I have a little more time to write today. My background is as an acute care nurse, but I spent my youth in nursing homes (as my mother was an aide there and even from a very young age I used to enjoy going in and talking to patients; later I worked there as an aide myself during HS and early college until I later moved to a hospital). I also assisted my cousin in the care of a very close aunt in her journey with Alzheimer's, including picking out and transitioning her to memory care, attending care meetings and events at the facility, and end of life care.
Just to clarify about DNR/DNI that someone mentioned upthread, it matters most if a cardiopulmonary arrest occurs. It means that someone would be "let go" naturally if it did, and not have to undergo CPR, shocks, intubation, etc., which can be very difficult on an elderly body, and to what end? It doesn't mean that normal care won't be provided or that in the event of a heart attack, which could actually be very mild, that there won't be transport to the hospital for care, etc. I hope that makes sense, but here is an article which helps explain it.
https://www.shannydo.com/blog-1/2017/1/11/the-cold-truth-about-code-blue
I think hopper fan's approach is a good one. Involvement means that people know that the patient is being watched, and that's a good thing. I love that they helped out with events and made decorations for the tables, did crafts with the residents, etc. We did similar things with my aunt. My daughter used to bring books and read to the residents. They didn't care about the words in the books so much, but they loved watching my daughter, there would be so many smiles, and my aunt would look proud because even in her state, she knew that my daughter was "hers", and it made her happy. (Not to mention it helped foster a love of patients in my daughter who is a few months away from becoming a nurse herself.) I also liked to talk and joke around with staff when I was there and I think that was helpful to my aunt as they felt comfortable with us and thought we were a nice family, etc. If I had a request I would explain or ask things as nicely and tactfully as I could, as I understand how approach can make all the difference. I like to bring little somethings for staff, too, for the same reasons. (Like homemade cookies or candies.)
Each state defines and regulates "assisted living" care (which in our case included memory care when my aunt was still functional), so what might be the case in one state may not be the case in another. (This is why on threads like these there can sometimes be a little confusion or disagreements because things can vary from place to place. For example in my state, by definition of assisted living, residents must be able to do everything for themselves with minimal assistance, including taking medications, toileting and eating. After that, they need skilled nursing care.)
There are Medicare guidelines for Hospice care. Generally it's when life expectancy is six months or less, and a patient is not actively undergoing care for a "cure". (They don't want to pay for both.)
https://www.medicare.gov/coverage/hospice-care
For hospice I would choose an agency that's reputable in your area and choose a primary nurse that shares your philosophies on end of life and one that you have a very good rapport with. It can be very difficult making the decision to involve hospice, as even the word
hospice scares people, but really they are there to help provide whatever the patient and family need to have the best end of life care experience possible. I've had this experience now myself with my own mother and I had all the same difficult feelings as everyone else has, but overall, it was a good experience.
OP, take comfort in the fact that so many walk this path.
You sound like a very caring and lovely daughter, and I wish you all the best with your Mom.
on senior day when many elderly were shopping.
