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The rehab facility tested her before her release and said she was just fine to return to AL, but the AL facility insisted she go into memory care. They said they had to follow state regulations. My mother does not like it there, and I don't blame her. She loves to go and do things, make new friends, play cards, bingo, dance, do crafts. She is capable of carrying on a decent conversation. True she does repeat things now and then. When I asked her why she stays in her room most of the time, she said she's afraid of the people around her. They act strange and won't talk. I made arrangements for her to have lunch with her close friend who used to be just a few doors down when she was in AL. She looks forward to those days. I asked the facility to retest her, but they said they already did. What can I do for my mom to get the care and stimulation she needs and misses?

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Get her out. I live with my husband in a facility that has done the same thing to many people here who don’t need memory care. I have seen their rapid decline after they do this. How would you like to be in a place where you can’t get out? The residents who are truly in need of supervision and are an escape problem act totally different from the ones who still have some brain cells left. The facilities do this because a room becomes available in memory care. They have the opportunity to fill it with your mom so that they can then rent her room to someone new! It’s all about the money. I see it every day. I had 3 doctors write letters on behalf of my husband saying that he didn’t need memory care. They had to back away because doctors know so much more than the poorly educated managers and caregivers that work in these facilities. Don’t let them bully you.
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Reply to DocWife
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Hospitalizations, surgery and anesthesia often cause cognitive decline. Call the Area Agency on Aging, request a visit from the ombudsmen and explain the situation. Ask them to perform a needs assessment. Then see where you go from there. Maybe mom did need an increased level of care after the hospital? Are those services available in assisted living? Will there be an additional charge for them?

Is she in a continuum of care facility? You should not be paying for the increased cost of care. Does this facility accept Medicaid?
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Reply to gladimhere
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State regulations. JUst add any of your own support. Talk to the social worker over there.
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Reply to Parise
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Talk to the Ombudsman.
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Reply to Llamalover47
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Sometimes, post anesthesia, elderly patients may have a temporary decrease in cognition. Perhaps that is why facility assessor suggested MC. Perhaps now, they need to do a reassessment
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Reply to drooney
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Take her to a doctor outside of the facility to be tested. Even if you have to pay for the appointment. You will then know the truth. My mother was suffering with a bad rash around her neck and that nursing facility actually had a wound doctor coming in for 4 months and that poor thing was still clawing at her neck. I went in person to the local dermatologist and got her an appointment and that dermatologist diagnosed Mom within FIVE minutes. She wasn’t getting enough vitamin B and niacin. She wrote instructions and the transport van took my mother back to the nursing facility and I made sure the nurse practitioner read the dermatologist instructions. 3 weeks later, the rash was gone! Wound doctor was paid by Medicaid for nothing for 4 months. That was not his field. To me, it was common sense that she should see a dermatologist. But noooo, they paid a wound doctor to come there! I handled what they would not. Due to what happened, Medicaid paid the transport and dermatologist. Get a 2nd opinion. Like the other person said, call the Ombudsman. I preferred to get my mother seen outside of the drive-by doctors they bring in there. Good luck to you and your sweet mother.
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NYDaughterInLaw Feb 15, 2020
Great answer, Elaine!

Most doctors only know how to order tests and write prescriptions. There is no incentive for them to stop milking the Medicare Cash Cow. It's unethical and causes harm to their patients.

Doctors "study" nutrition for all of about 5 seconds in medical school. 99 percent of doctors have no idea what they are doing when it comes to basic biochemistry and how it impacts upon the skin, which is the largest organ of the human body! Nutrition is basic biochemistry.
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Her cognition may have been affected in the hospital by anesthesia, imaging contrast agents, pain killers, sleep medications. It's called hospital delirium, when patients return worse than when the left. Sometimes they can regain their previous abilities a few months after the hospital experience. Here's a link to an article by Dr. Leslie Kernisan--she has an amazing web site. https://betterhealthwhileaging.net/hospital-delirium-what-to-do/
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elaineSC Feb 14, 2020
YES, you are so right. My Mom had mild dementia and had to have one eye removed and she was a different person after the surgery immediately. Her mind was 3 times worse. She was ranting and railing at nurses at the hospital saying they were “messing around” with my Daddy! It was strange and upsetting. They sent her to AL for rehab and she had to just stay there. The trauma of having the eye removed coupled with anesthesia and some pre-existing mild dementia put her way out there. No way could she go home. She needed 24/7 care then. Anesthesia monkeys with some people more than they are admitting.
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Definitely contact the long term care ombudsman for guidance as they will know the laws and facilities in your area. Hospitalization and anesthesia can have some impact, but one can return to their prior state of functioning. At the risk of sounding cynical, maybe it has more to do with filling beds and making openings...and if you speak of moving to a NEW facility they may be able to have her back where she was...is her same room available??
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Reply to robinr
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What regulation are they referring to that would override an approval to put her in AL? They need to show it to you in writing - the regulation and the agency who uses it. With written document in hand, contact Ombudsman regarding the info you have that said it was ok to go to AL.
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Reply to my2cents
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My Mom entered memory care in April 2019. It was decided she would be there rather than AL. After about a month of complaining she had no one to talk to, and some of the residents were bothering her, she was told she could go to the AL side everyday, and also eat her meals there. She goes back to her room when ever she wants to, and get the help she needs from the staff there. Maybe this is something that could be done for your Mom. That way she could spend time with her friend and do fun activities. The nurse in MC took off the bracelet all memory care patients wear so she could go freely back and forth.
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Reply to brieco322
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My mother got put in MC because she was a wanderer and had figured out many sly tactics to escape the building. She was quite competent in other ways but for her own safety we had to corral her. The staff have been very good about bringing Mum to the other floors to participate in activities. She loves that and never wants to go back to her room but at least she does have opportunities to interact and be busy. Maybe see if the Activities staff can arrange for your Mum to do the same.
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Reply to kaptagat
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Look for another al if possible. Also I believe it’s her right to move. Call your local ombudsman they will help.
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Beekee Feb 14, 2020
Sure, it's her right to move , or daughter's right to move her, but will the place give back their deposit???
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There are mini memory tests online that you can give to her yourself and get a better idea where she scores. To me the biggest telltale sign is when they draw the clock. My friend was in AL memory when he fell and broke his hip. He scored a 14 out of 30 before the fall and a 6 when he was released from rehab. Anesthesia kills the memory. I also think you should have a right to see her test score. Good luck!
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Reply to Barb53
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Which state law are they referring to that they must follow? Did they say anything specifically about how your mom fell short of the AL standard? There has to be an objective standard for both the law and level of care. Due to the rehab and AL's disagreement on her scoring, I'm wondering about the tester also.
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Reply to MaryNTN
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Get her tested by her doctor. If he/she ways she is ok. Then, they will more likely follow the doctor's orders.
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Reply to Taarna
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It is not uncommon for them to have a lower cognitive score after surgery with anesthesia. My dad entered rehab after a fall and as the speech therapist worked with him and retested him his score improved a lot. One thing you could do is have her doctor refer her to a speech therapist (these are the people who do the cognitive tests and help them bring their scores up) and have her tested and worked with. She doesn’t sound like a candidate for memory care from what you say.

You say they re-evaluated her...I would ask them for their test results. You should be given those as part of her medical record. And then ask what their scale is for an acceptable score. Find out which cognitive test they used. There are different ones. Find out which one the rehab used and also what the s ore was. Then start fresh with the ST's evaluation.
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robinr Feb 14, 2020
With speedy discharges, the timing of the testing may be a factor as well.
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They put my aunt in "memory care" where she was locked in (not out and about the facility playing bingo and doing flower arranging) and she had no one to talk to who could carry on a conversation. I thought that she was as sane as she ever was. I believe that she was mis-diagnosed because she had excellent long term insurance and other financial resources that the facility could access as long as she was kept locked up in a more expensive part of the place. They kept adding things to her bill. They would not give her an extra cup of soup without adding it to her bill. If all of that funding stopped, they would have put her out on the street. Within three months, she caught the flu from one of the other patients, and died.
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Teddy2019 Feb 15, 2020
That is so awful. So sorry for your loss. I feel they are doing the same with my mother who pays from her own private funds. How great is THAT for them! I really hate to have to move my mother to another facility, but that is maybe what is going to have to happen. The really only extra help she needs is with her medications. While in AL, we paid the extra $800.00 a month to have the service of the nurse giving her meds to her on a daily basis. She showers, dresses herself, etc. I do realize she has memory issues, such as not remembering the name of the facility where she is, or that I talked to her earlier in the day. I'm just not sure where that line of AL care and MC care is.
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Does the facility state your mother needs MC because of cognitive issues or because she needs more assistance while she recovers from her fall? My father's MC required he have an attendant for at least 1 day whenever he returned from a hospital stay to re-integrate and re-evaluate his care needs. Once when he had the flu, he had an extra "half" attendant for 3 days (half attendant splits her time between two residents). The facility had an AL and a MC wing and tried to keep costs down and as consistent as possible while providing a good care quality. One way they made that work was to add floating staff when a resident needed extra care, usually for a limited time frame.

Does your mother's facility offer extra attendant or sitter care? Would it be feasible to return her to AL if she had some extra attendant hours?
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Teddy2019 Feb 13, 2020
They came to her rehab center to evaluate her with their own MC scale. The rehab facility also evaluated her and didn't agree with the assessment. Upon returning to her facility they placed my mother directly into MC and ask that I move the furniture that no longer fit in her new place in MC. I recently ask that she be reevaluated and they said they did and she is no longer able to be in AL and that they have to follow state law. Doesn't sound like mom will ever be able to be with her friend again. I took her today, to the AL sing a long and she loved it. She could read and keep up with the whole thing and did very well, perhaps even a little better than some!
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I would tell the Facility that your Mother may need to move because of this.
Have you looked at the Rehab doctors discharge papers. General a facility goes by what the doctor says. I would take Mom to a doctor for testing and not leave it in the hands of a facility. At my brother's Assisted Living he is the most mentally aware along with about two others. All others have quite a lot of mental deficit, but are safe, don't wander, can make it to the common room for meals, don't have incontinence, and etc. so they do not need the level of care available in Assisted Living. I would meet and discuss with the facility to find out exactly what they are seeing that they think requires memory care in the case of your Mom. If you don't agree, then do consider looking for another facility if they are available in your area.
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Teddy2019 Feb 13, 2020
Unfortunately, there is little choice in her area. She is in the best facility and it is a wonderful place. I would really hate to have to move her to another place. I guess we are just stuck with the situation. I have been requesting that she participate in the AL activities and she has been doing some things. Today, she and I went to their sing-a-long and had a great time.
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You'd have to move her out of the MC she's in now and try to get her accepted into another regular AL at this point. The ratio of care givers to residents is much lower in AL than in MC, so if they feel that your mother requires more care, they'll insist she stay in MC and they're not likely to change their minds.

My mother faced the same thing after she was hospitalized for pneumonia last May and then went to rehab. She became wheelchair bound and her dementia did go downhill somewhat after that whole traumatic event. So the ALF refused to take her back in the regular building where she'd lived for 5 years, but agreed to take her in Memory Care. She constantly says she'd rather go back to the ALF but truthfully, she's in no shape to do that even though she IS higher functioning than some of the other residents. She constantly says she's 'afraid' of one of the men there, but she has no reason to be. He's not violent and she weighs twice what he does. She's just put it in her mind that she's 'fine' and they are all 'nuts' and 'stupid morons'. I have to let a lot of what she says go in one ear and out the other because truthfully, she DOES have dementia and she IS incontinent, etc., and she's not in much better shape than ANY of the other residents. Just marginally, and with dementia being progressive, it's a downhill slide ANYWAY, if you get my meaning. My mother loves to complain, so even if I were to move her to the Palace of Versailles, she'd find the gold to be tarnished.

At this point, I can move her out of MC myself, but I KNOW that no other ALF would accept her. If you truly feel that your mother is not MC material, then look around for another ALF you like. She'll need to be assessed, of course, before they will accept her. Again, they all have criteria and only want residents who are pretty independent and not in need of TOO much care. My mother was beginning to become burdensome before she got sick last May, and I feel like the ALF was waiting for their opportunity to move her to MC. They let her get away with needing a lot of extra care for about 10 months before the incident.

Wishing you the best of luck.
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Reply to lealonnie1
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Teddy2019 Feb 13, 2020
My mom isn't a complainer, but she does complain that the days are long and she doesn't see anyone. However, she also tells everyone that she never hears from me, even when she just face-timed with me and the great-grandsons that day. I guess, it's just going to be what it is. The problem is that MC is $1,000. more a month and that puts us a little short each month.
It's not enough to cash out, so I pitch in. That's not good for my bottom line, but I don't see a better alternative at this point.
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