My mom has been in rehab unit since May due to pacemaker placement, then a fall in NH that resulted in hip fracture. Since that surgery, her dementia has gotten worse, some days are good but each day not sure how her mood will be. Today she was pleasant but tired, yesterday she was not happy & a bit nasty to all. A private room came open in the dementia/Alzheimer's unit & I'm not sure if she needs to be there yet. When I toured the unit, I felt it was a little depressing but they say there's more activities to keep them busy which mom does need. And she likes going to the activities. We prefer the SNF but we also prefer a private room which may be hard to get. Right now, there are none available. Our fear is she will get confused & depressed switching rooms,(totally different floor) and she's familiar with the SNF as she's now free to go to those areas. How do we make this decision which can have a big effect on her life?

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Mom got the pacemaker due to Afib & she occasionally has a bout of Afib but the pacemaker & meds put her in rhythm. She has a dual chamber pacemaker. She did have a CT scan, I believe after the first fall. Our visiting hours are the same since we go to PT with her, which is 10 or 11 am and then we stay the afternoon with her until dinner. 3 of us daughters take turns so only 1 of us is there. She was awake a lot at night and they started giving her Melatonin which has helped some but she seems more tired during the day now. She's always kinda anticipating what comes next. She'll say "Now what do I do?" or "Where do we go now?" "Do I stay here tonight?"
It's a very nice NH although, as with most, they need to have more CNA's, 2 for 16 in a rehab + 1 nurse just doesn't cut it when alarms are going off & most need assists. The dementia unit is about the same ratio. For now, we think she should stay in her rehab room for the remaining 29 days out of the 100. Then we'd like to see her in regular SN unit where there's more conversation & it's much more appealing. I'm afraid the dementia unit would be too drastic of a change.
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Another thing to watch out for is what time of day various folks are visiting. We were mystified for a while because my SIL would find mom weepy and anxious and I would find her unworried and happy (vague ALL the time, but emotionally very different).

With the help of the kind folks here, we figured out that SIL was visiting in the evening and I in the early afternoon on weekends; Mom was sundowning when SIL was visiting! Talked to geripsych; they adjusted her med schedule which helped enormously. Just a thought.
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As far as I remember, although the pacemaker procedure is technically under local they still may still have given your mother a sedative. I'm sorry she got whammied with all the side effects.

So 5-6 weeks... I don't know, ask her geriatrician if you rate him/her, but it could be she's got plenty of settling down still to do, maybe? But the fact that she's doing so much better now than she was in the immediate aftermath is promising.

Again only guessing, but, so, did they find A Fib so recommend a pacemaker? If her dementia is vascular, the pattern doesn't follow the good days/bad days of Alzheimers so much, it tends to go in plateaux and then steps down, without the day to day variations. So if your mother is *improving*, then the improvements are on something else that's been upsetting her brain (anaesthetic aftereffects, infection, general shocks to the system of major surgery). So that's good. Although she may still have had a series of step-downs during all these traumas so that her dementia is worse than it was, just not necessarily as bad as the other problems have been making it look.

Goodness wouldn't it be wonderful if someone could just give us a diagram! Did she have a CT scan of her head done at any point?
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Hi Countrymouse, thank you & others for responding. My mom lived alone at 92 as of May. She had some dementia, forgetting the daily skills, less conversation but she was doing okay with daily visits from family & home care. She fell, UTI-related, they kept her & she ended up needing a pacemaker. This was done under local anesthesia so we thought good, no delirium, etc. Wrong, she ended up with full hallucinations, didn't sleep for 4 days. She was in hospital for 12 days. She then spent 30 days in rehab, made great progress & then fell in rehab & fractured hip. Full anesthesia & & days in hospital, complete with hallucinations again & 3 days of no sleep. She returned to rehab July 4, slept 4 hrs there & was awake for 60+ hrs, complete with hallucinations & delirium. since then, her dementia is much worse than before fracture. She was making no progress in rehab until 1 month after surgery when family started attending every PT. She still often needs 2 assists for transfer, says she can't walk a lot in PT but then does 30 - 50 ft with walker but it's a struggle.
Her moods are different day to day, she forgets the routine there, where she is, sometimes our names. She asks if she lives there, does she have a house & where is it. Then some days, she's clearer & pleasant. She still has a sense of humor occasionally. She's been playing bingo & likes to watch baseball. Sometimes she'll say really far-fetched things which leads us to the Alzheimer's issues. She likes to be around people & 1 of us has been there everyday. But now 2 of us go back to teaching which will limit our time & we're afraid this will have an effect on her. I just don't want to see her in a unit that has more advanced & it's a bit more "institutional" than the area she is now.
Thank you for listening!
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Persoall I would opt for a private room any time. I have had more than my share of room mates from hel.
Last time i returned to the same hospital they had converted many doubles to singles and included a long couch caregivers could sleep on. It was hospital heaven if there is such a thing. Now if they could just do something about the food!
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Taking the private room while it's there is a plus; and as well as that it could avoid another move further down the line when your mother is less able to adjust. So I can see the attraction.

On the other hand, how long has your mother had to recover from her hip surgery? Don't forget that setbacks take longer to get over for frail elders. If you feel she's making gradual progress - even if it's two steps forward, one step back - and she's taking advantage of the greater freedom of movement in the SNF, it might be better to wait and see.

What sort of dementia, by the way?
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My 94 year old mom has been in a private pay memory care for about 18 months

Not all memory care is the same - I wish we could afford a private room

I would encourage you to try and spend a little time in the memory care to just sit and observe the other residents

Are they all wheelchair bound and passive or are they walking or acting aggressively

I once read someone post that they always regretted putting their mom who was still quite verbal in a memory care unit where no one could speak - she was lonely and isolated

No decision is easy, but don't feel rushed to make it until you know it is the right one
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We faced a similar choice after my mom had a stroke and then broke her hip in AL.

Mom went to a NH for rehab after the hip break ( she was diagnosed with vascular dementia after the stroke). We chose the rehab/nh based on the assumption that mom would be there as a permanent resident after rehab ended. There is also a memory care unit within the building.

We opted to keep mom in the nh section in a shared room. While she was in a private room during rehab, we elected to move her to a shared room when she became private pay to extend the time her money would last. We also felt she would be less isolated if there were someone else in the room ( mom has had some issues during hospitalizations with paranoia when she is alone in a room; having someone else there, even if she's not interacting seems to keep her tied to outer reality).

Overall, I think the NH side has been a good choice. There are activities, but mostly mom does not participate ( never was a "joiner"). I think the nursing staff does a better job of noticing her health changes ( she's had a couple of bouts of pneumonia, pleural effusions, heart issues) than non-medical staff in memory care might. The MC unit has many patients who are sort of floridly outgoing, not at all comfortable for my mom who is very quiet, reserved and private. It's just a better fit overall, even as her cognitive skills have declined.

If mom starts getting uncharacteristically nasty, make sure she is checked for a UTI. These can cause extreme behavioral symptoms in the elderly.

We've also found it useful to have a geriatric psychiatrist involved in mom's care. She was suffering from terrible anxiety after the stroke and meds have helped much.
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Does she wander? If so, she is going to need the secure environment of the memory unit. When she has a bad day, is she very disruptive to other residents and staff? Behavioral issues might be another reason to need memory care.

Other than that, she would probably do fine in SNF. About half (or more) of the residents generally do have dementia. Check out the activities offered by the SNF.

There is a higher staff to resident ratio in memory care, but since so many of those residents need more care, there really isn't a lot of extra staff time for those with less severe needs. A disadvantage of going into memory care in early stage dementia is that most of the residents may be far less social and able to interact, leaving those that are higher functioning somewhat isolated.

She will probably experience some confusion no matter where she moves, and she will adjust. I wouldn't let that drive the decision.

See if you can arrange to have a couple of meals with Mom, in both dining rooms. How does she seem to fit in? Go with her to activities in both sections. What seems appropriate to her ability level and interests?

I'm sure that the private room issue is going to loom very large as the baby boomers need care centers. They didn't grow up sharing a bedroom with three sisters or brothers. Sharing a room may be unacceptable to them. At some point this is going to have to be addressed, but not soon enough to help your mother!
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