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Hi. My mom is 71 and has dementia. Its gotten must worse in the past 12 months and my Dad can no longer take care of her on his own.
She no longer recognizes Dad as her husband but thinks he's a distant relative who lives with her. We need to separate them as he has major burn-out and we are worried for his health also.
She also has anosognosia which means she doesn't realize anything is wrong and believes she is perfectly fine to take care of herself.


She becomes extremely angry and leaves the room anytime we bring up a care home. She says she is fine to take care of herself, that nothing is wrong, and that she's not ready to go to a home. She thinks all care homes are essentially for people who can't take care of themselves or hospices where old people go to die. She won't even consider touring a retirement or assisted living home to see that they are actually very nice places.


We have power-of-attorney and could force her... but I think we would physically need to tie her up to get her through the door. I don't want it to be traumatic.


We're thinking of maybe turning the water off and saying the water in the house froze due to the recent very cold weather...


Any suggestion on how do we get her into a care home?

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Does she actually have a medical diagnosis by a doctor for her dementia/ALZ? I'm only asking because 71 is very young and just need to discount UTI or thyroid condition, among other possible variables.

If she does have a diagnosis then employing an "therapeutic fib" like you suggested is perfectly acceptable. I would stop trying to get her buy-in into transitioning into a facility...it's never going to happen. Tell her the pipes froze or there is a mold or insect infestation that requires everyone to vacate the home for a week. Resettle her into MC care on the pretense it is the "hotel". Make sure the facility is in on this ruse (they will be happy to go along).

Is it possible to hire some outside agency help to manage her/be a companion to her during the day? Or adult daycare? None of this will feel good or easy, but it sounds like it is necessary. All you can do is what is in her own best interests and what doesn't burn out the other caregivers. May you gain peace in your heart about this decision.
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"We have power-of-attorney and could force her..."

You might want to double check the document AND the attorney who drew up the POA. Our mother, despite having AL in her plans before dementia kicked in, refused to consider moving anywhere, ESP not AL. Our attorney told me we could NOT force her to move, and suggested guardianship. I don't think she would have qualified for guardianship at that time, or perhaps a minimal level (I didn't know there were possible "levels", but Bab75 was granted SOME guardianship), but it was a moot point anyway, because the facility we chose would not accept a committal. In order to make the move happen, we had to come up with a plausible fib/scenario that she would buy into. Similar to what you and Geaton777 suggested.

This
https://www.agingcare.com/articles/things-you-can-and-cant-do-with-poa-152673.htm
spells out a number of things you can/can't do with medical or financial POAs, but basically a POA is giving you the ability to perform certain duties AS that person, in their stead. It can allow certain decisions to be made if the person isn't capable, but before assuming this also allows you to force a move, you need to double check with the attorney. The article doesn't mention moving.

Even staff in the MC unit told me they can't force residents to do anything they say no to, such as taking their meds, bathing, getting medical/wound treatment. They have to become adept at coaxing the person, working to get them to agree.

Shutting off the water might be a way to move her, saying it's temporary. Once in the MC unit, it should be sufficiently locked that no one leaves without staff allowing it. Do NOT try AL - they don't "watch" over them, so she could walk out at any time! I had suggested my brother mess with the Nest thermostat he installed - make it way too hot, then too cold, and tell her it needs to be replaced and will take some time (it was already into winter.) She injured her leg just before the move, developed cellulitis, which delayed the move a few days, but he used that to draft up a fake letter from 'Elder Services' telling her she moves to where we pick or they will pick. Thankfully it worked (but, funny note - not long after, when going there to work on clearing, cleaning and repairing, to sell it, the heating system DID die!)

Maybe, if possible, work with the place you choose and see if dad can move in with her, briefly at least, just to keep the hotel "ruse" up. Explain the unit lock is to keep infected OR bad people out. Have him leave, as if going to work on fixing the problem during the day. Eventually, given a little time, he can return home and visit during the day. She may also need some meds, to calm any anxiety during the transition. They did that for my mother - minimal dose, just to take the edge off. It was used later, when she had a UTI with major sun-downing, so I know she wasn't "doped up."

Never heard the term before, but it does seem that most people with dementia think they are fine. Part of that is due to short term memory loss. They are seeing themselves as they were several years ago, still healthy and capable! Mom was certainly adamant there wasn't anything wrong with her! I'm Fine. I'm Independent. I can cook. Nope. Nope. Nope. I also never used the "D" word around her. She might acknowledge forgetting some things, but wrote that off as she's "old and entitled to forget once in a while!" As she moved back in time, she thought a pic of herself was her mother. Self-image does change.

Another option, for getting her to see these places aren't what many remember from long ago is to schedule a meal with them (when allowed) and pretend you're going to a restaurant. When done, amble around (with a tour guide) to see the place. Mom actually thought the place was nice, but asked who's going to pay for it. I just said VA (long story, didn't pan out, but they don't cover that much!) By the time she was home, she'd forgotten why we were even there!
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Johnson1 Jan 30, 2021
I appreciated your post. You made some very good points😊
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I agree with many of the answers posted but I disagree with some others. I sometimes get the feeling that some people who have never actually been in this situation try to offer their uninformed advice. Even though I realize each situation is unique. My mother also has dementia with anosognosia diagnosed by a neurologist. She has no self awareness of her many deficiencies and she could not live alone. We started researching assisted living options without her because due to her anosognosis, she would never agree to move. You're the only person who really understands how bad it is for your parents so you're the best person to make that decision. We also used a little fib to get my mother to the AL residential home on the day we left her there. We told her that she was going on a vacation. The AL home she's in watches her closely and they will not let her leave. They are state licensed and they follow the Covid 19 restrictions. Plus, they've arranged Covid 19 vaccinations for the residents and staff. Initially, it was a rough start but my mother has adjusted well but of course she still talks about going home often. They will also restrict her visitors and her calls if there are issues with people trying to take advantage. Don't let anyone make you feel guilty about ensuring the best care for your mother because I'm sure it's already hard enough on you emotionally. Sometimes letting them age in place at home is just not the safest option and her safety is the first priority. Good luck.
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The answers suggesting home care seem unrealistic since that won’t be 24 hour care and things will definitely progress. If you are waiting for your loved one to suddenly agree to move, you will be disappointed.
My husband and I went through the same thing with my MIL but she lived alone. We resorted to lying to her to get her to the facility. Yes, she was initially upset, but within a few days she was very happy to be in her new home and never mentioned “going home” again. You need to take control of a bad situation similar to when you need to make decisions for young children.
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cweissp Jan 30, 2021
My MIL had early alzheimer's and was living alone in big house. She was becoming a danger to herself and didn't want to move. The ASL picked out for her was good. While we packed her up to move her - her granddaughters who she dearly loved took her to her new home. When her youngest son showed up she asked when she was going home - he told her she was home. Using the granddaughters diffused the initial pushback and it turned out easier than it could have been.

I do understand your situation is totally different - just a thought. Don't beat yourself up. It's a hard road with no easy answers. Good luck.
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CaregiverSonKD,

First off, make sure you have ALL your ducks in a row!!

Read the POA very carefully!
Do you have a diagnosis from a Geriatrician or Neurologist?
Perhaps speak with an elder care attorney.

We told my Aunt (Alzheimer's), that her home needed repairs and she needed to stay elsewhere while it was going on.
Although she still tells me periodically that she's going home tomorrow, she has no idea how long she's been in memory care. It took a little while, but she has settled in nicely.

I thought about cameras etc..., but after witnessing her start kitchen fires twice, I knew that wasn't a plausible idea in her case.

You'll get lots of advice pro and con ALFs! Only you know what the best option is for your parents!
There is no shame in placing LOs in ALF or trying to keep them at home.

Your local Council on Aging may also be able to give you sound advice.

Best wishes!!!
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This is a tough one because they do believe they are fine when they are not. And your dad is now in danger and should NOT be subjected to having to tend to her - he has enough problems. Get in cahoots with the doctors so they back you up. You say you have Power of Attorney so you could hire a caretaker who must be strong enough to stand up to her shenanigans and not allow her to scream and rant and misbehave. That could be a tough call before they walk out. I personally would seek out a suitable, well cared for place and then take her out to lunch or whatever, have an excuse you are picking someone up to come along or visit them, etc. Take two strong people with you and if you must, then you "take" her into the new place. Perhaps she could be slightly medicated before you take her into the facility. Many years ago I saved someone's life - she had dementia - and was determined to kill herself that night. It was a pure nightmare getting her physically into the hospital - she was "fine" - well, she was not and with help we got her into the hospital. She has full dementia and is in a nursing home ever since. Sometimes gentle force is your only solution. Do NOT let her stay home if you are positive it is unsafe and very bad for your father.
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Rusty2166 Jan 30, 2021
Cameras and caretakers don't always work. Perhaps take your father "out" the day you physically move her to minimize the trauma. Or say to her you MUST HAVE A BREAK for a week or whatever and during that time she must stay in a hotel for a week. That is an option. But you must do something with her because I assure you with her attitude and dementia, something terrible will happen and you will be left holding the bag and why should YOU be the one to suffer?
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With my dad we had to resort to “tricks” a lot too. I’d make up letters with fancy logos at the top saying things like why he can’t ride his bike anymore or where his boat went (they were in the shop!). It helped convince him...sometimes. Unfortunately, the only way we got him into a home was when he ran away and we had the police pick him up. Our elder attorney said if the police pick him up, you can use that as an opportunity to send them to a hospital and stay there for a few days and get the hospital to transfer him over to a living facility (there could have been other reasons we had to do it this way too). This might be an extreme case for you, because your mom doesn’t sound a far as my dad was (he was 80).
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Have you considered trying in-home care first? That would relieve your Dad from being her sole caregiver, lessoning burnout and the effects on his health. It might even make their time spent together more enjoyable and spark a bit of their husband & wife relationship. With the pandemic I don’t know what is being offered in your area, but there are day programs for folks with dementia to get them out of the house for a good portion of the day thus giving your Dad time to himself. Again, with the pandemic, these may not currently be open. Also, some assisted living facilities provide short term care in which Mom could move in for a short period of time while Dad gets a break. This might be helpful before making a facility a permanent decision.
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In-home health care sounds like your best option. If your mother resists outside help, you can explain that someone is there to help that "distant relative who lives with her.". Look for a health care aide or agency with a high enough level of skills to handle the variety of needs of both of your parents.
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You should deffiently not force her!

Especially with Dementia, it's better for her to continue living in her own environment tgat she is use to.

Why not install cameras to help keep an eye on her and have a Caregiver come by 2 or 3 hrs a day.

If you make your mom move befire she is ready..
Your mom would be lonely and very unhappy and could catch Covid.
I would think your Dad would also be lonely living by himself.

Later, You might see if they both would consider moving into an assisted living apartment together.
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disgustedtoo Jan 30, 2021
"Especially with Dementia, it's better for her to continue living in her own environment tgat she is use to."

Says who? It might be, but more often than not it isn't. Sometimes the patient doesn't even recognize their own home as home! I attempted to keep my mother in her own place, bringing in aides 1hr/day with plans to increase as needed. Less than 2 months later, she refused to let them in. The agency sent their "expert" to talk with mom. That woman is lucky mom couldn't pick her up and throw her out! Yes, we had some cameras too. They couldn't see everywhere, but were helpful, since she lived alone and no one lived close enough to make frequent checks on her. Between being unable to cook proper meals AND injuring herself, it was NOT safe for her to remain there. She actually "bruised" her leg just prior to the move to MC, and developed cellulitis. Had the move not been planned, that could have quickly killed her. CAMERAS would not have helped, nor would aides or any of us be checking her body for things like that. I doubt she would have allowed anyone to examine ANY part of her body. Going back to "home" and what she recognizes, 9 months after the move to MC, mom forgot her condo of 25+ years and was focused on the last house owned/lived in. So, exactly what is home to them? Depends on where in life they are currently existing. At some point I could tell mom was "living" 40+ YEARS ago - asking about her mother and comments about a cousin's baby (mother gone 40+ years ago, cousin's baby would be about 41.)

Cameras won't help this: "We need to separate them as he has major burn-out and we are worried for his health also."

"...could catch Covid."

While it can be easier to spread in a facility, PLENTY of people have caught it other places. Also, what makes you think bringing in care-givers 2-3 hours/day wouldn't bring the virus in? Or bringing it in yourself? We ALL have the chances to pick up the virus, and can even spread it before being aware of it, or even without symptoms of our own. Plus that still leaves poor dad with 21-22 hours/day to deal with care that is beyond his capability, per OP.

Lastly, statements like "Your mom would be lonely and very unhappy..." are YOUR opinion only. YOU don't know how this person's mother would be in any kind of situation. They can even be lonely and unhappy in their OWN home. Even saying dad would be lonely is guesswork. He would need some time to regroup and revitalize, but when he's allowed visits, he can spend the day with her if he chooses, or he could live in the AL part of the facility and join her for meals or activities AND form new friendships and participate in activities with others. He would also be more able to get out and about, free to live a semi-normal life again, rather than being cooped up in his own home with a woman who has no clue who he is. Perhaps he IS already lonely. He can't exactly go out for several reasons now.

I'm not saying facility is or isn't the best solution, but you and others ASSUME they are the worst.

You are entitled to your opinion, but it should only relate to a place or places and people YOU personally know. Blanket statements that facilities are ALL awful and should be avoided does a disservice and isn't helpful. Blanket statements about how someone might react or behave in a facility should also be avoided. YOU DON'T KNOW IT ALL.

Sometimes care in home can work and be best. Sometimes it doesn't work and can be the worst, for the patient AND the care-giver. Doing due diligence in checking out a facility is on the person/people doing the selection. There are MANY good quality facilities out there, you just have to weed out the ones that aren't. There are many ways also to make home care work, but offer MORE suggestions, not negative BS.
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