Siblings not on the same page

Hi mp1999 - Welcome to 'here'.

Just a thought on the long-haul - Eventually, he will not be able to be in assisted living, but the memory care. With inevitable decline, would you still want to have the entirety on your shoulders? Basically, where would you be getting the most assistance from - close to you or out-of-state?

Our situation is that MIL also has alz and vasc, and DH and I have our hands full to manage her care. mom (alz) lives closer to my brother and he has her DPOA and medical proxy, and also has my niece not far from them. This works out beautifully for all of us. I realize you are more than qualified, and each situation is different, but unfortunately, going forward with 'this' dreadful 'thing', it can get quite challenging.

Hi and welcome. I am sorry for your reason to be here, but really pleased you found this place.

Your dad is fortunate to have such engaged children. So often there isn't consensus around what is an appropriate level of care and often one child has all of the work of caregiving while the rest either Monday-morning quarterback or interfere with care plans.

Some random thoughts-

One issue with a parent's dementia is the tendency for siblings to get stuck around family roles and dynamics of growing up. That will not serve your dad's well-being in the long run. This is about him now. It's not your older sibs chance to pull rank under some misconception that they are more entitled by age or years of education.

Given that your dad has mixed dementia, it is possible he could progress in the disease more rapidly than a person with typical Alzheimer's does. It's also likely that he could follow the model of progression seen in VD which is a series of plateaus with sudden and sometimes dramatic losses of skills and cognition. This is to say that his stay in AL might be very short and that his ability to be the grandpop you'd want for your kids could also vanish much sooner than you'd hope.

In a lot of respects, dementia caregiving is different than other disease-related caregiving. It's not like nursing a person with a chronic condition like CHF, diabetes or leukemia where medical training is very important. As your dad's disease progresses, care will be more able providing quality of life—safety and comfort— not battling disease.

As the disease progresses, there will be times when you need to drop everything and be with your PWD. TBH, the SAHP of 6 kiddos likely has less flexibility for the sort of caregiving crises that may happen than someone who controls their own calendar, has no or older kids and/or can take FML. When your dad has something like a fall or UTI, he might be transported to the ER solo which means a family member (Ideally POA) needs to drop everything and meet the ambulance. You're familiar, I'm sure, with hospital psychosis. This is nearly universal when a PWD is hospitalized and generally means having a family member stay with them for the duration.

Allowing siblings to take this on will allow you to focus on your children which is ultimately job one as a parent. I'm an only which made me the default in helping my parents. I have one adult son with ASD and it hasn't always been easy balancing supporting his transition to adulthood and my parents increasing needs. There are times when both responsibilities get shortchanged.

What are the metrics by which your family is judging ALFs? It can be hard for families to know what aspects will make for a comfortable experience for the LO. It's easy to be swayed by things like decor when things like dementia training and dementia-informed programming is more important to quality of life. It's very possible, given his diagnosis, that he won't last long if the ALF is a hospitality-model and not a specific high-acuity facility dedicate to memory care. It's possible he might be far enough along to need MC now. There's an old saying here that by a time a family is willing to consider AL— the LO should be in MC. Care needs should drive placement. If he sundowns or is an elopement risk, MC would be better now. I would look for a place that offers both and tour to be certain you are he can start in AL.

Geographically, I would consider moving him if there are more family members who can and will visit him. IME, friends will disappear fairly early on as your dad's dementia is more obvious to others and he can no longer hold up his end of things. Family, too, tends to drop off either because they're older, your LO's condition saddens them or because they're uncomfortable visiting. Dad's brother did a 45-minute drive-by once. When dad was in MC for 2 months, his brother visited one time despite me picking a facility more convenient to him than me. As time passes, he's going to be less and less oriented to where he is.

Not long after I moved my parents north, my dad was confused enough to think he was in Florida. I don't think the move harmed him in any way but it did give both parents an additional layer of safety to be near me. I did not involve dad in the move; mom and I (and mostly me— I did the leg work and she picked from a curated set of options) picked an apartment (and later home) to which I moved them. We certainly didn't involve dad in any decision making but he may have been further along than your dad is. I did the logistics of staging and selling both their homes, shipping vehicles, moving households, establishing residency in a new state and creating a new medical team for both.

I feel your pain in this. My BFF's dad was spirited away by her brother. Dad didn't have dementia but was very elderly and frail. BFF was the youngest, still living in the neighborhood and had been the closest to her parents. She was mom to the youngest grandchild who was the apple of pop-pop's eye and it broke her heart for her then 6-year-old daughter to "lose" he last remaining grandparent and vice versa. But the bottom line was that her older, childless brother and his wife were more able to drop everything for dad which my friend could not.

All that said, I do have one friend who made this work with his dad for quite some time. Friend has a dozen kids and a big old house with a separate carriage house apartment down the driveway where dad lived. He and his brother were local and had some control over their schedules as doctors, but emergencies fell to my friend's wife. The 5 older kids were adults by this time and could manage care of the younger ones as needed. But even in this scenario, dad spent the last 2 years in MC.

I hope your family can come to a decision that is agreeable to everyone.
HB