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Most of the time, she's confused, but friendly and trying to be helpful. But when she's stressed (which can be triggered by anything that she perceives as attempting to control her) she has a very nasty aggressive side. In those moments, she's strong and quick, threatening to caregivers, and a danger to herself. She'll try to kick a door down, or throw things that break. I've been trying in-home care with the concept of kindness when possible - but she will no longer wait for timely meals/snacks or nap or sleep at standard times. She on a 3-4 hour wake, eat, sleep cycle - which means a single caregiver can't be available at times she needs being overseen. She has a trust fund (not unlimited resources, but adequate) but few relatives and none who are able to advocate for her. We've tried assisted living twice and been asked to move her, but the typical next stage lock-up type facility really doesn't fit. She is healthy, active, keeps her room tidy, goes for long walks and is a loner - so (having had her in my home for 9 months), I have a vision of a fantasy place that would work for her. It would have food available at any hour, have a secured outdoor space where she could wander around without supervision and otherwise provide basic room and board facilities. She doesn't participate in "group" activities - and when that is encouraged or required, it WILL produce the outburst. She doesn't want to work "with" anybody or within a structure designed to keep all the residents occupied - just needs room, board, extra food and drink (she eats everything in sight and is NOT overweight) and allows freedom to come and go (obviously in a larger contained space). Any ides how to find such a place?

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Has anyone investigated "supported housing"?
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Reply to Sendhelp
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I would focus more on what friend is like on her worst day, not her best, since, the worse days are when she really needs the care and she could suffer if it's not available.

A person with dementia, may be able to handle certain things at certain times, but, that doesn't mean that they are able to live independently. And, with her hair trigger temper, she could get herself into some legal trouble, if not in a protected environment. The staff at the facility where she is should have a healthy appreciation of what she's capable of and I would be surprised, if they haven't dealt with something similar many times. They should be able to say if her behavior is something they can accommodate or not. I'd continue to explore the medication with the staff's input and doctor's advice (a geriatric psychiatrist might be a good option, too), keeping in mind that as dementia progresses, her agitation and aggressive behavior may or may not change. I might also explore Memory Care now. There are facilities with all levels of care. I found that MC staff are far better equipped to manage agitation, outbursts, etc. than a regular AL.
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Reply to Sunnygirl1
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An AL is a residency. Friend is a resident paying a lot for living there. As a facility (they r overseen by the state) they are not allowed to force anyone to do anything. If she doesn't want to participate she doesn't have to. If she doesn't want to eat, she doesn't have to. Even if she has Dementia, the State says she has rights. If she says no, then the staff needs to walk away.

My Moms AL was made in a square. The Common area and the dining room were as you came into the facility. For those who could go out there was a nice porch to sit. For those who couldn't, there was a courtyard that only could be gotten to going thru the building. No outside outlets. My Mom used to walk around the inside all day. There were couches and chairs a long the hallway so you could sit. People stayed in their rooms others liked being in the common area. The activities director would go around knocking on doors to tell residents there was an activity. Maybe open a door to make sure the resident heard but no one was forced to do anything. Activities are for the residents that "want" to participate. I'd hate to think that I chose an AL that was on me all the time to do it "their" way. Yes some people do well with structure but others don't. She doesn't have to eat their time. Her meal could be delivered to room to eat when she wants. I was told at one AL they have a choice of eating a meal or sandwich and even taking the sandwich back to their room. Why can't they do that for friend. Then she can eat when she wants. Some save their desserts for later. Or stock her room with snacks, fruit etc.

ALs are just that. A place where a person gets assistance where needed. Yes, they have to be structured to a point to function but should realize that each resident is entitled to do what they want in their own time. Really, I am not a morning person. You are not going to get me up at 8am to dress and eat breakfast. Not really big on lunch (probably because I eat breakfast late) and dinner is usually small. So the only meal I would probably eat was dinner. I could have cold cereal and other things in my room. Moms had a kitchenette.
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Reply to JoAnn29
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the aggressive behavior might escalate given her erratic sleep pattern and some meds make it worse

since you are a friend, I assume you are not her POA or that she has signed a health care release so that you can speak to her doctor about her care ?
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Sassy75 Nov 11, 2018
I do have a POA for healthcare - and she is medicated at a relatively low dosage for anxiety. Her Dr has tried several drugs - but changing drugs takes time (going off one and on another) to avoid all sorts of reactions. Our problem is that she is smart and polite most of the time. When she has a meltdown, it's usually because something about what seems normal to the rest of us is very stressful for her. After living with her 24/7 for almost a year, I can't provide for all her waking needs - but she is totally capable of providing for herself IF we could find a safe environment where basic needs were met but otherwise she was free to wander about, rearrange her things, eat and sleep when she chose. It just doesn't fit the memory care model. And having even full time care (different shifts) is too confining for her. It's trying to make her fit a routine that is so stressful for her. I know these models of care are emerging - just need to find one in Central Texas.
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Awesome concept! I can see that this type of building would be great for a MC facility, especially for sometimes combative residents.
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Shangri La.
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Reply to shad250
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My father's MC uses a new single level rectangular building design where the rooms are along the long outside walls and the center is the common area containing guest bathrooms, glass walled visitation rooms, enclosed nursing station, open nursing desk, open kitchen, dining tables and chairs and couch/recliner/chair seating areas. One short end is the entrance to the wing and the other short end has a window wall that opens onto a covered porch and then a small garden area surrounded by a fence. Staff can see the call light indicators over the resident's doors from anywhere in the common area.

The kitchen is always open and an aid will fix a snack whenever he wants (this was a major factor in my choice cause Dad likes his snacks between every meal). Activities are scheduled and residents are encouraged to participate but not harassed if they decline. The center common room being just outside everyone's door seem to encourage people to participate or at least watch activities.

My father is also occasionally aggressive, often uncooperative and generally a loner, but he has settled into the MC very well.

The company building/running this type of AL/MC in our area only operates in TN. When they came to our town, they purchased farm land on the outskirts of town and built a single level AL wing with an "admin" building beside it. Three years later they added the MC wing where my father resides. They plan to add more wings in the future. Maybe there's a group using this concept in TX too?
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Sassy75 Nov 12, 2018
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Have you had her evaluated by a geriatric psychiatrist or behavioral neurologist? Meds might help tamp down her agitation.
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