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I’ve been a caregiver for my 93 year old grandfather for a year and a half. He lived independently for that time but I helped him with Med management and cooking because he has macular degeneration.

In January he exhibited some strange behaviors and was tested for a UTI but it came back negative, we scheduled a doctors visit. A couple of days before the doctors visit he had a fall that landed him in the hospital.

He spent days in the hospital, then rehab. His mental status initially would ebb and flow, totally cognitive to not knowing anything but who he was. Several tests were run, but I never got an answer on why this was happening, besides some narrowing of the blood vessels in his brain.

I am the only family member who helps and I realized taking him home was not a safe option. The rehab center said he would be appropriate for assisted living. I contacted 3 that I liked and they met with him and went over his case and agreed he would do “well” in assisted living and “did not need” memory care.

He was moved last week and I just feel like he needs more care than what they are giving him. He seems to be stuck in an earlier part of his life. He is refusing to use his Walker because he doesn’t think he Needs it. He has fallen at least twice that staff knows about. He is constantly wandering and looking for his wife.

He possibly has a UTI now. We’re waiting on the culture. I’m concerned he doesn’t even know how/when to get a drink if he needs one.

I have spoken to the director, nurse, and care attendants. They all tell me the same thing, he needs to settle in and he may need memory care in the future.

I am so frustrated because I don’t know how to advocate for him. The place I chose was so highly recommended. I’m scared he’s going to have a serious fall.

Doesn’t he seem like he needs a higher level of care than this?

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Based on your comment "I don’t think they are supervising him anywhere close to what he needs. The night I wrote this, he went into three other residents room, peeing in one, and in the last removing a knife from their kitchen and trying to cut off his wander guard bracelet. He had also trashed his own room." your grandfather ABSOLUTELY needs Memory Care immediately! I also agree with your assessment about feeling slighted; like this ALF took him where they had room, knowing full well he REQUIRED MC but waited till they had an opening to consider the urgency! Disgusting.

Either get him segued into their MC or find another Memory Care ALF for him, whatever you feel would be best. But with his level of dementia at play, he definitely isn't safe in regular AL.

As far as falling goes, there's no way to prevent it no matter WHERE he lives, and that's the truth. My mother has lived in regular AL where she fell 40x and now in MC where she's fallen 55x. Every precaution has been taken to prevent it, but she continues to fall again & again for a variety of reasons. In AL, it was b/c she wouldn't use her walker or call to ask for help when she needed it. In MC, it's because she's not cognizant enough to realize she cannot walk, thinks she can, tries to get UP and boom, down she goes. She's never gotten very hurt as a result of any of these falls, which is truly a miracle. She has bed and chair alarms, now a bolster on her bed which she managed to climb OVER on Tues night to fall on the floor.....it's just never ending. It's nobody's 'fault' either; not like I can point a finger at the MC and say AHA, it's because of YOUR negligence that mom falls! That's not the case. It's bc of combined dementia and old age that she falls.

Wishing you the best of luck with all that's going on here. I'd give this AL a piece of my mind if I were you b/c what they've done is flat out WRONG!
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Lost313 Feb 20, 2022
I have given the AL a piece of my mind, believe me.

The situation is hard because the rehab facility he was in for weeks said he'd be ok in regular AL, and every single place that did the assessment agreed too. I felt that maybe I was being dramatic since I'm uneducated in this.

It's also hard because I felt like I did my research and I was told this is the BEST my area has to offer. If this is the best, what's the worst? I'm honestly afraid to find out.

They are moving him to MC now that a room has opened. I'm hesitant to leave him here because of this experience, but I'm also afraid to move him in the event that this really is the "best" place.

I'm trying to let go of the fall thing.
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At 93, your grandfather is on the slippery slope to end of life – it’s just hard to tell how slippery and how far down he is now. He has had a good life, and a quick end is not such a bad idea. Solving one health problem after another is difficult, expensive, and often painful for all concerned.

Perhaps he will settle down where he is, perhaps not. Why not wait and see? And stop worrying so much? Death comes to us all, and the timing is not usually up to us.
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Lost, when my mom finished rehab from a stroke, she was assessed by several places, as well as by her rehab as being "perfect" for AL. She had a diagnosis of the beginnings of mild vascular dementia.

We took her to a great AL. They tokd us they woukd check on her every 1/2 hour for the first day. They did. She fell in that first 1/2 and didn't push her alert button.

We moved her (at their advice) to the one open bed in Memory Care. She needed more than that, and we added a temporary 24/7 aide.

The 3rd night, my mom fell with 2 aides in the room (hers and the roommate's). She broke her hip.

Thus, she ended up in a Nursing Home. I don't think this scenario could have been avoided.

As the discharge planner said to me, "Barbara, MY mom fell with 3 RNs in the room, and one of them was me. Old people fall."
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Lost313 Feb 20, 2022
I don’t like your answer, but I do appreciate it and understand it.
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He needs more care than the AL facility provides. If he's not orientated to time and place and thinks he's living a past part of his life, he has dementia.
If he doesn't have sense enough anymore to know to get himself a drink or to ask for one, he has dementia.
Your grandfather needs either placement in a memory care facility or 24 hour live-in caregivers.
The rehab and the AL facility may very well have a business deal with each other.
A resident in the AL your grandfather is in has a fall. They are sent to that particular rehab. An elderly person falls at home and gets sent to that rehab. Then the rehab refers that person to the AL your grandfather is in. These kinds of deals are more common than you think.
I worked at a beautiful AL years ago that had top ratings. They changed administration. The new administrator wanted every bed filled. They were allowing residents to stay who needed a higher level of care than what this facility could provide. It was unsafe and people got hurt.
Your grandfather needs a higher level of care than the AL he's in can provide.
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Lost313 Feb 20, 2022
Thank you, that is definitely a possibility because I know the director and care manager at the rehab facility are on a first name basis.
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Lost313: The entering other residents' rooms, urinating in one and pulling a knife from another's kitchen which you stated he did is indicative that he requires a Memory Care facility.
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As my daughter, RN, says they will fall. She turned her back on a resident for a second and in that second the resident got up from his wheelchair and fell.

ALs are exactly what tge name says, they assist. They assist with ADLs. No skilled nursing unless brought in my the resident at the residents cost.

Your father is a resident. He is renting a room at the facility and paying a care fee to help him with medications and ADLs. In my Moms AL they would not let me supply bibs because it was a dignity thing. So Mom had food on her top most of the day. An alarm on a Wheelchair probably would not be allowed either. This is the residents home so the AL is limited in what they can do unlike Longterm care. If its in Dads care plan that he use a walker at all times, then the staff should be making sure he is using it. But even using a walker, falls will happen. MC is usually associated with an AL. IMO the only difference between a MC and AL is that it is a lockdown facility. The care is not any different. Neither are skilled nursing.

I do agree with you that Dad may need more than an AL can give him. But don't expect a lot if difference between an AL and MC. I took my Mom from an AL to a nice LTC. By that time, though, she was in her last stages of Dementia.
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Lost,

My mom is in MC. She has a single room. In her MC, there are no shared rooms.

She is absolutely checked on frequently.

Unlike in AL, there is no access to anything remotely dangerous. For example, all of her toiletries are locked in a bathroom cabinet, and the caregivers unlock it when it is time for her shower.

I am pleased with the staff/resident ratio.

Since everything is built around a circle, she doesn't get lost.

I'm listing all of these things because they seem to me the MINIMUM that should be available in a MC.

If you're not happy with the answers you've been given, perhaps you WOULD want to make a facility change. You should be able to rest comfortably, knowing that your LO is WELL taken care of. If not, another facility might be the best thing.

I think of it like a parent changing schools for their child. :-)
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Sighopinion Feb 18, 2022
SIngle room MC may not be common I their area. I know in my area single room MC are reserved for private pay facilities.

For the many MC is a last resort option it is not pleasant for many elderly but more so a nesscary precaution. I do hope they get to stay within their ALF for as long as humanly possible.
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Lots of great suggestions here. I would get access to his full medical chart including meds. If he is taking any type of pain meds or muscle relaxers, that could be the culprit. Certain meds can cause a change in cognition/behavior. Everyone blames UTIs, but I've found meds are the first place to look.
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WendyElaine Mar 1, 2022
Good advice!! My mom fell 3 times —3 days in a row—while on muscle relaxants. Stopped the muscle relaxants and the falls stopped, too.
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Great advice and experiences given here.
First things first -------- there is no way to prevent falls in the elderly in any facility. AL's are the first line of defense for the elderly but they only offer an "assist" with living. MCs have a higher staff to patient ratio and theoretically have more training in memory care and dementia but in reality, with the number of low wages workers, such as those that typically work in the health industry, calling out, those ratios may just be on paper on any given night. SNF's have a higher state fo patient ratio (once again on paper) but falls happen all the time. More care given because the residents must need help with at least 3 ADLs (in NJ) but that doesn't mean they are under "eyes" 24/7. In any facility if you need 24/7 eyes, you will have to pay extra for that service (and remember one person working a 8 hours shift will have to use the bathroom at least once. I swear that our residents would sleep lightly, wait until the caregiver went to the bathroom, so they could get out of bed by themselves and crash!)

Like a toddler going to daycare for the first time, you probably need to give it sometime but definitely let go of the "fall" thing. You will drive yourself and the staff crazy and they will still happen.
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Debstarr53 Feb 26, 2022
You are absolutely right. Have to let go of the fall issue. My mom still lives at home and has taken a few falls. there is NO way to prevent the possibility of all falls. It's not possible to follow a person step by step 24/7.
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Ask them for their diagnosis and placement decisions in writing. They are legally responsible. Discuss with a Elder Law Attorney and social worker for an alternate placement.
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Lost313 Feb 20, 2022
Thank you! I didn’t know that was an option.
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