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My 95 year old FIL has been in assisted living for 3 years. We have been extremely happy with the care he has received there and feel very comfortable with the staff. It is the best facility we found in our search, is only a mile from our home, and the staff is more engaged with residents than at any of the other places we visited. My husband and I are there several times per week, so observe what is going on personally.

My FIL has some dementia, has been wandering at night, been more agitated, and had several falls recently in his room. He won't or forgets to use his walker in his room, and is very unsteady, bad knees, etc. He also hallucinates at times, and that has also escalated recently. Recently, he has been insisting that a staff member shoved him, and that they "don't like him". He also said someone threw him out of the back of a pickup, accused paramedics of abusing him on his last run to the ER, and accused his nurses in the hospital of roughing him up. He has been complaining fairly consistently about the staff member shoving him, and telling other people at the facility, etc. Yet he expressed no hesitation in wanting to leave the hospital and go back to assisted living (I know, I'm expecting this to make sense and shouldn't be).

Given all of that, we really don't believe there is any abuse going on at Assisted Living. But there is still that niggling "what if it's true?", in addition to how can we settle him down assuming it isn't? To further complicate things, my FIL has exposed his ugly prejudice more and more, and the staff member he is accusing is African American on the night staff. Any thoughts on how to deal with this would be appreciated. We are also concerned that he may not be able to stay in assisted living if he continues to act this way, disturb other residents at night, etc.

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Thank you pamstegman! I'm afraid you are right, and appreciate the encouragement and truth you offer.
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Work towards getting the memory care bed, because pops is on a downhill slide. You are wise to be working with the nurses and seek proper meds to hold the line for now. You are on the right track.
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Thank you Jeannegibbs! Your advice resonates with me on many levels. You are absolutely right that the staff handles it exceptionally well...better than we do :). They have upped his level of care to try to keep him in assisted living, but as with all things, it may not last and we need to be prepared for the next stage. He has had other declines in mental status, and sometimes bounces back to a better level for a while. But this time he has not so far. They do have a memory care unit at his facility, and the lead nurse there is a wonderful lady, so we would hope there will be room there. There are also other facilities in the area. We are in close communication with his doctor(s). I take him to all appointments, etc. And after the most recent hospital stay, he is on some new meds to try and get to dampen his agitation and hopefully minimize the wandering. Takes a while for those to build up, so time will tell. As you said, we just have to be flexible, and as prepared as we can be. Maybe just needed that reminder and the serenity prayer, so thank you :).
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Squirt, your FIL is not the first dementia patient this ALF has worked with, and they seem to be handling the situation well.

It seems to me that the bottom line is that FIL's dementia is progressing. That is not his fault, nor the fault of the ALF or any one staff member. It is just what dementia does. My first reaction is to consult with FIL's doctor. (If he doesn't have an experienced geriatrician or a dementia specialist, maybe it is time to get one.) FIL is now showing signs of paranoia, wild accusations, increased hallucinations, and wandering. It is possible that treatment for anxiety may be helpful, or that the doctor may have some suggestions for treating these symptoms.

Many ALFs will do their best to deal with dementia, especially for a long-term resident. But they are often simply not equipped to deal with advanced symptoms. For example, usually residents who start wandering need to be in a secure facility for their own protection.

It is good that you are working closely with management. Have a frank conversation about what their limits are -- that is, what dementia behaviors they are not prepared to handle. Does this facility have a dementia care unit?

You are absolutely correct that reasoning with FIL or trying to talk him into better behavior is useless. Dementia destroys inhibitions and telling him to keep his racial opinions to himself is not going to work.

Try to get some medical help. Other than that, things will just have to go along pretty much as they are. If they get worse (and they probably will) I'm afraid you are right that this is no longer a suitable environment for FIL. Be grateful that he has had three good years there. Be hopeful that he can continue to stay. But start preparing for the possibility of a need for a more secure environment.
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Thanks Countrymouse! Yes, he fell and was bruised extensively badly but nothing broken....staff called paramedics and us and he went to the ER. He also fell again later the same week and hit his head, another ambulance to the ER and hospital stay for a few days (cardiac enzymes off). I've never personally heard him use a racial slur to a staff member, but he has expressed his prejudice to my husband. So I think it is very possible that he could go off verbally when he is agitated. When he is in a state like that, there really is no reasoning with him, and even if we had a talk with him and he got it at the time, it would not stick. We are in close communication with the management there, and they know that we don't believe him, but it is still distressing to my husband to have his dad telling him people are "beating him up". The staff seems to handle it much better than I would, but I'm sure it's upsetting to them and other residents that he is telling others that. We are just trying to think though options that will hopefully allow him to stay in assisted living. At times he is quite "with it", and others not so much.
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Youch. You're exposing my ugly prejudice too; not because I imagine for a second that an African American night staff member is a problem, but because my thoughts went instantly to "but if he was provoked by racial slurs from the FIL..?"

I understand the delicacy. There are two ways you could go.

1. Ignore the colour issue, proceed as you would do if all members of staff were bright turquoise; perhaps seek an interview with your FIL's unit manager to discuss your FIL's allegations and make sure that nobody has any remaining concerns that there is anything untoward going on.

2. If you are aware that your FIL has been saying racially offensive things to staff members, perhaps you could have a conversation about how the facility supports its staff on that issue, and whether they have any recommendations for curbing his outbursts as well as his wandering.

The trouble is, if you have both of these conversations, and then follow them through to their logical conclusion, you're more or less saying that you believe your FIL's allegation that he was pushed by this staff member. So it'll have to be one or the other. Perhaps followed up by a nanny-cam?

Btw, I'm assuming that no harm came to your FIL as a result of the alleged shoving incident itself, is that correct? In which case, ***IF*** it happened at all it was probably a one-off reaction; and the introduction of surveillance would make sure it didn't happen again.
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