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She can't understand that she needs it for her oxygen level. She also refuses help with showers, even though she has fallen in the shower.

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I agree to have a discussion with the admins at the facility. What do they normally do if a resident won't comply with their treatment (oxygen for COPD)? Would she then qualify for LTC? If so, this is covered by Medicaid if she also qualifies financially.
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Falls will happen. No matter what, falls will happen. You cannot attach someone to Mom's side. Our balance goes and falls happen.
I don't know that you will have better luck keeping O2 on at night in MC. In fact you won't without a private attendant.
I would discuss this with the facilities involve due to the variation in what we are seeing and hearing out there.
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Have you spoken with the AL staff about the oxygen issue? Is she flat out refusing to even put it on? Or is it on and she takes it off in the night? Maybe they can have staff do checks at night at a certain frequency to see if she has it on.

If she is just going by herself into the shower, that is probably going to be a tough situation in AL, as they cant watch her 24/7. ML in general will be closer observation.
You may want to tell her doctor about these refusals also and see what they suggest.
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I don't see memory care being able to keep a mask on her without bringing medication on board (sedatives) to stop her from removing the mask. Even a private attendant won't be able to keep the oxygen on her if she doesn't want to wear the mask. And it will only agitate her and could cause her to have respiratory problems from fighting the mask being put on her. She has dementia and COPD, which can be a lethal combination. Once her oxygen gets low enough, the only option would be to call EMS, intubate her, and put her on a ventilator. And what happens when she's extubated and refuses the mask again? Perhaps it's time for a hospice consult. It's a hard situation.
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What does the AL say ? Usually they will tell you when it’s time for memory care . Ask what they think . I don’t see being able to force her to keep oxygen on though .
Memory care cant stop all falls . They aren’t one on one right next to Mom all the time. But they may be able to keep her out of going in the shower by herself . Ask the facility .
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Oxygen is a drug that needs a doctors order. Just like medications, mom has a right to refuse. Talk to her pulminologist and also consider hospice.
For the most part, some people do not feel short of breath when off oxygen. If she does feel shortness of breath, then hospice can help to alleviate symptoms. And if she has no distress, we'll, many people aren't even aware that they need it. They still go on for a few months or years
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From what I understand, nighttime is the most crucial time for oxygen. I would call a LTC facility and ask what they do in these situations. If they say they can handle it. Transfer Mom. When her money runs out, place her on Medicaid. There are ways to get around the income cap. Check with ur State to see if they allow Miller trusts or Qualifying Income Trusts.
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Are you speaking about an oxygen cannnula or mask? The COPD foundation has some suggestions for cannulas such as attaching from the back. For masks, you can try a different type.
https://www.copdfoundation.org/COPD360social/Community/Questions-and-Answers/Solution-to-removing-02-at-night.aspx

Talk with the AL facility about showering. ALs have different levels of service and in some each individual task requires an add-on payment. For instance there could even be a charge for standing by, watching while a patient showers versus assisting a patient with a shower. In any case, she should be using a shower chair and a handheld shower which can go in long way in alleviating falls.
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