My mother lives in an independent living facility but her dementia has worsened and she is starting to need more care. We are faced with a choice of letting her age in place with 2 full time aides that split the time or moving her into assisted living where she may have more social opportunities. My concern is that once we give up her apartment (which could accommodate a live-in aide) there is no turning back. Also concerned that the move itself will make her dementia worse and they may have to turn around and move her within a year into their memory care unit, which gets mixed reviews. I recognize that we are more fortunate than most to have these options and I'm incredibly thankful for that we do. I know this is not the case for many of you. At the same time, I would value the input from those that made this move and are either happy with it or regretful that their parent didn't stay in place. Thank you!
If you are her PoA you will be managing stuff for her in either situation, but managing "employee" aids will be more challenging, especially in this labor shortage. I have all 3 situations right now: my mom is 92 and lives next door to me, mostly independently; my 2 very elderly aunts (one w/advance dementia and the other no dementia at all) are aging in place through the help of some family and paid caregivers; my MIL is in a great LTC facility and is doing just stellar, even improving, after a bout with covid.
It's true the arrangement needs to meet both your needs, and there is no "right" answer, but if I had to choose, I'd go with a very reputable facility that has a continuum of care and lots of activities and outings, like in my MIL's case.
As far as change worsening her dementia, even new aids can through them off, and you won't be able to control employee turnover and last-minute sick days (and subs) called in. I wish you much clarity, wisdom and peace in your heart no matter what you decide.
You are asking yourselves some great questions. Here's just a few more;
Q1 Social needs: Some elders are not big socialisers & 1-2 regular aides a better fit. For others, a place to socialise & partake in activities is much better.
Q2 Care needs: How is Mother's general health? If some Dementia but physically strong, heart good, walking etc? Or frail, needing a wheelchair now or soon, lifting equipment, multi health issues? Could her care needs soon outstrip 1 aide? Are there any behaviours that would benefit from a team (sundowning, refusal to bathe?)
Q3 Continuum of care: If you go to AL, do they have MC onsite? If so, moving down the hall, or to another floor, with same feel, even some of the same staff is not usually too big a change.
There are many unknowns. You can only work with the known facts & then go with your gut. It doesn't have to be perfect - you can change the plan if you need to.
Lastly, be creative. Don't be afraid to look at what Mother needs & find other ways to solve.
I once met a lady, absolutely heartbroken to send her DH into care. Dementia mod-severe but the Parkinson's meant a team was needed to mobilise/hygiene. She added a regular aide for a walk/ride in the garden 2x week. He was a older man, a peer, someone to share a conversation with. Yes it cost, but as the aide did not need any medical knowledge, it was affordable. I though that was a great creative solution - it bridged the gap between facility care (but staff of thousands) & home with regular aide (but insufficient care). She had managed to get it all for him.
Strength to you for the journey.
Time came to move Dad to the facility's Memory Care, much smaller living space. We joked it was his college dorm room. All Dad worried about was if he was going to have the same chef preparing the meals, as he so enjoyed the food.
Dad had a favorite caregiver when he lived at home, and he was able to bring her along for a 4-hour morning shift. That gave Dad a routine and seeing the same smiling face each morning. She also went with Dad to Memory Care. She was no nonsense and made sure Dad went to his physical therapy class, while he was there, she did his personal laundry [the facility did the sheets/towels]. She also took Dad to any doctor appointment he needed.
Memory care/assisted Living building was monitored to make sure the Memory Care residents didn't go outside on their own. At night the elevator to their floor was in lock down with the Staff knowing the code. Same with the front door. No worry about Dad wandering outside. Whew, what a relief. And thank goodness my parents had saved for a "rainy day" as it was now pouring out there.
When funds are almost depleted we will apply for medicaid and use their in home support. It used to be called Medicaid Waiver but the name has changed.
This is the best fit for our mom and we can see her when we want with no restrictions. We are both retired so have a little more flexibility.
You need to do what works for YOU best.
Will the cost of this be such that it will deplete mom's funds sooner than expected?
Yes moving her into AL apartment might very well cause a bit of a decline. Or not. And if it does cause a decline she may or may not return to her baseline where she was prior to the move.
(this whole dementia thing is a crap shoot when it comes to trying to figure out what's next!)
There is a good possibility that even with 2 caregivers her dementia may get to the point where she would be safer in Memory Care anyway. That could happen at any time.
Does the facility in either IL or AL permit the use of equipment to aid in caring for mom? If the aides need a Hoyer Lift can they use one? Some facilities do not allow it and anyone needing equipment has to go to Skilled Nursing.
My gut reaction, if mom can afford it AND if the use of equipment is allowed I would keep her where she is.