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She believes she is not home, thinks she is at the mountains all alone. Has sundowning at night, but very confused during the day.

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Memory care.

My mother (with dementia) started in skilled nursing, and she darned near died in there from loneliness and neglect. People in skilled nursing are usually rehabbing from surgery or have major medical issues that need constant treatment. That doesn't sound like your mom, and it wasn't mine either. She didn't need a lot of attention, and she didn't receive it.

Memory care is more stimulating, and that's so important.
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Reply to MJ1929
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Memory care. My dad was in skilled nursing for a time after assisted living (it was not a high enough level if care due to his medical issues). His issues have stabilized and we have found a great memory care that not only keeps an eye out for medical problems as they arise but also deals with the dementia behaviors.
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Reply to Babs75
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She should first be checked for a UTI since the main symptom in the elderly is "sudden" or rapid onset of confusion, change in behaviors and personality, delusions, etc. Antibiotics can clear up such an infection and she may regain some former cognition. Untreated, a UTI can turn into sepsis and be life threatening.

If she's clear of a UTI she sounds like a candidate for MC.
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Reply to Geaton777
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I think she is passed an AL. Maybe Memory care. My Mom had no physical problems. She actually was pretty healthy and she was in a SNF. She was 24/7 care and could not be left alone.
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Reply to JoAnn29
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I don't think she would qualify for skilled nursing if she doesn't need physical care. Assisted living or memory care should be checked out I think. If she would try to leave assisted living to find her home, then memory care will be where she belongs.
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