then you need to talk to him about plans for when your mother
will NOT be safe when left alone, because from your account of
her behavior it may not be long.  you need to overcome the denial
that's probably going on and convince whoever in your family
would make the decision that you need to get her on a a waiting
list NOW.  otherwise, you could find yourself placing her in the
least desirable place during a crisis.

Hi Ronny,

Just for your reference, here are the stages of Alzheimer's as defined
by Dr. Reisberg. Sadly, everyone who lives into the later stages of AD
does get to the point where they need 24/7 supervision and support
(i.e. they can't be left alone at all).

Mary G.

Stages of Alzheimers

In 1982 Dr. Barry Reisberg published what was to become the best and
most widely accepted description of the stages of Alzheimer's disease.
Even today,years later, when experts referto a person being in stage 5
or stage 6, they are referring to Dr. Reisberg's scale of seven stages.

Adapted from Reisberg, B., Ferris, S.H., Leon, J.J. & Crook, T. The
global deterioration scale for the assessment of primary degenerative
dementia. American Journal of Psychiatry, 1982

Level 1

No cognitive decline - (or Normal Adult). No subjective complaints of
memory deficit. No memory deficit evident on clinical interviews.

Level 2
Very mild cognitive decline (forgetfulness or normal older adult).
Subjective complaints of memory deficit, most frequently in the
following area:
(a) forgetting where one has placed familiar objects;
(b) forgetting names on formerly knew well.
No objective evidence of memory deficit on clinical interview. No
objective deficits in employment or social situations. Appropriate
concern regarding symptoms.

Level 3
Mild cognitive decline (early confusional or Early AD). Earliest
clear-cut deficits. Manifestations in more than one of the following
areas:
(a) patient may have gotten lost when traveling to an unfamiliar
location;
(b) co-workers become aware of patient's relatively low performance;
(c) word and name finding deficit becomes evident to intimates;
(d) patient may read a passage of a book and retain relatively little
material;
(e) patient may demonstrate decreased facility in remembering names
upon introduction to new people;
(f) patient may have lost or misplaced an object of value;
(g) concentration deficit may be evident on clinical testing.
Objective evidence of memory deficit obtained only with an intensive
interview. Denial begins to become manifest in patient. Mild to
moderate anxiety accompanies symptoms. Deficits noticed in demanding
employment situations.

Level 4
Moderate cognitive decline (Late Confusional or Mild AD). Clear-cut
deficit on careful clinical interview. Deficit manifest in following
areas:
(a) decreased knowledge of current and recent events; (b) may exhibit
some deficit in memory of one's personal history;
(c) concentration deficit elicited on serial subtractions; (d)
decreased ability to travel, handle finances, etc.

Frequently no deficit in the following areas:
(a) orientation to time and person;
(b) recognition of familiar persons and faces;
(c) ability to travel to familiar locations.
Inability to perform complex tasks. Denial is dominant defense
mechanism. Flattening of affect and withdrawl from challenging
situations occur.

Level 5
Moderately severe cognitive decline (Early Dementia or moderate AD).
Patient can no longer survive without some assistance. Patient is
unable during interview to recall a major relevant aspect of their
current lives, e.g., an address or telephone number of many years, the
names of close family members (such as grandchildren), the name of the
high school or college from which they graduated. Frequently some
disorientation to time (date, day of week, season, etc.) or to place.
An educated person may have difficulty counting back from 40 by 4s or
from 20 by 2s. Persons at this stage retain knowledge of many major
facts regarding themselves and others. They invariably know their own
names and generally know their spouse's and children's names. They
require no assistance with toileting and eating, but may have some
difficulty choosing the proper clothing to wear.

Level 6
Severe cognitive decline (Middle Dementia or Moderately Severe AD). May
occasionally forget the name of the spouse upon whom they are entirely
dependent for survival. Will be largely unaware of all recent events
and experiences in their lives. Retain some knowledge of their past
lives but this is very sketchy. Generally unaware of their
surroundings, the year, the season, etc. May have difficulty counting
from 10, both backward and sometimes forward. Will require some
assistance with activities of daily living, e.g., may become
incontinent, will require travel assistance but occasionally will
display ability to orient in familiar locations. Diurnal rhythm
frequently disturbed. Almost always recall
their own name. Frequently continue to be able to distinguish familiar
from unfamiliar persons in their environment. Personality and emotional
changes occur. These are quite variable and include
(a) delusional behavior, e.g., paatients may accuse their spouse of
being an impostor, may talk to imaginary figures in the environment, or
to their own reflection in the mirror;
(b) obsessive symptoms, e.g., person may
continually repeat simple cleaning activities;
(c) anxiety symptoms, agitation, and even previously nonexistent
violent behavior may occur;
(d) cognitive abulla, i.e., loss of willpower because an individual
cannot carry a thought long enough to determine a purposeful course of
action.

6a - Requires Assistance dressing
6b - Requires Assistance bathing properly
6c - Requires Assistance with mechanics of toileting
6d - Urinary incontinence
6e - Fecal incontinence

Level 7
Very severe cognitive decline (Late Dementia or Severe AD). All verbal
abilities are lost. Frequently there is no speech at all - only
grunting. Incontinent of urine, requires assistance toileting and
feeding. Lose basic psychomotor skills, e.g., ability to walk, sitting
and head control. The brain appears to no longer be able to tell the
body what to do. Generalized and cortical neurologic signs and symptoms
are frequently present.

7a - Speech ability limited to about a half-dozen intelligible words
7b - Intelligible vocabulary limited to a single word
7c - Ambulatory ability lost
7d - Ability to sit up lost
7e - Ability to smile lost
7f - Ability to hold up head lost

Forgot to mention, Ronny, that usually the first stop for a person with
AD who has to go into some sort of institutional care is not a nursing
home. Nursing homes are actually facilities for people who need skilled
24 hour nursing care, which is usually only necessary for someone who
is in end stage AD, and is bedridden.

My MIL, for example, two or three years into her AD, first moved from
her apartment to what they call an "assisted living facility" - the
first place she went to was essentially sheltered and supportive living
- they would help with bathing and dressing, and provided laundry,
meals, activities, housekeeping, supervision of medications and a range
of in-house services etc. but expected residents to be continent,
ambulatory and able to get themselves to meals. They also didn't keep
residents under lock and key (while she was there, she could have gone
out the door any time, so obviously not a facility for a wanderer).
They expected a degree of independence and orientation, ability to tell
time, feed themselves, communicate. It was actually a really great
place with tons of great opportunities for social and recreational
activities and it was unfortunate that it was fine for her for only a
year. After that she started getting lost in the building, she couldn't
operate her door locks, couldn't be trusted with her own bathroom or
access to the communal kitchenette for snacks, couldn't tell time and
get to meals or activities, was having paranoid delusions about other
residents etc. etc.

Her next move was to a locked and specialized Alzheimer's unit that
provided security and more total supervision and support, but did
expect the person to be ambulatory, and to be able to feed themselves.
Fecal and urinary incontinence were okay - but they really needed the
inmates to be able to walk, get in and out of bed and chairs etc. It
was still assisted living, but a much more intense level of care - but
it was still not classed as a "nursing home".

It wasn't until the AD took her ability to walk and feed herself that
she had to go to what they defined as the heavy care ward within the
same facility - which offered the degree of acute care that falls into
a "nursing home" definition. Not all residents of that unit were
cognitively impaired. Her roommate, for example, had some sort of
neurological illness, so her mind was intact, but she was physically
helpless, was very stiff and hard to dress and bathe, prone to
bedsores, needed breathing support, and thus needed a lot of very
specialized care - as did my MIL in late AD. It was much more expensive
and took a lot more one on one care - but since none of the inmates
could get around on their own, no lockdown!

Mary G.