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My elderly neighbor has Alzheimer’s. She recently left the hospital after a fall. Her husband/guardian was told she needs support 24/7 and was not to be left home alone. He frequently leaves her to walk the dog down the street, work in the field, plow, etc.

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It sounds like he is having difficulty accepting her diagnoses and wants things to continue the way they were for probably many years. Have you spoken to this man in a kind and helpful way and tried to understand his motives? I’m not saying what he’s doing is right, but chances are he is unaware of the consequences of his actions. If they live on a working farm, chores still need to be done even if one of them goes down. If the farm was/is their livelihood, he may not want to take a chance on the farm going under. Would he accept help with his property? Or with his wife? Is there a church group who might pitch in and help? Family? Perhaps someone could gift them a dog-walker?

Bottom line is that he WAS told she should not be left alone because she has Alzheimer’s and is a fall risk and he is doing just that regardless, for whatever reason. She may be difficult to deal with and he is, in effect, escaping. Out of sight out of mind and all that. Offer your help first and try to ascertain why he’s leaving her when he was told not to. I wouldn’t call APS right away, but if he is not accepting of your help or anyone else’s, you may have to alert them.
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Alzheimer's sufferers tend to sleep a lot. Maybe he does these things when she naps and thinks she will be safe in his absence. Assisted living is so expensive and few have insurance that covers it. Home care can be difficult to get in some areas. It's practically non existent in my county. If you don't want to offer your assistance (and I don't blame you - it's a huge responsibility), maybe you can suggest to him an agency that could help out with her care or that he reach out to friends and family. She certainly shouldn't be left alone to wander off and get lost or hurt.
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All those things you listed I consider to be doing chores around the house. Not leaving someone alone 24/7 does not mean you hover over then 24/7. They don't even do that in a facility. Many facilities will only check on someone once every couple of hours. Is he also not supposed to sleep? Since when he is, she could wander in to another room.

There's very little you can do to keep someone from falling unless you have then in a bear hug all the time. Since even standing next to them, if they fall by the time you react they are already down. It's dealing with it afterwards and not leaving them on the ground for 10 hours.
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Nicene Feb 2019
Very true, and walking the dog can help with his health and anxiety.
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Like the old saying, "never judge a book by the cover," this may not look like what you think it does. As one post wrote that she could be sleeping while he does chores. I think you should get all the facts before making any decision.
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Have you talked to your neighbour about how he is coping? I think I'd do that first.
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Yes.
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That's scary because some Alzheimer's patients will start to wander & not know where they live or came from. They don't remember what day it is, or where they came from. My own Mom has Alzheimer's & she can't remember from 1 min. to the next. She only remembers when she was little. In her mind she's 3 yrs. old. I hope thus helps you.
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Maybe a concerned neighborly thing to do would be to purchase a small voice activated baby monitor set as a gift so the husband can keep an "ear" on his wife when he is out of the house doing chores. An older man may not even be aware such monitors are available. VTech makes a very good unit available on Amazon for $20 (doesn't recharge monitor's batteries) or $40 (charges batteries when plugged up and has an intercom feature).

Staying in the house or in the room with someone will not prevent falls. I was walking just behind my mother when she last fell in our home. Although some Alzheimer's patients may want to wander outside the house, many do not. Depending on your neighbor's stage of dementia and mobility, she may be fairly safe alone in the house while her spouse is outside.

I understand your concerns but would encourage you to approach your neighbors with a helping hand and try to contact their children or other family before approaching APS. When we became aware our 72 year old neighbor was leaving his bed bound 96 year old mother alone during shopping trips, we gave him a list of people willing to sit with his mother for 2-4 hours at a time. With his permission, a crew came and gave his house a spring cleaning one day too.
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