Moving Dad from AL to skilled nursing care. Any advice?

It occurred to me fairly often in my seemingly endless visits to the AL, MC, SNL sequences where my LOs spent the ends of their lives, that of the “awfuls” about successfully placing a geriatric patient with multiple disabilities, one of the worst was determining which problems you as caregiver needed to decide required the most attention and which ones you could “let go” a bit while confronting the worst ones.

One of the things you may have missed when you began this thankless task was that most If not all patients in residential care “….hates it…”, and that you, as responsible party, isn’t doing any of this because it’s joyful or rewarding or fun, but rather because he’s a sick old man who has learned during his independent life that the angrier he is, the faster he can get what he wants.

NOW, he has “hit the inevitable wall”of body system failure, inept social interaction, and decreasing ability to manage safely in less restrictive levels of care.

So those who are responsible for his safety and welfare no longer have a menu of choices, and must now release his care to the trained professionals available in SNF, and being part of that decision making process is NEVER easy for those who are responsible.

I’m truly grateful that “progressive care” for my recently departed (at 94) LO obliged me to accept the fact that she needed SN, and received it, as a hospice patient, for the last year of her life.

You’ve handsomely provided the level of care he’s needed previously, and determined, with professional input, that he now needs more, “different” care.

You’ve NO REASON to have concerns about your decision.

Be at peace moving forward.

He going to the correct type of care -- plain and simple. You're doing the right thing, you aren't abandoning him because he's on the downward slope, and the important thing to realize is that he's not the same guy you grew up with as your dad.

For me, that was perhaps the hardest part with my mom. She got REALLY crunchy in her final years and frankly, wasn't much fun to be around. She wasn't abusive, but just really crabby, not very nice to the caregivers, and was no longer herself.

She was my best friend and greatest champion all my life, but this weirdo was not the mom I knew and I had a hard time those last few months caring ABOUT her. Caring FOR her was easy, as she was in a memory care place, but one of the things that happened to her with vascular dementia was that her emotions (other than anger and crabbiness) just went away. She and I used to laugh until we cried, and she lost her sense of humor. We'd cry like dopes as the music swelled up at the end of a movie -- gone. She was a stranger in my mom's body.

Relief is good, so embrace it. I felt great relief when Mom finally died, because she, too, wouldn't have recognized who she'd become and not wanted to be around either.

No advice here, just know you’re doing the best for two people who can’t make decisions in their own interests any longer, and they’re both blessed to have you in their corner looking out for them

The first thing I would recommend is focusing on the doctors making the call so you aren’t shouldering the “blame”. Doesn’t mean you won’t get the wrath and blame from Dad but you can legitimately say it was the doctors who made the decision and if you need to you can give him hope even by saying if and when you meet the goals and they release you, you can go back to AL but that will take a while and a lot of work. If he wants to dream about building a cabin, let him. You can even dream with him by giving him pencil and paper so he, maybe with your input, can design it. Nothing wrong with some dreaming instead of anger and frustration if you can get it.

This may be a big adjustment for both your birth father and his wife and it may not be as big because he has been in other facilities so much but be prepared. Even in the worst of relationships there is comfort in having another person around and they have obviously settled into this if it wasn’t always the case. His wife may need more help now and will certainly need more attention since that’s what she’s used to even if it was negative. You are a very special loving person to be caring for both of them the way you are. I know how much emotional and physical energy this takes.

I find that while I’m not successful all the time trying to remember that I’m not dealing with a completely rational person and finding humor in the things that otherwise frustrate me helps me get through. If Mom wants to do it her way, even though I know it either won’t work or it’s 5 times harder that way, so be it as long as she can’t hurt anything. As MJ1929 points out so eloquently, watching her become less and less her is the hardest part of it all for me.

You are doing the right thing, you are listening to the professionals and you are taking into account everyone’s needs, your own too hopefully, it sounds like it’s come to the point where Dad isn’t going to be happy anywhere or at least admit to it so taking the opportunity to get him where he really needs to be is taking the best and most loving care of everyone. Good for you. Often the right thing isn’t the easiest thing in life.

I have not experienced this but I just want to say that I think you are lovely for doing what is best for your father and his wife.

So many times we people catering to their parents desires even though that isn’t what is best for them or anyone else.

Best wishes to you and your family.

On addition to all of the great advice given, have your LO moved by medical transport. Do not attempt to drive him from one facility to another yourself.

My mother attempted to grab the steering wheel from my DH while driving from one facility to another.

I get the relief! Just move him. If he gets mean while there I would walk out quietly and then reduce my visits. His wife deserves some peace. Save yourself!

A Geriatric Psychiatrist can offer sedation.

Very sad and tough situation. Fine a nursing home with a demtia ward, he probably needs the special care they give. And, check, re-check, double and triple check how long his insurance will pay. And start early applying for Medcaide, it is a complex process. Try to get expert advice.

Hoping this can help! My mom too became increasingly nasty, and she and the man she was with would bicker non-stop when they would visit.

They split up when she refused to try living in a warmer state during the winter. They sold their home and were done. I thought the nastiness would end because I thought their relationship was coloring her life, but I then became the target more, especially after a career move when I couldn't visit as often. She could visit us anytime as she was retired but chose not to, even though she was already driving all over the place to do other activities she wanted.

She was never complimentary about my education and minimized my career and accomplishments (also my SIL's), but always speaks highly of my brother's as well as her own. I heard bad things about almost all of her friends, put downs of their careers, yet she continued to do things with friends she said were terrible. This was all baffling.

When she started accusing people of breaking into her home, the police found no evidence of such. Her finances were in shambles, utilities threatening shut off, and credit card companies already freezing accounts.

She fought not to move to a senior community apartment and became even more unreasonable. My brother suggested we let her stay in her home longer because she wanted to, but her best friend said to move her right away. The friend could see the decline as they had been called multiple times for ER visits when she would fall and break a bone. I lived 2 hours away. She also came to our house with bad bruises from falls where she didn't go to the ER!

The retirement community where she went made her move first to Assisted Living, then to secure Memory Care all within 10 months after arrival. She accused me of being cruel because I didn't stop them from making her move, even though the community forced the move saying they would evict her if she refused.

The Memory Care facility asked permission to have their psychiatrist talk to her because of her negativity, anxiety, and frequent weepiness. She was also physically swatting at caregivers. She was put on an anti-depressant (sertraline) and her behavior and attitude improved. They forced another move during the last year to their Skilled Nursing Facility because of frequent falls and she now needs a mechanical lift.

Even though she confided for years she felt sad and could be depressed, she would refuse to talk to a professional. But professional evaluation and medication actually helped her greatly. It took being someplace where she could get the help she needed!

Dementia causes so many behaviors that aren't in the patient's control, including the nastiness, and recently I read Alzheimer's can actually start 10-15 or more years before diagnosis.

Good luck with everything you are facing!