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After doing some searches here, I'm confused about something. Why do providers recommend "skilled nursing care" for patients that are fall risks, especially when memory care is concerned, when I'm seeing as dangerous a fall situation in care as at home? Does anyone have insight?


Skilled nursing care has been recommended for my mom, who is a fall risk, and has a memory span of about 15 seconds currently. Her long-term memory is better. I am struggling to figure out how someplace filled with people can give her 100% of the time eyes on care any better than I can and keep her from falling. She is beginning to need help dressing and bathing, and can toilet herself but isn't able to stand safely without falling.


I would like to keep her home — for her sake and my dad's — but can't move in with them yet. Local care providers have offered little by way of assistance and creative solutions. Any thoughts would be appreciated as to how others handled this, the nursing home situation, and keeping loved ones safe.

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My husband is in memory care now. Before that I was his sole caregiver, as I have been to 3 other family members.

"I am struggling to figure out how someplace filled with people can give her 100% of the time eyes on care any better than I can and keep her from falling."
At MC, there is a team of caregivers 24/7. They are trained professionals whose training includes working as a team and understanding the psychology of their residents. They have seen it all before, and their experience is evident every time I visit, which is almost every day, You cannot provide that. Also, when hospice gets involved, that's a whole 'nother group with eyes on. It's free and helpful. Also at my H's MC, other wives and grown children interact with him when I'm not there. They call an aide if he needs help, as I do for their loved ones, or they hand them their spoon if they seemed confused about what it is (it happens). Socially it is wonderful for all of our Hs. They have friends and look forward to being with their group, none of whom can really talk but they've developed their own sign language, which is amazing. They are not isolated in a home with an exhausted caregiver.

"She is beginning to need help dressing and bathing, and can toilet herself but isn't able to stand safely without falling."
This is the beginning of a long downward spiral. Today is probably the best day she will ever have again. Dressing and bathing don't seem difficult to you yet. Maybe you can dress her in less than a half hour? With my husband, it could take an hour and a half by the time he went to memory care. He'd insist on putting on clothes himself, backward, upside-down, or not wear clothes, or refuse help or scream or babble I know not what. He'd remove his clothes and put both legs in one leg of his shorts, then not understand how to get out and become hostile toward me for trying to help. Baths? He wouldn't step up over the sill or out. Try that with a dementia elder who screams because the water hurts (it doesn't, but that's their perception). No matter how much explaining (gotta keep clean, it's just warm water, you have to get out because I can't stand here any longer), they cannot understand because each time it's a new experience, and in their mind, they've never done it before. A shower could take an hour or more, or maybe only ten minutes if he'd immediately sit down in the shower chair and let me wash him. Toileting becomes a nightmare when they purposely pee anywhere several times a day even when wearing a Depends. Standing safely without falling won't improve now. The only way she can be kept from falling is to strap her in a wheelchair, but sometimes they can unfasten themselves, so you need an attendant beside her to refasten the buckle. And leg muscles atrophy, so once in a chair, walking skills are lost.

These are the harsh realities. I've spared you some of the worst. My husband is the sweetest, kindest and most gentle man on the planet. Nothing indicated that he would ever become how he is now, but dementia is destroying his brain cell by cell.

I cared for my parents at home with caregiver help. I strongly advise you not to do that to yourself! You have enough to learn and understand so you can advocate for mom. You need to be planning ahead rather than for today. Be mom's daughter and best friend, but don't take her into your home. I will never allow my own daughter to become my caregiver. Never.
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Reply to Fawnby
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My MIL was moved to an ALF a solid year after she really needed to be moved. She lived alone with the 'kids' (ages 75, 73 and 69) taking 24 hr shifts with her.

Even tho they were RIGHT THERE all the time, she still fell. All the time.

They had made that awful promise to her that they would never place her.

It was a horrible, horrible 14 months. Finally she was so bad that they really had no choice. When they placed her in a beautiful ALF, she thought she was home, and that she's BEEN in an ALF for the previous 15 months. Upon arriving at the ALF, she was re-dxed as being waaay worse than initially thought and we were planning to move her to the MC unit on site. She fell several times in the ALF, even though one of the kids was with her the entire time. Having people on site made it so when she fell, she immediately had help.

She died one week after she moved into the ALF.

The 'kids' learned a really valuable lesson, although it was far too late. She should have moved right from the hospital (there after a bad fall) to ALF. She never even knew she was home.

All 3 kids were burned out and emotionally drained. My DH has not been the same since that experience.

At one point, of course he thought he should bring her here, to our house. I was pretty firm about that: he brings her here and I move out. Period. He thought I was horrible and selfish, but I pointed out to him that neither of his sibs were offering to house her. Didn't matter, he's still mad at me for being such a princess. (Joke is that I am far from a 'princess'--)

Think long and hard before you make the committment to bring mom to your home. It can work, but I've been on this forum long enough to know it usually ends in misery.
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Reply to Midkid58
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I just skimmed your previous posts. You seemed to have set everything up for these two, and it all fell apart plus your marriage. Now you are thinking of moving them in with you and hopefully getting paid. You also mention in one post that your daughter is pushing you to care for these two toxic people.

I think at this point you have done enough and given up enough. Living with them will effect your sanity. Its time to place them permanently into Longterm nursing care. No AL or MC, straight to LTC. A one time move. Both seem to need 24/7 help and one person can't do that. You won't have a life. And your daughter, she has no idea what taking care of two elderly uncooperative people is like. You don't owe your parents your life or your health. I feel so bad that your marriage suffered.

Please get them placed. If you don't have POA then call in APS and ask for help. Do not take care of these two on your own.
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Reply to JoAnn29
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Birdee,

You stated, "My dad doesn't go anywhere all day, and is fully capable of taking her to the loo... he just doesn't want the responsibility."

Then why on earth would you want to leave your mum with a man who doesn't want to look after her?

Your previous posts have said about your parents not getting on and how difficult they are. Why would you want to go and live with them, giving up your own life in the process?

Your mum needs more help than you are equipped to provide. Skilled nursing care means that your mum's increasing health needs will be met. She's not going to improve or get better.

Please be sensible, for both your sake and hers.
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Reply to MiaMoor
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Whatever you do...don't move in with them, bad idea.

It is time for you to back off and get your mother placed, it takes an group to care for someone with your mother's issues, certainly not one person. You cannot keep her from falling nor can anyone else, she will continue to fall. The signals from the brain no longer work with a person who has dementia.

Start the process now, do what is best for all concerned not just your mother.
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Reply to MeDolly
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With my dad I learned the danger of picking him up after a fall. It was a risk to both of us for injury to attempt it. We routinely called the fire department and they kindly came each time, lifted him safely, and assessed for injury. Likewise NH workers are trained in how to safely lift for both themselves, usually using two people, and the fallen person, and assess for injury. Many well meaning family members have been hurt themselves doing the lifting, or inadvertently caused further damage to the person they’re picking up. The falls are inevitable in the home or NH, a sad reality of advanced age. There is no solution for the falls, just a few preventative measures such as keeping paths clear and lowering mattresses. It’s clearly your choice where to have mom live, and neither choice is without issues. Make sure dad isn’t overwhelmed and know her condition will continue its sad decline. I wish you all peace
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Reply to Daughterof1930
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You don't mention your parents ages. From your first post last March, you were having problems with your parents then. You were even talking about AL for both. Your profile says Dad has his own health problems. Maybe a SNF is being suggested because Dad is not able to care for Mom. You also mention them being toxic so a good reason for not moving in with them.

Your parents should probably both be in some level of care. Mom will fall no matter where she is. My Mom was placed in a wheelchair where the seat slanted backward making it hard for her to get out of the chair. There was an alarm so when she did try to get up, the aide heard the alarm. Mom had a special mattress and pads on the floor around her bed. The bed was taken down as far as it would go to the floor. All precautions were taken but even then, they will fall.
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Reply to JoAnn29
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Birdee,

I think you know what is the right for you to do. My parents lived in a two story house and my dad was blind. They lived across the country from me. They had no close relatives or neighbors. We tried in home care. It's hard to find and expensive. When caregivers cancel, who comes?
My dad finally fell and he went into the hospital. My mom had dementia. She would wander, ring the neighbors doorbell at night, she thought people were following her. It was a mess. When my dad went into the hospital, they asked could he be sent home. The answer was no. My mom could not care for him or herself.
They went into SNC. My mom needed 24/7 care. My dad did too. My mom never adjusted. My dad did. My mom passed last year. My dad is still going strong.
I think my dad was thankful that they found a new safe home. Yes it was an adjustment but it was needed.
Please just listen to the voice you already hear. It may not be perfect, but it is needed and you are not supposed to give up your life for theirs.
I so wish you the best. This is a great site. People care and they understand.
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Reply to Sadkid22
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Not speaking for everyone, but my wife became a fall risk at home, and she moved into a memory care unit. Guess what, she falls there just the same. Doctors told me to make her use her walker, but? does that mean 24/7 eyes on care? Falling seems to be a part of her memory problem. Apparently balance is impaired when they have other loss of memory issues. Actually, she is probably safer at home, as she can lean on furniture, walls, tables etc when she is moving about. Big problem at home is it can be very hard for a 92 year old man to get her back on her feet. Worse yet, she would go to the bathroom, fall somewhere along the way, and crawl up to my side of the bed and wake me. It was affecting my sleep to have to get up every time she did and make sure she did not get in trouble. One night, she was missing and I found her sitting behind the wheel in our car. Good thing she does not have keys. This was solved by installing a key only deadbolt lock. Memory care units do an excellent job keeping them safe. Hard to break out, no cleaners, pills, sharp utensils or tools laying around to mess with. When one of them does fall, they have the help to get them back up, and take appropriate care in case of any injury. It would help if they had thick carpeted floors, but that would be a major problem to keep clean. The bad news, this care costs us, all out of pocket, $6800 per month. I do not know of anyplace that will give help paying this. It is not covered under our normal medical insurance, or medicare.
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Fawnby Apr 26, 2025
Part of my husband's memory care monthly fee is covered by his long-term care insurance. Even so, the benefits will soon be tapped out.
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I have my wife in a very good memory care unit. They provide her with so much that she would not get at home. Her day starts with someone getting her up, properly dressed, and to breakfast. Between meals they have planned activities that entertain and/or stimulate their minds. There really is something scheduled from 8AM until 8PM each day. The problem comes with those who do not or will not participate in things. They play bingo, balloon toss games, coloring, crafts, music, karaoke, anything to keep them stimulated and active. In the last year I have seen very little loss of her mental faculties. Her verbal skills have declined and I suspect that is just not remembering the words she wants to say. Yes, she has fallen, as most of them do, but there was help on site to get her up and evaluate for any damage. They administer her medications, and at times she makes it difficult for them. I visit nearly every day, and she is with family two nights each week for dinner. Sundays she still goes to church with me, and she does love to sing. Our lives are not what I would wish for, but they are the best we can manage with what we still have left. Life is not the same when you are in your 90s, but it can still be enjoyable and productive. Worst case, we can at least be examples of how to deal with memory loss and all the related challenges. I promised to care for her "until death do us part" at our marriage, and I will keep my promise. Actually, maybe the extra challenges are keeping me young at 92. When God closes one door, he opens another so just bloom where you are planted and keep moving. Life is good, well as good as you make it. I plan to enjoy whatever I can as long as I can.
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Isthisrealyreal Apr 29, 2025
Amen!
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