Losing track of time, missing meals in assisted living. Anyone have this problem? - AgingCare.com

Losing track of time, missing meals in assisted living. Anyone have this problem?

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My mom has been in an AL facility for two months she has undiagnosed dementia and can be confused about what day it is, and what time of day. The past few days she has been really confused about time and has missed meals in the dining room. Even though she has a clock that tells the time, date, and even the time of day, she is unable to process if it is 11:15, time for lunch. Yesterday, she had nothing to eat until I called her at 2:30. I told her that she needed to go to dinner (starts at 4:15). She said she would do that. I found out today that she went to the dining room way too early where they were having an activity and serving watermelon. She told me "dinner was bad, all they had was watermelon." So, she didn't even realize she was at an activity. She has food in her apartment but if she is not hungry, she won't eat. Some days are better than others and she manages to get to the dining room on time. I've already talked to one of the aides and they really aren't able to remind every resident that it is time to eat. So, now my plan is to call her at lunch time and at dinner time and tell her to eat. I would like to keep her in assisted living as long as she can stay (rather than a higher level of care) but am worried that she will end up in the hospital because of not eating. Has anyone had this problem??

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Freqflyer, that's exactly the situation I was in. Calling mom at mealtimes, making sure she went and upset when she would answer the phone because she chose not to go. And she has a thousand excuses so it's not always the dementia. "I'm not dressed, didn't have a shower, nothing sounds good, not hungry..."
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08/25/16.... since I past posted on this thread, which probably was back in June [the date/time stamp is now gone from the postings], I moved my Dad into Assisted Living from Independent Living, same complex.

Where my Dad lives, Sunrise Senior Living, an Aide comes to his room and gets him ready for the day, and later returns to take him to the main dining room if Dad hasn't already started to head that direction. Same for lunch, and same for dinner.

Whew, what a relief as when he was in Independent Living, I would call him at 4:30 to remind him to start getting ready for dinner. Then I would call back at 5:15 to make sure he wasn't in his room.... if he answered, my heart sunk, as he hadn't gone to the dining room yet. Now I don't need to worry.
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ALG - the other thing that comes to mind is hospice. If when the time comes you are likely to want to use hospice - which I highly recomend - ask if the NH will allow outside hospice care. Most do as its additional help. My brother and I were determined that this last move be - my mothers last move, so hospice could have been a deal breaker if not allowed. I really like my moms NH - it's only a few years old, is privately owned and is small-ish in terms of residents - about 35. The married couple that own my moms place are both RNs and therefore the place is very medically oriented. They have two Drs with one or the other being at the place most days. An interesting detail that helped swing my decision was that the mother of one of the owners is a resident there. All the rooms are private and all have their own bathrooms - which would have been a deal breaker for my mom, had it been different. The only negitive is that it's all private pay - you have to prove three years worth of resources to be accepted there. However, if a resident runs out of money after the three years they will allow Medicaid rather than force a resident to move. That flexibility showed me that while a business - they were caring and understanding.
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And thanks, Rainmom for the list of questions to ask. The nurses at the hospital said to NOT make an appointment for the first visit, just pop in. That's what I did with her current AL place and what I saw on that visit is exactly the way it is.
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The agitation, paranoia and aggression are mainly in the evening, which they are attributing to sundowners. She was not doing that in AL. She did this the last time she was hospitalized, so it is typical behavior for her when in an unfamiliar place. Right now, I'm not inclined to add to her list of meds but I will keep that in mind. The kidney problems will be resolved in the hospital. It is her unwillingness to eat that I think will cause her current AL place to not want her back. They don't deliver meals to rooms unless you are ill and she is refusing escorts and reminders to go to eat. So, they probably will think she is a liability. They do wheel residents in wheelchairs but she could STILL refuse that. I will check into the Memory Care rules for Illinois. I was not aware they might have different rules.
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Has she been evaluated to see if medication could help with her anxiety, agitation,etc? It sounds like she is in a lot of mental pain. I would explore this with her doctor. Please know that the delusions and false accusations are common and in no way your fault.

Can they get on her meds while she's in the hospital?

Will her kidney problems require her to be in a skilled nursing facility? Does she have an advanced medical directive?

I know that you said that she could return to her previous AL, but, have they discussed with you how they would handle someone who is disruptive and resistant to care? I had that happen with my cousin and it's not a good situation. When the dementia is of a certain level and they are not able to give her one on one attention, it might be that her level of care would be too much for a regular AL. I'd ask them about it and how to evaluate what type of facility she would get the attention that she currently needs.

In NC, Memory Care AL's provide care for the resident for as long as they live, unless they need skilled nursing care. They can stay there even if they are bedbound, incontinent, handfed and on hospice. So, I felt comfortable placing my cousin there. Regular Assisted Livings in NC have other rules and a resident has to have be able to meet certain abilities like being able to transfer with the help of one person, cannot be double incontinent, etc. So, at Memory Care, there is some peace of mind knowing that they aren't likely to have to go to a nursing home. I'd check the rules in your state to see how they apply to help you with the planning.
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I asked this very question of the Director at the AL where my mom was living. The first thing she said to me was if the place smells of urine - turn around and leave. I have bad memories of my grandmas nursing home from 40 years ago - most NH are no where near what they were back then. The memory that bothers me the most is of residents sitting in the halls in their wheelchairs - just sitting there - almost lines of them. So when I looked for my mothers new home, I looked for that - where the residents engaged? Visit on appointment and if you like one, do a surprise visit - I also had my brother do a couple surprise visits since they didn't know who he was. Hang around in a common area and listen for the call buttons - are they being answered in a timely manner? Find an occupied room that you can pop into - is the garbage can full or empty? Ask to see their calendar of activities - a good NH will have a printed up calendar for residents and family. Ask about visiting times - a good place will allow visits at any time - late at night is the only acceptable restriction - and even then visits should be allowed if you ask specifically. Ask about seeing a menu - how do the residents get snacks? Talk to a couple aides - how long have they worked there? High staff turn over is a bad sign. I'm sure you'll get lots of tips - these are just a few off the top of my head.
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Update on mom. She's in the hospital, due to acute renal failure. She began to refuse to eat in the dining room at AL, and had a UTI. Nearly a complete repeat of what happened in March, which triggered the move from her home to AL. Here we are again. More than her normal confusion due to the poor kidney function. Refuses meds, refuses therapy. Is combative and paranoid, threatens to escape and calls her nurse a "liar and phony". Accuses me of a variety of things. At this point short term rehab is next after release from the hospital and long term nursing home care will likely follow unless she can get back to her previous "normal" state of dementia. She can still go back to her current AL facility, or possibility of AL with memory care but I think that's a long shot. OMG what do I do now?

The social worker has encouraged me to visit the recommended SNFs that will take her for rehab, knowing that she might stay long term.

What do I look for in a nursing home? What questions do I ask. I do NOT want to make a bad decision, then move her again.
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Rainmom is right. I recall in the early days and I was trying to deal with my cousin. We would be in the car and I would be trying to have a conversation.....she couldn't remember what was said minutes beforehand.....I thought I was in the twilight zone. It's so scary and frustrating. I just couldn't figure out what to do. I found so many helpful people here and I learned that my ideas weren't that productive and how I had to reevaluate my expectations when it came to dementia.
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ALG - good for you! When I came here I knew very little about dementia. I asked for help and was given good advice- and I took it - same as you are. There is a wealth of experience here - no need to reinvent the wheel. Knowing arguing the small stuff isn't important will save you hours and hours of needless frustration. You are definitely on the right path!
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