Memory Care is too soon and Assisted Living is not enough. Any suggestions?

arlington628, there are times when it is better for someone who is higher functioning to be in Memory Care now so that they can learn their way around the facility, learn the Staff members, and be able to make friends.

Now, it is up to the senior facility to determine which section of the facility would be best for the new resident. The facility wouldn't have placed your Mom in Memory Care if they didn't think it was the right solution.

I remember when my Dad was in Independent Living facility and I got a call that it was time for a meeting. Turned out the Staff said Dad was ready for Memory Care, which really surprised me. Since I wasn't with Dad all day, that at night Dad was having sundowning and he was wandering. Oh my gosh. Sure enough the Staff was right, not long after Dad moved into Memory Care he was calling me thinking he was back in the 1940's. This wasn't the Staff's first rodeo.

My Dad was very happy living in senior living as he knew he could no longer maintain his house, and the cost of 3 shifts of caregivers every day was eating through his savings. Thus he had moved in at the right time.

Please note, some elders will make up stories trying to gain sympathy from their children so that the children would quickly move them out and back to home. It is difficult to know what is true and what is a tall tale.

Your post title is what I would say is the deciding factor. AL is not enough - this indicates the need for MC, even if mom is "higher-functioning." MC could, as some suggest here and in other posts, be a home-based facility, but I am not aware of any in our area, so we went with an IL/AL/MC facility. I have no experience with the home-based facilities, so others would have to chime in about them.

Our mother lived alone and when the signs appeared for needing intervention, she also refused to consider ANY change - no AL, no moving in with one of us and the hiring of aides, initially just for 1 hour/day to check on her, lasted only a few months before she refused to let them in. Her mantra was that she was "fine", "independent" and could cook. On one level, yes, she was "fine", but independent and could cook? No. Nothing would convince her of the need to move somewhere with help or have help at all. After the move, I found even more signs that this was necessary!

We had to move her January 2017. To this day she is mobile, dresses, bathes and cares for herself, feeds herself, etc, more "high functioning" than some, but she is NOT safe to be alone, not even in AL. When we brought her to see the place, my younger brother was adamant that she only needed AL, and that she would not want to be with a bunch of "old farts." The staff said no, she would need MC. (Mjlarkan's comment more or less confirms what I thought!) Nothing I could say would change his mind - however in comparing the two (her facility was recently rebuilt, opening in stages IL, AL and MC, 2016-17), it appears, to me at least, that AL is more oriented to people who need more help with physical issues, and therefore, in mom's eyes would appear to be more "old farts." Granted there are those who need physical help in MC too and there are many levels of capability, both physical and mental, and different progression for each, but in her case, like your mom, she was very unhappy about the move. For 9 months she harped on that brother about going back to the condo (thankfully she did not pester me!) At the condo she was becoming more and more self-isolated and the memory lapses were concerning, as well as the sun-downing we could observe in some cameras my brother installed. It was a matter of time before something untoward happened. Literally days before move day (she was not made aware of this plan) she injured her leg and ended up with cellulitis. It is a serious infection and delayed her move by a few days. My brothers took advantage of this injury and used a phony letter from "elder services" at the hospital to get the move done. Madder than a wet hen, but she reluctantly went.

Several months ago she started asking me to drop her off at Nana's place on my way home (her mother, gone about 40 years) or if I had a key to the place they sold 23 years ago. The staff reported that several times she put on her coat and took her purse, insisting that she was going to walk to her mother's or my place. Who knows what she would have done if still in her own home, or in AL (as others have said, they do not monitor 24/7 in AL, so even if someone is not currently a wanderer, it can happen at ANY time!)

I would say that if the staff feels it is safer for her in MC, work with them on making mom more comfortable. In any event, as dementia progresses, she will need to be there and it is difficult to make moves, as this move has proved, but can be even more difficult after the dementia gets worse! At the place our mom is in, they do bring the higher-functioning residents upstairs to activities in AL (I stopped by the other day and several, including mom, were upstairs for a "birthday month" celebration.) They get to go to another area for exercise (mom refuses, but needs it!!), hair and nail appointments, etc. They even have a few "outings." As for residents wandering in, I know mom's door has a lock (cannot lock it when exiting the room, only when in the room), which the staff has a key for. Ask if your mom has one, or if one can be installed. I have not had any reports from anyone, including mom, that anyone has entered the room when she is in there. We did find a resident on her bed when we went to her room after lunch, which did annoy mom, but we reassured her it was okay and had the staff remove her. That same day she told my daughter that "this place isn't bad and it's free" (she is not aware that her SS, pension and trust fund pays for it - better she thinks someone else is paying!)

Your mom may report that she is unhappy, even getting nasty with you children - this does happen often. Don't take the abuse personally, it happens and doesn't really reflect on anything you have done. It is often part of the adjustment period and may mean nothing really. You did not indicate how long she has been in the MC unit. If it has only been a short time, she will need more time to adjust. This can take longer for some people. What she says and does may not be reality. Reporting the incident with the other resident also may be a fabrication as some people do hallucinate or have "false memories". I would not use those as reasons to move her to AL. It is the overall assessment that makes the decision for AL vs MC. It sounds as though the place she is at is closer to you all, which is a good thing. Visiting more often at various times of the day may reassure you that she is safe and in the appropriate place. As someone suggested, perhaps a small dose of an anti-anxiety medication for a short time can help alleviate any excessive fear (I am not a proponent of medicating, however I know that they ordered one for mom early in her stay, and it hasn't been renewed, as I manage her medication orders, so I suspect it was just during that initial transition period, to help calm her. I have never seen her "doped up".) Check with the staff about whether a door lock is available or can be added. Ask them about their observations of mom's behavior and/or comments about the place during times you are not visiting. She may just be lashing out at you because of the move.

Although my brothers may not have agreed with everything at the time, I know that MC was the right choice for our mother. As far as most activity, she is "higher functioning", but the short term memory issues and "sun-downing" really would be an issue with regular AL. Home care was not an option, but just having more "social" interaction is often much better for those with dementia, especially higher functioning, because you want to keep them active and stimulated. They do not necessarily have to participate in all the activities, but just being with others, rather than isolated at home or with just immediate family, can have a positive effect. Talk with the staff to get a feel for how she is when you are not there. As several indicated here, what the parent says during your visits may not the same as when you are not there! Find out what activities are available. Talk to mom about what she likes to do - perhaps they can tailor some activities that she would enjoy. Give it some time and for those times when she complains or is nasty, learn to redirect, change the subject. If that does not work, cutting the visit short may be in order. Check watch and say oops, I have an appointment, I'll be by later, and exit!

Another suggestion to try during this transition period is using little "white lies." Shift blame for the move to the doctor (doc's orders mom!). Tell her that it is required by law until she "gets better." Some say this is false hope, but the key word is "hope." If she can believe that by improving herself that she can go home, she may stop fighting as much and "work" on getting better. It certainly can't hurt. It was hard for me to "lie" or deflect initially, but you can work on it and get better at it. It is not lying to hurt, but to calm and reassure.

Arlington, who made the decision to place her in the Memory Care part of the community? Was she independently assessed as needing memory care, or is that where there was a room available? Can you discuss a move to AL with her team at memory care?

From your description, it sounds as though mom may still be in the adjustment phase. Many folks with dementia are mad/scared/disoriented and emotional when they are moved from their familiar surroundings. Can you have her seen by a geriatric psychiatrist to see if meds for depression/agitation might be advisable?

My dad lived in a facility where the memory care was on one floor and AL was on the other 3 floors. The higher functioning folks in memory care were brought up to the AL main floor for activities and socializing with the less affected AL residents. Perhaps she can be given such opportunities. I would wait a little longer before moving her. It took my dad almost 4 months to adjust to his new situation. Most of the residents do lie to their children about
what is going on. One mom would moan to her daughter that things were awful. I would eat lunch there often and would see her laughing and having a ball with a nice group of ladies. I met her daughter in the elevator once and told her about her mother at lunch and she was so surprised. My dad would berate me for every little thing, then brag to others what a wonderful daughter he had. It can drive you crazy.

The residents in Memory Care progress at different rates. When my LO first entered, her roommate was quite high functioning. She took my LO under her wing and it was great, but, that resident progressed faster than my LO and soon was not high functioning at all and has since passed away due to effects of dementia. Things can change pretty fast. But, people are different. What level of care was your mother assessed to need?

I found that if a resident in regular AL has greater needs than the facility can handle, there seems to be a lot of issues. The staff is not equipped to handle a lot of issues that residents with dementia tend to have, such as resistance to care, severe short term memory issue-my LO would get reminded of dinner, but, forget about it on the way to the dining room, agitation, direct supervision needed for most activities, handling delusions, etc. Once in MC, the issues were resolved. The staff knew how to manage her care. So, I'd see how she's faring. The staff should be able to recommend what level of care she needs.

Did you confirm the allegations she had about MC? Sometimes, their reports may not be real. I'd confirm to make sure. I'd also keep in mind that having her completely happy and content may not be feasible. Sometimes the illness prevents that from happening and there is no way you can make it happen, but, if she's really agitated, depressed, anxious, etc., I'd discuss with her doctor and inquire about treatments. 

I went through this with my mom. She had pretty bad dementia but they evaluated her for AL. I think that was the right decision. She was higher functioning than the memory care and would have been aware of that. In AL she made friends who did not have dementia but loved her and watched out for her. I may have just been lucky but it worked out better than I thought. The only thing is that AL is not 24 hour care. Ask a lot of questions and visit the AL and see if there are people there her level and try to see how it it is for them. Good luck!

If you feel she is capable look into assisted living as long as there is 24 hour emergency care on call. It is very depressing to be in a living situation where you are higher functioning than the other residents.

I placed my dad a year ago at a facility with 2 buildings: a memory care and a more traditional assisted living facility. His final months of living at his own home involved wandering, confusion about family members, and extreme paranoia. So, when I brought him to the facility they immediately placed him into memory care. Well, the other residents in MC were mostly non-verbal and non-ambulatory. My dad became very depressed and started refusing to leave his room. My dad and one other guy were the highest functioning residents there.

The other guy was then moved over to the traditional MC, so we requested to have my dad moved as well. He moved right after Thanksgiving. It's a locked facility, so that's the main reason it works. The downside is that now he is one of the lower functioning residents (cognitively) which seems to intimidate him when it comes to conversations and activities. Like, he can't follow a Bingo game. So he seems to just sit in his room.

If your mother is ambulatory, conversational, social, and likely to participate in activities, maybe a more traditional assisted living would be beneficial. For my dad, the cognitive limitations still seem quite a hindrance to enjoyment of daily life and I'm not sure the move made much of a difference in his quality of life, sadly :(

While you must look out for moms safety and well being, you may not be able to be alarmed at all of the fears she voices. It is the same with the unhappiness she expresses. It's very hard with dementia to be able to sort out facts from fiction. I understand how hard it is when a LO doesnt quite fit their surroundings. My mom should have been placed in memory care, but I worked to get her into AL. Now that she is better she definitely doesn't belong in memory care. She feels that she is also too high functioning for the AL and wants to go home. I know at home she will not get the support, care and socialization she needs. Adjustment takes time, healing takes time. Don't be rushed by seemingly urgent things. My mom can make me "feel" like she's been "locked" up for years, when she's only been in AL for four months. She has otherwise improved so much.  Look at the goals and the facts. Also be an advocate for better care and more suitable surroundings and placement for your LO when applicable.

When my Mom was being discharged from the nursing home, they suggested an Adult Family Home. Now both of my parents are in an Adult Family Home close to me. They both have Alzheimer's. It's a perfect fit.