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Boy I love this site. What would I do without all your help. I have another question. Mom has dementia, finally determined today as likely Lewy Body, vascular, and strong underlying clinical depression left untreated, an after effect of child abuse. It has taken 6 months to get to this point and get letters of incapacitation. Mom is a pleasant woman, intelligent, with hallucinations and mild to moderate cognitive impairment. She has wandered a few times. Otherwise she takes care of herself physically and her home as well. I have now moved her in with me against her wishes. I am her guardian. My plan was Assisted Living where she could have an apartment, but would have to wear an alarm bracelet or anklet. Today the doctor said Assisted Living wasn't enough care for mom. That it wasn't 24/7 care, and that mom was not ready for memory care. The doctor was adamant. So I am confused. The facility I had picked out is secure, alarmed and has 24/7 nurses and they know moms issues and claim she's a fit for them. The doctor suggested mom continue to live with me in my home/business. I have an apartment on the third floor, mom stays on the first floor apartment. They are small and we can't stay together. Twenty three steps separate us. There are 8 doors and 2 alarms. I can install more as suggested, but I don't see this as ideal. Why not assisted living??

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The doctor's culture probably plays a good part of the issue here; most are very different from the US.... Also, I find that the people I visit here in AL do not get enough help with things (I help them what I can) like dressing, showering, etc. because the place doesn't pay as much as others and cannot get or retain good help (3 nurses in 6 months - all went to better paying jobs - cna's the same). I used to work in 2 "group homes" that only had 4-7 people and one or two people on duty at a time. It went well, and we actually had one with Alz who tried to wander, but we kept it locked and we and the other residents looked out for her - and each other. It was great, and I know of another place near here like that, with no more than 10 residents in a huge Victorian house with stair chairs and 3 staff on duty all the time. My friend with ALZ went there last year and per her daughter, is doing very well - I saw her and she seems just fine, better than the AL, because more interaction; like a big family.... something to consider? The owner of this one is a paramedic, almost a doctor many of them, in terms of ability and experience - I know, my husband is an advanced EMT and works with lots of them. I tried to move in, but they wouldn't let me.... (joke).
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Another thought is if she moves to AL, you can also hire a caregiver that comes in and sits with her for what ever times you feel she needs some oversight. Usually the AL director/ care coordinator can recommend agencies they've experience with.
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I had a friend with Lewy Body, and we found assisted living was the perfect match. The AL gave as much freedom as was desired by this person, while providing oversight and assistance. He wasn't a wanderer, but burned his house down, falling asleep with a cigarette, so many challenges. Suggest you find a way for Mom to try the AL and have the social worker report back the findings, and see if your Mom likes the setting. If the physician is risk averse, a recommendation for Memory Care is the solution. Doctors should not be like baseball umpires, calling strikes and balls or merely labeling someone with 24/7 care. Rather, you can be a craftsman who carves staffs from tree branches. Although the end result—a wood staff—is similar, the process of creation is distinct to each staff. Just as the good wood-carver knows that within each tree branch there is a unique staff that can be ‘released’ by the acts of the carver, so you understand that, within the facts surrounding each placement decision, there is an outcome that will best serve the needs of your Mom, if only you can find it. ” Good luck, any questions or brain storming call 602-710-2233.
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After my Dad's stroke, I tried to keep him in his own home with 24/7 live in aides. 3 months later, per his doctor, I found a great Assisted Living facility for him. His Dementia was at a standstill. He had his own room with a bathroom/shower. He had his living room chair and his TV. I had to buy him a twin bed and a dresser. All was well for about 3 months. All the rooms were in a circular around a common walkway. He could walk, stay in his room, go out in the courtyard, weather permitting or go into the family room. Soon, he was forgetting where his room was. He forgot where the dining room was and started to get somewhat aggressive. In order to keep himthere, I had to hire a livein aide. On top of the cost of AL I was paying the same amount for the aide. Then he started having swallowing problems and ended up inthe hospital with aspiration pneumonia. When he left the hospital, he went into rehab. I knew then that he couldn't go back to AL, so he stayed in the long term unit of the NH where he went for rehab. Long term care and AL are so different. My point to all this is that in a matter of just a month, the Dementia can worsen dramatically. If I had it to do over again, I would have chosen long term care in the beginning. Dad passed on Sept 1st.
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Assisted living memory care is 24/7. My mother is similar to yours. Memory care is for those who have beginning dementia to Alzheimers. My mother has memory loss due to what her POA(my sister) allowed the hospital to give her. I petitioned the court to place mom under guardianship, revoke the POA; which they agreed. You need to visit the homes and get the information. You as guardian can make the decision.
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Ah. He "has a different cultural background." I think that sums it up.

You need to make a decision within your culture. You need to consider what resources are available to you. You need to consider your skills and expectations. You need to consider the physical layout of your own building.

With no disrespect to the doctor's culture, you are free to listen to his medical advice and to fit that into your own cultural background.
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"The facility I had picked out is secure, alarmed and has 24/7 nurses."

This sounds like a Memory Care facility (a type of Assisted Living) and would likely be a good fit based on your description. Make sure they give you complete details of the add-on costs that usually are charged.
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Sounds to me like your mom needs AL Memory care, which in our facility is a locked down floor with a private nurse on the floor and it's own CNAs that are not shared with the other AL floors. When they get to this point a large single room is sufficient because you don't want them wandering from room to room. They have their own activities and many are very astute dementia residents. Not all have the agitated behavior of Alzheimer's. They have their own activities but as a group they will take them to the IL/AL activities. But as others state each facility is a little bit different. You have to do what's best for you and your mom. Good luck!
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I only know 2 people who have parents in Memory Care and both are 24/7.
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Let's look at this situation in a different light...here is my experience:

My Mom's primary care physician, who had seen her for decades before she went into memory care, was NEVER able to agree with me that she needed 24/7 care in a facility and out of our home (my husband and I took care of her for 5 years). That decision for him was easy...just words and then, the next patient! He did not have to wake up every night because mom was falling on her way to the bathroom. He did not have to repeatedly answer her questions and talk her down from anxiety and confusion. He did not have to clean up the carpet each time after she could not get to the bathroom on time. He did not have to give up work in order to care for her emergencies and confusion. He did not have the same personal experience.

One day, he even said that I should drive Mom everyday to her volunteer/day care work, instead of the two afternoons she was doing, as it made her happy. That did it for me! I could not believe my ears! HE did not have to take time off his work to do that.  THAT day, I realized that this doctor never looked at all the time and energy which I had already offered into her care. THAT day, I realized her doctor was not considering me at all, but was mostly worried about not being the responsible party who sent her to a place she may not joyfully want to be at. (Remember that doctors are human too and have their own issues.) THAT day, a veil lifted.  I made up my mind to resolve this issue on my own. I decided to accept making the lonely and the hard decision myself of placing mom in a home. I realized that had to be okay with that responsibility in my own heart, accept the future emotional consequences of it, and go directly to the facility to have her memory and care level appraised.

Well, she was diagnosed as mid-to-advanced level of Alzheimer and additionally had vascular dementia. Although she was not yet 'wondering' and was still physically vital, the facility's doctor assessed that she was ready to enter into memory care!

This situation made me realize that I had to risk making a very lonely decision on my own, moving beyond my own fear of placing mom away from home, from us, for her best care...a care which I could not provide anymore.

I wish you all the best!
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In the AL facilities I've looked at for my dad, there are medical staff on the same floor and around 24/7, but not literally by the patient's side all the time. My dad was just discharged from rehab, and recommended for AL but with an aide at least 8 hours per day for the first couple weeks while he acclimates and gets stronger. These ALs I've looked into did their own evaluations to see whether Dad was a good fit so I would think they'd do the same for your mom...if she needs a bit more care you can always hire an additional aide to check in on her more frequently as well.

In your case, it's not like you can be expected to be by mom's side 24/7 either so I can't imagine what this doc is thinking. Best of luck and lots of hugs as you navigate this transition!
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My Mom is in AL & it is NOT 24/7 care. She is alone regularly. They have one caregiver for about 10 to 20 patients. Someone is on site, but if she has an issue they might not be able to get to her. Also, memory care can be very frightening if your Mom still knows you & what's going on around her. There is a fine line between AL & Memory care & I would not want my Mom in memory care unless she no longer knew who I was or how to take care of herself. Your best bet is to visit many AL's & memory care facilities & check references from other patients. The doctors have to watch over your loved one & know the parameters of these facilities. Many facilities will take your Mom to fill space & bring in revenue, but once she gets there, if they can't take care of her, then you have to find another place. That's not good for you or your Mom. Hugs & kind wishes - this is such a tedious, tough journey - taking care of parents. I love my Mom, but since she has been in AL my life has constant ups & downs. I get texts & calls most every day with another problem or issue that my Mom is having. She's wearing me down along with all the care givers & nurses! Not sure how long it will be before they tell me we have to do something else. :(
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All assisted living facilities are not created equal. They offer varying living arrangements from apartments to private/semi private rooms. Also, some are qualified to provide a higher level of care. I made a mistake when my mother went into AL. I thought a nice little apartment would be perfect. She fell which resulted in skilled nursing for several months. When she was ready to go back into AL, I realized a room was the perfect fit. She has her own bathroom, TV, sitting area and plenty of space for one person (and privately when she wants). The common areas provide activities and areas where residents can sit and visit. Some residents are in wheelchairs and those who aren't use walkers. There are two nurses and several aides on duty 24/7.
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I think that your doctor is confused, which I find alarming. Either that or (as mentioned) you state has very different terminology for its care system than the rest of the country. I believe that he or she is thinking about adult day services (or adult daycare). That is more for respite and can be used for a few hours up to a full day. Assisted living is nearly always 24/7. People have their own apartment or room, depending on how upscale it is. They provide activities and social interaction. If it's a memory care unit in AL, it will be secured and should be staffed with specialized assistants.
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It depends on the state, but, in our state, AL's require a form (FL2) that is completed and signed by a doctor. It sets out the residents needs for care and medical conditions. There may be one that is required in your state.

Once the regular AL observed my LO attempt to wander. (She wheeled herself into the parking lot and tried to get into a stranger's car.) That was it. They were not able to keep her and she had to have a constant caretaker with her, until we had her moved to a secure facility. Most AL's don't have the staff to assign one person to watch one patient one on one around the clock. And the doctor said it wasn't safe for someone who wanders to not have the protection of a Secure facility.

Have you had anyone else evaluate her needs?
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He might not know what Assisted Living is.

Have you had an assessment done by the Area Agency on Aging in your area?

Or can the doctor suggest someone (covered by insurance) to do a professional assessment?
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Thank you all, good points and questions. This is our 7th doctor and the only one that wrote a letter of capacity for us and moved quickly to get is to this point. So for that I am thankful. All others just told mom to get her affairs in order, but mom would not. The doctor is young and a geriatric specialist and seemed on the ball. He does care for his parents and has a different cultural background than I do.
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Wouldn't the AL be doing their own assessment? If they have all the facts and feel that they can offer the level of care she needs then isn't that enough?
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What would the interim step be between AL and memory care? Did the doctor suggest anything?

You know though that you can ask other doctors as well as make your own decisions. What do YOU think?

I think I would interview other ALs just to see whether there's a consensus on what might be a best fit. I would think the staff at the facilities have a more practical, hands-on approach to what's necessary than a doctor, whose approach is more clinical and not as practical.

If they agree that AL would be a fit for your mother, go with the one you've chosen. It's your mother, your decision, with a doctor's recommendation if it meets your mother's needs, but not if it reflects an opinion not necessarily based on hands-on experience.

I've found that some doctors' first thought is "facility", whereas others are amused and admiring of my father's independence and insistence on staying in his own home. One even said "well, if you want to live to 100 and stay in your own home, this is what we'll do."

I think it depends on the doctor's approach and what he or she would do for a parent of his or hers.

And, of course, the doctor who thinks she should stay with you isn't doing any of the hands-on care!
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I don't understand where the doctor is coming from. In my state, a dementia patient who wanders is referred to a Secure facility. It's too risky to not do this, as non-secure facilities are not able to keep them safe. I'd think the doctor would be afraid of liability. Also, what doctor insists that a private individual provide care in their home? Very bizarre, imo. Caring for a person with those conditions is a full time, around the clock job. Maybe, others will have more ideas. I think I"d find a doctor who regularly treats patients who have dementia. How old is this doctor?

We had a family friend who had dementia and hallucinations. They frightened him to the point that he ran into the street, fell and broke his hip. He was not able to recover. So, hallucinations are a risks to the person's safety as well.

Also, monitoring devices are fine, but, they don't prevent the person from getting lost in the first place, walking out into traffic or getting hurt by strangers.  Do you feel that mom would be safe on a separate floor and that the alarms are foolproof?  
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That does not make sense to me at all. He actually thinks a single individual can provide more uninterrupted care than a facility with a round-the-clock staff? You have to sleep too, and go out shopping, and work (apparently). Plus you're not even on the same floor as her most of the time. I really can't imagine what he's thinking.
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