assisted living - regular or dementia unit?

watergalMarch 27, 2008

My 84 year old MIL has been living alone in her home 2.5 hours away from both of her children. Most of her friends and neighbors in the neighborhood have died or moved away. She has congestive heart failure and doesn't see very well. For years, we have tried to interest her in assisted living or at least some in home help but no luck.

Two weeks ago she landed in the hospital because of heart problems. Her cardiologist/primary care doctor told her she can't go home from the hospital, and she listens to him, at least better than she listens to anyone else.

We found what appears to be a terrific assisted living facility in her town (she wants to stay local, not move near us). They are evaluating her, and so far are leaning towards the dementia unit, not the regular assisted living part.

We aren't convinced she needs dementia care. She's not stuck in the past or anything like that. She does get a little confused and disoriented, not sure how much is the brain and how much is not being able to see and being in a strange environment.

She had a history of wandering in the hospital, they had to put her in restraints for a while, and that is why they want to put her in dementia, where the unit is locked and she can't wander off. We believe the main reason she was wandering was because she was trying to find and smoke a cigarette.

She also had several days of hallucinations and real confusion early on in the hospital. We believe that was due to alcohol withdrawal. She is not supposed to be drinking, claims she doesn't, but when pressed admitted to "having a tablespoon" while dinner was cooking.

So the poor woman was put into the hospital and suffering from alcohol and tobacco withdrawal simultaneously.

Her regular doctor was on vacation during most of this, and we have had three social workers at the hospital in two weeks. First one was great, the rest not much help. First we were told she would need skilled nursing care when discharged, so we looked into that. Then they said assisted living would be fine. Then they said nursing home. Now we are on track for dementia unit in an assisted living home.

Mom is not happy about leaving home, of course. Regular assisted living would be good for her - she could get transportation to the store and outings (she had pretty much given up driving, thank God). There is a smoking area, so if she smoke her cigarettes when she wants, I don't think she'll wander. She wants to cook for herself, but of course they won't let her have cooking facilities, not even a microwave, for safety reasons. She's not a happy person in general, but I think the regular assisted living would be good for her and we've tried to present it to her that way.

Now the facility is saying they want to start in the dementia unit. Very few outings, much more limited dining room, being locked in - she will be furious and feel she's been tricked.

My hope is that they will get her in there, observe for a while, and agree that she can try regular assisted living.

We have to put her SOMEWHERE when she's discharged from the hospital, which will be soon. She could go to a nursing home, but they don't want to take smokers and she wouldn't be able to smoke there anyhow. The assisted living dementia unit says they can make arrangements to take her to a smoking area periodically.

Sorry this is so long. Feedback? Ideas? Help! Thanks!

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I know you have talked to the social workers, but have you talked to the person in charge of these different homes. It does sound like she needs a little more guidance/attention to start with because no matter where she goes she probably won't be happy.
Think of her as a child, and try to guide her where you feel is the best for both of you. Be firm, and kind,
BUTSince she does not want to live near you, find a place you can check on her at least once a day,--by phone, but not have to see her (drive) every day. This is a difficult decision for both of you. The confusion may be coming from medication, poor diet, lack of visiting also. Do as much research on line for ideas.

    Bookmark   March 27, 2008 at 4:22PM
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My mother was hospitalized last summer with a severe UTI. She almost died. Of course, part of it was the disorientation. She spent 10 days in the hospital, then went to a nursing home for about 3 weeks for rehab. She returned to her retirement apt., with the knowledge that she had to more somewhere else.

She was evaluated at the assisted living place on the complex, but they thought that she should probably be in a nursing home. However, they agreed to a 30 day trial.

My mom went to assisted living and thrived. They gave her the medication she needed (including an anti-depressant) and she got her 3 meals a day.

That was 6 months ago, and she is doing great. She had moved from her home of 55 years to the retirement apt., but never really jumped in to the activities there. She was in the place about a year and then had the UTI. In hindsight I wish we could have had her on the anti-depressants when she moved into the retirement home. It was so overwhelming for her. She has always had problems with bladder infections, and I think that this one must have been lingering for a while. She was on 2 antibiotics for quite a while to hopefully rid her of that problem.

Now, her mind is sharper than I have seen her in a year. She also does everything that the assisted living facility has and goes everywhere they go. If they go to K-Mart, she goes, and she hates K-Mart!!!!

I would try to press for the regular assisted living, if possible, and then go down to the dementia place, if needed. Maybe a month or 6 week trial would work. The assisted living place should see that her meds are taken when she needs them, and the interaction might be good for her.

Good luck. It is a hard decision. I will say that my mom is happy where she is, and should be around for quite a long time.

    Bookmark   March 28, 2008 at 6:17PM
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There are two people "in charge" of the assisted living. Each has been out to evaluate Mom in the hospital on separate days. At the second visit, Mom told the lady, "I've thought about it, and I'm not coming because I can't cook there". So now she is definitely going to be assigned to the dementia unit, which is locked, because she is considered a flight risk.

We also ran into the hospital psychologist today. He agrees that dementia is a good place to start her in, although he's seen definite improvement since she started at the hospital. Her primary care doctor actually started by saying we needed to find a nursing home for her, but when we told him we liked this assisted living place, he said it would be OK as long as they managed her meds (there are lots and she doesn't see too well - he thinks she's probably not taking them properly) and they check on her periodically.

We have visited her in the hospital 6 times in the past two weeks (5 hour round trip drive each time). She was stronger today, and quite lucid most of the time, but towards the end of the visit said a couple of things that didn't make sense. She was going to "go down" to dinner, and then when she finished eating, she said she was "going to go back to her room now". In reality, she only moved a couple of feet from her bed to her chair and never left the hospital room at all. And then when we were leaving, she was convinced there was something on my husband's head, said it looked like a "rabbi hat" or something, but there was nothing there.

She does have a UTI, and after reading a bunch of posts here, I understand that can create dementia symptoms too. They are treating for that, and she says it's gotten a lot better so far.

This coming Tuesday we are scheduled to move her out of the hospital and into the dementia unit. I hope there are some people there she can relate to, not that she's much of a people person, she may not even try to meet anyone.

She refuses to let us move any of her furniture - the home can provide furniture (actually, it's nicer than what she has now!), so she's obviously not commiting emotionally to this move. I think she understands that she may never go home but refuses to admit it. The psychologist even said that if necessary, let her think she's going there for rehab for a few weeks, if that's what it takes to get her moved in. We did manage to trick her into handing over her car keys and house keys to us. I was worried, probably unnecessarily, that if she somehow did manage to get home, she'd just get in the car and take off for parts unknown.

Honestly, it's a lovely place, and I wouldn't mind moving there if I needed the care. Mom won't be completely happy unless she's home. Actually, she's kind of cranky there too, and she needs to be on antidepressants but refuses. Over the last 2 years, she's had to take ambulances and cabs to the ER numerous times because she wasn't feeling well, including dehydration during a summer heat wave because she refuses to use A/C. This past summer, we asked her why she didn't have the windows open in August. She said it was because she never got around to bringing down the screens from the attic and putting them in because they were too heavy. Of course, we would have done it if only she'd let us know she needed it.

She's fallen a bunch of times, nasty bruises but amazingly no broken bones. The house has stairs. She told us in the hospital that she hadn't been taking showers very often because it was too hard to get in and out of the tub. She also said she would wear the same outfit for 2 or 3 days without washing it. The toilet is dirty and the house is dusty. If only she'd agreed to get some help earlier, perhaps we could have postponed this move, or at least gotten her moved before she needed the dementia unit.

In the past, we hadn't visited very often because Mom has a history of manipulation and creating alternate "realities" about family history. She treats my SIL like crap, but SIL helps a lot until she can't take it anymore, then backs off for a while until she feels too guilty, and starts letting Mom push her around again. Mom's latest tale is blaming SIL for "this whole hospital thing" because SIL couldn't drop everything to leave work and drive 2.5 hours to take Mom to the doctor. Even though Mom had taken herself to the ER the day before but refused treatment and went home because the ER wanted to do blood tests and "I already had that done 2 weeks ago"!!!

Anyway, thanks for letting me ramble, and thanks for the helpful posts. I really admire all of you who are caretakers in your own home. My DH told me early in our relationship that his Mom would never come live with us, no matter what, because he couldn't take it. A two-day visit just about pushes him over the brink as it is. She can't live with SIL because she refuses to be under the same roof as SIL's husband, even though they've been married over 20 years!

    Bookmark   March 29, 2008 at 12:05AM
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Well, Mom is supposed to move tomorrow. No one from the hospital has been able to confirm whether or not she's actually going to be discharged. I have all the stuff she needs ready to go. I hope we can get this over with - I'm not sure I can stand it much longer!

    Bookmark   March 31, 2008 at 2:13PM
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It certainly sounds as if she is headed for some sort of dementia. Putting her in the unit now will keep from having to upset her more by moving her later.

    Bookmark   March 31, 2008 at 2:35PM
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After reading all this, I am just glad my MIL fell and hurt her leg, which developed into an infection, which lead to pneumonia and two heart attacks that killed her. She was hospitalized for a couple of weeks, but never had to go into a nursing home or assisted living, and she never had cancer, which was her biggest fear since her husband died of liver and colon cancer. Her death was a blessing.

    Bookmark   March 31, 2008 at 6:35PM
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jannie, I'm sorry about the loss of your mother, but it sounds like she had a fairly peaceful end.

We got her moved, it wasn't as bad as I expected, only minimal fussing by Mom, and she actually said some positive things about the place. Her mind was getting pretty fuzzy by the end of the day, but it was a long and stressful day for everyone, so I'm not too surprised.

In 15 days, they will reevaluate to see if she can move from the dementia to the regular assisted living. After spending time with Mom yesterday, the staff person said she thinks it's likely she may get to move up. But DH and SIL and I aren't so sure now. The activities in dementia are nice and I guess they are appropriate, but it reminds me of a preschool (sing-a-longs, finish the sentence, storytime, snacktime, a board with the date and weather on it). Mom is still functioning WAY above that!

It is so odd to see dementia in a woman that was completely "with it" mentally at Christmas. Can someone really go downhill that fast???

    Bookmark   April 2, 2008 at 5:48PM
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>>It is so odd to see dementia in a woman that was completely "with it" mentally at Christmas. Can someone really go downhill that fast???Actually, yes. One thing about dealing with the elderly is that when something goes wrong, it really knocks them for a loop and recovery is a LOT slower than it "used to be." Add to this numerous prescription medications, all of which have different side effects and different dosages, along with complex interactions that have not only never been tested, but never been tested on the elderly (a great many prescription medicines are tested on mature adults but NOT seniors), and mental confusion/disorientation are often seen temporarily when the elderly are put in new, confusing physical surroundings (such as a hospital).

It's good of you to be watching out for her. Often, as londondi relates, an elderly person will improve in a good facility, simply because someone is making sure they eat properly, take their medications on time, etc. It does sound like your mother has some very mild dementia beginning, but not serious enough to need the more intensive caretaking of the dementia unit.

Best of luck to you and your family going forward. I hope the facility works out well for your mother.

    Bookmark   April 2, 2008 at 8:22PM
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I know you are relived to get her settled. Please keep one thing in mind. She may make a friend or two in the unit, so don't move her unless she understands the reason for it, and agrees. It would be just one more upset and which may not be a good thing.

    Bookmark   April 2, 2008 at 8:42PM
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It occured to me tonight that almost all of her confused comments over the last week or so revolve around not being sure where she is, often thinking she's back at her house. Yesterday, it was things like "Make sure the back door is locked" or "I'll need my tote bag to carry my book when I take my tea downstairs" or not understanding that she has a new phone number and thinking that if someone calls her at her house she will magically be able to answer the phone.

So I'm wondering if it may be some sort of psychiatric thing, a defense mechanism or denial or way of working through the fact that after 55 years in the same house with the same routines, she's suddenly dropped down in a brand new place and she was unable to have a say in the matter (not that we hadn't been trying for years to get her involved in looking at assisted living, mind you!).

I hope she works through it. She'd never agree to see a psychiatrist voluntarily!

    Bookmark   April 2, 2008 at 9:53PM
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I would caution against moving her into assisted living now that she is in the dementia unit. From dealing with my 93 year old mother, I can testify that almost all moves/changes in living situations are traumatic and take a terrible toll on the elderly loved one.

You said. "...She does get a little confused and disoriented, not sure how much is the brain and how much is not being able to see and being in a strange environment." Failing vision only compounds the confusion. She can't really see where she is and who she is dealing with. It creates anxiety, and every time she has to adjust to a new situation, her fears are increased.

    Bookmark   April 3, 2008 at 4:11PM
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I hate to say this, but it may be that she is not the one that is in may be you and your way of looking at the situation.

This is really not confusion as to where she is, it may be a matter of her brain simply not functioning enough to understand that she is NOT in her home. It's hard to explain, for example, my mother could carry on a conversation about general things like the weather, someone's dress or hair....general things. But she thought she was downtown in a bank rather than in a nursing home. Somehow, she had reached a conclusion that it was a bank. That was reality to her. She probably didn't know what a bank really was at that point.

That's the problem with certain types of dementia. The reality is to them what their brain is telling them. Nothing you can say will sink in. If you try to correct them, they don't understand why you are thinking the way that you do. Then they think that you are being silly, dumb, or just plain lying. Just agree, nod and change the subject.

This may be a tough road for you. Just remember that your main objective is to keep her safe. Far too often, people with poorly functioning brains wander away and get lost. Then they become frightened and try to hide to "protect" themselves from the unknown.

Don't forget to take care of yourself and your family at home too.

    Bookmark   April 3, 2008 at 8:03PM
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There was a very ugly phone conversation between Mom and DH tonight. She complained about everything - the food is terrible and there isn't enough of it, the staff is surly and unfriendly, two residents almost got into a fight in the dining room and she can't eat under conditions like that, the new phone I got her is too hard to hold, they went out on a bus ride but all they did was ride around and that was stupid. We are "piddling away" all her money and shouldn't spend any more. So now I have to take back the few things I had carefully bought for her on the cheap at Walmart that she needed, like some dishtowels and plastic cannisters for her huge collection of snacks that are supposed to be in containers, and the rechargeable flashlight that the home said we should bring.

We expected her to be unhappy, she's always been a complainer, but this surprised even me. And of course it made us furious because we've been busting our butts nonstop and taken LOTS of time off from work for the last month to find her someplace nice to live.

She's insisting that we take her to visit another retirement community that one of her friends moved to years ago. We had offered to take her many times over the last several years, but she had always blown it off because it was "too expensive". It is a great deal more money, it's a luxury place with lots of amenities like a pool and a computer lab that Mom would never, never use. She's heard her friend talk about it, but the friend is in Independent Living, and Mom can no longer handle that. My DH said he'd call tomorrow and get the prices for her, but he's not going to take any more time off from work, he'll only go when he has a free Saturday which won't be for a couple of weeks.

We suspect that it's one of those places where you have to put up a big entrance fee. At least I hope it is, because then she would have to sell the house to pay for it, and I'm sure she doesn't want to sell the house. And even if she did, it would take at least 6 months to a year to get it sorted and emptied out, painted and recarpeted, and then list and sell it.

I think the advice I've been given here is accurate. I am in denial, she's probably got early dementia. I almost wish her dementia were more severe, then I wouldn't feel so bad about her being in the dementia unit! I think she could function in the regular assisted living now, at least for a while, and be less miserable there, but she's never going to be happy anywhere if she's not at home, and she can't handle home any more.

DH is really aggravated. He's threatened several times to give up power of attorney, let someone else do it. The only other possible candidate is SIL, who wouldn't be a good choice for many reasons I won't go into here. Or possibly the daughter of one of Mom's former neighbors who has befriended Mom, but she's a sweet girl, and we would never ask her to take on that burden. DH was going to visit this weekend, but if she's still being cranky, he's not going to go, why drive 5 hours just to get yelled at?

How far gone does someone need to be to be declared legally incompetent? How time consuming and expensive is the process, and how does one go about it? I feel a moral obligation to keep her safe, but I fear she's somewhere in that twilight zone between competent and noncompetent.

What are OUR legal and moral obligations if Mom is not far gone enough to be declared incompetent and decides to move back home? She's never taken initiative to make phone calls to get any kind of help. And at this point, we are pretty darn tired of setting up help for her when all she does is refuse to consider it or complain about it. If she feels she can be independent, then darn it, she can live at home with her filthy bathroom, and no transportation to the doctor and the grocery store, and keep falling down the stairs when she's carrying the laundry basket, and get herself to the ER every few months because she's in another medical crisis.

I used to have a lot of sympathy for the woman and her situation, but frankly I've had just about enough.

    Bookmark   April 4, 2008 at 12:12AM
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The legal aspect of it will be different from state to state. You need to check with a lawyer that you trust. In my state, it was a fairly easy to do thing. There are two types here. One is for the person, that is, placement in a NH, and the other kind is for financial affairs such as selling property.

Also, the POA that you have may not cover everything that you need. For example, banks usually want their own POA to handle transactions for accounts, CDs, annuities, and things like that. This is another thing you need to check on. Does she get a SSA check or a pension? Where is it sent or is it a direct deposit check? It can be sent directly to the NH, if all the paperwork is done.

She's going to complain about everything. That's the pattern of her behavior. It won't change, no matter where she is. It's going to be rough until she settles in.

    Bookmark   April 4, 2008 at 8:24AM
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Watergal, it really sounds, in so many ways, like she is developing some kind of senile dementia, which could even be Alzheimer's.

You are will need to come to terms with this, and we know it can be very difficult because you want to hold onto the idea that she's still the competent, clear-headed person she used to be.

I would follow the doctors' recommendations and leave her in the dementia facility if I were you, because it is safer. You need to make good decisions for her now, because she can't do that any more.

In the guide I recommended in the thread, "Free Booklet for Alzheimer's Care," they say:

"You will need to contact your family lawyer or legal aid service to help you take care of three very important legal documents while your loved one can still talk with you about them:

- Living will
- Durable power of attorney for health care
- Durable financial power of attorney"

There is more explanation in the booklet about what is involved with those. It also says:

"... If you were unable to get these legal papers, then asking the court for guardianship may be your only choice. - The time to ask for guardianship is when she can no longer make good decisions about money and how to care for herself."

    Bookmark   April 5, 2008 at 5:29PM
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My DH has financial power of attorney. We found a bill from the lawyer for drawing up a living will or health care POA, maybe both, I can't remember. But we have to get a signed paper from MIL in order for them to tell us if they exist and give us a copy. I guess we need to confront her about that soon, but I hate to add any more fuel to her fire of discontent right now.

My frustration is that right now, she is way too high functioning to be in dementia and would be much happier in regular AL, and probably safe for a while. But who knows how long that will be - a month, a year, five years? It really seems unfair and unkind to keep her in lockdown unnecessarily when she could still be independent.

I kind of hope the CHF gets her before the dementia gets too much worse.

    Bookmark   April 6, 2008 at 8:23AM
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Please, please, please remember that while a person may still be functioning well (cooking, talking, personal hygiene, etc.) the mind MAY be at a state where it can no longer guide the behavior of the body with logic. This is the problem with dementia.

For example, they may be capable of walking to a nearby store, shopping, paying for the things, talking to people, but when they leave the store, may find that they can't make the proper decision as to which way to turn to go home. They make drive and forget they have a car parked nearby. They may be able to cook a good meal, but overlook such things as turning off the burners, using clean dishes.

Dementia is a weird thing. It doesn't affect all of the brain, and all people, the same way.

I remember that my mother called us one day. She wanted my husband to look at her car. It was making very peculiar noises when she drove. He went and looked. We were horrified. She had hit something hard enough that the fender and bumper were pushed back up against the tire and what she heard was the noise of the tire being scrapped off. She didn't remember hitting anything. She had been driving regularly to get groceries, go to church, etc. Just never noticed a thing wrong. We have no idea how long it had been like that as it didn't look like fresh damage. She didn't even seem to understand that something had happened. BUT, she still knew that she needed to go to the store for groceries and cook meals.

    Bookmark   April 6, 2008 at 12:37PM
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I'll throw in my two cents too. As Agnes has said, your MIL may function fairly well in some areas but not in others. And as I said before, any move is traumatic and can throw your loved one off. My mother moved to a new assisted living facility last November. She had toured it twice, had lunch there twice, was part of the moving process & packed boxes, etc. The day of the move, she went down to lunch and had a lovely time, chatting with both staff & residents. The next morning I got a call from her telling me she had to move because all the caregivers were Iraqis and not Christians like she thought. Later she headed out of the facility and started to cross a busy street to escape. Of course, the staff went after her and tried to convince her to return, but they didn't get anywhere. I eventually drove over & helped get her back into her apartment. She told me the staff had chased her out of the building and tried to push her into the street.

Even now, she mainly complains. Her reality is so limited that she thinks her facility used to be one of her brother's restaurants. She can't keep straight who my son is, her one & only grandson. Yet, a year or so ago I thought all these kind of things were just annoying personality quirks. Now I realize that she was slipping quickly into dementia, and the process had been going on for quite some time (I just didn't recognize it).

You need to take care of the legal stuff ASAP. Given her mental state right now, she may not even cooperate with you too much. Can you contact the attorney that drew up the documents and ask him what you need to do in order to take a more active role in your MIL's legal affairs?

I know this is hard for you and your husband. Part frustration, part worry. Feel free to continue to come back to this forum for encouragement. Most of us have been or are in similar circumstances. There's a lot of good advice and, even more importantly, a lot of sympathy, understanding, & encouragement.

    Bookmark   April 6, 2008 at 3:27PM
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Thanks to all of you for the advice and support.

It is going somewhat better. DH visited on Sunday and Mom was pretty good. Still complaining about the meal portions being too small, but DH said dinner looked fine. She's had trouble getting the layout of the place, it is not that big but it is a little confusing, especially if one doesn't see well, so he walked her around and helped her locate "landmarks". She hasn't figured out how to use the shower yet, he showed her how to use the controls. She didn't complain much. Apparently she is quite bashful about asking questions of the staff, so it's hard for her to grasp the routines.

She has miraculously been socializing and even won two bingo games. There is not really anyone to talk to there, the other patients are pretty out of it. That's the worst part.

She is definitely frail, has been complaining of dizziness, and fallen a few times there (well, really just kind of "slid down", not a total fall). The staff took her blood pressure, it was quite low. She's supposed to have a appointment with the house doctor within the first week, I'll be interested to see what he says. She also has a followup with her cardiologist (she has CHF) on April 16th - he had been her primary care doc as well before she moved into AL.

SIL reported that her visit was not as good as when my DH saw her. But SIL has always had a tendency to overreact and misinterpret, plus MIL likes to push SIL's buttons.

I'll be going up in a few days to visit when DH is out of town. I want to see how she's doing myself, and eat a meal there with her to check out the food.

The director appears to be leaning towards moving her up to regular AL when the 15 days is up. SIL thinks Mom is too confused but finds the dementia unit "creepy". DH and I think Mom needs to be around people she can converse with and make friends with, and be able to go on little outings to the store (that was pretty much her only hobby for the last decade).

One other concern is that regular AL has "happy hour" every day, with choice of ginger ale, apple juice, and wine. Mom is NOT supposed to drink, doctor's orders, it worsens the CHF significantly. Of course, she's not supposed to smoke either, but it appears drinking is the bigger problem. We will have to see if the AL has a way to refuse giving her alcohol, or if that is her "right" as a competent person to make that choice.

If they can't control the alcohol, do we have a moral obligation to keep her locked up in the dementia unit just so that she can't drink? Or should we let her make that choice for herself? It's obvious that she is getting weaker, not sure how much longer the heart is going to hold up, so do we let her enjoy a drink if it makes her happy or keep it away from her to prolong a life that she's not enjoying all that much?

BTW, she really needs to be on antidepressants, doc has tried but she refuses.

    Bookmark   April 8, 2008 at 8:21AM
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,,," so do we let her enjoy a drink if it makes her happy or keep it away from her to prolong a life that she's not enjoying all that much? ,,,,"

What would you want if you were in the same situation and others were planning to make the decision for you?

This is a problem that many have faced before. We are responsible for doing what we can to keep the patient from unsafe situations. However, to keep them totally away from danger, we would probably have to confine them to the bed. We have to make the decision, Safe, but as happy and content as possible.

My concern with allowing her to be moved from the dementia unit to the AL unit is that there is no way of knowing how upsetting another new situation would be. It could be a big mistake. And then, the awful truth with dementia is that today is one thing, and tomorrow may be much, much worse. She'll make friends where she is too.

    Bookmark   April 8, 2008 at 9:07AM
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Regarding the wine at "Happy Hour:" Years ago an old family friend faced a similar decision. Her 87 year old mother-in-law lived with them. Each day the dear MIL ate 2-3 pieces of chocolate candy. My family friend was concerned that all this candy was bad-- sugar, calories, cholesterol, etc. So she discussed the candy eating with her MIL's doctor. He told her not to worry about it. At 87, he felt the MIL had earned the right to eat something that she enjoyed. He didn't think it would harm her and would actually give her something to look forward to each day.

I know about alcohol & CHF. But I doubt that the assisted living facility will be giving the residents huge glasses full of wine. And I bet they won't get more than one drink per evening. I don't think such a small portion would really do that much damage. And the special daily occasion would give your MIL something enjoyable to look forward to each day. That goes a long way in creating contentment.

I do, however, share Agnes' concerns about the move into the AL unit creating an upsetting situation for your MIL.

My mom has been in assisted living now for almost three years. The one thing I can tell you is that the complaints will NEVER stop. My biggest regret is that I always reacted to every complaint. I spent so much time, money, & effort trying to make things better for her. In the end, I neglected my own health and left my husband (a CHF patient) alone for hours at a time just running around trying to manage every bit of my mother's care. When she moved into her latest place, I finally decided to let the staff do their job. I visit her regularly, call her regularly, etc., but I don't agonize over ever little thing. Amazingly enough, my mother seems relatively content.

Don't make yourself sick with worry. Use your best judgment. There is no perfect solution. It seems like you're doing the best you can under the circumstances.

    Bookmark   April 8, 2008 at 6:10PM
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Bizarre turn of events. The AL staff is more than willing to move her from dementia to regular AL, but she doesn't want to go! They even have an identical room available now.

They've been encouraging her to go up there for some activities. She tried a few but now is making excuses not to go. They are doing their best to make the transition slow and easy so that it's not another trauma for her. They supposedly have a few residents who live in the dementia unit but have pretty much free run of the place there. I don't quite understand why someone would choose that option. I don't think MIL has befriended any of the dementia residents, but she may be developing relationships with some of the nurses and aides.

They did start letting her go to the main AL dining room for meals, hoping she would make some friends. She even found that rather overwhelming. They did find a gentleman tablemate for her, and she enjoys the attention. But she scurries back after meals, doesn't hang out to socialize. And she prefers the bingo in the dementia unit, probably because she wins much of the time because she can focus better than the other folks!

We took her out shopping. She has various vision problems, some of them probably not fixable, so shopping is pretty hard for her, as she can't see the merchandise very well. So I guess the shopping trips on the bus are not a big enticement, although I would think that 24/7 access to the smoking area and the hot tea in the snack bar would make her very happy.

Her mind is much sharper, and she actually was pretty happy when we visited a few days ago and surprisingly grateful for the little things we did for her. She is still pretty tippy when she walks - we and the staff both worry about her falling, but she refuses to use a cane.

She scored 24 out of 27 on the mini-mental. We don't see any dementia for now. Not to say that it couldn't flare up at any time.

So who knows? She may just choose to stay in dementia land. She's still WAY better off than she was living alone in her house. And if the dementia flares up, she'll already be in the right place. Her money, her choice. Sure not my choice though.

    Bookmark   April 19, 2008 at 9:01PM
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Sounds as if she has made a decision that suits her. She feels comfortable there. That's the main thing.

Sometimes people will talk about dementia as if it's always a crazy or insane state. It isn't. Sometimes, it's just a matter of the wheels turning at a different speed than they once did. The outgoing personality becomes introverted, and the introvert becomes the star of the show. The hard worker gets lazy and the lazy one becomes one who can't sit still. The good memory is for past events, those recent ones are sometimes not as clear. Simple things get muddled. It's a condition that is hard to be very clear about until the behavior becomes noticeably different.

She may have found a niche where she feels that she fits in.

My medical dictionary gives the definition as an irrecoverable deteriorative mental state, and then goes on to list over 20 different types of dementia.

    Bookmark   April 19, 2008 at 10:38PM
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Watergal, I've found that the memory care units were always smaller and had more staff than the assisted living portions of the facility. Perhaps that's why your MIL feels more comfortable. Less overwhelming and more interaction with caring staff. Also it's a whole lot easier chatting with friendly, talkative staff than trying to strike up conversations with strangers. Staying put may be a less stressful choice for her right now. As long as she can join some AL activities when she wants to, that may be the best solution.

    Bookmark   April 20, 2008 at 7:02PM
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I am reading a lot of similarities to what I have been dealing with my mother for the past 1-1/2 yrs. I wish you luck - as it can be soooo trying!

1. I received plenary guardianship of my 65 yr old mother just over a year ago. Here in FL, I'd say it was a fairly time consuming and expensive route (excess of $5K). I was pushed into seeking this formal route (vs power of attorney) because everyone was concerned my mother would have tried to revoke the POW. Now I see that wouldn't have been an issue --- she believes everything I tell her regarding legal issues and isn't motivated enough to find out otherwise - so I feel that I should have stayed with POW and avoided the aggrivation (annual Guardianship plans, annual Accounting, petitioning for various fees, guardianship accounts, etc). It's costing about $3500 per year now. I have an appt with a separate Elderly lawyer - family friend - to get advice on medicaid planning and to see how long I really need to retain this "guardianship attorney".

2. Whenever I need to do something that I believe mom is going to be upset about, I just tell her that it is "court appointed". She doesn't recall the hearing - but I assure her it is true.

3. She too was a heavy smoker and drinker (the actual cause of her dementia - alcohol persistent dementia). But, somehow she completely FORGOT that she did either. Now she says she smoked "years ago" and that she used to "have a drink or two of wine - socially". Ha. But, her doctor did specify (in a letter) that the ALF not allow her to have alcohol - that it would interfer with her blood pressure and diabetes management. Shock.

4. I sought out a memory care ALF due to recommendations from the court (via the 3 person, court appointed Examinining Committee). I toured several ALF's with memory-care units and they each assured me that their entire staff had special training to deal with dementia patients. Right. They call me every time that they cannot get my mom to wash her hair, that she puts the garbage in the wrong place, she leaves windows open, she eats the wrong things, etc. For cripes-sake - why can't they take care of these things if they're so well trained?

I'm glad your mom (MIL ?) is taking fairly good to her placement and is actually taking part in some of the activities. My mom was so isolated - and will have nothing to do with the "old folks" and their "stupid crafts and games" in her ALF. Too bad.
Again - good luck to you. What a duty, huh?

    Bookmark   April 21, 2008 at 12:51PM
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You also need a Comfort Care document in case her quality of life is nil. It tells the care unit not to give her life sustaining meds. Also my attorney added something for my POA, that most people don't think of, my POA can pay all outstanding bills after I die.

    Bookmark   May 4, 2008 at 10:26PM
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Well, the management finally convinced MIL to move out of dementialand. We visited last weekend and she is doing great! She even signed up for a bus trip to ride on a local tourist railroad. She's not doing much with the regular daily activities, but she does lots of walking around the hallways for exercise, and she has found a scrabble buddy. We are helping her decorate her room, bringing over a few pieces of furniture.

She looks healthier, happier, and more relaxed than I have seen her in years. Having people around to talk to is good for her. She still complains about some minor things, but last visit she never even mentioned wanting to go home!

So far, so good! Now let's home she can stay healthy enough that we don't have to find a nursing home for her, because this AL doesn't have one.

    Bookmark   May 9, 2008 at 9:43AM
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Sounds like good news. Also sounds like a respite for you, a chance to catch your breath, and gear up & get prepared for the next situation. Good luck.

    Bookmark   May 9, 2008 at 6:09PM
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Yes, it is great news. Although I do find myself in a perpetual state of waiting for the next situation to hit...

    Bookmark   May 9, 2008 at 6:22PM
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I'm so happy for you and your MIL, Mom is also 24 on the MMSE. Fortunately she is in Independent Living, and still capable of her own bathing, fixing snack, caring properly for her 2 cats, plants.

She wasn't too happy at first, because she can't drive (has glaucoma). She really wanted to to my brother's, where she would have been very alone as he works far away.

Then, a blessing......a gentleman with all good mental faculties, but bad knees and in a scooter...asked mom out to dinner one evening...he drives. Well, those two have become the "item"!!!!

But don't you know, he ended up in hospital with a mild heart attack, and as we speak, is now in the rehab place for a few weeks. I was anxiously waiting to see if that would put mom in a tail spin, but she's been holding up. In a little while, I'm going to go get her and take her to see her "boyfriend" at the rehab, before bringing her here for Mother's Day dinner.

She was just getting into the shower when I called! I'm sure she wants to get all pretty for Boy George!!!!

The minute she got attention from this fellow, and he seems rather smitten with her, all negative thoughts on her part flew out the window! She always has needed a man around. Now I find myself rather selfishly praying for an effective and thorough rehab on his part, because he has been so GOOD for her....

All the stories we can tell about our ailing parents...we are OUR support group!

    Bookmark   May 11, 2008 at 10:18AM
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