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My 88-year-old mother has been declining mentally and physically for about a year. It is no longer safe for her to live at home on her own. We have found a senior facility that we really like. But, do we place her in assisted living or place her in the memory care unit? The facility did an assessment and told us she is right on the verge of needing memory care. Although she has dementia, she can still carry on conversation and enjoys talking to people. I fear that if she is placed in memory care there will be little stimulation, as most of the residents appear significantly less mentally aware. However, if we start her out in assisted living, we may be faced with needing to move her to memory care within a few months. Have any of you faced this type of decision?

I faced this exact same dilemma a few years ago. At the time, I couldn't imagine my mother being happy in the memory care section of the assisted living facility. It was going to be a huge change for her to even move into assisted living from her home so we opted to hold off on memory care until her dementia was further along. At the time she was not a wanderer, sundowning was minimal and she could easily carry on a conversation. At first she enjoyed the many activities but after about a year and a half, she was much more confused and quite frankly wasn't interested in crafts, movies or happy hour parties. Eventually, the staff said she tried to wander on "field trips", she rarely talked with the other residents and she needed much more prompting for daily life activities. She seemed ready for memory care, so we moved her to that section and even that was easier because by then and we just told her she was going to a new room that was better for her. Within a day or two she was settled in and in all honesty felt safer with more care. I was glad she had enjoyed that time in assisted living. It probably took more work to move her twice but she just wasn't ready. If your mother is not at risk of trying to leave or feel confused by the freedom of assisted living, I would encourage you to place her there and then move her to memory care when needed.
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I agree with finding a facility that has both AL and MC in same facility, if possible. If she has to be moved, it's easier that way. Who did the assessment saying that she was close to MC? I ask because, I know that someone with dementia can progress really quickly to need MC AND they can really struggle in an AL if their needs are great. That happened with my LO and it was not only hard on her, but, very stressful for me. I didn't know that much about MC when I placed her into AL. They did assessment and thought she was fine for that level of care, but, her needs changed quickly.

Due to the level of care she needed, I got daily, sometimes more, phone calls from the AL. There were so many things that she needed help with. She went to a wheelchair and bladder incontinent. Plus, the resistance to care....AL staff are not just trained to manage the care of someone with dementia, like MC are. They will remind residents, but, if the resident has short term memory loss, they forget soon after the reminder. And, they need lots of prompting to bathe, bush teeth, change clothes, eat, etc. Based on my experience, someone with significant dementia, even if they are verbal, are not going to be fine in a regular AL.

When I moved my LO to MC, she immediately relaxed and was able to get the one on one attention that she needed. And, they allowed her to go to the regular AL section for visits, special occasions, holiday parties, etc. In her case, it worked out. Each person is different.
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Judy79 Feb 11, 2020
My mom was in a MC unit and it seems she started to go down hill from there. When we moved her to another location that it totally memory care only, she seemed to improving some.  She is 89. She still needs help with showers and dressing.  They fix the meals there and keep her room cleaned at all times.

I don't approve of the AL/MC.  From what I have learned, the place where she is now, they started out AL/MC but it didn't work.  I hate the separation from the AL part of it.  Not all who live in the MC should be separated from the AL side.  My mom is the higher functioning in some areas. 

What is your experience where your LO is now?  She must be in a lovely place to have everything done for her like that.  My mom wasn't too lucky at the first place she was.
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We started looking at AL because of mobility issues and mild cognitive impairment. Three years later, after a fall, we went directly into MC at the recommendation of doctors/rehab. It had to do with his ability to handle Activities of Daily Living (There are six basic ADLs: eating, bathing, getting dressed, toileting, transferring, and continence.) He was at high risk for falls and unable to anticipate bathroom needs, so we needed someone to check in on him hourly and that could not be provided in Assisted Living. In Memory Care, there was no reason WE could not take him to any of the activities in the building provided to the rest of the people in AL (including dining) but could not count on the aids to do that for him, as they couldn't be dedicated. So they preferred someone to come in with activities/church service and preferred he eat in the MC dining facility. The only problem was that the residents of MC were not all mentally in the same place, so it was difficult to find activities appropriate and interesting for them. Meals were not social but something for the aids to get through. Yes, I think lack of stimulation/companions of his choosing made his dementia worse. It was isolating. Be prepared to supplement with your own activities, visitors, go together out to meals and other venues, etc. Give your loved one some control back over his/her life. I really think this is the key to staving off the inevitable.
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Respect2honor Feb 23, 2020
Thanks for the very helpful post.

Yes, indeed. The practices you describe in the model of care can "Give your loved one some control back over his/her life."
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It seems that a lot of folks fall between AL and MC.

My LO fell between the two and continues to do so after a year and 9 months of residential care.

It was VERY TOUGH for me to accept the recommendation of the center that she needed the locked MC placement, but they proved to be absolutely right.

There is PLENTY TO DO in her MC unit, and higher functioning residents can go to religious services, concerts, the beauty salon on site, and MANY other activities with the higher functioning AL folks.

Socialization and boredom are NEVER concerns in her residence. Look for good programs before you choose......
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disgustedtoo Feb 11, 2020
BINGO! Mom's place has activities, even field trips for those capable and willing, hairdresser, sometimes join in special activities or events with the AL/IL sections, etc.

My suggestion was to visit the MC area again, preferably at meal time. You would see a much better representation of all the residents. At other times the only ones you might observe in the "common" area might be those who are more challenged, physically and/or mentally, who require more care. Others may not be present, so you don't get the full picture.

Mom's place (and her residence) just started year 4. Those who moved in at the same time and similar level are gone. Others have moved in/out. There is always a mix of capability present in her place, and various activities geared to the resident's interest/ability.

Always go several times at different times of the day to get a better idea what ANY facility offers.
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Right now, living alone, there is little activity to keep those skills going. With the stimulation and activities of assisted living, she could easily improve and thrive. I would place her in assisted living. Give her the benefit of the doubt; don't hasten her decline. Think positively!
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We moved our Dad into the assisted living side of a really nice facility. They too thought he was borderline, but we went with assisted living. He was only able to stay there for a week because he kept getting out and wandering around and going into other peoples' rooms. We found that the move to the facility from his home of 33 years caused enough confusion to push him over to the need for memory care. We find that the memory care side provides all the stimulation he needs and wants and is a much safer environment for him. Good Luck with your Mom.
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My mother started out in Assisted Living & had to move to the Memory Care annex after 5 years. It's true that the MC is a bit less stimulating and the residents aren't as sharp as our mothers may be, so that's the dilemma. If it were me, I'd place my mother in the Assisted Living section UNLESS she has serious memory issues or you feel that she'd be unsafe using a microwave, or unable to function properly with the independence that's offered in such an environment. Only you can answer that question. My feeling is to put off Memory Care as long as possible, because she'll wind up there until the end of her life, more than likely. So what's the rush? My mother always says she wants to go back to the Assisted Living section, but last night, for instance, she called me at 8:15 pm asking why I hadn't called her. I did call her, 2 hours prior, and we'd had a 10 minute phone conversation. She'd completely forgotten it. Plus, she was insisting it was Tuesday even though she has an Alzheimer's clock in her room displaying the fact it was Saturday.

Wishing you the best of luck.
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disgustedtoo Feb 11, 2020
If she were truly in the early stages, perhaps, but the staff said she is on the cusp. Moving is sometimes hard on dementia residents.

My concern would be more to ask about the other residents. Are they only seeing those who are visible at the time of visit, those who require more care or are not mobile, while the more "with it" residents are elsewhere?

Our mother was the first to move into the newly opened MC (entire IL/AL/MC was rebuilt) section. The other residents vary in capability and progression. Generally in the 3+ years she has been there, the mix has been varied between those who are more capable vs those who need help (or move on, either to another facility or pass.)

ANY MC facility should have activities and socialization to keep the residents active. I would either find another MC facility, or find out if they are only seeing those residents who are less capable (visiting at different times might be more revealing, esp at mealtimes.)
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My mother was also right on the line between both types of units. We weren’t sure what to do. Facility thought she might not engage with people in AL and because there is less staff, she might just stay in room. We also did not want to move her to MC if she declined. We put her in MC and for her, it was awful. She was too high functioning for MC and she had no one to interact with. When we would take her back there, she would get off the elevator and basically run to her room. I still feel bad about it. We moved her to a different facility and she is much happier. I would put your mom in the AL unit and not worry too much about moving her if you need to later.
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Or she may thrive with proper nutrition, social stimulation and proper med management.

I would place her in AL and see how she does. MC is not for someone that can function at all from what I have seen.

My dad improved tremendously by getting the above.
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lealonnie1 Feb 9, 2020
My mother is in MC and can function quite well. Everyone is at different levels of dementia and need in a MC environment, at all stages of the disease. Some are in MC due to mobility issues AND dementia combined; when they become too much for AL, they can be transferred to MC.
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Parents moved to AL 6 months before Dad passed away. Dad was on Medicare hospice status during that time, so hospice RNs, CNAs and social workers came in multiple times a week to check up on him, bathe him, make determinations as to need for oxygen, hospital bed, etc. AL staff was there to check in and help if there were an emergency, like a fall, or a bathroom accident and to get them to meals. We kids were also there almost daily to check in, change the beds, do the laundry, shop for groceries for the apartment (Dad hated the food there and meal times were ridiculously early.)

Mom has dementia. Her short term memory is totally gone. She repeats the same statements/questions multiple times a minute, all day long. She could not help Dad in any way, and actually caused him a great deal of irritation at the end.

Once he passed, the AL staff told us she would need MC immediately. She was assessed as being at a 6 year old level of functioning at the time, less now. While the AL area had good programs and there were lifelong friends living there, Mom became confused and somewhat agitated in any group setting, even family. She could take one or two at a time but not more. She gets more agitated later in the afternoon. She cannot remember to change her clothes, bathe or shower, go to meals, take her medications, go to bed. She does not remember that dad is gone and does not remember that she doesn't live in the family home (sold) any longer. She constantly packs "to go home." Constantly asks where Dad is.

Her MC area is locked, but they have all day program of activities that she can participate in. There are occasional "excursions" to the AL area for programs. We can also take her out for lunches and MD appointments, but she's resistant to that. We are told she enjoys the "crafts" projects but hates "bingo" since it involves groups of people talking at the same time. She has her favorites among the residents and some less favorites but she is not one to rock the boat. It is a great relief to family that she has 24/7 oversight, since that's what she needs. She seems pretty settled and content there.
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