Most of the time, she's confused, but friendly and trying to be helpful. But when she's stressed (which can be triggered by anything that she perceives as attempting to control her) she has a very nasty aggressive side. In those moments, she's strong and quick, threatening to caregivers, and a danger to herself. She'll try to kick a door down, or throw things that break. I've been trying in-home care with the concept of kindness when possible - but she will no longer wait for timely meals/snacks or nap or sleep at standard times. She on a 3-4 hour wake, eat, sleep cycle - which means a single caregiver can't be available at times she needs being overseen. She has a trust fund (not unlimited resources, but adequate) but few relatives and none who are able to advocate for her. We've tried assisted living twice and been asked to move her, but the typical next stage lock-up type facility really doesn't fit. She is healthy, active, keeps her room tidy, goes for long walks and is a loner - so (having had her in my home for 9 months), I have a vision of a fantasy place that would work for her. It would have food available at any hour, have a secured outdoor space where she could wander around without supervision and otherwise provide basic room and board facilities. She doesn't participate in "group" activities - and when that is encouraged or required, it WILL produce the outburst. She doesn't want to work "with" anybody or within a structure designed to keep all the residents occupied - just needs room, board, extra food and drink (she eats everything in sight and is NOT overweight) and allows freedom to come and go (obviously in a larger contained space). Any ides how to find such a place?
A person with dementia, may be able to handle certain things at certain times, but, that doesn't mean that they are able to live independently. And, with her hair trigger temper, she could get herself into some legal trouble, if not in a protected environment. The staff at the facility where she is should have a healthy appreciation of what she's capable of and I would be surprised, if they haven't dealt with something similar many times. They should be able to say if her behavior is something they can accommodate or not. I'd continue to explore the medication with the staff's input and doctor's advice (a geriatric psychiatrist might be a good option, too), keeping in mind that as dementia progresses, her agitation and aggressive behavior may or may not change. I might also explore Memory Care now. There are facilities with all levels of care. I found that MC staff are far better equipped to manage agitation, outbursts, etc. than a regular AL.
My Moms AL was made in a square. The Common area and the dining room were as you came into the facility. For those who could go out there was a nice porch to sit. For those who couldn't, there was a courtyard that only could be gotten to going thru the building. No outside outlets. My Mom used to walk around the inside all day. There were couches and chairs a long the hallway so you could sit. People stayed in their rooms others liked being in the common area. The activities director would go around knocking on doors to tell residents there was an activity. Maybe open a door to make sure the resident heard but no one was forced to do anything. Activities are for the residents that "want" to participate. I'd hate to think that I chose an AL that was on me all the time to do it "their" way. Yes some people do well with structure but others don't. She doesn't have to eat their time. Her meal could be delivered to room to eat when she wants. I was told at one AL they have a choice of eating a meal or sandwich and even taking the sandwich back to their room. Why can't they do that for friend. Then she can eat when she wants. Some save their desserts for later. Or stock her room with snacks, fruit etc.
ALs are just that. A place where a person gets assistance where needed. Yes, they have to be structured to a point to function but should realize that each resident is entitled to do what they want in their own time. Really, I am not a morning person. You are not going to get me up at 8am to dress and eat breakfast. Not really big on lunch (probably because I eat breakfast late) and dinner is usually small. So the only meal I would probably eat was dinner. I could have cold cereal and other things in my room. Moms had a kitchenette.
since you are a friend, I assume you are not her POA or that she has signed a health care release so that you can speak to her doctor about her care ?
The kitchen is always open and an aid will fix a snack whenever he wants (this was a major factor in my choice cause Dad likes his snacks between every meal). Activities are scheduled and residents are encouraged to participate but not harassed if they decline. The center common room being just outside everyone's door seem to encourage people to participate or at least watch activities.
My father is also occasionally aggressive, often uncooperative and generally a loner, but he has settled into the MC very well.
The company building/running this type of AL/MC in our area only operates in TN. When they came to our town, they purchased farm land on the outskirts of town and built a single level AL wing with an "admin" building beside it. Three years later they added the MC wing where my father resides. They plan to add more wings in the future. Maybe there's a group using this concept in TX too?