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My mom is 93 years old, with dementia. (My dad died last December 2015.) In the last 4 months she fell, broke 4 ribs, hit her head which caused a brain bleed, several days in ICU/hospital then skilled nursing. She improved, did well, they discharged her to go back to her home. We hired a CNA to visit with her 2 separate hours per day and help with cooking, showering, etc. (My sister and I live near her so we too would visit everyday for a few hours.) First week she was fine, second week she stopped moving, showering, eating. She refused to talk to the CNA, said she was watching TV and did not want to talk to her. She kept telling us she did not need anyone coming to her house and while she was in HER house she did as she pleased. Third week continued same behaviors. By end of the third week she fell again, broke her hip, broke more ribs, another brain bleed. Back to ICU/hospital, skilled nursing. This time they strongly recommended she go to assisted living. However, in the 2 months she has been in assisted living, she has made a remarkable improvement. With home health care and visual/verbal stimulation she is stronger, walks very well with her walker and her brain is sharper. She now calls me several times a day asking to please take her back home. She says she can't stand being around all these "old people" they are driving her crazy. (all the patients are demented and are very passive, quiet and don't bother her at all.) But she keeps insisting she is well enough to take care of herself at home and wants to be in her home. I am afraid if we take her back home with some home health care she will revert to where she was when she last fell and broke her hip. (We are afraid she won't let the CNAs help her, will ask them to leave, will stop moving, showering and eating.) She could fall again and break even more bones, or not. We cannot afford 24 hour care in her home, so the care would be sporadic, two hours here, two hours there throughout the day. What should we do? Is there a professional type person that does evaluations of demented patients to determine whether or not they are capable of being at home on their own? Could use your advice and counsel on this issue.

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I recall when my cousin was so insistent that she would be fine at home alone with her neighbors checking in on her a couple of times a day. In reality, she didn't have the ability to make a sandwich, operate a tv remote, read a calendar, do any laundry, take her meds, bathe, recognize an emergency, etc. She didn't even know her date of birth or what town she was in. So, allowing the person with dementia to make the call on how self sufficient they are isn't really an option, after they are out of the early stage.
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We heard the "I'm going home" speech from mom many times. The answer is "No it's not safe. You are safe here." Taking her home will reverse everything she has gained. Safe means someone else cooks the meals, manages the meds, cleans the room, does the laundry and calls the MD. Without social contact, she will "stare at the four walls" and call you hourly to complain.
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People with dementia really aren't capable of knowing what is in their best interest. Your mom is clearly not able to live alone. Except for the early stages, it's just too risky. She has demonstrated why it's so risky and detrimental. Her belief that she can do it, demonstrates her poor judgment. I'd hold firm. It's for her own best interest. I can't believe that her doctor or any evaluator would think she's able to live alone, even with people coming in. People with dementia, except for early stages, need continuance supervision.

I would try to adjust to the fact that mom may not agree or get on board with the decision. But, she may move past that and even forget about it.
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Persons with dementia beyond the very earliest stage cannot live alone safely. That is the long and short of it. Having sporadic help coming in does not cancel the fact that your mother would be living alone.

She is now in an environment where she is thriving. Why would you consider putting her in an environment of high risk?

But she may be correct that she is more alert and lively than the others in her facility. I take it she is in a memory care unit? My friend's father had the same complaint when he was in a memory care unit and he managed to convince his doctor that he didn't need to be. He moved to the "regular" assisted living unit at the same facility and did very well.

If your mother has improved enough to want to interact with others perhaps she should try a facility with more residents at her level of interaction. In most assisted living facilities and nursing homes more than half of the residents have dementia, but they don't need the extra level of care provided in a dementia unit. Unless your mother is a wandering risk, you might consider a move for her -- but not, certainly, a move back to living on her own.
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I vote "no" to taking your Mom back to her home. And as you know dementia doesn't get any better. In fact, you probably noticed more memory loss after each fall.

You are right, your Mom will fall again, have another brain bleed, and find herself probably in long-term-care. That is what happened to my Mom because she was too stubborn to want caregivers, or to even use a walker [that was for old people... she was 98, so I guess that meant at 108 she would finally use one].

You could ask your Mom's doctor to give you a script for Occupational Therapy to come over and preview your Mom's home, give suggestions, and hopefully tell you that Mom needs a higher level of care.
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You don't need a professional consultant to answer this question. Leave her in assisted living, period. She made a "remarkable recovery" because she was getting help, nutrition, stimulation and supervision. Your roles have now reversed. You are the adult and mom has to do some things she doesn't like. I suspect you know what will happen if she goes home. She would be in the ER in a matter of hours.
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