My grandmother has Type II, and a year ago, had massive muscle wastage, a pretty major opiate dose and fell frequently. When she self-selected her diet or ate what the rehab facility provided, her blood sugar spiked and plummeted regularly because both she and her local community are a heavy carb society (as in noodles on top of mashed potatoes with corn on the side?). That put her on sliding scale insulin. Her physicians had prescribed a huge daily dose of OxyContin for post surgical pain and moderate arthritis. The falls, plus the insulin meant that the state of Indiana said she had to be in LTC.
Of course, she was falling because she ate terrible food, so her blood sugar was awful; because the insulin made it worse by spiking/troughing, and the opiates made her unsteady, unmotivated and foggy. (She does have cognitive damage from her strokes, but just getting her off the opiates has done wonders for her cognition.)
She was also deeply depressed in LTC because it was noisy -- they use 110 db pressure alarms to keep people in their chairs and beds -- and she had no privacy. So add in sleep deprivation and startle responses... Many of her issues were iatrogenic.
I moved her to Colorado where we don't use pressure alarms at all; we got her on a carb controlled diet and her type II went back to only needing oral meds; we got her off the oxy and only an NSAID and she's much better. Colorado allows her to be in AL even though she does fall about once every 3-4 weeks, and she's allowed to go out on her own. She's had physical therapy to help her build balance and muscle, and while she'll never marathon, she never did in the past, either.
But yes, we're paying for it. AL is always self pay, though with Veterans Affairs Aid and Attendance, it can be helped a little.
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