your instincts are right, but the best facilities usually have
waiting lists, and you need to get her on at least one.  the one
sure thing about AD is that it's unpredictable, and that you need
to plan for thw worst and hope it never happens.

Sounds to me, iIf she is beginning to fade pretty quickly, and to the level
that she doesnt know who her sons are, I'd say your brother is right, either
now, or in a very few months time, which is probably the length of time it
will take you to arrange a facility.
No point saying, after a crisis in lets say 6 months time, "right she needs
a care home NOW" because that is going to be a few months away and what will
you do in the meantime?

Dave, I hate to say this, but your brother may be right.   If she is having
even an occasional lapse where she doesn't know her sons, she is farther
down that road than perhaps she appears.

My mother in law seemed perfectly fine on the outside, but later on, closer
observation of how she handled her bills and such, showed she was really a
lot worse than she appeared to be at that time.   She was great at putting
on a good face, and hiding her real problems.  Eventually it got very bad,
and we had to step in, but we waited longer than we should have too.

My mother in law was determined to live on her own for as long as possible.
This translated to staying on her own for almost a year after her doctor
told us she shouldn't be living alone anymore.  At that point she had lost a
lot of weight, was unable to cook for herself anymore, and too many other
dangerous signs that she was starting to lose it, than I can go into now,
including double dosing herself on her prescription medications, because she
forgot she already took them, burning the handles off of her cookware, and
paying her taxes twice... etc. etc.

But oddly enough she didn't appear to be all that bad, and later on she
wasn't.....as long as someone was guiding her life for her when she came
here to live with us.   Her responsibilities and challenges were less, so
she *appeared* to be much more in control of herself than she really was.
This may be the case with your mom too.   There are people looking after
her, so you may not be able to assess her real state yourself.

People with Alzheimers quickly lose cognition of what day it is, what time
it is, and day from night.   They might start getting dressed for the day at
2 AM or put their pajamas on at 3 in the afternoon.   They often become
delusional and imagine situations or people from the past playing roles in
their current day to day life.....This is in addition to the forgetfulness.

So how can you tell really?

There ARE tests that can and should be done by professionals, that could
assess your mothers skills and abilities, and believe me they will tell you
whether she is capable of staying on her own any longer, even with people
dropping in regularly, and part time caregivers, she is still alone a lot of
the time, and you wouldn't want a disaster to happen first, in order to know
whether or not she was capable of staying alone.

I would make an appointment and get her fully tested as soon as possible.
Don't wait for a disaster to happen.   Get her tested and get a
professional's opinion.   Your brother will respect you for it, and your mom
will be safer for it, and you will live to have no regrets for it.

On the other hand, you can guess at her abilities, let her live alone, wait
till something bad happens and act later.

See my point?

I'd get her tested asap.

Dave,

My Father-in-law ws incredible at hiding his deficits from people. My
Mother-in-law would tell the doctor, "but he thinks people are coming in at
night stealing things, he insists he has no cardiac condition and won't take
his meds (and gets violent if I try to make him take them), he forgets what
he is saying or where he'd going, he compulsively enters sweepstakes." He
forgot he had children unless he saw them daily (and we live 400 miles
away).

But based on the quick orientation eval in office, the docs kept thinking he
wasn't far into dementia at all.

It was only when he would up being admitted inpatient for his cardiac
condition (because he refused his meds) and medical staff observed him for
48 hours straight, delusional behavior and all, that the doctor not only
agreed there was a problem, but said it was nursing home time, immediately.
Within two weeks of going into a nursing home, his brain worked out that he
must be a widower to explain his situation, even though we had family
pictures in the room.

If your mom is covering her inabilities, you may not discover them until its
an emergency.

A really good neuro-psych evaluation takes hours. And for dementia patients,
the doctor should be a neuro-psychiatrist who does a lot of geriatric work.

One of the terrible things about brains, the less you use it, the less you
*can* use it. Just like toddlers need a lot of stimulation to develop their
brains, dementia patients often need a lot of stimulation to maintain their
awareness and function. Dementia patients left alone often hallucinate
because their brains are 'filling the vacuum.' You might consider a day care
situation (usually run by a local nursing home, council on aging, or elder
affairs bureau. They involve the participants in lots of activities, keeping
them alert longer. Evelyn can tell you about how important that was for her
MIL. Night time is often difficult because it's dark, and quiet. It can be a
very frightening time of day. (could you mom get up and get out safely if th
e apt got smokey? Would she be able to get out, panicked, without falling
down the stairs? If she has access to a stove, oven, toaster, iron, etc -
she can leave something on and not remember it.)

We wish we'd planned sooner. The first nursing home, though beautiful and
clean, could not keep my FIL's medication balanced and he got violent. Then
they threw him out because of behavior their lack of care created. The
second nursing home kept the med schedule much tighter and he never had
another episode.

I don't want to say outright that your brother is right. But he may not be
wholly wrong either. A really good eval will let you know just how much
function you mom has, and when you should be planning for her to need 24hr
care.

<....from others who have been down this road.>
Dave,  I've been (and am still going) down this road.  I think we as a
society are conditioned to think that keeping them with family is
automatically the best thing.  However, when you are dealing with
dementia-nothing holds.  You do what you have to do with what you know
and make the best decisions you can.  I think your mom will guide you if
you just stay in tune to what she is feeling/enjoying and what is
distressing to her.

Having said that there is something to be said for being among your
"peers" even if they're demented too.  Disregard the upheaval of a
move-which is emotional and traumatic no matter how you do it.  Your mom
is gradually losing track of our world and if she isn't already will be
in her own reality and if you're lucky will still spend some time back
in yours.  Now what kind of environment best supports that reality?
Safety is number 1 and failing judgment is going to happen-usually when
you least expect it. At home there is a basic routine needed if the rest
of us are going to function(eat, sleep, and be merry).  If her
perception of what to do next is out of kilter, how does that affect the
rest of the household? When she is lost and nothing or anyone is
familiar, are you prepared to deal with it day-in and day-out?  What's
the answer when she says I don't know what to do now-and she can't
comprehend the words you use to make a suggestion? What do you do when
she doesn't know what to do with food?  And then spits it back to you
when you attempt to feed her?

With normal aging you lose what you don't use.  With dementia I found
the home environment stifled my MILs initiative-because it was beyond
her comprehension.  Thus the environnment contributed to her withdrawing
from interaction or participating in things she used to enjoy.  Day Care
helped a lot-for awhile; but even that became beyond her.  She had no
idea where she was, how long she'd been there, what she should be doing,
what was coming after, etc.  When we placed her in a dementia-specific
ALF-she came alive and blossomed.  She could wander or sleep as she saw
fit.  She has kept up her social graces even tho' the conversations are
gibberish.  There is a semblance of programmed activities-she has no
idea what they're about, cat naps thru them; but "knows" she needs to be
with the others at specific times. There's always some activity, even if
it's just other residents walking around.  Or she can close her door and
sleep.  She's helped when needed, treated nicely, and kept comfortable.
I know that she's much more functional placed in the ALF than she would
ever be with us.  Part of it is that she's not continually "tested" who
is this and what do you know today?  She has no idea who her family is,
that she had 2 husbands, etc. and is continually trying to find her
mother.  Not to the point of distress; but I can leave and let her keep
looking.

Another aspect is that if you're like us, your experience with dementia
is limited.  When a new behavior crops up, what's the best way to handle
it?  This list is a great help, but each of our folks is unique and some
things you have to work out for her.  Having experienced caregivers
really helps.(I never did find satisfactory answers to my problem of her
using toothpaste to disimpact herself while here.  No one had ever heard
of that behavior.  At the ALF (granted she'd deteriorated), they just
hid the toothpaste and gave her the colace.  End of problem.)

Now what to do?  I strongly urge you to visit your options and discover
what is available.  If you can swing it, go and spend a few hours in the
more likelier candidates.  Supper and afterwards can be very revealing.
 Get a sense of how calm the residents are or aren't.  I would suggest
you come up with a rough time frame after your visiting and go by how
your mother is doing.  For me, I knew the place we chose was absolutely
the right one when I walked in the door.  I just had to wait 5 months to
convince my husband.  The facility says they like to get them earlier
rather than later, in order to establish routines for the later stages.
 Something to consider.

And don't seek your mother's approval.  Because it's not going to
happen.  You don't reason or cajole into her acceptance, because it's
not in her realm of experience even without the dementia.  And as we all
know, there's this fear and negativity of the unknown.

Fortunately, there's no right or wrong.  Only her suffering may be
alleviated some, if you don't wait too long.  And you can probably
prevent a crisis by thinking ahead.
Best wishes
Beth

I would agree with the other posters - you may not be ready to place
her today or this month, but you need to have the plan ready to go in
a moments notice, since things can change quickly with this illness -
and she would appear to be in stage 5 of 7 as a minimum from your
description. At this stage, so much of her has been eroded that losses
going forward will be stunning (i.e. they won't be subtle - they will
be things like toiletting).

Have you done some homework about facilities in the area to find out
whats out there, what you like or don't like, what would be best for
her? Are the places you've seen suitable for a person with a
progressive dementia (i.e. can they handle someone who may be very
confused and will ultimately need heavy nursing care, or would you
have to move her if she has behavioural problems or needs heavier
care??). Has the money angle been worked out in terms of what she can
afford? Are there waiting lists? The desirable places often have long
lists, particularly for something specialized like a dedicated AD unit
-  usually the best choice, since you need a secure facility and staff
who will understand the unique issues that go with dementia.

Get everything ready to go, including putting her name on any lists
there are, and then be pleasantly surprised if you don't have to put
the plan into action for a while - as opposed to being shocked by her
decline and in a pickle because you haven't planned for the crisis
you've landed in.

When my MIL got into trouble, it happened fast, but fortunately we had
her name on the lists and a spot came up.

Mary G.