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First tour of a memory care unit. One day I feel it's time to move mom into memory care and then the next I think maybe I can meet her needs better. She is getting harder and harder for me to handle physically. If she ends up on the floor I can not get her up by myself, have to call a neighbor. That doesn't happen often but I have had to call a neighbor on 2 occasions. And the memory care unit I toured was lovely but I'm not sure they can meet her needs. And I'm not sure I'm emotionally ready to let her go. I have several more memory care facilities to tour, I do not want to be rushed but I don't want to be caught in an emergency situation and not have a choice. I'm having trouble letting go and could use some sage advice. Thanks

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Thanks Sendme2 help...I believe you have offered encouragement to me before. She is needing more physical help than I can safely offered...the last time I had to get her back into bed I hurt my back and could not straighten up...mom said I must be very strong! I had tears in my eyes.....The place I have chosen is 15 miles away and I plan to visit often, keep my sitter a few days a week to also visit and home health has assured me they can offer her PT and speech therapy while she is there. I have a beautiful daughter that will also visit her. My sisters agree it's time to place her in memory care and when ever I have doubts about the move something happens that tells me it's time.....I truly believe God works in mysterious ways! (I'm not sure I'm suppose to mention God but I couldn't have gotten thru the first day without Him).
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Dear Oldestof3, Came by to offer a few words of encouragement, then read that you were looking for sage advice. That disqualifies me. Except, that I am absolutely sure you can give better care than the memory care unit. You just don't want to get hurt or risk hurting Mom.
So, remind yourself that you can still be there for her to pick up anything they won't be doing for her, and you will be there, like, loving her, visiting her, comforting her as only you could. Then, you can rest assured at night they will be there too. There is no shame when your loved one requires more care. You will have an entire team of helpers!
Pick a place close to you.
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Paradise76, thank you for your comments. I have read thru them several times and appreciate your input. I have visited several memory care units. I would have like to visit more but I only can do one a week and that doesn't get much progress. The one I have chosen has a smaller resident population and a better staff per resident ratio than any other facility I visited. And I've visited twice and each time the residents seems very happy and talkative. I'm hoping to have mom settled by the 2nd week of Dec. I know some of the posters here have been doing this for decades and so many seem to have relationship problems with either the parent or sibling and I am so lucky I have neither. Mom was not the perfect mother but then I wasn't the perfect daughter and she did her very best. My siblings live on opposite sides of the country but visit as often as they can and offer all the support they can so I do feel some guilt in putting mom somewhere besides my home but to be perfectly honest, I want my house back...I want my life back. I think mom will benefit from being around other people close to her age.. right now it's just her and me. She is in later stages of dementia and is getting very stubborn..if she doesn't want to do something she is NOT going to do it...and that includes a bath. If I get a sponge bath in once a week I feel I've accomplished something. I have rearranged my house, let my yard and garden go, quit going to church and lost my social contacts for taking care of her. I thank God he has sent her to me to love and care for as long as I could but I believe in my heart the time is right to do something else. If this move does not work out I will not hesitate to bring her back home. I can not believe what some of these posters put up with and I am so grateful mom has been pretty cooperative. I love her so but it's time to let go.
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I agree with what is being shared,but let me add some things you might not think about ...I'm a professional caregiver who has worked all shifts combinations of care...first in AL after which I went to private home care. Some Techs "do their job" just that, it's a job..a pay check...esp if the staff is young. I got extremely upset & eventually left the facility because my "ethics" we're so far off those of staff. In Memory Care, the overnight tends to overlook a lot of things that need to be done. Wanderers are watched but staff figures they will wear themselves out & go to sleep. I am making some general observations, because there are good facilities. My caregiving belief is that a loved one should stay at home as long as possible (medically able to stay at home)..it is safe & familiar. If you decide on "in home" care, you have the ability to know who will be providing the care, not just "Mary" works 3-11 today, but not sure what patients she will be with". Private CGs can appear wonderful & not be...if that is the case, you search for another...most times in Al & NH you don't have that luxury. Most everyone thinks home care is so much more expensive. If you work with an individual you have some leeway of price negotiation. You have the control of food..and the $ spent...you know their likes/ dislikes..institutional food (well, we all kno what that's like, plus most food trays are dropped off..not totally concerned whether the person can feed themselves), the kind of incontinence products used (facilities buy bulk in 4 sizes & whatever fits),and may not be changed as often esp. is high. Yes, you can take in what your loved one likes, but you'd do that at home too...still buying it on your own. Schedules for private caregivers can be adjusted to YOUR needs. When I work ...say..9 pm-9am..I don't sleep cuz things happen in an instant. In every situation "supervision for safety" should be the priority of the caregiver.
If you need total care, don't feel you've not done your responsibility...you just absolutely can not survive 24/7 care with other issues besides dementia going on.
Another example...we all are concerned with hydration. At home the caregiver can be 1-1 & makes sure something is drunk even if they fix a milkshake or something yummy. Water is distributed at the beginning of the "tech's" schedule, & not til the next shift change. Another example (I get so upset at times). I had a client (in a facility) with pretty severe Alzheimer's that I was "sitting" with to keep company, watch safety, etc...she was an aspiration risk so her liquids were to be thickened. Shift change...rounds of hydration...tech (GNA), brings in the shift cup of water totally unaware of the need to be thickened, and leaves room. I went to shift supervisor & she stumbled through papers to make sure what I said was right.(not the 1st time either staff member had worked with this lady). By the way..thickening agents can be bought in drug store & easily used at home in any type of liquid..yes including coffee &OJ.
Back to $...if you get a private CG at $15/hr during the day, with a little differential for nights & wkends. do the math & add what you would be paying extra for the things YOU know your loved one wants...it comes pretty close to 24/7 home care being financially close to NH/AL. Also in most cases you have more control on medication administration. You can set up the med boxes, give the instruction to CG to put the med in a little cup & set the cup in front of person...& watch the meds being swallowed...that is not dispensing meds w/o license. The caregiver watches, maybe puts it in hand, but you are filling boxes. This way, you can make sure the meds are not just kept in cheek til they are out of the administration line & spit into the closest plant (seen that happen,too)
Please forgive my soap box stand, I just want to see decisions made for the right reasons. If you have a family of more than one sibling, you can still make the decision together. I have been interviewed by 4-5 people at once AWAY FROM THE LOVED ONE. Once a decision is agreed upon, then take CG to meet your loved one, & you introduce person as a friend that will be spending time with you. I have a client with severe dementia (still mobile) that was told when I started she & I were going to have a dinner date on Wed nights..(while they left for a while)...no problems..no fussing about food, hands on care, or going to bed.
Anyway...if you are looking at facilities, go in with your eyes open, your nose open (you can tell a lot), don't be afraid to ask hard questions & get standard rehearsed answers. They are "selling" their facilities whether it be AL or NH. Ask the private CG (agency, dept of aging, or independent) those same questions. You even have the ability to do background checks, drug testing, professional & personal references. There are goods and bads everywhere. Explore all your options. You are not a bad person...you are providing the best for your loved one. If your loved one does not have or has very little dementia, try to get the decision made while your loved one can have some input, say stroke patient...keeps a little independence to their lives.
Really, I'm only offering tips...been a family caregiver at my house, one in AL & NH, and presently one with several clients with varying needs.
Thanks for listening. We all want the best for those who gave to us. Now it's our turn to give the best back. God bless all and good luck in your searches and decisions.
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You're expected to provide your own furniture?? I've never heard of this. If you live close to a major metropolitan city, you'll have more options for care homes/facilities. Google Agency of Aging or something like this; I forget what it is. And also review the food menu/choices for your mother. Some of the smaller facilities skimp out on the food as one measure to cut costs - for higher profits; "A lovely and filling afternoon snack is provided" is usually just peanut butter on crackers.
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thanks Careisgiving for your input. I hadn't thought to ask about moving mom from one home to another or about a male aide in this last facility I toured. Unfortunately, the only residential place I have visited is run by husband and wife team and he seems to do most of the care giving. Not right for mom.
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Until you decide what to do with your mother, ask her doctor to order a Hoyer Lift to be used in the home. It's covered by Medicare (the manual one and not the electric one, in the year I got it...don't know about now). If she falls again, you use this device to lift her off the floor and into the chair or bed. My mother is immobile so I have to use to Hoyer Lift as I don't have anyone else to help me out. It's not easy to let go but you shouldn't feel guilty, either. It's a difficult decision all around to make. Before you sign-on to a facility, read the fine print on what they require should you decide to move your mother to another facility. I'm not trying to scare you but I've read stories of some facilities giving family members a very hard time when they want to move their loved one to a different place. And find out who does the bathing of female residents and if they have have a man do it, are you okay with a man bathing your mother or at the very least you should be able to request a female to bathe yor mother. Several years ago, my mother temporarily stayed in a small group home while recovering from a hospital stay. After she was there for a few days, I went into the home as usual to see how my mother was doing and I heard her screaming. I rushed to her room, opened her door and found a man bathing her. The man wasn't hurting her but she was terrified of any man touching her. I didn't know at the time that a man would be bathing female residents because all I only saw the female caregivers. I was shocked. I was told he was there only to help the female caregivers bathe the residents; he would lift the naked female patients into the shower, clean them up and carry them back to either their chair or to their bed. If you have the opportunity, look into group homes that specialize in dementia patients. These homes are residential homes, usually, with 6 to 8 residents, sometime a little more or less depending on the size of the home. They're also, usually, much cheaper than a NH and the small family home environment is not so intimidating to your loved one. The group home my mother was in for that short stint had two caregivers to five residents at the time and their illness varied from advanced Parkinson's to Alzheimers. I believe some were Medicaid and some were private-pay. The home was run a registered nurse. If you can find a home run by a nurse, then this will give your mother more options for onsite medical and rehab care.
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Another tour of a facility. With each tour I think of more questions to ask. Was I the only one who didn't know we are expected to supply our own furniture? You'd think as much as this will cost us each month a bed and dresser would be provided. Anyway, it was almost a Ta-da moment. We're getting closer to finding a good place for mom.
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Thanks for the question - it hit a nerve in my mind. The counselor my mom sees says I should get mom on the waiting lists for the next steps...If they call with a placement we can always turn it down...she says mom is concerned about the next steps...and I understand that. Makes me feel that I failed or wasn't up to the task...but I realize that it is a task no one can do by his or herself.
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thanks for comments...mom is getting harder for me to handle...she sat down in the floor last week and I had to call my wonderful neighbor for help. Last night she refused to go to bed and insisted on staying on the couch and there was just no way I could leave her there and go to bed myself. Each day I get another sign it's time to try something different. I feel I've done my best but her disease is taking it out of my hands.
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Hi Oldest, thanks for the update. One of the places I had checked out was a private home type setting. It didn't meet my expectations or my Mom's needs. That is a benefit of checking out a variety of settings. Try to note your impressions as the places seem to jumble after you have seen a few. lol Good luck with the search, I know it can be exhausting.
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Oldestof3, going back to the original question of when and/or if it's appropriate for some type of living arrangement out of the home, and how to make that decision....you might list all the issues for which you think help is needed, such as the falling, assistance with getting up, etc. List the solutions you're using now, and any possible alternate solutions and whether they're workable.

When yourlist is full of issues with possible solutions that have been tried and either failed or aren't working, that's a good indication that the situation isn't one which is viable and it's time to look for alternatives.

That approach might provide a more helpful and analytical perspective on this difficult issue.
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oldestof3, I'm sure you are learning the value of doing some research before the need! You'll be much better prepared when you need to move forward. Good for you!
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For anyone keeping up with my hunt for a memory care facility for mom I toured another one today. Small private home setting with a youngish couple running it. Mom would be #8 in their care but the male seems to do most of the care giving. I just don't see him giving mom a bath or helping her to the potty. I certainly don't see her excepting his help. And it's just the two of them during the wk with one extra person on the week ends.Just waiting for that TA-DA moment when I walk thru the door of that perfect facility. I'll probably need one by the time I find that!
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oldestof3, I don't think your mother, as you describe her, would be a good candidate for Assisted Living. Memory Care may or may not offer sufficient services. Nursing Homes should be on your to-see list, I think. One of the questions you might ask any place you visit is how they determine whether a potential clinic would be a good fit.
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Babalou, I agree that state regulation is a big factor. Many statements on these boards do not apply in my state. At the memory care place I had my Mom, everyone was wheeled/walked to the dining room for breakfast then off to the activities room. If they prefered, they could sit in the group living rooms, but those who went back to bed (typically after a very rough night) had to have the door left open. An other issue, financially, is that (in my area) Assisted living runs $6000/month; memory care is $7500/month and skilled nursing is $13000/month. These are averages! Some more a few less. So for private pay clients that can be appropriately cared for in Assisted or memory care, there is a big financial consideration!
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Oldest, different states have different regulations for Assisted Living (which is a category that includes Memory Care) and Nursing Homes. Just as an example, if a client needs a Hoyer lift or is a two person assist, in New York State, those services are only available in a NH, while in neighboring Connecticut, they are done in AL.

You'd want to ask, in any facility, are the doors to the individual room kept open or shut. In the AL continuing care facility my mom was in briefly, in the regular AL section, door were shut. In the two memory care wings, they were always open, allowing staff to observe, poke their heads in if an assist was needed. I don't believe they'd put your mom in her room and not interact with her all day.
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jeannegibbs....I'm not really sure the difference between memory care and a nursing home other than the memory care unit cannot handle a feeding tube or port a cath situation. On my tour of the memory care unit I was shown a lovely room with large private bathroom and roll in shower and I remembered thinking....I'd like to spend a week here...ha....No, I remembered thinking this will not do for mom. You can't put her in a room by herself and shut the door. If I get a sponge bath in once a week I count it a successful week!
She is weak and we move by wheelchair around the house, that is I move her by w/c.I don't know if she could wheel herself or not. Our w/c is a transport one with small wheels.
She stays in a nightgown and robe because if I get her dressed she refuses to change into a nightgown come bedtime saying she will sleep in her clothes...sorry, over my dead body! I've made a lot of changes in my life since she's moved in and a lot of compromises but will not have her sleep in her clothes.
Your comment that the memory care unit has a better ratio of staff to residents scares me since this unit I toured had 2-3 techs to 35-36 clients. I'd hate to see less.
I have several facilities on my list to check out and a couple have memory care units and skilled nursing units and those I will check out next. I have an idea when she is evaluated by one of these facilities they will decide she is better suited for a nursing home.
I do believe mom is in the latter stages of dementia. She is sleeping a lot and has trouble using utensils to eat. She talks nonsense all the time now and has a lot of trouble finding the words for things....I get a lot of 'you know, what is it? what is her/his name?'
I need all the help and advice I can get to give her the best care I can and I'm not sure moving her is the answer. When she is anxious or aggravated and uncooperative I think it's time but then I look at that fragile face and think maybe I can hang it a little while longer.
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As for the number of aides, the place my Mom was at -- had 1 aide per 8 residents. In addition, there was housekeeping personnel, a person who dispensed meds, and a nurse for one shift and on call for the others. There was an activites staff too. The place had capacity for 60 residents. Some had full time personal aides in addition to being in the facility!! 12 or more clients, I agree is way too many.
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oldestof3, why are you considering Memory Care in particular? Generally (at least here) that is for persons with dementia who are wandering risks and/or whose behavior is disruptive and need additional attention for that.

My mother with dementia is in a Nursing Home. She is immobile and could never wander and her behavior is very pleasant and cooperative. My friend's mother with dementia has been in Assisted Living. She is reasonably independent, is no wandering risk, and doesn't need extra attention to her behavior. Neither of our mother's need memory care. In fact, being around mostly people who have behavior problems and need extra attention might be detrimental to their calm demeanor.

The Memory unit where my mother is has a better ratio of staff to resident than the NH part where she is. But each staff member has a lot more to do, too, so I don't think my mother would get more attention there. Mom needs to be dressed, helped with hygiene, helped with toileting, wheeled to activities, showered, and put to bed. That works out fine in the regular NH. If she resisted help, fought with the aides, was uncooperative, etc. then she would probably need the extra staff in the Memory unit.

If your mom needs Memory Care, so be it. Find a good one. I'm just pointing out that generally more than half the residents in ALF and NH also have dementia, and those places can handle the "typical" needs.
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oldstof3: Thanks for your response. I'll follow this conversation so please keep us informed of what you find out. Like you, I only want the best for my Mom. Regarding the "techs". I'd be really interested in the type of training they have. Here, they don't even have to be CNAs. Maybe some other folks who've done the Memory Care route could give us some insight.
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Nojoy3...I've only toured one memory care facility so far and like you I was concerned with only 2-3 techs for 35 clients. I did see quite of few of the clients on the tour and most of them looked like they wouldn't need a lot of assistance but I know my mother will need help with most everything she does, dressing, bathing, eating, etc. I was also disappointed that I didn't actually see any of the techs...only the 'key' personnel. On my next tour I will ask to meet some of the techs. I have many more facilities to check out and I hope to find one that has more techs per clients .I will check out the difference in rules and regulations for the different types of facilities, thanks for the heads up on that.
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I can't give you any advice because I'm somewhat in the same situation. I've been thinking that a memory care unit might be the best for my Mom but I have some concerns. I contacted the two memory care units in our area and I am really concerned about the staffing ratios especially on nights. At one place it was one staff person to 15 pts and at the other it was one staff person to 18 pts. What kind of staffing ratios do the facilities around you have? I have also discovered that in our state memory care and assisted living facilities are not required to follow the same rules and regulations that nursing homes are. What have you found out? Both facilities here look nice but I just have a hard time believing that one staff person can care for 15 - 18 dementia pts. Imagine you're the one staff person. You've got some of your pts up wandering around totally confused, some are acting out, some are bedridden and need to be turned and changed every 2 hours,
some are up but incontinent and need assist with toileting and they aren't all cooperative with the task and on and on it goes. Maybe I'm just overreacting but I know how there are times when Mom (who is an easy care dementia pt) tries my patience. I just can't imagine one person caring for 15-18 pts. It sounds like a perfect storm for pt abuse or neglect. What are your thoughts?
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geewiz...the 9th place,eh. I will keep you in mind as I hunt the right place for mom and not be discouraged. Thanks to everyone for your words of encouragement. It's a hard decision to make.
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Oldest of 3 --- I too was primary caregiver for my Mom and I am # 3 of 4! Trust me when I say that you will still have the opportunity to be VERY involved if you move your Mom to memory care. She will still need you and you will still need to be involved. My Mom was a wanderer so it became easier for me to accept that I could not be on duty 24/7. I was very lucky that my Mom accepted the move quite easily. Like you, I took my time looking at places asking questions and observing how things were handled. When I saw the place I chose (it was the 9th place I visited) it met my Mom's needs more than any of the others. Hubby and I looked at each other and said 'this is the right place'. Good luck with your search. It is better to have some ideas than to be taking what has an open bed. Good luck with it all.
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Respite car is an excellent way to transition to a care facility. Most places offer it on a monthly basis. It sounds like it's time to give it a try.
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I think what you are doing, and the way you are going about it shows how much you love your mom and have her best interest at heart... there is no good time....it doesn't mean you have failed her,or don't love her, or are getting rid of her... it means you are smart enough to know your limitations with her physical needs. We never really 'let our moms go' , even after they are gone....
You will be there, where ever you place her, to check on her, advocate for her needs, and make sure she is being well taken care of.... taking the time to check out facilities is a great idea.... There will be no 'perfect' one, nor will they ever, at their very best, take care of her the way you do.....but then sometimes it isn't about us.... it is what is best for our loved one.... am sending you hugs of comfort and courage to do what you feel is right... whether that be more in home care or placement... please come back and let us know how you are and we will support you thru your choices....
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fregflyer...I do have sitters for a few hrs 4 days a wk and I wonder if extending their hrs might be an answer tho they are not here at 4:30 am when mom managed to get between the bed rail and mattress and hang from the bed waist down. I'm wondering if a time or two in respite care might help me and mom transition to a move to memory care. Luckily, money is not a problem at this point. I think she could handle the move better than I could. She just asked me what name did I go by so I know she will not miss me.
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Oldestof3, you may never be ready emotionally to let Mom move to a higher level of care, but physically you know you are ready since you already need help in picking Mom up. Sadly the falls will start to increase, and your neighbor might not be able to assist each time you call, thus it will be the EMT's. And sadly your Mom's memory will keep fading. She will need help with everything, and before you know it, you are doing 3 full-time shifts of caregiving.

What about having professional caregivers come in to help with a couple of the shifts? Or wouldn't the budget work for that?

Choice is the big thing. My Mom had a serious fall and is now in long term care never to come back home.... her choice was a place that had an empty bed, we had no time to look around. Now my Dad wants to look at Assisted Living so that he can choose what place he would like, or to continue to live in their home with 24-hour caregivers.
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