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Medical Forum / Diseases and Disorders / Alzheimer's / June 2006Taking dad to the nursing home
Hello all - I come to you as a middle-aged child who is trying to lend support to my elderly parents. My 84 y/o father has been diagnosed with mid-stage Alzheimers and has become too much for my frail 85 y/o mother to deal with. He has the "angry Alzheimers" with much paranoia and hostility. He still wants to be in control of daily decisions (i.e., does not want them to get Meals on Wheels because they are "too expensive," although they have more-than-adequate resources), but of course does not realize that he does not have the rational capacity to do so. On the advice of my father's geriatric specialist, we intend to place him in the Alzheimer's unit of the local nursing home very soon. Mom is about at the end of her rope, and not healthy herself. We know this is the best option. However, we are wondering "how do we get him there?" About a month ago, he vehemently objected when his doctor wanted him to stay for a few days for at the area VA hospital, not only for evaluation, but because there were weapons in the home that he had threatened to use on himself and others. Because he had not signed a POA, they had to do an emergency commitment and he was not a happy camper. He still talks about how they "put him in jail." In the meantime, I have been appointed his guardian, and due to behavioral problems and issues with wandering, etc., we have been advised to place him immediately. His doctor suggested that we say that we are just taking him for a ride, to a doctor's appointment, etc. and then take him to the nursing home. In reading things on the web, a lot of sites say not to do that. I don't feel good at all about deceiving him, but there is absolutely no way that he will ever agree to go willingly. How have others coped with this? I'll appreciate hearing about your experiences.... Thanks so much for your advice, Karla from Nebraska > Hello all - I come to you as a middle-aged child who is trying to lend > support to my elderly parents. My 84 y/o father has been diagnosed with [quoted text clipped - 29 lines] > > Karla from Nebraska Dear Karla, There are many of us who post here who have been in your situation. Wherever you read that you shouldn't take him to the nursing home under a ruse of some kind, it was quite simply wrong. I get so upset when I read stuff like that, because it can cause untold misery. When a person is suffering from an organic brain disease and no longer can think rationally, or make decisions for themselves, we have to do their thinking for them. Please realize that you need to say and do whatever you must in order that he will go with you willingly and be safe, and that your mother can also be safe. Around here we don't call it a lie, because it really isn't one. We call it "loving deception," because it is done with the persons best interest, health and well being in mind, rather than to deceive for some personal or selfish reason. I am reminded of the famous very old buddhist story of a man whose home was on fire and his children were inside and wouldn't come out. He began to call them, telling them "children come here, I have wonderful new toys for you here" When the children came out they cried because there were no toys, but he saved their lives from the fire. This story was to illustrate that it was not a lie, but a loving deception. Please don't listen to the people who say not to do this. They are obviously people who have not dealt with someone whose reasoning abilities are impaired, or they were operating under the mistaken illusion that the person was capable of understanding what needed to be done. You need to get him where he is safe and where he will get good care. However you need to do that, as long as it is done kindly, is fair.  SignatureBest Regards, Evelyn (to reply to me personally, remove 'sox') >> Hello all - I come to you as a middle-aged child who is trying to lend >> support to my elderly parents. My 84 y/o father has been diagnosed with [quoted text clipped - 62 lines] > You need to get him where he is safe and where he will get good care. > However you need to do that, as long as it is done kindly, is fair. Yep, agree 100%, thats the way to go. We just lied (call it loving deception if it makes you feel better :-) to my dad, told him he was going for a few hours for evaluation. (Make sure your father doesn't see you put a suitcase of clothes in the car, or anything similar) Otherwise, the plain fact is, he would simply have refused to go*, but he _had_ to go as he was simply too much for my mother to cope with any more, if he didnt go she would have had to move out for her sanity and then he wouldnt have been able to cope in any case. One difficulty is that the father doesn't sound so bad as mine, in that he would never have recalled what happened a month previously. Is the home geared up to cope with him being unwilling to stay,and possibly violent, and will he accept this ruse? In my fathers case he was taken to a psych unit and then the home later, so at least it was a hospital so the lie was plausible on the face of it, would it cause issues if he goes to the home? Could he be persuaded he was there for a day visit whilst your mother did some chores or similar if thats the case? Could he be taken to the hospital first an dthen the home? *in fact he did refuse to go even for an overnight stay for respite because he didnt understand his limitations (and even if he did momentarily, he'd have quickly forgotten them :-) SignatureTumbleweed email replies not necessary but to contact use; tumbleweednews at hotmail dot com I took my Mom to "see some friends" at the nursing home. She protested. I blatantly told her that it had been her idea, it was her friends, and they were expecting her. She forgot where we were going on the 20 minute ride over. When we got there, I told her something else to get her in the door, and voila, there she still is. I pretty much hate it, but it is for the best. SignatureLes Hello all - I come to you as a middle-aged child who is trying to lend support to my elderly parents. My 84 y/o father has been diagnosed with mid-stage Alzheimers and has become too much for my frail 85 y/o mother to deal with. He has the "angry Alzheimers" with much paranoia and hostility. He still wants to be in control of daily decisions (i.e., does not want them to get Meals on Wheels because they are "too expensive," although they have more-than-adequate resources), but of course does not realize that he does not have the rational capacity to do so. On the advice of my father's geriatric specialist, we intend to place him in the Alzheimer's unit of the local nursing home very soon. Mom is about at the end of her rope, and not healthy herself. We know this is the best option. However, we are wondering "how do we get him there?" About a month ago, he vehemently objected when his doctor wanted him to stay for a few days for at the area VA hospital, not only for evaluation, but because there were weapons in the home that he had threatened to use on himself and others. Because he had not signed a POA, they had to do an emergency commitment and he was not a happy camper. He still talks about how they "put him in jail." In the meantime, I have been appointed his guardian, and due to behavioral problems and issues with wandering, etc., we have been advised to place him immediately. His doctor suggested that we say that we are just taking him for a ride, to a doctor's appointment, etc. and then take him to the nursing home. In reading things on the web, a lot of sites say not to do that. I don't feel good at all about deceiving him, but there is absolutely no way that he will ever agree to go willingly. How have others coped with this? I'll appreciate hearing about your experiences.... Thanks so much for your advice, Karla from Nebraska Karla, I agree with all that has been said. You must get him there no matter how you have to do it. You cannot reason with a person whose reasoner is completely broken so you do the best you can the best way you know how to take care of him/her. I left my mother in a nursing home with her saying over and over, "If you loved me you wouldn't leave me here". My daddy refused to take her so my husband and I had to do it. Gwen I took my Mom to "see some friends" at the nursing home. She protested. I blatantly told her that it had been her idea, it was her friends, and they were expecting her. She forgot where we were going on the 20 minute ride over. When we got there, I told her something else to get her in the door, and voila, there she still is. I pretty much hate it, but it is for the best. -- Les "Karla" <karla_bergen@hotmail.com> wrote in message news:1151007277.649617.263720@r2g2000cwb.googlegroups.com... Hello all - I come to you as a middle-aged child who is trying to lend support to my elderly parents. My 84 y/o father has been diagnosed with mid-stage Alzheimers and has become too much for my frail 85 y/o mother to deal with. He has the "angry Alzheimers" with much paranoia and hostility. He still wants to be in control of daily decisions (i.e., does not want them to get Meals on Wheels because they are "too expensive," although they have more-than-adequate resources), but of course does not realize that he does not have the rational capacity to do so. On the advice of my father's geriatric specialist, we intend to place him in the Alzheimer's unit of the local nursing home very soon. Mom is about at the end of her rope, and not healthy herself. We know this is the best option. However, we are wondering "how do we get him there?" About a month ago, he vehemently objected when his doctor wanted him to stay for a few days for at the area VA hospital, not only for evaluation, but because there were weapons in the home that he had threatened to use on himself and others. Because he had not signed a POA, they had to do an emergency commitment and he was not a happy camper. He still talks about how they "put him in jail." In the meantime, I have been appointed his guardian, and due to behavioral problems and issues with wandering, etc., we have been advised to place him immediately. His doctor suggested that we say that we are just taking him for a ride, to a doctor's appointment, etc. and then take him to the nursing home. In reading things on the web, a lot of sites say not to do that. I don't feel good at all about deceiving him, but there is absolutely no way that he will ever agree to go willingly. How have others coped with this? I'll appreciate hearing about your experiences.... Thanks so much for your advice, Karla from Nebraska > Thanks so much for your advice, Pretty much agree with the rest that whatever it takes is the right thing. Consider too what he would advise you to do if he were not so afflicted. You must bear the burden for this decision but believe me, this group is full of those bearing the same burden so you are not alone. So rest your mind and say and do whatever is necessary for the future well-being of your father AND your mother. Thanks to all who have responded. I have a friend who went through something similar a few months ago and she said that they gave her mom a tranquilizer before they took her to the assisted living facility and didn't tell her that she would be staying until they got her in the facility. My friend said that in spite of the tranquilizer, her mother objected strenuously, but she felt it would have been worse without the medication. Does anyone have any experience with medicating the person who is to be placed? I guess I know what we have to do, but it doesn't necessarily make it any easier. I am sick with dread at knowing that the day is coming rapidly, but I know I'm not the only one who has had to go thru this. Even though I am 51 years old and have my own adult children, I have always valued my parents' approval, which makes this even harder. Karla she said that they gave her mom a tranquilizer before they took her to the assisted living facility and didn't tell her that she would be staying until they got her in the facility. My friend said that in spite of the tranquilizer, her mother objected strenuously, but she felt it would have been worse without the medication. Karla, unless you have tried him out on the tranquilizer before the day you will go it is most likely not a good idea. You can never tell how an elderly person will react to a new medication. He might fall, and then you could have Another real problem! Also, why tell him he will be staying? If it is an Alzheimer's unit, they know how to handle that part. Let the facility help you. Ask the nurses there how to manage this. Tell them when you are coming, and they should be ready to assist you. When we took Mom, two feet inside the door two nurses came up and introduced themselves and firmly told Mom that there were people she just had to meet, and they led her away in one direction while the social worker and I went another. I Am a nurse, and was fortunate to be able to keep Mom at home until she reached the point where she no longer knew me. A few minutes after we got her settled in the secure unit she forgot who I was, and after a couple of days was demonstrating the behaviors she only showed me at home, with the most familiar caregivers in the unit, and she no longer recognizes me at all. I am a "nice" visitor. SignatureLes Karla wrote: " Does anyone have any experience with medicating the person > who is to be placed?" Mary responds: Its actually very common, given that by the time people need placement, many have behavioural issues such as severe agitation - often a big factor in why they are being placed! A good dementia unit will EXPECT that the person will be unsettled at first, and its an idea to have a prescription for a tranquilizer in the hands of the facility when he gets there - to be used with discretion in the first days, as needed. Sedative use is not about zombifying someone, as per the stereotypes - its about keeping their agitation under control for own comfort and safety. Being all wound up is not a happy state of mind - and you really don't want your father all upset and perhaps even acting out his aggression physically or verbally on the staff, or other residents (its a good way to get kicked out before he even has a chance to settle in). Sedatives are appropriate for short term or periodic use only - he is agitated in the longer term, a better choice are antipsychotics, or antidepressants - something to talk over with the doctor. My mother in law was fairly mellow during her Alzheimer's journey, but even she had some times where the unit would call and ask if it was okay to medicate her temporarily. Every now and then she'd go through a few days where'd she'd get all wound up, and no one knew why (i.e. no apparent triggering event but she'd be up half the night, combatitive, ranting, pacing). It was not a kindness to leave her in that condition - and there was nothing that could be said to her that would calm her (i.e. she wasn't rational) I know you are dreading this, but I promise you, the anticipation is worse than the reality. The majority of people find that their loved one makes the transition much better than they thought. We certainly did our share of fretting when we realized my mother in law could no longer live independently, but in retrospect, we wished we'd made the move sooner. It was a HUGE relief to know she was okay and being well looked after. We hadn't realized what a strain it was to be constantly worrying and living from crisis to crisis with her. Also, by the time she went to assisted living and then the AD ward, she was at the point where deterioration became much more rapid (i.e. she was out of slack, so every loss was a big one), and we were very much relieved to have those major events, like loss of continence, ability to dress herself, bathe, walk, speak, etc. etc. occur in a secure setting. M. Mary responds: Its actually very common, given that by the time people need placement, many have behavioural issues such as severe agitation - often a big factor in why they are being placed! This is not common here. In fact as a professional nurse, this is referred to in the literature as using "pharmaceutical restraints". It is an ethical issue, just as the use of devices to actually physically restrain a person is an ethical issue. I am not referring to the anti-psychotic medications or the other Alzheimer's drugs. Tranquilizers are what I am referring to. We have laws against using restraints. The unit my Mom is in does not use them. When she began socking people right and left we went to the Psychiatrist and he prescribed Abilify, which took care of the problem and has not caused her to be a fall risk. Tranquilizers will make the memory and orientation problems worse for these patients. And makes many gait problems become frankly dangerous. The staff in a good facility know how to redirect aggressive behavior. I have watched it done, quite effectively during the week that we were working to get Mom set and correctly medicated. The danger is that facilities will use this to avoid giving proper care to people. SignatureLes > I have been appointed his guardian, and due to behavioral > problems and issues with wandering, etc., we have been advised to place [quoted text clipped - 4 lines] > there is absolutely no way that he will ever agree to go willingly. How > have others coped with this? Welcome to the club no one wants to join. You must understand. He is NOT rational. He can no longer reason. Regardless of what he wants, the reason you were appointed his guardian is because he cannot make decisions for himself any more. On moving day, someone takes him for a day-long drive somewhere else, while his favorite chair, family pictures, his clothes, and some familiar stuff that he likes to have around are transferred to his room at his new home. Then you ask him to come in while you "visit a friend here", and have the pre-arranged assistance of staff to distract him while you quietly leave. It's called loving deception, and sometimes it's just plain necessary. It's necessary not only for your mother's safety, but his. You need, however, to make sure that the facility has the ability to handle any aggressive behavior, and is willing to do so. So yes, deception is probably the only way you'll get him there, other than sedating him. And yes, it's the right thing to do. You can expect a lot of blaming of others for "putting him away" and many pleas to come home, which you should ignore, remembering that it's not him, it's the disease. You may be able to avoid blame for the evil deed by having the psych doc be the bad guy. Eventually, his abilities will deteriorate to the point that he'll probably take direction and won't remember who anyone is or what they did. Good luck. The key is to pre-arrange everything WITHOUT HIM GETTING INVOLVED. It's far better he doesn't know. Believe me, I know. Karla asked - > there is absolutely no way that he will ever agree to go willingly. How > have others coped with this? I'll appreciate hearing about your > experiences.... I agree with all the other responses. My father has a type of dementia, similar to AD and differing in others. He was living in an abolutely impossible situation. My siblings and I rented a truck, packed it, moved him. All the while with him protesting that he "would move, but not now" (He had purchased an apartment in a retirement complex and that's where his proactive acts stopped.) He is MUCH better off. He still, some five years later, protests that we made the decision for him. He is unable to evaluate where he is and how he is, and compare it with where he was and how he was. When I was a very young child and could not plan and decide, he and my mother took care of me. Now it is our turn (my siblings and I) to plan, decide, and take care of him. He will never thank us, it is beyond his capability. But I know we did the right thing. Stay in touch with this group, and let us know how things go. This is a wonderful source of support and a marvelous listening board. All best wishes to you, your mother and your father. SignatureA R Pickett aka Woodstock "Sometimes the facts threaten the truth" Amos Oz, prize winning Israeli author Read my book reviews at: http://www.booksnbytes.com/reviews/_idx_ws_all_byauth.html Remove lower case "e" to respond I had one other thought - Is there any way you can remove those "weapons" you speak of from their home? SignatureA R Pickett aka Woodstock "Sometimes the facts threaten the truth" Amos Oz, prize winning Israeli author Read my book reviews at: http://www.booksnbytes.com/reviews/_idx_ws_all_byauth.html Remove lower case "e" to respond > I had one other thought - > [quoted text clipped - 3 lines] > -- > A R Pickett aka Woodstock We removed his guns and knives during his three-day stay in the VA psych ward last month. That was part of the reason for his stay - he was very agitated, hostile, and was threatening to shoot himself and others. It is a relief to know that they are "gone." He periodically mentions that someone "stole" his guns...but usually forgets as quickly as he remembered. Karla Hi Karla, Sorry to hear about your father. Every situation is different and you know your father and how he will respond best. Despite my mother's declining cognitive skills, she KNOWS when people are not telling her the truth and it makes her furious and even less cooperative. Sometimes I don't tell her the whole truth. When she started wandering away from her assisted living facility we knew we had to place her in a locked facility. We showed her the facility, talked it up and she "decided" it would be ok to move. Once there, she was miserable because most of the residents were so much more disabled (But what can we do). Her dementia is progressing, so now she sometimes asks to "go home". We tell her we'll start looking for another place and that seems to ease her mind. It's partly true because if I did find another, better facility we might consider moving her. My mother has a deep trust for her children, so is generally cooperative, your father sounds different though. Even though there are generalizations that can be made about ALZ.. Every individual's situation and the manifestaion of the disease is unique. > Hello all - I come to you as a middle-aged child who is trying to lend > support to my elderly parents. My 84 y/o father has been diagnosed with [quoted text clipped - 29 lines] > > Karla from Nebraska |
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