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It's an awesome place. My 8 year old wants us to move there. But she doesn't feel she needs to leave home but we just can't afford 24/7 in-home care any more. The drive is over an hour from point a to point b.


She once attempted to physically assault another person, the driver, in her car when she was being taken to a Dr. she didn't want to go to.


What are some techniques that work on average? Should we lie to her about where we're going? I'd rather not lie . . .

I’m going to go in a totally different direction to your question..... I’d be very concerned that an AL is NOT where she needs to be.

Realistically to be ok for AL, it means they are good on their ADLs with minimal assistance and relatively good in their cognition and competency. Residents are expected to interact / play well with others. For residents in a AL for years, changes & declines in abilities are dealt with by staff as they’ve gotten to know & anticipate their needs. Your mom won’t have that latitude.

If your mom physically assaults others when things aren’t her way, she is NOT suitable for AL. Realize if she does this at the AL, it will be written up. It becomes a part of her medical chart & she’s probably going to be required to get a geriatric psychiatric evaluation with medication management before any facility will take her on as a resident. Often it’s a MC locked ward that can deal with this type of behavior. Some MC have ankle / wrist monitors for flight risk residents.

Also realize that IF mom wants to leave the AL and calls a cab, Uber, walks out on her own, there is nothing the AL can do. AL cannot force her to stay there.

You mentioned that the AL “looked at your strangely” when you asked about getting mom there via secured transport...... it’s cause this is way way way beyond the norm for AL residents. An new resident who has to be sedated and moved in against their will is not suitable for AL. That’s locked Ward residential.

If you are thinking / hoping that AL will be able to manage & subdue her behavior...... not gonna happen. Expecting an AL to do this imo is a crisis in the making. AL are not set up to deal with residents that need psych oversight. I’d suggest you look at getting a needs assessment done BEFORE moving her into any facility. The SW dept at a larger hospital will have names of RNs that do this.

also please realize that if you move mom to AL and she’s determined to be beyond their capabilities like at Day 3, she will need to leave - whether it’s you pick her up or she’s sent to ER - but she will still be responsible to pay for whatever days left on her contract. Could be 30 days $$ or 60 days$$$ or till the bed is filled by a new resident.
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cwillie Aug 20, 2018
A local AL recently had a man leave the building and unfortunately he was hit by a slow moving train. The staff had checked security cameras when they noticed him missing and called police - they were not considered responsible because there was never any guarantee that it was a secure unit. The flabbergasting part is that the family wants him to return there after he recovers from his injuries - some people are really in denial!
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"Dementia-like symptoms"?

Has she had a workup to rule out treatable illnesses?

Has she been to a geriatric psychiatrist to trial meds to treat her agitation?

Has she been evaluated for her suitability for this facility?

You need to engage medical transport for this trip and you may need some sedating meds. You probably also need to get used to "therapeutic fibs" like " the doctor says you need to stay here until youre stronger ".

Is the facility a secure one?
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Clesner, you need to make sure that your mom will not be able to leave this facility. You say “there may be a step between assisted living and memory care” , but you need to find out for sure. My mom had to wear an ankle bracelet when she tried to leave her skilled nursing facility and their doors all had buzzers and codes. After she cut off the second bracelet, we decided to move her to lockdown. Another reason she had to go to that unit was her penchant for slapping or clawing at people she didn’t like.

If Mom is showing these signs as well, you may need to do a rethink of her placement.

Also, for the transport, you need to do your own research. Google “Medical transport for people with dementia” in your area. When I asked st the facility for transport for my mom, I got the same blank look.
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If she's violent, I'm not sure that I would take that risk. I might consult with an attorney or law enforcement about the options.

Would she voluntarily go with you to lunch? Some people do take their loved one to lunch at the AL facility, and then have them stay, but, if she's opposed to it, she could just leave the facility on her own accord. Unless, it's a secure facility, with proper doctor's orders, the facility would not likely be able to keep her from leaving. Is she physically able to walk out? Would she be able to call a cab or other person to pick her up?

If she's suffering from mental distress, I'd discuss it with her doctor to see if she may benefit from medication or some other type of treatment.
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clesner Aug 20, 2018
Thanks. Yes, we're concerned about her leaving on her own from the facility, but there may be a step between assisted living and memory care that would not allow her to leave without "checking out."

But we're also working with her Dr. about one-time meds for the trip, etc. I was asking if the facility she's going to could recommend a EMS-type transport because I assume my situation is not unique and someone has found a way to meet the demand. But they looked at me strangely when I asked if they had a service they've used or could recommend.

One of the issues is that she lives 100 miles away from the facility so it's a relatively long trip.
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When you decide where your aunt should go, it’s not engraved in stone. My mom started out in Skilled Nursing on their “regular floor”, but after about 18 months, we decided to move her to Memory Care when she started to wander. Because your aunt has so many medical issues, she probably should be in skilled nursing where they can monitor her health.

Good luck with your decision. I know how overwhelming it is. I’ve done it three times and it never gets easier. Hang in there!
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I just read your newest post - ALs are designed to offer assistance to people who can not quite manage on their own, offering assistance with meals, housekeeping, medication management and bathing -someone requesting medical transport would be outside the norm for their residents. If you are concerned she may wander then you need to get reassurance from the Admin (in writing) that they can handle that, and that means a locked unit because staff are not going to be able keep running after her.

You can probably find patient transfer services in your yellow pages but it is expensive and they are not equipped to handle someone out of control.
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Talk to the doctor about meds to help anxiety, you might want to experiment with them a few times before the trip because sometimes they have the opposite effect to the one intended. Promise whatever it takes to get her into the car ( shopping? restaurant?), put her in the back seat away from the driver, with someone to mind her just in case. There is no reason you can't follow through with the shopping trip (or whatever) before you stop at the AL.

Sunny brings up a good point - Is this a secure facility and have you disclosed her "dementia-like symptoms"? Staffing levels at ALs, especially on evenings, weekends or holidays, are not normally sufficient to ensure that anyone determined to leave does not do so.
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Thanks everyone. As with most things surrounding my Aunt's condition, there are no single right answers. My Dad and I met with an AL facility today and I was able to focus more questions on the issue of her attempting to leave and we then got a little heavier into the pre-admitance evaluation of whether or not memory care would be better.

The problem is she has significant COPD and the consistent lack of oxygen (and plethora of CO2) has done a number on her mind. She's not all there, but definitely not completely gone when it comes to certain things. It depends on the day. She's getting over a UTI which really caused some issues the past few weeks too.

Ultimately her exact conditions vary so greatly from day to day, week to week, we're trying to find the most common denominator of behavior to narrow down what type of facility would be best.

What we do know is we can no longer afford 24/7 in-home care and no one in the family is emotionally or professionally equipped to care for her on a regular

All your answers are very helpful. My Dad and I don't know what we don't know so it's been a very frustrating and steep learning curve. Thanks!
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And just when you think you have it figured out, bam, something completely new.

You are doing all of the right steps. Keep up the good work, it will get sorted out and be okay.

Hugs!
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Reply to Isthisrealyreal
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Make sure that you consider NH level care; many nursing homes have separate memory care units.
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