My Mom is 86 with dementia following 2 hemorrhagic strokes. She has visual issues, beginnings of Parkinson’s like symptoms (shuffling gait, hand tremors). It’s a long story, but on December 19, 2025, she had her second stroke. I’m an only child, so after hospital stay, I moved in with her to care for her with home health and PT (at home). The mental decline did not start aggressively at first… she was weak and needed help physically. She progressed to walking (with slow shuffle) and could move around her house very well. Then the mental decline seemed to intensify. It happened so fast! She didn’t think she was in her house. She was constantly packing to leave. She thought she had to go to work everyday and was mad b/c no one was paying her any money. And she obsessed about money. Demanding to see the bank statement , accusing me of taking her money and changing the deed on her house. She was locking herself in the bathroom and getting mad because “someone” locked her in the bathroom! The paranoia and aggression hit. Seeing a man on the couch. Threatening her sitter with a (butter) knife, (I had hidden all the knives I thought, but she found that one!). She started falling and I couldn’t get her up. I placed her in memory care about an hour away. It was the hardest decision I have ever made. I agonized over it, prayed about it, calculated and recalculated… trying to find a way financially that I could hire more sitters and keep her at home, but I needed to be able to rent or sell her house and use that with her social security and I’m trying to get VA aide and attendance for widows… all of that and a small savings she has would take us into about 5 years of memory care. She moved in March 19, 2026. She was aggressive and resistant to the staff. They sent her to a behavioral hospital, but it ended up being a blessing. Doctors and therapist worked with her and got her meds adjusted and she was able to come back to memory care. She recently began having more falls and May 18th she fell and broke her hip, had surgery and I now have her in a rehab unit associated with a skilled nursing facility. Memory care won’t take her back b/c she needs a “higher level of care” than they say they can give. And I understand that if she doesn’t return to some mobility after rehab, but they say she is too much of a fall risk. (We had another memory care facility turn her down before I placed her in her current one because they said she was too much of a fall risk). The skilled nursing facility/rehab turned her down at first because of her history of aggression, but they reconsidered and took her but told me they were NOT a behavioral facility and if she showed aggression , she would have to leave. SO, the long term skilled nursing facilities don’t specialize in dementia/memory care (but most elderly people eventually get some form of memory loss) and most memory care facilities (at least in my area) don’t take residents who are fall risk (and aren’t most elderly people a fall risk?!) So the only option I see for my Mom is transition to the long-term care unit of the nursing facility when she finishes rehab, but she won’t get the specialized memory care she needs. So, back to my main question, are there even long term care skilled nursing facilities that integrate memory care? There is such a huge void in our healthcare system when it comes to caring for these patients.
If it is a locked down unit, it does not matter if it does not have a memory care unit. My mom's facility is just memory care, but many of the patients are unable to do any self care at all. My mom's roommate is beyond doing anything other than mumbling and eating food fed to her. The facility's policy is they will bring in hospice if needed, but they do not allow feeding tubes or daily shots of any kind (insulin, etc.). We got my mom medicated so she is no longer violent. I'm noticing a steep mental and physical decline this year, but she is being taken care of where she is. She is also a fall risk, but has had few in two years.
An elder with dementia who is an ongoing fall risk is one of the most challenging placement decisions. Once an elder starts to fall, the more they fall, then the falls get closer together, then rehab doesn't bring them back to their pre-fall abilities, so they become higher and higher risks, etc. No MC will want to restrain any resident to keep them from getting up and falling. My very elderly Aunt with advanced dementia got out of her barricaded bed at home one night, fell and broke her hip. While in rehab as I was figuring out where to place her, she continued to attempt to get out of bed and climb out the window, despite not being able to walk unassisted. She mercifully passed before she could be placed anywhere. I was going to get her assessed for LTC.
I'm so sorry for this stress journey with your poor Mom. It's not that there's a void in our healthcare system, as imperfect as it is. A high fall-risk elder with dementia is uniquely challenging care because it really requires one-on-one oversight -- and even then they still may fall, which is what happened to my Aunt prior to her final hip break: even with a vigilant family caregiver she fell twice before and broke bones. They are irrational and therefore unpredictable. They really do need to be restrained and technically facilites can do this but are extremely reluctant due to "optics" and litigious families.
Whatever LTC/SNF she goes to make sure they have Medicaid beds since LTC is covered by Medicaid plus an elder's SS income once they qualify. Ask about their level of knowledge and confidence in also dealing with dementia residents.
As for the "specialized memory care she needs" - at this point in her life what do you imagine that would include?