Mom's problem solving abilities are next to nothing, but also can put her in danger. Is she ready for AL? - AgingCare.com

Mom's problem solving abilities are next to nothing, but also can put her in danger. Is she ready for AL?

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She has never been very sensible, but in the past few years her diminished reasoning processes can put her in financial trouble, physical danger or pain, etc. She can no longer figure out the appropriate way to do a task, but because she's always had a lackadaisical approach, she thinks she's doing just fine, and often won't tell me if there's been a mishap. She now lacks good balance, strength and flexibility as well, and has fallen repeatedly because she tries to do things by herself that she should seek assistance for. I can be with her only once a week, and feel that she needs more care. There are no other available family members to help her. Need advice on making this move to AL a positive for her!

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Most older people (and many younger ones!) don't like change, so moving to AL could be something that she'd fight at first. However, in my experience, when there are good facilities available the people moving into AL start feeling safe quite soon after the move which is huge. Then, little by little they will start socializing. This can make a huge difference.

Everyone is different and not every community has good choices for AL. However, I do think that your mom needs something, so AL would be a good option. If that won't work, in-home care may.

Please keep us updated on how you get on with making this decision. Support on Agingcare should help.
Carol
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Common sense would tell you it is time for some type of continuing care... be it with caregivers coming to the home, or Mom moving elsewhere. It's a tough decision.

Ask Mom if she would enjoy being around people closer to her age, all the things they could talk about.... and what about not worrying what to eat for lunch or dinner... so many of us are so darn tired of planning weekly menus... plus dinning in a central location with new friends. And having fun things to do in the afternoons. Someone on these forums use to joke with her Mom it is like being on a cruise ship :)

Let us know how it works out.
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Hi - she is telling you about enough mishaps if you know about the falling, so that's good. To me, your visits once/week are plenty for a caring relative, non-professionals caregiver, and also I agree that's not enough for her. Once there's been more than one fall it seems she has entered a new phase. One option is to first have a caregiver making several visits a week and advising her on how to manage her home and behavior appropriately to her capabilities, and see if she works well with that? Best to you.
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One of your comments "her diminished reasoning processes can put her in financial trouble, physical danger or pain" to me means she is not safe alone in her own home. That along with lack of processing information and repeated falls is a signal something must be done. Her doctor or a geriatric nurse practitioner might also be able to give you support in convincing her to move. Having a caregiver come to the home will not, in my opinion be enough based on what you list in your post. The other thing you do not mention is whether someone is her POA and can handle her finances for her. If not, please consider getting this document as well as a health care POA. She will thrive and live much better elsewhere in a good ALF, but the battle is getting her to accept that. I agree with the other's suggestions.
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I have both financial and medical POA for my mother who is 86 and is in mid stage alzheimers. She refuses to move to AL or anywhere for that matter (for example, move in with me). Unless she is considered incompetent, which she wouldnt be since she is still able to feed and bathe herself, my POA's are useless to force her to move. She could reasonably revoke my POA if I try to force her. So while AL would be the best place for her as her memory is completely gone and confusion is setting in, I have no power to do so without spending a lot of money and taking her to court to obtain guardianship...which could backfire. The issue is really would your mother agree to move.
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I'd like to suggest that you do a few steps back in all this…..that you get your elder evaluated for which type of facility placement - AL, NH, or even if locked-unit AL /NH - is needed. It could be that they cannot do what is expected for AL in your area and that skilled nursing level of care is needed. Really you don't want to go through the whole move to AL and then get 30 or 60 days later a "30 day notice" from the facility that although they just love, love, your parent….they need to move and within 30 days as the facility cannot provide the level of care required. The vast majority of AL are all private pay and with a contract done, if they need to move to higher level of care, you could find yourself saddled with having to pay out the remainder of the contract or till that space is filled. Not pretty.

What I've found in this whole maze of elder care and Medicaid / Medicare is that so often we all are totally unrealistic on what the situation is for both our parents ability and what we expect a facility to do AND the staggering costs of care. AL expects them to be able to do their ADL's with minimal hand-on or 1-on-1 aides; the staffing at AL just cannot have residents who need higher levels of care. Medication management is a usual AL function but having to have staff present to always transfer of the resident from bed to bathroom / wheelchair / chair is not. I'd suggest your schedule a visit to the 2 or 3 AL you are thinking about moving them to and spend enough time there by going to a activity program and having lunch there…..then think carefully as to whether your elder can do what the residents of the AL are doing on their own. Speak clearly with the AL as to what your parent can & cannot do (or will not do). Make yourself notes. If they can't do what this AL fully expects of residents, then you need a NH or a specialized care AL. You could be lucky in that the AL will accept them BUT you will need to pay for extra aides to do the accommodations needed to enable them to live in the AL. This won't be cheap either as whomever will need to be placed by the AL to do that (and not someone you can get to work at your home) and the costs between the monthly AL fixed costs & the extra aides could be the same amount of what a NH costs (5K - 15K a mo).

If it seems they need a NH, then you will need to have orders written from their MD as to "skilled nursing care required". For those coming from living at their home, IL
or with family, there may not be the fat medical file that shows this need. Most NH admits are "incident based" - the classic is they fall / break a hip/ hospitalized / released to rehab at a NH/ end up staying at NH after rehab ends. That nice fat medical file showing "need" is there. If not, then you have to do whatever to get this done. I moved my mom from her home of 50+ years to IL; then after a couple of years from IL to NH and totally bypassed the whole AL stage; and it involved mom going to a gerontologist that also was the medical director of a NH to document need that would pass the required Medicaid review for medical skilled care needed.

Now if your elder has oodles of $$ & all this is private pay, then all this is not quite as difficult. But if they are going to need Medicaid to pay, it will be. Good luck.
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Establishing declining thresholds...and the actions to take based on reaching each threshold for the cognitive decline of a loved one can be very difficult. No one caregiver can do it alone. One of the main tasks for the novice caregiver (as if we don't have enough) is to gather more help and advice from others. To get the buy- in on other members of the "team" and assign tasks to members of the team. ~Here's what worked for me...as I was slowly thinking I could do it all at first...as I was slowly taking on more and sacrificing more with the continual decline of my care receiver...the slowly lowering of myself into the boiling pot of water like a frog so-to-speak.
1) Contact the primary care doctor and ask for a referral to a nurse specializing in geriatrics. Upon contact, setup an in home visit where the nurse will likely give your care receiver a mini-mental test/evaluation of her and the living situation.
2) Contact your care receivers primary health insurance company and request the same. They will likely send out a nurse to your home to give a mini-mental test/evaluation of her living situation.
3) Contact the dept. of aging center in your area and request contacts for persons who can come and talk to your care receiver, you and the rest of family members and friends involved in the care receivers care. Couslers on your team will be valuable for communicating to your care receivers and other members of the team who feel guilty/wonder if they are doing the correct thing/promised to the care receiver they would always take care of them and they would never go to a nursing home, etc, etc..
~Hopefully what results from all of this is a better grasp for the team members on the current condition of your loved one, if any actions are to be taken now, the thresholds for the future and actions to be taken, and any other planning that should be taken to prepare for the continual decline of your loved one.
~You will gain more knowledge and confidence in the decisions that are needed and when to take them...even when your loved one and other team members who don't buy in, nor understand start questioning you, maybe even yelling at you. You will at least have the backing of the results of evaluations and testing of your loved one to refer to. There is no bias with the testing, as it was your loved one that was evaluated. Its proof of your loved one's decline and what level it is at...even if you think she is "getting better" and "more with it today". It is very helpful for team members to refer to the evaluations and plan when the emotions and difficult decisions have to be made. It also is frank in that it lets you know that if you don't make the decisions...that in itself is a decision where you know in your heart that you are not doing well by your loved one. Your loved one is always communicating with you...letting you know how they are doing. It is one of our jobs as a caregiver to "listen" to them the best way we can; to record and document the indications of the continual decline. And believe me, there are good days and bad days that can trip us up...but remember...its a continual decline overall. Jagged up and downs...but an overall continual decline that we must plan for.
~Even now with my loved one in an ALF, I am having difficulty rallying the team for the next planning and decesions that are to be made for the next threshold that will be reached: when to go on hospice. (1 transfer?/ 2 transfer?/ feeding tube? / other?
~"To plan for what might happen is called insurance. To plan for what will happen is wise."
Continued best to all the caregivers out there!
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Also I'd like to add, that sometimes a facility will do an evaluation on a future resident. For my mom's move to IL, the IL required her to come to essentially 2 "play-dates" before they would accept her as a resident - first one was a full tour of the whole facility (this was a tiered one that ran from IL to AL to NH and hospice unit) and then look at the empty apts in IL, then lunch for play-date #1 and then for # 2 mom went over at about 10 AM and was there for most of the day - did an activity then lunch then the post lunch activity . She had to do this before her name could go on the wait list for the IL. Believe me if mom had seemed unable to do or unable to socialize well, they would not have put her on the future resident list or taken the hefty deposit. Then later when mom moved from her NH #1 to NH #2 (many issues with NH #1…), the second NH sent a 2 person team to see mom at the old NH to evaluate whether they could provide the level of care needed. RN and SW and they called me from her room where they were visiting with her to tell me all was OK. Really the good facilities want to do whatever to ensure that they can provide the level of care needed and that the elder can do well within however care or assistance is provided for the facility. Now my mom was in her 90's when she moved into IL, so likely some of this was driven by her age as most 90+ can't do IL, but mom was one tough old bird and very healthy with Lewy Body Dementia so pretty cognitive and competent for longer than the other dementias allow.

Really do whatever to ensure that the move is to where mom needs to be for care
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We had to wait it out, until a fall put mother in the ER. From there, we told the doctors that she was unable to live alone. She is doing well in the nursing home and gets good care. She is clean and safe.

I am thinking that your mom is not in good enough condition for assisted living. My 92 yo MIL is in a nice one. But, she doesn't need daily care.
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If you re-read your post, you will see that she is in danger and needs to go.

I was in this position in 2013-14. I kept up, over a year or more, a relationship with the AL. I visited and we chatted on the phone. They had good suggestions and were cracker-jacks at what they did.

Here is what finally happened: We actually "forced" my mom into AL (with the consent of her doctor and the Area Agency on Aging). I invited her out to lunch while she lived in her home, I took her to the AL for lunch, the staff joined us and "surrounded" her sort of, then I explained that my husband and I would be leaving but that she wouldn't. She cried and cried. A month later, she didn't remember a thing about it. I have since moved her and she remembers nothing about that either. Rely on the staff for help--they have been there, done that.

BTW, within three months of her move to AL, I had cleaned out her house and sold it. I visit her every day when I am in PA (about half the time).

Good luck! Be courageous!
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