AL facility is suggesting we move our relative to dementia care. We don't agree that it is necessary. Does anyone have experience with this?

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?

Has anyone asked what happened to the promise that she could stay there until she died?

I would get that answered before I agreed to anything.

Then I would have an independent needs assessment done and decide if I was going to continue to pay a facility that did a bait and switch or move her.

Listen to your gut, because these places will say anything to fill a bed.

I would speak to her doctor about it. Set up an appointment with her doctor to look at her recent behavior. Or to see if a different pattern of behavior is occurring with her.

Ask the staff for specific details for their opinion. You deserve answers to your questions.

I would also express any concerns about how you feel that a move to memory care may effect her negatively.

All the best.

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.

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.

I wonder if there was some confusion about being able to stay in her AL apartment, versus being able to stay in the facility until she passes? It sounds like they have multiple levels of care, as do many of the places here. Where dad was, they could move into higher levels of care as needed. Same with MIL, who moved nicely into MC from her AL room as she needed it. Yes they had a wait list for the Als , and several of MILs neighbors were moved when she was,, possibly up for concern, but really they all seemed to need it! Really MIL probably needed to be moved way sooner than she was,, she had to have a sitter all day long before the move.. which was expensive.

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.

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.

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.

Good insights from the other responders. I think the guarantee that she would never have to move from her AL apartment was contingent upon her cognitive or physical abilities to meet her ADLs never declining. If you haven't been able to be with her for several months due to the quarantining, much may have changed that you aren't aware of. I agree that you ask the facility to provide specifics about why they're making this recommendation, and if you still don't agree, get a second opinion.

"We know there is high demand for the assisted living apartments at this facility." If she's paying full price for the room then this isn't an incentive to move her since the room is at maximum monitization already. If she's getting govt assistance, then maybe. I wish you success in getting the clear answers you need to make the best decision for her.

A lot happens in few years with a person suffering from a Dementia. I don't understand why an AL would guarentee her being able to stay till she passed. ALs are limited in the type of care they can provide. They are not Skilled Nursing Facilities.

My first question would be does she need more help with her ADLs. What has changed to make them feel she needs more care in Memory Care. Which by the way is going to cost her more. I would tell them its hard to make that decision without seeing her. You could also take her out for a neurological eval. But may mean she will be quarentined. At Moms AL u kept your own doctor so I would not have made any decisions on the word of an RN. If there Is a doctor associated with the AL I would want to speak to him.

It does not sound like she needs to be moved to MC from what you are describing.
But .....
Have there been other incidents that you might be unaware of since you have not been able to see this person in a while? Has there been a decline that the staff sees that you might not be aware of? Is it possible that this person has tried to leave the AL facility while walking? If so did they actually get out?
If possible can you get another opinion, another person in to evaluate the cognition that this person has and if they are able to maintain a lifestyle in AL? I probably would not move them until an evaluation could be done. And is it possible to place cameras in her apartment so you can observe what he is doing so that you can have an idea what is going on?

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.

How much choice do you have in facilities? You are not describing a person who, in my brother's facility when he was living, would be asked to move. His ALF had cottages and there were a limited number of seniors in each cottage. The rooms were either one or two rooms, arranged around a core that included office, dining, communal living, bathroom and snack room. Seniors could wander halls all they wanted as long as they knew not to enter rooms belonging to others. There came a need for more safety and the facility made two of the cottages locked with greater number of staff, and these became not memory care, but safety from wandering and up level of care. If this facility isn't right now I would look around. Some Board and Care's are better, fewer people, often run by a family, and more homelike and cozy for some. Often less cost as well. I would contact some organization such as a Place For Mom were I you, and tour places available. You might also ask for a detailed list of reasons your relative is being asked to move in DETAIL. That is "Exactly what changes have you seen in the last two years that make you unable to accommodate her in her current living arrangement.
Wishing you good luck. These are, after all, a business. Things happen often sadly from that perspective,