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Because dad still drives, he has been putting my mom in risky situations. He insists on taking her with him places, and then she either has an accident (she is incontinent), or she falls and breaks a bone. We finally had to put a stop to it by placing her in Memory Care. Dad is still in Assisted Living and can see her multiple times a day. But, he is very angry because the facility and I (his oldest daughter) agreed that he cannot check her out of memory care to take her places without someone accompanying them. They've been married 50 years and dad is in complete denial about mom's dementia. If he keeps yelling at his caregivers, can he be kicked out of the facility?
Also, any suggestions on how to transition a long-married couple into this new life apart?

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Has Dad been seen by a geriatric psychiatrist? That's where I would start.

Denial is a strong defense mechanism and not easily penetrated. I feel for his pain, but mom's safety has to come first.

A good psychiatrist may be able to get through, or may be able to prescribe meds for agitation and depression.
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MamaBearlyThere Jan 2023
Although I appreciate the suggestion (I really do) and it is food for thought, it has taken a village just to attend his and mom's appointments with their regular physician and pick up their prescriptions, etc. I can't imagine how I would add on visits to a psychiatrist while I continue to work full time and run my own household. I doubt that dad would agree to go anyway.
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There are so many more restrictions in memory care and he's used to
having her with him. His distress is understandable and the caregivers
must have ways to deal with him. Talk to the director of the facility
about it. I suppose he could cause enough trouble to be kicked out. To where? He apparently doesn't need memory care too or he wouldn't be driving. Does he need to be in assisted living if your mom is not there? Independent living?
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MamaBearlyThere Jan 2023
I don't think he realizes the implications of his temper tantrums. He yelled at my husband yesterday, after he took dad with him to mom's doctor's appointment. My husband wanted to say "look, if it weren't for you, mom wouldn't have a broken wrist" but he stopped himself.
I do have compassion for my dad, and I try to be gentle and patient with him, but I'm only human and it's exhausting dealing with him. I've talked to the director and the head nurse--they are trying to be patient too, and have made helpful suggestions.
I still have children at home and still need to work full-time, so as much as he may want to move in with me, I cannot stay at home to see after his needs. He is not capable of living alone safely.
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Read your contract which should stipulate the circumstances under which residents can be asked to leave ALF. Let your father know he may lose his housing. However, know that it may be his wish to join his wife in MC. I am so sorry. This is very sad. Often facilities will be very understanding so long as they are able.
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MamaBearlyThere Jan 2023
It is a very sad situation. It is hard to remain hopeful about the future.
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Wow this is a handful of a situation!

From your short description of dad's behavior, it seems like he may have some memory or cognitive issues himself. He was making reallly bad choices about you mother's safety by taking her out and not understanding the risks, even though there were bad outcomes in the past. I am wondering if he is really OK to drive?? Of course he will really be mad is he loses his car, but once you're over this hurdle, that might be your next one to deal with.

Your restriction of not letting him take mom out alone is completely necessary. If your dad can't understand that then something is going on. Unless his personality is just stubborn, etc. Anyhow, have you been able to talk to him about this? That her dementia is too advanced for him to take her out anymore? Sorry but that's the way it is dad? Maybe therapuetic fibs are in order. Blame someone else "the doctor said mom can't go out right now". Something vague and can be repeated 100 times if needed.

Have you talked to him about the inappropriateness of him yelling at the staff? Telling him that you know he's upset but he can not continue to do this. They very well might want to boot him out. I'm sure they understand the cause of this poor behavior but there will also be a limit to their patience.

I would ask the staff for a suggestion or two. One idea is that he could benefit from a small amount of something to calm him down a notch or two. Might only be needed for the short term until he gets used to this new normal.

If he is allowed in her unit, he can probably spend a pretty good amount of time with her. Life is always changing and adjusting is much harder for our elders but hopefully he'll adjust and calm down soon.

Good luck.
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MamaBearlyThere Jan 2023
My dad is very stubborn and has always been somewhat childish. He is used to being taken care of--traditionally by my mom.
I don't want him to continue driving. He can't hear or see very well, and he has lost his navigator, mom. However, his driver's license is expiring in March and he does seem resigned to give up his car. I'm holding my breath until then that he will refrain from driving as much as possible. The AL does provide some outings, and we try to drive him places as much as we can, since I and my husband both work full time.
The AL staff are trying to be understanding, and they communicate frequently with me. I visit every weekend. But I am the brunt of his anger just as much. He blames all of this on me (mom's dementia, etc.) and there's no gratitude for the sacrifices of time and energy I have had to make.
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Calming meds. Ask his doctor.

What did he do when she had an "accident" when they were out together? Why isn't he grateful that she now has care more suited to her difficulties? It doesn't seem as if he has full understanding of the problems she faces now. Or of his, for that matter.

If he continues to be unreasonable, I'd suspect he has dementia of his own. (There is no reasoning with dementia patients because their brains don't function that way anymore.)

In the meantime, maybe you could make a schedule on a calendar to show dad when you'll be there to accompany him and mom on their outings. Once a week, not more, and then he can look forward to that. I really don't think that will satisfy him, though.

I wish you luck. This is not an easy situation!
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MamaBearlyThere Jan 2023
From what I can tell, mom has had multiple "accidents" while out with dad, that is why he has a towel on the front passenger seat of his car. Since he can't take her to the restroom to clean her up, she probably has to sit in it until he takes her home. His favorite destination is the Indian casinos. He usually goes on a whim, and without letting me know. He signs out of the AL and tells them he's going to CVS. It can take up to two hours to return to the AL after she has an accident.
My father (with all due respect) has never been the brightest person. Mom was always the one in charge, and handled their money, etc. He has always deferred to her, and he simply cannot accept that she is no longer the capable person she used to be.
He still believes (even now) that he is capable of taking care of her, when for the last two years I have been taking care of everything for them (from taxes to doctor's appointments, to buying him underwear).
Thank you for your perspective. It does help.
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I too think there is some age related decline here. I understand stubborn. I understand Mom did everything. If he gets agitated then he needs a little bit of something. And I would tell the staff to be firm with him that he can not yell and scream at them.
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You say in a comment, "..... it has taken a village just to attend his and mom's appointments with their regular physician and pick up their prescriptions, etc. I can't imagine how I would add on visits to a psychiatrist while I continue to work full time and run my own household."

Why have you not arranged to have your parents' PCPs set up IN HOUSE at the ALF/MC? Same goes for their prescriptions? You are doubling down on your efforts here and overwhelming yourself for no good reason. A big part of the reason to place elders in AL is to enjoy the benefits of having the doctors/lab techs/etc come to THEM on site so you can avoid all this schlepping them back & forth. Just getting on the medication plan ALONE will save you huge headaches every month. Plus, when you use the on site doctors, they call in the folks' prescriptions and voila, they automatically show up there w/o you having to lift a finger.

I think I would have disabled dad's car before placing mom in Memory Care and separating them. No wonder dad is upset; his wife of decades is now living apart from him. Yet he's still driving, a menace to the road with issues that should keep him FROM driving. There's no 'easy' answer here, but there are easier answers than others.

Dad, in my opinion, is suffering from some level of dementia himself that he would be in such a level of denial about your mom's condition that he'd be willing to leave her sitting in soiled briefs for hours on end. That he's willing to have her fall & break bones and STILL want to take her out in the car. This reeks of extremely poor judgment which is the definition of dementia.

Yes, the AL can ask dad to leave if his behavior becomes toxic enough. Check the handbook on what their rules are for eviction. ALs are familiar with belligerent and annoying behavior, to a degree, and it often takes quite a LOT for them to ask a resident to leave, ESPECIALLY since mom is a resident in their Memory Care unit. But still; you don't want to live in fear of this happening every month either.

I'd tell dad that as of January, Medicare is requiring a full physical for him or his benefits will be cut off, including Social Security. Lie, in other words, in order to get him to the doctor for a physical AND a cognitive test to determine where he falls on the 1-30 scoring range. If he fails, then maybe you can place him with mom in Memory Care, IDK. I think it's a good idea to wait until it's absolutely mandatory for an elder to go into Memory Care, but wait to see just how LOW he scores before you make any decisions. One step at a time.

In the meantime, I'd arrange to get them set up at the AL/MC with the doctors who come in a few times a week to see their patients. You may even be able to arrange an in house visit with a geriatric psychiatrist, which would be ideal. This includes traveling labs for testing, xrays, UTIs, all sorts of things. And the medication program as well. It'll save you A LOT OF HEADACHE.

Best of luck.
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Fawnby Jan 2023
Lealonnie, how low on the 30-point scale would you consider ready for MC? Just curious.
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