Mom has had a rough time lately. Dementia that is progressing, at least partially due to a fall giving her a broken foot bone, a bout with ischemic colitis (which has resolved), and another fall which was unremarkable (besides the 7 hours in the ED getting checked out).
After broken foot, had rehab to get her stronger and was able to return to AL.
After colitis attack, she's still in rehab. I've been arguing with the staff about getting her back to her room sooner rather than later. Mentally and cognitively she does much better in her room than in rehab. As of last week (before most recent fall), she was making the goals of being able to walk far enough to get to the dining room and to descend a set of stairs in the event of an emergency. They are reluctant to let her go because they could still work on things like her poor balance. That is very subjective and I feel like they are mostly just double dipping since we're paying for AL AND for rehab (Medicare paying for that).
She fell in her rehab bathroom because her memory is swiss cheese due to her dementia and she is not able to remember the constant reminders for her to call for help when she wants to get up to go to the bathroom. They, pretty understandably, don't want her to fall on their watch. You can only imagine how many times she gets up alone and does her thing. And surprisingly it took a few weeks before she fell, on the cusp of moving back to AL. I'm sure they're going to push to extend her again.
Now she is saying she just wants to give up. Not for the first time. Last time I told her that she could do that if she wanted and that would mean that she'd have to go to a nursing home and would get more care and wouldn't be expected to do as much for herself as she is in AL. She didn't really jump on that idea so I let it pass. Now I guess I'll give her the same info and see if it at all appealing to her.
Not sure what I should push her towards. Or as POA, I can work with the staff to decide if her AL days should just be over.
Or thirdly, she might even be ready for memory care. She's not a flight risk at all and is still pretty social. So I kind of feel like being with people that are REALLY far gone in their dementia journey might not be the best fit for her.
Thanks for reading and perhaps having any insight or kind words of encouragement. I'm pretty burnt out on all this! Of course her last two episodes have happened while I was trying to have some time away. One trip got truncated because I thought she was dying and this weekend away just got a nice dose of stress added to a relaxing time. Oh well.
You're wearing yourself out, so it might be time to accept the inevitable.
Also, there is no perfect solution - you could get your mum to the point where she can go back to AL only for her to fall again, or not remember things she knew just a short while ago, such as how to find her way around or how things work.
So, go with how your mum is right now, which is someone who needs more care than an AL can provide.
I think you know your Mom and her comfort and wishes best. I am comfortable with your making this decision with her input and the input of the care team.
I suggest you stop pushing your poor mom to do anything now. She suffers from dementia and should not be expected to climb or descend stairs to evacuate a building in an emergency! In reality, she needs Memory Care Assisted Living and that may be exactly what you're told when an evaluation is done on mom after rehab. There is only SO far she'll progress in rehab because of her limitations and inability to remember instructions.
Memory Care shrinks down her world FOR her and removes expectations OF her while still offering activities and interactions with others. She's likely to stop feeling like "giving up" then because nobody will be making unrealistic demands on her anymore.
In any event, the nurse at AL is definitely going to evaluate your mom before she's released from rehab anyway, so all this is likely a moot point.
Best of luck to you.
My 100+yr old Aunt with advanced dementia and mobility issues (and cared for in her own home by family) shimmied past her bed boundaries one random night and fell and broke her hip. Due to her advanced age and uncooperativeness, we waved surgery. We were trying to get her to at least pivot in rehab so she could be more easily assisted, but she was already still trying to get out of bed by herself in rehab. I was 1 day away from having her assessed for placement before she thankfully passed away in her sleep. The dilemma was that she needed LTC but was still "mobile" and was absolutely going to fall again. I had no real solutions, except to expect her to keep falling in MC until she could no longer physically get up. The good Lord solved my problem for me. But I totally understand your dilemma. I think one answer would be MC and realistic expectations about her risk of falling again.
May you receive clarity, wisdom and peace in your heart as you make decisions.
I would talk to her, but don't forget she has dementia, so she will most likely keep changing her mind. Probably according to her pain, if she is having a clear moment she may have a different view than when she isn't and her pain is more pronounced. Your mom is aging and it sounds like your mom is having one issue after another, she may get a break for a month or 2 then I suspect it will be something else.
I would definitely talk to the staff, ultimately this is your decision,
I would say follow your gut , your instincts, I'm feeling are thinking NH.
Also, you need a life , you need to go on a vacation, and enjoy yourself.
As for MC verses NH . Im not educated enough to have an opinion for that
Best of luck. Let us know what you decide
My FIL was in an AL for about 3 years. No stairs in his AL facility, but their rule was you had to be able to get to the dining room on your own whichever way (Walker, wheelchair, etc). The last year, he had 3 major falls, each followed by rehab. During the third rehab the AL told us they could no longer keep him safe and he would have to go to NH which was actually connected to the rehab place. He had argued against it previously, but when it happened he adapted quite quickly. He died two years later from a heart attack while eating tira misu in bed.
Thanks for responding.
Talk to the AL director and see what they think about bringing Mom back to the AL and having PT, OT brought there. If they feel she would be better served in an SNF then thats what it need to be. Mom can get therapy there. But this broken bone has probably changed things. They are good until they aren't and anything like this usually changes things.
Be aware that after 20 days Medicare only pays 50%, the other 50% is Moms responsibility if her secondary does not pay. That can mount up.
I understand and agree with most of what you say what you are saying about the advantages of the home (AL, in this case) environment over being in an unfamiliar, institutional environment. However, Medicare would here have to agree to cover in-home therapy without the goals of rehab having been met. Rehab has the goal (among others) of getting you to the point where you can function with in-home PT/OT. That goal so far isn't being met, and it sounds as if the OP's mother is going to have difficulty inmeetin it.