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My 92 year old mother is healthy physically but she has a severe short term memory deficit. She still lives in her own apartment and we have made arrangements for someone to see her everyday. “We” includes my brother and his wife, their daughter and me. I wonder if for psychosocial benefits it would be best for her to be in an assisted living facility. She seems happy but her latest saying is, “Come often and stay long!” I believe she turns on a tv at 5:00 pm until around 9:00 but otherwise sits in her chair listening to talk radio. She no longer reads. Is that sufficient and reasonable to maintain what is best for her? Or are we kidding ourselves that it's ok. She is, in my opinion, incapable of knowing how someplace different might help. Or does it?

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I think you should be asking if it’s safe for her to live alone at this point. When she is alone, is she capable of handling an emergency? Can she get out of there is a fire? Will she think to call 911? If someone tries to break in, will she call 911? How likely is it that she will wander outside and forget her way home?

As far as it being healthy, I think that’s a matter of opinion. Some will say if family comes by every day then she’s fine. But to me it sounds like she’s pretty isolated and is merely existing at this point instead of living. I’m leaning toward this being an unsafe and unhealthy environment but I don’t know it’s correct to say that AL would be healthier, because of COVID. It would be better because she would be amongst other adults & have daily activities to participate in
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Ditto to what Worried responded. My MIL wasn't remembering to eat. Over the phone I'd ask her very specific questions about what she ate, how much and when, and she always gave answers that I had no reason to doubt. Then when I went to her house to check more closely I found rotting food in her fridge, moldy fruit in the basket, no dirty dishes, no food packaging in her garbage. Once out in public with us she nearly fainted and we finally realized that she *thought* she ate but really hadn't. The isolation thing is huge. Not sure if your mom would still be able to be in AL (as long as she doesn't wander) but this is a discussion with the admin of a facility.
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Socialization is very important to maintaining cognitive health. My mother never wanted to go out or see anyone, and my dad didn't fight her on it, but once I placed her in a memory care facility, it definitely helped her to interact with different people in different ways.

Your mom sounds terribly lonely, and while she's happy-ish in her familiar surroundings, you need to make some decisions about her living situation with the knowledge that she isn't going to be getting better in her current set-up.
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I agree with Worried. Safety is the issue here.
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Nope, it's not safe for a 92 y/o woman with severe memory loss to live alone. Who knows what she can do by mistake one day without realizing it's dangerous? She can try to clean something & mix chemicals together creating a toxic cocktail. She can try to cook & forget to turn off the stove. There are just 1 million things that could go wrong, including that she can fall and wind up laying there on the floor until someone comes by and finds her.

Assisted Living/Memory Care can help her by providing 3 hot meals a day and snacks, socialization, activities.........help with showers, and about 1000 other things that she'll need as her memory continues to evaporate. Don't wait until it's an emergency before you place her out of harm's way. Most people don't even understand dementia and all the facets of it......so read all about it and then make your decision accordingly. "Psychosocial" benefits are only 1 of many, many benefits to living with caregivers who work around the clock.

My mother turned 94 yesterday & I cannot believe how far downhill she's gone in the past 6 months ALONE. It's staggering what she can no longer do on her own, including using the TV and the phone lots of times! If she didn't have caregivers to help her, I shudder to think how she'd be able to function at all with moderate dementia at play.

Good luck.
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RacklaMSW Jan 2021
Your solution sounds good, back in the day. I would not go near an assisted living or nursing home.
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Thank you everyone for your input. The difficulty lies in that I have made my opinion clear that Mom should be in a more stimulating environment like assisted living but my brother disagrees as he thinks this arrangement is going fine. And he does it because he cares, apparently believing that remaining in her own place is best.
I could try and push it but I’m not interested in creating a family rift. Historically he and his family have been the closest to her over the years.
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LoopyLoo Jan 2021
So... nothing will change, then?
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For me, I would never leave her alone. It appears to be a safety issue. If she turns on the stove, she could cause fire. She could let a stranger in the home. Bring her to your home and hire care if you can. Our parents took care of us years ago, we need to take care of them. And for goodness sake...don’t put her in a nursing home.
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MWR1985 Jan 2021
Thanks for your response. We will not consider placement until elderly residential care is safe from Covid. We live in Appleton, WI, a city of around 80,000 people. The quality of our assisted living and nursing homes are good, even those that care for primarily Medicaid elders.
The real issue is coming to an agreement with my brother as to what is best for our Mom. And her money that currently enables her to go into a private facility.
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Does she still make her own decisions? Do you and/or your brother have POA? HCPOA?

If you decide that your mother does need more supervision, do not move in with her. Once that happens, it will be very difficult to remove yourself from that situation.

And what is her financial situation? Is there any chance that your brother wants her to stay in her home so that his inheritance isn't spent for a facility?
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MWR1985, when my 95 year old Dad moved from his single family house over to senior living, he was so delighted being around people closer to his own generation. He had a really nice 2 bedroom apartment, large living room, and a full-size kitchen. Once a week he had housekeeping and linen service which was included in the rent. Plus one meal in the restaurant style dining room. My gosh, so many of the women were dressed to the nines for dinner :)

I above idea only works if your Mom can budget for the cost. Cost vary from area to area. My Dad paying $5k per month, he got a special discount due to winter and the community was trying to fill their rooms.

Once covid-19 is totally under control, make an appointment to take Mom on a tour of a senior facility. the facility usually likes to have you and Mom come at a time where they can serve lunch so one can get an idea about the food. Just make up an excuse why you are taking Mom there. Who knows she make see someone she knows or really love the place, or wouldn't step foot back into the place.

If Mom loves the place, tell brother that Mom wants to move there.
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I am concerned about the safety of your mother. Imagine what could happen if she forgets something on the stove/oven, or forgets that she started a bath, or forgets about medications....

She needs to have a person helping her to keep her safe. Consider whether there are enough people: family members, friends, members from your community of faith, and/or paid help to have somebody with her most of the time in her home. My MIL has 2 women who care for her in her apartment. If finances are tight, consider if she needs to move in with a family member or into a residential facility.
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NO!
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Not a good time to move to a facility right now because she would have to quarantine in her room for weeks, then that would really damage her psychologically.

Try your best to "Come often and stay long!" Also, hire someone to provide companionship for her when you all can't be there.

When the pandemic blows over, then you can search for a good AL facility for her.
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Malibu63 Jan 2021
I would have to say I agree! I am not sure it is best for her to stay at her home for many reasons (safety, socialization, etc.) but, being quarantined in a facility is traumatic. My sister is in a AL right now and struggles with the lock downs....Good luck to you!
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Do you have an attorney? Meet with them...or find a good one...and ask what your LEGAL options are. You may find out that all this talk of moving her to a community...if she does not want to go...is moot. What does your Mom want? Does she want to stay in her apartment or move to a community?? My husband and I knew what was best for my MIL's health and welfare but there was nothing we could legally do to make it happen. We allowed things to happen as SHE wanted them to...because we had no legal choice...and the last months of her life were miserable for her. She did not die a good death but we had no legal options. I hope everything works out for you.
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disgustedtoo Jan 2021
I will agree that legally one's hands can be tied. If of sound mind, absolutely we have no say in the decision. None. If dementia is involved, there is still a legal "issue", but when it comes to legal vs what's best, one has to do what's right.

We tried bringing in aides, initially to check on her, but with plans to increase the time and care needed, so she could remain in her own place longer. She thwarted that by refusing to let them in. I started looking at places nearer to where I live, as it was not safe for her to remain there. Any mention of moving, whether to my brothers' places or AL were met with extreme refusal to even consider it. AL had been in her own plans before dementia, but dementia lies to the person, and they think they are just fine. The Elder Care attorney told me we could not force her to move and said we would have to consider guardianship. I don't think her condition was at that point where she would be deemed incapable, but it was enough that no way was she safe to stay home alone. Secondary issue is the facility I chose would not accept a committal. So, we had to come up with a plausible reason that she HAD to move. I suggested some ideas to the brothers, but she provided it herself by bruising her leg and developing cellulitis. One brother wrote a phony letter from 'Elder Services' at the hospital, stating she either moves to a place we choose or they would place her. Madder than a wet hen, but she went with my brothers. Even staff at her residence told me THEY can't force residents to do anything, they have to work around obstinance and refusals, even when it's necessary medical treatment or taking regular medications.

Just as with taking her car, WE have to weigh our options and go with the BEST solution. Is it my right to take her car away? Maybe not, but I wouldn't want to live with the results if I backed down. If she killed herself or someone else, I would have to live with that. Is it my right to say she has to move? According to attorney, no, but again, I have to live with the results. Would I go to see her, take her shopping or to an appointment and find her dead? Would she fall down the stairs? Would she wander off? Any number of what ifs were enough for me.

Legal or not, I stand by my decisions!
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Can you afford companion care so she can stay in her own home? Moving is traumatic and will cause a some disorientation that will hopefully fade. For my mom, the issue was getting her medicines right - taking them when she needed them, and not taking them twice. A couple of times she got off schedule, and things went bad quickly. A good companion can interact with your mother and keep her engaged with activities appropriate to her condition - walks, drives, puzzles, coloring... Both my mother-in-law and mother went through a period when a companion could come every day and make sure they ate and took their medicines and got them settled in bed for the night. Eventually both of them started needing 24-7 care.
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disgustedtoo Jan 2021
Although it isn't the answer for all concerns about them living alone, medications can be managed by using a timed/locked dispenser. There were concerns about mom either not taking her meds or taking too many, forgetting she'd already taken them.

The nurse the agency sent to assess her before we started aides had suggested this. It did help, however she would often miss the daily meds, either not seeing the blinking light or hearing the alert. The aides were mainly to check on her and see that she took the meds (they can't dispense, but they can look and remind.) We never got past 1hr/day as she refused to let them in less than 2 months later.
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Is it "healthy" that she wants to stay in her home...sure everyone wants to stay in their home.
Is it "safe" for her to stay in her home? That is the important question.
Will she wander out and not know ho to get back home? Could she leave the stove on? Is it gas or electric? If gas does it have an exposed pilot light that could catch a towel, garment or paper on fire? Is is possible that the pilot light could go out and fill the apartment with gas? Is there a working carbon monoxide alarm?
Is she taking medications? if so is she taking them properly? can she over dose or under dose? If someone sees her everyday if she fell after someone left would she know how to get help or would she remain on the floor until the next person scheduled to see her arrives? And what if the person scheduled to visit did not show up that day?
All this is speculation. Unless she has been declared incompetent you can not "force" her to move.
On the flip side..falls are bound to happen no matter where she is. Accidents happen, that is a fact of life. And another sobering fact is : no one gets out alive.
If she is safe, if there is no chance she would wander she would probably be much happier living in her home. The best solution would be to have someone live in with her if that is an option. then she can stay until it is physically impossible for her to remain.
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disgustedtoo Jan 2021
As noted to another, even with dementia you can't "force" someone to move (this is per our EC atty.) We just had to get "creative" and come up with a plausible reason why she would need to move. Legal isn't always the right answer... IMO.

All the safety concerns are valid, and there are likely more. If someone can't be there 24/7, anything can happen (can for us too, but when not able to make proper decisions, even simple issues can be deadly.)

Agreed also that while falls are a concern, they happen everywhere, no matter how well someone is monitored. It matters more that there is someone available to help if/when it happens.

Funny is that my idea for prompting the move wasn't implemented, but could have worked. YB had put in a Nest thermostat. He could monitor and control it from anywhere with WiFi access. The old one she managed to flip from Cool to Heat in the middle of the summer. The heat wasn't running, but it was like a sauna in her place! Anyway, I suggested he mess with it, making it too cool for her (it was already into early winter), then maybe too hot, etc. Instead, he used her leg injury/cellulitis to draw up a fake letter (how nice of her to provide this "solution" for us!) The funny part is that a few months later, while working on clearing and cleaning, I discovered the heating system died! So my idea wasn't even really a ruse, it was reality! Had that happened while she was still living there, she would have been in a dangerous situation.
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Here is my two cents. Trust your gut instinct. Please install wifi cameras around the house so you can monitor her from your cell phone and really make an informed judgement call. Amazon's Wyze cameras are great. My mom "talked the talk" for a long time but the cameras took away the guesswork. She wasn't eating healthy, sleeping more often than not, often left the water running, forgot or double took her meds, and one time put a bottle of nail polish in the microwave because she thought it would loosen the top more easily.
Please make a consultation appointment with a good elder care attorney to learn your options about protecting and/or utilizing her assets to best serve her. You should have a durable POA and health care proxy in place before you make any major changes. Any changes in memory should be documented with her primary care physician. Lastly, if she has sizable assets hire a local caretaker (besides family) to keep her company and take care of her household needs for a few hours a day. I think that would be a help to all of you and give you some time to make a good assessment before you decide on moving her to an AL facility. Best of luck to you!
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My 92 year old mom also has memory problems. She was living on her own but was very lonely. She refused any outside help and was not taking her meds consistently. She doesn't like to cook, didn't want meals brought in and was living on junk food. She is now in a retirement home where she gets 3 meals a day, her meds are given to her and monitored, she has a call button to get help if she needs it and there are activities and people to socialize with. She is content there and we have peace of mind knowing she has company and is being well looked after.
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disgustedtoo Jan 2021
Put simply, yup, this was our mother and her situation. Age, refusing outside "help", unable to monitor meds, couldn't cook, refused to consider MOW, living on microwave foods and junk.

The last sentence fits as well. Initially she was miffed, but she eventually was content. The place was great, mom was well cared for and SAFE. She had 3 good meals per day, with snacks and coffee between. There were plenty of others around for socializing and varied activities for the residents.
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TAKE 'IMPOSSIBLE' SUGGESTION..

I agree , mom will be better, or you will be better knowing someone is around 24/7
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If you consider 'severe' short term memory, indicates potential problem. If she spends a good deal of time sitting, she may not get herself into troubles. First thing I think of, though, is remove all of the knobs on the stove/oven or unplug it to make sure she cannot cook even if she decides to try one day. Forgetting a pot on the stove is very likely w/short term memory.

When you say someone sees her every day - do you mean a drop in 15 minute visit or a couple hours every day? If she is happy and physically doing well, is there a way she can live with one of you for now? Just thinking that if you trust her at home alone right now, she must be in fairly good physical shape and should not require that much work for a relative that she lives with. Being around others and engaging in conversations more often is good brain exercise. It won't make dementia go away, but some say mental activity slows it down.

Being that she is physically able to get around and manage on her own at this time, I would try to extend her time outside a facility until absolutely necessary. With covid, she probably won't get all of the social gatherings in a facility that used to take place and could be more alone than she is now. Most have to stay in their rooms away from the other patients.

You might also consider a few cameras in her house - living room, bedroom, and maybe one that can pick up a hallway, etc. You could peek in on her through out the day to have a better idea of what she does. Amazon alexa has a thing that you can have an audio and video call with someone - you could put a little note on it for her to say, "Alexa call SusieQ" to reach you.

I would vote to move her in with one of you so you can spend more quality time with her while there is still some long term memory and she is able to get around on her own. Maybe even split time between you and brother's house - however - there will come a time that moving her around won't work. It will create more confusion for her. --- This last paragraph just my own personal opinion based on she is becoming unsafe living alone but she is not quite ready for solitude of covid practices in facilities. Really just needs more eyes on her daily and while you all are familiar to you, enjoy this period of time ---
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disgustedtoo Jan 2021
Depends on facilities, but mom's MC did NOT isolate the residents. AL, yes. MC no. Some tended to walk about, or want to be where the "action:" was. If the virus did get into the area, they might have had to implement something, but they worked around it. They staggered meal times and moved the tables further apart. They curtailed many activities brought in from outside and implemented more from within. I'm no longer on their weekly update, but up until late December, they only had one staff member test positive and no one else was infected (many tests done after that was discovered.) The AL and IL residents did have to remain in their own "apartments", but could go out if necessary (discouraged) and at some point were allowed some joint activities, keeping limited numbers, distancing and masking up.

In OP's case, I don't think her mother is really AL material. If she was, then she could remain at home.
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Not safe, no. Just think of leaving on the stove burner and that will answer your question. When this started happening with my aunt (and the building had to be evacuated -- fortunately no fire just smoke), she moved into Assisted Living.
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My mom was 86 when I moved her into MC at a facility. I was noticing changes and she would absolutely refuse any help. It took an “event” to move her. She moved to MC and was thriving until she fell and fractured her hip. They become so stubborn, I do not have a support team therefore I was it. I wished I could have gotten her to move into AL two years ago. She would not have it until there was no choice. Good luck
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Let her be in her apartment. It's what she knows and is comfortable with. If you are making it work for now this way, let it be. Believe me, she would not be doing anything differently at an assisted living center except wishing she were home, regardless of the literature and pamphlets about "activities" and "community". Home is best if you can manage it.
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disgustedtoo Jan 2021
"Home is best if you can manage it."

Learned LONG ago when watching The Electric Company with my kids:

IF.... is a very big word....
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Depends on whether her problem causes her to wander off unsupervised, or forget that she is cooking' can the situation be elderly proof. The problem is it will all work ok until it doesn't the question you have to ask is there a potential that your mother could seriously hurt herself?
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If she's happy in her apartment, let her be. Looks like you all have it covered, having someone visit every day.
I would suggest a life alert button for her. Does she need help cooking and cleaning?
If possible, could the visitor join her for a meal? Lunch or dinner.
I cook a well balanced dinner, with plenty of extra to bring for Mom and share a meal.
Also, perhaps a schedule for a daily call. I call my Mom each evening around 7.
Hoping your Mom can stay in her apartment, especially during the pandemic.
Best wishes.
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disgustedtoo Jan 2021
Life alert buttons are fine, but when dementia and memory issues are involved, they don't always remember they have it or how/when to use it.

We added some "safety" features for mom, including a flashing light for the doorbell, a timed/locked dispenser for meds, and cameras. Her hearing wasn't great and she would often forget to replace the battery in it, leaving her mostly deaf. She misplaced the portable phone (there was a wall phone too) multiple times. She dismantled the flashing light. She would miss the alarms, etc on the dispenser. She switched the thermostat from Cool to Heat, mid-summer! The place was SO hot (the heat wasn't running, but with all windows closed, heat and humidity built up!) One brother put in a Nest thermo - he could monitor and control it through WiFi, she didn't know how to mess with it. He also put in a cipher lock on the door, also able to control it and set it to lock at night.

We tried bringing in aides, 1hr/day, to check on her and see that she took the meds. That didn't last 2 months (she refused to let them in.) If she had an alert button, that would have been misplaced as well. Too often she would put away "supplies" and then forget she had them, use other things (wrapping items in torn up plastic bags for freezing, despite having baggies, plastic wrap, tin foil, etc) and ask for me to pick up more.

I also made extra for some meals (lasagna, mac 'n cheese, chili) that I could freeze and bring to her. I did not live close enough to provide daily meals. No clue how far away OP is, but that isn't always an option. She flat out refused to even consider MOW. She forgot how to cook things, so she relied on frozen dinners and junk.

Sometimes it just isn't easy trying to keep them in their own place, esp when memory issues are the big concern. Without being there all the time, we have NO way to know what deficits there are, what danger they pose for themselves or what they are doing daily. Cameras can only show so much.
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She'll be fine until some "untoward event" occurs - such as leaving the stove on or the water overflowing a sink. Her memory situation will only get worse with the passage of time.

It's time to start investigating other options.
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My dad was in his house until 93 with daily caregivers until he was hospitalized for dehydration. The hospital said it was not safe for him to return home, as this would happen again (he forgets to drink beverages), so he was discharged to assisted living over a year ago. He has now progressed to skilled nursing. It will probably be a medical incident that will require her to move.
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Your story/dilemma could be written by me.

Mom was about the same age and relatively healthy (hearing loss, treated for Mac Deg, on BP meds.) Clearly her short term memory was fading quickly. Once I realized this, I started learning about dementia (knew ZERO before that!) Of course during the early stages we have some options. AL is one. Bringing in aides is another. Safety enhancements when possible. Socialization is something highly recommended, but while this virus is still an issue, that is a problem. In mom's case, she was social before the dementia, but became increasingly self-isolated. She would make excuses not to join others for events at the Senior Center, etc. She would often plan or try to cancel appointments.

The more I learned, the more concerned I became. One brother isn't local, but even he was pig-headed and blind, esp when I tried to "inform" him. The other, right up to the actual move INSISTED mom should be in AL, not MC, despite what the assessment and staff were saying. Other than having more 'eyes on the prize', more services to help and more people around for socializing (not at the moment), AL is really no different than having your mom in her apartment with someone, whether you, brother, aides, coming in sometimes to visit and/or check on her.

When you don't actually live with someone, it's often hard to notice ALL the deficits. I missed the very earliest warning signs because she lived alone and I didn't snoop around to see how things were or even talk every day (multiple times per week.) Finances had to be taken over first - she was having difficulty, so I just made the decision to "activate" POA and take that on. Once we took the car away, then it became obvious she was no longer cooking. I could only provide so many home-cooked meals that could be frozen, but even then I'm not sure she knew what to do with them - frozen dinners and boxed crap was her go to, along with instant coffee (multiple cups would be found in the fridge, because she would even forget she made it and would make another, saving that for later!)

Once we moved her and I started working on clearing/cleaning/fixing the condo, MORE became evident. She was still mobile and able to keep herself clean and fed, but too much else was falling apart. Even though they can walk, talk and feed themselves, there is so much more to consider when they live alone.

I did note that you are pretty much on board with a change being needed, but brother isn't. Would it be possible for you to install some cameras? We had some, and they would record for a chosen set of seconds (mainly at front door and in the finished basement.) These only provided small glimpses into her daily routine (sat a lot reading, esp sale flyers and catalogs.) The big thing they revealed is that she began a nighttime OCD marathon, checking the door lock, sidelights, dishwasher and LR. It started out a few times/week, a few times those nights. It shortly became a nightly 1-1.5 HOUR trip, cycling through these over and over again! The camera couldn't see to the dishwasher, but I could count seconds, light on, light off, and same for LR, no camera, but pass-through window allowed the light to shine through. This was her version of sun-downing. Without the cameras, no one would have known!

If you can document her "doings" with the camera and show him, maybe you can convince him. Even better, or in concert with cameras, could you stay there for a few days and document what her days involve? Seeing is believing! If it's as bad as you think, get him to stay there a few days.

I would be checking the places you think are best, while waiting for virus resolution. You can still talk with them and get a feel for whether AL or MC is best. They will do assessment as well. Meanwhile, gather enough info to work on bro. They often just don't see the whole picture.
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Yes you are kidding yourself. It is not safe for her being alone all those hours. No one to make sure she is drinking fluids, or eating. For that matter, what she is drinking or eating. It could be cleaning chemicals etc. If she turns on/off the stove. Turns off the faucets. If she falls. If she goes outside without proper attire for the climate. Even though these are things she is not doing now, does not mean she would not do it. Things can change in a second and it will. Believe me, I went through it with my Mom years ago and now my husband. What they know this minute they might not know a minute from now. And if you think you have covered everything for her to be safe, don’t believe it. Sorry it’s just true fact from experience.
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I believe if you can, she should be put into assisted living where they can monitor her and care for her. This sounds like a situation that has the potential to "explode" one day. Don't let that happen - just do it now while you still can.
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She would absolutely hate to be moved from her own place to a Senior Home.
She will be happier getting to stay right where she is unless she tells you otherwise.
Besides checking in on her once a day in person, you should also call her once a day.

You should set up cameras in the home so she can be watched 24 7 by cell phone or lap top.
She should also have the Home Button she can push in case of an emergency like a fall.
She should only cook by microwave.
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Sarah3 Jan 2021
refreshing to see some folks understand everyone is different and having respect for a seniors wishes is a rare thing these days in a society that treats seniors as children. Unless a senior is truly incapacitated their autonomy to live out the remainder of their life how they want should be deeply respected
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