How do you balance your dad's wishes to stay at home versus his safety at assisted living?

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I moved my Dad (who just turned 90) to an assisted living facility four months ago because his memory problems are to the point where his doctors, our family, and I don’t think that it’s safe for him to live alone in his house any longer. He has not “adjusted” as the facility staff said he would; instead he is becoming more depressed.


I’m his only child; I moved to another state right after school because that’s where my career took me. We both lost our wives at about the same time ten years ago. I don’t have kids, so both of us live alone, 500 miles apart.


Dad had a mild stroke two years ago. He fully recovered physically, but he started having memory problems shortly thereafter. Last year he was diagnosed with vascular dementia. I started paying his bills and convinced him to stop driving. Up until this spring, he had no problems living by himself (with some help from his neighbors and family who live nearby). He sometimes gets confused about where he is, and the neighbors told me that on two occasions he was out wandering around the neighborhood in the middle of the night. They got him home safely, but it is still frightening. Dad doesn’t remember any of this. I used technology to the extent possible to support him at home (set alarms to remind him to take medicines, monitor the pill box, monitor his movements throughout the house to detect falls, etc).


His memory has degraded to the point where he forgets that he’s on medication. The neighbors suspect that he only eats when they bring him food each evening. This resulted in him being hospitalized for a week this past May because of high blood pressure and dehydration. He could barely walk when he was in the hospital. When he was strong enough to be discharged, the doctors said it was no longer safe for him to live alone and recommended that he move to assisted living. He refused at first; to get him to agree, the medical staff at the hospital told him that it was only for rehabilitation so he could recover his strength. I signed him into a facility near his house where he has stayed for the past four months.


I visited two weeks ago to pick him up for our fall fishing trip. Because of the care he received at the facility over the past few months, he is much stronger. He had no problem walking a quarter of a mile to the dock or climbing stairs at the ball park. He still likes housekeeping—he cleans up the kitchen, made his bed, and cleaned the cabin where we stayed on our fishing trip.


He did not want to go back to the assisted living facility. His neighbors and I had hoped that he would adapt to his new community, join activities, and make new friends. It’s been four months now and it’s not happening. Dad says he likes the people there, but he misses his tools and home projects. He does not believe the “rehabilitation” story anymore. Every time his friends or I stop by to visit he wants to know if he is going home. He says that he should have the right to decide where he lives.


I’m certain that if he leaves assisted living and I leave him alone in his house, he will wind up in the hospital again, or worse. I want him to move in with me, but he doesn’t want to move out of his house and give up the frequent contact he now has with his friends and remaining family. I can’t move in with him because I’m not in a position where I can fully retire. I quit working full-time right after his stroke and took a consulting position where I can work remotely some of the time. This allows me to visit him one week a month. He won’t let me hire people to come to his house because he is determined that he can live by himself. He’s really upset that I’m spending money on assisted living that he says is “unnecessary and unwanted”.


We’re planning another trip when I visit him next week. I’m not sure that he will get in the car when it’s time for him to go back to the assisted living facility. I am heartbroken that I can’t do more to help him. He’s a “Greatest Generation” father—WWII veteran, mentor, and best friend. I want his remaining years to be as happy and comfortable as possible for him; I’m trying to balance that against concern for his safety.


I read “Being Mortal”, a very good book on this issue by Dr. Atul Gawande. It helped me understand the medical community’s point of view. Dad’s doctor says the enforcement mechanism they use to ensure patient safety is the state’s Adult Protective Services, but he said they are only called for extreme cases.


I’m considering letting him come home and take the risk, although I would still hire people to visit him for at least a few hours each day to make sure he eats and takes medicine. I’m worried about the wandering though, but it has only happened twice.


I would appreciate hearing how anyone else has solved a similar dilemma.


Thanks for reading this long post.

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Thanks to everyone for so many thoughtful, comprehensive, and sympathetic responses. I really appreciate the advice and encouragement. You guys are wonderful!

I understand that vascular dementia, while it doesn't get better, can be stable for long periods, so he could be this way for a while. On his good days, he appears to have no problems at all. It's hard to tell someone who just cleaned out the kitchen, did a load of laundry, and took out the trash (climbing a flight of stairs in the process) that they have to go back to assisted living.

Dad thinks that because he can still take care of a house, he can take care of himself. I told him if that were true then he wouldn't have wound up in the hospital. He tells me "it won't happen again", but I don't believe it.

Your responses reinforce my thinking that his wandering is the most critical risk. The AL facility is designed to prevent this and they do a great job. I'm probably going to keep him there, but I'm also going to do more to get him busy with something.

Thanks again for all your kind responses.
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Linkabit, you already know the answer that is best for your father. His health and safety had become an issue when he lived alone. Now that he is being cared for properly, he seems to be thriving again. This is causing you to second guess your decision to move him to AL, when it really should be reinforcing your resolve. It sounds as though you are doing an excellent job of honoring your Dad's wishes as best you can. It's a delicate balance: you have to consider his emotional well-being as well as his physical well-being. Unfortunately with dementia, your Dad will need more and more assistance as the months go by. You have already made the most difficult transition by moving him to AL. It seems less disruptive, to me, to have him continue living there, than moving him home and then back to AL after the next medical/physical crisis occurs. And it will occur. It has taken my in-laws over a year to finally adjust to their "big move." Your Dad may need longer than 4 months.

My heart goes out to you! My husband is also an only child. In some ways, it's hard for him not having a sibling to confer with. But in many ways, it's very nice not to have anyone to argue about decisions with. I know this wasn't part of your original question, so please forgive the unsolicited advice. Do seriously consider moving your Dad closer to you. My husband's parents lived a few states away and had friends, neighbors, and cousins whom they relied upon heavily to support their independence. But when the crises came, it was my husband who had to take time off from work and travel to take care of things. He was quickly running out of vacation days, and his time away was putting a strain on our family, as we still had six kids at home at the time. Their doctors and hospital social workers finally convinced all of them that they needed to move closer to us. It was sad that they had to leave the home they loved, but they like their new home, especially because it means they get to stay together and out of a facility (for now).
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I wouldn't move dad back home, even though I understand it's a tough choice. Is there any way to get him involved with tools and projects while he's still in assisted living? Do they have any activities he could join that would be helpful to others? is there a senior center nearby that he could go to where they might have some projects he could help with? For example, our town has a senior center with a wood shop and they make all kinds of things. It sounds like he still needs some kind of purpose or project. Could he help any old friends with their stuff? I'd work on trying to find some way to give him some activities/focus where he lives now.

The sad reality is he's only going to get worse and at 90, that timeline may be short. This unhappiness phase that he's in now may last a few months and it wouldn't be worth it to move him back home and have his health decline so quickly that you're worse off than where you started. As our parents age, the choice moves from happiness to one of safety. Your dad is safe now and well cared for, from what you say. Don't put him back into a dangerous situation just to make him happy. With dementia, it's like parenting a 2-year old child. The child would choose happiness over safety, but as a loving parent, you do what's right for your child and the first consideration is safety.
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Despite my misgivings I'm not going to tell you not to do it, but you need to set some conditions in place before you even consider it. You already know that his health was in jeopardy when he lived on his own, so he MUST allow outside caregivers into his home, preferably EVERY DAY.
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Oh, I missed that he had wandered... in that case he has definitely reached a stage where he can not be trusted to manage without 24/7 supervision.
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It is a very tough decision. I believe that safety comes first. Dad probably does probably not appreciate that his safety is at risk. Someone made the comment that dementia is progressive and, at times, quickly. And you never know when. It would be lovely for him to be able to be at home with the needed help. The biggest obstacle, of many, that I see to that is his wandering, His dr has said he cannot live alone any more. That would be enough for me. 
Adjusting to the limitations of old age is not easy and made more difficult by a compromised brain. We all face those adjustments as we grow older. If your dad did not have dementia, and a friend of his was in his position, what would dad recommend?
Finding some activities with tools or such would be good for him . I am 80 and miss doing some of the things I used to be able to do, but recognize that that is life and look for compromises and for things to do within my limitations. He has lost the ability to properly evaluate his situation and to make alternative choices.  You are doing a great job of caring for him!
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I would move him home with conditions. Tell him he has to make it ok for you as well as for him. Installing cameras is one of the best things I ever did as it allows me to check on my aunt at anytime. I wish I had done that long ago. My aunt does not wander and it would bother me if she did but I worry about her falling. She also has a medi alert that goes off should she fall.
Her doctor ordered Home Health for her at my request. They come in once a week and take her vitals and are available for wound care, etc as needed. (So dad's dehydration, etc might have been caught sooner if you were connected with a home nurse). She also has an aid through them that allows her to have two baths a week and her linens changed.
Next I added a morning aid to come in and assist with the medication. This was after not taking thyroid meds correctly led to secondary problems. While the aid is there, she reminds aunt to change her clothes, brush her teeth, etc. and makes her a hot breakfast that always includes eggs. So she is well nourished. In addition she gets rehab to help with her balance.
Next because I realized I was getting worn out with the weekly trips I hired a couple (aunts great nephew and his wife) to take over buying her groceries, making her food and snacks, picking up meds from pharmacy, filling med box and various and sundry things that I kept putting off due to being stretched too thin. They also manage the morning aids. This allows me to come in and actually have time to enjoy my aunt instead of thinking I have to do everything each week. I pay them for one hour of work per day. Sometimes they do more, sometimes they do less. It works out. They live near by and can get to her home in minutes. The added benefit is they include their daughter and new baby in evening meals a couple times a week and aunt is at the heart of her family. I recently took a picture of the 9 month old baby sitting in the 90 year olds lap. So sweet.
So the key is to get the first person in the house. Maybe the HH nurse, after that hopefully he will see everything is going to be okay and it gets easier. I have the Arlo cameras. They are wireless and can be moved around to where they work best. You could set them up before he comes home and see what you think. With a late model smart phone you can check on him all the time. Of course you could also use your computer to check. No monthly fee from the icloud unless you want expanded services. There are many cameras and services available.
He can always go back to AL. Quantity vs quality of life is a consideration. At 90 they have had quantity. I love that you take him on the trips. But make him agree to changes before you bring him home and yes he will forget that he agreed but you just remind him that he did and let him see by your manner that is nonnegotiable.
At some point (by adding more hours) I'm sure it will be less expensive to pay for AL than for home care but if she has the funds then I will keep her where she wants to be.
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Hi Linkabit14. This is such a difficult decision for you. I had a similar situation even though I live about 10 minutes away from her house and the MCU (memory care unit) where she has now lived in for only 8 days. It's heart breaking to see her there and she is clearly unhappy but I had no choice in moving her from her home. She has great neighbors and the all kept watch over her, but when they started telling me that Mom was coming out of the house in her pj's and knocking on doors, I knew it was time to move her.

I understand your dilemma and I can only speak for myself, but I would not consider moving her back to her own home. Dementia does not get better, it gets worse as time passes and even though I would hire people to come to her house, there's always the possibility that someone wouldn't show up as planned, etc. and then my mom would still not be getting the best of care, like she will in the MCU. Before I had to move her, I had hired a nice lady to come in and spend some time with her, and do some light cleaning, but after awhile I could see that things weren't getting done and that the lady was not staying that long because she just had too many clients. I'd rather not go through that again. Since you can't be around all of the time, like I was, I would put some real careful thought into moving him back to his home.

I'm sorry that I can't help you with your dilemma but I wish you the best of luck with your dad. Please keep us informed.
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Wandering only happened twice? If he lives alone it will become a much more frequent occurrence. He is safe where he is.
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Linkabit14, I like that you decided to keep your dad in AL. We kept my dad in his home and it was a challenge for everyone until he passed. Your dad is where he needs to be. Getting him involved and interested in something should help. Prayers....🙏
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