My father is in his early 70s, and after a fall in home and hospital stay, he was diagnosed with mild cognitive impairment due to some short-term memory issues. Our family additionally ran the full spectrum of testing — MRI of the brain, 4 hr neurological testing and evaluation, and even non-FDA blood tests — which all point to early Alzheimer’s.
Mentally, he is still very sharp and has been recommended for assisted living by his neurologist and the director of the senior living facility after an evaluation.
However, due to history of alcoholism, our family is split, with two children pushing for memory care and the other two siblings suggesting assisted living with precautions such as a GPS tracker, limiting spending, and no driving.
Memory care seems like an overreach, as he has articulated his desire not to live there. He unfortunately does want to continue to drink, which will advance his disease.
Not sure how to handle this difference of opinions between family members. It’s already driving a wedge. Also not even sure putting him in memory care against his will is legal at this point…
My Mom was diagnosed with MCI and she lived independently for years before I came to be with her. You will need to take away the car, if he shows any sign of not being able to be mentally responsible or coordinated.
For us, after looking at what was available for assisted living and memory care, the only reason for memory care is flight risk, and at some point, all the add-ons for assisted living was more expensive than memory care.
For my Mom, when I went on respite care, she was in assisted living, primarily because she was a fall risk. Assisted living was just like independent living, except there was medication management, bed time checks, and the assurances she did not leave the facility by herself and that people would be more available if she fell. Otherwise, the range of "alertness" between the residents of assisted living were huge. Whereas in Memory Care, no one there had the capability of making or sustaining friendships.
It sounds like you are maybe looking as Assisted Living or Independent Living. However, the facility will end up making the final decision.
When my Mom was mentally alert, it was very difficult to find a managed care home that would be "right" for her, so we paid for in-home care and I was with her much of the time (tearing my hair out and oh so thankful for daytime senior care 5-6 days a week).
My understanding is that levels of care is not a tightly regulated guideline. What one home thinks is memory care is another center's higher level of assisted living.
What you do need to find is a home that you feel has the amenities, activities, the ambiance, the food, and the rules that you as a family can live with. When something goes not as expected, you need to be a united front to determine what to do about it.
Also you may have to make a decision of "what happens if he gets worse" or "what happens in case of emergency"? Will they let him stay in that center? Do you want to move him? Will they force you to move him?
I would only look at places that have both Memory Care and Assisted Living, otherwise you might be trying to find another place for him when his current facility will no longer provide the care.
But you will want to be able to move him to MC when the time comes, so having both levels of care available in the same facility is beneficial.
Also, AL is generally less expensive than MC, so he will be able to spend a bit less on care while he can still live in AL.
He will continue to drink. There is not much you can really do about that in AL. It’s honestly kind of beside the point at this time of his life, anyway. (He has to both want to change and be able, cognitively, to consistently make the choices necessary to change, for him to truly be in recovery with his addiction. It’s possible that he is capable of those choices right now, but his declining cognitive ability will soon render him incapable of continuing to make those choices.)
I’m sorry for what you guys are going through. These decisions are soooooo stressful. Minus the alcoholism, I went through them with my mom. Moving her to AL was the hardest thing I have ever done, because she did not want to go, but she was no longer safe to live independently. After about 2 years in AL, she started wandering and got lost outside twice, and family and staff had to find her and bring her back. So she had to move to MC. I thought that would be another hellish move, but it turned out to be 100 times easier because her cognitive abilities had declined so much. She has been in MC for 8 months, now, and she has no idea that she isn’t still in AL.
I wish you courage and comfort as you decide on your dad’s living arrangements.
As for the memory care, dad would have to qualify for the memory care unit as it is usually for more advanced dementia/ cognitive problems. Assisted living sounds right for dad at this stage, BUT, he could still gain access to alcohol by walking or getting a ride to the store. I’m pretty sure in some assisted living places that alcohol is acceptable to have. So that would be my worry with assisted living. Maybe dad shouldn’t drive anymore and gps sounds like a good safe idea. I’m sure at some point as his disease progresses and he has more severe decline, he will eventually really need memory care unit. *When touring these places, be sure to ask that if dad becomes immobile, will he still be able to stay at their facility and they take care of him when he becomes immobile. Some places don’t do that! So I was taught that very valuable question to ask! It sounds like your siblings and you are working as some sort of a team. Which doesn’t happen very often. So that’s great. I hope you guys find your answer soon. I wish yall the best!
My point in telling you this story is so you know I can relate to what is happening with your dad. If he still has some of his faculties and it sounds like he does, your dad is going to be able to circumvent the rules of assisted living, but it sounds like that is where he needs to start. Dementia is not a one stop shop situation....it is constantly changing. If you move him to a memory care nursing home at this stage, he will be miserable and fight you every minute of the day. In my opinion, based on what you have told us, he is not ready for a memory care nursing home. If your sibling don't agree, have them visit a couple of them.
Be careful with what you and your family share with administration of facilities.
In general alcoholics are considered to be more troublesome residents.
I would recommend the assisted living. It sounds like Dad still has a lot of cognition. The memory care will be problematic as drinking will not be allowed.
He will have access to alcohol in assisted living.
My dad was also alcohol free in the hospital after a fall. He went through pretty serious withdrawal. He then was sent to a rehab for six weeks and did not have access to alcohol. He was meaner than a snake during that period.
i’d recommend the assisted living with no vehicle. Let him manage his own money. I wouldn’t even restrict his money.
If you haven’t been to Alon, you may want to go to Alanon for yourself.
I would not overthink the situation. Alcoholics are going to do what they’re going to do.
What is sad is that if and when an accident happens in assisted living it will be a lifetime of “I told you so” from the other side of the family.
There is a such thing as mixed dementia meaning more than one type of dementia can be at play here. I wouldn't rule the alcoholism out as a cause of memory problems.
If he goes into an assisted living, he may still gain access to alcohol and rent a car. Assisted living is not like being in lock down or a jail like environment. Clients can come and go as they wish depending upon their mobility and other health constraints.
I had a client that was totally out of it one day, and the best I could do during that shift was to make sure he didn't fall and crack his head open.
Is he willing to give up driving? Can you keep enough restrictions on him that he won't, for example, rent a car and cause an accident?
Make sure you're all honest with the staff about what his alcoholism involves so they won't be caught off-guard and not recognize the need to intervene if a problem arises.
If AL is what is recommended, and is a good fit for him now, and he is capable of making his own choices, then you really have no reason to try and force something else.
But, because his condition will continue to deteriorate, I agree with a GPS tracker, take away any vehicle, so he can't drive.
If he's on board with the decision, he could name someone to take control of his finances, and allow him a debit card with a limited amount of funds available for his personal spending.
You can not control another person's decisions and life choices.
You may feel that preventing him access to alcohol is in his best interest. But, what do you have in your life that you wouldn't want another family member taking away from you because they don't agree with it? No one in history has been able to stop an alcoholic from drinking. And yes, it will probably kill him.
I wish you luck in finding a good place for him.
Good luck.
A warning. They WILL get alcohol and his mode was to go on the bus to the Walgreens for huge bottles of Listerine while he could. Soon couldn't do that and was in a locked (but still ALF) cottage. But took all the mouthwash he could find of any kind.
There's a reason you see Listerine on the end aisles in the stores in huge bottles, and that reason isn't that we suffer pandemic bad breath.
So very sorry. Try the easier way, and try to do it someplace where they also have memory care. A good facility will be your guide. Best of luck. If this is early Alzheimer's it can progress very quickly.
You can start with a good AL and the admissions person will assess whether he is a candidate for AL or MC. If he's a flight risk then he's definitely going to be in MC. But is he doesn't have an assigned PoA and it isn't activated, then he will be calling all the shots. He probs won't go into AL either.
If he does have a PoA then this person now needs to read the PoA docs to see what activates the authority. This person should get the dementia diagnosis on their clinic letterhead and signed by the doctor, stating they have sufficient impairment that now requires the advocacy of the PoA.
Even if the PoA is active, you will still have a heck of time getting a physically uncooperative adult to move.
He has a very general POA “if unable to make my own health care decisions”. The facility recommends AL but family members have pushed for memory care for the alcohol reason.