I have a grandma with dementia and a grandpa who is old and tired who we are signing up for assisted living. The issue we are having is how to actually get them there? He is okay to go, he knows they need more help and he is ready for it. She is adamant she has nothing wrong, and we need to butt out and leave them alone at home. She doesn’t remember she has fallen at least 3 times-the last time she got a staple in her head she kept forgetting about! They barely eat, we have hidden the keys from them, etc. she has gotten so mad as a result of her dementia, and she will not hear it if we try to suggest moving. We just aren’t sure how to actually get her there? Do we trick her? Drag her? Wait until she gets even worse? She gets around pretty well which also makes it hard. They are both in their 80’s. I have POA for both my grandparents. Any advice would be great!

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It usually takes a bad fall/injury, illness and weakness, trickery and manipulation, or a combination of all. You have POA. Does it require a doctor declare her incompetent for you to be able to take over? Is it a revocable POA? If so, does she know this? Does she get up and wander during the night? Is she violent at all? How bad is her dementia? Can she be trusted at an ALF to not try to wander off and stick close to your father?

The ALF will send someone out to meet them and do a needs assessment. Probably best to trick your grandma with this, telling her it is a home health nurse sent by her doctor. They will also be required to each get a TB test, so, more trickery.

If all the paperwork and TB tests and everything else has been done and you are asking about getting her to leave the house and GO there, probably the best thing is to get them out of the house for a full day or, even better, overnight, and have someone move their bedroom suit and some clothes to the facility and take them there when it is time to go home.

A friend who was an administrator of an ALF told me that every resident there was all but DRAGGED in there kicking and screaming and throwing a fuss. It takes at least a month for the resident to calm down and start accepting the new normal.
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I had same problem with Mom. Finally I went to some ALFs and realized they are more like mini-resorts. So I re-positioned the concept in my mind and hers.

I picked a place that is like a hotel with her own small apartment and kitchenette. I decorated it with all her adorable furnishings (greatly downsized), photos, books, etc. The facility includes call pendants, private bathroom, all 3 meals in the dining room, phone, cable, wifi, housekeeping, laundry, pest control, bathing, maintenance, utilities, doctor comes to facility weekly, all labs/tests brought in-house so she doesn't have to go anywhere for basic medical services. I did the math and the $3k/mo we pay is the same as maintaining a household and getting @ 20 hours a week of caregiving. The ALF provides 24 availability of care and a turn key experience.

I think it may help starting to talk about it like a resort, with full service and people almost "waiting on you" with all the convenience of the management being responsible for all the hassles of operating a household. Use her dementia in your favor. Don't argue at all. Find the thing she hates most about keeping up a house and then keep saying the same thing over and over..."How great! Never worry about the washing machine or AC breaking! Never HAVE to grocery shop! People there IF you want to help clean etc! LAUNDRY DONE FOR YOU!" Find her hot button and keep pitching the benefits.

Then, finally, and I mean this seriously, do not take no for an answer. Organize it with your Grandfather, move the stuff in yourself... even if he has to take her on a drive out of the house for you to do it.

Then drive her there to "take a look" and leave them there. She may be mad, but she'll forget. with 3 meals, ppl, privacy, activities... she'll forget and begin to accept it.

It is a mistake to try to "make her happy". Sadly with dementia, often a negative attitude arises that is not curable by you. And what they think makes them happy (freedom) is really a portal to neglect, injury, illness. My mom fell and fractured her pelvis twice and landed in ER/Hospital with UTIs twice! Yet she denies it all. You cannot reason with a mind that cannot reason or remember. What you can do is help them to be safe and in an environment that will support them as things get worse.... then you can start having a nice relationship with them when you visit and call. They are like your child now. Would you take an angry 6 year old literally about anything? Adopt a mindset like this: You are your grandmother's mother now. Do what is right for her well being.

One thing I always tell ppl from my experience... they NEVER get better. They always get worse. Better to plan now for this reality.
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Babs75 Dec 2019
Your entire post was spot on. That is my 93 year old dad. He lived in his own home (which is not safe) and everyone involved knew he needed to move to AL. Finally in September after a hospitalization, the doctor told him he couldn't go home. We had him transported via medical transport to the AL. At this point, he does not remember his 5 day hospitalization. I had a place all picked out, as I had been shopping for one for over a year. It has been perfect for him. He has made friends, participates in activities, the bus from his church stops there every Sunday to take him to Sunday service, 24 hour nurse on staff, gets 3 meals a day, and plenty of beverages (which was a problem living on his own) but he still constantly talks about moving home. He harps and harps on it. I am his guardian and I will not do that. I tell him to call his attorney. If this ends up in court and he wins, then I walk away from the guardianship. He would never allow med management at his house. It was always a huge battle. Now he loves it at the AL. He ate horribly before, now he gets good, nutritious meals and he loves the 24 hour coffee bar. We also bring in care from his old care service that used to be at his house. They are there 3 days a week and get him to all of his appointments and keep him company. They also take him back to the house for visits but those are few and far between now (I would love to sell the house and should this end up in court and he loses, I will do so). He really has the best of both worlds. He constantly fights me but then when we are out, he worries about getting back to the AL in time for the next activity. He is very conflicted.
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I'm afraid there is probably no "nice"/easy/drama-free way to get your grandma there. If your grandpa has a place picked out I would call the administrator and ask them for advice. They've seen it all before and can probably give you the best suggestions.
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It sounds like Grandma needs Memory Care rather than Assisted Living.
At that point it is a matter of placing her in Memory Care. Grandpa can move into Assisted Living in the same facility.
No matter what move is made she will not be happy with the move. But she is no longer in a position to make decisions for her own safety.
As to how to get her there...tell her the doctor as said she needs to go to rehab until she is stronger.
This is going to be a struggle for both Grandma and Grandpa.
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Like grandma1954 said, tell her the doc prescribed rehab. There are medical transport vehicles that can bring her there.
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When you do finally get to the transfer/move in day by whatever means, first have their new Assisted Living/sleeping space all set up to mimic their previous environment so that it looks as similar and familiar as possible, that way they will settle in more easier. We did this with my FIL, and he felt comfortable in his apartment right off the bat. His was a single/open room, sitting/TV room/bedroom all in one, with small kitchen separated by a half wall, and then his own private bathroom.

It took a few days for him to get used to it. But the coffee station was right down the hallway, and dining room was nearby, all the comforts of home. Cable TV and telephone set up, and we were done. Then the obvious of clearing out all their remaining belongings, but soon for them it is out of sight, out of mind, and their world becomes very small. Most of the time they are more than happy to let you take care of what remains, although the more difficult parents will give you heck for punishing them and wish to know exactly where all their remaining belongings are. It is a difficult time for you until everything gets situated. That's for sure!
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Once you get her in there, don't put a phone in her room. The facility must provide a public phone for her to use, but don't show her where the phone is, don't write down the sequence of numbers to call out on the public phone, don't bring her address book, don't give her a phone book. If she does manage to use the public phone to call operator assistance and write down some phone numbers of lawyers and doctors--well, she's having a good day, but it probably won't last. Contact all her doctors, lawyers, other professionals, friends and relatives and neighbors, anyone she might contact to "rescue" her. Contact them all, explain the situation. Ask the professionals not to respond to her calls and letters at all. Ask the friends, neighbors, and relatives to refrain from talking about "going home." If it's a secured facility, request the facility that only you and a few trusted others are allowed to take her outside. We don't need her friends taking her to the bank!
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BBS2019 Dec 2019
Everything you say is 100% true! My mom had a phone in her memory care unit until staff recommended it be removed. Mom had difficulty knowing how to make a call and when she did, she was calling all of us at all hours inappropriately to ask where dad was (he died,) to go "home," to call the family business (where employees had to deal with the call,) and the barrage of spam calls made her anxious. She thought she had to deal with all the spam call issues. So she called us day and night about that. She did not even realize when the phone was removed. She can make a call from the nurses' station if that is "necessary" but so far, not.
If your grandma's dementia has progressed enough that she doesn't remember falling, she might not remember her home soon after she gets to assisted living. I had to retain the home care person in order to convince my mom to go, and then to help me get her settled. I didn't tell my mom she was going until 10 minutes before I put her in the car. I had already moved her things in her new room that I had sneaked out of her house one by one when she sleeping late in the mornings. She didn't even notice her favorite chair was gone from her TV room and replaced with a different chair! Also, you have the advantage that your grandpa will be with her. That should calm her. Usually someone from the facility will help you with the move. I preferred to have the home care person because my mom knew and trusted her. It's the best thing you are doing. It's just hard on everyone to have to do it, but really she might not remember her home soon enough.
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I went through similar with my Mom. So after selecting the home for her, I arranged for both of us to go to lunch there. While we were having lunch my husband and BIL moved all her things into her room there. She had a favorite blue plush bed covering and when she didn't know what room she was in her home, I always told her, where ever this quilt was it was her bedroom. So I said that when we took her to her room in the home. She seemed to recall the quilt. Did she put up a fuse for about a week? You bet! Was it the best for her and did she settle in? Yes.

When someone is at the stage Mom was, it was were I needed to make decisions for her, as I would for one of my children, when they could not make safe decisions for themselves. I had to do what ever it took to make it happen. As someone close to me said, "Remember when her mind was right she gave you full power to make decisions for her if she wasn't able to. She knew you would do the best care for her."

Remember, what you are doing for them is for their safety and out of love. Hope this helps.
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* Get MD authorization or support that she/they need to move.
* Realize there will always be 'push back,' i.e., "I'm okay, I remember, I am capable" communication. It is a way for a person losing independence (and cognitive functioning) to hold on to their independence as much as they can. Anger is a cover for fear. This is expected behavior.
* As another said, make all the arrangements (is EASIER if you have POA or MD authorization/recommendation) and don't tell her what is happening. Get them there and then deal with her behavior of fighting, anger, rage - she won't be a happy camper and expect this. If you need more support, have those or that person w/you.
* NEVER EVER argue with a person w/dementia. It is a losing battle and ONLY keeps the rage / negative emotions going, raising everyone's blood pressure.
* Is there a social worker involved?
* Be sure to get whatever mental health support / counseling you need to keep going. And, exercise and eat healthy - really helps hold 'us' care givers together and deals with our own stress.
* Expect the unexpected and be ready to respond. Instead of arguing, agree or 'reflect back to them what they (or she) says. I understand that you feel . . . let her know you hear her.
* We are there supporting you. All this is easier said than done, I know. Gena.
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