Assisted Living for LO

Windsor320

Hello, I've been a care taker for Mom who has passed away from dementia. Now my Dad (who is 92 years old), is getting worse with the screaming and paranoid, hallucinations, and more agitated. (I'm his only care taker).   He no longer wants me to go out of the house because he thinks I'm running around with a gang, or I'm going to get hurt. I have to start going back to the office to the work soon and it's becoming a problem to even leave the house anymore unless he goes with me.  He now is on meds to stop all this, and once it wears off -I'm back to the beginning of this mental illness. Having someone come to the house for an hour or two to watch him take his meds is not the answer,  

He has gotten to where my friends and family have said it's time for putting him in a facility.  I have agreed since it has now taken a toll on me with my health issues. (from worrying too much). 

I am worried that he maybe thrown out of a facility since he is not a very nice person to begin with.  The meds tune it down deeply.  He is not the social type, and I've spoken with a few facilities to let them know upfront what type of person he is, and they said that is Ok.  They know how to deal with someone like him.  I'm stressing that he would be right back here with me, and I can't take care of him anymore. 

Thank you for letting me vent. 

LicketyGlitz

Hang in there, Windsor! Good that he's on medication to help relieve him, and you, of some of the paranoia and other tough behaviors he's experiencing and you're trying to cope with.

"He now is on meds to stop all this, and once it wears off -I'm back to the beginning of this mental illness."

Are these medications only prescribed temporarily? Is there some reason that if they are helping they will not be continued?

 It sounds like you've found a couple of facilities that are used to working with more aggressive residents. I understand your fears of finding him back home. Do your research on each of the joints - including in person visits if you can - and pick the one you think is best suited to offer your father a home.

 Good luck!

Windsor320

Thank you! LicketyGlitz

The meds are temporary usually his Dr. puts a limit on the use of his meds and has him come into the office, and be sure the meds really are working for him. 

Yes, we found a couple of places that we visited and they will review his medical and mental condition to be sure he is on the right meds, what stage he's in, and how he functions on the them, or adjust what he is taking.  These places we visited want them to be able to stay active, and to independent as long as he able too.

harshedbuzz

Hi Windsor-

Is your dad being seen by a geriatric psychiatrist? These are the specialists for psychoactive medications in the elderly. 

Does he have mental illness, dementia or a combination of the two?

It doesn't sound as if he's safe to be home alone, so headed back to the office would mean he'd need care while you are out of the house whether someone comes in or he goes to a day program.

If he does have dementia, you should be looking at a secure MCF not AL. Staff in a hospitality model AL will not have the training to manage and cope with the behaviors you are describing. Much as you want the least restrictive setting for him, he will not be successful socially in a traditional AL with those behaviors regardless of what the sales staff at the facility tells you. 

HB

Windsor320

Thank you Hashedbuzz

He hasn't seen specialist for pyschoactive mediation.  He doesn't display all the signs of dementia.  He is still able to dress, bathe and do some light chores.  I would like to take him to a specialist but he refuses to go.  I do think it's the combination of mental, and dementia since he is not displaying other characteristics dementia.

I agree with you that he will not be successful in AL and have told my family today.  Great idea but it's not a good fit.  They still want to pursue the AL option instead of someone coming to the home.  

harshedbuzz

Windsor320 wrote:

Thank you Hashedbuzz

He hasn't seen specialist for pyschoactive mediation. 

Perhaps this would be a good idea. There are meds that could reduce anxiety and also manage paranoia and hallucinations. These disease manifestations are real to him and can be terrifying. I'd try to get him in to see a geriatric psychiatrist. 

Another piece to this kind of anxiety, aka the gangs, could be what he's exposed to on TV. By midstages, my mom could no longer watch her beloved crime dramas if dad was around because he absorbed the storylines as having happened to him. By this point he couldn't really follow a plot, but he could absorb that most heinous scenarios as his own experience. A time came when I put parental controls on his set top box in order to keep him from things like CSI, The Weather Channel (always thought fires and hurricanes were headed our way) and also purchases. 

He doesn't display all the signs of dementia.  He is still able to dress, bathe and do some light chores. 

Dementia is more of a syndrome; there are a range of symptoms and behaviors that are part of each stage. There are certainly patterns of progression, but no two people will present in exactly the same way. Dad's dementia wouldn't necessarily look like mom's dementia. The type of dementia- Alz, vascular, FTD, WKS, Lewy Body, etc- have slightly different features. Personality can also flavor the behaviors and symptoms. 

Stages of Dementia Dr. Tam Cummings

I would like to take him to a specialist but he refuses to go.  I do think it's the combination of mental, and dementia since he is not displaying other characteristics dementia.

Do you hold his medical POA? If you do, I would find a way to finesse getting him in front of a neurologist for an evaluation. It's best not to warn ahead of time, but maybe to make up some story about a special Medicare exam that is required to keep his insurance or dropping by to see the doctor for a refill for something. What ever it takes. Ahead of time you sent a list of concerns you have so you don't have to throw dad under the bus. Most neurologists would give you alone time to discuss, but it's not universal.

You mentioned that he had always been kind of difficult. Same here. Dementia on top of dad's underlying mental health and substance abuse issues made getting to a diagnosis more difficult. But the geripsych's approach tamped a lot of that down and allowed him to stay home until about 8 weeks before he passed.

I agree with you that he will not be successful in AL and have told my family today.  Great idea but it's not a good fit.  They still want to pursue the AL option instead of someone coming to the home.  

Having care in the home 24/7 is typically way more expensive than a facility and way more work for the person who is juggling multiple caregivers coming and going and flaking when you need to get to work.

MC is typically more money than AL, but the staff should be up to the task of managing a difficult personality with dementia. I was amazed by how well the staff where dad was were able to keep him feeling calm and safe.

May flowers

My FIL has vascular dementia and he fits in several different stages. He is still able to bathe, dress, toilet and feed himself, but his short term memory is almost completely gone. I would put him at stage 5-6 in some areas and stage 4 in others. 

At our house he was able to watch/follow TV but eventually that stopped holding his interest and all he wanted to do was walk around outside or sit and do nothing. He lost interest quickly in activities or conversation.

We debated on in home caregiver and memory care, and went with memory care just because of their program - the day is full of activities and interaction. It has been only a week, but he is hanging out with a group of residents and they do activities together and chat on and off. Socially, he is much better off when he was here, I think just being in a group he is more willing to engage in things he did not here. So, in hindsight, it was a good choice. When we went to visit Sunday, he was sitting in the courtyard with another resident chatting. When we were leaving, he asked us to take him back to the group. While I know it isn’t helping his dementia, his days have purpose now. 

He would not have been able to do AL, because he needs guided to activities, reminded to do things such as eat and shower. Without outside stimulus he is in a state of inertia.

I don’t know that a live in caregiver could have provided that at the level the MC does. I don’t know that it would have been much different than it was here with me and my husband. Another thing that is nice is the caregiving at MC probably feels less like “babysitting” because a lot of the caregiving is part of the group and is probably not even noticed. Things he would pushback on here, he does not there as it is just part of the routine.

Some of the residents in my FIL’s group do appear medicated - I think some of them probably have some issues with aggression since it’s the nature of the disease. But they are not wasting away alone or in a state of limbo, they can interact and do participate with the group, but tend to doze off and on. 

MimiMinder

Good morning! I think the heart of the matter is in your final sentence: ...I can't take care of him anymore. Hold on to that thought and remember it is true - and there is nothing wrong with speaking your truth.

You have done an incredible job for your LO and now it is time to let the professionals manage his needs, including getting his meds adjusted. It's hard to let go, but it is also incredibly freeing realizing you can reclaim your own life. Maybe meet up with friends, plan a vacation, take a relaxing bath without getting interrupted...

As you are looking at AL facilities, I would encourage you to get a feel for the organization and staff. Is it a job or is it a passion? We have experienced both and there is a huge difference. Also, it sounds like your dad might function best in a secured environment (ie a security device on his wrist or ankle), because he might be a flight risk.

My mom was only with my husband and me for six months (she broke her wrist in AL during COVID and was slowly withering away before we brought her home) and then she wanted 'her own apartment' again. She is now in a secured AL (it's really memory care, but they call it AL) with incredible staff. I am no longer a caregiver but a daughter again. Even though my mother was on board with moving, she had a rough transition and had to be medicated for agitation. I held firm to the belief that she was better off having an entire staff take care of everything that my husband and I did. Once she moved out, she wasn't moving back in. Period. Line in the sand. And I am okay with that, knowing I had done an awesome job. And it sounds like you have done that, too!

Good luck in the coming days as you make decisions and know that we are here to be a sounding board and support network!

Windsor320

Thank you! 

Yes, I am his POA, on his will, and co-owner of all of his financial and medical information. 

It's a tough decision to make.  I know deep down it's the right decision and hard to let go.    He'll be well taken care of and on the right meds.  I will try to make an appointment for him to see a specialist.  I have found a medical practice that will come to the home to exam him.  My friends and family have said the same thing.  The 24/7 care at home is overwhelming.  

I visited a AL facility today and they told me that it'll take the care giver about 6-8 weeks to recover just as much time for the LO to adjust to new surroundings. 

Some places have the alert monitor with a GPS tracker for all the residents.  They also check on the residents throughout the day with locked doors so I know he'll be safe if it comes to the point where he starts to wander.  

The next coming weeks will be tough.  I truly appreciate the advice all of you have provided.