We are finally at a point of moving my mother into a senior living facility. Should we place her in assisted living or memory care?

She's going to have an adjustment period either way. If you're determined to have her stay in AL is it possible to have a caregiver come in daily for a few weeks, then re-evaluate? She will go through the same thing once moved to MC.
My experience was that mom probably should have gone to MC sooner than she did. She lived in her AL for 7 years and the staff were attached to her so they would look the other way when she got worse. I would notice things and talk to the director who would have them do extra checks on her and said she would let me know when it was "time." It didn't happen and I had to make that decision. The final straw was a blind woman (mom) with a walker straying 2 miles from her AL alone. She was found on the corner of a busy intersection and a good Samaritan brought her to the lobby of the independent side of her residence. I moved her within days.
She was horribly confused when she first moved to MC, packing her walker with clothes everyday for her "move" to her new apartment. All kinds of things went on and really freaked me out. Gradually she adjusted and has really thrived there.
Like I always say, this is hard stuff. No easy choices or quick fixes. Hang in there. Many of us have been there and we're listening.

I would insist that they give her time to adjust.

1 week is not enough time for anyone to find their footing.

Follow up to my original post... My mother had a bad fall at home on the day we were scheduled to move her to assisted living. She spent 5 days in the hospital with a gash on the back of her head. The doctor recommended moving her to a rehabilitation facility prior to her moving to AL. However, her insurance refused to pay for the rehab, so last week we moved her to AL. After being there less than a week, they are already telling us she needs to move to memory care. Her confusion has increased and they feel like she has to be watched constantly. I feel like the combination of the fall, the hospital stay, then the move into completely new surroundings has caused a rapid decline in her mental stability.

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.

I would wait on memory care and place her in assisted living first to provide her with as much stimulation as possible. I know a couple where the husband is borderline for memory care. The family is keeping him in assisted living until her deteriorates further. After all ,she may or may not decline quickly. As long as the facility can accommodate when she does need memory care, go with assisted living.

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.

Respect2honor - thanks for the vote of confidence! I have likened dementia progression being like the reverse of baby-toddler-child-adult progression. Babies learn to roll over, crawl, walk and talk at their own pace. Their capabilities improve, their knowledge improves and over time can be trusted with more independence. Every child is unique, although in general if there are no medical issues, these "milestones" happen within a range. There is no real "normal" for babies or people with dementia. Some progress quickly, others not so fast (babies AND those with dementia), and there are NO warning signs!

When my daughter was a baby, two co-workers had nieces about the same age. They raved about how "advanced" the girls were and had moved to a bed (my daughter was NOT ready for one IMO.) Each had a fall with some injury, one to the neck!

Many people leave infants on beds or a couch while they are sleeping, but one can't anticipate when that ability to roll over and fall off will happen!  

Climbing & walking - my daughter NEVER climbed out of the crib, but had to move to a bed finally at about age 3 as I needed the crib for my son, coming soon. I put chairs next to the bed and several times found her on the chairs (they prevented the fall to the floor!) He, on the other hand, was more apt to climb AND had a sister encouraging him, so I had to leave the side down - less distance to fall! She walked at about 11 months, HE walked at about 9.5 months! She became chatty Kathy very early, he had a handful of words and his finger to get what he wanted and didn't say much until he was about 3.

With dementia, it is the same. They don't do this or that until they do. There are no warning signs, blinking lights or sirens to warn us that they will wander, do something dangerous, eat something inappropriate, etc. We cannot be with them every minute of the day, and as with babies/toddlers, it only takes an instant for some disaster to happen! We can "baby-proof" the home for kids and adults with dementia, but there will always be that "moment" when something untoward happens.

What works for one (or more) doesn't always work for others. IF adult day care works, great. IF one can move in or have the person move into your own home and it works, great. IF having home aides works, fine, but that gets VERY expensive quickly if the person needs more than a few hours/day assistance. Even trying regular AL with outside hired aides can get expensive.

I have a friend who's MIL recently had a fall and had to move to AL. They are being told she needs to have hired help 24/7, at $39/hr! One month would be $28,080 and that's on top of the AL cost!!! She does have memory issues, so I recommended MC. There are more aides/resident and more coverage for needs. Mom's MC place is $8,232/month. If her personal needs (hands on care) exceeds 1 hour, then there will be additional cost, but NOT 24/7 at $39/hr. So far we have not had the extra cost and this is year 4.

magnumpi29 - as noted above, sure, if it works it can be cheaper, however my mother would NEVER go to an adult care center and we didn't live with her, so we couldn't take (force) her to go there! She had tried that with my dad, and he hated it. She, in her mind, was FINE, and would NOT consider moving anywhere else, would not have aides in or go to an adult care center. BTW, noted many times in other posts/threads, mom injured her leg just prior to the planned move. She didn't have enough sense to know how serious it was and didn't seek treatment or even tell us about it. Her neighbor was told and reported to me that mom "bruised" her leg. Nothing new there, but... Since OB was arriving the next day, I asked him to check it, send pix and then directed him to take her that night to the ER. It was cellulitis and could have killed her. For the most part, no aide is going to check her body whether they are in the home or at adult care center unless the fall/injury happens on their watch, so this would have festered and can kill quickly. At MC, they report all falls to me and check/monitor her for several days, just in case, so this kind of issue can be avoided.

afreil - so happy to hear that your mom was agreeable to the move. Hoping that she does well in her new "home." It would be interesting to know what you decided - AL or MC, and how she is doing there. As I noted, for some this works great, for others it is a difficult transition. We don't know until we do it and although some continue to complain about it (sometimes that can go on for a long time), give it time, don't feel guilty about it and enjoy your time with her while you can!


magnumpi29
"Your mom hates a home health woman coming in but loves nursing home staff coming in her room? Something doesnt add up and seems suspicious, I hope she wasnt being abused by home health and you didnt know it"
It could be as simple as this is mom's home and she didn't like having someone there. It could be a mismatch in personality. There are MANY reasons why someone might not appreciate or accept having someone in their home. Our mother initially allowed the aides in for the 1 hour we started with, mainly a sanity check to be sure she was okay and a med check. The plan was to increase the amount of time and tasks as needed. In less than 2 months she refused to let them in. They sent their "expert" to chat with her, and that woman is lucky mom couldn't physically throw her out of the condo!

There are NO simple answers. We have to work with what we have, what works for all of us and what is best for everyone, mostly the person, but for us as well. We have to support each other here in the decisions made. We can suggest until the cows come home, but in the end, what works for each of us is variable.

For those suggesting doc assess capability, most docs don't have a lot of knowledge/experience with dementia, or even a lot of interface with the person. Those who work in the field have better understanding and would be the better choice to rely on for determining capability/thriving in AL or MC.

I’d start her on the AL side first, who knows she might thrive there. What can it hurt?

Maybe the reason you’ve been told that she can’t enter AL is because residents must meet a certain criteria for admittance. Mostly relates to whether the can still do basic hygiene, stand on their feet for a certain time period, etc

Afreil, such good news that mom is ready for the move.

It can increase the quality of her life so much.

I hope that she finds contentment and even some happiness expanding her horizons for this season of her life.

My mother who is only 77 and high functioning with dementia has been in a memory care facility for the past week and it has been horrible . She does not belong there and I wish to move her to Assisted Living facility with level 3 care . Her MC facility is telling me I can’t do that .

Yes, I am in the middle of this dilemma, myself. We first placed Mom in AL. After breaking her hip and rehab, she declined some from the trauma of it all, but has bounced back pretty well. However, her facility would not let her go back to AL and placed her in MC. She is not as happy there and has little stimulation. I would recommend placing your mother in AL for as long as she can. Only move to MC if absolutely necessary.

That's a tough one. We were in the same situation. We went with Memory Care simply because it gives her the support she needs (and will only continue to need more of) which assisted living does not. And people with dementia almost always certainly have regression during transition trauma. The move throws all of their coping mechanisms up in the air. This presents in a myriad of ways, physically, mentally, and emotionally. We were able to find a MC that fit the bill.. Is secure but large and free-roaming, and has an unusual number of higher functioning individuals. If you are concerned about her not getting individual attention you wish her to have, hire a companion for her a few days a week. We hired a musician who was also a caregiver for my dad so he could continue to play piano, sing, and "have rehearsals." It has made a huge difference in the slowdown of his mental decline. We may do the same for my mom but that remains to be seen.
No facility, AL, MC, or SNF, will provide one -on -one companion care to any extent. Be skeptical if they tell you they do. Best wishes.

I am surprised tha tyou were not aske dby her doctor, for a screening process firstly. However, if they have said what is best for her, Let them try it for awhile. See what happens.

afreil: Best wishes to your mother in finding a good fit with her new residence.

I think Llamalover47 makes a good suggestion, "See what her physician and a social worker suggest."

Otherwise, I can share my experience. My mom has been in memory care for a little over nine months. The facility in which she resides is well run, has a good reputation, and the staff is well trained in being of assistance to folks with Alzheimer's and dementia. There are activities planned daily, on and off site, in which the residents can participate. My mom loves the trips to the museum in the city. 

Mom has been described as high functioning, and I have noticed she will gladly partake in activities. She does miss getting outside to walk daily, since it's been too cold, etc., over several months' time. Thankfully, spring is not too far away, and I believe she will resume walking then. She uses a cane but had PT and, so, she does fairly well. 

My mother especially likes to join in and help staff as she can; the staff knows she is a retired nurse, and she is encouraged and welcomed to be a helper.

That's a tough call. Because if you get her placed in the Assisted Living and then shortly thereafter, she needs Memory Care if may be very confusing to her. See what her physician and a social worker suggest.

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!

You know your mother better than anyone. Even so, the progression with dementia varies from one person to another. We get no warning signals for the next step. The most serious one would be wandering. Others have said this would be the sign that a move is needed, but if she wanders off, the first time could be the last (read BeeKee's post.)

Our mother could also do ADLs, and carry on a conversation, but also tended to repeat statements/questions. While searching/waiting for a place to open we tried hiring aides 1 hr/day to check on her. We installed cameras, more to watch who came/went, but to check on her as we weren't local. Over time I saw her wearing the same clothes (she had enough clothing to open a store), initially 2 days in a row, and eventually 6 days in a row! Sometimes they would be soiled with food droppings. Once we took the car away, I had to take her shopping and realized although she was buying fresh fruit, veggies and meat, she was eating frozen dinners and boxed crap. Had no way to tell if she was bathing. Found evidence of "accidents" when we finally got to clearing, cleaning and fixing condo for sale. She also started this odd OCD behavior just before bed - initially a day here and there, a few times, but it became 1 - 1.5 hour marathon checking the door lock, sidelights, dishwasher and LR, over and over! Most likely her "version" of sun-downing, although it was later in the evening.

To others, she might seem fairly functional, but clearly she wasn't. In her mind she was fine, independent and could cook. She wasn't and couldn't. She refused to let the aides in after less than 2 months. She wanted no part of ANY AL or moving anywhere (AL had been part of her plan before dementia) and wanted nothing to do with Meals on Wheels.

She didn't (that we're aware of) wander from her place, but again, there's no warning sign for this! Her "circle" of travel was slowly becoming smaller, so clearly she would've easily gotten lost. She was in self-isolating mode, making excuses or ignoring the other seniors who would all go to the Senior Center functions/special meals together. YB was adamant she would prefer AL, but there was nothing to stop her from leaving the building. She would, at this point, get lost in a "new" place, and would likely go out, looking for her "place." I said no. Staff who did assessment and met her said no. I do think MC was the best choice for her.

The first 9 months, she begged YB to take her home. Then she asked me to drop her at her mother's on my way home, or did I have a key to their previous home, sold >25 years ago! I know she asked staff many times to call her mother, gave them that old address and often said she was going to walk to her mother's, my place or her place. She, IMO, would have walked out of the place with no warning. In MC, fairly independent 2+ years, no walker before that, ADLs were done by her. It's only recently she won't stand/walk, so needs more help (into yr 4.)

In other responses I suggest going to visit the MC at other times, specifically meal times, when more residents are together. You might be seeing only those who are less mobile or more needy of supervision. Others could be elsewhere. IF all the residents are together and all appear to be minimally functional, could you try any other facilities? Mom's place is a mix and being there 3+ years now, I see residents come and go, some progress rapidly, others not so much. If there at certain times, it can appear that not many are very functional, but other times there are activities, meal times are fairly busy, residents are as active as they can be. Often they have outings for those who can participate, and other times they join the AL residents for special activities/occasions.

Not all facilities are alike, and must be checked thoroughly. Go at different times to get a better sense of the residents. Ask what their plan is for your mom if she's more aware.

Just wondering, you said your mom can no longer live safely at home, have you considered in home companions and adult day centers? Dorthy had it right, IF possible,(may not be possible), but really is no place like home.

From my experience with a relative, even though moves are traumatic, I would suggest going with the option that is most like home. My relative's main problem is that her short term memory is almost non-existent. Her doctors told her that she should not cook, not drive, and not try to navigate stairs. They also stated that a communal residential situation would be best for her. But, she doesn't require any assistance with daily living tasks except for med management and food prep. Even so, doctors, friends and other relatives all thought she needed assisted living. We tried that for two years. The AL residents who could carry on conversations were not all that mobile; the ones that were mobile were lower functioning. I felt like my relative was isolated, plus the facility's staff changed monthly and they kept raising the rates. So...we moved my relative to independent living with a home health agency providing med management. She has an actual apartment that is more like home; three hot meals each day; lots of quality activities; outings; entertainment; on-site physical therapy options. She looks and seems healthier. And we're saving $1600/month over assisted living. There is less daily "supervision," but even if we need to add more home health services, it's still less expensive than AL or Memory Care. The facility we found also has an AL section when the time comes for that. It's almost impossible to compare "apples to apples" when researching IL, AL, and Memory Care facilities. If your relative enjoys the company of others, is mobile enough to get to the dining room, is not a flight risk and can still learn new routines, I suggest you look into independent living options with some add-on services. It may allow whatever money your relative has to last longer, and despite the potential trauma of another move when the functional/cognitive abilities decline, the immediate benefits, at least in our case, have been remarkable.

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.

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.

I have found the facilities with inhouse memory care units were kind of one size fits all. Mom lived in assisted living for 7 years but when it was time to move her to memory care, I looked at both stand alone units to compare to the graduate unit where she was living and several others.
We had many signs it was time to move to memory care, a long list I won't go into, but the final huge sign was that she was no longer safe due to wandering. We ended up going with a memory care unit divided into 2 separate living areas based on functionality of the resident. Mom is really happy and thrives there. She is well cared for, safe, eats much better and is kept busy with activities all day long. She is out with the other residents most of the day and has a beautiful atrium patio to enjoy. Any need is taken care of with visiting dr's, physical and occupational therapy as needed and emergent needs addressed promptly. It hasn't been perfect but is a wonderful place for her to spend the rest of her life. If and when her dementia progresses she will move to a room on the other side with those less functional. Not looking forward to that day, but am glad in the mean time she is with people like her. It's not depressing for her or her family to visit and participate in the many activities and parties offered because she resides with people who still enjoy much of life.
So I guess, short story long, depending on her functionality, I would do assisted living as long as she's safe and well cared for AND allow the flexibility of looking at stand alone memory care facilities rather than just moving her into the memory care unit of her senior facility.

I'm not sure it needs to be a choice between AL and memory care. In my community, there are two AL facilities specializing in dementia. My mother is in one of them. Best of both worlds! We get the safety measures and understanding of dementia, along with an abundance of planned activities. Some of the residents are lower functioning than my mother, but she finds the ones on her level to socialize with. Before you make the choice you think you have to, make sure you are aware of all the options in your area.

I'd leave her in AL and let her enjoy the company.

We moved my dad to Memory Care, and I think that he suffered because there wasn't the social stimulation that he was accustomed to previously; however, he needed the safety measures provided by the Memory Care home. I was in denial for so long that once he was approved for Medicaid we didn't have sufficient time to start in assisted living and move later. Daddy was put on waiting lists and it just didn't work out. There are some facilities (and I hate that word!) that have both kinds of care and it seems that the transition may be easier.

Hi! We just placed my gramma in MC even though she is very high functioning. There is definitely a noticeable difference in the functional level between her and most of the patients in her cottage, but after much discussion with the facility, we are very comfortable with her placement. We did have the option of changing her to the personal care facility next door, but the extra attention they provide in the MC makes us feel more secure. One thing the facility admin discussed with us is that the independence of the residents in the personal care cottage leads to much LESS interaction due to the residents going into their own rooms more often to watch TV, etc.; and although she's pretty high functioning, she'd be on the lower end of functionality if she were in the PC cottage.

One thing that our facility is doing to beef up her socializing is including her on a regular basis in the activities in the PC cottages. I think that's been working really well. So as long as she's able, we'll continue to do that. This is a progressive condition, so the stimulation may help to keep her from turning the corner as quickly, but her condition will deteriorate, so I'd rather minimize the amount of change we have to subject her to.

Good luck!

I would put off memory care. My 94 year old mom moved into ALF October 1 with minor cognitive impairment after living alone until the last year where we had a 24/7 caregiver. She has actually improved with the addition of socialization and activities and now manages without any assistance and takes her own meds. She definitely has short term memory problems, but she remembers the important things, but does sometimes call me, especially after a nap, asking what day and time it is, despite two dementia clocks. When she moved in, the staff told me she is confused and they see her in memory care in a year. Now they say she is doing great.

In my experience it is not just wandering that is a signal for memory care. My mother does not wander but she needs prompting for personal care, eating, getting out of bed. She sleeps most of the day and night. Also, the ratio of aides to patients on the memory care unit is 2 staff for 14 residents. And I supplement her care with 1 hour in the morning every day.

My mom at first was not at the same level as the other residents, and she basically stayed in her room watched tv and played cards. Within this last year, she stopped playing cards and at this time is basically nonverbal so she is at the same level as the other residents and actually takes herself to breakfast and stays a bit before going back to sleep in her room.

Memory care was right for her.