Can Mom Progress from Stage 2 Dementia to Stage 4 Dementia in Weeks?

Can Mom Progress from Stage 2 Dementia to Stage 4 Dementia in Weeks?

Stage 2 to Stage 4 DementiaProfessionals have told me that a trauma could have caused Amy’s dementia (my favorite mother-in-law) to escalate rapidly. Is this true? Can all the dementia professionals and family members weigh in with their experiences?

My mother-in-law’s dementia was progressing slowly like my mom’s vascular dementia. There are four stages of memory loss and Amy was in stage 2, before the trauma. She repeated herself a lot, needed cueing for personal hygiene, medication management and had little desire to leave the home. Amy talked about not being able to remember stuff, but she could still read the paper, dress, bathe, toilet and feed herself.

Then Bill, my favorite father-in-law and Amy’s 24-7 caretaker, had a heart attack and went to the hospital. Amy could not understand where her rock and husband of 65 years had gone. She ended up having a psychotic break and eloping (The police had to find her and bring her back home.). A whole series of dramas happened and she hit a nurse. Then she too was hospitalized and put on psychotropic medications. Amy was in the hospital for three weeks in the psych ward.

By the time she got out of the hospital, the Amy I had seen months earlier was gone. The first time my husband and I saw her after the hospitalization (we live three states away) was so sad. The vivacious and sarcastic Amy was gone. It was like seeing a shell of her former self. Her lip trembled, her arm shook and she was so sleepy from the Haldol drugs. We immediately got the psychotropic medication reduced by half. It took us another three months to get her completely off the Haldol because we are not Amy’s Power of Attorney.

Amy was suddenly in stage 4 dementia. She needs help with absolutely everything and is not able to communicate her thoughts or needs. Hospice has been discussed in care plan meetings.

Has anyone else seen such a rapid decline with a family member or resident with dementia? Was it losing her husband, the psychotropic medications or both that caused Amy’s rapid deterioration? I believe that if my in-laws had planned ahead and moved into a Continuing Care Retirement Community (CCRC) that staff and residents would have supported Amy when her husband was first hospitalized. The CCRC would have rallied around her, helped her transition to the care level she needed and her world wouldn’t have changed so dramatically (she would have been dining daily with resident friends instead of being isolated in her own home).

What do you think?

“Your Senior Housing Options,” has a simplistic title, but what’s inside this new book can save a you months of research time.  Hear Diane Masson’s interview of how her mother and in-law’s faced the pivotal decision to plan ahead or wait until a crisis.  Learn the pitfalls from transitioning from your home to senior housing.  Understand what questions to ask, insider tips and dirty secrets revealed.  The decision to stay home requires caregivers.  Prevent elder abuse by determining if a home care agency is reputable, before they move into your home.  You are just not looking for today’s needs, but for your future care.  Discover key differences between rental facilities vs Continuing Care Retirement Communities.  Do you have enough financial resources if you need to be in a higher level of care for an extended period of time?  For weekly tips join at: 

Diane Masson has worked in senior housing for 17 years and is the regional marketing director for two debt-free Continuing Care Retirement Communities in Southern CA (Freedom Village in Lake Forest and The Village in Hemet).  Her first book “Senior Housing Marketing – How to Increase Your Occupancy and Stay Full,” is being utilized by senior housing professionals across the country.  Both her first book and second book, “Your Senior Housing Options,” have a 5-star rating on

Advocacy for my Mom Until Death

Advocacy for my Mom Until Death

My Mom and I

My Mom and I

My mother’s blood sugar spiked to 400 on Monday and 520 on Tuesday. She was fighting a UTI and ecoli. At 92, her body tried to fight it off. The doctor said the antibiotics would either work in two days or she would go down hill fast. It was the later.

The care ambassadors and nurses at Freedom Village were amazing. I lost count after twenty-three staff came in to say good-bye and provide loving care. One care ambassador said, “I’ve known your mom for two years and she was my family.” Another said, “Everyday she would greet me in the hall and compliment what I was wearing that day.” My favorite was someone reminding me of her love of cats and how she usually had one with her or would respond to the mechanical one that meowed, purred and moved. Her face would light up with joy.

My mom lived in a higher level of care for nine years. Seven years in assisted living and almost two years in skilled nursing in Lake Forest, CA. Six years ago, a doctor made a comment that her life was not worth living because she had dementia and couldn’t remember anything. I replied, “How many of your patients said thank you and complimented you today?” The doctor sheepishly said, “Only your mom.” I said, “Then she still is fulfilling her purpose isn’t she?” The doctor backed off and gave the best care until my mom left that Seattle hospital.

Through nine years of advocacy for my mom, I have done the best I was able, making decisions with the knowledge that I have. I am not a nurse and based my advocacy on her wishes and trying to keep her comfortable.

Extraordinary Versus Comfort Care

Hospice began on Tuesday and they were a Godsend. My husband was in Seattle saying goodbye to his dad on hospice when everything happened. A nurse, a social worker and a chaplain came from hospice to support my mom and me. I learned the differences between extraordinary care and comfort care at the end. The IV’s, antibiotics and unnecessary medicine disappeared. The morphine and adavan began.

Final Burst of Energy

After the chaplain said some beautiful words, my mom had what they call a “burst of energy.” I was holding her hand when she opened her eyes half way and said, “I love you,” seven times and “thank you” twice. Then she closed her eyes and the energy was gone. I will treasure that memory.

After she choked while attempting to eat, I said no more food. A caregiver patiently helped her drink some juice even though it took 15 minutes. That was the last time I saw her drink because she could not swallow again.

The turns every two hours caused her to cry out. The repositioning was to prevent bedsores. I called hospice when the gentle turns seemed to hurt her more and they said to reduce the turns to every three hours and give the morphine 20 minutes before. The nurses and care ambassadors were outstanding.   This little tip made the gentle turns easier for her.

The last day, she started to moan with every exhale. I called hospice again.   The gurgling in the throat had started and it was time to start the medication that helped with that. The director of nursing arrived before hospice and we started the PRN of morphine and adavan that had been preapproved by her wonderful doctor. Hospice increased the frequency of the medications to once an hour and said she was not to be turned again. Alleluia.

The director of nursing was there every hour to administer the comfort medications. I cannot say enough about the staff of Freedom Village Health Care Center and how they supported and loved my mom and I, to the end.

My husband came back from Seattle and the room filled with music. When the chaplain arrived they sang together and it felt like a send off party. Her doctor entered about this time, gave me a hug and said, “She is going out in style. I am so happy that she is comfortable.” A priest came to give her last rites. I said and prayed everything I wanted to with my mom and have zero regrets.

After nine hours, my husband and I decided to take a dinner break. The director of nursing said she would not leave my mother until we returned. Another change happened right before we got back.

The chaplain and hospice were called. The moan on each exhale came back and I requested more morphine for her. Her doctor gave permission. Chris and I sang a couple of songs to her. The chaplain arrived. I requested scripture and the chaplain was reading from the Gospel of John when she passed. God’s presence was in the room. She was comfortable and at peace.

Today is Sunday and I would normally go and visit with my mom. I wrote this blog to help me with my own grief today.

It seems ironic now, that my new book is dedicated to my mom. Writing this blog has been therapy for me over the last three years. After sharing numerous stories about my mom, several senior living people said you should write a book to help other seniors and their families. So I did and “Your Senior Housing Options” was published recently.

I love you mother and hope your stories in the book can help others learn their options and plan ahead. So many seniors wait until a crisis and lose their ability to choose like my in-laws did. The greatest gift my mom ever gave me was to plan ahead and move into a Continuing Care Retirement Community. Over 16 years, my mom had good transitions through three levels of care.

Witnessing a Mini-Stroke (TIA)

Witnessing a Mini-Stroke (TIA)



My sister-in-law witnessed my father-in-law, Bill, having a mini-stroke (TIA) this week. What a heartbreaking story. She was sitting with him in the living room and noticed his face droop on one side. Then his speech became garbled. It was over in two minutes and he could talk fine again. He had no idea it happened.   

She was understandable traumatized and wanted to talk about it. My husband and I are 1000 miles away and applaud her efforts to care for my father-in-law in her own home till he passes.  We both think she is a saint. 

Through my Internet research it says a TIA is a mini-stroke. TIA’s can be warnings that a bigger stroke can be coming. In my mom’s case, she has had so many TIA’s that she has been diagnosed with vascular dementia. I have never personally witnessed a TIA with my mom.      

I guess you could say we were lucky it was only a TIA with Bill. Unfortunately, my father-in-law is now on hospice. Hospice is comfort care, so the goal is no hospitals or ambulances if at all possible.

Every caregiver, family member and senior living professional should know the signs of a stroke and what to do. Stokes can cause permanent damage. If you get someone to a hospital in time, it can reverse the affects of the stroke. Go to to learn more. They say you should act FAST! FAST stands for: face drooping, arm weakness, speech difficulty and time to call 911.

Have any of you encountered or witnessed a TIA or stroke?

Diane Twohy Masson’s new guide book for seniors, “Your Senior Housing Options,”  is available on with a 5-star rating.  It reveals a proactive approach to navigating the complex maze of senior housing options. It will help you understand the costs and consequences of planning ahead or waiting too long.  Learn firsthand tips from someone who is currently advocating for three aging parents.

Among the thousands of seniors she and her teams have assisted in finding the right senior living community, the most difficult case has been helping her own parent. Masson spent two years exploring senior housing options with her mother before finding the ideal Continuing Care Retirement Community for her. After eight years in this independent living setting, she helped her mother transition into an assisted living community. Seven years later, even as a senior housing expert, Masson struggled with the decision to move her mother into a skilled nursing community.

More related articles by Diane can be found at or like Tips 2 Seniors on Facebook.

Diane Twohy Masson has worked in senior housing since 1999. She is an award-winning certified aging services professional and the author of Senior Housing Marketing: How to Increase Your Occupancy and Stay Full for senior living professionals.

Moving Mom 1000 Miles – Assisted Living to Skilled Nursing

Moving Mom 1000 Miles – Assisted Living to Skilled Nursing

Diane and her Mother

Diane and her Mother

Well, it is a complicated process moving a parent from an assisted living to skilled nursing.  Add 1000 miles into the equation and prepare for asking a tremendous amount of favors and help with no physical eyes on the situation. This is my story…

My mom has lived in a Continuing Care Retirement Community in Seattle, WA for 15 years.  For the past 7 years, she has lived in Assisted Living.  Her ailments have progressed to diabetes, severe vascular dementia, incontinence and now all symptoms indicate breast cancer.  Short-term memory loss and 90 years of age does not equate to any invasive procedures or surgeries.  When I visit her one-day, she has no memory of my visit the next day.

I could not stomach her completely alone (no children in the same state) and moving to the next level of care or a hospice community.  So my husband and I decided to quickly move her to Southern, CA, before she could not travel anymore.

All professionals who know my mom and I have been very supportive of this move.  Here are some of things that had to be put in place for this transition: Coordinating with the assisted living team where she lives, a nurse consultant to assess her and be our eyes in another state, her doctor, a home healthcare agency to take her to the doctor, the social worker at the HMO, the skilled nursing community that she was moving to, the federal government regarding her medical insurance and a Medicare representative.

The paperwork and logistics included filling out 27 pages of a Medi-Cal application, finding 22 additional documents for Medi-Cal, providing all the information that the new skilled nursing required, buying plane tickets, combining all our plane seats into one row, having someone drive my mom and us to the airport in Seattle and having Freedom Village Skilled Nursing pick us up at the airport when we arrive in California – whew!!!!

My mom does not know that she is going to move, because she cannot mentally process anything beyond 30 seconds in the short term and it would create anxiety for her – not understanding.

I am going to continue sharing my story as this moves takes place over the next few days.  Prayers and patience are needed to survive this.  I am excited for my mom to be located by our family in California and terrified of travel day.  I am her protector and don’t want her to suffer in anyway emotionally or physically.  It’s thrilling that my company in California is welcoming my mom with open arms – thank you Freedom Village.

Please comment to join the conversation and interact with other senior living professionals on what is currently being effective to increase occupancy on a nationwide basis.

Diane Twohy Masson is the author of Senior Housing Marketing – How to Increase Your Occupancy and Stay Full,” available for sale at  Masson’s book will be required reading at George Mason University in the Fall as part of the marketing curriculum.  She is currently consulting with Seniors For Living and two debt-free Continuing Care Retirement Communities in Southern California – Freedom Village in Lake Forest and The Village in Hemet, California. Connection and partnership opportunities: Email: