What does a POA do when they have placed the elderly parent with dementia in AL, who then systematically is alienating all the staff?

@Leolonnie - yes you are spot on. A big reason he is getting along only with the external caretaker who comes to help with bathing, is that he is a guy, but also is very polite and does everything he is told , very , subservient , is the word I think.

Ever since I made it clear to my dad that I am not helping him to go home, his latest thing was to move to an independent living place near me. I won't endorse this either since it will be totally inadequate, if anything he's heading towards memory care times soon

But now I have figured out what he imagines in independent living apartment - he would have this one subservient caretaker he likes, maybe a couple others like him for driving around, cleaning, who I would magically find for him (as is well known, men in caregiving careers are relatively few) and then he would want to call me in "urgently" for anything else,..... he does not want to deal with anyone else who is in a usual AL setting, and that seems to imply he wants no women involved.

Until my recent changes that I just had to make to myself to survive, in the past, I guess I was the good subservient son as he wanted it.

Has the Manager or someone in charge called you to discuss Dad's behaviour?

I would be asked if I could 'have a word' by the Nurse-in-Charge when visiting rehab.

Refusal to shower, refusal ro change clothing, refusal to talk to any Psychologist.
Like a 4yo No No No!

I attempted to muster my patientce & tolerence to ask a bunch of Whys.

Didn't NEED a shower (yet could not remember the last one).
Didn't NEED clothing changed (despite obvious smell & stains).
Didn't WANT to talk to anyone (yet didn't understand who this person was).

I realised cognition was worse that I had realised. Cognition + stress + anxiety.

An informal meeting came up with these solutuons to trial.

- Staff struck a compromise to shower on certain days. This would be SET & was written on the wall. No buts. Good cop, bad cop routine. Bad cop got that shower done. Good cop laid on the compliments afterwards (you smell lovely now ☺️).
- Clothing would be changed on shower days. Swapped out of sight to avoid tantrums.
- Psychologist arranged to visit.
She introduced herself with a quiet & calm manner, stating she had just come to say hello & ask how my LO was. Worked. A little trust gained.. Then some opening up about how SCARED she was. What had happened? Why she was there? When could she go home?

People in fear often lash out.

Allowing choice & control became the antidote to fear & loss of control.
Eg Must shower on set days. But choice of available (clean) outfit.

In time, adjustment was made to the regualr routine. Offering choice & allowing control where possible has worked to a (mostly) tolerable level.

I hope you too can get there.

Strugglin,
I edited a lot after you read my post. You might want to reread it .
I also asked if your Dad’s outside caregiver does his showers. And what does he need help with that he refusing to allow the facility staff to help .

Definately do not go in yourself and do more things for your Dad . That is counterproductive .

Your father sounds exactly like my mother and father in law were. Both alienated the staff and refused showers . I spoke to management at both facilities ( they were in different ones ). They both said the same thing , they will let you know when they need memory care.

You could try to get the doctor to order something for depression anxiety . My father in law had no results with the antidepressant. My mother took something for anxiety. It helped her . She refused an antidepressant .

I was given 30 days to put my mother in MC if she didn’t shower . Mom had stopped doing her own occasional “ sink bath “ of pits and privates . And wasn’t changing her brief as often . Which was I guess keeping the odor to a tolerable level ??? She refused showers and her room smelled so bad it was coming out into the hallway. I told the facility that they were not being forceful enough with her with the showering from the get go and let her get away with it too long , so I expect them to now try to correct this. They wanted me to talk to Mom . I told them that my mother would not listen to me or take showers for me and THAT IS why she was in their facility . Ended up going down there and going in Mom’s room with the facility director who told my mother if she didn’t shower she could not live there anymore . The director thought if she told Mom in front of me that it might work , since I placed Mom . It did . My mother only trusted the Charge nurse , not the aides . So the charge nurse and an aide showered her . I looked for a new facility and was in the paperwork stage to get ready to move Mom because she was refusing to shower again and refusing help with incontinence. She died before the move .

My FIL wasn’t much better about showers , he would yell at the staff too . His attitude was he was paying the rent there so they couldn’t tell him what to do.
We had to push that facility to push him more as well . He started allowing showers . But refused help with incontinence care , and he didn’t do a good job on his own . He did not change often enough. His room stunk too but he always kept his door closed .

My mother and father in law were still able to have conversations , unlike the people in the MC units . The facilities they were in kept them in AL a long time . They both died before going to MC . Mom most likely had a heart attack . They found her dead in her chair . FIL died of Covid .

strugglin,
does Dad like the outside caregiver ? Is the outside caregiver doing his showers ?
What does Dad need help with that he’s refusing to let the staff help with ?

Let the staff earn their pay.

Trust me, they have seen everything under the sun!

Stay away for a bit--don't make dad's dad behavior YOUR problem!

Perhaps they do feel dad is ready for a higher level of care. That happens all the time. IS he well enough to understand that his behavior is causing distress that he can control? It could be it's time for MC, which is not nearly as 'fun' as an ALF. You lose a lot of freedom in a MC facility.

Good Luck!

Does this AL have a memory care wing or bldg associated with it? If so, take dad on tour of it and let him know it's his next stop w/o a geriatric psychiatrist appointment to evaluate his medication needs. The vast majority of elders with dementia need antidepressants and calming meds like Ativan and "refusal" to face that truth puts his future OUT OF YOUR HANDS.

Do not underestimate the facility, they sent my mom to the ED and have refused to take her back until her behaviors are undercontrol.

It has been a nightmare, I hope your LO understands they need to adjust or adjustments will be made for them.

Leave things as they are. It's the job of the AL to deal with your father's 'behaviors'. This is why these places get the big bucks.

If he becomes too unruly, too stubborn, and too disruptive to the staff and residents they can evict him. Then you will have to find a new place for him to go.

You can have a talk with your father and level with him. Tell him straight that the AL is the last option for him because after that it's a nursing home or memory care facility.

Let him know plainly that if he is rude and makes 'trouble' for the residents and staff he will be medicated or put in a nursing home. See if this helps.

If it doesn't then you'll have to medicate or have him moved.

Is he currently on any meds for depression/anxiety/agitation? If not, please consider this as an option.

People with dementia lose the ability to bring themselves to a place of acceptance and peace because of their declining ability to use reason and logic. They also lose empathy for others, they lose their sense of time and connection to their own bodies (reading its signals), the develop paranoia, so they need external help in the form of meds and an understanding, compassionate staff.

The admins and staff can only do so much since your LO is losing his ability to learn and adapt. It's not fair to ask this of him when he organically can no longer do it.

I would let the cards play out on their own unless you yourself are seeing aggressive behavior.
Truth is that you are likely looking at a need to move out of AL into MC and I would be honest to tell this senior that is what he is looking at.

Sit him down and tell him that rudeness to those he is DEPENDENT on now will get him thrown into MC where he will be medicated, like it or not, and sharing a room with someone nastier than he is.
Lay down the law.
Now, if this doesn't work, then you ARE looking at MC and at medications, just as I indicated in the threat above. So much depends upon his ability now to understand and act on your advice.

And when you get the call from Admins there--well, you will be expecting it. Let them know that, and ask for their help and cooperation. Speak to MD re a trial of low dose anti depressants which often works.

Interestingly enough, medical marijuana is now used in MANY facilities. One in Austin recently working with a friend's mom who became completely non verbal. Guess what? It's WORKING and her mood is much better as well. l Guess it's called "Baby Boomers hit the Elder Care Communities?

Has your father been seen by a geriatric psychiatrist?

He sounds depressed and agitated.

I would let the staff and management work this out.