Helping Dad--now that he's in a nursing home...

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So, there's probably no good answer, but at least I can vent... Our folks are in Mass, while I'm in Detroit and my brother is in Seattle. My 91yo dad (depression, Parkinson's) went into the hospital in March with blood clots, and we took the opportunity to move him into assisted living. His wife, Stepmom, is still living nearby at the house; dad (who owns the house) has pretty much no money left, but does have longterm care insurance, which was paying most of the AL bill--and we cannot afford fulltime home care. After a few fainting spells in June, things went rapidly downhill in the hospital, and he spent 6 weeks at a psychiatric hospital where he was formally diagnosed with dementia, including Alzheimers. He went back to AL, but we were told to expect to move him to a memory care unit within several months. Things were ok--not amazing--for about a month, and then the falls began (as well as the wandering, including into stairwells). He's also had swelling in his legs (due in part to an infection). AL told us Dad wasn't safe and recommended 24/7 skilled nursing (which his neurologist also supported); we brought in aides (9p-7a) as we scrambled. We applied to an AL with a memory care unit, but they were concerned about his physical condition. Fortunately, there was an NH nearby with an available longterm bed (giving dad a roommate). Unfortunately, of course, it's not quite as nice as the AL setup. Brother and I talked to dad two days ago to 'prep' him for the move, and he sounded somewhat amenable. We had to talk to him yesterday as he was threatening to call the police. Fortunately, the doctor there invoked his health care proxy (me), and they are apparently telling him he's there for therapy. Nobody feels good about the situation, but we also can't figure out any other alternative that's realistically do-able. Any suggestions...


Adam, change of any sort can be agitating and upsetting to a dementia patient. I would stick with " the doctor says you need to be here for right now " and "we'll talk to the doctor about going back to AL" if he asks specifically about that. Additional meds may be needed to get dad over this " hump" or he may just adjust on his own.
There probably aren't any other alternatives that are realistically do-able. It sounds like you and Brother are being very thorough in what you are considering.

Your dad apparently needs skilled nursing and you have him in a skilled nursing facility. What about the security issue? Do they have an area where he can wander safely -- a fenced outdoor court, for example? How do they keep track of the residents who tend to wander?

It may take some time, possible a few months, for Dad to settle into his new environment. Letting him think it is for therapy for a limited time is probably a kindness during this adjustment period.
I would focus more on the care than how nice the place might look. Sometimes the more modest places provide the best care, based on my observations.

I wouldn't get too distracted by what he thinks might be best, since, his judgment is impaired. Trying to please him might not be the best thing and it could be unattainable. His wishes could change daily. If his doctor says he needs skilled nursing, then that's what I would go with.

My cousin went into Assisted Living upon doctor's orders. She had dementia and was not able to live alone. She agreed. We explained to her that she needed physical therapy, medication adjustments, meals, etc. which was true. She eventually forgot about that. She then went into Secure Memory Care and I really do think that is a good option for those who are suited for it, but if the doctor says NH, then I don't see how you can go against the doctor's order. I would confirm their security and how they ensure that he stays on the premises.

I'd see how he progresses and then re-evaluate.
I would be good to "ramp up" and be positive about how nice it will be to have a roomate to chat with during the day. Having a good relationship with the roomie in the NH can make all the difference. Good luck.

Doctor who gave this order, probably would not see the dad unless the doctor was the NH/AL physician as well.
Mincemeat- Not all roommate situations work out. In fact, whoever is there first may either be pissed to have a roomie and/or try to "rule the room"

I know this from experience, because when my mom was in a room with 2 other woman, the one woman made sure to block access to the one bathroom in the room, so anyone needing to go to it in the room had to go past her. There was no chatting between my mom and either woman.
I don't recall if there are relatives in the area where your father is, although I do have some recollection that your stepmother does have family. Are they visiting him? If not, would they?

If I recall correctly your father used to have some buddies he met with periodically. If that's the case, are they able to visit him?

I think one of the most important things with all this uncertainty and change is to have some continuity, especially with family or friends. They can be anchors in a storm.

If friends or relatives aren't a possibility, I recall reading here sometime in the past several months that there are some organizations with volunteers (or perhaps paid staffers) who make what I would call mental health wellness calls - kind of like visiting people who try to cheer up facility residents and bond with them to help ease the transition.

I think it might have been DaveM who posted on this, but don't recall for sure. I did a quick search and found this link for something similar - a Caregiver Corps, perhaps something like the Peace Corps. I haven't followed this legislation so I don't know whether it was passed or not.

I also don't recall if you're retired; if so are you able to spend some time with him as he adjusts to this new arrangement?

Also, can you talk to the staff to see if they can get him involved in cheer-up activities, such as music sessions?
Yes, Stepmom is in the area and visits frequently. Unfortunately, because she didn't move with dad into assisted living back in March, he's developed the delusion she's having an affair. It's not clear if her visits help, hurt, or both.
I've provided info on the Kiwanis and his Civil War roundtable to the activities director, who will follow up, as well as some other interest. I also notified our neighbor, his fellow Republican...
And still working--retirement is still quite a ways away.

Keep the conversation going (or start a new one)

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