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I have both my parents in AL. Mom has progressed to mild - moderate dementia & my dad is beside himself. He feels the need to "take care of her" even though there are staff around to help (though not always prompt). The main problem is that she has outbursts of anger toward him; other times she says things that make no sense.


Today she told him that she heard him talking to my aunt (who has been dead about 8 years) about buying shoes. This befuddles him as he doesn't know how to respond. I've been trying to help him with "therapeutic fibbing" but it's taking a while. She really needs memory care, but he does not. So we're planning on separating them, with her moving to the Memory Care side of the AL & he would stay on the regular side in a different apartment. He can see her anytime, but knows she will be monitored more closely when he's not with her.


The problem is that mom has moments of clarity when she seems to relate fairly well. What would be the best way to present the separation to her, with the idea of avoiding a blow-up or meltdown? At the AL there is another couple who has this same arrangement & seem to be doing fine, but I think the wife has more advanced dementia than my mom. Obviously we will try to discuss with this gentlemen, but I'd like to get some other ideas. Please advise if anyone has experienced this & has some recommendations. (By the way, this forum has been a great resource for me as I've been part-time caregiving for them for about 4 years & finally got them to AL. I have recommended AgingCare to others & even some health care professionals. Thanks to all who contribute!)

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My heart goes out to you. I have just currently gone through this. My parents were living in an in-law suite we added on to our home. They were there almost a year before a visiting nurse reported my mom for not letting my dad receive the help he needed. Long story short, we were given the ultimatum of getting my mom out of the home after my dad wound up in the hospital for 6 days after a fall or my mom being reported to APS. We then was able to convince my dad to go to rehab and get my mom into a Geri-psychiatric hospital. She was hitting nurses, refusing to let my dad get any help from anyone except her and she didn’t understand how to help him. We at first moved them into ALMC with separate rooms. She would stay in his room and watch TV. Then at night, she would wheel my dad to her room to sleep in her bed instead of the hospital bed. We then tried them in a room together. She exhibited the same behavior as before. We finally were forced to put him in a SNF and her in ALMC. They have been married 66 1/2 years. I have now even had to quit taking her to visit him because she upsets him by telling him to get up so he can get better and go home. It’s a horrible dilemma for me as their child. I have been told I have to do what I have to do in order to keep him safe. There really isn’t any other option sometimes.
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We're debating this as well. Mom has dementia and Dad is somewhat forgetful but his Neuro-psyche exam resulted in no diagnosis.

We found an AL with MC units in one of the buildings. I have been clear with Dad (and brother and SIL) that when mom must go to MC that (unless his condition changes) that I DO NOT want Dad in that environment full time. It is a very difficult thing to try and convince them of, but we have been paving this road for a few months. I dread the day we must move her due to her inability to 'follow the rules' and disrupt the AL living side of things. So far there have been none of the anger fits, but last time I stayed with them in their apartment she got up in the middle of the night and was sure her casserole was burning and when she couldn't find it in the apartment was about to go into the hallway, and from there who knows?? So the behaviors may result in needing the controlled access unit more than anything else.

They have been married for 63 years and neither sleeps well without the other. THAT is the hard part I worry about... but I keep encouraging Dad to make friends, sign up for the activities, go to the dining room for meals and once in a while if she doens't want to go, don't stay with her. TRY to continue to live and hope that knowing he's going to go without her gets her to leave. He's been almost codependent in the concessions he's made for the last couple years. She doesn't have to muster any effort at all... he caves on everything. She has a spell of falls in June/early July (thankfully no breaks) that landed her in the hospital and then rehab. I INSISTED on the rehab even though insurance only covered the OT/PT costs, to keep him from waiting on her hand and foot! She can't get up, has no balance, cuz she only has to go from bed, to chair, to toilet. He brings her EVERYTHING she asks for... and I've tried to explain how "helping that way is not really helping" and after the falls I think he sort of understood that if she had to get up and get her own drink of water, or snack, or sweater, that maybe she would not be so weak and lacking of balance.

This is a slippery slope and I appreciate all of you and your replies. This site has been the 2nd best resource I've found in the year I've been primary care for my parents. My Mom was diagnosed last December, but I think that was year 2 of the dementia. It has progressed quickly this year, and the transition to AL has barely 'settled' in - I hope we have a few months of this 'new normal' before we have to figure out the next one!
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My parents are both in a facility. Mom was diagnosed with AD about 7 years ago. Dad insisted that he could take care of her, though he really didn't know anything about AD. The closest sibling was 30 minutes away and parents refused to move. Dad reluctantly agreed to caregivers that we, his children, would hire, but then not let them in the door when they came. Mom would not eat well and they were obviously struggling, but he still would not accept help. One evening my parents were arguing and dad "fell," fracturing some vertebrae in his neck.

While dad was in rehab, we jumped at the chance to get Mom in MC. When he was released, he did not want to be home alone or away from Mom, so he joined her in the MC room, at a very good rate. Mom's AD has progressed to the point of angry outbursts. Plus, they know each other's buttons, push them regularly, and dad "fell" a lot.

After a third bout between them in a short period of time, the MC facility told us our parents would have to be separated. Because Dad had been restless and bored on the MC side of the facility, even though he had been given the code to have more freedom, we were happy to see him go to the AL side of the facility where he might have more activity.

We set up his room with his favorite bed, one that is positionable and vibrates, that Mom never liked. We brought him the coffee maker, stocked his fridge with beer and watermelon, brought jigsaw puzzles that Mom didn't want him to do on her and did anything we could think of to show him the advantages of having his own place.

That was two months ago. Unfortunately, in the beginning, Dad was at Mom's place every waking moment, wondering why he had to pay for a much more expensive separate room when he was never there. He was a mess!

Growing up, Dad was always very outgoing, even to the point of ignoring Mom when they went out to eat because there were so many strangers to meet. Dad has also been very self-centered, to the point of not understanding why Mom would even eat something that he himself didn't like. She has been his body, picking things up off the floor, walking across the room to get something, etc. At the same time, he has been her mind, paying the bills, tracking the schedules, etc.

When they were separated, he didn't know how to function. Even before they separated, when he was in rehab, he locked himself in his room and would not go meet anyone or participate in any activity without coercion. Dad is doing the same thing in his new AL room. He won't go meet anyone because he "doesn't like them. He doesn't need to get to know them, because he already knows he doesn't like them."

The MC facility finally started enforcing visitation hours for Dad to be able to see Mom. He hates it, but has now started playing games with the staff, to see how long he can get away with staying on the MC side of the facility.

Unfortunately, when Dad visits Mom, he is back to his usual behavior of turning up the thermostat to 90+ degrees which is too hot for Mom, blasting the TV on his station so he can hear it, and locking the door, keeping the two of them in the room totally by themselves.

On the other hand, Mom has been doing much better when Dad adheres to the visitation schedule! She allows the aides to help dress her, is less argumentative with Dad, is more manageable for bathing, and she has even ventured out of the room to be with other residents.

Each day is still a different story, but we are certain that separating them it has been the best thing. Granted, it has been a whole lot easier with them being in walking distance of each other, with us not being able to visit them as much as we like! This arrangement allows them to see each other and eat meals together much more often than they would otherwise.

I hope this helps!
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YsLadyMN Sep 10, 2018
Thanks for sharing your experience, 'us kids' are facing this decision as my mother progresses down the dementia road. Thankfully they are not very mean or unhealthy for each other, except for Dad waiting on her for 10 years meaning she can barely get up out of her chair without risk of falling... sigh. But it's good to hear how it's gone for others... today Mom wouldn't get out of bed and Dad called 3x before accepting "go do something and tell the nurse at the station to make sure someone checks on her every hour". Join in the activities, make friends and in the future tell her you're going to do _________ and hope she decides she wants to go with. She is not in the MC 'ward' yet, but we're faced with navigating that probably this year.

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I have just gone through this, it is definitely heartbreaking. My mom was combative, falling, delusional and accusing all of horrible things especially my dad and I. She was so clear in doing this that we thought she was just a senile angry person.

After she she began hitting my dad there was no other decision but to separate them. We sat them both down and discussed that the state wanted them separated for safety and that the memory unit had more experience with helping mom. The doctor said to tell her she had Alzheimer’s and needed more support, the psychiatrist told us not to tell her since she would forget. We asked the AL to talk to them instead and mom seemed to listen. Dad was angry and did not agree but we reiterated what AL said and told him that this way they will be in the same place vs being separated .

my suggestion is to talk to them both about what’s going on and concerns being careful not to put the blame on mom, have the AL talk to them about providing more care in memory and let them be the ones to tell them they have to separate. You just be the supportive adult child. Eventually your dad will understand and there will be brighter days. It’s a long road of good and bad days.

By the way, the move for them has been about 2 months now. Mom is in memory and dad is in AL. Mom’s quality of life has improved, no falls , no hospitalizations and less outbursts now that they are separated. I bring dad to see mom at least 2 days week for 3 hours and they are both happier. It takes about 5 weeks for someone to adjust to being in memory but it will get better. Just get your dad to socialize a lot in AL as they get lonely not being together.
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I worked in a facility where sometimes the spouse would move into the MC area to help out but it didn't work well. The aging spouse would try and tell their loved one what to do and it never worked well. They would be agitated and the dementia spouse would become agitated as well. The spouse is not trained in dementia care, so they aren't able to handle it properly or let things roll over their shoulders, realizing it is the disease causing the behaviors and not take it personally.
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nature73 Sep 8, 2018
You are so right. Poor dad is beside himself. No matter what I tell him be can't understand. I will pass on all this info.
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I found a AL/MC facility that had a choice of 2 bedroom, 1 bedroom, or efficiency apartments on their memory care floor for couple who were friends of mine and who made me their durable power of attorney. The facility only charged a little extra for the second occupant, but his care plan added a lot to the cost. It went from around $8,000 a month for one to over $12,000 a month for the two of them. The wife had frontal temporal dementia and was incontinent and starting to wander, needing 24 hour care. The husband just couldn't remember anything from one minute to the next and could not understand the changes his wife was going through. And they had to be together. As soon as the wife wasn't with her husband, she was looking for him.

I was relieved that I had found a place that provided excellent care for them. The head nurse guided me every step of the way as the wife's condition deteriorated. I needed that help since I had never done this type of care before and had to know what decisions to make.

After his wife's passing, the husband continues to live in that same apartment. He misses her everyday, but understands she is in a better place now and it's just a matter of time before he joins her. I visit him at least once a week, unless I am out of town, bringing him his weekly magazine as my excuse, but also always checking on things and his care. I am very impressed still and always thank the care-givers for their observations and insights.

I would echo the others in saying they should go together. Their time together may be short now, so make it work as long as you can.
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My friend that I take care of and am POA had to live in separate AL facilities from his wife. He has dementia she did not. She did not qualify for AL in his facility and her facility was too far for me to travel since I am a 7 day a week visitor for him. As it turned out it worked out for the best. His daughter would bring his wife once a week to see him. Because is was only once a week he was able to ‘showtime’ and she did not see his decline. When she fell and passed away, he did not see that decline which turned out for the best. Many times when she would visit he would call her Nanny thinking she was his grandmother. He is 92 but thinks he is very young. But everyone is different. It worked for us but may not work for you. All you can do is make what you feel is the best decision. And have no regrets.
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Gosh it’s hard to know when and how to do this. I’m in exactly the same situation myself right now. Mom’s Alzheimer’s is progressing to the point where she is losing her ADLs (she also has an ileostomy, so ADLs are a bit more complicated), and Dad’s dementia is progressing to the point where he doesn’t always understand her dementia. The AL portion of their facility does have increasing levels of care, but both Mom and dad are resistant. So I’m in close contact with the facility (they are in PA I am in AZ) in addition to my daily calls in order to monitor/track behaviors, and I have their docs (both PCP and geriatric psych) helping me assess them and the situation. Fortunately my folks have always listened to their docs (more so than sister and I because they are the parents and we are the children), so with the docs help Dad is becoming more open to the idea of some additional help. In the meantime I have Mom on the waiting list for a bed in SC (with her ostomy she will not qualify for memory care), and when a bed becomes available we’ll use all the info available to decide about the move (i.e. MAKE the move). Dad knows she is on the waiting list, Mom does not. I know they will not do well with this, but they are not doing well in the current situation either. A good day for Mom is rare, and when Dad is also having a bad dementia day or streak of days, it is just a disaster. I don’t know if any of this will be helpful to you. You are very much in my thoughts. I wish you strength and clarity for the road ahead.
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nature73 Sep 8, 2018
Your response is very much appreciated! "I know they will not do well with this, but they are not doing well in the current situation either" perfecty describes their situation. I will keep this in mind. What a mess! Whoever thought we & them would be in such a state? Best wishes to you too - I'd like to know how it goes for you.
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My parents are in the same situation, but my mom's dementia is more in the moderate range without anger except a few times a year. They live in a 2 bed 2 bath AL unit as my father insists on.
After her last hospital visit, i was concerned she might need memory care. I was advised by AL that they could provide more support and she did not need to go to MC until she needed to be fed or she wandered. Does your mom have either of these needs? Also, what is the highest level of care the AL facility provides? They are not all the same.
When I checked it out, the cost for MC for one person was about the same as the cost for AL for 2 people! So if money is a factor, please do your research carefully. My guess is that moving both to MC would require that MC cost for both. If your dad does not need it, it could seriously impact his social life and it may have implications regarding medical care as we'll. Investigate this carefully.
You might also consider if your mom would qualify for palliative care for dementia and if a part time private pay aide would be sufficient and less disruptive than separating them.
We had a conference with the AL staff and are having a paliative care evaluation, covered by Medicare, next week.
Also see if there are meds that can help with your mom's anger. My mom has melt downs that require meds as needed.
As an aside, when I can no longer take my mom to her multiple medical appointments, it may be time to reconsider MC regardless of other needs. She is a largest woman and is becoming weaker due to inactivity. If she cannot assist with standing and getting in and out of wheel chair, then I will not be able to take her.
At least your parents are already in a duel program facility! I dread having to move mine for the 4th time as it is so disruptive, but it may be necessary. Time will tell.
Good luck to you and stay in touch.
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Quite often, Memory Care will allow both to stay in the same room even if one doesn't need Memory Care yet.

Always ask, never assume. The answer could be yes.
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Why can they not both move to Memory Care together?
If he does not need the security of Memory Care he could be given the code so he can come and go as he wishes, just as if he were visiting.
He can continue to "help care" for her but obviously would have more help in doing so.
I know of more than one facility that allowed a spouse to move in and the spouse had NO medical problems at all.
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I have not experienced this but I’ve seen this happen where my dad is and it does work out. Does this facility have a social worker in place? If so you might talk to them and get their opinion on this. We are often hopeful during those periods of lucidity that the one with dementia is improving but they aren’t and they will go back to the previous behavior and it will get worse. You will need a fib to tell mom. Something also got the lines of....this place has some programs that we’d love for you to try for a while and then of course she moves in and doesn’t move out. It is so hard on you, I know to make these decisions but always always remember you are doing it to keep them safe. You did not cause the situation, aging and dementia did.
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Check out on your State legislation website.
Or the licensing website.

I was Shocked to find out that Assisted Living in Michigan cannot be licensed unless hold by a doctor.

They can't be licensed third party either. That means they can't supply any Medical Care and there is no one watching or mondering the facility.
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You cannot explain to dementia. Therapeutic fibs when she asks questions after the move. Dad will probably bring it up to her, hopefully he can deal with the agitation that could result. Do not tell her before if possible.

My Mom and stepdad had to live separately because of mom's dementia. He was able to visit when he wanted. In the beginning he would take her to the main facility dining room for lunch and dinner. First the dinner visits had to stop because of mom's sundowning behaviors. Later lunches had to be moved to the memory care dining room because mom was extremely disruptive to others in the main dining room. Once she ended up in the kitchen yelling that the couple eating with them was trying to get stepdad to pay for their meals.

Rules for him visiting will change. The facility may even ask him not to visit at all for a period of time, one week, two? Depends on how mom's adjustment progresses.

Good luck this is really hard for all of you.
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Sadly most of the people with dementia at my mother's nursing home have no idea why they are there and all of them are looking for a way to go home, it is just par for the course. I wouldn't bother trying to explain to your mother beyond telling her that she will get better care there "for now", and by using whatever therapeutic fib is appropriate at the time. I hope for your sake she will settle in easily, but be prepared for a few weeks of rocky transition.
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Would it be possible (under the rules and also financially) for them both to move together? My parents in law did this. (MIL needed the extra care, but FIL fell and died three weeks after the move, which was not what anyone expected.) Perhaps it isn’t a good idea if MIL is being very difficult for FIL, but it might make the actual move easier for both of them. Even doing it for just a few days might do the trick - imagining something new is always difficult and stressful, and experience takes away a lot of the stress. It might be worth checking with the management about whether they could share a double room for a few days in the new area.

I hope some other ideas will come out, too! It’s a difficult time for you all.
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