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A relative has cognitive impairment. When we moved her to an assisted living facility a few years ago, we were assured she could remain in that apartment until the end of her life. Staff were aware of her cognitive issues at the point she moved in - the major problem being she finds it difficult to find the appropriate word, but she could make her needs known. We are now being encouraged to move her from the lovely assisted living apartment where she has all of her favorite items and furniture, to the dementia care unit at the same facility. In the dementia unit, one could have a few knickknacks & small dresser but there is a hospital-type bed in one room with private bath and small closet. We know there is high demand for the assisted living apartments at this facility. How does one determine that the move is in the best interests of the patient vs the facility. This relative is perfectly capable of dressing, bathing, and feeding herself. She walks the corridors, but otherwise watches tv or out the window in her room. With covid, none of the family or relatives have been able to spend any time with her in-person since March. Walking the hallways is her only outlet. We do know that moving her to the dementia care unit in the same facility (which she is very familiar with) will have a very major negative impact. If we didn't know about the high demand for the assisted living apartments, perhaps we would not have such a negative reaction to the suggestion. We know to the extent possible these days this woman is still able to function. Does any one have any experience with this issue, i.e., facility suggesting a move that you don't feel is necessary and which will have a very negative impact on the patient?

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My LO did fine when first placed in AL, but, quickly she became to need more assistance than the AL could offer. She was past the point of needing reminders and help with things. Her AL told me that she needed more care. I saw what they meant and moved her promptly. The difference was immediate. She did much better once in MC. It was as if she could finally relax, because she sensed the staff knew how to care for her. It's difficult for me to imagine them telling you she needs MC, if she didn't. You can ask questions and see what they contend are the reasons MC is needed, but, I'd keep an open mind. In MC there really is more one on one attention and direct supervision at all times.

When you say that the resident is perfectly able to bath, change, and feed herself, I get it. She may physically be able to do it, but, the thing with dementia is that she may forget to do it. Then, they remind her...then she goes into the bathroom to do it, but, forgets or gets distracted. So, they then try to help...then she may resist...she may insist she already bathed...but, she didn't. They get confused and really need so much more attention and direct care. My LO would get lost going on the way to the dining room and forget where she was going and never get there for a meal. They told me that when reminders are no longer sufficient and assistance become completely doing the task for them, it goes beyond the scope of AL.

Maybe, they can explain their recommendation.
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Reply to Sunnygirl1
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Ask the administration to outline the reasons they feel your mother needs to move to the dementia care unit. Compare their list with their qualifications for assisted living. That should help you make your decision.
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Reply to Taarna
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Since you haven’t been able to visit her, have you considered that perhaps months in isolation has caused her to decline considerably? I think you need to have a meeting with the facility so you can get the full picture here, they wouldn’t just suggest she needs MC for no reason. She had cognitive decline when she entered AL which wasn’t relayed to the facility. If she had it then, she ha a probably gotten worse. Especially being isolated.
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Reply to worriedinCali
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Sarah3 Oct 13, 2020
Right exactly, and the other aspect to this is that when one entrusts a loved one to an AL they observe them 24/7 and can speak more accurately to what a person in there needs. Unless the op has valid founded reasons to believe the AL is not trustworthy ( and if that’s the case why has she remained there all this time)
If you look at it this way, life is a series of changes and with the first change was huge having her placed out of her home into a facility. Now that she’s there they’ve assessed at this stage they’ve observed reasons she now is best suited for Mc. The only way to have full control of her lifestyle is to keep her at home, in a way it’s that simple, once a lo is placed in a facility they are responsible for her care- if they have reasons to believe she’s better suited for that it’s their responsibility to move her to the different unit to accommodate her needs. As some others have said at this age things don’t stay static for years or even months necessarily, they can suddenly decline or experience other changes
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My sister works in a facility with all levels of care. She says there have been a decline in all residents due to the isolation and banning of visitors. It is especially evident in the AL residents as they had been accustomed to much more autonomy.

My mother was in AL until March, then hospitalized for a week with pneumonia. We had her placed in rehab to recover and saw an immediate cognitive decline. On the advice of doctors she was placed in SNC and we thought that was the end.

Then last month the facility recommended we find her a place in Memory Care. They told us she needed more mental stimulation than they were able to offer.

So we had her moved to a new facility that does not isolate MC residents, doesn’t require them to wear mask, and has a policy of multiple daily activities for them. No TVs in resident rooms and everyone eats together. The goal is to keep them engaged and not sitting alone. This also has the benefit of tiring them out so they sleep better at night. A separate staff ensures their safety from Covid.

Within a week we saw an improvement in her alertness and physical well-being. It also helps that she was taken off numerous anti-anxiety drugs that were turning her into a zombie.

Yes, it is more expensive but they have a higher ratio of staff to residents, plus extra training.
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Reply to Frances73
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Dear "ArthurKenneth,"

Once again your question is a reminder that every facility has it's own way of thinking and dealing with residents.

My mom was diagnosed with Alzheimer's in 2014 at the age of 89. I moved her into an ALF into a very nice one-bedroom apartment with a separate living room, kitchen, bedroom and bathroom. I tried to salvage the nice pieces of furniture from the home I grew up in to make it as homey as I could so the transition might be easier on her since she didn't want to move. She was able to walk, dress herself and eat on her own. She started at the basic level 1 care. Her main problem was not being able to take medications on her own and the Alzheimer's aspect was more time-related i.e. when did I see her that day, when did she eat last etc.

After a couple of years, I saw a social worker from hospice (even though my mom wasn't on hospice at that time) and had her evaluated. She did the MMSE assessment and felt my mom could still remain in the AL area but, should be moved up to level 2 care. When I told the Administrator of the facility, she said "no" your mom doesn't need it. So I had the exact opposite occur in our situation.

If it were me, I know I would find it unsettling to think they would want to move my loved one out of the AL side into memory care if it weren't necessary just so they could give it to someone else. I would definitely want a doctor's opinion as to whether it would be in alignment with what the facility thinks. At this point, it really doesn't seem like she needs to be moved.

Currently, because my mom did nearly die of severe dehydration and COVID in April we moved her to a new facility into their memory care unit and she's now under hospice care. She scored 14 out of 30 on the MMSE which is her lowest score to date however, she is there because she can no longer walk, dress herself, has lost 30 pounds and isn't eating very much. I moved her into a much smaller one-bedroom apartment because she is now in a hospital bed and there was no need for a living room, separate bedroom etc.

I can say this, I'm so glad she is in memory care just because she is getting much better and more frequent care as well as the caregivers and director of the memory care unit are better equipped to handle someone with Alzheimer's and other forms of dementias. My mom's attitude is very good considering all she has been through and as she approaches 96 in February.

I hope you will have a medical professional assess her before moving her.

I wish all of you the best and may you get some clarity when you make a decision as to whether to move her or not.
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Reply to NobodyGetsIt
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One possibility is to have a meeting with the medical team and get more specific insight into their position that a move is appropriate, or necessary.   There may have been changes of which you aren't aware that occurred during the Covid isolation, but they should be prepared to give you more specific information.   Just telling you she needs to move doesn't provide any rationale.  

One issue I would discuss is the correlation, if any, between the change and the shutdown b/c of Covid.
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NobodyGetsIt Oct 12, 2020
Hi "GardenArtist,"

Once again, we're on the same page. I was thinking the same thing about talking to a doctor/medical team and have her evaluated to be sure it's absolutely necessary.
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Recently went through moving Mom from AL to Memory Care. We got her the biggest room available, so although its a studio, there was room for a small seating area, along with her desser, bed, side table and little bookcase. She still has the same reqular full size bed she had in AL.
It ended up being the best thing for her. In Assisted Living, it required more individual agency to socialize or find an activity. They have to mask and social distance outside apartment. They will not stop them if they want to walk out front door. Need to remember when meals were being served, choose a table, choose from lots of choices, and there were fewer aides in that area. Most residents were nice, but still some mean girls around that didnt like that she sometimes told conflicting stories.
Mom can still get herself dressed, and choose a meal, and have a conversation. But as her dementia increased, her sundowning increased, and she started pacing the halls long in the night, and being very anxious ( looking for her children or parents)
In Memory Care because of the cognitive issues , they dont require residents to mask, and there are only a few tables where they eat communally. In the times between meals, they can sit in rhe communal area, and participate in activities or not, but the activities come to them. The aides in that area also seem better versed in how to roll with whatever mindset mom is in that day
None of it is perfect. Covid has complicated everything. I wish I had been able to get her to move to AL a year sooner. She moved in a couple of weeks before things got bad here, so nothing there is what we expected when we made the move.
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Reply to Gracie61
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Don't see how an AL could make a serious promise that someone would be able to live there for the rest of their life. Suppose they became bedridden and needed a SNF?
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Reply to rovana
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Isthisrealyreal Oct 12, 2020
Rovana, I was told the same thing.

Unfortunately we don't know until we know what we don't know.
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Did the AL give you actual reasons and examples of incidents happening as reason for why they want to move her to the dementia care part of the facility? They have to document any and all incidents or changes for all their residents. Demand to see every article and record for your relative. Do you have any official paperwork outlining what the criteria is for a person to be in the assisted living part of the facility? They always give you a packet explaining the level of independence a person must have to qualify for AL. I worked in an assisted living. It is different from a nursing home. Their criteria for the residents was that they had to be able to walk independently (using a walker and cane was fine), they could not be diaper dependent, and they had to be able to do basic ADL's on their own like getting dressed, going to the bathroom, and coming to the dining room for meals. If a resident couldn't manage these things independently they had to go. My place managed and administered their meds, prepared the meals, did their laundry, and assisted with bathing a couple times a week if a resident needed the help. That was it. AL is different than a nursing home. Make the administration of the place your relative is in, show you in writing what their criteria is for a resident in their AL area of the facility, and then make them explain to you in what ways your relative no longer meets this criteria. Don't take no for an answer either. From what you're saying it sounds to me like they want her up in dementia care for one reason: $$$$$ they charge more for that. Your relative sounds like she still has enough independence not to be in need of all that much hands-on care. A resident like her is easy-peasy for them up in dementia care. She's bringing in the big bucks but doesn't require all that much care. Don't let them get away with this.
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Reply to BurntCaregiver
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Doctors don’t have the final say. Facilities will always find a way to get rid of a patient and some of you should know that by now since it’s allegedly happened to your LO multiple times 😉
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Reply to worriedinCali
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NeedHelpWithMom Oct 14, 2020
I feel the same. Why are people surprised at this? It’s nothing new.

As situations change, circumstances change. No one can prevent it.

No promises can be made to keep a patient if they decline. No doctor can delay it either.
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