Accidentally a dangerous ALF situation?

Very likely but that could be skilled nursing. That becomes the end of the road in terms of places for him to be. Generally AL facilities don't keep someone if they are past the stage for living there. Perhaps MC is the answer. I think you should give it a little more time. He could also fall or wander in SN but likely not far. SN is a sadder environment than AL. I would let the facility have a little time having him around to assess his daily life there.

Hey lost
ive had similar journey with my dad, and posted quite a bit recently….. he’s gone into respite and not settling and now has a UTI
im told the same thing, he needs time to settle and I’ve been advised it’s a couple of weeks (dads there for a month)
dad locked himself in his room on his first day, which I found hard to understand how it happened. but his carers are lovely and I’ve had good talks with them. Now he has to be in the lounge (he shd be isolating as it’s his first week but they can’t leave him) There have been teething probs and we are working them out. I went in yesterday and he had no water to drink, but he’d been left breakfast and tea even though he said no, it was there. He didn’t eat it but when he woke they got him tea and a banana so he ate something. They tell me they see this all the time, this is what we do.
give it a little more time. Easy said I know (I’m a bit of a worry mess) but try
he will find a little routine

Assisted living should be checking on him every two hours 7/24.
When he was in the hospital was he given opioid drugs for pain? If he was that will bring on dementia in an older person. My mom has severe dementia now and it really became bad after her hip surgery due to the pain killers they gave her. My mom fell twice in assisted living. The second fall was a broken hip and broken elbow. She went into memory care after that. She fell again in memory care and broker her other hip. Memory care will not prevent falls, but it’s more attention than assisted living and they will make sure he eats. In my case I feel it was a staffing issue in memory care at night why mom ended up falling. She did not go back to that memory care.

Your on the right track to get him in memory care. Look at many facilities. When you walk into memory care if it smells cross that one off your list. Ask about staffing day and night. Make sure the community offers free transportation to doctors.

It’s all very stressful isn’t it?

Assisted living facilities are well aware of the residents' frequent falls. They have the appropriate protocols for such cases. They are also well trained to spot UTI's and other common ailments. I understand your concerns. You should trust the facility and let them take care of your grandfather. Remember that they have many residents and that your grandfather is not the only one. Old people like your grandfather have very labile mental functions. Stress, accidents, injuries, surgeries and medications of any kind, can alter their mental status easily. Do not forget that the aging process is also unstoppable. Do not expect a full recovery. At the most, an amelioration of the devastating effects of aging is all you can hope for.

As my daughter, RN, says they will fall. She turned her back on a resident for a second and in that second the resident got up from his wheelchair and fell.

ALs are exactly what tge name says, they assist. They assist with ADLs. No skilled nursing unless brought in my the resident at the residents cost.

Your father is a resident. He is renting a room at the facility and paying a care fee to help him with medications and ADLs. In my Moms AL they would not let me supply bibs because it was a dignity thing. So Mom had food on her top most of the day. An alarm on a Wheelchair probably would not be allowed either. This is the residents home so the AL is limited in what they can do unlike Longterm care. If its in Dads care plan that he use a walker at all times, then the staff should be making sure he is using it. But even using a walker, falls will happen. MC is usually associated with an AL. IMO the only difference between a MC and AL is that it is a lockdown facility. The care is not any different. Neither are skilled nursing.

I do agree with you that Dad may need more than an AL can give him. But don't expect a lot if difference between an AL and MC. I took my Mom from an AL to a nice LTC. By that time, though, she was in her last stages of Dementia.

I think you should take a wait and see as well. If he needs the higher level of care I am "assuming" it is at the same facility? If so the facility would have utterly no reason to deny he needs it now. And likely they don't KNOW yet. This is a matter of assessing.
The reason I would ask you give it all the time you think you can safely give it is that MC is not nearly as nice for the elder as ALF is. It usually has roommate situation, a lot of people who may wander, a lot more acting out.
This is a situation that is progressing on a downward trajectory. I think you know that. But just wait a bit and see if it stablizes. It well may not. But I would give it that chance. Your Dad is in advanced age, and seems to have sustained a whole lot of trauma.
I think that the facility, which would make a whole lot more money by moving on to MC, may be right.
Now if MC means a move off this facility, there may be more reason for them to say "wait and see". Still they will have reports from their caregivers, and they will know if this is care they can handle or not.
As to the falls and forgetfulness? That would be a constant WHEREVER Dad is placed. He will still forget the walker; he will still fall, and there will never be enough staff to prevent that.
Hoping for the best for you both.

Lost,

My mom is in MC. She has a single room. In her MC, there are no shared rooms.

She is absolutely checked on frequently.

Unlike in AL, there is no access to anything remotely dangerous. For example, all of her toiletries are locked in a bathroom cabinet, and the caregivers unlock it when it is time for her shower.

I am pleased with the staff/resident ratio.

Since everything is built around a circle, she doesn't get lost.

I'm listing all of these things because they seem to me the MINIMUM that should be available in a MC.

If you're not happy with the answers you've been given, perhaps you WOULD want to make a facility change. You should be able to rest comfortably, knowing that your LO is WELL taken care of. If not, another facility might be the best thing.

I think of it like a parent changing schools for their child. :-)

Based on your comment "I don’t think they are supervising him anywhere close to what he needs. The night I wrote this, he went into three other residents room, peeing in one, and in the last removing a knife from their kitchen and trying to cut off his wander guard bracelet. He had also trashed his own room." your grandfather ABSOLUTELY needs Memory Care immediately! I also agree with your assessment about feeling slighted; like this ALF took him where they had room, knowing full well he REQUIRED MC but waited till they had an opening to consider the urgency! Disgusting.

Either get him segued into their MC or find another Memory Care ALF for him, whatever you feel would be best. But with his level of dementia at play, he definitely isn't safe in regular AL.

As far as falling goes, there's no way to prevent it no matter WHERE he lives, and that's the truth. My mother has lived in regular AL where she fell 40x and now in MC where she's fallen 55x. Every precaution has been taken to prevent it, but she continues to fall again & again for a variety of reasons. In AL, it was b/c she wouldn't use her walker or call to ask for help when she needed it. In MC, it's because she's not cognizant enough to realize she cannot walk, thinks she can, tries to get UP and boom, down she goes. She's never gotten very hurt as a result of any of these falls, which is truly a miracle. She has bed and chair alarms, now a bolster on her bed which she managed to climb OVER on Tues night to fall on the floor.....it's just never ending. It's nobody's 'fault' either; not like I can point a finger at the MC and say AHA, it's because of YOUR negligence that mom falls! That's not the case. It's bc of combined dementia and old age that she falls.

Wishing you the best of luck with all that's going on here. I'd give this AL a piece of my mind if I were you b/c what they've done is flat out WRONG!

Lots of great suggestions here. I would get access to his full medical chart including meds. If he is taking any type of pain meds or muscle relaxers, that could be the culprit. Certain meds can cause a change in cognition/behavior. Everyone blames UTIs, but I've found meds are the first place to look.

At 93, your grandfather is on the slippery slope to end of life – it’s just hard to tell how slippery and how far down he is now. He has had a good life, and a quick end is not such a bad idea. Solving one health problem after another is difficult, expensive, and often painful for all concerned.

Perhaps he will settle down where he is, perhaps not. Why not wait and see? And stop worrying so much? Death comes to us all, and the timing is not usually up to us.

Lost, when my mom finished rehab from a stroke, she was assessed by several places, as well as by her rehab as being "perfect" for AL. She had a diagnosis of the beginnings of mild vascular dementia.

We took her to a great AL. They tokd us they woukd check on her every 1/2 hour for the first day. They did. She fell in that first 1/2 and didn't push her alert button.

We moved her (at their advice) to the one open bed in Memory Care. She needed more than that, and we added a temporary 24/7 aide.

The 3rd night, my mom fell with 2 aides in the room (hers and the roommate's). She broke her hip.

Thus, she ended up in a Nursing Home. I don't think this scenario could have been avoided.

As the discharge planner said to me, "Barbara, MY mom fell with 3 RNs in the room, and one of them was me. Old people fall."

It does sound like he needs memory care. Will you need a doctor to sign off on the move? My mother was in memory care for several years (now in skilled nursing). At one point she was falling often. She wasn't hurting herself, but the facility was required to call EMS every time to evaluate whether she needed to go to the hospital. She hated being in the hospital (didn't understand what was happening and hated being bothered constantly for tests and medication and oxygen). We changed her medical directives to "no hospitalization" (except for extreme emergencies) and hospice (comfort) care. My mother was not able to learn to use a walker. Her dementia had progressed to the point where she forgot how to walk. To solve the falling problem, the facility puts her in a wheel chair when she has to go to the dining room or common area. Hospice recommended using a geri chair (a supportive lounger chair) if she needs to take a nap during the day. Medicare paid for a hospital bed that rises up and where the back and legs can be raised. She's in a continuous care facility where the social worker advises when or if she should move to a higher level of care, which they have in a separate unit. I just got the call last week that they felt she should move to skilled nursing. She wasn't assisting with the transfers from her bed to the wheel chair, and more equipment is needed for her care now, like a bed lift. All the best to you.

Great advice and experiences given here.
First things first -------- there is no way to prevent falls in the elderly in any facility. AL's are the first line of defense for the elderly but they only offer an "assist" with living. MCs have a higher staff to patient ratio and theoretically have more training in memory care and dementia but in reality, with the number of low wages workers, such as those that typically work in the health industry, calling out, those ratios may just be on paper on any given night. SNF's have a higher state fo patient ratio (once again on paper) but falls happen all the time. More care given because the residents must need help with at least 3 ADLs (in NJ) but that doesn't mean they are under "eyes" 24/7. In any facility if you need 24/7 eyes, you will have to pay extra for that service (and remember one person working a 8 hours shift will have to use the bathroom at least once. I swear that our residents would sleep lightly, wait until the caregiver went to the bathroom, so they could get out of bed by themselves and crash!)

Like a toddler going to daycare for the first time, you probably need to give it sometime but definitely let go of the "fall" thing. You will drive yourself and the staff crazy and they will still happen.

As mentioned you have to accept old people fall. Even if you paid for one to one care they may still fall. That is just the nature of it.

Imo do not push memory care unless it is absolutely necessary. MC should always be a last resort option, the fall risks will still be present but comes with other issues stemmed from potential isolation due to being a locked down floor or unit, plus potentially the less welcoming feeling of such floor.

He needs more care than the AL facility provides. If he's not orientated to time and place and thinks he's living a past part of his life, he has dementia.
If he doesn't have sense enough anymore to know to get himself a drink or to ask for one, he has dementia.
Your grandfather needs either placement in a memory care facility or 24 hour live-in caregivers.
The rehab and the AL facility may very well have a business deal with each other.
A resident in the AL your grandfather is in has a fall. They are sent to that particular rehab. An elderly person falls at home and gets sent to that rehab. Then the rehab refers that person to the AL your grandfather is in. These kinds of deals are more common than you think.
I worked at a beautiful AL years ago that had top ratings. They changed administration. The new administrator wanted every bed filled. They were allowing residents to stay who needed a higher level of care than what this facility could provide. It was unsafe and people got hurt.
Your grandfather needs a higher level of care than the AL he's in can provide.

Ask them for their diagnosis and placement decisions in writing. They are legally responsible. Discuss with a Elder Law Attorney and social worker for an alternate placement.

No, He is getting the appropriate amount of care. I am sure that the staff make sure he gets plenty to drink with meals and with medications.

Small vessel disease type dementia is similar to having a stroke. Areas of the brain do not receive as much blood flow as needed. Brain tissues will decline in the areas with less blood flow. The symptoms you are detailing are a result of his small vessel disease. It will get worse in time. For now, he needs to adjust to the routine and environment of the facility where he resides. Moving him will just necessitate learning another facility's routines and environment... not necessarily getting "better care".

Lost313: The entering other residents' rooms, urinating in one and pulling a knife from another's kitchen which you stated he did is indicative that he requires a Memory Care facility.

If it was me, I'd take their advice and give him some time to settle in. The more moves, the harder it is. When we had to move my mom to live close by us from the state she had lived in her whole life, she was a mess at first. She has her routine now and is doing fine even though she has to go through drawers, cabinets, and remarks often how glad she is that she is finally here (next month it will be 3 years since she moved.) There is a lot of strange behavior, she has taken some falls, but gets up, forgets about how it happened and lives on. I just think, whatever happens, happens; as long as she isn't hurting anyone else. I can't control everything and it's been a hard reality to accept that fact.

I would say let him settle in and get used to a "new routine" and see how he adjusts.
The staff at the facility will be a good guide as to knowing if and when he needs a higher level of care.
Not that this is going to put your mind at ease but.,.,.Falls happen. They happen at home, in Assisted Living, Memory Care and in Independent Living. Not all falls are serious, some are and some are fatal.
If after a while you think he would do better in a smaller contained unit then Memory Care would be an option.

Here is my story: Dementia 101. In year 2021 my mom moved from her home to REHAB two broken wrists, then to assisted living. Fell went to hospital with hip and elbow broke then to REHAB. We moved her into memory care same community. 20 days in memory care she broke her other hip and went into hospital for two weeks and we moved her to a new memory care. She is doing fine. Don’t worry about if they move it was such a big concern with my sisters and there are so many articles on this. Bla Bla Bla - What is important is that your loved one gets the best care and that includes moving them. If she is not getting taken care of properly than I will move her again.