Ready for AL

John_O

Up to this point my father has continued to live alone despite exhibiting symptoms of the late moderate to early severe stages.  We have introduced a caregiver who comes for 5 hours a day, but we are too nervous now about leaving him alone for longer periods of the day.  We have also come to learn that a neighbor has been manipulating him to try and drive a wedge between him and us.  

I recently had a conversation with the director of a local memory care program who warned me (very seriously) that she has seen many examples of "anonymous calls" to authorities when neglect of people with dementia is suspected.  She said it results in a very complicated problem for families (involving frozen assets, legal intervention, etc).  This frightened me and considering the situation with his neighbor, I want to get ahead of this.

It is time now for him to be a safer place and we have found an AL facility we really like.  However my father has stated in the past that he absolutely will not move to an AL and he wants to remain at home.  I don't believe it's really his choice anymore, but I fear a very difficult set of actions that will have be done in order to accomplish it.  I also fear intervention from his neighbor during the process.

Does anyone have any advice about when it's time to move a LO into AL and the LO is very resistant? I appreciate any help here.  Thank you.

toolbeltexpert

John welcome to the forum, sorry for your situation. You don't mention if you have a poa. That's the first step if your father is willing to sign.  How has your dad responded to the care giver that's a real plus if that's going well. Keep posting I do have as much experience as so many here.

May flowers

It sounds like you are on the right path for your LO. It became pretty clear that my FIL could not live alone, and we moved here for a year, then memory care when his needs became more than we could handle. Our neighbors on both sides were critical of our moving him to MC. For many they see it like a nursing home when it is nothing like that. He thrived there for a long time through with structure and activities, and made friends. He is at a different stage now post surgery and is back home with us on hospice. He would require 24/7 personal care at MC on top of the monthly fee ($20k/month!), and the things that benefitted him in his early days there no longer apply.

Anyway, I remember reading tons of posts on here about moving him. You will find a lot of good suggestions here in previous posts. We were prepared for a battle - he always said flat no when we discussed it. So we got his things moved and were not planning to tell him prior to the move - but DH decided to tell him the night before and he took it better than expected. They kept him so busy, he didn’t have much time to sit and stew. I don’t know if it made a difference that he was moving from our house there instead of his home, I think he was already feeling uprooted somewhat.  

Whatever you do, I would keep the neighbor out of the loop - tell him you are taking him to a dr appt or something. 

MN Chickadee

Oh I would watch that neighbor situation closely. Nefarious things happen more than you think; friends or distant relatives or even strangers worming their way in and taking advantage of a PWD. You can see why, they would be such an easy target to get money out of. A friend of mine had her mom completely taken over financially and the person was even living with her eventually and controlling everything, and my friend had to spend so much time and money in court sorting it out. And there have been stories on these message boards over the years of various situations of people coming out of the woodwork trying to involve themselves. If you have concerns about dad being alone during the time the caregiver is not there that is definitely a sign it is time for round the clock care. Do you have a rock solid POA and have done care/financial/legal planning with an estate attorney? If not do that ASAP, both in preparation for moving him to care and to ward off issues with the neighbor. Is this an AL with some memory care services?  If it is not a locked unit and he doesn't understand the need to be there I would be pretty worried about him wandering off. AL and MC can have many definitions depending on your state so hopefully it has some aspects of memory care built in. Staff training in MC is also very different, a typical AL can mean a it does not have the staff ratio or dementia experience necessary to care for a PWD.

Most of us cannot tell our LO the truth. You have to work behind the scenes and use therapeutic fibs. Many blame it on the doctor. The doctor wants you to stay in this "rehab" or "clinic" for observation or until that bad knee improves or your blood pressure or if he is somewhat aware of his issues maybe it is a memory clinic that will help his memory issues. Sometimes there is an "issue" at the house, you can stay at this senior hotel until the burst pipe is fixed or the electricity is restored. Rinse and repeat. You don't have them pack up their bags and say now let's get in the car to go to the nursing home. Finesse the situation. We set up the room ahead of time while someone took mom on an outing. Then took my mom to the "senior center" which was the MC for lunch. Said let's stay for the activity after. Told her she needed to stay here this afternoon because we had to take dad to the doctor. We had the staff take over and distract so we could leave. Her loop was so short that by that time she didn't even know how she got there or the original fib. We left a note with the staff from her husband saying the doctor wants you to stay here a few days, I will be back tomorrow to visit, I love you etc. The staff went over it with her often. They are totally used to people who don't want to be there and should be skilled at distraction and validation techniques. Talk with the staff ahead of time about the approach. The initial transition can be very hard for all of you but it does get better with time and eventually he should settle in. It is both a very sad time and a relief to know they are getting the care they need. My mother had many good years in MC enjoying the activities, routine, and structure and the medical oversight by nursing was worth so much more than we anticipated. We still had a lot of fun outings and celebrations with her, as well as simple visits where we just enjoyed each other. Facilities have changed so much in the years since our grandparents were in long term care.  Life isn't over just because they are in a safe place. 

MacyRose

It sounds to me like your father may be beyond AL and actually ready for MC.  It was hard for me to realize that with my own father but AL only has 2 caregivers for 20+ people and MC has 2 for 10 or so - so that's a really important question to ask - how many caregivers to residents?  Now about that neighbor...danger, danger!  In your position, I would not tell your father that he will be moving.  If you have POA, you have the right to make this decision.  If your father doesn't know, he can't tell anyone and the neighbor will not rush to try to get his POA - and yes, crazy stuff like that has happened.  I would put the neighbor on the "No visit" list at your father's new facility.  As POA you have the right to decide who can visit dad.  I would select a facility as close to your home as possible - the closer the better, preferably not more than 15 minutes away from your home.   Tell no one the neighbor knows where dad is.  It's none of their business anyway.  Get dad's new place setup and ready for him and move him.  Make sure the neighbor's number is not in dad's cellphone or phone book - if he is even still able to use either.  Afterwards, you can go back to his house and get other items for his new place and his clothes.  Just be fairly subtle about the move so you don't attract attention.  If the neighbor approaches you, just say you are busy and cannot talk now.

Tell your father that there is a problem with his house that must be corrected and it is going to take a long, long time to repair and he must move out, so you found this great place for him to stay until it is repaired - and repeat.  Eventually he will forget about his house and get into the swing of the facility.  What I found with my father was if he knew I was going to move him, he would become distressed because he couldn't imagine how I could move him, so I generally didn't tell him he was moving until that day or the day before.  This way it cost him the least stress. There are companies which specialize in senior moves.  I hired them and they were turnkey - they moved everything for me and placed everything according to plan and even hung paintings, TV's and unpacked everything.  They are a godsend and take a ton of stress out of the move for you and your siblings.  Find one and use it - worth every cent - and it's not all that expensive anyway!  Initially you will be visiting him every day and then taper down to several times per week, if you want - sounds like you have brothers and/or sisters who can keep up with the visits.  Make sure everyone knows about the problem with the neighbor and also the story you will make up about the problem at dad's house which is fully covered by insurance but will take many months to get repaired.  After a while your dad will stop asking about his house.  While dad is in the facility, you can take care of cleaning out the house, distributing items between family members, selling off anything you want to sell and selling the property. If you want to get rid of the neighbor for sure, you can lie to them that your dad is deceased.  Remember you are doing this to protect your father, so there is nothing wrong with lying in a situation like this.

King Boo

An evaluation from a Geriatric Psychiatrist MD backed with tests results from a PhD neuropsychologist if needed to get documentation that Dad needs you to be his proxy.