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I have both my parents in AL. Mom has progressed to mild - moderate dementia & my dad is beside himself. He feels the need to "take care of her" even though there are staff around to help (though not always prompt). The main problem is that she has outbursts of anger toward him; other times she says things that make no sense.


Today she told him that she heard him talking to my aunt (who has been dead about 8 years) about buying shoes. This befuddles him as he doesn't know how to respond. I've been trying to help him with "therapeutic fibbing" but it's taking a while. She really needs memory care, but he does not. So we're planning on separating them, with her moving to the Memory Care side of the AL & he would stay on the regular side in a different apartment. He can see her anytime, but knows she will be monitored more closely when he's not with her.


The problem is that mom has moments of clarity when she seems to relate fairly well. What would be the best way to present the separation to her, with the idea of avoiding a blow-up or meltdown? At the AL there is another couple who has this same arrangement & seem to be doing fine, but I think the wife has more advanced dementia than my mom. Obviously we will try to discuss with this gentlemen, but I'd like to get some other ideas. Please advise if anyone has experienced this & has some recommendations. (By the way, this forum has been a great resource for me as I've been part-time caregiving for them for about 4 years & finally got them to AL. I have recommended AgingCare to others & even some health care professionals. Thanks to all who contribute!)

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Would it be possible (under the rules and also financially) for them both to move together? My parents in law did this. (MIL needed the extra care, but FIL fell and died three weeks after the move, which was not what anyone expected.) Perhaps it isn’t a good idea if MIL is being very difficult for FIL, but it might make the actual move easier for both of them. Even doing it for just a few days might do the trick - imagining something new is always difficult and stressful, and experience takes away a lot of the stress. It might be worth checking with the management about whether they could share a double room for a few days in the new area.

I hope some other ideas will come out, too! It’s a difficult time for you all.
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Sadly most of the people with dementia at my mother's nursing home have no idea why they are there and all of them are looking for a way to go home, it is just par for the course. I wouldn't bother trying to explain to your mother beyond telling her that she will get better care there "for now", and by using whatever therapeutic fib is appropriate at the time. I hope for your sake she will settle in easily, but be prepared for a few weeks of rocky transition.
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You cannot explain to dementia. Therapeutic fibs when she asks questions after the move. Dad will probably bring it up to her, hopefully he can deal with the agitation that could result. Do not tell her before if possible.

My Mom and stepdad had to live separately because of mom's dementia. He was able to visit when he wanted. In the beginning he would take her to the main facility dining room for lunch and dinner. First the dinner visits had to stop because of mom's sundowning behaviors. Later lunches had to be moved to the memory care dining room because mom was extremely disruptive to others in the main dining room. Once she ended up in the kitchen yelling that the couple eating with them was trying to get stepdad to pay for their meals.

Rules for him visiting will change. The facility may even ask him not to visit at all for a period of time, one week, two? Depends on how mom's adjustment progresses.

Good luck this is really hard for all of you.
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Why can they not both move to Memory Care together?
If he does not need the security of Memory Care he could be given the code so he can come and go as he wishes, just as if he were visiting.
He can continue to "help care" for her but obviously would have more help in doing so.
I know of more than one facility that allowed a spouse to move in and the spouse had NO medical problems at all.
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I have not experienced this but I’ve seen this happen where my dad is and it does work out. Does this facility have a social worker in place? If so you might talk to them and get their opinion on this. We are often hopeful during those periods of lucidity that the one with dementia is improving but they aren’t and they will go back to the previous behavior and it will get worse. You will need a fib to tell mom. Something also got the lines of....this place has some programs that we’d love for you to try for a while and then of course she moves in and doesn’t move out. It is so hard on you, I know to make these decisions but always always remember you are doing it to keep them safe. You did not cause the situation, aging and dementia did.
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Quite often, Memory Care will allow both to stay in the same room even if one doesn't need Memory Care yet.

Always ask, never assume. The answer could be yes.
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I worked in a facility where sometimes the spouse would move into the MC area to help out but it didn't work well. The aging spouse would try and tell their loved one what to do and it never worked well. They would be agitated and the dementia spouse would become agitated as well. The spouse is not trained in dementia care, so they aren't able to handle it properly or let things roll over their shoulders, realizing it is the disease causing the behaviors and not take it personally.
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nature73 Sep 2018
You are so right. Poor dad is beside himself. No matter what I tell him be can't understand. I will pass on all this info.
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I have just gone through this, it is definitely heartbreaking. My mom was combative, falling, delusional and accusing all of horrible things especially my dad and I. She was so clear in doing this that we thought she was just a senile angry person.

After she she began hitting my dad there was no other decision but to separate them. We sat them both down and discussed that the state wanted them separated for safety and that the memory unit had more experience with helping mom. The doctor said to tell her she had Alzheimer’s and needed more support, the psychiatrist told us not to tell her since she would forget. We asked the AL to talk to them instead and mom seemed to listen. Dad was angry and did not agree but we reiterated what AL said and told him that this way they will be in the same place vs being separated .

my suggestion is to talk to them both about what’s going on and concerns being careful not to put the blame on mom, have the AL talk to them about providing more care in memory and let them be the ones to tell them they have to separate. You just be the supportive adult child. Eventually your dad will understand and there will be brighter days. It’s a long road of good and bad days.

By the way, the move for them has been about 2 months now. Mom is in memory and dad is in AL. Mom’s quality of life has improved, no falls , no hospitalizations and less outbursts now that they are separated. I bring dad to see mom at least 2 days week for 3 hours and they are both happier. It takes about 5 weeks for someone to adjust to being in memory but it will get better. Just get your dad to socialize a lot in AL as they get lonely not being together.
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My parents are in the same situation, but my mom's dementia is more in the moderate range without anger except a few times a year. They live in a 2 bed 2 bath AL unit as my father insists on.
After her last hospital visit, i was concerned she might need memory care. I was advised by AL that they could provide more support and she did not need to go to MC until she needed to be fed or she wandered. Does your mom have either of these needs? Also, what is the highest level of care the AL facility provides? They are not all the same.
When I checked it out, the cost for MC for one person was about the same as the cost for AL for 2 people! So if money is a factor, please do your research carefully. My guess is that moving both to MC would require that MC cost for both. If your dad does not need it, it could seriously impact his social life and it may have implications regarding medical care as we'll. Investigate this carefully.
You might also consider if your mom would qualify for palliative care for dementia and if a part time private pay aide would be sufficient and less disruptive than separating them.
We had a conference with the AL staff and are having a paliative care evaluation, covered by Medicare, next week.
Also see if there are meds that can help with your mom's anger. My mom has melt downs that require meds as needed.
As an aside, when I can no longer take my mom to her multiple medical appointments, it may be time to reconsider MC regardless of other needs. She is a largest woman and is becoming weaker due to inactivity. If she cannot assist with standing and getting in and out of wheel chair, then I will not be able to take her.
At least your parents are already in a duel program facility! I dread having to move mine for the 4th time as it is so disruptive, but it may be necessary. Time will tell.
Good luck to you and stay in touch.
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Gosh it’s hard to know when and how to do this. I’m in exactly the same situation myself right now. Mom’s Alzheimer’s is progressing to the point where she is losing her ADLs (she also has an ileostomy, so ADLs are a bit more complicated), and Dad’s dementia is progressing to the point where he doesn’t always understand her dementia. The AL portion of their facility does have increasing levels of care, but both Mom and dad are resistant. So I’m in close contact with the facility (they are in PA I am in AZ) in addition to my daily calls in order to monitor/track behaviors, and I have their docs (both PCP and geriatric psych) helping me assess them and the situation. Fortunately my folks have always listened to their docs (more so than sister and I because they are the parents and we are the children), so with the docs help Dad is becoming more open to the idea of some additional help. In the meantime I have Mom on the waiting list for a bed in SC (with her ostomy she will not qualify for memory care), and when a bed becomes available we’ll use all the info available to decide about the move (i.e. MAKE the move). Dad knows she is on the waiting list, Mom does not. I know they will not do well with this, but they are not doing well in the current situation either. A good day for Mom is rare, and when Dad is also having a bad dementia day or streak of days, it is just a disaster. I don’t know if any of this will be helpful to you. You are very much in my thoughts. I wish you strength and clarity for the road ahead.
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nature73 Sep 2018
Your response is very much appreciated! "I know they will not do well with this, but they are not doing well in the current situation either" perfecty describes their situation. I will keep this in mind. What a mess! Whoever thought we & them would be in such a state? Best wishes to you too - I'd like to know how it goes for you.
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