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My father was living somewhat independently until a month ago but this arrangement was not safe for him due to chronic substance abuse and mental health issues. He was not paying bills on time (or at all), was paying for two different auto insurance policies for his car, frequently fell and had to call an ambulance, frequently tried to drive while intoxicated, could not remember how to turn the oven off, and ended up in the hospital twice in three months with injuries related to falls, malnutrition, and urinary tract infections. He was unable to speak clearly, walk, or remain oriented for weeks after these incidents. Two different doctors have now diagnosed him with dementia and have recommended 24/7 care/supervision. We tried in-home care and my father refused to let the people in. Following weeks of hospitalization, a SNF stay, and a stint on the psych unit of a hospital, my father is completely detoxed and his medication is regulated properly, so he is once again ambulatory and mostly lucid. My father is extremely intelligent and well educated and can carry on lengthy conversations about a range of topics. He is desperately unhappy in his current living situation (a memory care unit) and it is true that there is no other resident at the facility he can discuss politics, books, etc. with. He is a flight risk and would immediately leave any less restrictive setting in order to resume drinking, which would quickly result in this entire process starting over again. My siblings and I are at a complete loss as to what to do with him. With regard to his current cognitive/social functioning, he should be in an assisted living facility with other well educated, outgoing adults -- but he would quickly begin to drink again and his mental, physical, and emotional health would deteriorate rapidly, resulting in yet another hospitalization. . .

By the way, I suggest the book "Being Mortal" by Atul Gawande, for some insights about what makes life worth living near its end.
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Has he ever been this fully detoxed and lucid? Did he "escape" at that time? Do you really have an experienced basis for predicting what he will do?

You are using Memory Care as a jail sentence to keep him from drinking. "Flight risk" is a term from the criminal system. While the doctors may be right that he needs care and supervision to remain safe, not everyone with dementia needs memory care.

I would be inclined to let him try the more appropriate setting of assisted living. MAYBE he would quickly begin to drink again. Then he would need to be hospitalized, as you say. Would that really be so much worse than being locked up with people he cannot really communicate with? And POSSIBLY with the new meds he'd not quickly revert to old behaviors.

If he were my father, I'd take the chance.
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Would he revert quickly, having proper nutrition, meds on time and good socializing might keep him from needing to dull his wits.

Being in memory care when you don't need it other than for behavioral control would be hell for anyone. If he is mentally competent he does have the right to self destruct, just as you have the right to say you won't be bailing him out again.

Just a thought.
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