. Our moms are vulnerable, and abuse and neglect are too common.

I don't mean to sound dramatic, but if she forgets what her lifeline is for, you don't want her to be alone. Think of how you would feel if you arrived home from work to find she had fallen and hit her head.

Read the article! It's a great list! Our local senior center has an outreach program that provided us with a geriatric nurse to do a free home evaluation (safety, security, medication overview and dementia rating). The nurse was very helpful with suggestions, developing plans (short term and long term) and helping us understand the reality of the situation. I take her to all her doctor appointments and her primary doctor has helped with suggestions also of what we'll need to put in place next. If you are unsure what to do, I suggest contacting your local senior center or resource and primary doctor. My mom's doctors have also been very helpful in explaining to her (repeatedly) why she needs home health aides and more attention. My mom is with me 20-21 days out of the month and up to 10 days at her own home for now. She enjoys her stays here around her family and then her quiet time back at home. Until the money runs out or she's not well enough, I'll keep bringing her back home every other week, and filling the quiet home time with home health aides. Right now it works for us all. Thank God for the wonderful staff that helps us out!

Deep down it sounds like you already "know" she shouldn't be by herself for very long anymore. I would say a couple hours here & there during the day are fine, but I wouldn't leave her alone overnight, especially if she has dementia. It's just not worth the risk.

Laurie;; thanks for providing the link. For my mom, who does does not have dementia, the breaking point was last year when she was 88; in the course of one week, she had several attacks of overwhelming anxiety about relatively minor things...a small rise in blood pressure, an impending storm, a reaction to a new medication. Having taken off 4 days out fo 5 during the first week of the school year, I said "mom, this isn't working out for ME".

As I said, it wasn't any of the more substantial signs, falls, forgetfullness, etc that caused us to realize that mom could no longer live alone in her suburban home, once she couldn't drive. I was seeing how isolated and fearful she'd become about every small occurance, including what she was watching on the TV news. Everything got magnified. After a disastrous stay in an assisted living place where other family members were living (both too much and too little assistance) we did more research and she is now in a very nice Independent Living facility with onsite docs (including psychiatry for the anxiety) , exercise classes and the like. Watching her yesterday at Christmas with the family, I am struck by how much more "with it" and competant she looks this year as compared to last. Her balance is better, she is more assertive and less of an old lady than she was a year ago. Hope that you can successfully negotiate this change. Hugs and prayers all around.

Nobody is going to tell you this. Some doctors are better at this and some will tell you it is just your responsibility. First, how is her walking and getting around--falls are so common at this age. If they can get up by themselves then they will not tell anyone in fear of having to go someplace else. On her next doctor's visit, ask the doctor privately to tell you if there are any signs of falls. Also, dementia never gets better. That is already a sign to you. You can have her tested to check on the level of this also. Your biggest stress is probably the dementia when you are not home. It is difficult and I have dealt with it and my mom. The third issue is your anxiety and stress. Yes, that is a gut feeling that you must do something.
Start looking now at costs, possible care locations, paperwork, other, alternatives. You may NOT need it now but, like me, you could need it quite suddenly. Praying for you. Hope this helps just a little.

Ba8alou suggested this article, and I went and read it - it is a good one. According to the list of signs that a person can't live alone anymore, my mom really cannot. She's in her own apartment in my house, and I spend at least 3 - 5 hours a day with her, but she's still "independent" more than is appropriate, according to the list in the article. I'm even more relieved that the Dept of Aging is coming in to assess (then it's not evil me (as she sees me)) undermining her independence. Anyway, here's the article link:
http://well.blogs.nytimes.com/2012/12/24/staying-independent-in-old-age-with-a-little-help/

If she's already living with you, it won't be that big a change to have someone come in and stay with her when you're away, or perhaps take her to a senior center that provides "day care" (I hate that term for the elderly, it's very insulting and makes them sound like toddlers), so she'd be safe when you're going to be gone for hours at a time. The cost of a nursing home is astronomical, so state and local organizations are usually willing and able to help keep people at home, rather than have something go wrong that ends up putting your mom in a home of some kind (after a fall, for example). Check out what programs there are in your area that provide respite care for you, someone to spend time with her when you're away, etc... You didn't say if she'd be resistant to that (I know my mom will HIT THE ROOF when we tell her she's going to be getting help and going to "day care" a day or two every week - that's coming next week after the Dept of Aging comes out to meet her & assess her needs) - but if your mom is open to it, check into what you can do to prevent her being by herself for very long. It'll ease your mind, at the very least, and reduce the chances of a fall, an accident, her forgetting the stove or the iron is on, etc... all the things that CAN happen (not will, but can) and keep you both safe.

So sorry that you're having doubts and stress. NY Times article by Jane Brody yesterday 12 25 12 gives some good guidelines.

Hello. If you have a gut feeling about leaving your 89 year old mother alone I would go with what that feeling is. Me personally just from what I have been going through and also cared for my Grandmother many years ago I know that anything can happen when they are up there in age, While your mother may be well to do many things you just never know when something may change in a second and she is not okay. This is not to scare you or anything. My parents are in there high 70's now and I see a definite change in their abilities as they age. Like I said if there is something in your gut and heart that is not sitting right with you I would go by your best instinct. Maybe you could get the advice of others say her doctors opinion or other family members on what they think. There are so many resources for you to utilize to have someone there when you are gone that may make you feel more at ease then leaving her alone. My best of everything to you. And your Mom.