Should I sedate my mother prior to moving her to assisted living this Saturday?

Hi Alanna,
I'm a nurse too and was in your same situation 2 years ago.
My mother is a pistol and had told me that I was never going to put her in a facility.
As the Alzheimer's progressed, it was evident that she HAD to be placed. Knowing she'd never cooperate, I gave her 1-1/2 mg. Ativan (a med she was already taking in a smaller dose anyway) before we left her apt. to "go to the doctor" (go to the memory care facility).

Yup, I lied to her. Yup, I drugged her. I KNOW my mother and she would have physically torn me to shreds if I hadn't.
We arrived at lunchtime and we ate lunch with some other residents. I had permission, from the facility, to spend the night. Mom conked out around 2 pm and snored until dinner. We had dinner and, as the night wore on, she woke up. I asked them to medicate her around 3 am when no one was sleeping. I snuck out after breakfast. They told me NOT to visit for a couple of weeks so she could get acclimated.

What a time (for the staff) that was, she did things she never had, urinating in the garbage can or on the floor, (the bathroom was next door and she knew it), throwing her belongings away, tearing up cards, etc. but we all lived through it.

Don't mention moving to your mom again. It only freaks them out. Yes, sedate her or medicate her or dose her or drug her-really, whatever you want to call it-it's all the same in the long run. She will be much easier to manage or be more cooperative or less violent-however you want to say that too.

It was unfortunate that I couldn't set up her room at the memory care for her but she would have "caught on" to my plan. All I could do is grab a few clothes on our way out. I brought the rest of her things a few days later. She physically attacked me when she saw me. The nurse had to pull her off me.

Demented seniors don't think the way we do and don't understand the plan. Best to involve them as little as possible, IMO.

Good luck. And don't feel bad for what you HAVE to do. Like our parents used to say to us...."It's for your own good."

Yes, discuss it with her doctor. My LO takes a mild anti-anxiety before dental appointments. It helps ease her anxiety and she stays relaxed. She has a prescription for 1-2 pills. If you do that, I'd walk near by, hold her hand, etc.  Just to guard her balance.

I also wouldn't make a big deal out of it. Even though my LO had horrible memory, she did know we were going to the REHAB, which is what we called it, to sign papers on a certain day. But, she got sick that morning and said she couldn't go. Well.....we went. It was tricky, but, I got her there. I would discuss plans with the facility though. If she throws a fit and demands to leave, what will they do? Is this a secure facility? Would she have a phone number to call a ride or have cab fare? I'd have plans for any contingency.

The AL we went to, told me that they could not hold her. She could leave, but, they would try to delay her leaving and call me. Plus, she had no ride and didn't know any phone numbers to call anyone. Plus, no money to pay a cab. Hopefully, it won't go that way.

I would ask her doctor. Do what needs to be done to get it done in the gentlest, kindest way possible. I drug my pets for long car rides because the stress and anxiety it causes them is unhealthy. I see no reason for your mother to suffer.

I won’t go into the long story nor the gory details...

Mom knew she was being moved from AL to a nursing home. Mom had been 86’d from AL - she knew it but did not accept it. I knew it was going to be an ugly day - moving day.

Mom knew we were packing her stuff to move that morning. Moms private pay caregiver showed up and took mom out for lunch, trip to the library etc.

I busted my rear end setting up her very nice, private room as close as it could be to her previous AL and IL apartments. This NH allowed all your own personal furniture.

I had - ahead of time, secured a RX for Ativan, anticipating a meltdown from my mom.

Around dinner time the caregiver dropped mom off and I stayed long enough to get her settled. When I finally left I could hardly believe it - no fit or meltdown, mom seemed okay - accepting even. No drugs needed.

At 10:30pm I got the call from a terrified staff member. The poop had hit the fan and mom was having a meltdown of epic proportions.

Mom got on the phone demanding that I come get her. I did my best to reassure- used the “it’s only for a while... Doctors orders until you get stronger...”. Mom was just not having it.

So after mom verbally ripped me to shreds, she threw the phone at the staff member and was attempting to make a break for it... pushing her wheelchair with her empty purse in the seat - at the speed of a sloth down the hall towards the front door.

I asked the staff about the Ativan - nope, they hadn’t given it to her when she first started showing signs of getting agitated. I told them to do whatever they had to do - to get two Ativan in her. Eventually they did.

Things calmed down for the night. But there was still and long, hard fight ahead of us. I don’t know if we’d have made it if it wasn’t for the Ativan those first few weeks. For her - and for me! If I had to do it over again - I would have asked the NH to automatically give my mom the Ativan after dinner. I knew my mom. I should have known better than to believe that she was gonna go down without a fight.

Take what you will from my experience- but I’d recommend erroring on the side of caution. If you think your mother might put up a fight - just sssume that it is gonna happen and be prepared.

Your choice of words was unfortunate, there is a difference between sedating someone and giving them something to help with her anxiety, which I assume is what you meant to say. You mention she becomes agitated at home so I assume you have something available to give her, you might want to run the timing and dosage by her doctor.

If you can remove the moving date from the calendar, I should.

It's branded on my memory because it was one of the things I got wrong in a questionnaire: preparing people with advanced Alzheimers for appointments or events, the best practice advice is - don't. They can't retain the information, they can't participate meaningfully in the preparations, and all that happens is that they become repeatedly agitated and uncertain in the run-up to the move and the whole day gets off on the wrong foot.

On the day itself, you and your father assist your mother to dress and get ready as she would for any other trip out - you could, for example, tell her that you are all going for lunch at [insert name of facility]; and ideally make it true, and have lunch there together. You introduce her to key members of her team. You tell her, again truthfully, that you and Dad have to leave now for another appointment but [name] and [name] are here to help and you will be back soon. You leave them to it.

This may feel brutal; but moving your mother is the *right* thing to do, and this method is supposed to make the transition as smooth as possible. You may then go home and cry your eyes out if you want to.

It would be a good idea, too, to ask the ALF how they usually prefer to manage admission day so that everyone's on the same page and using the same approach.

Further thoughts.... in the last year or so there were some really good suggestions on acclimating to AL. I've been searching and can't find the specific posts I recall, such as how to first set up the room so that it's as close as possible to someone's preferred room at home, what to bring, etc.

These aren't on point, but they might help:

https://www.agingcare.com/search.aspx?searchterm=reassuring parent moving to AL

https://www.agingcare.com/search.aspx?searchterm=easing+the+transition+to+AL - see the first hit.

https://www.agingcare.com/search.aspx?searchterm=anxiety of moving to AL - not quite on point, but some posts might be helpful.

Aha! I think this was the thread I was searching for:
https://www.agingcare.com/questions/move-easy-for-dad-to-assisted-living-185662.htm

People with more experience than I offered what I thought were very insightful suggestions.

Even though you're an RN, the thought of "drugging" your mother kind of sends chills up and down my spine. But I do understand that you're trying to make it easier on her.

Is there some way you can involve her in the primary tasks of the move, i.e., find some way she can contribute, instead of sitting back while others are taking over?

Has she helped select what she wants to take, even if it's not needed?

Have you given her a plan, besides reassurance, of how her home, possessions and dog will be cared for?

I know that with dementia, she might not understand or remember, but to the extent that she's aware of what's happening, how can you reassure her, and allow her to participate (such as selecting what she wants to take, one thing at a time so it's not overwhelming) so that she doesn't feel as if a major issue in her life is being controlled by someone else?