It’s time

May flowers

I am so happy to have found this board! My husband and I take care of his 82 year old father who was diagnosed with vascular dementia in 2015. He moved in with us in July of last year as he wasn’t eating well or taking his meds. We considered memory care but decided to bring him here due to covid. He also has severe macular degeneration. 

We came up with a plan to move him to memory care when he got to a certain point and we are there now, I believe. Some of the things that make his care difficult are OCD behaviors that redirection and medication aren’t helping, starting to not know who I am, paranoia, wandering, and agitation. He has always been easy to deal with until the past few weeks, and now everything seems to be a battle. He is not physically aggressive and I don’t feel I am in danger, but he does require constant supervision. I have a 19 year old son who is here all day as well. My FIL is very restless these days, TV and music don’t hold his attention very long at all. He is either pacing or sitting and does not participate much in conversation, at least with me. He is a little more communicative with DH.

Fortunately, he does sleep at night, and he can still handle his own toileting, bathing (as long as we lay everything out and start his water), grooming and dressing himself. He can feed himself and is in excellent health - no other issues. 

I think we need to be thinking about placement in the next few weeks, my husband thinks we should wait a month or two. We have a lovely place picked out and they have openings and a nice courtyard where he could walk to his heart’s content. If we wait, I would like someone to come here a few hours a day to give me a chance to get other things done (I have a small farm). My husband is not onboard with that yet, but we are still discussing it. My main reason for wanting to do it sooner is I don’t want him to regress further before placing him. I think he might even make a friend or two there at this point, but I think it won’t be that way much longer. 

So, while we work this timing out, I would like to know any suggestions to keep my FIL safe in the interim. I put alarms on the doors and windows, so I know if he’s going outside and have an alarm mat outside in case he starts roaming at night. He has a phone with GPS, but I still keep an eye on him when he walks. He will walk up and down the driveway for hours or sit on the curb. Today, I set up his rocker on the back porch so he could be outside but a little easier for me to keep an eye on him. 

Anyway, I know this is long, sorry. If you all have any ideas for other ways to keep him safe while we work out the details, please share

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jfkoc

Please have your father-in-law tested for  a silent UTI and make certain a culture is done.

May flowers

Thank you for your reply, Victoria. I was pleasantly surprised to know that this facility is open to visitors now ( in patient rooms and outside). I believe they will fill up fast. They just opened in 2020 but already have great reviews. I hope we don’t miss this window. 

I am planning to take some time for myself this weekend and leave DH in charge of his dad. I am pretty sure he does not realize all that goes into it, or that he needs to be monitored more closely than he was even a few weeks ago. 

I’m going to call the MC place tomorrow and talk about my FIL’s needs, what they provide, extra cost, etc. DH is onboard with that. 

It is a hard thing, like you said. I think it’s only going to get harder if we wait too long.

May flowers

He tested negative for UTI, that is something we always check when things seem “off”.

ladyzetta

Placing your LO is a hard thing to do. I had to place my DH and placing sooner is better then later. It will give your LO time to adjust and get to know and trust the caregivers and make friends with the other residents. Hopefully the adjustment happens not to long after placement.  My DH felt comfortable around his caregivers and they all felt like family to me. Trust is a big issue and that takes time.

harshedbuzz

May flowers-

I think you are onto something in placing him while there's enough cognition left to engage with the other residents and the people who will become his hands-on caregivers. With the AMD, I could also see a case for moving him while he has enough vision to navigate the facility safely. 

There's another concern, the care model for most MCF is that residents are expected to function at a certain level on admission. If his vision deteriorates or he has an abrupt change in cognition which is common to VD, he may no longer be accepted at MC which would mean moving into a SNF at twice the cost and without the MC activity programing which he might enjoy.

HB

May flowers

harshedbuzz,

Thank you for your reply and what to plan for when things deteriorate. From what I can see doing some research, it looks like the cost of the MC and and a SNF are about the same and should be covered by his pension, which is good news. 

One of the questions I will need to ask the MC facility is at what point can they no longer provide care. Is there a standard level or does it vary by facility?

My FIL just had an eye appointment but they said his macular degeneration has not progressed much in 2 years, so I don’t think is fast moving. Our home is hard for him because it is a log cabin, and even with every light on, it is too dark for him. His bedroom is bright white with LEDs and easier for him to maneuver. No wonder he likes it better outside.

Some of his problem is processing language too, I think. When he first moved here, I put signs in large letters on his drawers and doors to help him find things, but it seems now it is more of a matter of not being able to process the written language itself. He can sound out the word, but takes him a while for it to register what the word means. 

We have a lighted magnifying glass for him to look at picture books, but managing the magnifying glass has become too hard for him. His glasses are bifocals and self tinting but even that has been confusing for him so we ordered some plain glasses hoping that will help.

harshedbuzz

May flowers wrote:

harshedbuzz,

Thank you for your reply and what to plan for when things deteriorate. From what I can see doing some research, it looks like the cost of the MC and and a SNF are about the same and should be covered by his pension, which is good news. 

My experience is that a private bedroom with en suite powder room is about half the cost of a semi private room in a SNF. This was the case in suburban Boston where my aunt lived and the Philadelphia area where dad did. Three years ago, dad's MCF cost about $7200/month and a SNF was a little over $12K. 

One of the questions I will need to ask the MC facility is at what point can they no longer provide care. Is there a standard level or does it vary by facility?

This is always a good question. Some fancier corporate MCFs tend to cherry-pick their residents and will show someone with behaviors the door more quickly than others will. 

Dad's MCF allowed residents to "age in place" (meaning they can live out their life at the MCF) but have an expectation that the family will hire in private caregivers and/or engage hospice services as care needs increase. Dad never got to the point where we needed to hire additional caregivers and he died the evening staff suggested hospice to me. My aunt's MCF was part of a larger CCRC; it made more sense to move her to a private room in SN on the next floor than to bring in extra caregivers. They allowed her to still spend much of the day on the MC floor doing activities because she was a sweetheart and they were fond of her after 5+ years in MC.

My FIL just had an eye appointment but they said his macular degeneration has not progressed much in 2 years, so I don’t think is fast moving. Our home is hard for him because it is a log cabin, and even with every light on, it is too dark for him. His bedroom is bright white with LEDs and easier for him to maneuver. No wonder he likes it better outside.

My husband envies you your log cabin. LOL. 

My mom and a couple of her sisters have AMD. The guardian aunt's is pretty severe and she does injections. My mom's is very stable which is fortunate as she's already legally blind in one eye because of damaged optic nerves. She needs a lot of light, too. 

Some of his problem is processing language too, I think. When he first moved here, I put signs in large letters on his drawers and doors to help him find things, but it seems now it is more of a matter of not being able to process the written language itself. He can sound out the word, but takes him a while for it to register what the word means. 

My father did this. It used to make me crazy when I needed to drive him somewhere as he'd read all of the signs for streets, stores, neighborhoods and billboards. But like you said, the words didn't mean much. The last time I drove him to the geriatric psychiatrist we drove through the town where he had had a business at one point. Ever hopeful to spark a memory, mom pointed out that one of the business names he read out had been a customer of his and asked if he remembered. He swore he'd never been there before and when she said he had he snapped back that "they must've replaced all the buildings with new ones". This is a town known for it's Victorian downtown- so no new buildings. 

We have a lighted magnifying glass for him to look at picture books, but managing the magnifying glass has become too hard for him. His glasses are bifocals and self tinting but even that has been confusing for him so we ordered some plain glasses hoping that will help.

I bought this for my mom so she can work her crosswords.

Brightech LightView Pro LED Magnifying Floor Lamp - Daylight Bright Full Spectrum Magnifier Lighted Glass Lens - Height Adjustable Gooseneck Standing Light - for Reading Task Craft Lighting - White - - AmazonSmile

May flowers

Thanks for your responses. I will look into the magnifying stand. Costs seem to be about half of what you mentioned  here in Georgia. Thanks for explaining how it works and what happens when the care needs increase.