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My mom is on Aricept and Namenda for uncomplicated senile dementia and has been on these two drugs for 12 years. My mom is 92. Overall her health is good. A small dose of Lopressor for the heart. Had a cardiologist appointment went well he does not want to see her for 6 months. My mom's mind is good except for vision and hearing. The facility wants to put her in Memory Care. I do not feel this is appropriate for her at this time. My mom has even stated if I go there I may as well die.
I think this facility is doing this for financial reasons. I do have a Neurologist appointment for her coming up. In the meantime, the facility wants to get a Speech therapist to do a cognitive test. I have looked at the test of questions. With her macular degeneration, she wouldn't pass. She is out of sight but not out of mind.


I am a 34+ BSN nurse. I am a case manager in the hospital. I think this is not right. Has anybody ever dealt with issues like this with a parent?

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Interesting that her vision problem is only in one eye. My grandparents had and mom has macular degeneration. There are glasses that can help her to see better. She will never completely lose her vision but will lose her central vision. With her hearing, she needs to wear her hearing aides in order to continue being able to hear. Not wearing her hearing aides leads to permanent deafness if the nerves are not stimulated regularly.

A speech therapist is not the right person to do cognition testing. That would be a neurologist. Advise the facility that you will discuss your mom's placement after receiving results from her neurologist. Be aware that medications for Alzheimer's type dementia work in the earlier stages but tend to not work in latter stages. That happened to my grandfather. He also had hearing and vision problems. Try hard to get her vision and hearing addressed since folks that lose those abilities decline faster.

Use those good nursing skills for your mom's best health care. You are her best advocate (coming from an RN with BSN too).
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My uncle was in nursing home and they recommended MC. I didn’t agree. I was visiting everyday for a half hour or so. At their recommendation I spent a day with him. It became very apparent to me why he needed to be moved. He’s now in Memory Care for two weeks and has adjusted well.
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Someone we see everyday--we don't notice the little, slow slippage of skills-cognition, vision, etc.

I don't see my mom everyday. Not even every week. Maybe once a month, and I am VERY aware of her sliding down, so to speak. YB, with whom she lives, doesn't notice and therefore doesn't address any issues.

Fair to him, there isn't much, if anything he could do differently. I wish he would take her to be checked out when she falls (which she is doing more frequently) but he refuses.

Looking at your mom with fresh eyes---no pre-conceived ideas about what you already know--and maybe you'll have an AHA moment when you see she does need a step up in care. Or maybe you'll be more convinced that she doesn't.
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The first line of your post says your mother is on 2 medications for 'uncomplicated senile dementia' for 12 years. I haven't heard the word 'senile' used since my grandmother's days, but I digress. You then go on to say her mind is good. With dementia in force for 12 years, how exactly is her 'mind good'? A diagnosis of dementia means her mind is compromised; not 'gone', but impaired.

Furthermore, a cognitive exam has little to do with vision and everything to do with memory questions; only at the end do they ask the person to draw a clock to see where their executive brain function is at, the rest of it is verbal. My mother has horrendous hearing & macular degeneration herself, has taken the MoCA cognition exam at least 10x and the first time she scored an 18 out of 30, declining over the years to a 10. Her hearing and vision had nothing to do with her score; it was her cognitive decline and dementia that led to her scores and her eventual placement in Memory Care 3 years later. Bad hearing and vision does contribute to developing dementia to begin with, however, because all the 5 senses play a role in cognition. Your mother would only face issues if given a written test; normally the MoCA test is what's given which, like I said, is 95% verbal.

Going into Memory Care AL is by no means a 'death sentence'; just another stigma attached to a higher level of care that's often warranted for a person with your mother's conditions; dementia, poor eyesight, poor hearing and a heart condition. A person does not have to be 'out of their mind' to live in Memory Care; they just have to have dementia and require a smaller environment with less decisions to make in general, and a higher caregiver to resident ratio so their needs can be better seen to. My mother plays games and socializes with the other residents & friends she's made in her MC on a daily basis! So she's not 'out of her mind' and drooling in the corner, as some people would believe the environment to be in MC, like some insane asylum of the 1800s!

At some point, your mother will have to take a cognition exam, even if you want to move her out of this ALF and into another. My mother moved from regular AL into MC in 2019 when her dementia was moderate; she's now advanced and I'm seriously glad she's where she is b/c she suddenly requires a boat load of care which is available to her in MC, thank God.

If you feel that the AL is trying to swindle you by saying your mother requires more care in MC, then by all means, look around for another AL. But be prepared for the new facility to want her tested there before entry. It's the way things are done in managed care these days.

Whatever you decide to do, good luck.
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disgustedtoo Nov 2021
Everything you said and then some!

Tests are tests and some have really no bearing on one's ability to do ADLs or get through the day safely.

We don't know what the facility sees that may impact their recommendation to move. It isn't clear if OP has any details either - perhaps she didn't share them, but that is what is more important before making this decision. The hearing and eyesight issues make life more challenging (my mother also had both, along with medically treated high BP), and can impact progression of dementia, but they, in and of themselves, are not the deciding factors.

If OP doesn't have details regarding this recommendation, she should get them - difficulties mom might be having, time of day, etc. OP should also find a way to spend whole days with mom. Even with more moderate dementia, many can hold their own and seem to be of good mind when we visit. Don't lead her to places, like dining area, or suggest times for meals or activities. Let her drive and see where it takes you. Spending a whole day might be illuminating. If after several long day visits she seems to be holding her own, then defer the move. They can recommend, but they can't force it.

And NO, moving to MC isn't a death sentence. You need to vet the place first, but as with lealonnie1 and others on this forum, not all MC units are filled with drooling zombies parked in front of a TV. My mother was in one for 4 years, and it was generally a hive of activity.
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A speech therapist IS qualified to do some types of cognitive testing. Mine did testing with me. A Speech Language Therapist deals with many aspects of cognitive functioning because the ability to think of words, identify objects, and speak them are related. You may notice that people with cognitive impairments may develop issues with misnaming things. For example maybe a horse is called a dog. Four legs and a tail, right? There are numerous cognitive exercises to do just as there physical exercises for the body. The SLT also works with the patient on the physical aspects of swallowing and speech. Which all reminds me, I should be doing my homework more!
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igloo572 Oct 2021
Yes! My mom had a ST do an eval on her. It was part of the team approach her gerontology group did. She had scar tissue in her throat which affected swallowing.

But one very important thing I hadn’t thought about that they (ST) were keyed in to notice was “code switching” on language and for having allowances on testing done to accommodate it.
That for those, like my mom, who’s first language was not English & fluently bilingual her whole 99 yr life, is that they tend to revert back to the 1st language as their dementia increases. So there are processing issues in answering questions in English whether spoken or written. If the tester is not aware of the elders background, they can take the hesitation or silence as not being cognitive, not understanding. Doing a mini mental & saying “Table, chair, pencil” when the elder instinctively and initially thinks “la mesa, la silla, el lapiz”, flat requires extra time to code switch. If this at all could be your parent, try to see if this at all could be happening for their cognition.
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My dad is legally blind - macular degeneration and glaucoma in one eye and totally blind (not even light/dark) in the other. He actually managed to complete the test with the drawings of the clock etc because the person administering the test knew that his sight was limited and didn't expect a perfect drawing; she just expected him to be able to show some logical effort and an ability to tell her what it should look like. Most of the test did not involve sight so he aced it - even with very limited short-term memory (but he did count backwards by 7's so long he had to be told to stop!) My dad's sight has continued to deteriorate, as has his hearing and memory but he is still in assisted living. He did get off the elevator a few times on the wrong floor and got turned around but someone always got him back to his apartment without incident. I have increased some of the services he receives so he gets more "cues' to go to lunch and dinner. He's over 100 years old and isn't terribly interested in social activities every day and is mostly content to sit in his comfortable chair with the tv on and dozing. Getting himself to social activities is his responsiblity and in Memory Care they would make certain he was involved in more activities and had more interaction outside his apartment. Your mom may actually benefit from Memory Care if she is having difficulty participating in the community due to her increasing dementia and loss of sight.
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Loss of vision in one eye shouldn't cause significant visual impairment.

If she has been on medication for dementia for over a decade she either never progressed beyond MCI (and many people don't) or she is well beyond the early stages of dementia, but I agree with Grandma1954 that I would want to know exactly what they are seeing as causing problems in her current placement and why they feel she needs memory care.
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DrBenshir Nov 2021
Not true! There is probably some AMD in the other eye but it has not advanced as much. Also, there is a significant neurological link between the two eyes, and between vision and hearing. If that isn't enough, poor binocular vision can impact all bilateral sensory and motor processing.
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Agreeing with VegasLady and Igloo572. I'd ask the speech therapist about what modifications they plan to use with your mom's vision problem. Between that test and the neurologist's exam, y'all should be able to evaluate what is best for her. You may wish to give the neurologist's office advanced notice as the appointment may take a bit longer.
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It is appropriate to give her a memory test, and it is appropriate to do so verbally, because of her eyesight. Once you have that information, you can make an informed decision about whether or not Memory Care is the right place.
I can imagine that if she's been living in a facility for 12 years, it may be hard for you to see or perceive changes in her cognitive abilities. Memory Care is not a death sentence, it is a place where seniors go who cannot remember things and need a safe environment.
Every change is not necessarily money driven. Only you can tell (us) if this facility is honest or not-- she's lived there for 12 years so it would seem that you trust them.
With my mom, it was very evident that she was doing successively worse on the memory tests but that you couldn't necessarily tell, from the outside, that she was losing brain power.
Again, I don't understand equating Memory Care with " I will die ". Does she have a geriatrician? They can help you figure out next best steps.
Wishing you luck. All of these transitions are hard and fraught. They may be harder for us than for them.
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disgustedtoo Nov 2021
Thank you for a sensible response.

Of course some (like this mother) think ANY change, NH, MC, etc is going to be the death of them. Despite having AL in her own plans, my mother refused to even consider one after dementia came calling - you'd think it was a dirt, snake-filled hovel the way she spat out the words!

Although tests might reveal some reduction in cognition, even that isn't what should be a deciding factor. Can't draw a clock? So what? Does drawing a clock have anything to do with being able to live somewhat independently? Nope. Those tests can be helpful, but some people can do just fine "independently" longer than others.

I think OP would be better served to:
1) get more detail from staff as to why they recommend the move
2) once you have input from #1, spend a whole day with her

Sometimes we don't see the changes that do lead one to need more supervision. We are not there all day every day, like the staff is. Spend several days, if possible, at different times. She may do find during your visits, chats, etc, but dealing with the stresses of everyday life, she may be exhibiting struggles with some activities which may indicate the need for more supervision.

My mother had both Macular Degeneration and hearing loss. I agree with another person, get her to wear the hearing aides as much as possible! Sadly my mother had already lost hearing in one ear (surgically correctable when detected, but she refused) and with dementia it was getting difficult to keep the batteries fresh AND get her to keep it in. The loss will accelerate and will also impact cognition. She started treatments for the MD, considered legally blind in the first eye. I helped her before and after the move to MC. With hearing loss, it was important to protect her eyesight. Treatment was continued 4x/year until she had a stroke. Between the wheelchair she was already in, dementia and then the stroke it would have been difficult to get through the whole process. I don't think the MD had any real impact on her dementia. The hearing loss likely played a part, but high BP, even treated with meds, for many years likely lead to her vascular dementia (never tested, but given condition, age and progression, this is the most likely.)

Get more input from staff - ask for details, times of day, etc and then observe for yourself. Spend some whole days with her. As others noted, it might be illuminating.

As for if/when MC is needed, do spend time checking the facility, even the one associated with her current AL. Just because the AL was great doesn't always transfer to the MC area.
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If your mom's mind is good then I wouldn't agree to it. Having macular degeneration shouldn't be a reason to place her in memory care. My mom (95) is blind in one eye (prosthetic) and has AMD in the other - only has 15% vision. She, too is also hard of hearing. She is in a residential assisted living, but not a memory care unit. Can I say she doesn't get confused once in a while?? Heck no. But for the most part she knows whats going on. Knows her kids, grandkids and basically what to do for herself - she just needs help doing it. Stick to your guns, you know mom better than anyone. Good luck!
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