Any tips on having conversation about moving to ALF?

Most elderly people are unwilling to have the conversation about what step to take next.

Your mom wants to stay in her home. Most people do. If she wants to continue to live independently she will need some assistance like an aide who stays overnight to make sure your mom is ok. That's the compromise. You and your siblings will back off if she gets someone in the home to assist her. That's how you frame it.

As far as AL goes, you can't force your mom to move there. You can't physically carry her on your back and plop her down in an AL facility. If she continues to live at home she'll probably fall and end up in a NH anyway so let her hang onto her independence for as long as she can---with in-home help.

I have to apologize, RhondaAllison, I didn't mean to sound so insensitive. What I should have said is that when elderly people refuse to budge from their homes, and there are a lot who do, what happens in many cases is that there is a medical emergency at some point which leads to a nursing home.

Again, my apology.

@Eyerishlass- Thanks, so any tips on a conversation starter? She is unwilling to have conversation and I would like to introduce the idea. She may refuse ALF, but it seems like that is a given if it is never discussed. I see the compromise and would be willing to go there if she were willing to discuss options. Her lack of rationale discussion is of course because she wants to maintain control; I get that and respect that, so I am hoping for feedback on how to open up the discussion.

Eyeirshlass, no need to apologize, but thank you. Yes, I sort of think that she is hoping for a fall and wants to hasten the end her life that way. Still we have the type of relationship that she could say that to me. I would respect if that is her thinking. But, still I want to discuss things like two adults!

Right. Well, first look at assisted living facilities in your area. Take a guided tour of a number of them . . . some allow dogs, try to find a few . . . ask prices and whether or not they have a la carte services as she needs them. Some have services just short of nursing home care; very helpful as time goes on. When you've found one that fits the bill, get full pricing information for basic services and add-ons.

When you talk to Admissions Coordinators, they will have VERY helpful information for you. They've been to your rodeo and back many times. When you find one you're satisfied with, ask the AC if you can bring mom for a tour at lunch time so she can sample the food.

All this without even discussing it with your mom. When everything's in place to spring the news, make an appointment with the AC, and have mom for an overnight with her puppy. Tell her that a friend of yours talked up the one you've chosen, and you JUST WANT HER TO HAVE A LOOK. She has no IDEA, after all, what AL is really all about.

Then sell her the sizzle. Forget the steak. That's for later. The activities; the gardens; the free transportation; the wonderful food, the pretty rooms. Maybe even see if your appointment can coincide with one of their entertainment programs...they have lots. Take her to that. Make a half-day out of it.

Go home and let it all sink in. Answer her questions . . . still talk about the sizzle. Let her steep on the busy day she's had.

Then tomorrow, talk about the steak. The STEAK is that she'd be close to you. She'd have no responsibilities other than taking puppy out and choosing from the meal menus. No fussing about doctor appointments. (They usually come to ALs.) She'd see you more often...your kids, if you have them...assure her she can easily afford it.

She'll be thinking about how much trouble it'll be. "No trouble at all!" I'll come for a few days to pack up your best clothing...photographs...some personal things you'd like in your room...and one morning? We'll go there for lunch...and you'll check in to your new suite!! "I'll handle every single little thing!!"

"I'd be sooo THRILLED to have you close by? You can't even imagine!"

(If you can't find a facility that takes pups, then tell her you're fencing your yard for her puppy; she'll have a wonderful life with you; and you'll bring her to visit every time you come. (Almost every ALF allows that . . . people love them.)

Good luck!!

I don't blame you for wanting to have an adult conversation about this with your mother. And I hope that happens. But if she is not being rational, at least on this subject, that may not be a realistic expectation.

I like Maggie's idea of taking her to lunch at an ALF BEFORE you have the conversation, but is that feasible? Were you thinking of bringing her close to you, eight hours away from where she is now? Or finding a place in her current town? Do other family members live close to that?

Anyway, having a specific place to talk about (even if it isn't the one she'd be moving to) would be good background for the conversation. (You are going to do this face-to-face, right? Not on the phone.) You can matter-of-factly show her the cost of an ALF, and compare it to the cost of staying home with the help she has now plus a night aide. Then you can talk about what she sees as the benefits of each. This is, of course, assuming she is willing to talk about it at all. One conversation is not going to settle this, but at least you are planting the seed.

Is your mom being treated for depression?

Thank you MaggieMarshall-
She will not be moving near me, nor would I take her dog. She has visited many friends who live at different places and tried one for 6 months when she could live in independent facility; this isn't our first rodeo. Have her for an overnight? She won't even talk about it; that is the problem! The places I have visited all take pets; not even considering one that won't. You are right that she would not have to go out for most of her doctor's appointments; good pro.

Thank you jeannegibbs-
One other sib lives in same town I think this would make things easier on them too, but he does not have confidence to talk to mom (long story). Yes, maybe just taking her to lunch as Maggie described would be good before the conversation. Yes, in person and she knows I want to talk about "the future". She is being treated for depression, but, self medicates and does not follow doctors orders due to confusion of what meds are for. A nurse manages her pill dispensary each week.

I know I cannot force her; she can be stubborn. She has a friend who was "hijacked" by her kids; took her "out to lunch" and checked her in at place they chose. So this is very scary for my mom. Right now I want to just start having some adult conversation about the future.
Maybe that is the thing to say to her!?

If she's going to have employed care givers in her house, you can show her you "hear" her concerns by putting a double lock on a couple of the bedroom doors for security. (We've done that at our home.) When we have care givers in to chaperone mom when we're gone, we put our personal papers in there (one is our office), our checkbooks, yada yada yada, jewelry, and any other valuables we're concerned about. We lock the doors when we leave the house. Mom could do that just on general principle. (Heck, I also do it when I have service people in the house. Can't be watching them all the time and not particularly safe to follow them around, in my opinion.)

In the end, you do what you can and accept that you can't control her life. I know you know that . . . but don't feel guilty. Some people can't get past their own desires, even when it's in their very best interest. And there's nothing the rest of us can do.

Thank you again MaggieMarshall-
I already do have the care givers with her six days a week. I am not sure what you're saying about double locks. Explain? My mom isn't worried about people getting into things that are not their business; she doesn't want to spend "so much money". Actually she has trouble getting up from the toilet/chair/bed and has to call the neighbor to come help her up about once a month.
You are exactly right, I cannot control her life as she is not determined incapacitated, nor will likely qualify in the near future. Thanks for offering comfort; it is terribly hard to sit by when she calls and is crying, needing help but is alone, has nothing to eat or cannot reach the food in the cabinets. It is the house and it's ongoing needs that is so draining.
Maybe to just tell her that I think the house is the problem and talk about an apartment with the hired caregivers?

I feel your pain...I'm in a similar situation only have both my Mom and Dad to deal with. My Dad has Parkinson's and dementia and my Mom has a bad heart, broke her hip and femur bone in March, shoulder problems and is getting ready for a knee replacement. Her mind is sound and Dad can be hit and miss depending on the day. We have done thorough research and tours for AL and are realizing it's not likely a good fit for them. Mom doesn't like people and ultimately Dad would need the Dementia unit and Mom would stay in AL. Neither wants this and it's more than they can afford or are willing to deal with at this point in time.
If your mom is having trouble getting up from the toilet, have safety rails installed. We had them installed in the shower and toilet area to assist. Get her a seat for the toilet that has the handles so she sits higher and gets a better balance when sitting down and getting back up. Get her a hospital bed in the house which will help her get in and out of bed- I am renting theirs. The life alert has been a God send and they wear theirs 24x7. Life alert will call the neighbors, family, MedAct , etc... We got Dad a recliner lift chair so it stands him up and helps him balance. All of these things are minimum costs and possibly could help make your Mom safer at home if the decision is to keep her at her house for at least the next 6 months.
Parents don't want to lose what they "feel" they can control and the money is huge for them. I get it. If she suffers depression and is totally against AL, than perhaps putting her into Independent Living that is more like a small home would be the option to consider. She gets hot meals cooked for her 2x's a day, transportation to shop or go to the doctors and still has independence. You may still need to keep the caregiver but perhaps could decrease the hours? It might be a good transition to AL since they generally are in the same community. Perhaps after a few months you could convince her to get rid of the caregiver for the same price and move her to AL. Wish you best...it's been an exhausting experience.

Thank you CarinC-
Talking about getting a hospital bed in her home might be a point of discussion since that was the last place she could not get up from. Brilliant! Yes, I am open to keeping care givers in a smaller situation such as apartment. You have helped one small step of cost/benefit analysis.
I upgraded her shower chair months ago since safety and comfort are key. She used LifeAlert to call neighbors to help again recently.
Fortunately she can afford what she needs but does not want to spend it. I understand being frugal; I am getting there myself being a good steward of her finances!
I am grateful for this forum to have other care givers with pearls of wisdom. Thank you all for your kind and ingenious thoughts.
Keep em coming!

You may have better luck discussing it with the dog. Seriously.
This has to be a guided tour ending up in a move to a safer, more purpose built/equipped location.

Dementia gets worse, and can spring surprise crisis on you at the WORST most inconvenient times.

One thing I did with my mom that I do not regret is just handling it for her. She couldn't make decisions anymore, and would just get mean & angry when a decision came up. She wasn't aware her reasoning was going, going gone.

I was able to get DPOA, so I could write checks out her account. My husband & I found a place for her nearby that was a continuum care campus. They also take medicaid. We toured, we reserved her spot.

Then we took her over for lunch & a tour. She LOVED the model apartment. We finalized the paperwork right there. They had to remodel the unit reserved for her, so for the next three weeks, we prepared her for the move. Then move day happened, and I did all the unpacking without her, so everything was in place when she was brought over for supper, to stay.

Yes, there were some transitional behaviors, but staff is used to it, and it's normal. It's a darn good thing she was there when she fell & hit her head in May. As an existing resident, she had preference for rehab after a hospital stay. Then with more dementia decline, she has been shifted down into the nursing home wing. Recently, she had another episode in the hospital, and was immediately put into a memory-care ward after. I did not have to do any work to find a spot for her when her needs changed.

If I had let her be at home, she'd be gone by now without a doubt.

Thank you sandwich42plus-
I like your style! Unfortunately sibs are not okay with that style. I do have DPOA for financial issues, but other sib does for medical issues since they are in same city. I would be fine with doing that since I manage her finances 90%; but, sibs will not go for it and she is still declared capable of making her own decisions by her doctors. Doctors see her at her best and know there is more to it, but, full battery of psych testing declared her capable with occasional assistance. She does get overwhelmed and then balks at ANY more discussion. So I do not have full authority.
I am really glad you took charge and made it happen. More dementia is a certainty once it starts. You were smart to select a facility with full continuum of care too; very important point.

RhondaAllison - oh Lordy - siblings! About all you can do is wait for an emergency and further decline. It's the most difficult thing to stand by and wait on a committee to catch up to reality. Time will take its toll, and if you have a plan ready to go, it will only help. As much as more hands to deal with my mom would have been nice, I was lucky not to have to pull reluctant family & deniers along with me to get anything done.

Disagreeing siblings are a huge problem people write about on the site. All it takes is one foot-dragger living in fairy-tale land to botch up desperately needed care & changes.

Thanks again sandwich42plus-
Yes, talking to siblings is like talking to her dog; I get the same inquisitive look without it sinking in. I have at least just started doing things myself and not expecting much else to get done.
Yes, it does feel like I am waiting for the phone call. And you're right that planning ahead is the best thing to do.

Rhonda, it's very difficult. Well done for keeping your siblings involved - I know how much it feels like pulling teeth, sometimes. For now you're in that limbo-land, knowing your mother is losing capacity but not there yet. Although, even when she is there, you're clearly still keen to find a compromise she's happy with: good on you.

Tips on starting the conversation - I'm not sure I'd even try right now. I think what I'd probably do is earmark some likely-looking ALFs, get their brochures, and leave them somewhere discreet with a post-it note saying - oo I don't know - 'worth looking at for future reference :)' or something that wouldn't put her back up; and hope she found them more attractive as time went on and getting about got harder.

I feel perplexed, sometimes, about this autonomy-safety conflict we have to try to resolve. If I hadn't uprooted my mother and transplanted her to this house with us, it's a racing certainty she'd have broken her hip, if not her neck, by now. Or died when she had her strokes. But, you see, then I think "...and?" It's the not being sure she would be worse off if I'd just left her to it that can get a bit depressing. I try to cheer myself up by reminding myself that sometimes there aren't any right answers.

Thank you Countrymouse-
You always have wisdom in your responses.
I really like that idea of leaving it as a seed to plant. It could back fire on me that she thinks I have made plans because she is a bit paranoid. But I think with that post-it note idea, it is more likely to be something that helps care givers have a reason to talk with her about the idea. The more other people talk, perhaps the idea will trickle in to positive conversations. I have requested the brochures and will be making appointments for my visits in the next few weeks.

It goes against all our generations instincts to allow there to be risk for our frail aged parents and yet we have promised to do as they wish. So goes the conflict the autonomy-safety conflict deep in our hearts.

rhonda i too hear you we need "this talk" soon here too! sandwich is right if she wont go then you wait until something happens? harsh but true! my siblings live abroad so its me here alone apart from a brother down the road but hes in "denial" wont listen to me and treats mum like shes normal? Mum has already been in the NH for respite and HATED it? its one of the best so she will be going there when she declines when is up to her? like your mum she is still competent according to docs? even if she is burning things on stove?? I may have to leave here just to get her to wake up to the fact that she cannot live alone anymore and that i cannot do this for much longer? IF i leave she will get carers in everyday twice a day BUT she will be alone at night? so unless we put her house up and pay for private carers at night i just dont know whats going to happen? she will not discuss anything and will just get angry? I fear that something happening is whats going to happen here as if she dosnt want to go we cant make her? And even if shes deemed incompetent its still not that easy to get her into a NH here we need a court order? I couldnt imagine forcing mum into a home against her will that would be awful i just leave it up to god now as i just cant think of a solution other than i stay here until she dies and maybe kill myself in the meantime? so stressful!
Like ive said before here you ARE lucky in US that you have some very nice ALs here in Ireland we are so behind in elder care and elders end up in NH when all they need is an AL? there are a few but only for the well off which is so wrong hopefully this changes soon! AL would be perfect for mum she laughs in my face when i mention it?
Good luck and let us know what happens!

Thank you kazzaa-
It does always surprise me that different parts of the world have different kinds of care for various populations. My son has mild autism and we are also lucky with him being a member of society here in the US.
I have thought about asking my Mom to try a week of respite. That would be one way maybe she would realize how much of a burden her management of her house is. I did also have a conversation on the phone with her about the problems with her house being overwhelming and expensive while her care is relatively easy to manage. At least my siblings are now allowing me to talk about ALF and I know what you mean about it becoming too late and needing NH if we wait. Baby steps, baby steps!

Well Rhonda update...........mums in hospital she collapsed in town i got a call from a store that they had called an ambulance! she went into town behind my back so i knew something was going to happen. Shes in hospital five days now as she was dehydrated and her diabetes and bloods were all over the place. SO you see i was right its happened now so i think NH is my only solution she is STILL adamant with docs and nurses that she outright refuses to let me control her meds so if she continues like this then she has to be ina NH for her own safety now. I am just waiting to speak to her doc as they are so busy up there i havnt got her doc yet? but i think now even the docs will agree its time for a home as the next time she will kill herself. Shes taking insulin so VERY dangerous with dementia! Ive had a strong gut feeling something would happen and now it did was probably meant to happen for me and siblings to realise she cannot go on like this!
Let us know how it goes with mum!! and my prayers are with you!

Mom needs to stay in her home as long as possible.
First...what are your concerns about her being alone at night?
You state that she has hired caregivers six days a week... but has nothing to eat and cannot reach food in the cabinets??? What exactly are these caregivers doing there?
Alarm can help you set up cameras around the house and inside the house...you are able to view live-streaming video right from your phone...computer...or tablet. They also provide sensors for each door and window and you can set up an alarm to 'ding' your phone depending on which sensor you
want to know has been opened or closed and it is immediate. My brother and I set this up for my Mom's house and it is one of the best things we ever did and provides a huge piece of mind.

Thank you Martha627-
Concern about being alone: falling down the open stairwell, not being able to get up off toilet (happens occassionally), falling out of bed (happens regularly), any emergency situation such as fire or theft she would not be able to manage due to dementia and physical frailty, as well she has had a couple of hallucinations (sun downing) and opened the front door for strangers she imagined. As well when left alone for long periods of time she reports that she gets so depressed she just sits and cries and thinks about death and her desire to die.
Her arthritis makes it difficult for her to reach into cabinets or the back of the fridge and pick up items, she cannot open containers because of the deformity in her hands. She is often found eating saltines and drinking instant coffee until someone comes and fixes any food. She gives them money for fast food for the care givers and herself when they are there.
Good suggestion about the monitor. I have had several clients who have used those very successfully. However, my mother refuses.
I agree stay in her home as long as possible and I think I am about at my maximum length. I manage getting her car maintenance, in home care, lawn and pool care, clothing, and the like from eight hours away. Maybe you have some help in defining when "long as possible" is no longer feasible for the caregiver? I am asking how to have a conversation with her as stubborn as she is on how to plan the future. I am all ears since she is my only parent.

Rhonda...
There comes a time when an elderly person such as your Mom cannot refuse options... especially when those options are safe alternatives for her to stay in her home or move to an ALF. Is there a senior center that she could attend during the day? My Mom attends one...I drive down every morning and fix her breakfast...her shower...her hair...and off she goes. Before having the conversation with her...do this.
First...make a list of your concerns and safety issues. Then jot down any solutions you may think of. Right off (for me)...I would place a door on the open stairwell...if your Mom's bedroom is on the second floor and this stairwell leads to her room...move her bedroom downstairs and get a secure safety gate for this stairwell.
For the toilet...you can get a raised seat with armrests that slides over the toilet...non-slip and it helps Mom so that she doesn't have to sit so low.
Falling out of bed...there are side rails that they make for toddler beds...Google them...not too expensive.
The monitor is there for fire and break-ins...not sure what you mean about theft...caregivers?...a break-in?? Why would she still be driving if she has dementia? If you know she has dementia and allow her to drive...you will be responsible for lawsuits. Disconnect the battery...try as she may...the car won't start.
Second...clear out the cabinets and place items that Mom likes to have...such a cereals...snacks...whatever it may be...on the shelves closest to her reach. Do this with the refrigerator as well. And place those items in containers that are easy for your Mom to use.
Third...there are several gadgets that help people with arthritis to open cans and jars.
Fourth...jot down the days and times the caregivers are at your Mom's home and the responsibilities of each caregiver.
Fifth...take your Mom shopping and allow her to choose items that would be easy for her to handle. Take her food shopping as well for the same reason.

Once you have done all these things with love and patience...and your Mom sees that you care deeply for her well-being...it will be easier to have the conversation.
Always...I cannot stress this enough...always give your Mom choices. I can just tell you from experience that the reason your Mom is so depressed is because she knows she is losing her independence and she feels worthless. Imagine how you would feel. What if you said "Hey Mom...how would you like to come and spend a few days with me? It would give you a break from here and I sure would love the company." I don't know your living situation...but giver her your bed...make it like a resort for her.
What types of things did your Mom like to do? Bowling...sewing?...Knitting?...Reading?...It's easier to have a conversation when someone is engaged in an activity.
I would get the monitor anyway... the police and firefighters can get there way faster than you can...if need be. We have a camera aimed at the front door and the back door...we know who comes and goes and for how long.
Get an account with PublicData.om and you can do your own background checks on anyone at any time. Run license plates...arrest records...anything...and you can check all states.

I'll share a funny story with you. I went to research ALF's...and one of the workers decided that my Mom was not in a safe environment being at home and called Adult Protective Services on me.
When I met with the case worker...she thought she was catching me off guard by telling me she had already visited with my Mom. I kind of chuckled o myself and pulled out my phone...scrolled to the video clip of her coming to the house...and showed her where I had checked her license plate on PD and knew where she lived and how long she had her car...and that she had had no arrest records. Her visit with my Mom took place while I was running my own errands. After she saw everything that we had in place for Mom...she started taking notes to give to other clients when she visited them.

About the times and dates for caregivers...switch them up...have one come in the mornings...every other day...to get her ready for the day and to make sure her meals are prepared...have another come at night...every other day...to make sure she has evening meals and a shower...I doubt she can handle the tub if she has trouble lifting from a toilet. There are great TV dinners that can be opened and left in the fridge that your Mom can just microwave...or bring leftovers that she likes...maybe something special you make.

Then the conversation can go like this:
"Mom...I love you so much...and I thank you for everything you've taught me and showed me how to do...I want you to know that I worry about you. I am so far away and wish that you were closer to me so that we could see each other more often. Wouldn't it be great if we could see each other every day? I sure would love that."
And tell her all the reasons you would love her to be closer...and all the things she could help you with. "Mom...you were always such a great cook...it would be so wonderful to have you near me and you could teach me all your recipes."

Use anything positive to build her self esteem and let her see what a great value she still is to you.

"Mom...I'm such a lousy house keeper...you were always so great at it...would you come and stay with me and show me how to get organized and how to clean my house?"

These are just examples...you can use your own. Maybe she was a great artist..."Mom can you come and help me decorate or pick out art?"

Once she sees that you value her and don't want to just shove her away somewhere...she will be more receptive to your conversation...

Martha627, you did get the part about RhondaAllison living 8 hours away, right? And you realize she is not trying to have a conversation about bringing Mom to live with her. You have some good, practical suggestions. I'm just puzzled about how some of them fit this situation.

jeannegibbs...you did get part that she asked for help with the conversation...right? I'm well aware of where she lives and that she visits her mother and hence gave suggestions to help with her mother. All of the suggestions I gave...were to help her move toward the actual conversation. One great way to upset someone...especially an elderly person...who doesn't want to have this conversation...is to be pushy and tell them what they should do instead of being kind and make it their decision based on giving them practical choices and at the same time...making them feel needed. Similar to how you addressed me...quite impolite.
Go back and re-read what I wrote. I'm talking about visiting...staying with her for short periods of time...this type of interaction helps an elderly person realize that change can be a positive experience...similar to what a parent does with a child experiencing separation anxiety.

Thank you all-
Awesome thoughts and focus. And yeah Martha627 I really love your story; right on!
The bank has contacted APS months ago due to large sums of money being taken from ATM when Mom uses credit card and checks almost exclusively. Not sure why she has to have around $1200 a month in cash...
My mother owns a car for other people to drive her places, she does not drive.
I like all the healthy food choices, but I can't from my home manage such details with the ladies who mostly do the shopping for her.
She has refused anything that would improve safety or mobility near the stairwell, the toilet, the front door, etc These were all offered as ideas and she chose to decline them all. I want her to have options but it is such a weight for me.
Maybe the better question is how to get along with adult siblings who do not see the degree of disability or have secondary gains ($$$) and would rather let it go than invest the time.

Rhonda...you have POA...do what you need to do.
The ladies that do the shopping for her are paid employees...they do what they are paid to do or you fire them and hire people that will.
Either your mother is stashing the cash or giving it to someone.
Cameras are around $1625 for the entire system and you can easily install them in the home.
I would immediately if we had outside caregivers.
As far as adult siblings...same thing. Either they do what you want or they don't come around. Simple.
My eldest son was living with my mother at one time and I had him legally evicted because he was using her money and food my brother was buying for her...for himself.
If she refuses the safety issues...then you implement them anyway.
If you've actually tried to offer her choices and you hit a brick wall..then you make the decisions.
Ask yourself this...what can you live with...your mother being mad because you implemented safety procedures or her falling down the stairs, breaking her neck, and either being in a wheelchair or dying?
My brother and I take care of my mom. I go every morning and Saturday evenings...my brother on Wednesday afternoon and Sunday. Our sister (older than me)...came down 3 years ago for 2 weeks...that was the first time in about 10 years. haven't seen her since. And we don't dwell on it. Life is too short and i prefer enjoying it.
My sister is missing out...I love taking care of my mom...even as crazy as it gets at times...and it does get crazy...she used to be quite hateful and physically abusive...I just practiced love & patience and prayed it would end and it did...like all the phases she goes through...it's a chess game...mom makes a move...we make a move.
But she took care and raised me...how could I not do the same for her?

Yes, but Martha although Rhonda has POA her mother still has capacity and therefore still makes all the decisions. It's a waiting game; and while you're waiting keep doing your best with gentle, imaginative persuasion. For example, Rhonda, with things like grab rails, you can get estimates for the work and line someone up to install them; then it's a rubber stamp job waiting for your mother to give the go ahead. I know this doesn't always work - my neighbour, 15 years younger than my mother, had the most glamorous bath aid you can imagine and kindly (or proudly!) showed it off to her. Mother was pretty ungracious about even going to look at it, let alone consider getting one herself. Well! - you can only try.

I think a nicely-turned handrail can lend a certain chic to a hallway, myself...

Countrymouse...No she doesn't have 'capacity' as Rhonda has already written:
"any emergency situation such as fire or theft she would not be able to manage due to dementia and physical frailty, as well she has had a couple of hallucinations (sun downing) and opened the front door for strangers she imagined."