How do we tell if memory care assisted living or skilled nursing is needed?

Mom had a stroke on July 1; lots of rehab; she's got expressive aphasia, depression and has now been diagnosed with vascular dementia; she becomes agitated and paranoid in the early evening, and agitated at other times. She's been on low doses on Klonopin for several years due to extreme anxiety, which appears to be fueling, in part, her labile bp (yesterday 210/76, today 90/60) After nearly two months of rehab, we moved her to a lovely AL facility with their highest level of assistance; they were checking on her every 45 minutes, escorts to meals and activities. She wouldn't talk to the visiting nurse who came to evaluate her for further therapy and aides. On her second day in the facility, she was found on the floor of her bedroom, conscious, but not knowing how she got on the floor; she did not push the "panic" button on her wrist. She's now in hospital, no broken bones, thank goodness, but again, disoriented, sad, agitated in the evenings...is it time for skilled nursing? The docs are working on getting her bp meds stabilized, but it's difficult with her agitation and dementia also stirring the pot. Any advice is appreciated.