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My in-laws went into AL in October 2020 and were relatively happy. Jan 2022 he broke his hip, had to go to skilled. March 2022 she broke hers, had to join him. She had been fairly clear cognitively until then, now she has good and bad days, she doesn't remember pretty much the last 5 years, she thinks she went straight from her own home to where she is now. He passed away in June, and she doesn't understand why she needs to stay, she thinks they were only there for him.



She has lung cancer, is on a lot of meds, and now has mild dementia. She cries every time we visit and talk to her that she hates it there, and insists she can live on her own in an apartment. This is not an option.



I don't know if moving her to another facility would help or not, we think she'll be unhappy in any facility, but then again maybe not being in the same one where he died might help?



Thoughts?

Is there a psychologist/psychiatrist who visits patients in this present facility? There was one in the AL section where my mother is now in SN and one in the facility I hope to move her to. This type of professional could possibly help with the adjustment both with talk therapy and possible medication if proved necessary.

I know that there are times when my mother can accept advice from a kind staff member as opposed to me stating certain facts and realities.

I would advise against moving her unless there are blatant issues that are problematic. Changes can be a difficult adjustment. Her husband will still be gone. He can't be erased with a different environment.

I hope you find a solution that fits the needs you all seek.
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Just a question ..was she the type who enjoyed these activities prior to her injury/ related issues and dementia? I can’t imagine it ..since my idea of activities are mostly more solitary. I like reading , some tv or movies, walks, bike rides, going to the beach , being with immediate family , and while I can be sociable I’d hate to be forced into it in a daily basis. Maybe if I were not in my right mind it would be different ? I’m also a light sleeper so forced cohabitation would be awful and I do hope more places develop accommodations that allow privacy - can’t understand why being roommates during hospitalization and in skilled nursing was ever a thing! Is she now okay mobility wise? Would she possibly do okay with an apartment at a senior living place with perhaps prepared meals she just has to heat and her meds prepared along with the hospice help and some additional aides ? What about a small care home ? Heartbreaking that she is so unhappy.
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PeggySue2020 Sep 1, 2022
With all these meds, I can’t imagine she is on hospice. And with multiple medical conditions plus dementia, I can’t see her functioning in a regular al.

OP, are you yourself comfortable with this place? Is mil clean, fed, changed regularly? Are her neighbors quiet? If so things could might be a lot worse elsewhere.

Tell mil that the doctor says she has to stay there until she’s better.

Tell her the
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Is it a problem for her/you/ the SNF if she needs to be prompted for activities each day? Depending on how far ahead activities ar put on the schedule, you could put a whiteboard on one wall with activities you think she might like written on the board each day (by you or an aide). (I'm assuming you can receive the schedule up to a few days in advance, either from their website or by having the facility e-mail the schedule to you. Then a staff member could suggest she go to one of them, or if you are talking with her on the phone, you could suggest one of the activities. Activities that have a physical component should be especially good; there is a lot of evidence that physical activity has a positive effect on people who have depression and possibly also on cognitive decline.

It sounds like the main issue from your viewpoint is that she does not go to activities unless they're specifically suggested to her. However, she will go if prompted. With her level of dementia, she may always need prompts, and it sounds like that could be done without too much difficulty. Also, this problem is likely to occur wherever she lives, so it sounds like staying with the same company would work out at least as well as moving., and with less or no disruption.
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I personally believe that when you have dementia, visual becomes very, very important. You may not be able to interpret what is being said, the food is often not very familiar, leaving your eyes to clue you to what is happening in the world.

Is she is a Memory Care unit or is she truly in Assisted Living? Why does she cry when you visit? What about it does she hate?

Try to see if you can "fix" what she hates in her current place. However, it is very, very possible that the place holds too many sad memories for her and you should move her to another place. Yes, she will probably be unhappy in whatever place she is, however, the "unhappy" might be more manageable at a new place.
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Some people with dementia don't know they have dementia. People with dementia are also likely to decline mentally and physically over time. She will need more care, not less, as this happens. She needs to be in memory care/assisted living. In time, she is also likely to forget her husband. My mother did, as her dementia progressed, even though she had a very happy marriage. She reverted to her early childhood memories. Some women with dementia are comforted with stuffed animals and baby dolls. You might try this. When a person with dementia wants to go "home," it is symbolic - it means they want to go back to a time when they were independent and capable of caring for themselves. It's difficult to adjust to an assisted living facility with their schedules and routines, but give her some time. She may get used to it. Your mother has dementia; her judgement is impaired. Her medical POA must now be the one to make decisions for her best interests.
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SherryH1968: Perhaps your MIL requires a higher level of managed care facility living.
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caroli1 Aug 31, 2022
She is already in NH; she moved out of the AL after she broke her hip, according to the O.P.
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Hip fracture causes delerium in many older people. For some they return to previous cognition, almost normal. Sadly some will continue to fluctuate, having periods of confusion or staying confused. A step-down into a *new normal".
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I’ve been there once. My wife was in care after a broken hand. She had other issues which I thought skilled care could improve. In reality it made things worse so I brought her home. She is not getting better but is happier. She has dementia and can not walk or stand. I would not want to be that way but that is me. I don’t think you will find care better than you can provide because it is all about money. If you can afford to stay in 5 star hotels then maybe you can find a good care facility
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Reply to Sample
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keep visiting, keep an eye on her for being in that state, its too emotional for her that is why she crys when visiting, say calming things ask dr to give her buspar a mild tranquilizer.
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With her issues she is probably very vague about his dying there, or will be before long. Moving her seems like opening a whole new can of worms. They often don’t react well to new surroundings, especially at first.
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I presume she's in Hospice? Perhaps a family appointment with the doctor and Hospice people can bring her clarity and acceptance. Asking a Geriatric Psychiatrist to meet with her would give her an opportunity to talk and get medications; no one should have to face that nightmare sober: Hell no!

I would never expect happiness from anyone who is suffering with a terminal disease and forced to live in an institution. I watched my mother die of lung cancer (who refused Hospice) and that's why I'm opting for the Death with Dignity program so that I can be in control of when and where.

Let the professionals help her deal with the 5 Stages of Grief with heavy doses of relief. Blessings.
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if maybe she’s given drugs she shouldn’t be having. I was told from the few ppl whom were going there it’s really a transition to going to a deep sleep.
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LoopyLoo Aug 30, 2022
The facility is not trying to kill her, or any patient, via meds. What do you even mean by “I was told from the few ppl whom were going there”? What people? Where?

Please stop with this anti-med, anti-facility rhetoric. It’s fine if you think all facilities and meds are all part of a sinister plot to kill old people. It makes no sense at all, but no one can stop you from believing that.

What is NOT fine is blaming meds and facilities for anyone’s problems here. You are spouting fallacy after fallacy and it is not helping anyone.
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U gotta have mad love and selfish less ppl
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Getting old sounds so scary from the stories I’m hearing.
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How is it she’s going to hospice? To me it’s sounds like once u go there they automatically start given u drugs so u can die off. What a shame. I pray to God that he will guide me through my old age. Place hood God Fearing ppl my way. Bc I want to bd in my own home dying no extra drugs and definitely not having ppl that really don’t care about me. I pray I could be home have ppl come attend if need be. Otherwise I hope to be able to be fit enough that I can take care of myself.
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LoopyLoo Aug 30, 2022
For the love of God, candyapple. Stop already.
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It’s possible it maybe that reason bad memories of her husband. It doesn’t beat a try to see if she can live on her own she probably pay someone to assist her and place cameras in the home. No one wants to live somewhere other than there home. I don’t under why ppl don’t adhere to than. I guess when it’s our turn or in there foot steps we only get than see what that person was feeling. I’m noticing not playing a quilt trip I see some ppl must be place. It seems like some ppl give up on parents quick, fast and a hurry when they were there for us. We didn’t asked to be born however, we’re here. We must all do the best we can to help and at least fulfill someone’s request at least u or we can never say we didn’t try..
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LoopyLoo Aug 30, 2022
Placing an elder is not giving up on them.

I ask in all seriousness… why aren’t you volunteering to care for these people that you insist will be killed in nursing homes? If you have a job and a house, why not quit your job, sell the house, and move to wherever these poor souls are? Or at the very least, pay for their care so they can remain at home? Why will you not step up?
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I don't know that your MIL would be happy in ANY managed care facility, whether it's Memory Care AL or Skilled Nursing, truthfully. Wanting to live in her own home is her desire, and that won't be accomplished in ANY managed care facility, let's face it. Her dementia doesn't seem too 'mild' either, if she's not aware of what's transpired with her health and why she needs to stay put where she's at. The belief that she can live alone with no help is a delusion that only an elder with advancing dementia would believe.

The goal is to get MIL involved in activities where she's at, involved with other residents and out of her room. Is that happening, or is she staying in her room all day with too much time to think? My mother was in both Skilled Nursing and Memory Care; the SNF was for rehab for about a month and Memory Care was long term for nearly 3 years. She was okay in both places for one reason: b/c she got OUT of her room and went to the activities, meals, movies and other things that were offered in BOTH locations. Both environments were similar except the Memory Care ALF was much smaller, and her room was nicer (no roommate in either place). The ALF was homier; she was able to get to know the staff on a personal level and she made a few friends there too; the routine was constant every day and the care was excellent (in both locations, actually).

Go tour a few Memory Care ALFs and see if MIL would be qualified to live there, IF she has the funds to private pay. See what you think and if you feel she'd be happier in a Memory Care or if she'd just be complaining the exact same way about wanting to live alone, etc. Many elders just reminisce about wanting to go back in TIME to when they were younger and healthier and living independently, which is no longer feasible. THAT situation cannot be recreated for them, no matter what you do.

Best of luck.
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SherryH1968 Aug 30, 2022
Thanks, she doesn't really have the means to go back to AL, Medicaid only paid $292 a month to the one she was in before, they negotiated with us to let her stay when her funds ran out. There is a memory care owned by the same company, could ask if they would be willing to do the same, worst that could happen is they say no, right?
We know a couple of the aides there are really good about trying to get her to get out of her room and go to activities, but not all of them do and I think on those days she just sits in her room.
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Just need to comment on MJs reply. She had a bad experience but my Moms was not.

After time in an AL, money ran out and I had to place Mom in LTC. I requested she not be left in her room all day. So Mom spent her time in the common room. There were activities every afternoon. Either playing games or watching a movie. There were special aides that their only job was the common area. Mom was in a wheelchair but able to scoot wherever she wanted to go. It had a large sitting area that looked like someone's livingroom that vistors could take the residents. A gazebo outside where the lawn was landscaped. Even had a small vegetable garden for the residents to work in that could. The residents were clean and happy.

So maybe tour some of the other facilities in the area and see if things would be better.
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SherryH1968 Aug 30, 2022
Thanks, they do have activities, and a beautiful courtyard she can go to whenever she wants, but if they don't come in and ask her to, she doesn't. A couple aides are really good about it, but not all.
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If she does not NEED Skilled Nursing I think a transition to Memory Care would be a better option.
Is there a MC option where she is currently? If so maybe a "visit" for some activity and getting to know people. Try that for a few days and see how she adjusts.
And...because it is me and I am such an advocate...Is MIL on Hospice? If not you might want to see if whoever is her POA would consider having her evaluated to see if she qualifies, she most likely would, she would have a Hospice Nurse come see her 1 time a week, a Hospice CNA come do bath and order supplies. (the SKF CNA would no longer do her bath) but you would have all the supplies you need provided (briefs, wipes, gloves, ointments, etc..) and you would have the option of having a Volunteer visit her 1 time a week and if available music or art therapy if she/you wish.
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SherryH1968 Aug 30, 2022
Yes, she is on hospice, and they have been wonderful! She has a bath aide, a chaplain, a social worker and a nurse that all visit once a week, so that helps. When people ask her if she wants to go do things, she does, but she doesn't if left up to herself, I don't know if it's because she doesn't remember or what.
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There is at least a 50/50 Chance that her crying has very little relationship to the facility, since she had adjusted relatively comfortably to it previously.

Other much more relevant factors are likely to be her progressive dementia, effects of a anesthesia during hip surgery, and the inevitable toxicity of the drug load she must take for her other issues.

Assuming that her PCP has done everything to help her manage the “lot of meds” she is taking, have you asked for a trial of an anti depressant and/or anti anxiety medication?

The likelihood that a major shift in her care setting would be helpful is pretty low, but depression can and does certainly occur as part of dementia. Maybe give that a try?
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SherryH1968 Aug 30, 2022
Thanks, she is on anti depressants and anti anxiety meds, they definitely help. For some reason when she was first there they discontinued her anxiety med and big surprise, she was having anxiety attacks. Hospice was very helpful with getting that straightened out.
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I would make a decision independent of her being unhappy. In other words, look around for another living situation, talk to the director where she is about whether another placement such as memory care might be a better fit, do your research, but don’t include MIL or her opinions in any of it. That may sound inconsiderate but it’s the opposite, her life has changed drastically with many health changes and a huge loss, what “happy” was could well be over for her, and whatever hoops you jump through may or may not help. Try really hard not to get caught in conversation with her on this, change the subject often, it will only frustrate you both. I wish you the best in figuring this out, she’s blessed to have you
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SherryH1968 Aug 30, 2022
Thank you, I think that is what we are going to have to keep doing, just making the decisions and redirecting the conversations with her. She is in the memory care wing of the SNF she is in, and I think part of why she is unhappy is most of them are worse cognitively than she is. She can go to the other wing and join their activities any time she wants, she just doesn't do it without prompting.
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Skilled nursing can be pretty miserable. My mother was in it for seven months because I didn't know any better, but after they darned near killed her from neglect (she wasn't sick enough), I decided to move her to memory care and life was happier.

Is her cancer such that her death is coming relatively soon, or is she mostly rehabbed from the hip and just in there taking lots of pills? Memory care might be a better option for her if it's a facility that have different levels of care where the more highly-functioning people have different activities than the lower-functioning ones. Be sure you have one that will care for her through the end of her life.

My mother was in a wheelchair, had heart failure, was nearly blind from macular degeneration, and mostly deaf -- all in addition to her dementia issues -- and she did very well in memory care. She improved vastly after leaving skilled nursing, too, because the focus was on mental stimulation and having things to do, rather than being "sick." They got her up and dressed every morning, got her out to the common room for breakfast, and she didn't go back to her room unless she had to go to the bathroom or be changed (later). They had activities all day long, and she received a ton of attention from the caregivers, because that's the focus. She eventually went on hospice there, and she had twice the attention because the hospice nurse was coming a couple times each week, and she died peacefully there.

It was a good decision to move her.
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SherryH1968 Aug 30, 2022
She's on hospice, they do a lot for her, and manage what meds she is given. She is in the memory care wing, but can go to the other wing any time she wants, and does when someone prompts her to, she just doesn't think/remember to do it on her own. She is on Medicaid, so Memory Care at the assisted living level isn't an option.
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