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

You should attempt to discern why her possible hallucinogenic thoughts, such as she thought the woman was going "to eat her face" are occurring. Check medication list.

Can you not find another place that would appeal to your Mom more? Home is where they always want to be, but eventually, it is not safe for them to be there especially alone. And it seems like such a waste of money to have in home care when Mom sleeps so much. Assisted Living will probably not do much for Mom at this stage, but you really should give Memory Care another chance at a different facility. Mom will still complain....but then, they all do to a point. Eventually, they learn to love where they are and are comfortable with it. Tour a place first, their goal is to keep the resident safe, engaged and social, etc. Best of luck...it's hard work.

I can relate. Just placed mom 83 with dementia in ARCH a week ago.Despite being alert, social, ambulatory, keeps asking: when I'm coming for her, and that her (unstable/homeless) son is getting a place for them, and she has to do her taxes. Mom doesn't qualify for Medicaid, AL here (hawaii) is 5K & up (way above her budget) for a shared room. Mom's entire income goes to CH. Caregiver working with geriatric Dr. & meds management at this point. Cannot bring mom back since she only wants to be with unstable son. Despite doing
everything to take care of her & make her feel wanted- she was making plans to leave.
My heart goes out to everyone on this wonderful site.

Just yesterday my mom told me how terrible lunch and dinner were, and then proceeded to itemize what she had. She ended up concluding that both meals were good. :) We do sometimes like to complain.....

You might want to consider a 6 bed “board and care”. I don’t like that name BUT my mom needed to be more stimulated (upon other issues that were occurring) in her memory care at a medium sized assisted living facility. She transferred from AL to the memory care. Now she’s in a lovely home and she helps with food preparation, plays games, goes outdoors when SHE wants, and has individual attention when SHE needs it. She has flourished in this new surrounding. Look around and see what is out there. There are many! Some are not so good and some are under recognized. You can get a good idea of level of care the caregivers provide when you visit the home for the first time. If your mom has outbursts, a good home will have the staff that can care for her and ensure she is safe both mentally and physically.

One thing I made sure to do when my Dad moved from his home into senior care was to set up his bedroom the same way he had it at home. Such as the highboy dresser was to the left of the bed, the night stand to the left, etc. Of course, due to windows I couldn't set it up completely the same, but close enough.

That way when Dad should awake in the middle of the night, and he saw his highboy dresser he knew he was at "home".

I learned after the fact, that I should have brought Dad's old bedspread from home for him to use instead of buying him something new.  The old bedspread I remember going back to when I was a child.  My late Mom could make things last for half a century :)

Dad also could budget to bring in his favorite caregiver from his house to the facility, She worked mornings. Thus Dad got to see the same smiling face each morning, that gave him routine.

You and your siblings, are going through one of the hardest things a child ever has to face with their parent. My dad was in the hospital and they told me that he needed Memory Care. When I went to look, the memory care in my area were all very low functioning wheelchair-bound, nonverbal High needs people. My dad was so sick they believed this was the level of care needed. I put him into skilled nursing against his will and had to move him to one that had better Rehabilitation. He never got well enough to live alone, but he was well enough to be angry as a wet hen with myself. I used the redirecting, giving false hope, as in this is a shortstop for you to get better then you can make a different choice. This is in an adult Home Care Assisted Living facility, after he had in home PT and OT, with a very immature physical therapist telling him you don't need this kind of help because you can remember what the face of a clock looks like. Can't cook, or remember to brush teeth, blind in one eye, comprised sight in the other, can't remember to take meds, never changes his clothes but, you don't need AL. Wow, so now for the last three to four months I have been dealing with, I'm all better, he remembers that PT told him he didn't need care because he can remember a clock face, I'm moving home which is 450 miles away from myself and my husband. I have a brother that lives in that area and lived 3 miles away from him when he was sick Nigh to death, he cannot understand why I am so very concerned about him going back to this area, he argues that that's where all of his friends are and my brother as well. But he was within days of being dead when my husband and I picked him up and brought him to our state, he had valled for help moving, wanted a new start, because of the dementia he can't remember that he was almost dead and all of these friends had seen him within a week of us picking him up and none of them said you need to get medical help, you obviously have something going on, we new the moment we saw him something was wrong. The doctors told us that this was long-term uncared for, untreated congestive heart failure, kidney disease which had advanced to renal failure, poor nutrition Etc for the first 3 days of the hospital stay they were preparing us that he may not make it. So, you know your mom better than anyone, you and your siblings please do as suggested above, stop in Daily at different times to reassure her and to watch from the wings, my dad is really great at trying to send me on a guilt trip about all of his fears, there was a fellow that loved his dog and would go take a nap in his room so he could cuddle with the dog, he made it sound like he was being invaded by aliens, how terrible the facility is, they only feed him cold cereal and sandwiches, he's miserable, miserable, miserable. When I speak to the caregivers or other residents I get an entirely different story, I am still learning how to deal with the dementia combined with a narcissistic manipulating personality. But if I had a crystal ball I would have never used that you could get better and go someplace else, as that has created a Non-Stop nightmare for myself, my husband and the caregivers. Sorry I did not mean to make this about myself I think that everybody has given you tremendous advice, they have all actually helped me from having a mental breakdown, so please use the advice but use your best judgement for your mom, go to the assisted living area and watch, that might be enough information for you to see that Mom's not able enough to be in that environment or that is where she needs to be. I love that my dad is in a home setting it is called Assisted Living, however, he will be able to age in place right through hospice. He is allowed to have his little chihuahua and there are caregivers 24/7, he has made friends even though he says he hasn't, that's just part of manipulating his daughter trying to make me bring him home. Best of luck, it is the hardest Journey we face with our parents. Please know most facilities are quite happy to allow you to be a spectator, talk to Residents, come in to try the food, etc. they want you and your loved one comfortable, as it makes their job that much easier so don't hesitate to ask questions, walk around, spend time and in my opinion if they have a problem with that it's a red flag and you should not be thinking about putting mom there anyway.

If you have multiple memory care buildings in your area, be sure you look at a number of them - they are very different, and you may find one that you are very comfortable with. Otherwise, you can have your mom stay in AL but hire extra care privately to supplement what the AL staff provide - my family does this for my mother-in-law who is right on the border of needing memory care but doesn't want to be in the MC unit. Just note that in this case, the person providing the care does need to be coming from an agency (so, licensed, bonded, insured, and background-checked), you can't just hire someone off Craig's List and expect the AL to allow them in.

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.

At my mother’s facility, they have two different buildings w two different levels for Assisted Living. They first wanted her in the higher level because of her level of dementia. Mom balked and said things like how much older those people were than her. (She was 86. Lol) What she really meant was she sensed they needed more care than her. They all had walkers and she didn’t at that time. They worked w me, and we ended up at the lower level Assisted Living with her room right next to the nurse station and dining hall. It has worked great. I know someday she will move up a level or two. Please express your concerns to the team at Memory Care. They usually are experts at what facility is best.

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. 

Ginach, I know! As a general opinion, my dad will say the food at his ALF is wonderful. However, if you question him after any one specific meal, such as "hey dad, how was breakfast today?" he will indicate it was cold, sub-par, not too good, etc.

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.

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.

We had a lock on our door to prevent others from entering during naptime...or nighttime. Master key given to all staff.

Also, it takes 1-3 months generally to adjust to a new place...sometimes longer (my dad's 2nd move took about 5 months).

Our MC doesn't make everyone come out of their rooms unless they want to...ppl are free to drift around as well. It's very spacious and there are activities all day.

When my mom was here, I had found them an internal 2-bedrm apartment (within a building) that was AS "with enhanced care". That was the only transitional place in our state. It was a great place until dad had his neurological shift and then later, mom's memory issues started to surface (then we had to move to a locked facility).

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.

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 :(

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.

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?

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 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!