Handling His Phone Calls: Dad's First Week in AL

lisatinaustin

Sorry for the really long post in advance. I can be wordy and this is my first post!

My 82 year old dad does not have an official dementia diagnosis, because he resists seeing doctors of any kind. My brother and I each lived 3-4 hours away from him until last weekend, when my brother FINALLY managed to get him moved from his own home of 42 years to a very nice AL 10 minutes away from him. 

A bit about my dad BEFORE dementia: resists going to the doctor, resists medicine, resists rules, resists authority, values freedom, independence and his money over most things, although he loved his wife (who passed away 8 years ago) and my brother and I. He's a very intelligent man, a PhD who taught college chemistry for years. He was known to be a friendly man to his friends, co-workers and neighbors. 

These traits have greatly magnified with his progressive dementia (except the friendliness!). He resisted moving from his home until we finally pretty much forced him to because of multiple things: 

• he locked himself out of his house and fell and injured his back in the process
• thought we locked him in his house and turned the thermostat to freezing (we didn't)
• couldn't figure out how to open the front door to get the delivered meal we order him
• couldn't figure out how to make or receive phone calls
• couldn't figure out how to use the thermostat
• would stand in the middle of the street for long periods of time without a shirt on
• would walk into his neighbor's house without knocking, multiple times
• would forget where he lived
• started losing chunks of memory, mostly short-term, but sometimes even all memories of when we were children (40-50 years ago)
• had delusions and would forget who we were sometimes
• in the process, he refused to have a home caregiver in his home to help with any of the above

Now that he is in AL (just 4 days now), he wanders around the hall and goes in other resident's rooms, walks in the hall in the middle of the night without a shirt on and looking for his laundry or trying to use the nurse's station phone, and refuses to go to activities. The AL has said he might have to have a full time sitter or move to memory care. The resident doctor will do a cognitive evaluation on him tomorrow.

No to my specific question: He has been calling me telling me my brother is corrupt and took his money (not true) and is controlling him, that the place is terrible and all his freedom is gone and they control everything about him, that it is terrible and that he might have to threaten if things don't improve, etc. Sometimes he rambles on in a monologue, and eventually his voice trails off so much that I cannot hear him and I usually just hang up and he forgets. But when he does ask me what I'm going to do, what do I say to him that would be helpful?? When I say we are doing what is safe for him, he gets angry and denies that he has any issues or needs help. He thinks he is perfectly healthy and normal.  Do I just listen, ask questions and then just say we will have to look into that, but in the meantime be sure to try to follow the rules for now? 

Thank you for any input! 

JJ401

If it were my dad, I'd do memory care. Staff in memory care units deal with the in and out of rooms, and other behaviors on a regular basis. Hiring a minder in assisted living would only work while the minder was there. Once the minder leaves, he will revert to his previous behavior.

As to the phone calls. Acknowledge and distract. I'll talk to brother about that. Wow, it really rained last night. 

He is always going to say he is fine. He has anosognosia -- the lack of awareness that he has a problem. It can't be fixed. You will find ways to get around it.

Cynbar

Yes, go along with him, tell him you'll look into whatever it is. Keep your voice calm and reassuring. Avoid trying to explain or reason with him, he has lost the ability to understand and process and make reasonable decisions. Dementia is about so much more than just memory loss, it's about loss of judgment and executive function and often paranoia, which you are seeing. Reasoning with him will only make you both frustrated and angry, it's as if you are talking different languages now.It does seem that he is more appropriate for memory care at this point, their staff will have more training in dementia and related behaviors. And don't feel badly about limiting the phone calls, you don't have to answer every one .

Laura4yoga

Don’t be sorry for ANYTHING! Just make sure the facility is the correct fit for him. So much more help is needed in all assisted living settings. You are doing the right thing! During the entire process of Alzheimer’s things constantly change. Not easy but he will adjust and settle in soon!

lisatinaustin

Thank you all for taking the time to reply with advice for my dad. It has been difficult to NOT try to reason with him, because he's always been a very smart man who seeks out reason and logic. Yes, I do have to remember he is no longer himself anymore, even if he does a great job of playing off like he is and begging for reason and explanation. I like the response of empathizing with his complaints ("yes, they sound very rude" or "oh, I wouldn't like that, either") and then something like "I'll see what I can find out" (then I'm not technically lying, just finding out that he was wandering in other's rooms, etc.! ) Then I'll change the topic and talk about his great grandson (which brightens him up ... I send photos of the baby to his digital frame).

I do hope that memory care is where Dad ends up, although it seems to be more my brother's decision since he has been handling everything living closer (I'm still 3 hours away from Dad). I, too, was thinking that if has a "sitter", but wanders around in the middle of the night, how that would help matters.

Thank you all again.

jfkoc

Welcome from me too

I would take time to call him a couple of times a day. I would not ask how he is doing but would share a little something....tell him you just watched an old Gunsmoke on TV and ask if he ever watched westerns. He probably did and may talk your arm off.

You might also send him a car or a short note.

Amymv

Hi Lisa,

I am so very sorry your are going through such a difficult time.  It will be good to have the doctor evaluate your dad and get a clear picture since your dad isn't a fan of doctors and has not been to see one.  

I agree with the others here that you should listen to your dad, acknowledge you have heard him, let him now you are concerned, and redirect.  My mom used to call often to complain and at times it truly was hard to tell what was real and what wasn't!

He will adjust with time and maybe he will need to go to memory care.  Time will tell. I hope your dad's friendly disposition will return and that he will find new friends and fun activities to keep him occupied. 

One other suggestion is to keep an eye out for urinary tract infections.  They can really mess with the elderly and make dementia symptoms worse.  I am not saying your dad has one, but it's something to watch out for.

Sending you well wishes and prayers!

lisatinaustin

Well ... Dad just called after his medical evaluation and wants me to call the police (in his home city where is no longer located!) and is SUPER anxious and upset. I didn't promise to call the police, but did say I will talk to my brother. Come to find out, my brother is moving him to memory care today ... and getting him his covid vaccine, so it's a rough day. I have trouble redirecting Dad when he just anxiously rants on and on, so troubled and afraid and upset. I did say I would "look into it" and that "I can understand that you are afraid" ... but it seems trite to just start talking about the weather. He also asks if I know anything about it ... I hate the lying!

Rescue mom

Well, I was going to say get to memory care yesterday, but it’s been done, which is good for everyone. The behaviors you describe are indeed beyond most ALs, and most MCs are better suited to handle all that.

You cannot reason, convince, or be rational with him anymore. His brain is broken. He cannot think like that any more. Logic is no longer involved. That’s what dementia does.  Telling him to follow rules won’t help, you can’t convince him, he won’t remember. Etc.

When he complains, you were exactly right. Just say “I’m so sorry that happened/it’s like that, I will look in to it.”  Or, “we’ll talk more later.” Or “I wouldn’t like it either,” then talk about grandkids—you did great!  Fibs are hard. But there is a greater good involved. Better to tell him a fib than to let him be upset and angry. 

Does his med eval include the possibility of Rx drugs? Sometimes they are needed to help our LOs have some quiet in their own heads, if the acting out gets really bad. Nobody wants them drugged out, but the proper meds can bring great relief to them.

Repeated phone calls are a frequent problem. You do not have to take all his calls.,If there is an emergency or a real problem, the staff will contact you.

ADH77

Sounds to me like you should be looking into memory care options now. I'm surprised that this assisted living facility accepted your father--many do not accept residents with dementia, since progressive dementia will quickly put the resident beyond the care abilities of assisted living. Better to get started now while you (hopefully) have some time to weigh options. It can take awhile to get someone into memory care, as you'll want to find a place that meets your needs AND has availability. 

Regarding what to say to your father, I wouldn't engage on the substance of what he's saying beyond calmly sympathizing, and then switch the subject to something he finds pleasant. Basically, try to de-escalate him. What he's saying isn't true, but he can't know this, so there's no point in trying to get him to "see" what's really going on--he can't.

Sorry you're dealing with this. Good luck.

King Boo

Good for you brother.  He recognized that your dad has higher acuity care needs and requires dementia trained staff.   Care needs drive the decision making, not emotions, even though of course it is very difficult.

How is your brother at talking with Dad?  Since you are learning the fine art of 'the fiblet', it is likely that he too is on the learning curve.

It's probably counter productive to tell Dad about things like the COVID shot and a move to MC - or is brother, also, remembering the Dad that used to be, conversational, detail oriented, etc.

The best answer is the one that brings the most comfort.  

My spin upon our move from MC to snf:  "Hey Dad, I'll be here tomorrow, we're getting  you a nicer room"

"Hey Dad, you deserve the best!  The help over here is much better."

"The chef over here has a great reputation!  We all like good food."

Appeal to what would appeal to him.   Explainations have to stop, except to pave the way to smoother care.

I'm glad he is at an appropriate care leve.

End-of-rope

Here's a thought:  Are you sure your dad is expecting an answer from you when he is complaining about everything and demands that you do something about it?  My mom goes on her never-ending rants and asks me what am I going to do, but I have learned to say absolutely nothing.  I just keep quiet and after a very brief silence she starts ranting again.  In my mom's case redirecting doesn't work.  As soon as she hears my voice attempting to answer her question (if she even pays attention, which hardly ever happens) she will get more agitated and become aggressive towards me.

The "call the police" demand is a daily occurrence with my mom.  At the MC facility they removed the phone from her room because of her constant calls to 911, and now she has a no-dial phone only to receive calls from the family.

I hate fibs so just keeping silent works well for me.  Maybe it will also work for you.

Definitely your dad is in MC level of assistance.

lisatinaustin

Thank you all for your replies.

@end-of-rope. This is actually the method I tried a day or two ago and it worked well. I just listened and let him talk, and kept saying "I'm sorry about that." or "I know, that must be hard". Then I talked about my kids and grandson to distract for a little bit which he enjoyed. He did come back around to the topic again ... he was actually crying several times on the call (is this a normal symptom of dementia?). 

Overall, I think he is learning to adjust to memory care. The staff is trying to get  him to engage more in the activities and with others there, so they have not been making sure his phone or Grandpad calling device are charged up. But I'm okay with that for now until he gets better adjusted. It beats getting the 20 voicemails in the middle of the night when he lived at home. 

End-of-rope

@lisatinaustin:  Memory care was a complete shock to my mom and even more to me.  MC, as opposed to AL, has MANY restrictions.  My mom still complains about everything after almost a year.  In MC, at least at my mom's facility, usually residents don't have cell phones, because they lose them and/or they are not able to use them anymore, or they call all day long the family and the police.  If my mom wants to call, she needs to request the staff assistance to call through the facility's phone.  She has a land line in her room but with a no-dial phone after all phones were removed because of her constant calling to 911.

Yes, my mom cries a lot and begs me--when not demanding it--that I get her out of the facility.  It's not easy for them nor for us.  On time, residents tend to get used to their new environment, but the time it takes varies with each person.  Unfortunately my mom is high fall risk, so she's fallen several times and had been sent to the hospital and then to rehab, so when she goes back to MC we have to start the adjustment all over again.

Participating in group activities helps them to get adjusted, but my mom many times refuses to participate.  Currently she has no option to refuse anymore because after her last fall they have her under constant supervision in common areas even though she would rather be alone in her room (another source of daily complaints.)

I hope your dad adjusts quickly to his new surroundings.  Best wishes.

lisatinaustin

@end-of-rope ... your mom sounds alot like my dad, although Dad has only been in MC for about a week. Today he got angry with my brother and SIL when they visited him and told them they put him in this prison. When I talked to him, he said they are "evil" and did this to "benefit them". I actually backed up my brother (at brother's request) and said "you are in the place that can help you, and I agree with brother and even packed your things." Futile conversation after that. He thinks it is a prison with no freedom, which is understandable. He thinks he did something wrong to deserve being ostracized by us, even to the point of saying it's not worth him living anymore! He also does not like going to the activities or socializing with others and prefers to stay in his room. But then he unplugs his TV, his clock, his Grandpad video device and has nothing to do.

End-of-rope

@Lisatinaustin:  My mom still complains that she's in a prison.  As I'm the POA, she has demanded many times that I force other members of the family to get her out of there because I'm not going to do it:  "I put her there."  When the delusions hit, then she tells me that EVERYBODY else gets out of the facility, go shopping, to restaurants, to parties, etc., even during the pandemic when they were under lock-down.  I couldn't believe how manipulative an Alz patient can be until finally the lock-down was lifted and I was able to go into the facility and confront my mom's stories with the staff.  When she had nowhere to run, she finally blew-up stating that, whatever she had told me, after all, "was what SHE wanted."

It's useless to try to reason with a PWD.  You shouldn't even tell your dad that you agree with your brother because it will only agitate him more.  At best, if you want to say something, tell your dad you'll talk to your brother.  But the complaints will continue.  It's hard to adjust to a total lack of freedom.  I've even made the mistake of trying to explain to my mom that she has an illness (unspecified) and she needs special care that can be provided at the facility...  She jumped like if she had been bitten by a snake, and started shouting that she was not crazy, and all kinds of offensive things towards me.  I never mentioned a "mental" illness, but she knows something is not right and sometimes she wonders what is happening to her and why is she not able to understand things anymore.

Regarding "not worth living anymore,"  at least for my mom is a normal conversation.  She is very dramatic and for years on end has been saying that she should be dead already.  Nevertheless, she is always concerned if she thinks she hasn't taken her medications for cholesterol, hypertension, osteoporosis, etc, and wants to make sure I don't forget to bring her the nutritional drinks.  Last week the staff at MC called me very concerned because my mom had grabbed a fork, had pulled the collar of her blouse down, and had shouted that she didn't want to live anymore, and had pointed the fork at her chest by her heart.  No, she didn't poke herself with it. She is too scared of pain. Just threatened to do it.  My mom later told me the story with a knife instead of a fork.  Anyway, for years my mom has been threatening to kill herself with a knife.  It's a recurrent thing with her.

Your dad may be unplugging his electronic devices because he doesn't understand how to use them anymore.  At least, that happened to my mom.  She is unable to use a phone, a computer, a TV, or any kind of remote control anymore. I used to log in remotely to my mom's computer to help her with what she wanted to see or hear but, after the last episode of fall-hospital-rehab, when she came back to MC she never mentioned it anymore.  I think she has already forgotten the computer altogether.

Your dad is frustrated with his situation.  And so are everybody else involved. It's unavoidable.  We just need to pray for serenity.