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From everthing I've read, it seems like vascular dementia, after a stroke, is the most likely dx. Mom is 90, was most recently living in IL but had a stroke July 1, is now in subacute rehab. She is increaingly suspicious, a bit paranoid and not reasoning from facts. The AL facility does not accept patients with dementia, what are the choices/options here ? She's got enough funds for 10 years in al but only 3 or 4 in a skilled nursing facility.

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If the facility does not take dementia patients, there are many that do in what is commonly called memory care. Memory care is slightly more costly that AL, but you must remember there are facilities that are not appropriate for someone with dementia. Their likelihood of wandering alone presents many dangers to them.
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Speak with the social worker at the rehab facility about where she could move. Not the admissions office but the social worker.

Also what are her medications like? She may not yet be on the better dementia meds as still recovering from a stroke. If she can be moved, I'd take her to a gerontologist for a full evaluation to see what probably type of dementia and where she is on the scale for it.

How is she doing in rehab? In order to stay in rehab and have it paid by Medicare, they need to be "progressing" in their care. So if they are there from hip surgery, they have to be getting up and increasing in their PT time and walking on their own time. Most elderly don't do the "progressing" needed in order to stay in rehab. Ask the floor nurse to connect you with her therapists to see what she is like for rehab. continuing for her. Medicare seems to do the first 21 days in rehab always, then another 7 days maybe but rarely the full 100 days that Medicare rehab can go.

Since she still has the funds to private pay, you all will have lots more options on where she can move into. But I would look into a facility that takes Medicaid with limited # of Medicaid beds. Most facilities that are somewhat nicer often structure Medicaid beds to be "self-selected" from their existing residents. So if you are there on private pay for 2 or 3 years, then you go on the list for the next available Medicaid bed. Evenutally your name comes to the top of the list. Understand? This way she can stay in the same place, although once on Medicaid she will need to share a room but being there a couple of years she may buddy-up with a resident so they want to become room-mates.

Oh make sure you have all her legal updated and her funeral planned. Most facilities will require that you have the funeral planned and in her chart & also many now require an advance directive done and also in her chart.
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Vascular dementia or a stroke can cause depression depending on which side th damage is to her brain. It may be wise to have her evaluated and treated for that before anything else. A qualified geriatric psychiatrist should be able to help.
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In a few instances, some financial services providers, such as banks, have required a letter from my Mom's doctor, stating that she is not mentally able to conduct her own financial affairs, in order for me to act on her behalf, even though I have the POA documents. I also had to provide this doctor's letter, along with the POA documents, to the title company when I sold her house.
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Mom is taking xanax twice a day and celexa at night per MD. It has made her much happier, and now she is recalling the good old days and laughing.
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Ladee, thanks for the response. I did it out of love, but our lives were so close after 56 years of marriage. I am sure that in reality, it is harder on me than her. It is hard not to feel that she feels punished rather than loved. She is probably the youngest resident at 73 years of age and the most coherent. She has all the major handicaps of Alzheimer's, yet she is very conversant in a conversation.
I will try to give feed back from time to time.
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The benefit of getting a diagnosis for dementia is for planning for the future since it will progress and getting medications that can help slow it down, help with paranoia and sundowning. Unless your mother needs skilled nursing, a memory care unit would be your best choice. My mom was in AL for a short time until a room was available in their memory care unit. There is little difference in the monthly fee with memory care being a little less. This will vary from community to community depending on the level of care your mother needs. My mom is very mobile, can dress herself, toilet herself, feed herself, she needs help with meds, safety, eating regular meals, and reminders to bathe. She cannot make decisions, it causes her too much confusion and anxiety.
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Just out of curiosity, has anyone else noticed that the post above mine by fbcatp has been posted on more than one thread?
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You do not say where you live. Can you have her at your home? Getting a correct diagnosis, instead of just assuming you know unless you are a neurologist, will benefit how Medicare/other insurance will pay for treatment. At 90 yrs. old with a previous stroke might render her life expectations limited, and if she has enough money, speak with agencies who handle patients with dementia (after you get her diagnosed) if that will be your choice of a place for her to live.
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Thanks to all for your feedback. Mom is in Connectcut, near one of my brothers. I'm in nyc, I'm a psychologist and the designated "point person" on the medical stuff. I'm told that there is a state reg in Ct that doesn't allow pts into AL who need their meds crushed, which at this point, she does. Is a memory care unit for someone with a mild cog impairment subject to different regs than pkain vanilla al?
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