kdaly0273 Asked July 2017

I have made the incredibly tough decision that it is time to put my dad in assisted living. How do I tell him?

I have made the incredibly tough decision that it is time to put my dad in assisted living. He has been in a rehab facility for about two months now. Not that it has been any easier since we have had major issues with this facility since day one. (I recently wrote about my "caregiver burn out" as I get no help from my family.) My question is, do I tell him before he is transferred? As POA, can I make this decision without his consent? He may not question the move at first, because I had mentioned I was going to try to get him moved because of all the issues we were having with the current place. He has been diagnosed with dementia and aphagia. It is getting worse and I work full-time and have two children to take care of. He cannot be left alone all day as he is a fall risk and this is now a safety issue. Since he has been in rehab for so long, he has lost his in-home care through the VA and would have to go back on a wait list when he comes out...this could take weeks to months to get services back and it only cover 4 hours a day 3 times a week. Anyway, to get back on topic, my brother, mother, and I had planned to sit and talk with him. Then, at least two people told us not to tell him till the transfer was done. The assisted living director said they could have one of their doctors sit with all of us (after transfer) and tell him that he needs to be there for his safety. The AL place sent over all the paperwork to the rehab place, but that director at rehab is saying she cannot fill out the paperwork because my dad has not been told yet. Can she force our hand here? I am so torn. He will be upset either way. He may refuse to go if I tell him now. I know he will be very mad at me either way. I guess I am asking what is the best way to handle this situation? How do you handle telling a person the time has come for him to be cared for in assisted living when he doesn't want to go?

Assisted Living

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I think what I would do is tell your dad that you've found a MUCH better place for him to stay, where the doctors need him to be to practise walking and speaking. You leave it vague (don't being up home unless he does), if he asks about that, you tell him that down the road, the doctors will assess his ability to live safely at home.

We did something like this when we moved my mom, post stroke, to a really nice AL ( she had been livingi,in an IL at that point). We needed to tell her she was being discharged and where she was going.

It didn't really help. I took her in my car ( don't do this, I would use medical transport if possible) and she became hysterical, tried to grab the steering wheel.

Helpful Answer (14)

Remember that while you cannot force a decision for a competent adult, you can certainly make decisions for yourself. And you have decided that you can no longer care for him in your home. If necessary, be firm that that is not an option.

My heart goes out to you. Nearly all the caregivers in my local support group have had to place their loved ones in a care center of one kind or another. It is truly a heartbreaking decision to have to make.

Helpful Answer (11)

My brother and I went over today and spoke to dad...it went better than I thought. We just laid out everything that has been going on in the current facility, from missed showers, to them losing or not washing his clothes, to the most recent incident...he had poop on his sneakers that they knew about and did not wash off before putting back on his feet. My kids and I walked into his room yesterday and it smelled like poop. They had called me in the morning to tell me to bring another pair of shoes, but I did not think they were going to put the poopy shoes on him. Anyway, we said we were incedibly unhappy where he is (which we are) and we think there is another favility that would take better care of him (which there is.) He can take a shower 7 days a week at the new place, if he wants to. (This place only showers him twice a week. My dad actually likes his showers.) They have church on Sunday where the place he is at now has it on Wednesdays. We highlighted all the postive reasons why he needed to go to the new place and all the negatives as to why he needed to leave this place. He said he understood and agreed. We didn't give him timeframes and he did not ask. I am really hoping he understood everything we told him today and we have a smooth transition. Thank you everyone.

Helpful Answer (11)

I had to move both my parents into assisted living. Prior to moving them (from CT to MD) my husband and I looked at 5 assisted living situations. We chose one that was a two bedroom apartment balcony in a pretty setting with great staff. Turned out to be the best price as well. Neither of my parents wanted to leave their house which had become a death trap - my dad was falling continuously and my mom was sleeping in the dining room on a hospital bed due to a stroke. Neither could navigate the steep stairs, manage their medications, purchase food or sadly understand the calendar of appointments I'd created and put on their refrigerator. We kept showing them photos of their new apartment, talking about the food, how they'd be safe and well cared for and would have things to do, make new friends. And, having a doctor tell my dad he could no longer drive was helpful. We ultimately had a family meeting with my mom's brother and they were more accepting, though they still ask if they can go back to their house on occasion.

Helpful Answer (8)

Thank you all for the advice. We are actually putting him in a privately owned AL. He has the means to pay for it month to month with very little coming out of his savings and does not have to apply for medicaid at this point. And, he really can't refuse...I am not in a position to care of him anymore (I have been doing it for 5 years) and no one else can take him. He requires too much care and he is a fall risk. For his own good and safety, he needs more supervision.

Helpful Answer (8)

You owe your father the respect of talking to him first, not hauling him to new places against his will.
Yes, this will be a hard conversation, and likely he will have 101 reasons why he won't go--but when we had this talk with hubby's father--he finally said, Ok, he'd go. He really didn't want to be a burden, he knew enough to know he was not capable of even walking up/down stairs and he couldn't feed himself.

I did most of the talking. Hubby sat on the couch in trembling fear. It wasn't a "here's your choice, dad" kind of conversation, it was a "this is your only option, we're so sorry" kind of situation.

Had he been in better health he would have fought us, I'm sure he was simple exhausted.

I wish you luck in this difficult task. Make sure you and brother are ON THE SAME PAGE!! My brother will routinely tell me he's got my back over something and then caves in when Mother kicks up a stink. Talk beforehand and rehearse what you're going to say and make sure you support each other in this.

Helpful Answer (7)

Thanks for coming back and telling us how it went. There will be other bumps in the road but I know you and brother feel better having been upfront with him. I also think a parent likes it when their children agree on next steps. There is a measure of comfort there.

Helpful Answer (7)

The issue with the rehab director saying she can't process the transfer to the ALF because he hasn't been informed: she is correct.

Until your father is deemed to lack mental capacity, the decision of where to live is his. You have POA for him, which is good, which means you can act on his behalf. But what you can't do is act without his consent until he is formally recognised as being unable to consent on the grounds of his (legal) incompetence. A dementia diagnosis on its own won't cut the necessary mustard.

So you either have the difficult conversation with him - which I hope will be a lot less difficult if you adopt some of the sensitive approaches others have described - or you go through the process of having his mental competence assessed.

If the worse comes to the worst and he flat-out refuses AL and his doctors won't agree that he lacks capacity, how much time in hand have you got at rehab and what other in-home services are available? The same director who's digging her heels in might like to go through his options with you, if she can't support this one.

Please don't think I don't sympathise with your position. You have every right to make it clear how much his staying at home has depended on your commitment to date and to make it equally clear that that can't continue. Just not (not yet, anyway) the absolute right to decide what's good for him.

Helpful Answer (6)

Talkey, it sounds like we were in identical situations. Although I appreciated my brother coming with me yesterday, he hasn't helped much the last 5 years. Simply taking dad to lunch, church or a haircut would have been such a huge help to me...neither he, my other brother, nor sister seemed to understand that.

Helpful Answer (6)

It doesn't help while you're in the thick of it, but the positives to remember are that dad is going to assisted living which in my opinion is far more pleasant than a nursing home and that he has financial wherewithal to afford it

I didn't tell my mom when I made the decision to move her to memory care straight from the hospital - she fought tooth and nail going into her room - it was agonizing for both of us

Do the best you can to reassure him he's not being abandoned and make his room as pleasant and familiar as possible with some of his favorite things

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I have made the incredibly tough decision that it is time to put my dad in assisted living. How do I tell him?

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