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Father in law medically is in fair shape for having COPD and congestive heart failure due to care and meds. However the NH wants to send him to Assisted living. The family would like to see him stay in the NH.


He also has moderate dementia diagnosis and fails testing for decisional capacity. He probably has narcissistic personality disorder and grandiose thoughts of himself. He thinks he can do anything and dosent care who gets hurt in the process.


We don't know what to do with him. He won't listen to us and says he fired his son as healthcare proxy. (Son is also POA) but I guess that's also in question. The father also makes false accusations about theft, and tells the NH that the only thing he will accept is to go home. We all know that's not the place for him.

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Granjan,
In my state elder caregivers of all levels and agencies(NH, AL ,Home Health Companies and VNA etc.) are required to have periodic training on dementia care. Not to say everyone learns or remembers proper approaches. Unfortunately some caregivers are not good at working with dementia patients no matter what they are taught!
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Quirky, you are on the right track with seeing the neurologist and looking to follow-up with a court order if necessary. Hang in there. At least it sounds like the rest of the family is in agreement about his needs, so that's a big step in the right direction right there.
Sad to think about this, but if he's ranting about buying an arsenal, I'd think a court would take notice now of the issues that could arise from that.
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Nursing homes are often not secure
5 years ago my mom was h*ll bent on escaping even though she was there just temporarily following surgery

Facility said get her a 24 hour aide or we call APS if she escapes and this was after a fall she had in her room there in which she cracked her tailbone but they didn't know it

The demented with behavioral issues do not do well in nursing homes
- they are sedated
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Don't fall for this trick. The NH my late mother was in pulled this stunt my telling her "you're too well to stay here." Dumbfounded, my brother and I laid a large chunk of change down for an AL. They were very much wrong...in fact DEAD WRONG!! My late mother suffered a stroke less than 48 hours later at the Nursing Home!! She did pass away.
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What can the VA do for him? We had a cousin who had Alzheimers' who was in a VA hospital and it worked well for him. (If they have staff people who might be more strict with him he might respond. It does sound as if he wouldn't do well in a home care situation because of his stubbornness and attitude. It could be that he is too physically strong for the NH to handle.
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Lots of NHs do not train their staff to deal with dementia patients. Irresponsible but true. Memory Care facilities do, however it is hard to find one that has Medicaid beds. Perhaps you could have a patient planning meeting with the nursing home and tell them your frustrations and then listen to theirs. A plan can be formed as to what can be done to change his behavior, i.e. different medication. He may be taking meds for his behavior but perhaps a different one might be better. There are many on the market. I would do everything I could before moving him. That could open up a can of worms that is worse than what you are currently dealing with.
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If the nursing home deemed him well enough for assisted-living, then he needs to go into assisted living since she no longer needs to be in the nursing home. With assisted-living, there are people who come in and help with whatever you need help with including bringing in meals. My foster dad was temporarily put into an assisted living building but I found out he was signed up as a regular tenant and not assisted-living. I think someone was mistaken because someone was obviously bringing him food, I saw stuff in his fridge he would normally never buy for himself but usually brought that kind of stuff back for me from soup kitchens and stuff. This wasn't possible since he was in the hospital but someone was bringing him food every day because it was piling up in the fridge. This is how I know someone comes in and helps you where you need it, my foster dad was temporarily given an apartment before someone took it away within the week and put him into a nursing home despite the rent already being paid. 

As for your father-in-law accusing someone of theft, don't take this lightly, It happens to the elderly more often than you may realize. In fact, there was a POA living with my dad who ended up stealing from him and I'm dealing with the aftermath of it now since he died. If an elder suspects theft, please, take it seriously because more times than not, the elder is usually right. I strongly encourage you to do your homework on this one because it's more common than you may realize. Go onto YouTube and type in elder financial abuse and educate yourself about what really goes on behind our backs, it will definitely shock you. Another thing to look at is about abusive guardianships. Abusive probate guardianships are also more common than you think because they're actually predatory. There's a video out there in three parts titled, "how your elderly parents will become wards of the state". I strongly encourage you to educate yourself about the very high risk of someone else having access to your money and assets, this will really open your eyes and your jaw will probably drop wide open. After starting to deal with the after affects of elder financial abuse against my bio dad with Alzheimer's, I started doing my homework and finding out things I didn't otherwise no and I never would've otherwise known had it not been for what was uncovered after dad's death. If your father-in-law yells theft, immediately investigate very thoroughly because more times than not the elder is usually right if something that really does go missing. The trick is to find out why that something is missing because more times than not it turns out to be theft and usually by someone closest to you but not always 
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Quirky21,

I think you nailed it with your comment, "I think they are tired of his antics." They basically don't want to deal with him. However, if he is already demonstrating suspicious behavior, and from other things you have mentioned, assisted living may not be the right environment. I would speak with his physician for assistance with the decision. It may be rough having him at home for your family. Perhaps an adult family home environment could be considered?
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Go to local VFW and get your dad VA Aid&Attendance. He qualifies. Don't try to do it yourself.
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Memory care! It sounds like he needs to be in a locked facility for his own safety. In my state, you must be approved by a doctor for MC and they will give calming drugs to ease the transition.
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Quirky, your story could be ours and I know just how you feel. We knew if Mom went to assisted living, it would not be long before she was back in the hospital. The social worker at first pushed for assisted living (we had some behavior problems also). I visited every assisted living place in the area, and it just would not have been enough care for her. They ended up moving Mom from the rehab part of the NH to the memory care wing where she was able to get more individual care. She was used to the surroundings and a move would have been too hard on her. Then if assisted living didn't work out, it would have entailed another move, and on and on. Looking back, I am so glad we were able to convince them to let Mom stay there.

I hope the Dr. is somehow able to help you convince the NH. I know what a hard time this is.
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To me it sounds like the nursing home wants your father gone, but knows that they cannot send him home as it would be an unsafe discharge. My mom didn't need help dressing, showering, eating, etc. She has mild dementia and is unable to take medications on her own. That was enough for them to keep her in the nursing home.
I cannot imagine a nursing home being unable to deal with dementia patients. I would bet the majority of nursing home patients have some type of dementia.

The nursing home would be able to pursue guardianship if he is a danger to himself.
If you cannot afford an elder care attorney, contact your local area office of the aging. They should be able to help guide you.
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Thanks for the replies. He is on Medicaid and Medicare in MASS and the NH is fully paid for by his social security and VA benefits. There are a few assisted living places in the state that would be the same setup, all others are additional contributions. It is the social worker from the facility that is advocating for more freedom and a less restrictive environment. (she said this is not jail and he should be able come to go and go as he pleases). They are also not certified by the state for dementia. Due in part to his wishes to leave, and that medically they say he doesn't need the daily nursing care they provide. He dresses himself etc. I think they are tired of his antics. My father in law is a difficult character, he yells and screams about needing to go hustle some money at the casino, needing to buy a new arsenal of guns, and that "they cant keep me here" kind of thing. I am sure he has said more than once he is going to sue the NH, his healthcare proxy, and other such nonsense. I think the nursing home is worried. Lately he has said nothing will be acceptable to him but going home and getting his SS and VA checks back from the claws of the NH. The family knows the nursing home is the best place for him, the NH says you cant go home, its assisted living at best.. He has moderate dementia now, and his extremely narcissistic personality only exacerbates the situation. We recently had a meeting with the elder services rep and social services. We asked him about getting behind the wheel and driving and that "maybe its not a good thing for him to do". Well he said I don't care I'm going to do it, it doesn't matter what you say. (even if it hurts someone else) That's his answer for most things.

The family feels terrible about all of this, if he would only listen to reason he could have more freedom, but we all know he will stop his meds, make poor decisions, etc, and end up back in the hospital. We are thinking that we may need to pursue some court order to keep him in a NH and safe from himself and for the safety of others. We have a meeting next week with the neurologist that did the decisional capacity evaluation.
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quirky21, curious why a nursing home would want your Dad to move to Assisted Living? Unless Dad is doing much better.

Usually with Assisted Living, the facilities are self-pay unless Dad's State has a waiver program which would pay some of the cost. With a nursing home, it is either self-pay or paid by Medicaid.
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Talk to the social worker. My Mom's Nursing Home talked to me about moving Mom to assisted living. We KNEW she needed more care than what assisted living would give her. I talked to the social worker about this and Mom was able to stay in the Nursing Home where she was getting great care and where she had wonderful nursing assistants 24 hours a day to help with her daily care. She also had Dementia. Hopefully the social worker can help you.
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