Making to transition to a memory care facility

As much as I didn't like putting my wife into memory care, it is best for both of us.

I would leave the stepfather out of the conversation. I don't think he is able to make correct decisions. Talk to your mother and tell her it's the best thing to do. It's for her safety. It is not abandonment or betrayal.

My wife has been in memory care since the beginning of May. It was a difficult transition for me. I keep telling myself that I could take care of her but I'm just lying to myself when I say that. When a person reaches a certain stage of Dementia or Alzheimer's, the best thing to do is to have professionals take care of her or him.

My mom, who was a caretaker for a lot of her life, told me that when she was growing up they did not have people with Dementia or Alzheimer's. They called it a second childhood. Watching my wife and the residents of the memory center, I cannot help but agree with this.

I am sorry you are dealing with situation.

You don't mention what stage your father is in or what his capabilities are. Have you spoken with his physician to address these behaviors? Are they new? Has he been checked to rule out for any cause - like a urinary tract infection or other infection? If all medical issues have been ruled out, his doctor may be able to address the behaviors with medication. The behaviors may be manageable.

As for facilities, I think you should do the legwork and find somewhere acceptable. Once you have, then speak with your mother and let her see the place. She may be more willing to make the change once she sees there is somewhere acceptable that he can go to.

@rsquire Ross asked:

A big part of making this work is going to be the context of the specific marriage. Is this a marriage of decades or a later-in-life union? Does stepdad have adult children who may be at cross purposes to your mom's wellbeing or in denial?

So I am looking for some advice:

How to we have the conversation that has her recognize that his care and her well-being need to be taken care of?

This is a conversation to have with your mom without stepdad present. If you have siblings, an intervention of her children might be more effective than just you although I pulled it off as an only.

There are a couple of different angles you can take; I tried several before finding the one that resonated. First, what's her objection? Does she see enduring his abuse as the "in sickness and in health" from her wedding vows? Is she worried others will judge her for "putting him in a home"? Are finances an issue? Sometimes there just aren't available funds for a MCF and sometimes elders are hell-bent of leaving an inheritance. Other times older people have a mental picture of "the home" as a terrible place. FWIW, mom ticked a lot of these boxes.

If it's the money piece, you could help her sort out qualifying for institutional Medicaid. Don't believe that she won't qualify until you've been told so by a certified elder law attorney. If it's her thinking she needs to be his sole caregiver, framing a facility as added trained professionals to her team might help. If he's fighting healthy foods, medication and/or showers, you can point out that she's not caring for him as well as a team would.
Another positive to a facility that you could point out is that she could stand down as a hands-on caregiver and go back to being his loving wife.

None of the above strategies worked for me, so I was forced to change course. I reminded that fully 1/3 of dementia caregivers die before their PWD. I presented placing dad (who I did not get along with) while she could choose the facility as preferable to me "inheriting" him as my Plan B was the SNF near my home (not a bluff; I'd made preliminary arrangements) as soon as the POA agency came to me upon her death or incapacity and then transfer to the first MCF that would accept him. I'd already toured a dozen facilities to narrow my list to 3 contenders and took mom to tour those to get a sense that they weren't terrible places. She finally caved after a week of sleepless nights during which he was blathering on about murder-suicide.

We had his antipsychotic medication increased and had him placed within 2 weeks. Unfortunately, the stress of dad's care and mom's inability to stay on top of her own care even with home health aides was such that she had a medical crisis a few months later that cost her the vision in one eye and driving and consequently her independence. And mine.

How do we have the conversation with my step-father that it is time to move to a facility that can better take care of his needs?

YOU DON"T.

Best practices are to make all of the arrangements and set up his room at the MCF behind his back. Given his likely anosognosia, he can't appreciate a need for him to need that level of care. His reality may be that he's doing all the IADLs and ADLs independently himself.

Most people use a fiblet to get their LO into the MCF. I told my dad that he had an appointment with a new specialist doctor to help him "get stronger" (if stepdad has a chronic condition that needs managing you can use that). We drove him to the MCF and the activities director swept him away to join others at afternoon snack time. (we told her our plan ahead of time). Other fiblets include situations like a broken water main or termite tenting.

Most people who move to MC need some time to acclimate to the new setting, people and routines. This can take a couple of months for some; dad who was challenging as PWD go, had calmed down in about a month. Until then, I went with mom to supervise the visits otherwise he would take her to his room and excoriate her. I kept him in the public areas of the building and whisked her away if she started being abusive. He wasn't going to learn from this, but there was no need to endure it as it wasn't helpful to either.

All that said, has he seen a geriatric psychiatrist for psychoactive medication management? This could improve the situation by dialing back the feelings driving the agitation and anger. Your mom doesn't have to live as she is.

HB

Hang in there! I found Zinnia TV to be helpful to lessen the anger and angst in my LO:

https://www.zinniatv.com/