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MIL is 91 and has lived in an AL for 2 years which has been a very difficult transition for her. She has some dementia and is unable to manage ADL's or any daily detail without assistance. She is no longer able to talk on the phone since she refuses to wear her hearing aids nor can she understand how the phone or the remote for the TV works. She does not cooperate and will stay in her nightgown all day, not attend meals (they bring them to her at an additional cost of 550$ month) and one of the biggest issues is her refusal to shower. Part of her contract allows her an assisted shower X2 weekly She will tell us she is showering herself, (impossible) however we can tell by her appearance and her ADL record kept in the nurse station she is not.
She is living in a large AL and we are beginning to think the staff turnover, coming and going of different staff, confusion on where to get mail etc is keeping her in her apartment since it is safe. She is aware her memory and ability to manage is declining and I am thinking she is isolating herself as a means of keeping the secret.
We are acutally looking at 3 new facilities that are smaller with an increase in 1:1 interaction.
She says she likes her apartment but complains about the staff constantly and only tolerates 2 of the regular staff.
How can we manage a move for her with the least amount of stress for all of us.
We are pretty sure a move would be in her best interest.
By the way, she goes to the doctor often enough and is under a doctors care for depression, dementia and hypertension. Aside from some aches and pains she is in great health.

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From what I've seen it's not the size of the facility but how it's run. A large facility with adequate staff can be as good as a small facility with the same staffing. Where the difference would lie is whether the personality of the person in care is better served by what the facility offers.

What you described, Ellenship, is horrendous and shouldn't be allowed in any size facility. I don't understand why such a place is allowed to stay open. I'm so glad that you found another facility that is good. That's wonderful news.
Carol
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My father too has dementia at 87 years old. he is unablet to take care of his daily needs... Two years ago we put him in a large 70 person assisted living.. He was not getting the care I expected from them. He would be unbathed which we could tell by his dirty hair and his body odor. They let him sleep many days and leave a food tray up in his room. I don't know about you but who wants to eat cold food and who knows how long it sat up there? His be was always unmade..many times he would be sleeping on the bare mattress with not sheets.. All of this made me so very angry. We have since moved my father to a smaller facility where there are 16 beds.. What a wonderful change. He is clean, fed and awake when we come to visit. He talks more to us rather than just sitting and saying nothing. We are happy we made the move.
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I hung in until mom went into the hospital and rehab again. That gave the perfect opportunity to move her. It gave me the time required to investigate and find an Adult Foster Care Home/Residential Care home that would offer 24/7 care for about the same cost as the negligent AL she was in. A Place for Mom is a wonderful resource and I would recommend it. They will give you options and you can tour the facilities ahead of time. Decisions made without a time constraint are much more rational. Try to find a place that will accept her things and give her as little change as possible, maybe offer an added bonus.
The large corporate facilities are of absolutely no use to me and the one she was in made my life hell for years. Never again.
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Even though it will be stressful, I have seen the problems with having someone with dementia and other problems in an assisted living facility. In our case they kept our relative doped up as much as possible and she complained that they let her fall. At the very end they suddenly moved her to a nursing home - since they didn't want to have her there for her last days, and they never bothered to call Hospice. The move in her last days to the nursing home was VERY stressful, and we found her sitting in her underwear, extremely distraught. If your mother needs to be moved somewhere to get better care, do it now rather than later.
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First order is a routine of movement. Shopping trips to the grocery, to church or park. When she feels comfortable with a routine of movement then negotiate for a permanent change of place. Communications and movement are key factors for maintaining health regardless of mental capacity
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Try looking for a smaller venue for her to live. We call it a 6 pack, board and Care. Try making her go to adult day care once a week, if you can
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Thanks everyone for your helpful and kind words. We have made the decision to move mother to a smaller facility with an increase in care. She will still have her 1 bedroom apartment and eating in a much smaller dining room. Her showers will be given by the same staff person and she will have an increase in safety checks as well as escorts to meals and activities. We have until May which will buy us some time. We are hopeful that mom will be more comfortable and at peace.
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Anytime there is a move it may be upsetting and cause more confusion. I think a move to a smaller facility would benefit her. She can receive more 1-1 attention, and she may feel more like attending some of the facility activities. I think the benefits outweigh the cons. I may be difficult to move her at first but in time she should adjust. It sounds like some of the issues are related to dementia. Many people with dementia refuse to bathe and state they are completing this task on their own. contact your local Area Agency on Aging, they can give you information that can assist you. You can also ask to speak with the long term care ombudsman who can also give you info and answer any questions you have.
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$550 a month for meal delivery! Outrageous! If that were billed to my parents I would be moving them before that bill was done in the paper shredder. But seriously, I do know these AL do have a lot of little charges for each and every extra thing they do.....its just so sad our vulnerable seniors are paying so much.
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I had a similar situation with my mom in terms of falling through the cracks at a large facility. She is disabled from a severe stroke and unable to care for herself; she also gets confused easily. She got lost in the shuffle in a large AL community. While she was generally well cared for, she felt isolated. When I moved her to a smaller AL she did much better socially. I'm an only child so the move was stressful for both of us; but it worked out for the best in the end.
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To move or not to move.....that is the question. I'm with Carol on this one. I'd certainly look into a smaller facility. What have you got to lose by checking it out? At age 91, this patient may or may not be terminal. She has dementia, depression and hypertension and is being treated for all three, I assume. Her behavior is not unusual for someone in this situation. What's the alternative? To stay put and suffer? Remain stressed? No matter where she goes, there will be problems.
It is so unfortunate that these facilities are poorly staffed, with high turnover rates, and in addition to the exorbitant monthly rates, charge for room delivery of meals!
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At 88, my mother is at about the same stage. She doesn't wear hearing aids, but some days she can push a button on her phone to call me and operate the remote control, and some days she cannot. I moved her to a different assisted living facility almost two years ago, and my only regret is that I didn't move her sooner. The first facility made almost no effort to get her out of her apartment, and staff turnover was a big issue for me. Whenever I had a concern, I had to speak to a different person, and I began to doubt that any of my concerns were being passed along to other staff. After it took three phone calls to get the staff to remove old food from her refrigerator (they were on quarantine because of a flu outbreak and were delivering meals to the apartments), I decided that there was more benefits than negative effects to a move. She was a bit more confused for a week or so after the move, but by the end of the second week she didn't remember the move or having lived in a different facility. I think it helped that the floor plan of her new apartment was very similar to the previous one. Also, the staff at the new facility is helpful and stable, and although she can't remember any of their names, she likes them. They have an activities person who "rounds up" several of the "memory impaired" residents for activities a couple of times each day. This is important because she cannot remember the day of the week or what activities are happening on a particular day. She still complains about some things, but like other posters have said, she doesn't have much else to do. The key thing is that I am much more confident that she is getting good care, both physically and mentally, and my stress level is lower as a result.
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I'm going through this very same thing with my mom too (but she's only 73!). My opinion is do not move her. Elderly with dementia have a very hard time adjusting to a big change like that and it can be very traumatic, not to mention stressful for everyone involved. I have a similar situation with my mom's assisted living, they are actually a brand new facility and have been having a lot of growing pains and turnover in staff. As a result my mom is getting minimal attention. Luckily I live 3 miles away so I go there everyday to visit her, get her up out of bed, take her for a walk, do her hair etc. However, I've started communicating my requests to the AL and I would encourage you to do the same. Stay on top of the facility, talk to the director and RN and hold them somewhat accountable for what they should be doing for her! I'm tired of having to pay (a lot!) for something I'm not getting or allow mom to just stay in her bed all day. It sounds to me like they should be providing your mom with a little more assistance and encouragement. I also might suggest, if your budget allows, I have a lady from a Visiting Nurses association visit her once/week for 2 hours. It's $19/hour and it just gives her something to look forward to and gives me peace of mind if I can't get to her that day. She will visit with her, do her nails, take her for a walk and just basically provide companionship. Best of luck to you and don't feel bad, just give her lots of hugs and know that she has had a long life and is blessed to have a loving family that cares for her and loves her!
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Are family members able to be more involved with her care. I realize that family may also be older with their own health difficulties. I f someone could be there to take her to the dining room and eat with her that might help.
She clearly needs to be kept clean so again is a presence possible for the two shwers a week. Make sure the help knows what they are doing and treating her with respect and dignaty. re they possibly sending male aids in to help with the shower. i don't think many 91 years olds would be comfortable with that. I am 76 and have learned to accept the necessity to have males in the nursing profession but it takes some getting used to and for the male to be extremely respectful. If you need to move her make sure it is the right place and as suggested it may be time for N/H
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Ferris is right, in my opinion, in that your mom may being doing the only "job" that she has left - she's complaining. It's hard on you, but sometimes we have to live with that.

If she is not getting decent care, then a move may be in order. However, moves can be very stressful (you've indicated that you already know that). She could suffer even more of a setback.

I think that I'd agree with the majority here right now. Yes, a smaller facility may have worked before or could work now, but there's no way to know.

Whatever you decide, don't wallow in guilt. You are trying your best. We can't make others happy, and people your mom's age often have many things to be unhappy about. They are legitimate. Her only way to express this may be to complain.

Please keep us posed on how you are doing.
Carol
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I hardly expect her to be in "great health" with a terminal disease. She is doing exactly what people with dementia do. As her ability to communicate verbally and hear what is being said, and with depression, she would rather not bother. Moving is STRESSFUL for anyone and it sounds like you are fretting needlessly about something you cannot change. She will die and her surroundings and staff turnover/ratio difference is not going to change that. Instead of moving her, try to be more supportive of where she is at this point in time. No matter what you decide, she will complain about another set of circumstances. At 91 yrs. she has been tenacious to live this long and she is not going out without a fuss! Enjoy her for the time she has left. The only "job" she has is to complain. So what?
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Keep distracting her the whole time you are moving her, if that is what you decide to do. Tell her how nice this new place is, and that she had to move because the other al closed down. If you think she wouldn't know. Tell her they will take good care of her here. Maybe she will accept the new place and settle in. It won't be easy, but I think things will work out. Good luck.
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It sounds as though a smaller setting that specializes in memory care would be the best setting. Are you in touch with her doctor? Are there incontinence issues? Sometimes that is a reason that elders self isolate. Talk to her doctor about some antianxiety meds to ease her mind during the transition.
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Well if she is still in good health, she's probably better where she is. the main thing is that they are taking care of her.
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It sounds like your MIL is falling through the cracks at her current assisted living.

Any kind of move is going to be extremely stressful for her. You can tell her ahead of time but be prepared for obsessive and anxious behavior. Or you can give her very little notice and have everything in place by the time you move her. How you deal with it depends upon her dementia.

I hope you'll be moving her into a nursing home. It sounds like she needs more care than an assisted living facility can provide.
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