Assisted Living vs In-Home Care...thoughts anyone? - Alzheimer's Disease & Dementia Message Board

sunnydaze1 · 11-04-2007, 10:09 AM

My mom, whom we suspect has dementia/alzheimers..has been steadily declining, almost rapidly the past few weeks.

She is still very aware of people, places, current events...but ask her to warm up her cup of water in the microwave for some tea, forget it...it just does not compute in her head.

I help her as much as I can with the upkeep of the home, she gets Meals on Wheels everyday, and my elderly aunt stops by at night to warm up some supper for her.

The latest problem is her meds...she isn't able to get her nitro patch on correctly. I found she had part of the foil wrapper stuck inside her bra and the rest, including the patch, was stuck to the wrapper she threw out.

Just getting the times straight in her head on when to take her meds is very confusing.

I broached AL with her a couple weeks ago and she just about went hysterical. Slowly, with the help of my aunt, we've been bringing the subject up again. She still doesn't go for it, nor does she want anyone in the house. I know she never will willingly go.

My question is, if I give her an ultimatum, I certainly don't want to, but if I do, would in-home care be better for her? She really only needs someone to get her going in the morning, meds wise, help with washing, etc.; and to prepare a light supper for her. I guess I feel if I can keep her in her own home rather than moving her, it would be better.

This whole situation is driving me nuts as well as my aunt and brother and his wife.

Would it help to tell mom the stress that this has brought to my life so she would realize? Has anyone done anything like that?

Thanks for any help you can provide.

PS: I do have POA and am in charge of all her finances; billing; etc. She also has top of the line Long-Term Care Insurance...it's just getting her to use it!!

Gabriel · 11-04-2007, 11:05 AM

Your situation sounds exactly like where I was a a little over a year ago except Mom was also the full time caregiver for my Dad who has had vascular dementia for year. Mom blamed her inabilities on Dad and Depression for two to three years. There was also a good confabulated excuse. Dad has always been good natured and Mom is the fighter. When we realized Mom was having difficulties it appeared that she went down faster. In reality we just knew what to look for and were no longer accepting her excuses. She also lost her reason to cover her inabilities.

Medication became a real problem. Mom confused her antiviral for shingles with hydrocoden and I came home to a totally disoriented Mom suffering all kinds of effects from the pain meds. I later realized that she drove Dad to his doctor's appointment 50 miles away under the effects of pain meds. We started putting their meds in pill boxes but they would forget to take some, take too many, or try to fix them and totally mess them up. It was a Xanax overdose that put Dad in the hospital administered in good faith by Mom that finally tipped us off to extent of her confusion. We gave Mom an ultimatum at that point and she chose in home care over a facility.

That is when we hired a sitter. This lady was an angel and Dad loved her. As long as Mom though she was there to help with Dad it was ok but the day she realized that the sitter was for her as well it all went down. Mom hated this lady in her house. Thought Dad was delighted with this arrangement Mom was miserable. That last day Mom became physical and hit the sitter which ended inhome care. Dad was furious with Mom because she was rude to their "guest". Mom truly did not want to be a burden on us girls and the help she needed at home also annoyed her. There was no ultimatum at this point. We just found a facility and put Mom and Dad in Assisted Living. Now Mom is happy for the most part in her little apartment and Dad is miserable. On the other side of the coin my Grandmother stayed at home with in home help for years before going to a facility.

We have applied for Mom's LTC and it was accepted so we should start receiving benifits next month. Mom was pleased that she had done this and in the end it was this policy that made Assisted Living ok with Mom. It gave her back her sense of independence in a round about sort of way. No longer was she dependent on a sitter or us for her needs.... she was paying her own way. Also kudos to you and your Mom for getting all the paperwork in place that you will need!!!!!

So each situation is different and you have to try what you think is best at the time. Denial and personality on the part of the patient is like a stone wall and there is no good answer how to get on the other side. Even if they agree to your ultimatum that doesn't mean they will live with the decision. You just have to do what you think is best with what you know at the time and go forward from there being aware of the situation each day. Know that nothing is carved in that stone wall and the way around it is forever changing. You just have to take one day at a time and do the best you know not only for your loved one but for you and your family as well.

Know I keep you in my thoughts and prayers.....

Love, Deb

Dingoes · 11-04-2007, 01:05 PM

My grandmother was in a very good assisted living facility last year, but she didn't participate in any of the activities, withdrew to her room to the point where people had to bring her meals to her, refused to get dressed or out of bed and called us with minor crises at least five times a week (and sometimes five times a day).

We felt it was better in that situation to try and bring her home, built a bedroom and handicapped-accessible bathroom for her and she lived here happily enough for about four months. She had a meltdown induced by not taking her meds no matter how much we wheedled, ended up in the hospital and is now in a rehab center, where she is obviously miserable. Her goal (and ours) is to bring her home when the psychoactive drugs (antidepressants and Aricept) have time to work. On the plus side, she seems more lucid already. On the minus side, she hates it there and must stay at least another two weeks.

When she comes home I'm assuming we'll have to get her in-home care of some sort, depending on how severe the symptoms are at that point.

I guess what I'm saying is, at least in my experience so far there has been no right answer. We're still working toward keeping her at home, but I'm wondering how possible that's going to be, for how long.

Gabriel · 11-04-2007, 01:20 PM

You are right... there is no right answer set in stone answer. It is doing what you think is best at the time and going on to the next episode. Wait and see how much better she gets with the UTI treatment and new medication. She may do well at home with in home help..... especially if she realizes her alternative is assisted living. Or you may have to rethink your options and come up with another answer. That is one of the stressors of this horrible progressive disease. You know what works today may not work tomorrow and you are always waiting for the next shoe to drop. Just do the best you know at the moment with the information you have. Then be open and flexible to changes that create the need for a new choice.

I hope you find what is right for you and I do keep you in my thoughts and prayers.

love, Deb

jimmyjane · 11-04-2007, 02:58 PM

My mom was alot like yours Sunnydaze1 and we had been through all the arguing and trying to "show and tell" her how much she was not taking her meds right even though I was preparing them for her weekly plus taking her meals to her and I lived 35 miles away. The doctors weren't much help and she just quickly or conveniently forgot anything she didn't she didn't want deal with. Luckily, I guess I would say, she got up one night, became disoriented or dizzy and fell near her bed where my brother found her sleeping at noon the next day and called the ambulance. Thankfully, she was fine except for a UTI that was very bad and supposedly caused the diorientation. The doctor then told her she could not stay home alone and we scrambled trying to decide what to do while she spent a few days on antibiotics in the hospital. She had good medical and LTC insurance. I knew I could not care for her in my home living in rural area miles from hospital and drs. She was also very mean and demanding to family,especially me, and at that time I did not know how to handle or be patient with her. We found a live-in but that only lasted a month as mom hated a stranger in her house and said and did awful things to her. She always said she would die if we put her in a nursing home. I felt she would think any facility away from home was a nursing home. We finally got her into an alzheimers/dementia care facility and that was our miracle. It's in another town from where she lived but still about 30+ miles from me and my brother. It is bright and cheery and they know how to coax her out for activities and meals. Most of the her meds were dropped and a couple new ones added and now she is the happiest I've seen her in years. I've learned through watching the caregivers how to act with her and I think the stress has been taken away from me so I can enjoy her company again even in her sometimes confused self. Don't get me wrong, things are not always perfect for her but it's what worked best for us. I think everyone has to find their own way for loved ones with this terrible disease and whats good for some isn't necessarily the best for others. I wish we had done more research ahead of time to be more prepared for that inevitable day. It's now been 3 years since the day she came to this facility and for her the everyday schedule, the great activities director, loving CNAs and nurses, and cheery atmosphere have been the best she could ask for in this circumstance. I have since become a pet therapist and visit several AL, alzheimer/dementia facilities,and nursing homes. Some places seem sad, lonely and uncaring as I always imagined but if you research well and ask everyone you run into (and I mean EVERYONE) you will find all kinds of stories and places and willingness to help. An alzheimer's support group is a great resource even if you have to go to another town to find one. And your mother doesn't have to be diagnosed with alzheimer's for you to go...it's for anyone involved with someone with dementia related problems. Sorry my first post is so long but I felt your pain and just wanted to let you know there is help. I also wish I had found these messageboards before my mom had problems... I've learned so much here. Thank you all and good luck Sunnydaze1. Let us know how it goes.