The doctors and family members feel that the Alzheimer's patient can no longer stay in his house because he makes poor choices when problem solving. He does not want anyone coming into his house to stay with him and refuses to go into assisted living because he feels it is one step closer to death. No matter how many times we have tried to explain that assisted living will make life easier for him because he doesn't have to worry about the upkeep of his house, laundry, and meals each day, the person doesn't want to leave his house.

We would like him to decide which assisted living facility he would like to go but don't know if we should check-out the places without him or take him to look at them. A year ago, I took him to just see what assisted living facilities are like reassuring him that he didn't need to go to one at that time. He broke down, got sick, and cried. A year later, it's time for him to move into a facility, and I am not sure if he should accompany me. He has mild to moderate Alzheimer's.

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You know, there comes a point where someone suffering from ALZ/Dementia can no longer make informed decisions about their care. Thats why they assigned a POA when they could decide who would make decisions for them.

Its nor "forcing" them. Its doing what has to be done for their safety. Its no longer what they want but what they need.

I think taking them on "tours" is a waste of time. Find a place convenient to family that meets his needs. Then move him in. Tell whatever fib you need to get him there. We told my Mom it was a new apartment.
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He will not make the decision and that is clear. I would say that breaking down and crying is a normal and appropriate response. I would ask him if he wants to go with you. If not, I would tell him you will go and make the best decision for him you are able. But gently make clear that this is how it will be now. It is, as with very young children, best not to give choices when choices are confusing and frustrating. It is best to gently say what will now happen.
Don't expect a good response. Expect an honest one. Which will be grief. There are times when grief is a fact that cannot be avoided for you all.
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The fewer options the better in,my experience. Good luck. I don't mean that fatalicstically. It seems just too many options complicates things.
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Decisions are usually not a good idea with dementia. When we moved my dad from IL to AL, even though he approved of the new apartment, he later would ask, who decided to move me here? At first he hated the change. They often do so be prepared for the anger which is part of grieving from confusion and giving up control. Later though he loved it there. So no, I would not give him a choice. And if he does hate it, give it a good 6-9 months...likely he will have changed his mind. Do not under any circumstances up and move him to a different place without giving it time because the adjustment phase hasn’t concluded. Plus another move can be just as unsettling.
Go into this knowing this is the right decision but expect some resistance on his part and know it’s normal. Be ready with "therapeutic fibs" to placate him. Hope all goes well.
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I visited all the assisted living places in my town and decided for my mom on a small place that is in a house, much like her own house, and close to my house. I took her for a visit and she refused the cake and tea they offered her and just glared at me as if I was murdering her. She wouldn't be nice to them or me during the visit. She forgot about the visit immediately. A week later I moved her in. I already had her things there, new bed with her beadspread, her dresser and favorite chair, and clothes. Funny, she hadn't noticed those things gone from her house. I retained her home care lady for four days and the two of us were there most of that time to help her get used to things. It took a couple of weeks, but she really was just fine. I still cry when I think of the day we took her, knowing she would never be back in her own lovely house again. But I had to be strong for her own safety. It's hard making decisions for someone else, but with this disease it is necessary.
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Diane, unfortunately some of us have to wait until our parent develops a serious illness or had a bad fall before we were able to make that decision for senior living. The parent goes from 911, to hospital, to rehab, then into Assisted Living, Nursing Home or Long Term Care.

The above was the only way my Mom would leave her house where no strangers could set foot in "her house". Sadly she didn't even know where she was after going into long-term-care due to serious dementia brought on head trauma. She needed a village to help her :(

My Dad, on the other hand, couldn't wait to move from the house her shared with my Mom. At 94 he was tired of cleaning gutters, doing yard work, shoveling snow, and the "honey do" lists that he just couldn't do anymore but Mom would insist. After Mom passed, he was ready to sell and move. When I pulled up to the first senior living facility, which looked like a Victorian hotel, he asked "where do I sign up?". The place was so nice, even I wanted to rent an apartment :)

Now, if a parent is dealing with very limited eye-sight, I can see where moving would be difficult trying to find their way around a new place. Later on I believed that is why my Mom refused to move.

Some very elderly parents will refuse a nursing home as they remember back when they were kids or teenagers, a relative leaving home and moving into a facility. Usually the facility was the County Asylum, not a user-friendly place as all types of disengaged with reality patients were placed together. My great-great grandfather was in such a place due to brain injury caused by a farming accident. He was only in his 30's.
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This is a fun one - what brought me here in the first place! Depending on his stage of dementia, decision making might not be up to him. While it is nice to say hey, here are your options - door #1, 2 or 3, he may refuse. There does come a time when someone responsible has to make that decision.

Oddly, mom used to visit all the places local to where she lived (free lunches/tours.) She would also often say something about cleaning out stuff, in case she had 'to get outta here.' When I asked what she meant, she said assisted living. So, this was in her "plan." Fast forward - early signs on dementia, we proceeded in steps... Take car away when it became obvious it was an accident waiting to happen. Help when we could (groceries, doctor appts, etc.) Even one neighbor was somewhat helpful, at least for checking on her (55+ condo area.)

The next step was to explore bringing in help. She was still able to "self-care", but needed a little oversight. Locked/timed med dispenser needed to be checked as sometimes she wouldn't see/hear the alarm. We hired aides 1 hour 3x/week, bumping that up shortly after to 5x/week (didn't care what they did for the hour other than checking meds were taken) since it seemed to be going well. After a few more weeks, she refused to let them in. Great. Time to start checking out places... We settled on one that isn't far from me (her condo was 1.5 hour each way!) We had to wait for their rebuild of the old facility, then they opened in stages (IL, then AL - MC was last.) MC was delayed a bit until they had enough residents.

Meanwhile, mom was adamant that she was fine, independent and could cook (NOT!) She refused to move in with any of us (I wouldn't be able to care for her anyway.) When AL was mentioned, the response was "Paugh! I wouldn't live in one of those places!" So the old mindset of what NHs were in the past didn't apply. She KNEW what the places in her area were like. We did bring her for a visit/free meal/tour. She liked the place, but her big question was who will pay for this? Bring on the fibs... VA. Medicare. Whoever. She wasn't 100% convinced, but seemed to like it. However, on returning home she told me that it was a nice trip, but she wouldn't go the next time - she thought we were looking at houses for my brother who was with us! Elder Atty says we can't drag her there, suggested guardianship. Facility said no committals! Rock|us|hardplace. Facility said just get her here, we'll do the rest.

Just before the planned move, she injured her leg, didn't tell anyone and ended up with cellulitis. This delayed the move a few days. It also gave YB the idea to make a fake letter from 'elder services' at the hospital that treated the wound, saying she moves where we choose, or they will choose. Madder than a wet hen, but she went reluctantly. To her it was a temporary thing. Still wants out from time to time, but is now in year 3.

So, it isn't always a preconceived notion about NHs (though it can be.) If at all possible, come up with a ruse to get him there... vacation, house needs big repair, etc - something that is plausible but seems temporary. Don't call it what it is (AL/MC), pretend it is just a temporary move for whatever plan works. With dementia, date/time becomes muddled and he can be told tomorrow, next week, whatever, and have no clue when. Fibs can be a great friend/tool! Blaming the doctor for making the decision is another option - takes the onus off friends/family members. Whatever works - while sometimes nothing can be done but wait for that inevitable fall/injury/illness, sometimes that is too late!
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Before you choose or tour places be aware that if your Loved One is going into Assisted Living it will be a matter of months maybe before they have to transition to Memory Care. So choose a place that has a Memory Care section. This section should be locked so that the residents can not leave on their own. Assisted Living residents can come and go as they wish.
Once that is out of the way....
What is your loved one like? Do they like activities? Lots of people? If so look for a place that has those things. Again keep in mind that what a person likes now may be way off in 6 months.
And when you go visit have a lunch or dinner during your tour.
And when you have it narrowed down to 2 or 3 stop in unannounced sometime and just see what it is like as the residents go to breakfast or lunch. You would not be able to get into a locked unit but the rest of the facility you should be able to get into . Try parking in a back lot and try a side door, they are often unlocked.
One other thing to think about IF there is a possibility that this person may have to go on Medicaid look for a facility that will accept Medicaid. Usually once a person has been private pay for 1 to 2 years a facility will "let them" stay if they go on Medicaid. So do not start looking at Private Facilities that do not accept Medicaid
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My own experience in all sorts of situations is that it’s easier to get someone to say what’s wrong with something, than to choose what they like. I’d say see two facilities that you think will do, list for yourself and then tell him honestly the good bits of both of them (and bad if appropriate – eg distance),. Then ask him which is worse and why. You may get some genuine insight into what he does and doesn’t like, that will send you off to look at another place. Or you may realise that your own judgement is the way to go. Then it isn’t his choice, it’s yours, because this is what you have to do.
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Zdarov Jun 2019
For what it’s worth, I also think choose between 2 and not 3.
I took my parents to the places I liked the most after I’d seen at least 7 of them. I explained they were getting too forgetful and I needed them to get used to living resort style living while they could get acclimated because they were going to have to move either way. They love it but it is one day at a time as they get mad and resentful but it only lasts a day then they are happy again...
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