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My MIL is physically doing fine and social, but often is unable to communicate well (aphasia) or be self-directed. At other times, she's coherent, and understands what's going on. She can get dressed no problem, can sometimes work a phone or tv, but not always. She's in independent living now, (very recently - not even a week) but she gets more confused at night, and doesn't watch tv, and everyone else is in their rooms. She gets confused and cries and it's heartbreaking.



What kind of care is available for someone who is mobile but who needs a lot of direction and monitoring? I'm afraid if we put her in memory care that she'll have even less social interaction. Even at this facility there's not much talking at meals, and only a few residents engage socially.



Thoughts?

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“Usually” but not necessarily formally, “assisted living” is the level of care between “independent living” and “memory care”.

A well run “assisted living” facility should provide ample activities supporting social interaction, conversation, and cognitive/memory stimulation.

Does her current facility offer assisted living? You may need to ask specifically to find out.
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I agree with what AnnReid wrote. Or, can she afford to hire a companion aid while she is in IL? My very elderly Aunts had a lady (from an agency) who was their companion for 6 years and she was awesome. Drove them on errands, did light housekeeping and meal prep, played games and chit-chatted with them.

Your MIL sounds like she is Sundowning. Having an aid there right after lunch until bedtime would maybe help with this.
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Adult Family Homes would be better, but her own home is best if an option, then bring the care to her.
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The idea of a hired companion is great. Those hones do not provide anything near what we eish for and what our loved ones need.
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lealonnie1 Oct 2022
Not true at all. My mother lived in a Memory Care ALF and had wonderful activities and socialization all day long every day, with a great activities director who worked there. Do not speak for 'all homes' or what 'our loved ones need.' Oftentimes, a 'companion' is not nearly enough help for an elder with dementia who's Sundowning in the evenings! What would the 'companion' do about it? "Her own home" is not often an option for elders with dementia either, as 24/7 care is WAY more expensive than a Memory Care ALF, and most people cannot afford $12K a month.
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She may need regular Assisted Living but likely Memory Care AL. A person can be fully mobile, but if they need 'a lot of direction and monitoring', then regular AL is not the right place for such a person. The ratio of caregivers to elders in AL is about 20:1, whereas it's more like 6:1 in Memory Care which is set up specifically FOR elders who need direction and extra care. My mother lived in both; regular AL for 4 years and then I had to move her into their Memory Care bldg after her dementia progressed to the moderate stage and her life was too confusing in AL. The staff in Memory Care was excellent and she had FULL socialization and activities all day long. The CG would come help her get up and dressed in the morning, then out to the activity room for breakfast and interacting with the other residents. Then they'd have games, movies, and activities geared towards their level of ability. Crafts, too. There was a nice garden (that was secure) where they could walk or sit and enjoy the nice weather.

People have a skewed vision that an elder has to be drooling and incoherent to 'belong' in Memory Care, when that's not true at all. I suggest you go visit some ALs that also have Memory Care available on site, and see what they have to say. Also, the intake coordinator nurse will tell you where your mom belongs once she 'interviews' her and determines her care requirements, etc.

Good luck.
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Cover999 Nov 2022
😆. Care to share where these wonderful facilities are?
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My mother’s MC has morning and afternoon activities.

Three meals/day, and snacks whenever she wants them.

All of these provide opportunities for her to be with others.

Perhaps a tour or two of different MC facilities would set your mind at ease as to the different levels of residents who live at these facilities.
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If COVID-19 restrictions limit social contacts in an independent or memory care facility, that does not work out for Mom's situation. She requires memory care. Speak with a social worker about these concerns to help find the right placement for her.
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Good Morning,

How about if you visit a Geriatric Neuro Psychologist. Sometimes a little bit of evening medication can do the trick. It calms them. Mornings' and nighttime used to be a nightmare before mother was diagnosed with Lewy Body but now it's calm and peaceful.

I take my mother every 6 months for a visit. It would break my heart to see my mother so pensive and worried but now she is a different person talking about who we should send Christmas cards too. It makes me happy.

Oftentimes, at a certain time of the day the medication wears off so there may an adjustment period. The color lavender is also calming for the elderly so I have a lavender Lands End comforter for her and pajamas NOT a night gown that they could trip and get their feet caught and good slippers. Mom's rosary beads and clean handkerchief go under her pillow each night. She knows the routine, her meds are dispensed and then I turn the light out.

It wasn't always like this, believe me. But I want to give you some hope. You don't want them so medicated that they are lethargic and wet themselves.

TV is not good for dementia. Perhaps, some soft music that she is familiar with and wind down for the night. It's only been a week, it's like sending a child off to camp. There is an adjustment period. Over time you will see things play out. Always check your mother-in-law for any type of bed sores.

In these type of facilities they can often go unnoticed. Don't assume anything. All the places are crying for help and they need to be monitored by family and checked on routinely which is sounds like you are on top of things.
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You need to meet with the social worker at that facility. If they don't have one, she may be in the wrong place. Mom sounds like she also needs SLP therapy for communication and cognition. Can she read? If so, make her a list of things that she can do with instructions. Bring her craft activities. Get her an easy to use video communication device so that she can chat in the evenings. (I got my mother a Grandpad, and it is the best thing I ever did for her.) Even if her speech is poor, she might understand and appreciate the connection of hearing about your day and seeing other family members. More frequent communication might also help her sustain her language skills. Mom sounds like she is depressed. Get help with this. Hopefully this will help short term, and other advice for long term planning.
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I got my mom a private caregiver who comes in every afternoon, has dinner with her, takes her to events if she wants to, but Mostly is there to tuck her in bed at night and tell her that she’s safe and God loves her. It’s the best thing I ever did. Mom suffers from confusion in the evening usually because she’s had a busy day and she’s overtired but this has been a great help. Four hours is the minimum that I needed. I got the private caregiver that I found through someone else who was working in the assisted-living that she was staying at. I asked if she knew someone and she got me the best one. Moms AL changed license which means
even less
staff and now mom needs MC. I didn’t like their MC. I found one that is perfect and the private carer will go with her. It is like me being there.
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You may need to hire private care for her for evenings
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If she is in " independent" living now and, you are noting decline changes, perhaps it is time to have her reassessed by PCP or Geriatric specialist for present care needs, perhaps to " assisted living"
( this is different than memory care unit) or perhaps 1:1 support during specific needs times. She most likely will continue through the disease process needing different accommodations at different times to remain safe. Safety is a most important factor in all circumstances.
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ToriBr: Perhaps she requires a higher level of managed care facility living.
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My mother is in AL. Only been there 3 months. I took her there and admitted her. She is 95 with dementia. Incontinence is a major issue.
I am struggling with my decision to put her there. She is depressed also. Doesn’t want to participate in activities unless someone comes and gets her and goes with her.
her room smells so badly of urine because she won’t wear depends. Wears nothing. Besides soiling the bed. When she stands leaking urine on the carpet. This was the final straw that made my decision to move her from living alone. I thought AL could get her to wear depends. She loves company. But expects people to come constantly which isn’t really realistic. Not a lot of family left. Or friends at 95 years old
the nurse there suggested that I might want to take her to a neurologist for testing and recommendations. She said AL might not be right for her. But she didn’t feel there MC would be good for her either.
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I’ve found that the best dementia care comes from Independent standalone facilities or adult foster care homes that focus exclusively on memory care.

Most places offering AL have mc as an afterthought. The priority is maintaining the nice Marriott foyer, maintaining the bocce ball court, drop offs to the city or symphony, which leaves less money and time to devote to mc residents.

Mom not socializing could mean she’s intimidated by a crowd that can largely do these things. In an mc environment, she’d feel less pressure.
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