We have been advised that a one on one caretaker is the best but by far more expensive choice. What have others done in this situation?

StillsaneinSD, your mom's situation sounds complex. Regarding the bed alarm. There are bed alarms that she would have no way to know it is there. It's silent in the room when it alerts, but beeps to alert the staff where they are. The staff can carry the device on their person so they can hear it even if they are in another part of the unit and it doesn't disturb her or other patients. It can be kept on vibrate. I'd also examine the height of her bed. Lower may be safer.

I would still reexamine her medications. If she's not content, I'd wonder if other med options might work better. Does she have a geriatric psychiatrist? It might be a good idea.

Also, I'd examine if she is having pain that she can't verbalize. That is something that the nurse/director of the AL my cousin first lived brought up. My cousin was falling a lot and getting fractures. She was also resistant to care. We suspected that her pain was not being managed adequately and it was being reflected in her behavior. Her doctor prescribed Cymbalta that treats pain, anxiety and depression. It really helped her and her anxiety, pain and falls DECREASED substantially. Her falls and anxiety seemed to go hand in hand.

Of course, sometimes it's just something that you can't figure out. I have a friend who's father cannot walk, but refuses to stay in a wheelchair. He has severe dementia. He will actually turn the wheelchair over by leaning out of it. It's quite sad. He's in a nursing home right now and they have a safety belt on him by doctor's orders and they keep him at the nurse's station in the direct supervision of a nurse at all times.

stillsaneinSD, the one-on-one private caregiver is a great idea if it is within the financial budget.

My Dad had two caregivers, one came M-F and the other on Saturday. Dad had them for a year starting when he lived in his house, then in Independent Living, and finally in Memory Care. Even though in Memory Care he had an Aide who would get him up, shower, and help him get dressed, he looked forward to the private caregiver who would come right after breakfast and left right after lunch, 4 hours.

The private caregiver would take Dad for a walk, Dad used a rolling walker as he could sit on the seat when he got tired. They would spend part of the morning on the facility sun porch where Dad would read the newspaper and the caregiver worked on a jigsaw puzzle, plus both would chat with other residents. She also would try to get Dad to do some activities, but he just wasn't an activity type of guy.

Dad was friendly, he would always tell me about the nice fellow who lived in the apartment right next door.... with both having dementia, it was like they were meeting each other for the "first time" every day. Dad would start sundowning and think he is at work at a meeting and would miss the bus so he will stay at the hotel.... the hotel was his memory care room, and the taking of the bus was from the 1940's.

Thank you, Sunnygirl1. We discussed all of these alternatives with both the Executive Director of the facility and the on-site doctor. My Mom is still social but her gait is unstable; i.e., she is crossing one foot in front of the other when she walks so she trips and falls. She doesn't understand what the walker is for or where she should put it. She still knows enough to know that she is losing her mind. It is heartbreaking. Medication changes have been discussed and tried. Increased Trazadone does not work; makes her worse. She seems to be on the optimum meds right now. There are no patterns to the falls. She will not sit in a wheelchair, or keep her walker with her.

The alarm for the bed is another idea we have discussed but knowing Mom she will rip it out the first time it goes off.

Are you assured that she is receiving good care at the Memory Care facility? If so, then, I suppose that a personal care person might be nice. First, I think I might discuss your concerns with the facility and see if they can try to engage her more in activities. The problem is that with dementia, the patient may not be able to engage. Our idea of what might be amusing might not appeal to them.
I wouldn't get my hopes up over the personal care person helping your mom regain her memory, have more conversations or be happier. The brain is damaged and that's why they are behaving that way. I don't know of any residents in Memory Care who know anyone else's name, or the staff. Repeating the names will not help them recall them either.

What I would do is discuss medication with her doctor. If she is depressed, she might need medication. That can often really help with the patients mood and that can result in them being more at peace and content. (Not a med that drugs them.)

Also, I'd discuss her medication with the doctor to see if there is something she is taking that could cause her to be more prone to falls. Falling is common with dementia. Sometimes, it's due to poor balance.

I'd ask the staff for details about the falls to try to figure out what is happening. Does she need a wheelchair? With dementia, the mobility goes down over time. The muscles lose the ability to do what they want them to do. I might explore a seat belt that attaches at their waist that alarms if she gets up unattended.(She may need a doctor order for this.) The staff can then get to her. And also a alarm for her bed, that will alert if she gets up unattended at night. These things really helped my cousin, who is in Memory Care. She was falling and getting frequent fractures.