My sister and I live several hundred miles away, but a brother live 5 miles away. Mom has lived in the same neighborhood with many or the same neighbors for 60 years. She is physically healthy, does stairs, and takes frequent walks and still does light yard work. She get meals on wheels, and has a neighbor look in on her almost daily for about on hour. Her short term memory is poor. She has lived alone for 17 years. She gets herself out of bed, makes her bed daily, dresses and bathes herself, gets her meals together, washes her dishes after each meal, takes out the garbage, keeps her house clean and organized, but seldom does laundry, has no incontinence, fills pill box weekly and manages her meds by herself with some occasional supervision. She lives in a rural neighborhood.

Some neighbors and relatives says she needs to move to "assisted living" because it is not safe for her to be alone. I believe if she is removed, her mental and physical condition will deteriorate. Although she is lonesome, she is not a social or particularly outgoing person and does not engage new people or old friends, though she is pleasant to all. Despite encouragement to do so, she seldom will turn on the TV or radio to combat loneliness. Her cognitive decline is evidenced by her inability to follow a TV story or read a novel or follow any process through progressive steps to complete a task, eg. following a recipe, prepare a letter/card and mail it. Her doctor suggests more supervision would be beneficial. Her children agree.

I am pursuing having a non-skilled home health aide come into the home for 4 hours per day - mostly for our peace of mind. I do not know what to require of this person , except to be a companion who can help her make sound decisions in everyday life. Mother is strongly opposed to this. And others say she must be taken out of the home - this alternative makes the 4 hour companion more suitable to her!

I am seeking criteria or some assessment that supports my desire to keep her in her home - or criteria that supports when the decision for her to leave her home is best for her.

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Txcamper, excellent insight. You've reminded me that I also need to regularly check with my father's neighbors, although generally they provide me with alerts and updates. It's good to have a network of supporters in a neighborhood.

I also learned from one neighbor that my father had fallen but he withheld this information from me.

"It takes a community to care for an elder" has a lot of truth to it.
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In addition to what all Garden Artist has written, I would interview the friends and neighbors who are helping her out to find out exactly to what extent they are helping. They might be doing more than you know. That was our situation. Once we moved mom out, the neighbors came to us telling us all kinds of stories where they had bailed her out or were taking care of business. We were under the assumption that things were more ok. The only reason we moved her out was she had a health issue and we had her stay with us for a while and then decided to make it permanent after a couple of months. We saw her for a couple of days every two weeks for years since dad passed, talked to her daily, took her to most doctors appts, I actually didn't like it when she said someone else was going with her because then I wasn't getting a feel for her health. She would just say everything's ok. This is just our experience, but I think it could be more common than what we think.
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1. You and those in your family closest to your mother know her better than those who have decided she needs to be in a facility.

I can't tell you how many people have told me that, and frankly, they don't know what they're talking about. These are not people who have daily interaction with my father - they might see him occasionally, or have no contact at all, or just know of him. Their judgment is not based on knowledge of strengths and weaknesses.

It's not a case of recommending what's best for my father as they really don't understand him; it's more of a reaction to what is becoming a norm for older people.

2. There is a concern because of your mother's dementia, but from your description, she can still manage well enough on her own. That likely will change, but there's no way you can tell when it will.

3. I would identify and list any aspects of her life that you think could endanger her safety, then evaluate those to determine if they would justify AL living. From your description, there are cognitive issues but they're comprehension issues, not safety issues.

For me, this would be the criteria for considering AL.

4. Would she leave doors or windows unlocked? Leave a stove on? Is she in danger of hurting herself any other way? Is there a security system on the house?

5. What I would do is get her a life alert pendant as well as a lock box. If anything does happen, the company that monitors the pendant can contact your brother as first responder and EMS as second responder, or vice versa. The lock box will contain a key with combination that can be changed; it's to allow police or EMS to get into the house if necessary.

6. I think the health aide is a good idea, but can understand that your mother doesn't want one, especially as a companion. This will probably be a delicate situation unless your mother can gain confidence in her and not feel as if her independence is being jeopardized.

Is there anyone you know, for example from her church, or your brother, who could assist the aide in becoming acclimated to your mother, or who could provide the companionship and support you seek? That might be a less threatening situation, in the sense that she won't feel as if she's being given and adult baby-sitter.

In many ways I would prefer that my father be in AL, but I know that he wouldn't last more than a few months because his independence would be so compromised and he would have nothing to live for. But he is fortunate to have very caring neighbors who enjoy taking him under their wings. Not everyone has that in their neighborhood.
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