When should you seriously start to consider moving your parent with dementia from assisted living to memory care?

We moved our step-mother 3 years ago, she was roaming around outside and dumpster diving, she was actually climbing up the ladder and jumping in.

She would take treasures home with her, rocks, sticks, shells, her room was filled with them.

We knew it was time, we were fortunate a studio opened up in MC and we transitioned her to her new room.

I am a firm believer in not waiting until it is an emergency, also, for both my mother and step-mother my brother and I chose a facility that had a step up program, AL-MC-NH as moving around the elderly is not a good idea.

Good Luck!

My mother was allowed to stay in AL for about 8 months when diagnosed with moderate dementia. People here will say that no one with dementia belongs in AL, but I was told by two different AL directors that most of their AL guests had some degree of dementia. Telling the same story over and over is one thing. Forgetting how to use the toilet is another.

We finally had to move her to MC (on the facility's recommendation) when her behavior became too disruptive for the AL unit and she needed someone to keep a close eye on her at all times.

Now. You are asking the question because your intuition is telling you it’s time. She’ll do better there if she has enough of her mind left to acclimate and learn the new routine and maybe make friends as much as they can in MC. My brother was sure my dad wasn’t ready ,,, he wasn’t like “those people,” but dad was assessed by the MC and brother was wrong. dad is doing great in there. Much better than any of us could have guessed. It’s a huge relief that he is somewhere that knows how to deal with this awful disease.

Ask your loved one's doctor AND consult with the ALF about their services. Some ALF's can transition people as their needs change.

The ALF should provide you with the patient care assessment qualifications for or to meet ALF criteria. And you should have the parent 's PCP provide you with a
" level of care needs assessment" for the parent; this will tell you what level of care ( ALF, skilled care, dementia) your parent needs for safety and caregiving reasons.

hlwynn: If you're posing this question, the time may have arrived.

It is a difficult decision but when my mom began to fail, it was a quick decline. In her case, it was not a subtle downward decline. She went from functioning pretty well to not functioning at all over night. I think it depends on the type of dementia but as others have said, evaluate if the current care they are receiving is sufficient for them. Make your decision on their needs today with the realization that (except in rare cases) it is highly unlikely that they will improve.

If you have to ask, I would say yesterday.

Start doing your homework now, don't wait until it is an emergency situation.

Well, ideally, BEFORE it gets to be a problem.

But that pretty much never happens. Most people wait until it's an untenable situation before they actually have the courage to step up and act. And it's often just awful, rife with drama, tears and confusion. (And that's the CG's I'm talking about!)

DH's mom had a bad winter--and was in an out of the ER and rehab for a few months. At that time, she should have been moved to a nice SNF. She has the money to pay for expensive care for about 4-5 years.

Instead, the kids brought her home and thus began the long road to purgatory.

For the first few months she was HOME, she thought she was in a NH and commented that it was a pretty nice place after all. So that told the kids she WOULDN'T die if they placed her.

Her dementia, while not truly dxed as far as I know, is getting worse each day. But she's still hanging in there.

She would be angry to be in a NH, but she's angry at home. I guess that's not unusual. She'd get better, more consistent care in a NH, that's for sure.

IF you can start looking at places and get input from your LO about where they would choose to live, that would be great. But, as I said, so often we wait until the very last moment and it makes the change so hard.

We grow too soon old--and too late, smart.

This needs to be discussed with the facility and her medical provider.
Social worker(s), nursing staff, MD at facility should be able to help you make a determination based on what your parent can / cannot do, and how their cognitive functioning has / is changing. Every person is different to degrees.

You need to consider:
* Cognitive functioning / decline (brain changes)
* Physical abilities / moving around
* Safety - how much 'hands on' care / time do they need
* Incontinent? Bathing support?
* Medication management
* Socialization / activities (options)
* What care might be needed moving into the next few months / year.

Gena / Touch Matters

My mom was in a very good ALF and they were willing to keep her even with her ALZ dx. I was in constant contact with the staff and most especially with the director, to ensure they were comfortable and capable of managing her, even with her "weirdness". I also kept tabs on problems and issues she was having with them, sorting whether they were minor or significant and whether they affected her happiness.

Mom loved going outdoors and walking outside and they were happy to let her do that, as long as she stayed "in the yard". When she started getting braver and venturing away a bit, they started getting antsy about her and when she willfully eloped and got all the way to the highway (about 100 yards from the facility), the director told me it was time to look for MC. A few days after she told me that, Mom eloped again and this time punched a nurse who tried to make her go back. Police were called and she had quite a stand-off in the parking lot of her doctor's office (which was between the ALF and the highway) when I showed up. That was their final straw and she was not even allowed back at the facility at all - I had to take her that day to a memory care I had found as soon as they had told me to plan on moving her.

For us, it went VERY quickly from "we got her" to "get her out of here". Had I known then what I know now, I would have had a MC picked out as soon as I placed her at the ALF, knowing that MC was the inevitable next step.

One thing I've noticed - and I'm not sure if it is a ALF vs MC thing or if it is a facility vs facility thing - MC has been much more willing to use medication to keep her calm. At ALF, they seemed to try to minimize her psychotropic meds whereas MC uses them to keep her calm and themselves safe. I personally have no problem with that - calm and happy is how I hope she can spend her days now, more than aware but combative, which is what we were getting without the meds.

My MIL walked out the front door of the assisted living at 3am. That is how we knew...

But before then we had NEVER thought that she was a flight risk but aging and dementia surely make their actions unpredictable.

When they can no longer function properly in AL, because their needs are greater than the care that's available. Or they're wandering out the unlocked front doors to outside. Or trying to turn the tv on with the telephone, or trying to make a phone call with the remote.

The facility they are in should be discussing this with you.
BUT if your parent is...
At risk of leaving the facility.....it is time to move to MC.
Needing more help than they can provide in AL... it is time to move to MC
If they are becoming more isolated, will not leave the room...it might be time to move to MC where the unit is smaller, fewer people and more staff.

When others at AL start avoiding them because they're "weird," when they can't get themselves to (or don't remember) activities, and when you feel like you need to do most of the assisting in addition to what they get there.

Memory care is wonderful because they really focus on mental stimulation, one-on-one conversations, and they aren't focused on everyone's medical ailments even though they all have them, too. My mother did so much better in MC when I decided that socializing and mental stimulation were the most important things for her quality of life and I transferred her there.

hlwynn, I would seriously consider the opinion of the MD involved in care and the input of the administration at the ALF. ALFs vary widely according to how they can accommodate patients. Some have a sort of intermediary care where the person may require a locked cottage sort of accomodation, but can still participate comfortable in a close community of not too many people. My brother's ALF was such a place, and their cottages had about 14 rooms around a common area that included a bathing room, a small kitchenette, a dining room that was common and a TV common room at the other end. There people seemed to do so well, knowing one another in their cottage, having weekly meetings, game nights, and etc. And they were often able to watch over people as they progressed a bit in their dementia. At times it became clear that too much caregiver time was needed and the needs were above level IV and at that time the admins reached out to family. All that COULD be done was, as the level of care needed in MC portion of facility was so much more expensive that it was the deal breaker for families and clients, but all worked in concert to try to keep things running smoothly, and there was a good deal of community love and feeling present as well as a good deal of administrative oversight.

Do discuss this with the administration where your loved one resides and I surely do wish you the very best of luck.