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My 86-year-old mother-in-law broke her hip 3 years ago. She was very uncooperative during her rehab stay and refused to make life-style changes (wear better shoes, remove loose rugs, rearrange furniture, use walker, get LifeAlert, use portable phone) to aid in her recovery at home. During the last six months she has declined rapidly, falling three more times, with the last fall leaving her semi-conscious on the floor for 10-12 hours before she was found. She spent 3 days in the hospital, 30 days in rehab and has been moved into assisted living for a 30-day trial period. One week into the trial period, the staff have already indicated that they do not think she will adjust. She has refused to eat, refused to do physical therapy, refused to participate in any activities including church, and refused to let staff change her clothes after she had an "accident." She needs 24/7 care and we believe that she will also refuse to cooperate with home caregivers. What do we do now?

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She sounds tough. With all of her health issues, I'm surprised assisted living even took her. She sounds like she may need a nursing home. Not that she will like that any better, but the staff may be more patient about her adjusting. Otherwise, if the AL says she must go, you'll have to try another. I'm surprised they are giving up in just a week - most people take several weeks to adjust. Please keep us posed on what happens,
Carol
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Unless there truly is medical need or the patient is suffering from dementia I really hate to see nursing home placement for obvious reasons. Unfortunately, as Carol pointed out, it may be the only option if mom's behavior does not improve.

There may be another possibility, though, that you might consider. Assisted living facilities are typically thought of as larger, almost resort style properties. Becoming more common are what have become known as "Adult Family Homes". These are smaller ALFs, typically under 14 beds, where caregiver patient ratios are higher, and care is more intimate. Pricing is similar if not less than larger facilities.

There will be no where near the social interaction, activity, etc., but hey, not everyone thrives in those environments. With more attention and calmer surroundings maybe mom will do better.
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I don't know how helpful it will be, but the only two things that come to mind are ... first, you must have a consultation with her doctor - would medication help? Second, I recommend that you get in touch with your state's elder care representative, and your social worker (once your mother-in-law went into assisted living, she should have one assigned to her case - ask the staff to help you find them) ... you can try talking to the state ombudsman (sp?) - this is the person you can file complaints with on abuse/neglect for nursing home patients - not that your case applies, but I'm sure they've seen it all, and may offer you some additional options or insights.
~FyreFly
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Thanks for the comments and suggestions. I think that her current assisted living facility reacted quickly because she was not a cooperative patient while staying in their rehab facility and became worse when she was moved to the ALF rather than going home. She has never accepted the fact that she is no longer able to live alone.

I've been impressed with the smaller facilities and think that they could be an option for her. We chose the current facility because it was affiliated with her church but that doesn't seem to matter as much to her since she refused to attend church services. She just keeps insisting that she wants to go home.

Her current facility has offered to move her to back to rehab until we decide what to do next. (After a week of refusing to eat and to do physical therapy, her condition has worsened again.) She now believes that moving back to rehab means that she will be going home soon. The facility has suggested that she have a geriatric psychiatric exam. Would this be helpful?
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A geriatric psychiatric exam would be a good idea.
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