A relative has cognitive impairment. When we moved her to an assisted living facility a few years ago, we were assured she could remain in that apartment until the end of her life. Staff were aware of her cognitive issues at the point she moved in - the major problem being she finds it difficult to find the appropriate word, but she could make her needs known. We are now being encouraged to move her from the lovely assisted living apartment where she has all of her favorite items and furniture, to the dementia care unit at the same facility. In the dementia unit, one could have a few knickknacks & small dresser but there is a hospital-type bed in one room with private bath and small closet. We know there is high demand for the assisted living apartments at this facility. How does one determine that the move is in the best interests of the patient vs the facility. This relative is perfectly capable of dressing, bathing, and feeding herself. She walks the corridors, but otherwise watches tv or out the window in her room. With covid, none of the family or relatives have been able to spend any time with her in-person since March. Walking the hallways is her only outlet. We do know that moving her to the dementia care unit in the same facility (which she is very familiar with) will have a very major negative impact. If we didn't know about the high demand for the assisted living apartments, perhaps we would not have such a negative reaction to the suggestion. We know to the extent possible these days this woman is still able to function. Does any one have any experience with this issue, i.e., facility suggesting a move that you don't feel is necessary and which will have a very negative impact on the patient?
Wishing you good luck. These are, after all, a business. Things happen often sadly from that perspective,
One issue I would discuss is the correlation, if any, between the change and the shutdown b/c of Covid.
Once again, we're on the same page. I was thinking the same thing about talking to a doctor/medical team and have her evaluated to be sure it's absolutely necessary.
But .....
Have there been other incidents that you might be unaware of since you have not been able to see this person in a while? Has there been a decline that the staff sees that you might not be aware of? Is it possible that this person has tried to leave the AL facility while walking? If so did they actually get out?
If possible can you get another opinion, another person in to evaluate the cognition that this person has and if they are able to maintain a lifestyle in AL? I probably would not move them until an evaluation could be done. And is it possible to place cameras in her apartment so you can observe what he is doing so that you can have an idea what is going on?
My first question would be does she need more help with her ADLs. What has changed to make them feel she needs more care in Memory Care. Which by the way is going to cost her more. I would tell them its hard to make that decision without seeing her. You could also take her out for a neurological eval. But may mean she will be quarentined. At Moms AL u kept your own doctor so I would not have made any decisions on the word of an RN. If there Is a doctor associated with the AL I would want to speak to him.
"We know there is high demand for the assisted living apartments at this facility." If she's paying full price for the room then this isn't an incentive to move her since the room is at maximum monitization already. If she's getting govt assistance, then maybe. I wish you success in getting the clear answers you need to make the best decision for her.
If you look at it this way, life is a series of changes and with the first change was huge having her placed out of her home into a facility. Now that she’s there they’ve assessed at this stage they’ve observed reasons she now is best suited for Mc. The only way to have full control of her lifestyle is to keep her at home, in a way it’s that simple, once a lo is placed in a facility they are responsible for her care- if they have reasons to believe she’s better suited for that it’s their responsibility to move her to the different unit to accommodate her needs. As some others have said at this age things don’t stay static for years or even months necessarily, they can suddenly decline or experience other changes
It ended up being the best thing for her. In Assisted Living, it required more individual agency to socialize or find an activity. They have to mask and social distance outside apartment. They will not stop them if they want to walk out front door. Need to remember when meals were being served, choose a table, choose from lots of choices, and there were fewer aides in that area. Most residents were nice, but still some mean girls around that didnt like that she sometimes told conflicting stories.
Mom can still get herself dressed, and choose a meal, and have a conversation. But as her dementia increased, her sundowning increased, and she started pacing the halls long in the night, and being very anxious ( looking for her children or parents)
In Memory Care because of the cognitive issues , they dont require residents to mask, and there are only a few tables where they eat communally. In the times between meals, they can sit in rhe communal area, and participate in activities or not, but the activities come to them. The aides in that area also seem better versed in how to roll with whatever mindset mom is in that day
None of it is perfect. Covid has complicated everything. I wish I had been able to get her to move to AL a year sooner. She moved in a couple of weeks before things got bad here, so nothing there is what we expected when we made the move.
When you say that the resident is perfectly able to bath, change, and feed herself, I get it. She may physically be able to do it, but, the thing with dementia is that she may forget to do it. Then, they remind her...then she goes into the bathroom to do it, but, forgets or gets distracted. So, they then try to help...then she may resist...she may insist she already bathed...but, she didn't. They get confused and really need so much more attention and direct care. My LO would get lost going on the way to the dining room and forget where she was going and never get there for a meal. They told me that when reminders are no longer sufficient and assistance become completely doing the task for them, it goes beyond the scope of AL.
Maybe, they can explain their recommendation.
Once again your question is a reminder that every facility has it's own way of thinking and dealing with residents.
My mom was diagnosed with Alzheimer's in 2014 at the age of 89. I moved her into an ALF into a very nice one-bedroom apartment with a separate living room, kitchen, bedroom and bathroom. I tried to salvage the nice pieces of furniture from the home I grew up in to make it as homey as I could so the transition might be easier on her since she didn't want to move. She was able to walk, dress herself and eat on her own. She started at the basic level 1 care. Her main problem was not being able to take medications on her own and the Alzheimer's aspect was more time-related i.e. when did I see her that day, when did she eat last etc.
After a couple of years, I saw a social worker from hospice (even though my mom wasn't on hospice at that time) and had her evaluated. She did the MMSE assessment and felt my mom could still remain in the AL area but, should be moved up to level 2 care. When I told the Administrator of the facility, she said "no" your mom doesn't need it. So I had the exact opposite occur in our situation.
If it were me, I know I would find it unsettling to think they would want to move my loved one out of the AL side into memory care if it weren't necessary just so they could give it to someone else. I would definitely want a doctor's opinion as to whether it would be in alignment with what the facility thinks. At this point, it really doesn't seem like she needs to be moved.
Currently, because my mom did nearly die of severe dehydration and COVID in April we moved her to a new facility into their memory care unit and she's now under hospice care. She scored 14 out of 30 on the MMSE which is her lowest score to date however, she is there because she can no longer walk, dress herself, has lost 30 pounds and isn't eating very much. I moved her into a much smaller one-bedroom apartment because she is now in a hospital bed and there was no need for a living room, separate bedroom etc.
I can say this, I'm so glad she is in memory care just because she is getting much better and more frequent care as well as the caregivers and director of the memory care unit are better equipped to handle someone with Alzheimer's and other forms of dementias. My mom's attitude is very good considering all she has been through and as she approaches 96 in February.
I hope you will have a medical professional assess her before moving her.
I wish all of you the best and may you get some clarity when you make a decision as to whether to move her or not.
My mother was in AL until March, then hospitalized for a week with pneumonia. We had her placed in rehab to recover and saw an immediate cognitive decline. On the advice of doctors she was placed in SNC and we thought that was the end.
Then last month the facility recommended we find her a place in Memory Care. They told us she needed more mental stimulation than they were able to offer.
So we had her moved to a new facility that does not isolate MC residents, doesn’t require them to wear mask, and has a policy of multiple daily activities for them. No TVs in resident rooms and everyone eats together. The goal is to keep them engaged and not sitting alone. This also has the benefit of tiring them out so they sleep better at night. A separate staff ensures their safety from Covid.
Within a week we saw an improvement in her alertness and physical well-being. It also helps that she was taken off numerous anti-anxiety drugs that were turning her into a zombie.
Yes, it is more expensive but they have a higher ratio of staff to residents, plus extra training.
Ask the staff for specific details for their opinion. You deserve answers to your questions.
I would also express any concerns about how you feel that a move to memory care may effect her negatively.
All the best.
I would get that answered before I agreed to anything.
Then I would have an independent needs assessment done and decide if I was going to continue to pay a facility that did a bait and switch or move her.
Listen to your gut, because these places will say anything to fill a bed.
I had to learn the HARD way - any facility no matter how good or bad they may be is ALWAYS a business first and foremost!
Unfortunately we don't know until we know what we don't know.
A social worker referred me to this forum and I have found it helpful. I wanted to experience an in person support group so I searched and I found one that was held at an assisted living facility. This facility only had independent living and assisted living. It did not have memory care.
We would meet once a month and two of the women that attended our meetings lived at the facility.
Their husbands used to live there as well but they were asked to leave because as their health worsened, their care level went beyond what the assisted living could offer. Their wives placed them into nursing homes.
The assisted living facility told the wives that they do everything possible to keep a person as a resident but it isn’t always possible to do so.
So I wouldn’t take a promise that was made from any facility as being true. Who can predict the future like that? People’s health can go downhill and they don’t have any other choice but to change their plan. It’s sad.
I'm so glad that you were able to find another facility within such a short time especially one that could and would handle her needs.
Thankfully, for you and your MIL it had a good ending and you were also able to get a refund having gone through a lawyer!
Hope she is doing well now in her new environment!
I truly don't see how the facility could have promised you that she could stay there for the rest of her life when she has dementia which we all know worsens.
Even without dementia, she could worsen physically and need more care.
Those pretty little things you've brought to her apartment are probably more important to you than to her. I guess my advice would be to ask the facility what has changed that makes them feel she needs more care.
Good Luck.
Secondly, your family member has been dealing with cognitive decline for 'years' now, according to your post, and dementia is progressive. That said, it may indeed BE time for her to move to the Memory Care section. What you don't see is how she's dealing with a microwave and a refrigerator and getting herself to and from her apartment and and and. There are a TON of things these AL residents are expected to do independently, with no help, that after a while, become impossible for them TO do when dementia is present. We don't get to witness that b/c we're not there 24/7.
Lastly, my own mother has lived in the same ALF since 2015; first in the regular AL section in her own apartment with a microwave, fridge, etc. She was diagnosed with dementia in 2016, but I knew she was going downhill for years before that diagnosis. She became more and more of a burden to the care givers as time went on, and on occasion, was a 2 person assist because of chronic vertigo. I knew they wanted her OUT of there for at least a year before she got sick with pneumonia and was hospitalized, then moved to rehab for 20 days. When it was time to go back to her apt at the ALF, the nurse came to the rehab to do an assessment and said No, you no longer qualify for your apt in AL, but we can take you in the Memory Care building. So that's what we did; we moved her out of her apt and into Memory Care which is a shrunken environment where she can function a whole lot better b/c there's less to deal with.
My choices at that juncture were........either move her into Memory Care or find another ALF that would be willing to accept her WITH a 4 year old dementia diagnosis and several health issues on her plate. There may have been an ALF that WOULD have taken her, certainly. I know that Morningstar Assisted Living does accept residents who are turned down by other ALFs for having too many issues, and they will charge nursing home rates to house them. That's the trade off.
You can always look for another ALF to accept your loved one, or, you can accept that it's time she's housed in the Memory Care section of her facility. You can also get her doctor to come in and give you his or her professional opinion of where your loved one would be best off living.
It's a catch-22, in reality. My mother says she 'doesn't belong' in the Memory Care, that there's nothing wrong with her at ALL and it's the others who are all 'stupid morons' and 'crazy' and yada yada. Meanwhile, she is lost in time and space and has no idea WHAT'S going on, even with an Alzheimer's clock to TELL her what day and time it is. Denial is very common for patients AND family members when dementia is involved. We tend to see them as 'much better' than they really ARE, and they tend to see themselves in the same light. When I worked at a MC ALF before the plague hit, we had one lady who insisted she was only staying there as a 'hotel' b/c she was perfectly fine (similar to my mother) and her daughter agreed. That hotel, however, was costing her $6500 a month. And I listened to her repeat the exact same stories 200x per day, day in and day out for a solid 7 months.
Sometimes, you can't win; they're not going to be happy EITHER way. But the bottom line is, the AL decides where your loved one belongs and they get to make that decision. If you disagree with it, you get to move her to a different place if you can find one to accept her. And then, if/when she declines a bit further, you'll be faced with the SAME decision all over again. If you do move her, be sure to find an ALF that DOES have a Memory Care wing.
Best of luck! I know how dreadful this whole thing really is.
The facility is trying to function as best as it can. I bet the staff appreciated that you were cooperative.
People with dementia or ALZ will certainly decline. There is no telling how and when it will occur.
My godmother declined horribly. She was a huge burden to the staff at her nursing home. She would have been kicked out of an assisted living facility.
Caregiving is a tough job, even if a person doesn’t have dementia.
All the OP can do is question their opinions. If they are there on a daily basis and I am not there everyday I would certainly take their comments seriously.
Being able to dress and feed oneself are not determining factors for the move to memory care. Many people with moderate levels of dementia are able to feed and dress themselves. My Mom used to wear scarves everyday and dress herself in an elegant manner, but she could not follow a recipe or remember why she left the kitchen. She knew exactly which eating utensil to use if the Queen of England came to visit, but she could not remember my friends who had visited many, many times. Your best bet, as many previous commenters posted, is to meet with the facility and ask for specifics. All facilities are expected to keep a care plan for your mother, so ask to see the comments in the plan. You have a right to the plan.
I would also discuss with the community bringing your mother's furniture to MC. That is unusual that they do not allow her own furnishings and bed. MC is not a medical model, so there should be no requirement for a hospital bed. Do not place any valuables in her room (misplacement and theft) and, to make her comfortable quickly, bring along items she knows, like her bedspread, photo albums, artwork, furniture, memory box and anything management recommends.
Carefully review the terms for termination of the contract. Consult a lawyer. If the facility determines your mother needs to be in MC and you refuse, that could be cause for termination. When senior care communities promise to keep a resident for the rest of their life, do not believe it. Period. There are many factors than cause the relocation of a senior, including behavior problems (sometimes caused by poor management), health changes, memory loss, ability to pay, etc. Know your rights and responsibilities so you can give your mother a good life and have more effective communication with the operators of the community.
The vast majority of operators have your mother's best interest at heart. If they think she needs to move to memory care, then listen to the reasons and examples they give. You mother will have a higher quality of care with greater staff accessibility. The fact that the AL rooms are in such high demand speaks well for the community.
They treated her like a "queen" and loved her as much as her family did. She was also fortunate enough to maintain a sense of humor. Why this happened is a good question -- All I can say is she reacted differently to me than she did the caretakers at the AL. I found it interesting that they could say to her "It is not nice to talk to your daughter that way", - and she would stop and then say she was sorry to me. They would know when she wasn't feeling good because her sense of humor would stop.
I know it is difficult, but I found that getting to know the caregivers on a personal basis helped both Mother and Myself. I Do now understand however, why they would want to move your LO with the explanation you have. When Mom first moved in they told me that she would have to be moved to MC only if she was to become a danger to herself or others. That never happened. Is there something going on with your LO that you have not been made aware of? Talk to the facility in detail. Get more answers. Good luck, this is never easy!
Even her Dr says she's fine where she is.
They probably just need her apartment for someone else and have beds available in the Dementia Care Unit.
Stand your ground and they can't make you move or yell them you will take them to Court and win because they told you she could stay there along as she lived and her Dr says she is fine
I just witnessed a similar scenario. Nursing Facility Administrator was suggesting a "higher level of care" for a resident. The doctor stated "he disagreed."
The doctor had the final say.
If they want to move a resident, it is probably because she is requiring more from them than they can provide in independent or assisted living (wherever she is now) They should be able to tell you exactly why they feel she needs to move. Get a detailed explanation.