Is it memory care time or? (Sorry, I know it's a much-asked question.)

Is there someone there 24/7? If so, this can be as much or more money than MC. As you are finding out, the hiring and coordinating of multiple CGs out-of-state is like a job.

If it were me I would transition her to MC. Then you need to make another decision if you continue to be her PoA: MC near you? Or where she currently lives? I would strongly suggest MC near you if you want to keep a close eye on her.

Or, you talk to social services for her county about getting a legal guardian for her so that you can resign.

"I would love to see my friend around and interacting with other people, feel like she has purpose, dine with others, do activities."

My friend, you are in denial about her dementia. It only gets worse. People with dementia and memory impairment are always bored because they can't remember they were just "entertained"; they can't think of things to entertain themselves and keep doing it for more than a minute. Please educate yourself about dementia so that you have appropriate expectations for her care.

I hope you are getting reimbursed for flying there every 8 weeks...

How attached is she to the dogs? How are her interactions with them? If they are a source of interaction and comfort to her, then it may be hard to move her at this point.

Or has her apathy spread to them, in which case they may fade from her thoughts once she's been moved? Are the dogs getting adequate care, or being neglected because of your friend's inability and the caregiver having too much else to do?

Definitely this is too much for one caregiver with limited breaks. (Has she been paid appropriately, including with taxes/benefits?) She'll need assistance and as Geaton said, the costs for multiple household employees adds up.

It's very kind of you to do this for your friend, especially long distance.

Three things really stand out…turning on a gas stove in the night, yikes, so dangerous, the cost of around the clock caregivers, and the isolation for both your friend and the caregivers. Any one of these point to memory care being a good idea. You won’t be able to guarantee she will be content there, or enjoy activities, or even interact with others, let that go as out of your control. What it will do is eliminate the risk of her starting a fire, wandering off, paying and scheduling caregivers, the risk of their burnout, the isolation or your friend and the caregiver, and likely less cost. Seems it’s time for MC and closer to you would certainly be easier if you plan to remain involved

Yes, it's time to get her placed. She is only going to worsen in the next year. Don't ask, just let her know there is going to be a change for the better and she is going to have a new home with new friends. Buy her something nice to go in her new MC room. She is unsafe now and needs placement ASAP.

How old are the dogs? Are they being cared for appropriately? Can you find a memory care that will take her and the dogs? You might have to rehome them, maybe with someone who can bring them to visit her if they can't go with her.

If she is putting the stove on, the time for memory care is here, no doubt. This is backed up by the doctor who suggested it was time for memory care as well. As much as I worry about the dogs and understand they are important to her and she to them, if she leaves the stove on and burns the house down, the dogs will die along with her. Or if she fills the house with gas it could blow up the whole neighborhood.

Start looking for a solution for her dogs along with memory care for her. You are doing a wonderful thing and we should all have such good friends. It's time now to protect your friend and her dogs and her caregivers from her growing dementia.

As dementia progresses, the things you think would amuse or interest don’t any longer. The damage to the brain may cause such lack of focus that conversations aren’t possible. Following a book or tv show may no longer be possible. Memory Care facilities usually have supervised activities for the residents. Those who are able can engage. Abilities vary. The important thing is that she be safe and cared for 24/7. Regardless of the amenities, sometimes a person who has dementia may not be happy and content. Anxiety and agitation are common. You can ask her doctor about meds to treat those symptoms. They can help a lot, based on what I have seen with my cousin sho had vascular dementia and my dad who had Alz.

My cousin seemed to relax and be more content in Memory Care. She had been obsessed with her pet cat, but she completely forgot about the cat in a few weeks. Keeping her at home wasn’t feasible.

Good luck with everything.

Hi Geaton777,
Yes, live in caregiver who is getting burned out. Trust me I am not in denial abt dementia, what it is and what it does. Its been 3 +years. I've seen the subtle and the drastic changes. When I go see her, I take her to the movies because she loves that, and in fleeting moments there is joy, esp. with popcorn; she often falls asleep and once we leave the theater, she doesn't remember we went. In MC she may choose to sit in her room rather than participate in activities. Who knows. My expectation is she will be safe, she will be closer to me and I can see her more often and ppl will interact with her. Dementia marches on no matter her location. I don't expect that she will suddenly perk up and be who she was before dementia.
Thanks for the response, I do appreciate it.

First of all, the caregiver is not burned out because judging from what you've said here, they're not doing their job. There's no excuse for your friend to be in dirty clothes that are on backwards or for her hygiene to not be kept up on. I did this work for 25 years before going into the business of it. You tell this 'burned out' live-in caregiver that you're going to burn her paycheck if you find your friend in dirty clothes on backwards again. Laundry is part of her job. It's also part of her job to interact with your friend so she doesn't just sit there in front of the tv all day. I think this caregiver needs to be replaced.

You may have to accept that how your friend is now, is how she's going to stay. Many times a senior who is miserable, bored, and resentful of being a senior will embrace the total negativity at everything and become part of it. Let me ask. Does she sit in her office watching cable news all day? That's a bad thing for miserable, bored seniors. It's bad for anyone.

If she's still willing to go out with the hired companion, she hasn't completely given up on life yet. The companion should start going with her to the local senior center for some activity and socialization. One of the top reasons why so many seniors refuse to join their local senior center is because they don't want to go alone. She may enjoy it and they understand many of the people coming in have dementia. When the dementia worsens, adult daycare is a good option too.

Another thing. She should not be eating her meals alone. She has a live-in caregiver who if she is not going to sit down and eat with her, can have a coffee or something and keep her company while she eats. I strongly recommend you have a real talk with this live-in caregiver because she sounds like she's a big part of the problem. Your friend may also benefit from a low dose of anti-depressant medication too. Definitely worth talking to her doctor about.

Some memory care facilities accept dogs, but I'm not sure if they'd take four of them. The memory care place where my husband lives encourages dogs to visit their loved ones. The dogs cheer all the residents even if they don't interact that much with them. So it is possible that your friend could take one or two dogs to live with her in such a place, but she needs to be able to care for them and walk them, unless you employ a dog walker to visit every day and do those things. Then the other dogs living elsewhere could be brought to visit your friend. Sometimes an aide at the MC will bring resident's dogs to visit the resident and then take them home at the end of her shift.

There are all sorts of ways to solve this problem, so ask around when you visit facilities to gather information.

This was my mom. She now lives in assisted living and will be transitioning to MC soon--with her 1 little dog. Idk what your hesitation is... it's time.
Best of luck--you are a very nice friend.

Your intuition is telling you that it’s time. Nobody wants this. Your friend is not going to want this. Today is as good as she’s going to be, except for the occasional clear day, where you’ll feel like you have your friend back for a couple of hours.

Dementia only goes one way. It’s easier on the patient if she’s moved before she declines further.

Could you move her closer to you into a facility so that you’re able to visit? If no, can you continue with the caregivers so they visit her in memory care regularly to help her get settled or keep her company? you’re gonna have to come up with some sort of story on why, because she won’t have the capacity to understand. Something bad has happened in the house, so she needs to move out of it for a while, as an example.

Out of sight equals out of mind. For a good year, my dad kept asking when he would be going back home. And we told him it would be after my mother (who was in the assisted-living side) is able to go home. he eventually stopped asking. Dad passed in March. Mom is still in the assisted-living side.

We lock the door of my 95 year old dad at night. Dementia and can't remember which door leads to the bathroom. He has a bathroom in his room. I have a baby monitor by my bed to hear any distress. He was wandering through the house, at 2:30am he would stand at the foot of my bed - had turned on our bedroom light and was asking where everyone was. Somehow he had turned on EVERY light in the house and it's a 3,000sq ft house! This is a man who can not see very well at all due to glaucoma - blind in one eye and poor vision in the other. For his safety and our sanity the door is locked at bedtime and unlocked during the day. He was mad at first but was able to accept the reason of keeping him safe and us not wanting him in our room while we are sleeping. I suggest the same for your friend until she can be put in memory care.

We lock the door of my 95 year old dad at night. Dementia and can't remember which door leads to the bathroom. He has a bathroom in his room. I have a baby monitor by my bed to hear any distress. He was wandering through the house, at 2:30am he would stand at the foot of my bed - had turned on our bedroom light and was asking where everyone was. Somehow he had turned on EVERY light in the house and it's a 3,000sq ft house! This is a man who can not see very well at all due to glaucoma - blind in one eye and poor vision in the other. For his safety and our sanity the door is locked at bedtime and unlocked during the day. He was mad at first but was able to accept the reason of keeping him safe and us not wanting him in our room while we are sleeping. I suggest the same for your friend until she can be put in memory care.

Tough question I struggle with daily. I don’t have an answer for you. But a small suggestion. I pulled the knobs off the gas stove. Moms pull off easily. Hers may too. One problem solved.

P.S. If she doesn't have a bathroom in her room she could use a potty chair and remove the need to leave her room.

It's really sad that a person wouldn't even recognize their own pets. You know she's not going to get any better and better safe than sorry! She needs to be protected from everything at this stage and you can't stop her from wandering off or falling and breaking bones that don't heal very well at her age. Memory care will dispense her medications and assisted living may check but won't be responsible. Automatic refills will be sent directly to the facility and there's a nurse who can make sure she gets what she needs if she starts to have any complications. I'm sorry the pets will have to go, she's unable to care for them. Depending on the breed, you could check to see if someone owns a lot of land, like a farm,who could take them all together? I agree that it's going to be a lot easier for you and her if she's closer to you.

Yes, it’s memory care time, and her dogs may have to go elsewhere.

Don't assume all MC facilities are the same. My wife is in a MC facility that seems surprised that they can't treat her like a rational, normal person. They want additional money because they state her level of care needs have increased but can't tell me how the additional money will be used for her care.

Memory care is exploding and because, in most states, is considered assisted living, it is virtually unregulated. Choose carefully. Visit and evaluate, often. Look at staff turnover. The facility my wife is currently in has had three supervisory MC nurses in 6 months. The current one dislikes my wife making the situation even worse.

Obviously I have to find new, appropriate care for my wife, but just don't assume that the glitz of MC is a fix all in every case.

I would rely on the live-in caregiver's feedback. They are in the best position to see if your friend needs more care than one caregiver can provide at home.
A live-in CG will suffer burnout quickly, especially being disturbed all through the night. That's a 24 hour job. I hope your caregiver is not staying there because they don't have another place to live. That could complicate their assessment of your friend's readiness to move to a care facility.

From all you have described, I agree with you that she may be happier in Memory Care. She thinks she wants to stay home and be with her dogs, but she is failing to recognize her home and her dogs, and is bored. Memory care will have many more people for her to interact with, and to care for her evolving needs.
It is too late, sadly, to get her old life back. It will happen to us all. This is her new life. Help her to make the most of it.
What a great friend you are, managing all of this for her!

So many stories to share and so little time. Find her wonderful memory care place - put all her pictures and things of comfort around her and make sure care giver around to take her places once a week if safe. It is time...and you sound loving and caring and it is the hardest thing we face...Currently a friend's amazing husband is gone mentally and had a hard time transitioning. Start the messaging now and mention the music, shared movies and extra support. Keep visiting when you can but it's time.

Regarding the dogs is there anyone there that can take them as it is never good when pets are not in a trust as you know what can happen. The new pet owners can bring the pets to visit if they are friends and if not maybe they will consider stopping by. My dogs and cats may outlive me so I have money attached to the top three that will take them. Animals are expensive and should be given the appropriate care and support and not be a last thought in my opinion.

You are a gift to her. Talk to doctor about appropriate medications and about caregivers. They become family or become disenchanted. It is a calling. I had to change my caregivers for my husband three times until I found "the one."

Best wishes.
KA

MY FIL spent the last 6 months of his life in MC. It was a lovely facility - clean, good food, planned activities that patients could participate in at whatever level they were, and a wonderful caring staff. At this particular facility, the staff were hired based on how they like and interact with the patients; specialized training was secondary. There was a resident dog and cat. The dog was tied up at meal time because he was being overfed by the residents....lol. The cat roamed freely and some how knew when someone was going to pass and would stay with that person.
Vannygram2 - you are a wonderful friend and your friend is blessed to have you in her life.

You have described the same situation I dealt with trying to help my sister-in-law ! Her own family, inc daughter, just blew her off, so I jumped in. No one deserves to be abandoned & what a great friend you are. I attempted to keep my SIL home for about 4 yrs before the slow yet inevitable surfaced. Your description of your friend is identical - can't remember things or people from 1 moment to the next, kept forgetting her husband had passed away 7 yrs earlier, loved her little dog, but friends stopped by 4x daily to walk, clean-up and feed, Can't understand how to play cards anymore, write anything, use the phone, operate the shower (with someone there). Locked her out of the basement (full stairs) and hired housekeeper for cleaning, laundry, hygiene. Doesn't cook, forget about pills and taking, would lay in bed for double-digit hours or just sit in a recliner. Took away her car keys, removed her charge cards and checks and I revamped her home to keep her as safe as possible. Fortunately I live only 7minutes away, so was there constantly. Following a fall in the middle of the night, she broke her wrist in 3 places & I needed to place her in a rehab unit for approx 5-6 months. Could no longer stay in rehab and knew she could not go home. I decided to try and place her in an Assisted Living facility (knowing LTC would be the eventual status). She had a beautiful room, 3 meals daily with other residents if she chose, activities to participate, inc 'field trips' to shop or go out for lunch with others, & I surrounded her with her own furniture, favorite pictures & wall hangings. She started off well yet began isolating in her room, would not seek out company or join activities, refused eating the food (extremely basic & very picky), refused showering by the aides, hallucinating, and took to laying in bed for double digit hours. She was there for 11 months & with her continuing dementia decline, and becoming totally incontinent , the facility let me know I had to place her in LTC. I knew this was coming yet still difficult for us both. I was able to place her pup (another friend interviewed about 20 homes/people before placing & he's doing fine still). She's in a shared room (confined to a wheel chair now) and continues to comment how much she 'likes this place, everyone is so nice!' (music to MY ears), has made friends, participates in activities, most frequently is bright-eyed and smiling. Still somewhat conversant & knows her mother (98 1/2), her brother, and me. She does not speak much about her deceased husband except to say what a wonderful man he was, nor her little dog and understands this is 'home'. I did need to sell her car and her home and make arrangements to dispose of all the personal items - and no, family did not want anything or offer to help. This is my 3rd experience with a dementia afflicted senior (FIL, Mother & now SIL). She is only 78 & I am 68. Sh is a lovely person & I love her very much. Make the decision you know you must for your friend's sake and yours. Move her closer if you can & you'll have the opportunity to visit more often. My own mother recognized only me to the end, help your friend keep her friend in memory (you) as she travels through her journey. I apologize for the length of response yet hope this helps you towards making this necessary decision. Remember, people may have negative input no matter what you do, just remember your friend trusted you to do what ultimately would be the best for her ! Lean on that.

Hi are there no day programs your friend can go to? Sometimes they are called memory care clubs. They pick up and drop off and provide meals and activities. Just a thought.
Not clear to me why your friend would have dirty clothes. Sounds like CG might be burning out.
You are a good friend and she is lucky to have you in her life.

I just want to thank you for caring so much about your friend. Even though her cognitive functions are declining, I believe that in the moment when you are there, like at the movies, that is a time that she is enjoying you and your time together. It is sad that she doesn't remember, but it is something she enjoys in the moment.

I also want to thank you for worrying about her dogs. I hope you do take in the 2 who will be happy to stay together, that's important for them. They will all miss your friend. I am glad you can find places to take the others.

We should all take care of each other as you are doing with your friend. It's true she might not be "happy" about things but that can change when she is living in her new place. If it does not, at least she will be taken care of and eat and be safer. You're doing the right thing!

You and CG should look into Medicare's GUIDE (Guiding an Improved Dementia Experience) program which provides support to dementia patients and their families, helping them stay in the community for as long as possible. It includes a care manager to locate appropriate resources and help determine whether staying home is still feasible. It also pays for 80 hours of respite care a year...

https://www.cms.gov/priorities/innovation/files/guide-model-patient-caregiver-fs.pdf