How do you decide if best for parent to "Age in Place" or be in assisted living?

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My mother is 81, and has been extremely lonely and depressed for many years. It eventually pushed her into mild dementia. After a bad fall with a brain injury in March, she graduated to moderate dementia. Her short term memory took the biggest hit. After a hospital and rehab stay, my brother and I selected an ALF to see if she could adjust to assisted living. It's been 2 very loooooong months.
She is miserable in the assisted living, and her most frequent complaint is due to having such a small living space, and constantly begs to go "home", even though she only has a vague idea of what home is. My husband and I work full-time, so living with us is not an option. I feel guilty in not helping her to get back to her patio home, even though I know she would lose the small bit of social interaction she has at the ALF. It feels like there is no really good option, and am being drained by the amount of attention she needs. We've hired a companion to spend afternoons with her and assist her in learning to socialize, and I have spent almost every evening with her trying to help her adjust. Her misery is really wearing on me. I'm thinking that going back to her patio home with some paid assistance is going to be the least of the miserable options. Even though she will quickly be crying about "staring at the four walls, alone".
Does anyone have any wisdom to share?

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Social isolation will occur if she ages in place in her own home. Maybe the ALF is not the right one for your mom, so you may want to consider looking for another facility. I would also reach out to the activities director of the current ALF to see if there is anything that can be done to better engage your mom in the community life.
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Catwoman, it is my experience that unhappy people are going to be unhappy wherever they are. If the ALF is adequate, I would say leave her there for her own safety. Take back your evenings for you and your husband. Get reports from her companion, drop in to see her a couple of times per week, and give her time to adjust or not. She wants you to fix what can't be fixed and I suspect the guilt is dealt out to you as thick as sludge. Catwoman, she did "age in place." Now she is past that. She needs the care that an ALF can provide. You cannot do it all. Take care of yourself!
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The answer to this question depends on you and your situation. Many people want to remain in their home, but do nothing in advance to prepare for it. There are many frail seniors presently in the home and are alone and socially isolated. This is really an unhealthy situation.

I am a strong advocate that a person should remain in their home as long as possible, if the person is safe and has a support system in place.

I do not think that a person should remain in their home at the expense of other family members - meaning many family care givers give up jobs, outside relationships and are financially affected.

Care givers do not realize what they are agreeing to do when they say they want to support someone in the home. It may be 10 years or longer of care giving.

My suggestion to you, is to sit and discuss what your family member wants and expects as far as living arrangements.

Now, here is a step that many care givers do not take- SET LIMITS AND BOUNDARIES as to what you are willing and able to do.

Sit and discuss- I cannot take care of you when you are no longer able to walk, become incontinent, become a behavior problem, socially isolated etc.

Put all this in writing. Then, everyone knows what to expect.

Discuss options- nursing home and assisted living. Include those in the conversation. This is a way to make informed decisions comfortably.

Diane C.RN
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As previously mentioned, each situation is different. It sounds like whichever choice you make, there will be complaints.but you do have the big picture of what is best for your mother - let that guide you. In looking back, I wish I had put Mom in her dementia care facility a year before I did. I let Mom age in place until she no longer recognized that "place" as her home of 47 years. Then I rented a duplex for her that was close to my house so she could still keep her little dog. That worked out well until she lost the ability to entertain herself by reading, and the TV didn't penetrate her brain any more, about a year ago. That's when I should have moved her. She eventually fell which precipitated our decision to put her in the facility. It's the best thing that has happened to her . . . and to me!! I had not realized how much of my life was taken up by caregiving. I'm confident she is well cared for now and she is enjoying being around people and out of isolation. Yes, I'm still the person who matters most to her and I try to visit daily, but she has access to activities that are on her level. No, she doesn't interact a great deal any more, but humans weren't intended to be isolated and she appreciates the diversions. I might have agonized about this decision a year ago, but with the fall, there was no other choice. What I'm getting at is that 1) deep inside you know what is right for your mother and 2) you are entitled to a life as well. She has lived hers and this is still her journey, you can't take it on for her.
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Catwoman, does the ALF has a social worker on staff or someone there who can assist with acclimating your mother to the facility? Most of them do. Is there a "job" (like putting books away in the library) that your mother could do at the ALF? Is she mentally able to participate in any of the things offered there? The ALF should work with you to socialize your mother at the place. Tell them she is having "social adjustment" problems. My mother was living in her own home after my father died, and she was getting more and more depressed. It happens when you are staring at 4 walls. Your mother is much better off in the ALF where she is being watched, getting her meals made, and, at the very least, she can "people watch." The first few months at an ALF can be a difficult adjustment for a lot of seniors, but, in the long run, it is the best place for her. JMHO.
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I preface this by saying every decision is so personal to the family and the patient. This is our experience: Our mom is now in assisted living. She has moderate dementia, has had two heart attacks, a broken hip, a stomach bleed requiring transfusions, and two small strokes. We consulted with our neurologist on the possibility of allowing her to stay in her home with help. The answer was a resounding, "No." There comes a time when you have to look at safety and the level of care needed and forego your own wish to keep a person in their home or even bring them to your home. The doctor told us several things: 1. Most patients with dementia do better when they have interaction with a variety of people on a daily basis. 2. Given our mom's level of dementia and physical problems she was exactly where she needed to be and we should feel good (not guilty) about having her care given in a professional care setting. 3. Dementia is a progressive disease and it's easier on the patient to transition through the end stages in a care setting where professionals who understand this disease can soothe them and alleviate anxiety. 4. Some in-home care can be considered elder abuse depending on the level of the patient's level of dementia and physical compromise from other illnesses. Although it has taken our mom a whole year to adjust she is now happy and "at home." We call her regularly and visit her 3-4 times a week and take her for short outings. She has found purpose in her life as she considers herself the caretaker of those who are more compromised than she is. She was lonely at home and had started to have paranoia about a man who was watching her at night. She sleeps like a baby now, has gained weight, and says she likes being waited on hand and foot. Not every day is good but most of them are a huge improvement from where she was a year ago.
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Terrimerritts, Not everyone is cut out to be a caregiver whether it is for a family member or not. J.ust because you were able to do it for yours don't mean everyone else can do the same. For one, everyone situation is different so can u try not to be so harsh n maybe a bit more open-minded toward others.

Catwoman, you can only do so much n hopefully she will be able to settle in n be comfortable. All ALF r not the same so u may want to be checking other places that can give your mom the best care they can if the place she is already staying is not able to give her that care. Eventhough, she has memory loss, she is a human being. I would think she will remember some stuff n a place that does activities would help your mom even if she don't remember it later she enjoyed it at the time. That what I think about my mnl when we take her once a wk to an activirty respite care for four hrs. I know she is smiling when I drop n pick her off n even though she don't remember what they all done that day, I can see it on her face that she enjoyed her self. Now, next Wed will have to start all over again to explain she will be visiting her friends at the church n that she will have a good time. of course next Wed there not open due to holiday. U get what I mean. All u can do is the best u can n live your life too.
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I struggled with this same situation....After visiting many assisted living and nursing homes I realized my Mom wasnt quite ready for permanent stay there. I think many times, we put our parents there because its is the easy way out for us, but not necessarily the best situation for our parents who have done so much for us. Yes it is stressful...but there is homecare options there. Please visit your Social service dept located in your city or town hall. They have an abundance of information. We recently received funding for my Mom to receive 30 hours per week of homecare and 3 visits a week to Adult Daycare. She is loving her life. My Mom has dementia and needs 24 hour care. The adult daycare program weekely and funded 30 hours helps her and the family needing to be with her 24 hours a day. In addition we have hired an aide for an additional 10 hours per week or arranged for babysitters to watch her when we have special occassions at night or weekends. You can qualify to receive this type of funsing even if you choose to have your Mom move in with you., allowing you and your husband to continue working. Afterall...you said you spend your evenings at the assisted living...that time can now be spent at your home and you will notice that your Mom is not as depressed and miserable or as needy.....At that age, all they want is to be with family, not strangers...All the best...you are not alone!
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Some 'problems' cannot be solved. Do the best you can--without trying to do the impossible. Obtain any help at the AL facility--and--see if you can find an empathetic resident who will take your mom under his/her wing and 'friend' her. Just a good listener can do wonders. Being at home is not the solution.
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Ditto what Only1of3 said. She's absolutely right. And you know what? Getting old stinks. It's not for the faint-hearted. Aging can be lonely and depressing, and, exacerbated by the fall, you did the most loving and practical thing - making sure she's safe and clean. These are agonizing times for us kids w/ older parents. But we must remember as per 'friendofnature' that you are entitled to your life. If the resources are there to provide AL care, put them to good use as you have. You'll still beat yourself up...we all do...just hopefully not every day. Warmest regards...
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