When do you know it's time to place them in a nursing home?

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My mother who has dementia and smokes caused a small fire on our front porch, luckily I caught it before it really took off but didn't sleep much because she gets up all night long to smoke. Suffers from sundowners too

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I agree with the majority of people here in that your mother needs more supervision than one person can give. When the safety of the person with dementia or the safety of the caregiver becomes an issue it's time for outside help.

A memory care unit sounds like a good start unless she has physical issues that require a nursing home.

Please consider this option before a fire ends life for both of you. We'd love to hear an update from you when you can get back to us.
Take care,
Carol
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First thing is take away the cigarettes! Smoking ruins brain cells, and is probably the most dangerous habit one can have with dementia because of the fire potential. Keep yourselves safe first, and if she cannot stop smoking (how is she getting the cigarettes?), then do what you must do.
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Sounds like it's time to me.....She needs more supervision. The smoking is going to a big issue for nursing homes. If they allow it at all it would be outside. Good luck.
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Secondhand and third hand smoke is far more dangerous than actually smoking. The third hand smoke comes from the walls, carpeting, etc. When one could smoke on airplanes, my husband was invited by Boeing to inspect the back of the aircraft's fuselage on a plane that had crashed. It was gummed up with nicotine and prevented the engines from running properly. Smoking is THE worst addiction one can have because of the 4000+ chemicals being absorbed by the body. I worked on the project to get smoking banned from aircraft so my husband was not exposed. (He still got dementia because smoking was not banned in the cockpit and the captain ruled). Now it is!
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A memory care facility may be what she needs rather than a nursing home. It doesn't sound as if she needs skilled nursing care, just supervision.
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First, I agree with what others have said, but my specific point to you is one that I had a LOT of trouble letting sink into my brain and heart when I took over POA for both my parents. It is this: YOU are now the parent. You must figure out how to reverse roles with your Mom and make all your decisions on what keeps her safe and healthy. SO...unless your mom is still driving herself to the store to buy her own cigarettes, you must remove them or somehow limit them to supervised use only. With dementia, your mother's brain is damaged and her executive decision making ability is making her function like a child....SO YOU become the parent. If dementia is making things unsafe in the home, your choices are hire caregivers to be with her when you cannot; look for a memory care facility or look for other placement...like a small group home situation where they accept dementia as a diagnosis, but resident are not ever unsupervised. This means, if you do not have POA already, with control of her finances, you must get that control via POA or guardianship. It means, also, that, depending on her total money situation, you need to consider that you may eventually be needing to qualify her for Medicaid or VA Aid and Attendance, if her husband was a war time veteran....and in getting ready for that, you look for placement in facilities that are licensed for accepting those types of residents when the money runs down low enough. If you do not have an eldercare attorney already, it's worth a few hundred to have a couple meetings with one to set up all her paperwork properly and learn how to get started on these applications. Our attorney has staff who helped me with all these applications and helped me understand how to spend the money properly that Mom had left when we were getting Dad qualified. If you plan ahead of time, it saves a lot of time and money and potentially penalty time being added. If Mom is up and around easily, memory care will be better for her than a nursing home, because she will be up and dressed each day, eating and living in a family atmosphere....and not just relegated to her assigned room and a dining room for meals etc. All activities are geared toward those with memory issues, rather than those who are just plain old, in memory care or a small group home.
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Your situation is very trying and I would suggest if financially possible hiring a night aide to sit with your mother while you sleep. Nursing homes are very confining for wanderers and smokers. Just know not every aide will be a fit so if one doesn't work ask for another. Be sure to lock away money and checks (blank and returned) as a safety measure. It would still be less expensive to keep her home. You could even consider contacting your church or temple to locate someone privately. Retire aides need a little extra income and since there is no heavy lifting they may be a possibility. Life is a challenge.
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Interesting thing on the smoking piece. When mom last saw the vascular doctor he asked her how long she smoked. She never smoked a day in her life, but her brothers and best friend smoked like chimneys and he said well your lack of blood flow and general circulation mimics those patients of mine that have smoked. He said you were around enough smoke in your life it appears to affected your health pretty profoundly. And said of course diet and exercise, or lack thereof, didn't help, but he seemed genuinely surprised she never did.
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Many who smoke say smoking makes them feel calmer, which is true. Actually it is the process of inhaling deeply and strong exhaling that creates the calmness.... one can get the same result using a soda straw cut to the length of the cigarette. It's the addictive nicotine that keeps the person going back to cigarettes.

Then there is the smoke which contain Carbon Monoxide, Formaldehyde, Lead, Tar, Acetone [stuff found in nail polish remover], Ammonia, Arsenic, and many other chemicals.

Some have suggested to others to use the e-cigarette, but from what I have read one is just substituting harmful chemicals for another group of harmful chemicals. Plus anyone with dementia might do damage trying to re-charge the e-cigarette, using power sources not approved by the manufacturer to recharge a lithium-ion battery can result in an explosion and fire.

Lauri1, I hope you can get your Mom is quit smoking as it will be hard to find a nursing home that will allow smoking, it will be a huge challenge. Example, our large regional hospital system here in my area bans smoking anywhere in the building and on the grounds which also includes the parking lot.
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I think if she is cognizant enough to understand consequences as put forth by you, then it is reasonable to say to her that if she continues to smoke you cannot have her in your home. I hope, having said that, that you too do not smoke! There is a childish aspect to early stage dementia and she would see that as lacking in parity, probably failing to understand that not only is it a health issue but a danger issue. Anyway, if you are unable to get a reasonable night's sleep, or attend to your own needs or those of your family, then it may be time. Personally, I could not have a smoker in my home, no matter who they are or where they smoked. I would not be willing to live with it. My dad, who has no dementia but smokes a pipe non stop, is not respectful of our rules about smoking only outside. My parents would tell us, not ask us, when they'd be coming to stay for a three or four week visit every winter (we live on a golf course in Fla. so perfect free vacation for them). My dad lied about smoking in the bathroom in the opposite wing of our home. Just lied and thought what? I couldn't smell it? We put up with a lot, including my somewhat demented, angry and bipolar mother's tirades and selfish behavior, but the smoking was the final straw. I had to tell them that since they didn't respect our rules in our own home they could no longer plan their trips to stay here. A lot went into that and built up to the point where there was no other option suffice to say. They pulled out the we-are-the-parents card refusing to accept I am a middle aged grandmother, not a teenaged rebellious child! Ah, well. Its one thing if your parents don't have funds and you do what you have to do as best you can. But you still only are obligated to make sure they are warm and safe.
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