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From this story, what I would do is reach out to compatible elders in the dining room or at activities. Find a sane friend to live with.
This always having another in the room has to be difficult and I am so sorry for it; I hope you will get a "good roommate" and be able to adjust. This would be hard for many of us.
Private pay you can pay for your own room. It might be a matter of how many private rooms are available.
My grandmother shared a room with a lady who had to be heavily medicated or she would scream all day long. My FIL shared a room with a gentleman and my FIL had very little hearing so he would turn the TV up to the highest volume, and then play on his phone at highest volume. We would be able to hear it when we got off of the elevator.
If you are private pay - and there is a room available - I would assume that you would have to go through the request process.
If you are on Medicaid or in a VA nursing home where the VA is footing the bill - the shared room is likely your only option - even if rooms are available.
My FIL was in a VA nursing home - fully paid for by the VA. He started as private pay (very briefly) and he had a private room. They moved him to a shared room once the VA picked up payment, but he didn't have a roommate until the last month or two that he was there. A lot depends on whether the facility is at capacity or has some wiggle room.
Also, as far as the medical issue angle - even if you tell the doctor you have something that you believe will get you a private room (again - I can't think of a single thing except a highly contagious disease that requires isolation and PEP protocols for anyone that comes into the room, or possibly extremely violent outbursts - which will only get you medicated - not lose you a roommate) they will most certainly confirm the assertion before they give you a private room.
If you are self-pay, there will not be a problem, you pay, you get.