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My mom is 93 and after a UTI last fall has had a decline in cognition. She is now a fall risk as well. She has 24/7 live in care, but because she can be so mean to the caregiver (and me as well), the caregiver doesn’t know if she can stay. I have looked into ALF and had an evaluation. Suddenly she is level 3 care because she wears depends at night just in case and they count each pill she takes, even though they are prepackaged by pharmacy and she needs to be prompted to go to activities and 2 showers per week. That’s $1500 in care alone.


I am not sure though if she actually needs memory care. She cannot remember when she had a bowel movement so is obsessed with that. She demands prune juice at night, after she has slept for a few hours, saying she hasn’t gone in days, while she actually did go, then she’s up all night and calls me saying she is sick and needs to go to the doctor.


When she wakes up from a nap, she doesn’t know what day it is and wants breakfast, screaming at the caregiver that she doesn’t want dinner.


She dreams up things while napping, so if someone called her before she fell asleep, she insists they were there visiting her.


She hides things during the night and can’t remember, like her precious Xanax, then calls saying that I took it and she needs it immediately, and I’m killing her because I took it.


I just don’t know if she can even be alone in her room in ALF.


We have no official diagnosis. Brain scan results were consultant with dementia, and short memory tests she gets half wrong. There is no way she would be able to withstand a few hour neuropsych eval.


In your collective opinion, is this a memory care patient, or ALF? Not sure I trust senior living evaluation. They have vested interest.

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My brother is in Assisted Living. The people in his cottage may have memory deficits, and they may require w/c or incontinence supplies, but their behavior is the primary concern. They must be well enough to sign out at the front of the cottage in the log book if leaving cottage, and at the main cottage if leaving facility, and they are in fact free to leave on walks, across to library, on bus. They vary in terms of how much care required due to fall risk, for showers and so on. They must be capable of coming to the dining area for meals. The truth is, that having a elder with severe dementia plus all of the needs you mention, with the yelling and probable inability to be left alone, would at his facility definitely be in memory care, no choice about it. Sometimes they skate close to the edge with some folks, because despite some problems they are of a peaceable nature, but general disruption to other residents is NOT a good thing. My bro is there because he has an early onset probable Lewy's, but has excellent long and short term memory. He has a benign brain tumor that makes his balance iffy, but so far--knock wood--no falls. He is often in communal area, playing games, chatting with others who, like him are really quite "with it". One man is there only because he suffers with frequent seizures, and needs to be safe, has no support system in his own town, which is the case with my brother. So you can see that putting someone who needs not only a lot of care, but who might be screaming and so on, is quite disconcerting for residents, and in their weekly meetings they make it clear when they feel someone needs more care than can occur in their situations. So what I am saying I think is that this depends on the facility. What their requirements are. You might need to take tours, and there may be some that will not require memory care per se, but that will have a big bump up in staffing to do this care. Let us know in an update how it goes for you and for your Mom.
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AllieB4, usually the senior living facility will do an evaluation to help guide them to the correct living section. Chances are it would be a combined Assisted Living/Memory Care.

My Dad [95] had resided in Assisted Living/Memory Care, for him it worked out great. He first started out in Independent Living, but once he started wandering at night, he was better off in AL/MC. Everything that Dad needed was available to him. He had daily housekeeping, daily linen service [the facility supplied their own sheets, pillow cases, and towels] and Dad had 3 meals a day in a menu styled restaurant... the Memory Care unit had their own separate dining room.

My Dad didn't have a official diagnosis but it was evident he was sundowning, and he was a major fall risk thus had to use his walker at all times [he was pretty good about that].

As for prescription and over-the-counter meds, Dad wasn't allowed to have any type of medicine in his room. A MedTech would go to his room morning and at night to give Dad his required medication, including a prescription pain cream [Dad called it liquid gold as it worked so well].

Cost wise, in my area, it was around $7k per month, and for the care that Dad got it was worth every penny. Plus Dad enjoyed his "college dorm room" surrounded by all his bookcases filled with books.

Dad would also keep his dorm room door during the day, it made it easier for the Staff to peek in at him, and for Dad to say "hi" to other residents on his floor. Dad also wore a medical alert pendant. And yes, there were Aides to help with showers and for getting Dad dressed.
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My mother 92 was in an ALF for 4 years, dx with dementia (but pretty mild) in 2016. This ALF had a point system; the rent came with 9 points; 3 for help with showers, 3 for night incontinence, and 3 for laundry (or whatever else you want to use the points for). Medicine administration was $400 a month (so no more hiding Xanax for your mother). All in all, her studio was $4,200 a month in the burbs of Denver Colorado. If you think this ALF you're looking at is too expensive, look further.
My mother is now in Memory Care (part of the same ALF) at $6,400 per month all inclusive except for Depends products). Her care can go UP UP UP but I pay no more in fees; this includes medication administration as well, even if her meds increase 10 fold. Memory Care is for those who need a lot more help than a regular ALF; help with ADLs and things like that, plus have memory/dementia issues. My mother scored a 10 or 11 on the MoCA test and is the BEST one in Memory Care, meaning the most lucid. You need to get your mother properly evaluated before a decision like this can be made. She sounds like a Memory Care candidate to me, because ALFs just want people who are SLIGHTLY difficult, not 24/7 difficult, if you know what I mean. Your mom sounds further along the dementia trail, based on your description. But the other posters are right; the ALF itself will do an evaluation of her and let YOU know where they feel she belongs. DO look around though.........there are LOTS of facilities around these days. I interviewed today at Anthem Memory Care, for instance, and they have a much different setup than the place my mom is in. 2 people can share a room if they'd like, which makes the rent much more affordable. Plus, if a person is not very demented, they don't have to be locked in and can go in and out the front door without assistance or permission, etc. I had no idea places like that even existed. So..........don't assume the first place you look at is the 'only' way things are done.
Best of luck!
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AllieB4 Aug 2019
I guess I just wanted to know if you all thought she was a memory care candidate. I have no point of reference. I guess I don’t necessarily trust the ALF assessments. I have looked at 2 places and called several others. One of them also has an all inclusive memory care for $6400.
My mom does not wander, yet. She is not strong enough anymore to go out the door. She uses a walker exclusively now because her feet are wobbly and she loses her balance easily. A year ago she was independent and driving!
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I agree about having your mom assessed by someone who is trained and authorized to do it. There may be requirements regarding how many ADLs she needs help or total support with. I'd try to be very candid about what she realistically needs.

In the beginning, my LO did ok in regular AL, but, soon I had to transfer to a MC, due to the extra care she needed pretty quickly. They didn't mind helping with Depends, but, not when she became double incontinent. They would remind her of meals, but, she would forget on the way to the dining room. She also resisted care and they just were not equipped to handle that. The change to MC made a huge difference. She immediately responded to the increase level of hands on care.

If she is placed somewhere where there is not enough care, it will not be good for her or you, since, you'll get daily calls about issues. But, there are facilities that have a regular AL on one wing and an MC one too, so, a transfer would not be too disruptive.
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