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She is 87 and has a longterm care insurance policy; it will cover both facilities. She is incontinent and has had 2 uti's in the last year that make her unable to care for herself i.e. falling out of bed (never calls for help because she is unaware of it), hallucinations and delusions. She forgets to eat (or lies about doing it/lost 10lbs in last 2 months) and sleeps 15-20 hours per day. She may or may not remember to take her meds and complains we are pushing meds on her (she agreed on them except for the uti antibiotics). She cannot shower by herself nor initiate it and has taken to staying in her pjs/robe without putting on real clothes. She stopped going to the Council on Aging several days per week and church with us. She has trouble operating phones, tv remotes, Kindle or iPad anymore. She has a Bi-pap for obstructive and central sleep apnea and cannot put her mask on by herself and refuses to put it on unless it is true bedtime. She likely had strokes from prior to sleep apnea diagnosis which also contributed to the dementia. In May 2015 we built a home with her in mind because she felt it was time to sell her home and move in with us as I am her only child. We moved into our home in Nov 2015 and even though she had lived with us 10 months of 2013 and from Dec 2014 through to moving into the new house, she had a terrible time adjusting to the move and spiraled down until the dementia diagnosis in June 2016. She has recently asked to move into a facility which I am willing to go along with as she also has a good deal of narcissism which is getting worse and is miserable. I feel she just wants to get away from me and hubby because we know the real her. I have full POA which was set in 1994 long before the dementia started. She cannot manage her finances and was regularly being taken advantage of by companies she ordered from but never realized it. She has spent the years prior to living with us shopping and spending the money from selling my father's business after he died. She went through it almost and I hope she will not outlive her money. I don't think she is capable to live in assisted living without having to pay for all the extra care she would need to receive but feel that a nursing facility may be too restrictive as she is still somewhat mobile with a walker (rollator). I would love to hear from those of you in similar situations.

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A nursing home will definitely be able to meet all her needs, now and into the future (with a few exceptions.)

An ALF may be able to meet all her current needs, but as you note you may have to pay extra for some of the services. If her health declines she may need skilled nursing. An ALF may be able to deal with urinary incontinence, but if mom becomes double incontinent they may ask her to move to a higher level of care.

As her dementia progresses it may not be possible for either the NH or the ALF to meet all her needs. Choosing a facility with a memory care option might be a good idea. For example, most NHs and ALFs cannot safely deal with dementia residents who wander and who may leave the building unsupervised. Many do have a secure floor or wing that can keep these people safe.

Realize that the person showing you around is essentially a sales person. Probe a bit beyond their sales pitch if you can. I asked in one facility whether all the staff who come in contact with the residents speak English. Yes, I was told, that is a legal requirement. Do they speak it well enough to communicate with a confused person with some hearing impairment? For example, can you understand them? Well, no, she admitted sometimes she did not understand what they said.

If your salesperson assures you they can deal with delusions and hallucinations, ask how many residents currently have those behaviors, and how many staff members are trained to deal with them.

My mother lived with my sister for her "assisted living" period -- Sis and her husband provided the assistance. When Mom declined, we placed her in a nursing home. That worked very well for her. She started out with a walker but after a fall needed a wheelchair. There were lots of walkers, wheelchairs, and motorized wheelchairs there. After her fall Mom needed two people to help her transfer out of bed, to the toilet, etc. An ALF is not licensed to do two-person transfers.

There is a lot to consider.
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To me, it seems a Nursing Home might be better suited for her than an Assisted Living facility due to her daily care needs. But, that doesn't mean you should write off ALFs. I think your best option is to discuss her condition thoroughly with some local ALFs and get their opinion on if your mother is going to get the care she requires and then determine the total costs. Many ALFs do have nurses on sight 24/7 and do cater to the individual, and some already include this type of care in the standard cost of rent. So if an ALF will accept her and you can budget for it, I would always suggest an ALF over a Nursing Home. I believe she will feel much more independent and healthy in this type of environment while still being able to manage day-to-day.
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What I meant by restrictive was that a nursing home might be too restrictive for her capabilities but a ALF might be too loose for her ability. The assessment would be very helpful. I have her primary care and the neuropsychologist both saying they will give me whatever I need to admit her from their perspectives. Yes, for her to ask to go is amazing. Of course it will be told I made her go into a facility when the story is told.
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Well, that's a new one - a narcissist asking to move to ALF. Wonders will never cease!

What you want is a professional needs assessment, and I would have expected both ALFs and NHs to start with that anyway. So maybe the best thing to do is to shortlist some likely places, then ring them up and ask what they would advise.

A nursing facility ought to be perfectly capable of assisting your mother to use her rollator, by the way. I can't imagine that being totally immobile is a criterion for admission?
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