Is assisted living considered 24/7 care? - AgingCare.com

Is assisted living considered 24/7 care?

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Boy I love this site. What would I do without all your help. I have another question. Mom has dementia, finally determined today as likely Lewy Body, vascular, and strong underlying clinical depression left untreated, an after effect of child abuse. It has taken 6 months to get to this point and get letters of incapacitation. Mom is a pleasant woman, intelligent, with hallucinations and mild to moderate cognitive impairment. She has wandered a few times. Otherwise she takes care of herself physically and her home as well. I have now moved her in with me against her wishes. I am her guardian. My plan was Assisted Living where she could have an apartment, but would have to wear an alarm bracelet or anklet. Today the doctor said Assisted Living wasn't enough care for mom. That it wasn't 24/7 care, and that mom was not ready for memory care. The doctor was adamant. So I am confused. The facility I had picked out is secure, alarmed and has 24/7 nurses and they know moms issues and claim she's a fit for them. The doctor suggested mom continue to live with me in my home/business. I have an apartment on the third floor, mom stays on the first floor apartment. They are small and we can't stay together. Twenty three steps separate us. There are 8 doors and 2 alarms. I can install more as suggested, but I don't see this as ideal. Why not assisted living??

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I think that your doctor is confused, which I find alarming. Either that or (as mentioned) you state has very different terminology for its care system than the rest of the country. I believe that he or she is thinking about adult day services (or adult daycare). That is more for respite and can be used for a few hours up to a full day. Assisted living is nearly always 24/7. People have their own apartment or room, depending on how upscale it is. They provide activities and social interaction. If it's a memory care unit in AL, it will be secured and should be staffed with specialized assistants.
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That does not make sense to me at all. He actually thinks a single individual can provide more uninterrupted care than a facility with a round-the-clock staff? You have to sleep too, and go out shopping, and work (apparently). Plus you're not even on the same floor as her most of the time. I really can't imagine what he's thinking.
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I don't understand where the doctor is coming from. In my state, a dementia patient who wanders is referred to a Secure facility. It's too risky to not do this, as non-secure facilities are not able to keep them safe. I'd think the doctor would be afraid of liability. Also, what doctor insists that a private individual provide care in their home? Very bizarre, imo. Caring for a person with those conditions is a full time, around the clock job. Maybe, others will have more ideas. I think I"d find a doctor who regularly treats patients who have dementia. How old is this doctor?

We had a family friend who had dementia and hallucinations. They frightened him to the point that he ran into the street, fell and broke his hip. He was not able to recover. So, hallucinations are a risks to the person's safety as well.

Also, monitoring devices are fine, but, they don't prevent the person from getting lost in the first place, walking out into traffic or getting hurt by strangers.  Do you feel that mom would be safe on a separate floor and that the alarms are foolproof?  
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Wouldn't the AL be doing their own assessment? If they have all the facts and feel that they can offer the level of care she needs then isn't that enough?
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What would the interim step be between AL and memory care? Did the doctor suggest anything?

You know though that you can ask other doctors as well as make your own decisions. What do YOU think?

I think I would interview other ALs just to see whether there's a consensus on what might be a best fit. I would think the staff at the facilities have a more practical, hands-on approach to what's necessary than a doctor, whose approach is more clinical and not as practical.

If they agree that AL would be a fit for your mother, go with the one you've chosen. It's your mother, your decision, with a doctor's recommendation if it meets your mother's needs, but not if it reflects an opinion not necessarily based on hands-on experience.

I've found that some doctors' first thought is "facility", whereas others are amused and admiring of my father's independence and insistence on staying in his own home. One even said "well, if you want to live to 100 and stay in your own home, this is what we'll do."

I think it depends on the doctor's approach and what he or she would do for a parent of his or hers.

And, of course, the doctor who thinks she should stay with you isn't doing any of the hands-on care!
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Let's look at this situation in a different light...here is my experience:

My Mom's primary care physician, who had seen her for decades before she went into memory care, was NEVER able to agree with me that she needed 24/7 care in a facility and out of our home (my husband and I took care of her for 5 years). That decision for him was easy...just words and then, the next patient! He did not have to wake up every night because mom was falling on her way to the bathroom. He did not have to repeatedly answer her questions and talk her down from anxiety and confusion. He did not have to clean up the carpet each time after she could not get to the bathroom on time. He did not have to give up work in order to care for her emergencies and confusion. He did not have the same personal experience.

One day, he even said that I should drive Mom everyday to her volunteer/day care work, instead of the two afternoons she was doing, as it made her happy. That did it for me! I could not believe my ears! HE did not have to take time off his work to do that.  THAT day, I realized that this doctor never looked at all the time and energy which I had already offered into her care. THAT day, I realized her doctor was not considering me at all, but was mostly worried about not being the responsible party who sent her to a place she may not joyfully want to be at. (Remember that doctors are human too and have their own issues.) THAT day, a veil lifted.  I made up my mind to resolve this issue on my own. I decided to accept making the lonely and the hard decision myself of placing mom in a home. I realized that had to be okay with that responsibility in my own heart, accept the future emotional consequences of it, and go directly to the facility to have her memory and care level appraised.

Well, she was diagnosed as mid-to-advanced level of Alzheimer and additionally had vascular dementia. Although she was not yet 'wondering' and was still physically vital, the facility's doctor assessed that she was ready to enter into memory care!

This situation made me realize that I had to risk making a very lonely decision on my own, moving beyond my own fear of placing mom away from home, from us, for her best care...a care which I could not provide anymore.

I wish you all the best!
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It depends on the state, but, in our state, AL's require a form (FL2) that is completed and signed by a doctor. It sets out the residents needs for care and medical conditions. There may be one that is required in your state.

Once the regular AL observed my LO attempt to wander. (She wheeled herself into the parking lot and tried to get into a stranger's car.) That was it. They were not able to keep her and she had to have a constant caretaker with her, until we had her moved to a secure facility. Most AL's don't have the staff to assign one person to watch one patient one on one around the clock. And the doctor said it wasn't safe for someone who wanders to not have the protection of a Secure facility.

Have you had anyone else evaluate her needs?
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Thank you all, good points and questions. This is our 7th doctor and the only one that wrote a letter of capacity for us and moved quickly to get is to this point. So for that I am thankful. All others just told mom to get her affairs in order, but mom would not. The doctor is young and a geriatric specialist and seemed on the ball. He does care for his parents and has a different cultural background than I do.
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He might not know what Assisted Living is.

Have you had an assessment done by the Area Agency on Aging in your area?

Or can the doctor suggest someone (covered by insurance) to do a professional assessment?
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All assisted living facilities are not created equal. They offer varying living arrangements from apartments to private/semi private rooms. Also, some are qualified to provide a higher level of care. I made a mistake when my mother went into AL. I thought a nice little apartment would be perfect. She fell which resulted in skilled nursing for several months. When she was ready to go back into AL, I realized a room was the perfect fit. She has her own bathroom, TV, sitting area and plenty of space for one person (and privately when she wants). The common areas provide activities and areas where residents can sit and visit. Some residents are in wheelchairs and those who aren't use walkers. There are two nurses and several aides on duty 24/7.
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