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My mom has been in an ALF for 4 months and, as I have written, is a natural introvert. It has been very difficult to get her out of the room. She is going to a few activities but likes to eat in her room. The dining room gives her anxiety due to the noise and number of people. She is not a natural social person and the thought of chatting with the other residents just scares her.
I am noticing an increase of apathy and some signs of depression. During my visits I try to get her out of the room so she can interact and get more comfortable but it does not seem to be helping.
Should I consider a doctor’s visit for possible medication to help her? How do you know if this is a sign of the disease progression or a result of the new environment?
Should I give it more time since I know many patients take longer than 4 months to adjust?
Thanks, as usual, for your guidance.

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Edit: *She* is normally a person who prefers quiet.
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Reply to Llamalover47
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Msblcb: Tbh, I cannot blame her for not wanting to eat in the perhaps noisy dining room, especially if she PREFERS to be alone. Perchance that would be torture for her as is normally a person who prefers quietude. She should be seen by a physician who comes into the facility routinely.
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Reply to Llamalover47
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I wouldn't make her eat in the dining room. I've been in a NH. The dining room is the worst. Noisy. Let her eat in her room if she wants to.
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Reply to Becky04469
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I whole-heartedly sympathize with your mother. After decades of home office self-employment I am now working with a team (whom individually I love) based in an office (which I hate with a passion). I can't hear myself think. I can't stand the conversations. I want to strangle people.

And I never, ever eat either there (we have a little kitchen area, people heat up meals and lunch al desko) or in the organization's canteen. The thought of a meal or even a snack in this bear garden turns my stomach.

If your mother is going to select activities she is doing well. Encourage it, and seek out additional opportunities for enrichment - not necessarily in the ALF, or perhaps of a kind that three or four of the residents could enjoy together.
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Cover999 Sep 27, 2022
Is the bathroom situation there at least decent?
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Perhaps provide a few opportunities to invite one resident to join you and her for dinner; you can provide the fake candles and tablecloth! Perhaps the activities director could choose a few that she might enjoy. When she finally clicks with someone, you can back out or continue on.

Bon Appetit!
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ConnieCaretaker Sep 27, 2022
I meant to say to dine in Mom's room or outdoors if possible.
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What "apathy and signs of depression" are you noticing?

Are you an introvert? Do you understand how exhausting it is for people like your mom to socialize? She's going to activities. Just because she wants to eat her meals in peace in her room does not suggest that she needs medication. Introversion is not a mental illness.

Most introverts prefer to socialize one-on-one. Maybe she'll make a friend but that takes longer than 4 months. Ask the social director if there's another introverted woman who might be a good match for your mother. If so, ask her to arrange for the two ladies to have tea/coffee for two.

Perhaps she would also benefit from talking to someone who cares about her feelings. I'd get the pastor/chaplain to visit her.
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Reply to NYDaughterInLaw
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In most ALF or other facilities there are patient care planning meetings to which the PCG/ POA is ( should be invited) to attend and participate, as well as the patient ( if able ). The patient and PCG presence with the team may also be a good place to further assess your mother's adjustment to ALF and/ overall status; as well as to explore your questions. You of course can and should ask these questions with the ALF staff / physician as they arise if you wish; you do not have to wait nor should you . But attending the
" care plan" meeting is also a good idea even if you have already addressed the concerns.
A main priority is that your mother remain safe. Having her faith leader and/ or a facility Chaplain visit her regularly is also an excellent support for her and yourself. Regular visits from the Social Worker also may be beneficial as well as offering any 1:1 volunteer companionship services as available.
It is always good to honor " patient rights" which is that the patient has the right to refuse as well as accept various care, activity, dining etc etc experiences; as long as the patient is safe and not harmful to self/ others
It often does take more than 4 months to adjust to a transition of any nature. Looking at change through " the lens of grief" helps us to understand that your mother may indeed be " grieving" the need for change and placement; this is natural. A chaplain or a social worker can help address this perspective with your mother and/ or you.
Your self care is important so be sure to see your doctor, practice good self care ; some people say being a parent is hard; well being an adult child brings difficult changes and is hard too.
Blessings......
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Reply to janicemeyer18
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When you were arranging her moving in, did you explain that your Mom is an introvert? Does the care team see a problem?
You say she is going to a few activities, that might be enough for her.
As an introvert myself, I can tell you what creates a situation of apathy and indifference..being forced into social engagement. It is exhausting and generally annoying being around people for very long.
The whole "lets go around the room and say a bit about ourselves" meet and greet...is the very definition of HELL for an introvert.
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Becky04469 Sep 27, 2022
very true
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You might speak to the social director (they have various titles usually suggesting joyous life). That person may have ideas for drawing her out, or finding an individual interest. I would not expect an older person to change in any profound way. I live in assisted living and it is full of the usual diversity of people. Some very nice, some less, cliques, romances, etc. It is a bit like high school but not as difficult. I would agree about talking to her doctor. I used to work in nursing homes and have relatives in them. I thought the medical care of the house doctor could be a problem. Too many people to see, too reliant on nursing's evaluations and suggestions about numerous patients. I worked as a consulting psychologist and was able to spend more time with a person and to give suggestions to the staff and overworked doctors. They usually accepted and appreciated them. If possible, you could take your Mom to a geriatric physician privately to get an opinion. However, there was a bill my company presented to the insurer or family. Still, even one visit often provided a different perspective, and you might see if such a service is available. And I could stop by unofficially to check on things. A real problem is the medicare is such a pain to work with, paperwork wise, and pays so little, that a serious doctor who wants to spend time and effort rather dreads the consults. A very philanthropic and/or terribly overextended physician is usually who becomes involved. And they do have to make a living and pay overhead.
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Reply to Moxies
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So sorry you are working through this, and yes it can take a long time for a LO to adjust to a facility. My mom has been at a wonderful nursing home (NH) for 2 years and still has not adjusted as I would have like but she has adjusted her way.

That is part of this process. We can hope and want our LO to adjust in a way we think is good, appropriate or to meet their needs. But at the end of the day, they "adjust" their way. Letting go of our own wants or what we think is "an appropriate adjustment" is the hardest part.

In my mom's case, the facility has so many daily activities: group exercise class (one can do this from one's wheelchair as needed), a daily movie in a movie room, outings in to their beautiful gardens, a game room (lots of folks there all day), a library, "hallway bingo" (one only has to come to the door of their room to play with others in the same hallway, a beautiful dinning hall and one can get dinner from 5 to 7, NOT at a specified time).

My mom will have none of it. Instead for the last two years she eats all means in her bed in her room, won't get out of the bed unless necessary like when they take her for a shower. Will not leave the room for any reason, except for that 2 times a week shower. Won't engage with anyone other than the aides and medical staff there. Has the TV blaring 24/7 (she has a private room), the lights are out and the blinds are closed.

Yes, the psychiatrist on staff, psychologist, her geriatric MD, the social worker, all have tried. And yes, she is on two different Rx meds for depression and anxiety. So after 2 years of this it just is what it is.

So I have had to let go of any hope she might "adjust" in a way that she'd "make friends there" or "engage in activities." So she has adjusted and it is her way, not what I had hoped for. But I have accepted that.

This is a tough journey. Give yourself time to adjust too, you both are going through this in your own ways. And finding ways to let go of what you want for her "adjustment" may help you both in the long run. She has to adjust in her way with her care team, they are not new to this (they've seen it all before), and all you can do is let "the adjustment" whatever that may be happen in the time it takes to happen.
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Msblcb Sep 27, 2022
Thank you for your comments. I think my effort is because I want to see her "happy" but what I am realizing is that she may be happy as she is (not my definition of happiness) but her's, none the less. I am trying now to meet her where she is at rather than try to change her. But, thank you for your comments. Very helpful.
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Your mother may be a good candidate for therapy or counseling from a trusted advisor. If she's religious, it could be a religious advisor. Her facility may be able to recommend a therapist who understands geriatric care. My mother's facility brought in someone to speak with my mother. I don't know how helpful it was, but I thought it was good for her to have someone talking to her who was focused on her needs. I also got my mother a simple radio and told the staff what kind of music she liked. The staff had to turn it on for her. She had advanced dementia, and wasn't verbal, but I think she enjoyed listening to music. If your mother likes TV she can also use it as background, but find channels that don't produce anxiety. It's good that your mother is going to some activities. Some people prefer to be alone. I wouldn't worry about it. If she wants to sit outside on a patio for a couple of hours at a time and do nothing, or in her room, let her do that. Moves are difficult for seniors, having to get used to new people, new routines, and a new environment. Hopefully in time she'll settle in, and she may find people she likes to be with, in time. All the best to you both.
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Reply to NancyIS
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Interesting, all these solutions involve some type of medicine.

Maybe it is a depressing atmosphere that you don't see. Regarding her eating in her room, good for her, dining room could be a den of gossip with some residents smiling in other resident's faces and talking about them behind there back.

There was a tv show that mentioned this, where the woman smiled and talked to people that passed by her, then as soon as they were gone, she talked about them.
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lealonnie1 Sep 24, 2022
Interesting how you always have a wealth of television show knowledge to share here on Aging Care, Cover. Which is about as useless as, well, tv show comparisons to real life situations. You forgot to mention the Pit of Venemous Snakes the OPs mother could also possibly encounter in the Horrible & Treacherous ALF dining room. How would Uncle Phil guide you out of THAT scary situation? 🙄
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Doesn't your mother have a doctor coming into the ALF to see her regularly? Mine did, and saw her at least once a week. Then the PA (or the NP, she'd see either one, rarely the doctor herself) would call me after the visit and we'd have a chat. That is VERY helpful to set up if you're not already doing so. Then you can speak to to the care provider about your mother's apathy/depression and whether it's a good idea to get her medicated. My mother suffered from depression from 2011 when she got very sick with GI issues and had 2 hospitalizations; I called her PCP right away and told him she was DEFINITELY depressed, so he agreed to put her on Wellbutrin. She immediately had a complete turnaround with the Wellbutrin and started feeling much better, eating, going out again, etc.

I suggest you set up an in house doctor at the ALF and get them to call you after each visit with mom. That is THE most beneficial thing you can do is to have that direct line of contact with her health provider. And the meds can be ordered and delivered straight to the ALF once the provider orders them.

Good luck.
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Msblcb Sep 24, 2022
Good idea. She is seeing a house doctor but the communication with me is not as thorough as it should be. I am asking for updates rather than being told proactively. I have set up a session for this coming Monday. Mom has a terrible head cold and I think it has effected her ability to taste. She is not eating enough. My plan is to discuss those issues along with perhaps an antidepressant/appetite enhancer. Thank you for the feedback,
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I think it would be a kindness to your mother to have the apathy and depression addressed. This is common, my dad certainly dealt with it and a low dose of Zoloft was a big help
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Reply to Daughterof1930
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Ask the social worker at her residence who they use for consultations for their residents.

”Differential diagnosis” is part of a good psychological or psychiatric or neuropsychiatric evaluation, and a good exam er will know what to look for.

As long as you’re supportive and affirming of her new residence you don’t need to be overly concerned about the specifics of your mother’s situation or how to address them.

In my LO’s case, we consulted a psychiatrist recommended by her facility because she was quite obviously intensely anxious and distressed early on, but with small doses of well chosen medication and some focused encouragement, she was enjoying her “hotel” by about 6 months there.

We received a document indicating that my LO has dementia after her eval was completed, and it turned out to be a HUGE help to support her POA.

Do your research with the social worker. You’ll feel better when you have at least a tentative plan.
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Msblcb Sep 22, 2022
Thank you! Wonderful guidance!
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