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Old 10-12-2012, 05:40 AM   #1
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How to deal with family denial

My father in law has recently been admitted to a Dementia care unit after a period of time in the hospital with violent and obsessive behavior. He has been diagnosed with dementia and alzheimer's. He is on medication now and is doing much better, but there's no way he'll ever go home to live again. My sister in law (his daughter) is in charge of his care and although she's doing a great job getting everything organized, she's somewhat in denial about the possible ramifications of a visit home. (She only recently gave up on the idea of him going home to live after witnessing one of his episodes for herself. His home is not near either of his children and the family living nearby, while saying they can take care of him, isn't equipped or even willing to take on that kind of responsibility.) He doesn't want to stay in the facility and still thinks that it's temporary. His home is 1.5 hours away from where he currently resides (it's very close to my sister in law) so not only are we looking at a long car ride both ways, his history of violence concerns me a great deal because if he decides he doesn't want to leave, it will require police intervention to make it happen, if they can even do that because he hasn't been declared incompetent legally. So,if he really puts his foot down there's not much anyone can do at this point. He is only cooperating because he is just far enough along in his progression that things are fuzzy after awhile and he forgets that he wants to go home.

Does anyone have any experience with this type of problem? It would be really helpful to know how others have dealt with the situation because it's all very new to us and happened suddenly so we're just not even sure what to do at this point.

 
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Old 10-12-2012, 08:40 AM   #2
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Re: How to deal with family denial

Clarinet,

I am so sorry that your FIL is in the dementia unit now. To make things clear first, I think your FIL is incompetent. Just need the doctor to write up a letter saying he has dementia and needs daily help. That is incompetent since he is in the dementia unit now.
You said that he forgot to go home so that is also like moderate stage of Alzheimer's. He should not drive and is incompetent and needs people's help daily.
I have to say that the dementia unit is good for him unless the NH is not up to standard and you can try to find a home that is near the family. However, too many moves can only confuse him and make him decline more.
I don't know what med he is taking. If it is antipsychotic drugs or antidepressant, he can calm down. If it is things like aricept or namenda, I have to say these are not effective to slow down dementia and he will still be confused. (At best he would be perceptive but this does not help caregiving.)

He has the diagnosis of Alzheimer's. Alzheimer's is a type of dementia. So no way the SIL can deny because it is in the diagnosis and the doctors all say so. Perhaps she just needs to understand the nature of caregiving for demented person. Please get the books about dementia or Alzheimer's regarding caregiving. Once he is incompetent, the police are not needed. Rather, you should get home care or medical professionals to help him out. Call 911 if he is violent but no police. It sounds like no one can take him home so a dementia unit is fine. 1 hour and half is not too bad. As long as family visit him and see to it, a dementia unit may be better for his safety so he would not wander around and get lost.
Also since he forgets to go home, it is unlikely that he will one day know it all and pick up everything and go home. The staff won't let him without telling the family. His memory will get worse. The thing you should do is to make sure he likes the NH's activities and etc. Try to make him like the new home. Say it is his home if necessary.

This site has many good advices so please stay put for more info. Welcome to this board and I am sorry that it is dementia that brought you here.

Regards,
Nina

Last edited by ninamarc; 10-12-2012 at 08:49 AM.

 
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Old 10-12-2012, 09:13 AM   #3
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Re: How to deal with family denial

You have every right to be concerned and glad you found us here. Several of us have been through this type of situation including me.

My Mom and Dad was very much as your FIL is now. Because of their inabilities and behavior is was necessary to put her (with Alzheimer's) and Dad (with Vascular Dementia) in AL. They both wanted to "go back home". In my years of dementia experience I have never met anyone with dementia that didn't want to "go back home"!!

I also understand the difficulties of knowing what to do regarding our loved ones with dementia who do want to go back home. We want to make them happy. If they just see home maybe they will be more content... perhaps. We don't want to take home away from them. But the question is... are we satisfying our desire to keep the concept of "home" intact or are we don't what is best for the.

First my experience with Mom and Dad. Once Dad was in AL we never took him back to the house. He adjusted well to AL. He thought it was temporary and for Mom. He never speaking of "home" but he was content where he was. Mom on the other hand, my sisters decided it was imperative to take her back to see the house. The first time she went back sent her into a depression when she left once again. It was actually worse than the first time she left. The second time she went back to the house it was as if she was not sure where she was. As we were leaving she ask to go home. So where was "home" for her at that point? The third time we went to her home town and had lunch with some of her friends, she was scared, stayed by my side all afternoon, and had no idea that there was even a "home" in that town. Non of the trips ended well.... and as soon as we returned to AL she was talking about going HOME!

You have to put yourself in your FIL's frame of mind to understand. The anxiety of dealing with a house, bills, and day to day living in that house was too much for him and probably part of what lead to his behavioral problems. You have taken the steps need to get him help and find a place that he is relatively content. If he thinks that is temporary... that is ok. Let it be temporary as long as need be. It will eventually become his home in his mind.

If you do take him back home he will respond in two ways and neither of them is good for him. He will either respond as he did the first time he left with anxiety and depression or he will not know why you took him to that house and be anxious and depressed because he is aware that you expect him to remember something he can't. Why put him through that anxiety?

Then we have to understand what "home" is to someone with dementia. There are moments they remember their recent past "home"... the house you are thinking of taking him back to. Rather than being fond memories and a nice place to visit it brings on anxiety. It is something that is lost. If found they want to hang on to that again. So why give it and take it away repeatedly. At other times they may be thinking of "home" as their child hood home. Their long past memories come back, blend with the moment, and they wish for that comfort and security of their childhood home. Which bring on the third "home". This is the "home" which only resides in the safety and security that desire where they are free of the confusion and anxiety that their dementia causes. This is not a place but a state of being that you can not give them. The last "home" is their heavenly home. I have been able to asses Mom and Dad's desire to go "home" to each of these places. So so not assume that going "home" means going back to the house they came from. Even if it is the brick and mortar house they came from... why take them back only to take them out again enhancing the anxiety they fell.

From experience, my recommendation, ff your FIL is content in his "temporary" home.... leave him be. Don't add anxiety by taking him to a place he may or may not remember but will surly add to his angst.

Your SIL is probably sad that Dad is no longer able to stay at home. She is probably feeling some guilt because Dad had to leave his home. She is missing her home and Dad being there. I get it because I felt those same feelings. But we have to deal with our own emotional turmoil without taking Dad with us Perhaps talking to the SIL about her feelings will help. Armed with information about FIL's state of mind you might be able to convince her that it would not be good for Dad... if she knows you are concerned about her emotional well being

Love, deb

 
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Old 10-12-2012, 10:26 AM   #4
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Re: How to deal with family denial

I am not sure what you mean by him leaving and the police... Are you saying the family still try to move him? Where would he go? Incompetency doesn't have to be "declared" like being blind and etc. It is something subtle and the doctor's letter telling the IRS or the authority is enough. Anyone with moderate stage of Alzheimer's is incompetent. He is incompetent because the brain is sick and he is confused even though he can walk about and talk a lot. You would see that his talk often is not making any senses or it is not realistic.
The drive of 1 hour and half, to be honest, is not so bad. This does not mean the family are not responsible. SIL needs to visit the home once a week and see to his care.
Keep contact with the NH personnel and they will ensure you that he is Ok and don't need to worry. Sometimes they will call the family if he is sick or requires your attention. You seem to be saying that this home is too far for the family. You are saying SIL finally accepts that Dad needs a dementia unit. So it is good.
Are you saying you guys will still try to move him to another home that is closer?
I would say if he likes this home now or that he is used to it, keep it as his current home.
I know it is hard to adjust to it. You also seem to say if you want to move him to another home, he won't like it. I am just a little confused that you want him to leave this home?

For a demented person, peace and being stable is important. Once he left his own house, he will not remember it very well anymore so he will like this current home. Also the other thing is, it depends on what he can do in this home. My late FIL thought he was "working" in his NH in the last 2 years when he was in the memory unit. (He had had home care in his own house alone for at least 5 years.) He liked to work there so it was better than his old house. In his old house, he kept saying he wanted to work with my husband which was impossible. (Not even the same field.)
The other way to do it is to wait until he forgets more and more so he could be moved without any objection. We waited until my late FIL forgot about lots of things including his own house.

I think it would be helpful if you find out if he really likes this home and if you like the management of the NH.
Before you move him to another NH, you should at least compare it with others. Sometimes a good home is not very closeby. If you can find a better home nearby, it is a good thing. You can just tell him that you are going out to another place. Don't tell him the exact details as he will be confused.

Regards,
Nina

Last edited by ninamarc; 10-12-2012 at 10:37 AM.

 
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Old 10-12-2012, 11:57 AM   #5
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Re: How to deal with family denial

The other issue is I am not sure what you mean by family denial. The SIL's denial or the other family members? Also, what is a visit home in your definition? Not a facility? I think the SIL is doing the best she can. Not sure why Dad ends up in this facility - must be because it is the best one? Maybe the family think it is too far and why it is so far... Sometimes the best place is not closeby. Some nursing homes are like hospitals and some are like home with nurse stations. There are also facilities for demented people only.

I am not clear about your so-called denial. For sure your FIL denies that he has dementia. My late FIL never admitted it but he said his brain had something wrong. It is hard for families to learn about this in the beginning. It takes time to learn about this disease.

Hugs,
Nina

Last edited by ninamarc; 10-13-2012 at 09:57 AM.

 
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