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My aunt for whom I am the POA was moved from Independent Living to Assisted Living at a Brookdale facility in March. She has Alzheimer's dementia. She was originally assessed as needing only medication administration and being reminded when it was mealtime-also she had a companion go with her to appointments and to the store. I have taken over her finances.

After she threatened to commit suicide to the director, she was taken to the ER but declined to admit herself (she denied making the threat when the psych team finally arrived). She doesn't have a Mental Health Power of Attorney so they released Her. The facility mandated 24 hour care for 72 hours.

To make a long story short, although as her POA I approved some daytime private companion care for her, when I got her invoice at the end of May I was floored because they had kept the 24/7 care. Their justification was that one night at 9:00 she tried to leave her companion and walk out of facility toward her old apartment, which she insisted was still her home. Then there was another incident where it was logged that she woke up agitated at midnight, went out into the hall yelling, hit the companion, and it took another companion to get get her to the nurses station to give her a tranquilizer.

I told them she couldn't afford 24/7 care and had never been told this was a possible cost when she moved to AI. I was told her maximum personal service fee (above the 4000+ room and board fee) would be $1500. They also tell me she is "not ready" for the memory care unit which would be a flat fee which is more than the base room/board/personal service fee of AI, but about 1/3 the cost of the latest invoice with all the private duty care they slapped on her.

They made some cuts to the # of hours of daytime care she gets but have kept the 10PM-7AM care in place. I have basically told them I need to know what hours they were mandating (not suggesting) private care as a condition of her staying in their facility so I can determine if I need to have her moved again. The care manager I hired for her (we live 2000 miles apart and I am her only family) will be meeting with the administration to tell them their night time logs she asked to see do not justify night time private care.

My question (finally) is- shouldn't assisted living facilities provide some level of security more affordable than private companion care at night for residents with dementia who they say are not ready for locked memory care unit? Especially for someone who never tried to leave the facility until AFTER they imposed 24/7 care?

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It is my aunt, not my mom. As I said, I had no reports of her trying to leave until after she was given companion care. My question was the same as yours-how do I know it is not the experience of strangers being in her apartment at night the cause of these two incidents? That was also the only incident reported to where she hit a companion. When she awoke, and went running in the halls yelling and the companion followed her.

I will ask her to check out the memory care unit, in the event her condition progresses to the point she needs it. It is on the other side of the floor she is living on now.

My understanding is that during the day and evening hours she does well with companion care and it helps her more fully participate in the activities. She doesn't need one at her meal times or when she is napping during the day.
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If she is in danger of leaving the premises and/or she is a behavioral problem (hitting people) she needs to be in a safe place with sufficient trained staff to see to her care. Whatever the ALF's protocol is, you are in charge of where your mother lives. If they think she is "not ready" for their memory care unit, find another place that will accept her.

Do you think your mother is becoming a "wandering" risk?

Is her behavior out-of-bounds?

Or does she just not like a stranger in her apartment all night?

I can understand that they are not prepared to to provide security for Alzheimer residents who wander or are violent, but then in the next breath to say she doesn't need memory care seems totally inconsistent.

What is their memory care unit like? Has the care manager checked that out yet?
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They provide whatever services are ordered by the doctor. No more, no less. If she is suicidal, she gets a suicide watch.
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