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Dad, 87, was put into a nursing home early this year to rehab a foot heel burn that took a very long time heal [diabetic]. Now the foot is better but his brain and legs don't 'connect' any longer and, as the nurses put it - he refuses to even attempt to walk. [He had had 3 prior instances at home where he either fell to the floor or sat on the floor - and could not get his legs or feet under him to stand or crawl - for hours and with help from us, EMTs, etc!.] Between his diminishing mental capacity and inability to physically care for himself, he is now a permanent resident at the nursing home.

Mom, 86, cannot physically or mentally deal with him any longer. When she goes to visit now, he wants her to take him home so he can 'help her around the house'. He is loudly showing anger that she is going to leave him 'here to die'. It is hard for her to return to see him again.

He says he can walk, but he won't - and we understand this is part of his dementia. How do we respond to him? Is there a way to make him understand? How do we help Mom through this?

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It is tough, but the demands to go home may stop. I have seen some patients who insist they are going home every day, but others stop and seem to accept they are at their home. This could eventually happen with your dad. Also, keep in mind that you never really know what home he may be wanting to go to.

I have a friend who took her insistent mom home for a weekend visit. Only her mom failed to recognize her home and insisted she was at a hotel. Upon her return to the nursing home she told them her daughter was now living in a hotel and she never asked to go home with her again.
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Your dad can't reason because of the dementia. Trying to reason with him must be very frustrating for him and for you. When our loved ones have dementia it's tricky because they look like our parent and sound like our parent but their brain is being damaged by the dementia which affects the personality. We expect them to act just like our parent but they can't do that any longer because of the dementia.

I agree with what sunflo said. Tell your dad that he has to become more mobile before he comes home. The physical therapist said that he has to be able to walk on his own if he is to go home. This takes the blame off of you and your mom and puts some control back in your dad's life. You know he'll never be able to get up and walk again but he doesn't know that.

And support your mom. If you think she's visiting your dad too often tell her it's ok to miss a day or two. If you think she stays too long while your dad berates her tell her it's ok if she doesn't stay long. Just be there for her. On days you know she's going to visit call her later and see how it went.
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Your poor mother. Your poor Dad! Poor you!!!

This is really hard. His conviction that he could walk if he chose to is an absolute classic - making some kind of sense of his changing world, poor man. I love how he plans to help out with the chores… Responses to him: don't contradict or try to explain, go along with his belief. E.g. "well, perhaps when you're feeling better we could go down the corridor and get a coffee, Dad."

Is the NH providing any physical therapy to improve his mobility? With care and the right assistive devices would it be possible for him to walk? I hope they haven't given up on him completely.

It is so, so hard on your mother to have to hear harsh words from him when she leaves him behind. I think the first thing you should do is provide constant reassurance that she has NO choice about where he lives and that he is in the best environment, whatever he says to her. That she is not leaving him to die, she is not abandoning him, and she is continuing to care for him.

Is anyone able to accompany her on visits to the NH? It would make her journey home easier on her mind, if so.

I think she would feel worse if she stopped going, otherwise I'd suggest giving it a miss for the time being. But until he adjusts to the NH (and, to be a bit brutal about it, becomes too frail to be angry any more) this is going to be rough on her. Enlist the staff's help with settling him when she's ready to leave. Keep visits short, sweet and purposeful. She doesn't need to go every day, but should establish a routine that suits her, and feel free to change things around until she finds what works best.

And if, on a given day, she really can't face it… well, then, don't go. But beware the one-off becoming a habit. I'd be the last person to judge her if she never went near him again, but I believe she'd do it to herself. What she's aiming for is to have nothing to regret.

How is she in herself, by the way? Is she managing all right on her own?
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Wow. This is so tough for you and especially for your mom. My heart aches for both of you having to go through this. First, keep an open dialog with the NH care team to enlist their help in working with him and reinforcing that he "can't go home until he can walk around the hall 10 times without falling", etc. This is the little white lie that motivates him (maybe) but puts the burden back on him to help himself and take the "blaming" off you and mom.

Its hard to make a dementia patient comprehend their situation no matter how much you try to reason -- it WILL TAKE A LOT OF PATIENCE...so steel yourself (make sure you are rested and in a good mental place) when you visit or talk to dad. Whenever he gets belligerent...just state "Dad, we can't wait for you to come home but the dr says you have to be able to walk and get around easily before he will release you home"....then quickly redirect dad and take him outside for a walk; plan little picnics where you bring some homemade chicken or spaghetti or treats (whatever his favorites are from mom's cooking) and continue with that. When the belligerency starts up; just calmly tell dad you and/or mom have to go and "we'll see you Tuesday" or whatever.

This is very hard; but this would be my approach for now. Later, when he is more bedridden and memory impaired you can tell him "you're home now; this is your home". You can do other things, like decorate room maybe with his favorite paintings or pictures across from the bed so he can see them, his favorite chair, rug, lamp; a bedspread or blanket from home -- to make it look more like a room he would recognize from home.

I'm not in your shoes; but this would be my approach. Also, consider cutting your visits shorter or a little less often if mom and you need so that you can adjust mentally to this hard time and be "at your best" when you visit dad.

Take care.
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