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?
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.
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
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.
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.
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.
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.
Unfortunately we don't know until we know what we don't know.
As situations change, circumstances change. No one can prevent it.
No promises can be made to keep a patient if they decline. No doctor can delay it either.