Must mom (aged 66) who is Bipolar, chronic UTIs, and short term memory issues go into assisted living?

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Mom was recently hospitalized for disorientation, confusion, and memory problems due to a bipolar episode and an untreated Urinary Tract Infection. Mom has had Bipolar since 1981, and has complied with taking her medications. Her psychiatrist switched her psychiatric drug 3 months ago, so her bipolar was triggered. Mom claims that she had no sypmtoms for her UTI. She has been successfully living by herself for 10 years, after her last bipolar hospitalization, except for hygiene problems.

Due to the medications received from her hospitalization, Mom's bipolar is under control, she has no confusion, and she has no UTI. However, the rehab center has discovered that she has short term memory loss due to Mild Cognitive Impairment. The rehab center now claims Mom should go into Assisted Living as that is the only way to ensure medication compliance (she takes over 12 pills a day); daily bipolar mood checks; and socialization with other seniors. Mom wants to live in a rental apartment near me. I, home health aids, and frequent psychiatric visits will ensure that her bipolar is under control, she has medication compliance; and she has proper hygiene.
This rehab center takes a very dim view about a patient's ability to handle Bipolar, and feels Assisted Living is the only way to go. During her life, Mom has been able to control her Bipolar without Assisted Living. Given Mom's short term memory issues, bipolar and susceptibility to UTIs, must Mom go into Assisted Living? Which medical professional can I ask that would give good advice? Many psychiatrists seem pretty lazy, and just want to prescribe pills instead of giving practical advice.

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Thanks everyone for your helpful advice. I agree with all of your answers, and it is nice that there are people out there like all of you who will take time to give someone their perspective.
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sounds like the rehab center is affiliated with or taking kickbacks from ALF in the area. hospice sometimes pushes AL too. the staff and family provide all the care and hospice makes more profit. the conflict of interest is so great that in 2013 medicare will cut the amount of daily pay to hospice for people in institutions.
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I think that if she can take her pills and does take her pills and does not want to go to assisted living you should leaving her to live independently. She also may want to find a new rehab center. Most Psychiatrists are lazy and pill pushers.

Are you willing to check in on her every day to make sure she takes her pills and is taking care of her self? If the answer is yes, then let her move close to you and work from there. And no they cannot make you move her into Assisted Living.
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Nobody "must" go into Assisted Living. It is an option, and sometimes it is really the best option, but it is not a requirement.

Could Mom consider a 6-month trial? She could move into an apartment near you, but with the clear understanding that it is temporary, to see how it works out. Or she could move into Assisted Living, with the agreement that she'd try it for 6 months and re-evaluate it then.

Mild cognitive impairment is not in itself a compelling reason for assisted living, but with the other complications here my personal guess is that Mom would benefit from (and deserves) the support and the social environment of a good ALF. But it also sounds like she has done an extraordinary job of managing a very difficult disorder. If she feels strongly about it and you think you can have the support in place for her to live in an apartment, then that may work, too. Be aware that mild cognitive impairment may get worse over time. Even if she is able to be in an apartment now it may be necessary to make another decision down the road.

You mom has been very successful in a challenging situation. Above all she should not feel that ALF represents failure. The goal is to get her into an environment that will best support an excellent quality of life.

Have you visited some ALFs with her?

If Mom has been seeing a geriatric specialist for her primary care provider, that would be an excellent person to discuss this with. The rehab place is naturally looking at the general bipolar population. They don't really know your mother. Psychiatrists are typically medicine mangers, and often refer patients to someone else for talk therapy. Her psychiatrist may or may not know her well enough to give good individualized advice about her living situation.

Bottom line is that you know Mom best. You and she should talk this out. Don't make any "permanent" decisions. If she tries out ALF or an apartment now, plan on re-evaluating the decision frequently.

Bless you for your thoughtful caring.
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