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My mom is in an independent living apartment, has a companion that comes in from 10-2 M-F 5days/week. She has a guaranteed spot in skilled nursing when time comes. She has declined gradually since moving there 6 mos ago. We started companion after she fell in July and spent a week in the hospital. MRIs showed no damage to brain and no dementia even though she was hallucinating prior to fall. Now she is sometimes incontinent, uses walker, bed rail and today companion said she almost fell asleep on her feet otw to bathroom. I bought electronic pill dispenser to help with meds but she tore it up within a week - pried back off and ripped batteries and wires out. I am afraid for her when she is alone but can't afford 24/7 care and I work. Should I try to see if they would approve her for skilled nursing? Does Doctor make that determination? She always perks up at dr appts and puts on a great show of being perky, then goes back to a flat affect when we get home. She goes in and out of alertness when I'm with her. She spent about 10 days in rehab after hospital stay and now has physical and occupational therapy in her apartment and a nurse comes and checks her every week. Not sure what comes next - it's almost like awaiting for the next disaster to happen.

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She sometimes toilets independently and can walk to the dining room sometimes, but if I don't show up and help her get dressed to go to dinner then she would probably just sit there and not go. I will call dr today and get him to refer us to a neuro and ask for those tests. The facility is only independent and skilled nursing. I guess I would need to pay for any additional care out of pocket. She can do that for a while but not indefinitely as her money will run out. Her income would cover the skilled nursing facility. I guess we need to add additional companion care during the day like pill management - I can do that with her companion company.
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Does your Mom's Independent Living complex offer different level of "assistant" care that can be bought? Such as my Dad kept forgetting to take his medicine so I added a "pill management" level of care where an Aide brought the pills for Dad to take twice a day, thus no pills were allowed in his apartment for safety reasons.

Then my Dad had issues with falling too much even with using a rolling walker, so I added another level of care at a cost where an Aide would check in with Dad once an hour, and help him get ready for bed. Dad's outside Agency caregivers did the morning work of getting him up, shower, dress and made him breakfast and lunch.

Then Dad eventually needed even more care, as it was decided to move him over to the Assisted Living/Memory Care section of the complex. He was happy to know he would be in the same complex where he knew the nurses/Aides and maintenance help. Yes, he had to downsize but as long as he could bring all of his books he was content. I kept his morning caregiver on to give him a sense of routine. But now all meals are in the main dining room.
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You take her to a good neurologist and get her tested to determine the placement level. That takes more than an MRI. Ask for PET or SPECT imaging with specific contract fluid that reveals amyloid plaques (Alzheimer's). She is far beyond independent living. If she can toilet independently and walk to the dining room, she might qualify for assisted living.
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