Does my mother need a higher level of care like a nursing home?

I work in an ALF and have for 2 decades = the facility should be providing these services to your mother - this is what assisted living is. Meet with the Director and find out why this isn't being done.

minerva, has your mom been checked for a UTI? if she's not suffering from that, then it sounds like there's another issue here, possibly alzheimers/dementia. Time she got to the doctor to rule these things out.

In addition to the excellent suggestions above - it's possible to have a sort of in-between stage where a hired caregiver comes to the Assisted Living facility to encourage the resident to bathe, and change their clothes. I think that full nursing home care can be depressing to the elder, and can hopefully be put off. If she's at any risk though, of infection, etc, she may have to have the safety of total care. There are some good online resources to help you decide what's going on with her. I watch online training videos and have found them to be very helpful.

Minerva, Bathing may be something they could add on for an extra fee. The staff she already knows would be the best choice for bathing assistance. Making an appointment with her doctor would also be helpful to find out if she has any medical issues. Dementia is a possibility at her age so share your concerns and ask for her to be tested. Moving her to a new facility could possibly confuse her even more, exhaust all other possibilities first. She is fortunate to have a daughter who is concerned about her health. May God bless you.