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My grandmother is currently in a rehab facility following a hospital stay. Until now, she has been living at home. She has dementia, limited mobility and BP issues that cause lightheaded-ness. This combination has led to her having several falls, fortunately so far without major injury. Her dementia and mobility have both recently diminished to the point where we no longer feel we can keep her safe at home. So we are planning to have her transition either into assisted living or a nursing home after the rehab. The core question I'm struggling with is of course how to break it to her that she can't go back home. Should we just make a clean break or should we plan to allow her a temporary farewell stay in her home before her move?

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when my dad was diagnosed with Alzheimers and Parkinsons and had to be placed in NH I went and took pictures of the home inside and out printed them out and put them inside a Photo book of memories along with other photos and wrote descriptions of how christmas was at home, etc
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From my view point .... NO!!! Here are 2 good reasons why.

1. If you had a hard time actually getting them into residential care, do you REALLY want to relive that drama when it is time to go back and they throw a "mother of all colossal fits" in order to stay home.

2. If the house was not exactly as it was the moment they left, it will become a THING or an obsession.

In my father's case, he has the most nasty, smelly, gross Archie Bunker sofa and chair that needed to go. One of my brothers brought him home after much whining and guilting....and the stuff hit the fan because a family member moved into the house and put their own furniture in part of it.

The loss of the scruffy couch has become a full blown OBSESSION, and I am sure that house will be haunted looking for that couch that now is nowhere to be found. There is a lot of mileage to any visitor to please, please, make sure my kids put my couch back where it belongs.

Clean break advice is the best.
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When we placed Mom in memory care, she kept asking to go back to her house. We kept putting her off because we were advised by the MC director that taking Mom back to the house (which we were emptying and putting up for sale) would inhibit Mom settling in at MC. Well, in a years' time Mom has yet to settle into MC. All the same, I don't think taking Mom back to the house would have helpful. My experience with Mom's memory is like this: every time anything with a negative association is referenced, either by Mom or people she talks to, it's something that sticks in her mind. It's sort of like a child, whom you don't want to remind of something they want but can't have, so as not to "stir them up." Wish it worked the same with positive stuff like something pleasant we did with Mom, a gift, a happy day, etc. She forgets all the good stuff and only remembers the bad. Sheesh.
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I think that I'd let the doctor or the social worker be the one that tells her. Then you can blame it on them. 

Do you have her medical POA? If so, then it is your responsibility to see that she goes to where she is going to get the best care. If you don't have medical POA, then who does?

Also, where are her own adult children like your mom or dad? What are their thoughts and feelings? Why have they left all of this on you? 

This is your and her best chance to get her the 24 hour care she needs by people working in three 8 hour shifts who get to go home.  

Otherwise, you will have to try to do 24/7 care by yourself until she has a medical emergency like a fall and ends up in the hospital at which point her dementia would be worse.

I don't think that a short visit to say good bye would be a good idea for she would keep asking to stay longer.
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With my mom, we made a clean break. I think this is much better. Moved all her furniture and favorite things into the ALF all in one day. She adjusted very quickly and enjoyed it there.
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I think even the other family member's opinions should be weighed -- and also "depends."

My mother was terrorized by my sister and a niece (daughter of my deceased brother), who both claimed to be wanting the best for my mother. My mother and I had a workable plan in place, that insured my mother's happiness to the greatest extent possible. It turned out the other "family members" didn't want to be "stuck" with having to help (they didn't "have to" since my mother had enough money to hire help). Getting people to be forthcoming with their real (and underlying) thinking is NOT easy and usually requires some work.

So, again -- "it depends" is the only honest answer.
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I certainly agree that 'it depends' is almost always going to be the right response. But from the off, this OP has explained the dementia and the falls and stated that the caree's family has already concluded that she can't be looked after any more at home; it sounds as if they've given it their best for some time.

Once dementia is active in the picture, there's also the point about how much longer to wait; and that - if it's a racing certainty that the person will eventually have to be in memory care sometime - then her best chance of settling in well to a facility and forming meaningful relationships with the staff depends on moving in there as a functioning human being, with a personality and interests, rather than as a parcel of needs in a wheelchair.

Really good memory care facilities will respect all their residents as people, that's best practice; but it's so much easier to see them as people if you get to know them before they've completely vanished.
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IMO the answer is "it depends." It depends on how much loss of memory and lucidity there is, how independent she was and is still capable of being, etc.

The word "safe" can be cruel, and even that word depends - safe from what would be the question. Safe from life is cruel IMO. Plus, there is really no such thing as "safe," anyway, since people in nursing homes and "memory care" centers can and do fall and get injured. If they are made to be in a wheel chair (for their safety, of course), they can and do try to get out and fall in that process (I've seen that more than once).

None of the responses here have even mentioned help at the affected person's home. That would have to be in my list of considerations.

But, first and foremost, I would take the "happiness" of the "subject" into consideration. If my grandmother still recognized me and other family members, it would be my opinion that she still had enough of her mental faculties to say what would make her happy - and I believe her "happiness" should be the first consideration - unless her brain function is so far gone that nothing makes her happy any longer, in which case everybody else's responses here would be at least okay.
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IMHO, don't take her back to say "bye, bye" to her house and here's why--
#1 She's never going to want to leave the house.
#2 She's going to be talking about "her house, her house, her house"-there's never going to be an end to it.
#3 To what purpose does it serve to make this elder sad?
#4 Perhaps she's not even lucid enough to know that it's her house.
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Dear Friend,

You are very considerate granddaughter. This is a hard one. When my grandmother was admitted to hospital. My aunts used this opportunity to move her to a nursing home. My grandmother asked to go home, but no one would support her in this decision. She is not even allowed to visit! I guess it depends if your grandmother asks to visit. I normally try to do what others want and given her age, this might be the respectful thing to do.
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I went through the same with my then 85 yr old mother. After 2 weeks in the hospital for a dislocated shoulder & broken arm from a fall in her home, she went to Rehab for another 3 weeks. During that time I secured an apartment in a senior building which has assisted living amenities but mostly independent living. It was a very difficult decision but one I had to make. The rehab facility caseworker needed to know if she was going back to her home which by the way was very unsafe due to stairs (kitchen on first fl & bedroom and bathroom on 2nd). The day she was discharged we drove straight to the senior apartment. She cried to go to her house. We moved what furniture she needed from her home to apt hoping to make it as familiar as possible. I stayed with her 24/7 that first week. I told her the doctor wants her to get stronger and stay in this one level apt before transferring back home. She cried all week. I 2nd guessed my decision many, many times. I asked her if she trusted me to take good care of her and she said she did. That was the turning point. Fast forward going on 3 years and she loves her new apt. We sold her home and she'a enjoying everyday in a clean, safe & healthier environment. My life has changed much due to being one of her caregivers but if I had to do it over I wouldn't change a thing. Tough at first? Absolutely!! Is it perfect now? Not really. But we do the best we can and pray for strength to keep going. All the best to you and your grandmother.
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After quickly moving mom in with me after a cataract surgery (something she never wanted and fought me on for a few years) and because of her dementia, I learned to change the subject when she would talk almost daily about going "home," that or ignore the comment since she would say it so often when sundowning. When out and about, we'd actually drive into her old neighborhood and passed her house many times, with mom looking out the car window and not even recognizing anything. This house had been one she and dad purchased after we kids had gone, obviously apparently "home" to her, but it sold very quickly with no time and surely no reason to prolong her agony by doing a last walk-through. I wasn't trying to be cruel, just did not see the point, since the whole Alzheimer business frankly has been nothing but a damn downer for all of us since 2003. You make them comfortable as much as possible where they are. Mom's now in memory care and has adjusted to their routine and seems actually more contented than when she lived with me.
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How old is grandma, how bad is her dementia? Does she have any concept of time? My 93 year old mother lived with me for 2 years. During that time period she believed she was "just visiting". She would tell people she just got here.

This is difficult, telling the truth is different with someone with dementia. It could upset them to the point that the will get extremely agitated and confused.

Get some guidance on this from a dementia expert. When I moved my mom and then sold her house, I was told NOT to take her to her house again. I am so glad I didn't. Mom never accepted her Alzheimer's diagnosis. In her mind, she is fine. When she went to adult day care - she worked there. Now she lives in a memory care center and she has no clue she lives in an a assisted living community. There brain doesn't reason like a normal brain anymore.

Saying goodbye to her home, which she never will return to, I think would be too painful for her. If I did that with my mom, I think she would have refused to leave. Transitioning her from rehab, will be so much easier.

Once she transitions to her new home, she may even forget her current home. My mom has been in memory care for 6 months now. She has no recollection of living with me, sometimes I am her sister and sometimes I am her daughter. She asks about her siblings and parents that have been dead for decades and never speaks of the home she lived in for over 60 years. It is sad, but you can take comfort in that she will continue to lose her memories and will no longer remember the home she lived in.

This may seem selfish but do what is easier for you too, which would be the transition from rehab.
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Three years ago, I went through the exact same thing with my grandmother. Your story, word for word, is a near carbon copy of what we faced as a family. Gram had mild to moderate Alzheimer's at that point, was in her early 90s and was adamant that she would not be leaving home (yet out came the argument, on a daily basis in, fact, that she would also not be allowing 'strangers' in the door). Suffice to say, it was home care or assisted living, and she had the means to pay for long-term care so we let her decide. Unfortunately, she never remembered to use her walker at home, became light headed constantly (from medication) and dysphasia became an issue. She was a serious fall risk and in and out of the ER constantly -- so much so that county services came in and questioned whether gram was receiving adequate care at home and warned us they could step in and appoint a legal guardian if they believed her welfare was in question. (someone from the family was there every day, and her caregivers were wonderful ... but she always tried to run, rather than walk, bruised very easily, did crazy things like try to stand on chairs or tables when you turned your back, etc.) Gram eventually hurt her leg/hip and was moved from the hospital to rehab, on the lower level of an assisted living facility. Ultimately, the plan was to move her upstairs as her dementia had gotten worse, and yet we as a family did a terrible thing by trying to allow her, at that point, to have a say in her care going forward. Gram, as always, insisted on going home. We felt awful for even considering that we would not honor her wishes, even though she was no longer capable of making the best decision that would keep her safe. Needless to say, this was a vicious cycle. Home. Hospital. Rehab. Discharge. Home. Hospital. Rehab. Assisted Living. Discharge. Home. Hospital. Round and round we went until it was perfectly clear we had been making the wrong decisions all along.
I know it's horrible to hear your loved one cry, "I want to go home." But please ask yourself if your grandmother is in a state where she is cognizant and aware of her condition. Is she mentally and physically capable of assisting in her own care? If the answer is no to any of those questions, you must do what is right for your gram and make sure you find a reputable, clean, and well staffed facility for a long-term stay. Please make sure they have a secure memory unit with staff equipped to help a person with dementia.
If your gram asks about home, I firmly believe the best thing to do is redirect, keep her calm and help her let go of the idea and move on to something else. Arguing with her or trying to reason will only make her more insistent, agitated, and distressed (as it did my gram. We learned the hard way). I would not advise you to go for a car ride past the house, walk her by the house or allow her to return to the home for even a day or two. Getting her to leave again will be extremely hard, and you may be more shocked to find her version of 'home' after she's returned isn't the home she was talking about all along. Best of luck. My thoughts are with you, your family and grandmother as you deal with this.
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It all depends on how much your grandmother understands and remembers. I often think that avoiding the subject and not giving someone a straight answer when asked directly is unnecessarily cruel. The elder who is not as demented as people think feels that they're being gas-lighted.

When my mom moved to a nursing home, never to return to her home, I was honest about it, but very very gently. I told her that I'd found her another place to live, that it was a "retirement community," that it was closer to me and I'd be able to see her every day (both true). I told her she would never have to be alone again (she feared being alone). I told her there would be nurses and other workers there to help her 24 hours a day. I also told her if she really hated it, she could leave. This is also true. I neglected to mention that the move would be to a different facility instead of home. She never asked to leave. One thing that helped was doing A LOT of research beforehand. I contacted 22 nursing homes in my area and tour 17, many of them 2 to 3 times. I applied to the 4 that were acceptable to me and she was accepted by 1. Comparably, it's a nice facility and making a careful choice in the first place will help you if you have any doubts about your decision. My mom has a private room, which is a plus, and we visit often. We've made her room nice with her own hamper, colorful comforter, lamp, vase of fake flowers, and (very important) a clock with the time, date, and day of the week. But I digress....

I feel firmly that you should give her a version of the truth she can handle. Be as honest as possible, as gently as possible. You would want someone to do that for you.

As for taking her to say goodbye to her house, if that's coupled with news of a sale or someone else moving in, I think that may be unnecessarily cruel. Love is your guide. You will know what she can handle.
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Sham. My Mom was in the exact situation as your GM. After rehab, we just moved her to a memory care facility where we had already set up her room with many of her own things. We told her (enroute) the doctor wanted her to have more time to get better. We told her we had a found a wonderful place for that and there were gardens, etc.
I know we were very lucky but she actually never asked when she was going home. And, when she did mention home it was her childhood home. Keep in mind, the dementia prevents your grandmothe from thinking clearly so family has to make things as easy as possible for her.
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Mmmmm...

When it became certain that my 96 year old great aunt would not be able to return to her home, we still kept up the fiction that she was going to residential care to convalesce - helpful that in the olden days, when she was a gal, nursing homes often were called convalescent homes - and that story never had to change. We kept her apartment ticking over; and as a matter of fact had she ever wanted to go and see it we'd have been happy to take her. But not many people are as stoical and blithe in their outlook as darling auntie was, may her memory be for a blessing...

Anyway. If you are becoming concerned that your mother is in for a nasty shock at the end of rehab, you'd better start gently preparing her. Don't tell her what's happening: instead, ask her questions. Such as "suppose we thought about getting you better first, giving you more time to build your strength up - how would you feel about trying that?" or "What has the doctor said about your being able to go home? There's still quite a lot to think about, you know." So that you're working round to a "not yet" rather than a flat "no." And for heaven's sake don't get into an argument about it! We'll see, or let's see, or one thing at a time, or maybe, or even we'll do our best - these are all useful responses to keep in mind.
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Thanks for the answers so far! I'm new here and it's nice to see there are people so willing to help!

She is in fact mentioning home. Whenever I talk to her or visit her at rehab she says she wants to go home. So far I have danced around the issue and avoided saying things like "you have to do your best at PT so you can go home!".

I believe that when she says she wants to go home, she is indeed talking about her current residence, not childhood home, etc.

The amount of time remaining in rehab depends on her progress and participation. Something like 10-20 days.

I don't really think she's looking ahead at the plan per se. In her mind there is only one possible plan: going home!
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Well.

Either your grandmother is looking ahead and asking what the plan is, in which case she has a right to be involved in the discussion and to express a view of her own;

Or she isn't, in which case you go ahead and develop a care plan in consultation with her health care team and decide on her behalf what options overall would be least upsetting for her (including whether or not to raise the subject of her home - I personally would vote 'no' unless she herself brings it up).

How much more time to do you have to work with before she needs to move on from rehab?
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First thing, is Grandmother asking to see her house?   If not, then don't mention it, don't take her to see the house.

Some have found taking their love one back to see the house one more time created a terrible problem.... the elder refused to leave the house to get back into the car.

If Grandmother is asking to go "home", you need to quiz her to find out which home is she talking about.   For my Mom, I thought it was the house that she and Dad had sheared for many decades.... turned it it was her childhood home from the late 1900-1920's that she wanted to go back and see.

At Assisted Living bring items from her home, hang up pictures that she always likes.   For my Dad, his prize possessions where hundreds of books, so we brought that along with all the bookcases which thankfully fitted.
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