Your Mom is not doing well in the Assisted Living Community

sunriseThe death of my father impacted my Mom cognitively. For years they were a team that managed their dementia by being together. Now my Mom’s alone with no wing man.

Her decline is escalating and unfortunately, she’s getting more combative. I’ve noticed this on my visits as we interact with others in the community — at least she is usually kind to me. However, she now believes someone stole a card set she used to run bridge games and this is causing grief for everyone. She has always tended to perseverate on specific topics and this month, it’s the bridge card set. My mom turned over the set to a woman to run the games but doesn’t remember and/or doesn’t like it on any given day.

I was called by the head of the community and they asked to have a meeting with me. They took me through a litany of events and issues and are worried that they are going to be unable to care for my Mom. She is refusing to take the prescribed medication, which includes a change to give her Lorazepam daily. Before, it was used as needed to reset her anxiety, but her behavior now has moved the recommendation to a daily dose.  

I ask for suggestions, my Mom can’t be the first resident they have faced they have trouble helping. The head of Assisted Living has decades of experience as well as do the collective experience of the other staffers at the meeting. They share the varied things they have done to try and help my Mom that have failed — many that worked for others. They have even tried a variety of new things given my Mom’s interests and mobility. The psychologist and the head of the dementia care unit have spent time with my Mom over the past few weeks and felt that unless she started taking the mood medication (Lorazepam), the community would be unable to help my Mom. The biggest difference with my Mom is her mobility.

If we can’t reset my Mom’s anxiety, and her behavior, they will put her on a 30-day discharge plan.

So here we are and the first step is getting my Mom to take her medication. I ask if they can just give her the 1 pill. It’s very small, she could easily take it and then they could reintroduce the vitamins and other medication that they believe are “essential.”  My Mom has never liked taking pills and resents that the staff watch over her while she is presented with 7 pills in the morning. Most of them are vitamins. I requested that they minimize the number of pills my Mom was taking several months ago, but the doctor felt strongly we should not make a change. She recently just refused to take any pills.

As my Mom continues to decline, it’s still surprising how many things she can do. However, her disease is moving her into a very negative place and we are struggling with how to best help her manage within her community. Just when you think you have a handle on the situation, it shifts and challenges you in new ways. Confronted. 

Please share your experience – positive or negative with different medications or a similar behavior.

15 thoughts on “Your Mom is not doing well in the Assisted Living Community

  1. Hi Kay,

    For reference I was the daughter from Maryland involved with moving my parents out of their house due to major dementia- mother, brain damage due to loss of oxygen during heart failure – father. They both passed within 3 weeks of each at the end of August.

    While my mother was in the Residential Adult home – to help ease of giving her the meds that were required to keep her mood stabilized (and believe me – she was very combative at times) the meds were ground up and put in her ice cream – She LOVED ice cream. Problem solved – I can’t imagine that this could not be a solution for you and the Assisted Living facility. As far as the vitamins – you can make decisions for her – regardless of doctors suggestions – If she is getting nutrition from the food she eats then that should solve this problem trying to stuff vitamins down her throat.

    Bottom line is trying to keep the peace with her – also keep your sanity.

    Vickie Mick

    1. Thank you Vickie. My mom rarely eats and now it’s only peanut brittle, Pringles or a Pb&j sand which she makes. She won’t eat one made for her. The vitamins seem silly on top of everything else.

    2. I work at an assisted living and if the doctor prescribes vitamin, we have to give them to her. Better to work with the doctor to change the orders. Also, in Washington, only nurses can breakup medicine once received at the AL so if it’s caregivers handing out meds they can’t be grounded up.

  2. Kay, I don’t if your mom is on any other meds specifically to address the behavior/cognition issues with her dementia, but refusing to take all pills is not uncommon at the same stage that combativeness, paranoia (believing people are stealing things from her) and an inability to keep her “happy” and engaged for any period appear.

    I suspect this is your mom’s fear (she knows something’s wrong, and with your dad gone, she’s got no safety net, but she doesn’t know what is wrong) as well as her last gasp for independence (I just finished a chapter on this stage in my new book I’m written) and just before there is no choice but to hospitalize her in a geriatric psychiatric facility to get her on the right medications to adequately address these behaviors (trust me, it’s night and day, and she won’t be comatose, but much like her old self except the neurological decline will still be there).

    I would suggest being proactive and talking with the dementia folks on staff and see if a voluntary – it’s 10 days usually – admission (you’ll have to approve it) to a geriatric psychiatric facility where your mom can get an individualized and specific medication regimen that can effectively address these behaviors so she can stay where she is if they have a memory care unit.

    Does the assisting living have a memory care unit? It sounds like your mom is still in the general population. If the facility does have a memory care unit, this will give you and your siblings time to get her moved over to that side, set the room up cozily and invitingly for your mom, and have a place for Mom to come home to.

    Until you can have that conversation, I’d suggest giving the meds she’s currently taking in applesauce (if swallowing is not an issue yet, it will be, and applesauce or something like it) or pudding. That usually does the trick. I made sure before Mom’s psychiatric hospitalization that no one every mentioned anti-anxiety medication to her (her PCP or in the hospital) because I knew she would refuse to take it.

    Hope this helps a little. I know this will be hard. It was for me, but I think a proactive stance is better than having your mom hit her breaking point (it’s on the horizon), be involuntarily hospitalized, and kicked out of the assisted living which means you and your siblings will have a whole lot of work to do in very little time.

    Mama didn’t get kicked out, but I knew I had to move her from her independent retirement community to an assisting living facility with memory care after her breaking point. That was two weeks of hell…it got done, but I never want to go through something like that again if I don’t have to.

    1. Thank you! She’s in asst living and they have a dementia unit but because she’s so mobile and at times still lucid, they say she doesn’t qualify.

      Appreciate the info! Have you thought of doing ebook or a weekly newsletter based on the stage of dementia? You always have great insight. While a whole “book” sounds overwhelming to me as in doing extra cycles already, shorter or time released topics I could digest in smaller bits feels comforting.

      Many thanks!

  3. I’m sorry to hear about this latest struggle. My father also suffered from paranoia and sometimes would not take his meds. Lorazepam can cause side effects in elderly patients, though others (like both my parents) tolerate it quite well. You can google for more info on the scientific studies that have been done.

    Ideally a non-pharmacological solution (like ice cream or some other behavior modification tool) would work, but I do believe that medications have their place if patients are in distress. Is Lorazepam available in a non-pill form, such as a llquid or patch?

    1. Thx – my mom is critically lucid if you try most incentives or diversions.

      We discussed a patch and shot option which are the fall backs.

      Wish we could have pre-empteed. The issue better but hindsight seems to be 20-20!

  4. My Mom walked into assisted living , she participated in activities n field trips … then she got depressed n secluded herself ( only after 30 days ) they started upping her meds within weeks she was immobile , couldn’t get out of bed ( they told her this ISNT a nursing home !! ) I made plans to bring her home , the day prior she had heart block passed out n sent to ER ……….. now she has a pacemaker n is in rehab because she cant walk ! ( the surgeon said it was med induced …. ) I look at pictures from assisted living n now shes a totally different person in only 2 mos time.

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