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At the end of 2018, my husband and I moved my then 96 year old father from southeast Texas to Pittsburgh, PA. He had moved to an independent living facility a couple years earlier and had recently started to fall and end up in the ER. He was also running out of money. None of my nearby siblings were able to help him, so we moved him into an independent living facility just a couple miles from our home. At the time, his mobility has ok, he could still get around with his walker and cane and he had a motorized wheelchair to get from his independent living apartment down to the lobby and dining room. His cognitive function has been excellent. Over the past year, his decline has picked up speed and we made several trips to the ER for various issues. He started losing weight, he started getting confused, he was having more and more trouble with the telephone and we added more in-home care as time went by. But the pandemic really accelerated his decline. In June he got a UTI and spent 6 days in the hospital. That was all it took for him to lose what little mobility he had. He went to skilled nursing for PT and rehab, but it didn’t help much. Now he’s out of money, he on Medicaid and at 97 he needs 24-7 care, yet he is constantly telling me that he plans to leave the nursing home. He’s fallen out of his wheelchair a couple times but he still thinks he can walk. He understands that we gave up his apartment in the independent living, but he is convinced one of us kids is going to take him in. He is beyond the level of care any of us can provide him at home, he is exactly where he needs to be, but I don’t know how to tell him that this is permanent. I’ve tried gently to tell him that he needs more help than we can give him and he seems to understand, but the next time we talk he tells me he’s going to get on a plane and go back to Texas so he can live with my brother and his wife. How do I tell him that this is where he’s going to stay until the end of his days?

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I wouldn't.   He probably recognizes his situation, and is comforting himself by believing that he can get past this stage.  

Try switching the subject when he raises the issue, perhaps asking him if he'd like you to get anything for him - book, magazine, take him for a ride in his wheelchair, etc.).    I would assure him though that you'll do the best you can to help him.  That alone may offer him more comfort than a specific discharge date.  

Sometimes we all need to reassure ourselves of a better outcome, especially in very trying times.
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If he hasn't actually started the process of leaving he is just talking his frustration out.

I would not keep repeating what you have already told him, he isn't retaining it.

When he brings this up you can change the subject to something you know engages him, end the call/visit, mumble some answer and move to going to do an activity, really anything that ends that conversation.

It is difficult when you know that it is what it is and they just want out.

Best of luck redirecting his desire to leave the facility.
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Platitudes and redirection.
"Gee dad, maybe you'll be strong enough by springtime" ... "You can't fly because of covid".... "doctor says not for a month at least"...
and then "what did you have for lunch today" or whatever else might distract him. If he won't be distracted end the call - "love you dad, gotta go now."
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Radioabby Oct 2020
This is most how I’ve been dealing with it. Last week I told him that its not safe to fly and that not only am I not going to put him on a plane, I won’t even put myself on a plane. He understood that. And I have told him several times that he needs more help than we can give him at home. Last time he fell out of the wheelchair, I said “its a good thing someone was there to help you right away and you didn’t have to go to the hospital, they can take care of you right there” and he agreed. That’s probably the best way to handle it.
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If you have never told him this, then tell him gently and kindly and give him the HONEST reasons why. RealyReal is correct that he may not retain this, and if this is the case then I would not repeat it endlessly, causing more disruption and upset each time, but try the gentle diversion methods. I find that too often we try to hide the truth. Not everything has a fix-it in the long slow slide down for our elders. I am sorry for the pain for you all.
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Karsten Oct 2020
I view you as one of the best advice givers on this forum. On this one I may disagree though. Is honesty always required.
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Do you need to tell him?
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Always remember this -- if they ask you the same thing time and time again, stop answering truthfully if it hurts their hearts to hear it "for the first time" over and over.

I like the other suggestions to say things like "not for at least a month," or blaming doctor's orders. Eventually that place will become home, and the queries will stop.
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