My mom with Alzheimer's is going downhill fast. Could it be due to her environment?

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My Mom has had Alzheimer's that we know of for about 6 years. She has done well until lately. I had her at my home and had a caregiver, she started to fall quite often and one night it was bad she hit her head so hard that I had an ambulance come take her to the hospital.
The Doctor advised us that it was time to put her in a home and that she requires 24 hour a day care. My family flew in and we found a very nice place but now I wonder if it was the right decision. I was shocked when I went in the home, I still had horror thoughts of a nursing home from way back when my great grandfather was in one so I was quite surprised to see just how nice it was. I could not ask for more with the staff members, they are all so caring.


Lately my Mom has become very combative. She tries to hit the aids, she cusses them out and has scratched some. Although its very embarrassing everyone knows it just the disease and they know that after she gets up in the morning she will return to her sweet self.


The concern that I have is when you walk into the home there are a lot of residents that are in wheel chairs, kind of slumped over and sleeping, some don't talk. Mom seems to have gone down hill very fast the last month and I can't help but wonder if its because of her environment. We had to again take her to the hospital about 2 weeks ago, this time she kept saying she hurt, was very sick to her stomach and her blood pressure was way out of control. She checked out fine except for a yeast infection, they think at this point she can't decipher itching from pain. She is refusing to eat, I'm lucky to get a couple bites of a Cheeseburger in her, I say Cheeseburger because if nothing else she would always eat that so I bring them to her in hopes to get her to eat. I have though about bringing her back home but I know in my heart that I do not have the means to take care of her and that is very hard to admit. I though that I would take care of her until the end, I had even told my sister that if I had to hire 2 people I would but now I do understand a little better that its not easy to work a full time job and try and depend on caregivers, I did not have a lot of luck with them. Do you think the reason for mom's sudden decline is due to being put in the nursing home? She thinks its her apartment, I'm amazed she has a little dog that is with me and when we took her to the hospital the first time its like she has forgot about her dog. The dog was her whole life and she had never mentioned her again and its been about 3-4 months. I would appreciate any advice, its devastating watching your loved one go through all this. I'm not sure if I mentioned but at this point she will not even try to walk, I think she is to week because she will not eat.

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Aveeno, glad to see your name back on the forum. My Mom also had a serious fall with head trauma which placed her into accelerated dementia.... prior to the fall she was still doing well for someone in her late 90's, still living at home with my Dad. But Mom refused caregivers or cleaning people into HER home. And she refused to move to Independent Living. So I backed off.

After that serious fall, Mom had to go live in long-term-care. There was no way I could be her caregiver, plus it would upset my Dad having to see Mom in her current state 24 hours a day. Dad accepted caregivers for himself immediately as Dad couldn't stay by himself as he was a fall risk, too. At noon each day, the caregiver would drive Dad to the nursing home so Dad could see Mom, and the caregiver would feed Mom her lunch. After an hour, Dad wanted to go home. He finally accepted the fact that my Mom wasn't getting better, and wouldn't be coming home.

For my Mom, she needed the 3 shift care, and in her state of mind she thought she was in a hotel and that I had a room down the hall. She could no longer walk, or even stand. She was constantly trying to climb out of bed or out of her wheelchair. Her dementia kept getting worse and worse within the 3 month span, due to her head trauma :(

I had no guilt that my Mom was in long-term-care. Both my Dad and I resented the fact that she was so stubborn that it put her in this health situation. Two weeks after my Mom had passed, Dad announced he was ready to look at Independent Living. He picked out the place and he enjoyed living there, wishing, of course, my Mom would have been there with him.
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Aveeno, I'm not sure if this helps to set your mind at rest or not - probably not, I'm afraid - but I don't think it's the environment. The recent increase in your mother's falls risk leading to her actually injuring herself makes me think that she'd started downhill well before you moved her.

You've made sure she is in a good environment with caring people and all the right facilities. It has to have been the right decision; I'm just sorry that even the best place can't always give us the results we'd like to see.
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In answer to your original question. There is a reason her doctor said she needed to go into a place that had 24 hour care. He saw that her disease was progressing and knew what was probably coming. Irregardless of how she behaved before, the truth is she will never go back to that behavior and will continue to go downhill. Some behaviors will ease off or go away but others take their place. Sadly, this is the way of Alzheimer's. Moving her causes deterioration, whether or not it is from home or to home. Either place will no longer be familiar. We have to come to terms with the fact that there is no rhyme or reason for our loved ones behavior nor is there a way to predict it. On a scale of 1 to 10, my own mother went from 4 to 10 in a matter of 8 months. Do some research on this disease and prepare yourself for what is coming. One other thing.....there is a big difference in a regular nursing home and a memory care facility. Aides in a nursing home are not trained to deal with dementia issues. They should be, but they are not.
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Hi Aveeno,

I had the same thing happen with both parents. It's all part of the unforeseen torture that we go through. I believe that when you place your parents into a care facility, they somehow get that they can be themselves again, and that they don't have to put on any false "masks" for fear of being found out how bad things really are for them.

My parents lived on their own until last year. Yet my mother was diagnosed with Dementia and the CAT scan showed that she had lost the judgement part of her brain 15 years earlier. Dad was diagnosed with mid-stage Alz that was at least 5 years in the making. None of their friends, neighbors or me (for that matter) noticed, and they worked hard at looking normal because they wanted to stay in their home.

It was only because my Dad didn't remember what a toilet was for that my mother agreed to come a stay with me in my home.

They've been in an AL home for almost 6 months now, and I've since moved them into Memory Care. I think my Dad is doing better, and they really know how to control the meds. there. The psychologist at the home did tell me that it would take 6 months for them to get used to the change.
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I feel for you. My 93 yr old dad declined pretty rapidly after a fall in December. He hit his head and although they did a CT scan and didn't see anything, I suspect it exacerbated his dementia. You just never know what causes the deterioration, the fall, the natural progression of the disease or the change in location. My dad was going to adult day care for about a year. In January, he started hallucinating and being combative. They needed to change his medication and he ended up the in the hospital for 3 weeks while they got him balanced again. From there he went to rehab for about 2 weeks before he ended up in the hospital again due to flu and pneumonia. Between the hospitals and rehab, it was all very destabilizing. So all I can say is that sometimes the nursing home is the best place and with the progression of the disease you want them to keep from falling but sometimes this is indicative of the next stage of the disease. It sounds to me you've made very wise decisions and that the illness is taking its course. Try not to feel guilty. Best wishes.
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Aveeno, we had so many of the same feelings you do and our family still talks frequently about guilt feelings for "putting" grandpa in the nursing home, even after he passed. My mom was convinced that if we took him home he would try to walk again. But we have no idea whether that actually could've happened. My mom was risking her health caring for him and I have my own little family and could not help her as much as she needed. We could not afford the 24/7 home care.

He was definitely happier and content at home but he was also declining really quickly, and was not safe. Most of the time when we walked in the house he was asleep slumped over in the chair. He was starting to brace objects against the door when we weren't there and when my mom left for a couple hours one evening he fell (after prior repeated falls) and broke his leg. I just keep telling my mom that if we'd brought him home he would have fallen again, and maybe worse. There are only so many times that can happen before someone else would step in anyway and make sure that he was in a facility.

Some days the NH wasn't bad, other days you'd cry after the visit, but at least at the place he ended up in (after changing facilities) he was rarely falling and the people there knew him and liked him.

It is just a really sad and imperfect situation. I feel like if the person is having their physical needs met, are safe, and know they are loved by family (or friends), sometimes that is the best we can do.
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I would blame her decline on the disease rather than the environment or conflict with another resident. My mom moved from AL to the memory care wing about 15 months ago. She had conflicts with a male resident who was loud, gruff and said inappropriate things. Once, mom tried to kick him and fell backwards, into the arms of a staff member who was rushing over to deal with the situation. Mom also had other incidents of aggression which the staff thought stemmed from the presence of the male resident. Then, the male resident was moved to a SN facility (and died a few weeks later). My mother's aggression changed very little, so meds were added and adjusted. I don't like that she is on these meds, but I understand that there is no good alternative. The AD is causing her actions and her decline, not the other residents or the staff.
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I understand your concern. My mom has Alzheimers and lived with me for 2 years. Like your mom, she was pretty happy living with me (even though in her mind she was just visiting) and going to day care (which was work or school depending on the day).

She moved to memory care in August. There were times last year where I second guessed myself if mom should have stayed with me or not. Not so much anymore. Remember dementia is a progressive disease, she will get worse and she may have other health problems. I don't want to sound discouraging but all those falls may indicate more problems are coming. My mom was diagnosed with bladder cancer last April, she is now under hospice care. She is highly anemic and has several falls and trips to the ER. I can honestly say now, that moving her to memory care was the right thing. 

It's never easy, just take heart that as she get worse your mom is in a place that can care for her at all stages of her disease. Also, I like you,  am not equipped to be a full time caregiver; I did not want my home to be a 24/7 care center. Now when I see her, I am glad she is not with me - I miss her terribly but I am not able to care for her like I could one year ago.
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Aveeno

Most folks at mom's memory care which is not a nursing home are in wheelchairs and slumped over

Mom at almost 94 is one of the few that still talks

Nearly all are on anti-psych meds and some rapidly decline and a lot don't eat except dessert

I too would rather have mom at home but caregivers are unreliable and she was running away from them and falling

She has fallen at memory care too and so I have private caregivers with her 12 hours a day and it's still not enough to prevent UTIs

She scratches aides too and cusses them out
We switched from one drug to a second which helps a bit more

As I understand it NH are under pressure to reduce psych drugs and xanax may not be the right one for your mom

Does mom have her own doctor or she only seen by the NH doc?
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Granjan makes excellent points. I'd inquire of any issues at the NH that are of concern and explore if they are trained to deal with the issues that your mom is having. Based on my experience, the Memory Care facility was much better equipped to manage the needs of my LO, who has significant dementia. Of course, if the doctor says that she needs skilled nursing care, that has to be honored. Do you know if he meant that she needed around the clock care or skilled nursing care. I'd check that out.  Regardless, she shouldn't have to endure unacceptable behavior from other residents. 

I'd also keep in mind that the abilities of the person with dementia may fluctuate. Some days, you may see what looks like an improvement, but, the next day, it's much worse. I learned to expect the unexpected.
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