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?
The staff at the facility will be a good guide as to knowing if and when he needs a higher level of care.
Not that this is going to put your mind at ease but.,.,.Falls happen. They happen at home, in Assisted Living, Memory Care and in Independent Living. Not all falls are serious, some are and some are fatal.
If after a while you think he would do better in a smaller contained unit then Memory Care would be an option.
Small vessel disease type dementia is similar to having a stroke. Areas of the brain do not receive as much blood flow as needed. Brain tissues will decline in the areas with less blood flow. The symptoms you are detailing are a result of his small vessel disease. It will get worse in time. For now, he needs to adjust to the routine and environment of the facility where he resides. Moving him will just necessitate learning another facility's routines and environment... not necessarily getting "better care".
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.
Imo do not push memory care unless it is absolutely necessary. MC should always be a last resort option, the fall risks will still be present but comes with other issues stemmed from potential isolation due to being a locked down floor or unit, plus potentially the less welcoming feeling of such floor.
The rehab facility he was in reminded me a bit of psych ward and I had hoped a calmer more normal situation would help him be in a better place. It hasn’t though, and I don’t see any signs that it will.
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.
Im sorry about your mom, it’s such a sad disease. I am happy that you have things figured out for her though. That’s wonderful.
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."
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.
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!
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.
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. :-)
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.
The reason I would ask you give it all the time you think you can safely give it is that MC is not nearly as nice for the elder as ALF is. It usually has roommate situation, a lot of people who may wander, a lot more acting out.
This is a situation that is progressing on a downward trajectory. I think you know that. But just wait a bit and see if it stablizes. It well may not. But I would give it that chance. Your Dad is in advanced age, and seems to have sustained a whole lot of trauma.
I think that the facility, which would make a whole lot more money by moving on to MC, may be right.
Now if MC means a move off this facility, there may be more reason for them to say "wait and see". Still they will have reports from their caregivers, and they will know if this is care they can handle or not.
As to the falls and forgetfulness? That would be a constant WHEREVER Dad is placed. He will still forget the walker; he will still fall, and there will never be enough staff to prevent that.
Hoping for the best for you both.
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.
It is only now that everyone agrees he needs MC. Apparently a space has opened up in memory care as well, but I feel slighted. Like they wouldn’t listen until it became a problem for them.
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.
When he was in the hospital was he given opioid drugs for pain? If he was that will bring on dementia in an older person. My mom has severe dementia now and it really became bad after her hip surgery due to the pain killers they gave her. My mom fell twice in assisted living. The second fall was a broken hip and broken elbow. She went into memory care after that. She fell again in memory care and broker her other hip. Memory care will not prevent falls, but it’s more attention than assisted living and they will make sure he eats. In my case I feel it was a staffing issue in memory care at night why mom ended up falling. She did not go back to that memory care.
Your on the right track to get him in memory care. Look at many facilities. When you walk into memory care if it smells cross that one off your list. Ask about staffing day and night. Make sure the community offers free transportation to doctors.
It’s all very stressful isn’t it?
However I don’t have a lot of faith in this facility because I felt like I was ignored until they had an “appropriate” spot for him.
Can you tell me more about your move from one facility to the other? That seems like it would be very hard on someone, but if care is better then it seems worth it.
ive had similar journey with my dad, and posted quite a bit recently….. he’s gone into respite and not settling and now has a UTI
im told the same thing, he needs time to settle and I’ve been advised it’s a couple of weeks (dads there for a month)
dad locked himself in his room on his first day, which I found hard to understand how it happened. but his carers are lovely and I’ve had good talks with them. Now he has to be in the lounge (he shd be isolating as it’s his first week but they can’t leave him) There have been teething probs and we are working them out. I went in yesterday and he had no water to drink, but he’d been left breakfast and tea even though he said no, it was there. He didn’t eat it but when he woke they got him tea and a banana so he ate something. They tell me they see this all the time, this is what we do.
give it a little more time. Easy said I know (I’m a bit of a worry mess) but try
he will find a little routine
I think that this differs in our care teams. I feel that they are ignoring the issues, the first the couple of days they didn’t even check on him besides at meal times which I am paying for someone to escort him to and from the dining hall.
After speaking to the director, she said they were still learning him and they would do better, but I just don’t know.
I feel like, my sister would rather see him restrained than see him fall. I don’t want him to fall, but I don’t know that I want him literally tied down for however long he has left.