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She really would have preferred to stay at home, but repeated trips to the ER after falls finally convinced her. But she hasn’t left her room since she moved in. Says the planned activities aren’t interesting. Hasn’t gone to the dining room, has all her meals delivered to her room. She sleeps most of the time. She had mobility issues before the move (pain walking, used cane, walker or scooter) but it is getting much worse and now she can barely make it to the door and she is in a studio. She has med manager telling her she needs to walk, as well as her doctor and family. It’s like she has given up and is just waiting to die. She has mild dementia with hallucinations and delusions. Not bad enough for memory care, but we are now trying to figure out if she should be in AL. Cost of care would basically double. So far I have been paying majority of her expenses until her house sells, (closing is the end of this month) at which point I will be reimbursed. But with the added cost of AL, her assets will only last her about 2 1/2 years. And she makes too much for Medicaid. Not really sure what you can tell me. Just concerned about her lack of will to survive. And she is on antidepressants.

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My mother moved to MC in December, as well.

It wasn’t until THIS month, that she came out of her room for something besides meals. She has also quit sleeping all day. She is now out in the activity room doing puzzles, and bingo, for goodness’s sake. Both are activities that she would NEVER have done in her previous life!

What seems to have made a difference, is attention by a geriatric psychiatrist. They switched her anxiety and depression meds. It’s been a miracle!

Best wishes to you.
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When she moved in what she asked to quarantine for 2 weeks?
Has the IL facility curtailed a lot of the activities?
It is very possible that she does have some depression.
Since she is in IL can she come and go? If so would it be possible to set up a "date" with her take her to lunch once a week. It would give he something to look forward to.
I can see where it might be difficult to meet people and get to know them when everyone is wearing a mask and you can not "read" facial expressions.
I would next time she has a doctor's appointment mention the isolation and see if she can be reevaluated for the depression, it is possible that a medication adjustment is necessary. With the diagnosis of "mild" dementia it is possible that with the move, the isolation that her dementia has caused a decline.
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Taking that first step to sit at a table for a meal or go on an activity with strangers is a challenge for most people — even harder with pain, mobility issues and cognitive decline. If you are able, join her for meals in the dining room and help her to make some friends. Once she is comfortable at meals, activities may come. If you are unable to be there, you could see if there is a consistent volunteer who could help her for a few days. Having a physio therapist visit would help her get moving. When you visit, try getting her out of her room, even if it is just to walk down the hall, sit outside or in the lobby for your visit — anywhere she can be around people. Finally, regardless of what stage in life you are at, people need purpose. Get her a plant she can care for and watch grow or a beta fish in a 2 gallon tank. With my Mom, they had an activity room we could book for Sunday dinner. My sister cooked dinner for Mom or we would order takeout. When the room was booked we were given a separate table in a corner of the dining room. Regular Sunday dinner was something for Mom to look forward to every week. Hope things work out for your sister. Things are much tougher now with COVID and visitation limitations. Hopefully once everyone is vaccinated, things will improve. Take care.
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sazure Mar 2021
Please don't get a betta fish. I used to do betta "rescue" from a NYC pet store (most dying from wrong environments, and they would flush them live down the toilet. A horrific way to die in chemicals and not fast!) One woman there even got a disease from her hands being in their tanks water (which I knew of and gave her info to take to her doctor).

I raised aquarium fish since a small child and they require more care than imaginable. (and studied fish Ichthyology - diseases, in college).

Betta's appear to "get by" as they can breathe air from the top surface if the water is foul, which it easily can be. Filters need changing (and a two-gallon means most often the "flow" from the filter is too fast for these fish). I kept mine in huge heavily planted aquariums, with schools of catfish. (even in a 70 gallon with other appropriate fish). (dampered the water flow from over the back filters)

The get fungus, little tears in their fins which turn into fin rot, and other diseases which are hard to spot at the beginning, when they can be better treated, for the untrained. (and harder to heal). They feel pain esp the mouth and death to them is painful as well.

"""""""""""https://pethelpful.com/fish-aquariums/diseases-of-a-Betta-fish""""""""""""

Plants yes indeed!
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It sounds as though she definitely needs assisted living. I am assuming, since you decided this was a move that needed to be made, that she was not getting out of her house a whole lot either?
You don't give us an age. I know that my brother, not overly social, did have a bit of adjustment in ALF where he had two rooms. He gradually did get out and socialize a bit more, and take part in things. There may be some adjustment.
And again, you could be correct. She may have lost interest in living a life that consists after one loss after another. This is normal for some people. They honestly tire of it all, and would prefer it were over. It isn't an unreasonable option. You say that she is on antidepressants. Do let the doc know that this particular medication doesn't seem to work for her. There are other options. But eventually you yourself may have to accept that this is where she is at now, and that things may not change a lot. I am so sorry, and wish you the best.
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Geriatric psychiatrist for sure!

If the current med regimin isn't working, then another needs to be tried.
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She definitely sounds like less of an IL resident and more of an AL resident. I am surprised with her dementia they let her into IL as usually they will do a cognitive assessment. She probably needs more eyes on her. Where my dad was in AL they wouldn’t allow you to have all your meals in your room...only if you were sick. Getting them out to meals is part of an activity and socializing.
Sure sounds like depression with constant sleeping, no socializing and waiting to die. Is she on anything for depression?
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Sounds as if she has given up. And just wants to sleep and never wake up. I'm sure you have told her if she doesn't walk she will lose what mobility she has. Antidepressants are not the cure all. She must want to get better.keep visiting,calling her, encourage her, support her. And the staff needs to do the same..it took me over 10 years to come out of my depression. The biggest thing is she MUST want to get better, she is like the little baby elephant who got stuck in the mud and mama was trying to move the mud and aunts and uncles then a whole village of men came to help but the baby elephant had to take the steps he had to accept the help and walk out of the mud. Noone could take the steps for the baby the baby had to take the steps. So as we say she is stuck in the mud. Keep putting out the help but she has to accept the help and grab onto the. Branch and take the steps.. Good luck, may your sister get better quickly. God bless
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Sorry as I didn't read all the responses and may possibly repeat some things.
I experienced this problem over and over for the nearly 20 years I worked as a nurse supervisor in both AL and memory care. Does her facility have an "ambassador" program? This is someone on campus who can spend time with her (encourage her to participate in meals and activities) until hired help can be found. Finding our reason(s) for remaining motivated when we get into our senior years is perhaps the hardest thing any of us will ever do. With age we will all require a different level of "attention" and your sister is tipping the scale in this area. While my prayer is for her to have longevity, my greater concern is for her to enjoy what time she has remaining. It's all about quality, not quantity. During my career, I performed my own personal assesssment for each admission which concentrated on 5 hallmark areas. Nutrition, Hydration, Exercise, Rest and Stress Management. Under stress management is found pain/discomfort. My greatest concern is for your sister to be pain free. She will never move on (and will only digress further) until she is physically able to do so. Opioids may address her pain but have awful side affects--mostly constipation! Tramadol (Ultram) is better but can make her a bit loopey. Certain individuals can balance their depression through exercise but with your sister, she can hardly move so we have to start with baby steps. My recommendation is for her to try CBD oil, a warm soak in a bath with essential oils followed by a gentle foot massage twice a week--to start. Spending quality time with her is what she needs most at this point in time. Cannabis perscribing physicians can be found online and will be able to recommend optimal dosages. Use some of her resources from the sale of the house to hire a caregiver. Not just any caregiver but the right fit for you and her. This is where you'll really have to do your homework; by interviewing for the right person. Someone who she can truly relate to. It will be a lot of work but when you land the right person, it will be well worth it! This caregiver will be someone your sister will REALLY enjoy spending time with, talking to and laughing with. For my seniors who had no remaining friends or family, I always used Reader's Digests' mantra "laughter is the best medicine." Not just reading jokes to them but utilizing other resources like You Tube. Look for Art Linkletters "kids say the darndest things" and Hollywood Squares with Paul Lynn and countless animal videos. For the moment--as long as she's laughing---nothing else will matter and she will begin to regain her quality of life.
I feel your sister stands a good chance of remaining in IL as long as she recieves the attention she needs which will result in her willingness to thrive.

I wish you well and will keep you both in my prayers.

My Best,
Ken
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Once her money is depleted, she will be applying for NH care. She may be eligible for a NH medicaid bed at that time, or may have enough to be self pay at a NH. The facility will be aware of her money and monthly income to help her apply for appropriate program.

She may not really be 'independent' living. Sounds like she needs more care than that. I would ask if IL or AL would send a person to her room to take her to physical therapy sessions. You may also be able to get her doctor to order home-health people who would send therapists to her via Medicare payment. And, perhaps weekly nursing visits. Sounds like she needs to be engaged rather than waiting on her to engage herself. If you can get in to the facility, find out if you could order a meal and eat with her in the dining area. Sometimes people don't feel comfortable going alone into a group. A more extroverted person might be able to get her over the hump
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Yes, she is "bad enough" for memory care. Folks in MC aren't are staring off into space and non-functional. Many of them seem pretty normal, but like your sister, there are some issues that prevent them from functioning independently. That's why she's locked herself in her room -- she absolutely doesn't belong in Independent Living.
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