My father is being verbally abusive to the Assisted Living staff and now they are considering eviction. How can we help him?

CJ:

In his case, old nasty habits like making everyone else feel like garbage won't go away that easily. Particularly if he derived some sick pleasure from it. Apparently no one had the courage to stand up to him, so there was no incentive for him to change.

Make him an offer he won't refuse: clean up his act and keep a roof over his head or a park bench complete with shopping cart. If he starts with some violin story like "I'm a sick, old man" that's just a built in excuse designed to flip the script on everyone and keep doing what he's doing. Behaviors like his will repeat themselves unless there are real consequences that he can feel. And the time will come when he won't be accepted at ANY nursing home or assisted living facility; let alone the homes of family members.

Once you've firmly explained to him the few options at his disposal (e.g., a park bench instead of an apartment on Park Avenue), a psychiatric evaluation shouldn't be a problem. It takes a lot of energy and mental sharpness to constantly manipulate and make everyone's job -- and life -- miserable.

Barring a serious mental illness, he's aware of the potential consequences of his abusive behaviors. And he'll continue to violate rules and norms unless others enforce them ... consistently.

A 92 year old man is not likely to understand the threat of being put out on the street and after years of this behavior change is impossible. Get real - you can't change him, you can only change how YOU deal with this. It's likely that there are under lieing issues at work here - dementia, fear, anger... At 92, the cause is no longer important, how YOU deal with it is important. Any good assisted living facility should have a social worker, counselor or other professional who is willing to come to your fathers apartment to speak with him and make an assessment. He might need anti-anxiety meds or a change to a nursing home. For you personally, you have to emotionally detach some what to deal with this abuse. Keep visits with him short, be sure to do something he enjoys during the visit. When you arrive tell him you have an appointment and can only stay 30 minutes or so. Ask what he needs and provide it if you can. Then DO NOT feel guilty; accept that you can only do so much, that you can't "fix" him or solve all his problems. You can still be respectful and not take his abuse. I have a much older brother who's exactly the same way. He is the ultimate jerk with family members but with other's he's polite and even nice. He is at the point where he needs help now so we take him to the local Veterans clinic and in a few months as his illness progresses, he'll go to a Veterans home. These places are full of other men - and he behaves completely differently around men. This might also be an option for your dad. Check with your local veterans affairs office. My brother served in Korea - it was not war but was considered a war zone at the time and qualified him for VA benefits. Some place with other men might be just what your dad needs. Good luck.

CJ, You will need to go against his wishes, and as a result experience his anger/fury at you. There is no other solution. Behind the scenes, get people who can help you get your Dad to go to have a psychiatric evaluation. (There is strength in numbers.) In my experience, the anger from Dad will occur but it will not last forever. At a certain point, he will have to give up. He really doesn't have a choice here, because he is abusing people. You just do what you have to do, and let the chips fall where they may. Good Luck.

A leopard seldom changes his spots... I think this is a well established behavior pattern for your Dad. No one has ever challenged him apparently so it continues. I would be very serious and honest with him. No facility will accept him if he continues to behave this way. If he visits the Dr regularly I would just make an appt for him for a psyc eval. He needs to know the consequences of his behavior.

I have been through this with a 68 year old Alzheimer's patient. I would take your father to a local emergency room that has a psychiatric ward. I would then do everything possible to get him admitted (including lying if you have to; chest pains, shortness of breath, whatever it takes; they won't admit him for just being nasty). Once he is in, they will likely do the evaluation while he is there. I don't know what state you are in, but in Florida we have something called the "Baker Act". If you feel he is a danger to himself or others you can "Baker Act" him into the hospital and then let the psychiatric hospital evaluate him.

As for him being kicked out of the ALF, I've been through that too. They absolutely must help you place him. If you refuse to pick him up, they have to find another facility for him.

I know this is tough, I'm still living it. My advice may not be "proper", but when you are dealing with the system, it seems to be the only way.

Sad commentary on the way things are if you ask me. We cannot know what will happen to us but I hope to die while I am asleep in my chair... take care j

Sharon S - Good advice! Don't worry about being "proper" - the way things are managed for profit and the "do the least possible" attitude of most providers, we are forced to handle things in this way. These situations of combative and abuse patients who can't control their behavior must be addressed. There are many issues which are too great and complex to discuss here but know there are others who understand and don't judge when you are forced to use these methods.

Even meds don't necessarily help but they do calm him down... the verbal use will always be there and has always been there... trust me, I know... It hurts... YOU are only responsible for YOUR actions and reactions. The assisted living facility should just put up with this - don't they? My dad is in a nursing home and I feared eviction b/c of same. I guess they put up with more there.

With out dropping into a hornets nest lets look at this objectively. An assisted living facility is a place were people go when they need additional help. If and when a person becomes "out of control" the ALF has the right to discharge this person. Nobody- aides or family member or others who are living with them should be subjected to behavior that is disruptive or out of control. With this said, depending on the type of or degree of dementia, possible "threats of a park bench" may work. If you go to the ER and the person is calm, they will be sent home. Baker acting is a good choice only if the person is a threat to themselves or others. It's only for three days- and then they will be discharged- hopefully with meds that will work. The reality is that some of the people that we love and care for have a personality that is difficult. It will take a special person or facility to handle this situation. Medications may work- but before you go this route make sure that they do not have a UTI that can make their behavior worse. Talk to them about the behavior. Is there something in the environment that can be a trigger? ,There are some people who are hopelessly difficult and manipulative.Their personality is strong and controlling- it come from insecurity and fear. Yes, medication may be the answer to your prayers but it will make your loved one into a zombie, reduce their quality of life and make make them more prone to falls. Medication may reduce nutrition.I would check out other living arrangements (after a medical exam) to see if there might be another ALF that either locally or further away from you that may be a better fit. Despite strong personalities that we can not change, there are facilities that can deal successfully with your loved one. Good luck and may God bless.

Nat, thank you for your explanation.. never gone the assisted living route, I am totally clueless. And the meds can make em zombies... true.. so do you want them faking nice or truthfully mean? Hard to tell! My dad has a strong personality that has only gotten worse with age - you have to do what you have to do! And don't feel guilty about it!