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My husband is 69 and has had dementia for 4 years. He can be volatile and obnoxious at times. Recently he fell down a flight of stairs and sustained a brain injury as well as broke all his ribs in multiple places on one side. He was hospitalized for 3 weeks and then moved to a rehab for the past 3 weeks. He is stir crazy and no longer receiving rehab but just stuck in the facility. He has attacked nurses 3 different times and has moderate to severe sundowning. The facility is in Maine where the accident occurred but we live in PA. I have been told that assisted living is best for his safety and mine. He is sometimes rational and begs to be taken home, promises to behave, etc. His dementia is definitely worse than before the fall. I am torn about the best next move. All is complicated by the fact that we live 8 hours away. I do not feel safe driving him home. How does one decide?

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For your safety and his I think Memory Care NOT Assisted Living.
He can be medicated prior to the drive BUT medicating him would make him more of a fall risk.
Discuss with the discharge planner and or the Social Worker and see if medical transport would be the better option. Check with your Insurance company and see if it would be covered.
I would not suggest that you make this drive yourself, have someone go with you if you do transport him yourself.
AND..
He sits in the back seat.
Child lock (if you have one) engaged so he can not open the door unless you unlock it)
He sits in the rear passenger side NOT behind you.
He stays belted in his seat.
Position yourself so that he can not grab hold of your clothing, your hair or you.
(slide your seat up as far as you are comfortably able to drive.)

A word of caution.
Many facilities will not take a resident that has had a violent outburst in the past 60 some 90 days. When you are looking at facilities ask about this and you may have to have a doctor indicate that he is under care.
Helpful Answer (17)
Reply to Grandma1954
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Read your letter and pretend someone else wrote it. What would you tell them? It's obvious that you are not safe with him, his track record so far gives every indication that if you bring him home, you will be the next one attacked. You know this. You don't feel safe. Do what you have to do.
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Reply to iameli
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Donttestme Nov 26, 2022
Such good advice! I think if everyone posting would read their letter as if it were someone else’s problem and see what advice they’d give.

Emotions can make decision making so hard.
(3)
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He can't "promise" you anything.

Find a facility close to you and hire medical transport to get him there.

Are his behaviors being addressed with medication?
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Reply to BarbBrooklyn
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My husband, of 40 years, has been my best advisor and therapist, helping me deal, with my parent’s increasing poor health, dementia, and three younger sisters. He has a brilliant saying that he has used often, over our lifetime….”step outside your body, and look at yourself, listen to what you’re saying, thinking, and you might realize the situation better”.

Please trust your gut intuition, that made you ask this question, probably knowing we’d say, what we’re all saying. It’s ok to make sure your man is taken care of, and IT DOES NOT have to be YOU, doing the taking care of, yourself. You matter too, your safety, and as said, promises are beyond your man now. Wishing you peace, and clarity of mind. Deb
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Reply to Odaat59
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Find a home close to you, place him in Memory Care for his and your own safety.

He will not get better, this is a progressive disease that has no cure, His promises mean nothing as his brain is broken. He is in the aggressive phase, you will not be able to handle him in your home. He is a danger to you.

Hire a medical transport to move him.

I wish you the best!
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Reply to MeDolly
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He needs memory care, not assisted living. He has dementia with violence. No assisted living would want him because they can't handle those issues. You're in danger if you're alone with him. You should not drive him home, it would be a nightmare. You should not take him home on a plane or a train, that puts even more people in danger. He needs medical transport. Find a memory care facility, close to you or far from you, whichever you prefer. I'm very sorry, but this never gets better. Take care of yourself and realize he isn't who he used to be.
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Reply to Fawnby
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I'd get him into Memory Care Assisted Living near your home; have him medically transported there for safety reasons. Have a geriatric psychiatrist evaluate him for proper medication to keep him calm, and go from there. You can't have him attacking staff in AL, or he'll be asked to leave. So that's where the psychiatrist comes in to help figure out the best meds to keep him calmer and less agitated in general, so attacks won't be an issue (hopefully).

Combining dementia with a TBI is a recipe for disaster, really. You decide to do what's best for BOTH of you, after taking care of him for 4 years and knowing what it's all about. He can't 'promise' you anything, really, b/c dementia is always changing and DH has no control over his behaviors. He can 'promise' you to behave from now until forever, but once he gets back home, all bets are off. That's the nature of dementia, and why it's best for all concerned to have him placed in a Memory Care AL where he can be with others in the same boat, and have activities to occupy him, doctors coming in to the facility to see him, meals served, etc. You can go there every day to see him if you'd like, and take on the role of being his wife again, instead of his exhausted caregiver.

Wishing you the best of luck moving forward.
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Reply to lealonnie1
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jgmay57,

Not at home, you don't even feel safe traveling with him. If you attempt a home trial from the rehab facility, you risk losing the opportunity to have him placed with the assistance that you now have available to you. Don't try it, for both of your sakes.

Personally, with someone so volatile, I wouldn't be looking at AL. Memory care may be the best option because they usually staff with ppl better trained to deal with complex mental health issues, which your husband certainly has.

You have to do what is best for both of you and having him at home is simply not an option.

I wish you strength and clarity in the decisions ahead.
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Reply to Luta65
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I had a client last year who blocked me on her basement step and would not move out of the way. She was deadset in her mind that I was stealing her stuff. Who wants trashbags, and depends? I was doing the laundry and she had been yelling and complaining about me all that day. I was so sick of it.

This lady was almost as tall as me and even though she was frail, I could have fallen down those steps and broke my neck. It came down to my safety and hers. Of course they tried to beg me back, but I was done with being abused verbally and it was bordering on physical abuse. These people are not safe in their homes and they become an endangerment to themselves and others especially when they go into sundowning mode. They won't mean to hurt you and it's part of the illness. However, my health got very bad afterwards and I'm still struggling a year later.
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Reply to Scampie1
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If your husband has attacked three nurses does that not tell you something? He is not a candidate for at home living with a caregiver. In a facility there will ways be more than one person caring for him but at home what happens if caregiver is attacked and no one is around. You also say he's had a serious fall, so safety should also be considered. You shouldn't be driving him home especially on a long road trip, that also is not safe for either of you. The social worker at the facility he currently is in should makes arrangements to have him placed back somewhere near you and your family and that includes safe transport too. Unfortunately his mental condition will not get better only worse so the sooner you start on a plan the better. Best wishes.
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Reply to Breezy23
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