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Mom had a stroke on July 1; lots of rehab; she's got expressive aphasia, depression and has now been diagnosed with vascular dementia; she becomes agitated and paranoid in the early evening, and agitated at other times. She's been on low doses on Klonopin for several years due to extreme anxiety, which appears to be fueling, in part, her labile bp (yesterday 210/76, today 90/60) After nearly two months of rehab, we moved her to a lovely AL facility with their highest level of assistance; they were checking on her every 45 minutes, escorts to meals and activities. She wouldn't talk to the visiting nurse who came to evaluate her for further therapy and aides. On her second day in the facility, she was found on the floor of her bedroom, conscious, but not knowing how she got on the floor; she did not push the "panic" button on her wrist. She's now in hospital, no broken bones, thank goodness, but again, disoriented, sad, agitated in the evenings...is it time for skilled nursing? The docs are working on getting her bp meds stabilized, but it's difficult with her agitation and dementia also stirring the pot. Any advice is appreciated.

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Update.after a three day stay in the hodpital, she was deemed stable enough to move back to AL with round the clock aides. She was weepy, hysterical on dischsrge, kept saying "don't send me" we made the tough decision todsy to move her to memory csre in the same facility. The Visiting Nurse who saw her today said thst she was cslm and happy.
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My mom would also lay on the floor and not push the help button. Her aide would come in the morning and find her on the floor. She had to go to a nursing home. Unless your mom has live in skilled nursing she needs to go to a nursing home. She will get 24 hr care and you don't have to worry if she is on the floor or what is going on with her. She will have a chance to make friends and socialize which might help her dementia. Sometimes they stay on the floor to communicate with you that they feel neglected or just to get your attention. The connections she makes at the nursing home will make her feel better about neglect and she will get the attention she needs. My sister is now in a nursing home and they are wonderful with her. Of course I stay in constant contact and visit often but I feel she is safe and she is making friends and getting the interaction she needs
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I had a similar experience with my grandmother. The Dr. in the hospital suggested the Skilled facility for rehab/permanent care and I decided rather than confuse her by moving her back and forth after every rehab stint she would be better off in a skilled facility to stay.
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It is time for a full neurological work up including CT scans, and take a serious look at her medications, she may be over-medicated or have serious medication interactions. AL may not be enough, take a look at memory care facilities.
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