Mom too high functioning for assisted living?

I usually read through before commenting, but so many posts about that A$$ of a doctor riled me up!

Anyway, this was the real question:

"What do I do now? My mom called me last night to ask when she was leaving because of what this doctor said. She wants to come home or live in an apartment alone. She cannot live alone."

The doc issue's been beaten to death, hopefully.
The stay or go is stay for now (since it is locked down, she should be okay there. I've read often that care homes are less expensive and a bit more "home like", so she may do okay there.)

The remaining issue is dealing with the crap doc planted in her head. Hopefully with a little time she will forget all that. If she asks when, tell her you're looking into it and then try to change the subject. It's a little harder, sometimes, to do this on the phone, but if you can distract her after "acknowledging" her question, eventually she might forget. Don't say no, don't try to explain why she needs to stay, just acknowledge her question, defer it and then change the subject to something different - ask what she did today, what was for lunch, dinner, etc, some quick succession of queries to get her focused elsewhere. If she does this in person, same response, then try to redirect her to some other topic, let's get a cup of tea, a snack, go for a walk outside if it's nice out, etc.

FIRST comment - that doctor is an idiot. Just having a little chit chat with someone in the earlier stages of dementia doesn't mean squat. My mother was also caring for herself, toileting, bathing, sometimes getting her meds (we went with a timed/locked dispenser in her place, before MC.) Finances? HAH! Cooking? Thing of the past - cooking downgraded to beep beep beep beep, hmmmmm, beeeeep, microwave dinner is done. Remembering where she put the paper towels, plastic wrap, trash bags, extra supplies, etc? Nope. She'd ask for more. I have enough plastic wrap to last the rest of my life!!!

My mother also drifted back in time, asking about her mother (gone 40+ years), her previous home (sold 25+ years prior), references to others that went back about 40 years. She actually had that "step down" 9 months after the move to MC, but she was still mobile, self bathing, dressing, feeding herself, etc.

I'm glad to see that the owner of the facility apologized. The owner should take this a step further and request THAT doctor not return in any way shape or form.

Let me repeat: THAT doctor is an IDIOT.

This although not an official memory care does have training in Alzheimer's and dementia. She does have word search puzzles and they have regular puzzles and they do outdoor activities so she is getting some level of stimulation. It is a locked down keypad facility but it is just a care home with 12 residents.

We looked at dedicated memory care unit. I'm not sure how people afford them. There's one down the street from me but it's over $7,000 a month now I know I could spend down her money there and try to get her on Medicaid.

Get another doctor and keep that one away from your mother.

Your mother needs to be in memory care, not assisted living. A good memory care place will have residents who cover the spectrum of functionality. My mother's place has people who are reading books, watching TV, writing, dressing and showering entirely on their own, and people like my mother who can't do anything for herself any longer. For activities they separate the high-functioning folks from the low-functioning ones, and everyone's meds are handled by the nursing staff.

If your mom is just in regular assisted living, it isn't going to last long if she continues to decline. I'd be looking for a memory care facility instead if you don't want to have to move her again, which is very stressful and confusing for dementia patients.

To give everyone an update... I'm not sure what you would call the doctor I don't know if he has a contract with the facility because they do bill insurance. He's been working in this facility for 3 years but he also has a private practice where he sees other patients so that's why I'm a little confused.

I have talked to the facility director who reassured me that they would be looking for a new provider and that they would take my mom to any provider I wanted them to. The facility is approximately 40 minutes from where we live which is where my mom's regular primary care and neurologist are.

They apologized again for the doctors behavior said that he has never done that before and they were shocked by the fact that he would even say something like that.

I'm leaving her there for now as I really like the facility and the people that work there just not the doctor.

Thank you for everyone's support a lot of you brought up the same issues that I had of how unprofessional the provider was. I have forbidden him to see her and they better follow through on their promise that they will find a new provider to come into the facility.

I politely threatened them and told them I would pull her out in a heartbeat. That if that were to happen I would be reporting them to the state and the doctor to the medical advisory board.

I’m posting about a different system that may not be at all relevant, but just in case it is…

My MIL2 moved into a NH that had a visiting doctor who checked regularly on all the residents. Her previous doctor of about 40 years knew her and FIL2 well and pretty well did whatever she asked (eg sleeping tablets that have since been withdrawn). MIL fell out with the facility’s doctor and ‘sacked him’. DH then tried to find another doctor. Disaster! The official charging rate for an on-site visit was uneconomic for busy doctors unless they had multiple patients to see there. DH simply couldn’t find another doctor who would visit, and family ended up having to take her to appointments for every repeat prescription. Original doctor really was very busy, and just didn’t want to bother getting back into the problems with MIL.

What may be relevant here is to find out the system at this facility before you work out what to do – even what to complain about. It sounds as if this system is not working – no authorisation for doctor, no handover, no proper assessment, etc etc. Perhaps no-one has complained, and you would be doing everyone a favor to make a fuss. Perhaps there’s more to it that you ought to know before you do make the fuss.

Best wishes, Margaret

Wow! I’m sorry you’re in this situation, but I’m appalled that a professional of any kind dealing with the elderly would have a conversation like that in front of the patient/your Mother.
High functioning today does not mean she will be a week from now. There must have been assessments of your Mothers condition prior to being able to move her in. Somebody thought she belonged there.
You did the right thing for your circumstances. It’s better she become acclimated to the new environment and make some friends while she is still high functioning. If you’ve found a place that will be comfortable for her and easily accessible to you as well I wouldn’t change anything. A doctor can’t just say “she doesn’t belong here” and you have to move her....can they?
The director of the facility should be able to help you clear things up with your Mother.
Change is so hard on our parents. If they don’t already have symptoms of dementia just relocating them can, I know from personal experience, bring on dementia like symptoms. It can take weeks to months for them to regain their equilibrium. I hope another move will not be necessary for her.
Best of luck! Dianne

I recently read an article about how many attorneys are believed to be practicing law who have dementia.

They miss filing dates, court appointments, have their files in a mess and although they can talk a good game when securing clients, they are way past the time they should be practicing law.

I assume the same could be said about some doctors and other professions. as far as I know dementia is an equal opportunity disease and not everyone who has dementia has a caring spouse or child alert to the changes going on.

This one lawyer they were featuring in the article would get dressed appropriately and drive to the office each day. He would show up at the court rooms at odd times. The attorney he hired to help expand his practice discovered the mess and had a hard time getting the law board to help her do anything about it.

The demented attorney was furious with her and of course he had a large number of dissatisfied clients who were calling non stop.

He is dead now and the lawyer they interviewed for the article is working at another firm but if she hadn’t blown the whistle on him he would have gone on to harm other unsuspecting clients. It read like there was little that could be done to stop this practice. It’s pretty much up to the clients to realize they shouldn’t hire the guy.

This doctor needs a closer look.

I'm guessing you put her in memory care assisted living and not regular assisted living? I see nothing wrong with regular assisted living as the care needed can be zero up to whatever she needs. If she is in a memory care and the other residents are really advanced, then that is a quandry I faced with my dad. He WAS high functioning and I thought assisted living was better for him and the he could negotiate and thrive with assisted living. I was wrong. He needed memory care because he needed to be in a more open living arrangement instead of tucked away in an apartment. He needed to be brought out to communal activities and kept an eye on. He was moved to memory care (a nice one with open floor plans that seems homey) and he really likes it. I wish I had done this to begin with. He now NEEDS it for sure and is no longer high functioning.

You know what's best for you mom. just fire that doctor and hire someone else.

Tyger;

My mom initially went to AL and it was "too much care" and not the right kind. But she only had Mild Cog. Impairment, not a long standing dx of Dementia.

My mom's Independent Living Facility had a doctor who was not "staff" but who had an office on the premises; he saw both IL and AL patients. There was a formal "handover" of mom's care from her PCP to this doctor. Did that happen? Did mom initiate it? In our case, mom informed us of everything she did (part of her kinda dependent personality, and she trusted us, God bless her).

There is a double edged sword here, as I alluded to in my first post. If mom is so all-fired able to tend to her own affairs, then certainly she can arrange to move somewhere, right? At least according to this doc?

I am wondering if perhaps this doc comes from a culture in which it is the norm for adult children to drop everything to care for their parents. And not realize that you need to earn a living.

In my mom's case, her new IL gertiatrican invited me to his second visit with her and called me afterwards to verify the validity of her responses.

He wisely refered her to a geri psych doc; that was the saving grace for all of us.

I am sorry that you are having this experience and would seek out a well-recommended geriatrician to see your mom, asap.

With what you have written an AL is where Mom needs to be. Independent living is just that. She needs to be able to do everything for herself. Maybe Mom was having a good day when this doctor talked to her and I have no idea where he was coming from. ALs are not just for Dementia residents. Its for anyone that needs some kind of assistance. The good ALs keep their Dementia residents on a MC side. My Moms didn't. But it was a nice place.

What you need to do is get Mom to a Neurologist for a formal diagnosis. Make a list of what she can and can't do and make sure he sees it. Tell the facility that this doctor is not to see Mom again. He was very unprofessional. He should have approached it as "why do you feel your Mom needs to be here". 30 min is not enough time to make that kind of decision without knowing Moms history. I continued to take Mom to her own doctors when she was in her AL.

You change doctors at once because this one sounds pretty insane, to tell you the truth. Your Mom is in Assisted Living? So was my brother. He was "with it, able to walk on good walks with his cane, up and about, out and about". But there were reasons and indeed not as many as you describe you Mom having. I also had (one) medical person tell me "It is too early for him to enter care " and I would even visit him in his small home to make sure he was OK. However, both my brother and I made the decision for him, knowing he had balance issues and he has a diagnosis of probably early Lewy's Dementia.
You say this is an "in house" doctor. THEN you say this doctor is NOT affiliated with this Assisted Living Facility, so I am confused. But first of all, ANY doctor who discusses this in front of a patient is nuts. First of all, if she is perfect then it is up to HER when to leave; what does it have to you. He can send her home. Why would it be on you to decide "what to do with her". Secondly, you tell us your Mom has a dx. of Alzheimer's Dementia. Yes, a UTI may have brought this placement choice to a certainty. Yes, she may be better. Which is GREAT!. But yes, ALF is the right place for her.
I am irate. It all you say is true this physician should not only be banned from your Mother but should be reported to the licensing board. He is not only inappropriate, but he sounds completely loonie.
I sure hope you will update us after speaking to administration about how to proceed with a new doctor and reporting this one.

You say that this doctor doesn't work for the facility. Someone has arranged his services and in my experience, it is the facility that does this.

You had to have signed up for this service, if not, you have to get the authorities involved pronto, because receiving medical care without consent is illegal. And this jackazz is causing harm. Go after his license if he was not approved by the POA to provide services.

My dads facility had a set up with a "doctor" that would come to the facility, what they neglected to tell us was that they would be coming in twice a month. Whether he had anything going on or not, 200.00 bill to his insurance company. Unethical behavior to say the least. I would file a complaint against him and his office, who needs to see the doctor twice a month? Besides being on hospice this kind of setup is nothing but insurance fraud. (My personal experience, these "doctors" do this type of work because they are incompetent and can't hold a job or patients in private practice and they should never be able to treat anyone.)

If your mom is convinced that she can live alone, then she can arrange for her own move. No assistance from anyone to prop this up. I had to do that with my dad and he eventually got well enough to actually pull it off. The point being that he had to work harder at his mobility and taking care of himself to be able to do it and it ended up being a good thing for him. Just the trying is beneficial for anyone, so let her know that she is free to do whatever she can do, that doesn't mean ordering others around and having someone come pick her up or anything else, she must do it.

I would also be telling the owner of the facility that their service provider needs to be replaced and stay away from your mom. I would also tell them to deal with her, it is their fault that this guy had access and did this, so they can deal with the fallout.

Sometimes we just have to step back and let our elders figure it out or flounder.

Don't get sucked into the bs from this idiot. Putting someone in care IS NOT abuse. I think that I would speak with the owner and ask them how they see that accusation working out, because they have committed fraud if mom really doesn't need care. I know that a needs assessment was done, it is standard procedure all based on what they can charge. So they accepted an individual that had no care requirements and they are charging for care not needed and their service provider is accusing you of elder abuse by placing her, please dear owner, help me understand exactly how this works?

Your story makes me livid! The doctor's behavior is beyond reprehensible. How dare him question your decision to place your mother in a care facility. Many residents in AL are high functioning, i.e., can pretty much take care of themselves with little help from the staff.

“How would you feel if you were dumped in a facility” is an outrageous and inexcusable statement. I'm sure this doctor has never been a caregiver, nor does he understand the emotional and physical toll caring for a LO with AD takes on the family.

If the facility director has apologized to you for the incident, you might ask for the doctor's dismissal. Your's is only one case. How many other families has he embarrassed or made to feel guilty?

Don't move your mom. Stand your ground. As Ann suggests, get a assessment in writing to support your decision. If she's already been diagnosed, get a statement from that doctor.

The best thing we ever did when my LO appeared to fall between two levels of care, was to have her formally/legally assessed by a geriatric specialist who then wrote a document for my use stating that LO was unable to are for herself.

The document revealed that Memory Care was a better (if not ideal) placement than assisted Living care, and also served to legally establish my ability as her POA to assume responsibility as representative payee for her SS, transfer savings from her savings accounts to one central account in her name and the name(s) of her POAs, and any other matters that needed verification.

I don't have a care level right now. The doctor is the house doctor that comes into the facility bi-monthly to check the residents

This is a straight assisted living. The care provider sees the issue. I didn't think IL was an option. Yes she is competent but doesn't know what day, year and month it is and thinks the current president is George Bush..which one I don't know. She thinks her mother is alive but she has been gone 25 years and told the doctor she lived alone prior to moving in which is also not true.

My biggest issue is the medication. Will she even remember to take it.

Is this a regular AL or is it memory care? If it is not a memory care I'm a little confused by the doctor's comments, AL is designed for people who need/want minimal assistance with tasks like housekeeping, meals, and medication management, although it is true that some facilities are now accepting people who need much higher levels of care. People often ask what the difference is between IL, AL, Memory Care and a NH, the reality is that the lines between them have become very fluid.
If this doctor is not affiliated with the facility how and why did he get access to your mother?

Since mom is "competent" tell her she is free to arrange a move. Buy yourself some time.

Give yourself some time to digest this information. Have you asked the doctor what level of care mom needs? Independent Living with pill packs delivered and meals served 3 times a day? That model served my mom well.

Does this facility have an appropriate IL placement for mom? What is THEIR assessment of her current nerds?